Getting back to work after stress, anxiety or depression: Practical Guidance for SMEs

Mental health… we’ve been hearing a lot about it recently. But did you know that mental ill-health absence is one of the leading causes of absence from work? A team of researchers from Kingston University, Loughborough University and Affinity Health at Work have produced a toolkit to help small businesses manage sickness absence following mental ill-health. Here, we provide some background and six simple steps to help you support someone back to work.

What is mental ill-health?

Mental ill-health can be caused by work itself, such as poor management, uncertainty, or non-work factors, such as bereavement or divorce. In some cases, mental ill-health can co-exist alongside other health problems, for example, depression as a result of a long-term condition. The signs of mental ill-health can include; struggling with workload, low levels of concentration/focus, negative attitude, feeling anxious or irritable, changes in how they interact with colleagues, tiredness, having sleepless nights, increased drinking and/or smoking, and headaches. Typically however, the onset is signalled by a change in behaviour.

How does mental health affect my business?

Not only is there a strong moral case for looking after the mental health of employees, but mental ill-health is one of the most common causes of absence, costing business between £1,205 and £1,560 per employee, per year (this includes all employees, not just those who are off). Mental ill-health not only has a huge impact on the individual but can also have a big effect on your business. The majority of people are able to return to work following mental ill-health absence, but many report that it is poorly managed and up to 20% either relapse or leave the workplace. So having the right skills as a manager to manage a successful return is key.

How do I support a member of staff who is off work?

Early and effective intervention is vital to support employees to help them get back to work and help them stay at work. People may need therapeutic or medical support, but this doesn’t mean they don’t also need you. Many business owners are unsure of what to do or what to say when it comes to mental health absence. A common response can be “I feel out of my depth” or “I don’t want to make things worse.” Talking about mental health can be difficult, so people often choose silence in fear of saying the wrong thing. However, an employer is often the first point of contact when they are unwell and when they return so it is important that they have the skills and knowledge to support the returning employee.

What guidance is out there to help me support an employee back to work?

Using the latest research and working alongside business owners, managers, employees (who had been off work previously), employment lawyers and human resources and health professionals involved in managing an employee back to work, the toolkit including guidance, checklists, templates, exercises and ideas of what to say and do.

We propose six steps to help employees, business owners and managers navigate through the return to work process. Here are some top tips:

  1. Talk early on while the employee is off work
  • Communication in the early stages of absence can seem quite formal e.g. requests for a fit note, which may lead to feelings of genuine care getting lost. Employers need to make sure that communication at this stage is about the employee and their health, rather than when they are coming back.
  • Talking early on can help the employee feel valued.
  • If you, as the line manager, don’t have a good relationship with the employee, it may be helpful to ask a colleague to check in.
  1. Develop knowledge and skills
  • Employers need to be encouraged to consider whether they have the skills to support the returning employee: our research, supported by BOHRF and CIPD, has identified a number of manager competencies that have been found to be effective for supporting returning employees.
  • If work played a role in the absence, it is important for the employer to consider how the team are coping and review how their work is designed/managed.
  1. Maintain communication throughout absence
  • Maintaining contact throughout sickness absence has been found to improve the employees’ likelihood of returning to work. It can support a sense of belonging and help relieve the anxiety of returning to work for the employee, and can help both the employee and employer with work planning.
  • It is helpful to agree up front how often (e.g. once every month) and how (e.g. email/ phone) communication will happen.
  1. Preparing for return to work
  • Employees often resume their full workload on return, and this leads to further problems. Instead, gradual returns allow the employee to build up their confidence back in the role.
  • It can be useful for an employer to think through how the employee’s role could be adjusted to make the first few days/weeks easier to manage. An informal coffee/phone call before the first day back may help the employee’s anxiety.
  • Employers can also start to think ahead to the "return to work" (RTW) conversation – do they know what to do, what to say, and how to say it?
  1. Return to work conversation
  • Setting aside time for a RTW conversation is important so that employers and employees can develop a plan to make sure that the return is an effective one. Do you have the skills, or the office space, to make the most of this conversation? Do employees know when/where it will take place and what to expect?
  • Our toolkit provides a conversation guide to help both manager and employee with this conversation.
  1. Keeping healthy and productive at work
  • Many people who experience mental ill-health only experience it once. However, it is important to maintain an open dialogue and agree a plan for regular check-ins.
  • Wellness Recovery Action Plans can be helpful for all team members, not just the returning employee, and regular reviews of the way work is designed and managed can give employees the best chance of staying healthy and productive at work.

We could all benefit from knowing a bit more about mental health, the potential signs, triggers and where to get help. With 1 in 3 Fit Notes citing mental ill-health as the reason for absence, understanding how to support people back to work, and what keeps people back in work after mental ill-health sickness absence, is important for all of us.


If you are interested in hearing more about the project or accessing the toolkit please contact:

This article was written by Rebecca Peters, Research Associate and Dr Joanna Yarker, Associate Professor in Occupational and Business Psychology at Kingston Business School, Kingston University London

Project team: Joanna Yarker, Rebecca Peters, Rachel Lewis, Emma Donaldson- Feilder, Robert Blackburn and Fehmidah Munir