The result of more pressure on organizations is an increase in bullying, another major source of stress, adds Cooper. According to his investigation for the TUC, a staggering one in four of all workers reported having been bullied in the previous six months, 47 per cent in the previous five years. The bullied have a higher incidence of mental illness, but so also do those colleagues who witness the bullying; Cooper calls this `passive bullying', and just like passive smoking, it can make you ill.

The Bristol Stress and Health at Work Study identified other stressors, such as inconsistency and lack of clarity. Highly stressed workers were less likely to say that the information they got from their line managers was sufficient and consistent, and were more likely to be subject to expectations which were hard to combine or even contradictory. This is a particularly significant point in explaining the dramatic increase in stress in the public sector, and was echoed in the Whitehall Study, which found that `the need to resolve conflicting priorities' is associated with a higher risk of psychiatric disorder in both sexes.

The stories Peter Piranty hears in the course of his counseling for a mental health charity in the UK that specializes in stress in the public sector confirm many of these findings. His clients come predominantly from education, the police, the NHS and social services. He attributes the sharp increase in stress in the public sector to the way in which the government's reform of public services has been imple­mented. What most worries him is how the pressure to meet targets, and the public scrutiny, poison some organizational cultures.

There's been a real increase in the last ten years in the blame culture as many more people are talking about bullying. [Under pressure] some organizations become unhealthy and defensive, with paranoid, persecutory cultures. It can be quite subtle, and a whole organizational culture can be bullying, so that managers say things like, `Don't come to me with problems, come to me with .'

I hear appalling stories of senior teams frightened of the style of a senior officer – in any other situation it wouldn't be tolerated. I hear of rigid ways of behaviour – of defining what excellence is, and what commitment is. My conclusion is that a lot of the British workforce is very unhappy, and there's a lack of recognition of the emotional costs of the workplace.

When an organization is driven, symptoms of stress can manifest in two ways. One is to put your nose down and deal with what you can deal with. The other is to take a lot of interest in other people's failings, which leads to inter-group rivalry and dysfunctional teams. If people are frightened of being accused of not being able to do their job, they will pick on another weak member of the team; there's macho talk of `If you can't stand the heat, keep out of the kitchen.' The bullied person often takes on the responsibility.

The drive to increase accountability and transparency in the public sector increases the pressure, adds Piranty: “Before, you might have had a private discourse about a cock-up; now it's all very public. So many people think they know how you should do the job, and people's jobs become more difficult. Social workers, for example, are damned if they do and damned if they don't; society tasks people to make those awful judgments and then disembowels them in a very public way.

“Organizaions are always working to capacity, there's no reserve because it's argued that it's too wasteful. People are working at such a level that it only takes one more thing – a personal crisis or work crisis [for them to snap] – there's no reserve. Some mission statements can be really crass, for example, `Zero tolerance of defects'. People are expected to `strive for excellence' rather than be good enough. A high proportion of the people coming to see us are on anti-depressants, they don't see much of their kids and they're bitterly resentful that they don't have more time at home.”

Piranty says that people who are particularly vulnerable to stress are `those who are very good at caring for others and who will put their clients first. There's a high burnout among carers, who are very good at looking after others but not so good at looking after themselves.

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