Emma Bradshaw, Clinical Director at HealthHero, explains how employers can support someone back to work after a mental health absence, from staying in touch to planning a phased return.
Mental ill health is the most commonly cited cause of long-term absence in the UK, and the chance of someone returning to work falls the longer they're off. Here's what helps at each stage of a return, and how to tell when someone needs more support than an EAP can give.
When an employee is off work for mental health reasons, most of the focus is on managing their absence. The fit note is recorded, cover is arranged, and dates are entered into the HR system. But planning for their return often gets less attention, even though this stage is key to helping them come back and stay at work.
As a clinician, I believe returning to work deserves as much attention as treatment itself. The good news is that most helpful steps are low-cost and can be done by managers who know the employee well.
Employees absent for four to six weeks have a 96% chance of returning to work, but after more than a year the chance falls below 50%, according to evidence cited in the government's Keep Britain Working review.
Mental ill health is cited among the top three causes by 41% of organisations in the CIPD's 2025 survey, ahead of musculoskeletal injuries at 31%.
Stress, depression or anxiety caused or made worse by work led to 22.1 million working days lost in 2024/25, more than half of all days lost to work-related ill health, according to HSE.
Just 43% of organisations use phased returns or other reasonable adjustments to manage employee mental health, the CIPD found.
When returns to work go wrong, they often follow the same pattern, and employers can change most of these factors.
The Keep Britain Working review found that 93% of fit notes in England deem the patient "not fit for work", and heard that they are often extended without further consultation. The "may be fit for work" option, which lets a health professional recommend a phased return, altered hours, amended duties or workplace adaptations, appears on only a small share of them. That usually leaves the employer to build the plan for coming back.
Employees off with anxiety or depression may find it difficult to hear from work, while managers worry about bothering them, so both sides end up waiting. Without an agreed plan for staying in touch, returning can feel more difficult as time goes on.
The CIPD reports that only 29% of organisations train managers to support staff with mental ill health. Where training is in place, 73% of employers say their managers feel confident having sensitive conversations and guiding people to expert help, compared with 57% where it isn't.
HSE estimates that 964,000 workers had stress, depression, or anxiety caused or worsened by work in 2024/25. If work contributed to the absence and nothing changes, employees return to the same pressures that made them unwell.
Some absences require clinical treatment as well as good management. Zurich UK noted in the government's Keep Britain Working announcement that 9 out of 10 employees return to work when they have vocational rehabilitation, but only 3 out of 10 actually receive it.
The government's fit note guidance shares an important message for managers: "the right type of work is usually good for people's physical and mental health." People can often return before they feel fully recovered, and work can even help their recovery. Here are six steps to support this process.
Early in the absence, agree with the person how often you'll be in contact, who it will come from and whether they'd prefer a call, a text or an email. Acas advises agreeing how often to keep in touch so that it isn't overwhelming, and reviewing it regularly. Keep these conversations focused on how the person is doing, and share work news only when they want it.
The Keep Britain Working review suggests that employers and employees agree on a return-to-work plan, starting support from two weeks and no later than six weeks into the absence. Early planning gives employees a clear path back while their chances of returning are highest, and allows time to involve occupational health or specialist assistance if required. Employees do not have to wait for their fit note to end. They can return at any time, even before it expires, without needing to see their healthcare professional again.
Before or on the first day back, meet with the employee to agree on a plan. Acas recommends discussing how ready the person feels, what support or adjustments they might need, and how the return will work. I also suggest asking what they want colleagues to know, since that should be their choice. Discuss any early warning signs you both might notice if things start to slip, and ask if they will need time for therapy appointments, as many people are still in treatment when they return.
A phased return involves slowly increasing work duties or hours, and it is one of the most helpful adjustments employers can offer. Decide on the starting point together, review progress every week or two, and be prepared to adjust the pace as needed. Shield the employee from any backlog that built up during their absence, and set one or two clear priorities to begin with.
If work played a role in the absence, returning is the time to make changes. HSE's Management Standards highlight six areas of work design linked to stress: demands, control, support, relationships, role, and change. Use these as a checklist during your conversation. Problems such as a heavy workload, difficult relationships, or unclear roles will still be there unless they are addressed. I recently wrote about burnout, which is often where these absences start.
Recovery from anxiety or depression often has ups and downs, and support can feel like it disappears just as normal pressures return. Keep checking in for at least a few months, watch for early warning signs you discussed, and act quickly if they appear.
An EAP is the right first step for most people. Short-term counselling helps someone manage what's happening, and it stays available throughout an absence and return.
HealthHero's EAP also includes support for managers, so the person planning the return has somewhere to turn too.
Some absences need more. The first sign I'd look for is EAP counselling that has finished without enough improvement. An absence stretching from weeks to months is another, as are repeated absences for the same difficulty and symptoms that follow a traumatic event, such as an assault or a serious incident at work. Conditions like recurring depression, PTSD and OCD usually need structured clinical treatment from a psychologist or CBT therapist to give someone a lasting route back to work.
That's the gap our Specialist Psychological Services are built to fill. Each referral starts with a clinical assessment and a written report covering the person's difficulties, the recommended treatment and practical return-to-work guidance. Treatment is typically 12 to 20 sessions of evidence-based therapy, including CBT, trauma-focused CBT and EMDR (eye movement desensitisation and reprocessing), delivered within NICE clinical guidelines by our UK-wide network of more than 270 registered psychologists and accredited CBT therapists. Progress is tracked with clinical measures throughout and each case has a dedicated case manager. With the employee's consent, HR receives clinical reports, so the return can be built around clinically informed adjustments that help prevent relapse.
We've also run projects with employers aimed specifically at long-term absence, supporting people who had been out of the workplace for a prolonged period back into work.
Two anonymised cases from the service show what this can look like. One employee had recurring severe anxiety and OCD, triggered by stress at work and at home, and had been absent several times. After 16 sessions of CBT, with return-to-work guidance for their employer, they completed a phased return to work, with better mood, less anxiety and a considerable decrease in OCD behaviours.
Another employee developed PTSD symptoms, including hypervigilance, nightmares, flashbacks and anxiety about going back to work, after being physically attacked by a customer. Over six months and 20 sessions of CBT and EMDR, which also supported them through a court case, their symptoms eased significantly and they went back to work on a reduced shift pattern at first.
It can be. Under the Equality Act 2010, a mental health condition counts as a disability if it has a substantial, long-term effect on normal day-to-day activities, such as working set times or interacting with people. Long-term means it has lasted, or is likely to last, 12 months. When a condition meets that test, employers have a legal duty to make reasonable adjustments, so it's worth taking HR or legal advice on individual cases.
Consider it when EAP counselling hasn’t brought enough improvement or an absence is stretching from weeks into months. At HealthHero, a free pre-referral consultation with our clinical team can help you decide.
The Keep Britain Working review puts the annual cost of poor workplace health to employers at around £85 billion and estimates that each day of sickness absence costs £120 in lost profit on average. HSE figures show each case of work-related stress, depression or anxiety led to an average of 22.9 working days lost in 2024/25.
If you’re planning someone’s return right now and want the right support in place, talk to our team about HealthHero’s EAP and we’ll work it out with you.