Mental Health and Stress at Work

Mental health in the workplace is a topic which more employers are beginning to turn their attention to, and it is becoming more widely acknowledged that having a healthy mind is just as important as our physical health. The impact of the pandemic on the mental health of people is yet to fully unfold but it’s worth noting that prior to the pandemic outbreak it was reported that almost one in four employees were already found to be struggling with their mental wellbeing.


Stress, anxiety and depression are thought to be responsible for almost half of all working days lost in Britain however the relationship between mental health and the workplace is complex.

In the following sections we’ll look at the implications for businesses and the actions that employers can take to support better mental health outcomes.

Why it matters

How can employers apply this knowledge and benefit from it?

Identifying Mental Health Issues

Very few people experience entirely positive mental health and wellness at all times, and it is highly likely that non-work factors (financial/relationship/family/health) will affect everyone at some point in their working lives.

Remember that poor mental health occurring in the workplace doesn’t necessarily have to be caused by the workplace, although it is still likely to have a knock-on effect through loss of productivity, possible sickness absence, reduced engagement or the need for time off work for intervention and support.

Stress effects broadly fall into three categories, typically these being Behavioural, Physical and Emotional effects and there are some signs and indications which may suggest a decline in mental health or the onset of stress. However, it is important not to make assumptions or jump to conclusions as many of these effects could be as a result of another health issue or something else entirely.

Behavioural Effects

Emotional Effects

Physical Effects

Changes in work performance or productivity

Declining or inconsistent performance

Loss of motivation or disinterest in work or hobbies

Indecision or lack of concentration

Extending hours of work, i.e. evenings, weekends, outside shift patterns or whilst on annual leave

Arguments, aggressive behaviour, criticism, confrontation, unexpected outbursts or immature behaviour

Defensiveness, withdrawal, resigned attitude or reduced social contact

Poor colleague / employee / manager relationship

Personality clashes, malicious gossip, bullying or harassment

Increased/ad-hoc sickness absence

Increased smoking, alcohol consumption or drug misuse

Low mood / emotional outbursts

Distress or anxiety expressed in verbal or written communication

Moodiness / mood swings

Increased sensitivity

Crying or tearfulness

Loss of humour Changes in how they interact with other people

Describe feeling overwhelmed

Irrational or illogical thought processes

Nervousness or irritability

Poor or disturbed sleep

Fatigue or malaise

Recurrent headaches or migraines

Digestive or stomach complaints problems, such as IBS or indigestion

Nausea / dizziness

Visible tension or nervous speech

Sweating or constantly cold

Skin sensitivity / reactions such as acne

Frequent colds or flu Rapid

heart rate / chest pain

Unexplained aches or pain

Findings by the annual CIPD workplace wellbeing survey have highlighted that amongst others, the main reasons cited for workplace stress are:

Unrealistic workload including too many conflicting demands or priorities
Not feeling supported by management
Negative working relationships

Other reasons include lack of trust, poor change management, harassment and bullying and feeling lonely or isolated at work.

The UK Landscape

Back in 2017 an independent review of mental health at work was commissioned by the Government; Thriving at Work – The Stevenson/Farmer review of mental health. The report highlighted the need to better support the mental health of all people currently in employment, including helping those with mental health problems to remain in and thrive through work.

The study concluded that underneath the stigma that surrounds mental health, the UK faces a significant mental health challenge that presents significant costs to both employers and the economy, which are increasing year on year.

While many individuals with recurring or prolonged mental health conditions are able to work at full capacity, one of the key trends affecting mental health is presenteeism. This occurs when individuals attend work even when they are unwell (with poor mental health), and work at a reduced level of productivity or effectiveness.

Presenteeism and absence from work are closely linked, since individuals have the choice between absence from work or attending despite suffering from poor mental health. As sickness absence numbers continue to fall, the incidence of presenteeism has risen significantly, as more people choose to carry on working, either at the workplace or, as we have seen as a result of the pandemic, exclusively at home. More than half of the annual cost of poor mental health at work is attributed to presenteeism.

“Leaveism” is also a feature of a growing number of individuals who are unable to ‘switch off’ from work and it is becoming increasingly common as working remotely and flexible working have become easier due to advancements and improvements in technology. The recent pandemic has seen a large proportion of the UK workforce being deployed to work from home and in some instances investment into technology has been escalated to enable more people to work from home. Some UK businesses have taken steps to prepare for the re-opening of their premises and returning employees to the physical workplace, but many organisations are also turning their attention to whether they need the number or size of premises they did prior to the pandemic.

Early indications suggest that many employees now find themselves preferring to operate from a blended home-office environment and it would be unsurprising if some organisations haven’t started to consider cost savings that greater homeworking can bring and make this a permanent contractual arrangement. Each sector will need its own debate on this, particularly around which jobs roles can thrive and support improvement to health and wellbeing, and which of those might be compromised.

Both prior to and during the pandemic, rising levels of debt have led to an increase in stress caused by personal finance worries and young professionals have emerged as the most vulnerable demographic in the workplace, which may be attributed to the prevalence of zero-hour and temporary contracts. This group are twice as likely to suffer from depression as the average worker and are more susceptible to leaveism.
The report also highlighted that the scale of poor mental health in the general population is significant, but that poor mental health and the onset of mental health conditions are often preventable. Therefore, recovery is possible for many people.

Costs to Employers

The annual cost to employers due to poor mental health is estimated to be in the region of £45 billion, with more than half of this cost attributed to presenteeism (in the region of £27-£29 billion). Additional costs arise from sickness absence, staff turnover and indirect costs such as the adverse impact on creativity, innovation, and the impact on other employees.
The average cost of mental health absence per employee ranges from £1,475 to £2,277. This is similar across the public and private sectors, the public sector average cost per employee being slightly higher than the private sector average cost per employee (£1,716 compared with £1,652). Across both sectors, the largest contributor to costs is presenteeism, two thirds of the total cost.
Recent figures from the UK Labour Force survey (LFS 2018/19), highlighted that 12.8 million working days were lost due to work-related stress, depression or anxiety and that this is now the leading cause of absence from work and accounts for 54% of all reported ill health absence. There is a positive case for investment in mental health though and studies find an average return of £5 for every £1 spent on mental health intervention.

What is the challenge?

Mental health problems and work-related stress can have very similar symptoms, and this is one of the reasons why it can often be difficult to know whether an individual is suffering from work-related stress. Many common mental health conditions and stress can exist independently, so those who are experiencing work-related stress may experience many of the physical or adverse effects, without having other, more serious mental health
problems. Those who suffer from mental health conditions might do so without experiencing stress. The key differences between them are their cause(s) and the way(s) in which they are treated.

However, work-related stress, if not managed properly, can aggravate existing mental health conditions or lead to the onset of more serious mental health problems. Therefore, if work-related stress reaches this point then it can become much harder to separate one condition from the other.


The Health & Safety Executive (HSE) define stress as the ‘adverse reaction people have to excessive pressures or other types of demand placed on them’.

Examples of stress can include:

  • Physical stress: as a result of poor diet and nutrition, physical illness or disability, sleep disorders, physical abuse (self-inflicted or by someone else), or recreational/illicit drug use.
  • Emotional stress: as a result of relationship problems, conflicts or demands either at home or work, peer pressure, verbal or psychological abuse or behavioural issues.
  • Environmental stress: social issues arising from poverty, poor housing or poor living conditions, unemployment or poor/unsafe working conditions.
  • Acute stress: caused by illness or accident, bereavement or trauma including things such as childbirth, assault, rape or imprisonment.
  • Chronic stress: long term and prolonged, may be as a result of any of the above factors but which may also include financial debt, inequality, stigma or discrimination.

The challenge for employers is that they may not always be aware of an individual’s exposure to or risk of the different types of stress, or their vulnerability to it.

Vulnerability to Stress

An individual’s ability to deal with stress – their vulnerability – varies from person to person and there are number of factors which can contribute to this.

There is strong evidence to suggest that our genetic makeup influences the way we respond to stressors and the coping mechanisms we employ. Many people have positive ways of coping with stress, such as physical exercise, sleep, rest or accessing support, but inevitably there are many people who have less healthy coping mechanisms, which might include overworking, self-medicating through alcohol or drugs, or adopting unhealthy habits such as binge eating, not taking enough rest or physical exercise, all of which can impact and in turn increase their vulnerability to different stressors.

Our individual thinking style and our perception of ourselves and the world around us can also affect our individual vulnerability to stress. Those who have a more positive mindset appear better equipped to cope than those who don’t, but other factors present in our childhood, or negative experiences in later in life, can also increase a person’s vulnerability and ability to cope.

Managing Mental Health at Work

Whatever a person’s vulnerability to stress or poor mental health and their ability to respond might be, it is in the employer’s interest to develop a culture of awareness, openness and support to reduce the incidence and impact, and it will be those employers who take effective action to manage the effects of stress who will get the best from their employees.

Employers and those with people management responsibility need to take some time to fully understand what the sources of stress or pressure are in the workplace as it will only be when these are being controlled properly that there will be any positive benefit to the mental health of their people. Offering training solutions in things such as resilience or mental health and stress awareness are less likely to have the desired impact or outcome if the sources of stress within an organisation are not firstly identified and are actively addressed. The HSE Stress Management Standards provide a step-by-step risk assessment framework allowing employees to identify the main risk factors and focus on the underlying causes and prevention and measurement so that organisations can gauge their performance in tackling the key causes of stress at work.

The 2017 Stevenson/Farmer review on mental health at work set out a total of forty recommendations for employers, the UK Government and other stakeholders. Within these recommendations, six core mental health standards were highlighted as being applicable to all employers, irrespective of their type of business.

The recommendations were for all employers to:

  1. implement a mental health at work plan
  2. develop mental health awareness within the workplace
  3. encourage conversations about mental health
  4. improve working conditions
  5. promote and train managers in effective management practices and mental health
  6. to monitor employee mental health and wellbeing.

Specifically, or in addition, employers should consider mental health vulnerability as part of continuing fitness for safety critical or high profile/high pressure roles. This type of assessment is generally undertaken by specialist occupational health service provision (OHSP) and will go beyond routine or general health assessment.

In October 2019 a review of progress was undertaken by the Thriving at Work Leadership Council, a consortium consisting of senior industry leaders, government bodies and the mental health organisation MIND. It found that greater support for mental health is now provided for employees, particularly in large organisations. There is also increased social awareness of mental health issues and there are some positive signs that there has been a reduction in the level of stigma at work, although the review acknowledged that it takes considerable time for employment practices and workplace culture to change.

The review also highlighted a disproportionate number of young people in work with poor mental health and an increase in the prevalence of mental health problems among young people generally. The Government has now also outlined its commitment to making Statutory Sick Pay more flexible, allowing more phased returns to work after a period of mental health absence. However, there are still areas where legal clarification or additional government support is required, such as ensuring that the provisions of the Equality Act 2010 provide protection for serious long-term mental health issues and the requirement on employers to provide reasonable adjustments. Reasonable adjustments might include measures such as changes to working hours, different role responsibilities, or time off for mental health recovery intervention, and this would mean that employees are protected if their mental health problem meets the definition of a disability, i.e. it has a substantial, adverse, and long-term effect on their ability to carry out normal day-to-day activities, and they have notified their employer about it.

Building Organisational Resilience to Support Better Mental Health at Work

Although the 2017 report findings did not emphasise the need for formal stress risk assessments it is acknowledged that the HSE’s Stress Management Standards are one of the ways that organisations can identify those things which may impact or potentially cause stress at work. However, if formal mental health/stress risk assessments are not being routinely undertaken, then, at the very least, there some key factors which organisations can be considering as part of their approach and which fall broadly into four key areas:

  • Workforce Demographic – using data to understand the population of employees – things such as age/gender, shift patterns and the type of work or contractual arrangements to help identify ‘at risk or vulnerable’ groups
  • Leadership and Management – whether management behaviour is supportive and responds positively to mental health issues at work, e.g. is there leadership commitment to mental health and wellbeing being part of longer term strategic business plans, is workplace practice and culture healthy, do leaders and managers demonstrate positive behaviour by role modelling and engaging with wellbeing programmes, and have leaders and people managers received adequate training?
  • People Management Practices – identifying specific job role risks (high risk/safety critical), adherence to people management policies or procedures, results of engagement surveys, numbers of grievance or disciplinary issues, employee feedback (including that taken from exit interviews) and engagement with existing Wellbeing programmes
  • Support Mechanisms – understanding what the organisation already has in place to support the health and wellbeing of employees, for instance EAP or counselling services, benefits, support networks or open forums and the communication and accessibility to these services.

Leadership and Management

With issues such as presenteeism and leaveism already being significant factors in respect of mental health at work, it will be even more important for organisations to consider the work landscape in the post-pandemic era and whether changes to the physical workplace or the remote/virtual work setting could impact on employee mental health and wellbeing. Pre-existing mental health and wellbeing strategies may need to be adopted and adjusted to meet the needs of a ‘virtual’ workforce, which may mean greater investment into online resources or digital applications that are instantly accessible, providing employers with the opportunity to measure health improvement and return on investment.

Leaders and people managers also play a vital role in creating a healthy workplace culture by identifying and tackling issues at a local level. This group can have both a positive and negative impact on employee wellbeing and research suggests that those who have less contact with their manager experience poorer mental health. Consequently, managers who positively engage with, and are actively participating in organisational wellbeing programmes are likely to advocate healthier behaviours that can bring positive benefits to mental health. Managers can, without realising it, influence how an individual employee engages with and responds to wellbeing programmes, including those specifically aimed at supporting improvements to mental health.

As more managers are faced with the prospect of managing an entirely remote team, they may need further support and training to build their emotional intelligence skills, particularly if they may be dealing with complex issues which could arise as a result of declining mental health.

As people managers can directly influence the mental health and wellbeing of others, they themselves may need to gain a better understanding of their behaviour and where they may need to focus on improvement. Some key questions for managers to consider are:

  • Am I open fair and consistent in my approach? Is the individual’s workload (and my own) fair and realistic?
  • What things might I be doing which could negatively impact on members of the team?
  • Am I confident in handling conflicts or problems? Do I need further support in dealing with conflict resolution or do I have access to up to date people policies?
  • How strong are the relationships across different groups of people and are there things which can be improved? Do my team work together cohesively?
  • Am I good at providing knowledge and clarity on what is expected from team members? Do they all have clear objectives and understand their role or is this an area which could be improved upon?
  • Do I invest in building trust within the team? How am I going to maintain or make sure trust is part of the day to day way of work?
  • Do I invest in my own development? What are my skills and how might the skills of others be better utilised? Is this a time when someone might relish the opportunity to take on more responsibility, or are there projects for people to work together?

Undertaking routine analysis of things such as return to work interviews, employee surveying and consultation with employer representative groups on work-related stress and mental health issues, will help provide greater insight and help the organisation identify areas for improvement, thus allowing for appropriate solutions to be implemented. Training those with people management responsibility to recognise situations that are likely to cause work-related stress and ways in which to build and maintain resilience can then become proactive and positive management techniques.


Depending on the experience of working life during the pandemic, many people may already be feeling a level of mistrust with their leaders and as economic uncertainty lies ahead this is likely to be increasing fears around job security. This will present very real challenges for organisations and their managers as organisations move into new phases of the pandemic crisis and there is a real danger that good work may be pushed to one side in favour of workplace survival and economic recovery, leading to declining mental health and stress-related health issues. Health and wellbeing should therefore remain a key business priority for senior business leaders.

The size of the organisation, its resources and the demands it faces are relevant in determining what is reasonable, but organisations who take a holistic approach to managing work-related stress and mental health through combining the experience and knowledge of HR professionals, wellbeing or safety practitioners, operational management and specialist occupational health services, are more likely to ensure that the approach is appropriate and more likely to become effectively embedded. Those organisations that are driving a positive and open approach to healthy workplace culture and are adopting good people management practices will be better equipped to manage workplace stress and mental health issues way beyond the impacts of the pandemic.