Höga krav och begränsad kontroll - Mellanchefers perspektiv på stress, utmattning och förebyggande arbete inom socialtjänsten

This study examines how section managers within social services describe their scope of action and preventive work in relation to stress and exhaustion among social workers. Work-related exhaustion is a major cause of sick leave in Sweden, and social services constitute a particularly high-risk context due to heavy workloads, emotional demands, and organizational constraints. Using a qualitative research design, the study is based on semi-structured interviews with five middle managers working within child and family services and foster care services in different municipalities in the Skåne region. The empirical material was analyzed using thematic analysis. The results show that section managers experience a strong and formal responsibility for the work environment and for preventing stress and exhaustion, while simultaneously facing limited control over key organizational resources such as staffing, budgets, and workload distribution. High and unpredictable workloads, staff turnover, extensive administrative demands, and fixed budgetary frameworks are described as central organizational challenges. Preventive work is primarily carried out through relational and presence-based leadership, including emotional support, prioritization of tasks, boundary-setting, and continuous dialogue with staff. The findings reveal a structural imbalance between demands and control, which constrains managers’ ability to conduct long-term preventive work. The results are interpreted through the demand–control–support model, Hirschman’s theory of exit, voice and loyalty, and the concept of ethical stress. The study highlights how loyalty to the profession and organizational mission may delay exit while increasing the risk of accumulated strain. Overall, the findings demonstrate that prevention of stress and exhaustion cannot be understood solely at the individual level but must be situated within broader organizational conditions. The study contributes to existing research by highlighting middle managers perspectives and their key, yet constrained, role in preventive occupational health work within social services.