In recent years, we've made significant strides towards removing the stigma around mental health, both in the workplace and beyond. Topics previously considered "taboo" have become more freely discussed, and although there is still so much progress to be made, employees are becoming more comfortable sharing their struggles and receiving the support they need.

Companies that have fostered more inclusive cultures have both helped accelerate this change, and benefitted from positive working environments where employees feel confident any mental health challenges they share with their managers will be heard, accommodated and supported.

Despite progress, many employees remain reluctant to share; a 2024 survey found that 42% of employees wouldn’t open up to their employers about mental health struggles over a fear of negative repercussions.

In this article, we’ll look at the scale of the impact before exploring some of the less obvious signs of mental health struggles that employers, managers and colleagues should be aware of.

The impact of mental ill health at work

It’s well known that mental health challenges often prevent people from bringing their best and most productive selves to the workplace. The scale of the impact, however, is perhaps more shocking:

Absenteeism

• In 2024, roughly 10% of UK adults took time off for mental health reasons
• In SimplyHealth’s 2025 report, mental ill health is cited as the leading reason for both short-term and long-term absences.
• In the 2023/24 financial year, work-related stress, depression, or anxiety accounted for an estimated 16.4 million working days lost, making up over half of all days lost to work-related ill health

Productivity

• According to the World Health Organization, depression and anxiety disorders cost the global economy $1 trillion each year, primarily due to reduced productivity

Attraction & Retention

• In 2025, approximately 35% of UK-based employers believe that the mental health and wellbeing support they offer is a key reason employees choose to stay with them.
• More than half of employees who have experienced mental health challenges have considered or have already resigned from a job because it negatively impacted their wellbeing

The Signs: What to Look For

As an employer, you can only respond to what you observe or have been told. Unfortunately, many people still feel the need to put on a brave face and appear as if nothing is wrong, making it difficult or even impossible for managers to always know whether an employee is struggling.

Despite this, there are behavioural patterns that signal a mental health issue employers should be aware of.

1. Changes in Performance and Productivity

Mental health conditions such as anxiety or depression can have an major impact on an individual’s productivity and quality of work. For example:

• Fatigue and a lack of motivation are common symptoms of depression and burnout and are likely to affect productivity.
• Anxiety and depression directly affect cognitive function. This can lead to concentration and memory issues which can significantly impair someone’s performance at work.

It’s important managers consider the possiblility of mental ill health when addressing performance issues, particularly when they are sudden and uncharacteristic.

2. Increased Absenteeism and Presenteeism

Attendance patterns such as increased in absenteeism can also be an indication. For example, an employee might take an unusually high number of sick days to cope with a mental health issue, even if they provide a different explanation.  

Presenteeism - when someone is physically at work but not mentally or emotionally engaged due to their mental state - is another sign. Individuals who seem unusually distracted, aloof, withdrawn or disengaged in the workplace maybe struggling with their mental health.

Presenteeism costs UK employers an estimated £24 billion annually, far more than the cost of sick days.

3. Changes in Behaviour

Employees struggling with their mental health may seem unusually:

• Withdrawn
• Quiet, or less communicative
• Absent, from team socials or meetings, for example
• Irritable
• Frustrated
• Unenthusiastic
• Hysterical

Changes to an employee’s behaviour, whether observed or told about, should be taken seriously. It might be nothing to worry about, reaching out and offering support or even  signposting to available support can make all the difference to a struggling employee

4. Disengagement

Becoming less engaged at work is not always an sign of “quiet-quitting” or an attitude problem, but sometimes the result of a change to someone’s mental health.

Mental health issues such as anxiety and depression can lead to fatigue, distractibility and restlessness. Often, these feelings can cause someone to lose interest or enthusiasm in their work without meaning to.

How to respond, as a manager

How to initiate the conversation

You can’t (and shouldn’t try to!) force an employee to open up about their mental health, but you can offer a safe space and reassurance that anything shared will be confidential and met with support.

• Find a private space: If you feel you need to speak to an employee, find a confidential, quiet setting
• ‍Lead with observation: Reference behavioural changes without judgement, not assumptions about their health

Example: "I've noticed you've been quieter in meetings and missed a couple of deadlines. I wanted to check in and see how you are doing."

• Listen actively: Allow the employee to share what they are comfortable with. Your primary role is to listen with compassion and validate their feelings, avoiding the urge to offer immediate solutions or therapy.
• Maintain confidentiality: Reassure the employee that the conversation will be kept private, adhering to company and legal guidelines.‍

Offering Resources and Practical Support

• Know what resources are available: It's important to stay updated on what resources, support systems and benefits are available to employees.‍
• Ask for their input: Asking directly "What can we do to support you?" shows someone that you are flexible and determined to help.
• Consider personalised accommodations: Make it clear that you recognise that everyone has a unique relationship with their mental health, and you are willing to be flexible to accommodate that individual's specific needs. This may encourage an employee to propose a change they were previously fearful to.

Implementing Reasonable Adjustments

After agreeing on which adjustments an employee feels would benefit them the most, you should work with HR to implement them. Sometimes, they might be unfeasable and a compromise will be necessary - the most important thing is maintaining collaboration and communication to find a solution.

Here are some practical examples of reasonable adjustments known to have worked in the past:

• Adjust workload and deadlines: Temporarily redistributing tasks, prioritising critical work, or adjusting deadlines can help ease the pressure on an employee who is struggling.
• Flexible working:  Temporary changes to working hours and greater flexiblity around breaks and remote working can help employees to cope, manage symptoms, and attend appointments.‍
• Plan a follow-up: Offer a check-in to see if the adjustments are working - adjustments may need adjusting!

Looking to draft a policy? Check out our policy hub for a wide range of templates and guides!

Review your benefits package

Many companies now offer Private Medical Insurance (PMI) as part of their employee benefits package. While PMI plans enable employees to access the support and treatment they need when they need it, they are rarely comprehensive, and some areas of healthcare remain uncovered.

Someone who's mental ill health has been triggered by or exasserbated by pregnancy loss, menopause symptoms, specific challenges around neurodiversity or anything related to reproductive health, they will likely need specialist support that may not be covered in their PMI plan.

At Fertifa, we make sure employees are supported through all mental and physical health journeys.