Mental health at work

Introduction

Poor mental health is a critical issue among the European population. Survey data from 2023 suggests that 46% of Europeans had experienced emotional or psychosocial problems, such as depression or anxiety, in the past twelve months. Half of those dealing with mental health issues do not seek professional help^[1].

Using the workplace as a setting to promote good mental health, not only helps protect workers' mental (and physical) health and well-being but also makes good business sense. This article aims to provide an overview of the causes and consequences of mental ill health in the workplace; and provide an informed commentary on the methods and practices to develop and sustain psychologically safe and healthy workplaces.

Mental health in the workplace

Work can contribute to the development of mental ill health through poor working conditions and work organisation issues^[2]. However conversely, employment can provide individuals with purpose, financial resources and a source of identify, which has been shown to promote increased positive mental well-being^[3]. The economic and social impact of mental ill health is widely recognised as is the importance of promoting mental well-being and preventing mental disorders in society as a whole. In 2023, the European Commission adopted the “Communication on a comprehensive approach to mental health”^[4], with the aim of encouraging Member States and stakeholders to take prevention-oriented actions to address mental health challenges. The approach explicitly refers to the importance of tackling psychosocial risks at work. Already before the COVID-19 pandemic, mental health problems, such as depression, anxiety disorders and alcohol and drug use disorders, affected more than one in six people across the European Union in any given year^[4]. Besides the impact on people’s well-being, the total costs of mental ill-health were estimated at over € 600 billion – or more than 4% of GDP – across the 27 EU countries and the UK^[4]. The EU comprehensive approach to mental health identified the workplace as one of the most important social contexts in which to address mental health problems and promote mental health and well-being^[4].

Understanding mental health and mental ill health

Mental Health

The World Health Organisation (WHO) and the Ottawa Charter for Health Promotion^[5] define health as: “… a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"^[5]. This definition provides a comprehensive and holistic understanding of the concept of health, including and supported by three interconnected areas: physical, mental and social health. This holistic definition of health has two basic assumptions: (1) there is no health without mental health; and (2) health cannot – and should not – be viewed as merely the absence of illness or disease, but rather as a state of positive physical, mental and social wellbeing. The WHO^[6] suggests mental health should be conceptualised as ‘a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in. Mental health is a basic human right. And it is crucial to personal, community and socio-economic development’.

Mental disorders and mental ill health

Mental health encompasses more than just the absence of mental disorders6. It is a positive state that enables individuals to live fulfilling lives. In contrast, mental illness is a specific condition that can impair this state. Mental disorders are characterised by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour. They are usually associated with distress or impairment in important areas of functioning^[7]. The ICD-11 (International Classification of Diseases, 11^th revision)^[8] published by the WHO, is the global standard for diagnostic health information and includes also standardised diagnostic information for mental disorders. The DSM-V, published by the American Psychiatric Association^[9], is another commonly used diagnostic manual for mental disorders. These manuals provide a classification system that aims to separate mental illness into diagnostic categories based on the description of the individual’s symptoms and the course of the illness. Examples of mental disorders include anxiety disorders, depression, bipolar disorder and schizophrenia. Estimates suggest that 1 in every 8 people in the world live with a mental disorder^[7]. 

Mental health is influenced by various biopsychosocial factors a person is exposed to during their lifetime, and specific mental health conditions should be assessed and treated by a trained healthcare professional with the required expertise such as a psychiatrist or a psychologist. Early intervention is key to addressing risk factors and signs of distress, ensuring timely support, and preventing further deterioration in well-being and developing mental disorders^[1]. 

Employers and occupational safety and health (OSH) services are neither responsible for such tasks nor expected to assume such a role while providing support to workers. However, there is well-established evidence that the workplace plays a crucial role when it comes to mental health. This influence can be either negative or positive. According to the Eurobarometer, 29% of respondents believe that the working environment plays a key role in early intervention, ranking it third after primary and community care (50%) and educational settings (43%)^[10]. 

The impact and costs of mental health problems

Data from the OSH Pulse survey^[11] show that in 2025, 29% of the respondents reported that they experienced ‘Stress, depression or anxiety’ during the last 12 months, that were caused or made worse by their work. Only ‘Overall fatigue’ (37%), ‘Headache and eyestrain’ (35%) received higher responses. The prevalence of poor mental health (stress, depression and anxiety) was higher than average among women (31%) and respondents aged 25–39 (32%). Significant differences were also observed between work sectors, with the highest prevalence of mental health problems found among education sector workers and health and social care workers (both 31%), and the lowest among those working in the supply of gas, electricity or water, and mining or quarrying sectors (25%)^[12].

The impact of mental health problems in the workplace has serious consequences not only for the individual worker, but also for the productivity of the enterprise. Worker performance, rates of illness, absenteeism, accidents and staff turnover are all affected by worker’s mental health status. Estimates based on EU data from 2015^[13] indicate that the total cost of depression attributable to exposure to psychosocial risks at work amounts to approximately €44.7–103.1 billion (in purchasing power parity euros). The highest costs were found to be related to job strain and workplace bullying, while the lowest were related to long working hours. Estimates from the UK suggest that the cost to employers of poor mental health has increased by 25% since 2019, reaching an annual cost of £53–56 billion in 2020–21^[14].  

Absenteeism, unemployment and long-term disability

Across the EU almost 16% of all work-related health problems are described as Stress, depression or anxiety (Labour Force Survey, 2020^[15]). These work-related health problems bring about increasing levels of absenteeism, presenteeism, turnover, unemployment and long-term disability claims. For example, a systematic review found that psychosocial stressors at work were associated with an elevated risk of sickness absence due to a diagnosed mental disorder^[16].

Presenteeism and productivity

A review study^[17] examining the relationship between mental health and worker productivity found clear evidence that poor mental health is associated with reduced productivity. However, the research predominantly focused on the most common mental disorders, namely, depression and anxiety. Most studies rely on self-reported questionnaires, surveys, administrative data, and regression analysis, while only a limited number have employed longitudinal data to assess long-term effects. Sickness presenteeism refers to being physically present at work, but mentally cognitively absent. The reasons why people continue to work while unwell are often similar to the reasons why people take time off work due to illness. Common mental disorders such as anxiety and depression, along with musculoskeletal disorders and gastrointestinal problems, are the most common causes of presenteeism^[18]. However, stigma and feelings of shame surrounding mental health issues can increase the likelihood of 'presenteeism', whereby individuals can often be reluctant to disclose their problems, especially if the workplace climate does not support an open communication. A German survey of 5,177 employees^[19] found that, although 23% of respondents rated their current mental well-being as poor, a majority reported that they would feel ashamed if diagnosed with a mental illness. The above mentioned EU-OSHA worker survey (OSH Pulse) confirms that 48% of European workers indicated, that they thought revealing a mental health condition at work would have a negative impact on their career^[12]. Workers with moderate well-being combined with strong mental health-related stigma were found to be the most likely to experience presenteeism^[19]. Supporting findings arise from the Mind Workplace Wellbeing Index, which shows that most respondents admit they would still go to work despite experiencing poor mental health^[14]. Data from the European Working Conditions Telephone Survey (EWCTS, 2021)^[20] show that people in high strained jobs (high job demands/low resources) report higher levels of presenteeism and are at higher risk of depression. Presenteeism significantly impacts workplaces, leading to substantial costs. UK studies estimate that the annual cost to businesses of presenteeism due to poor mental health in the workplace is £24-28 billion (2021 figures) which is four to four-and-a-half times the cost of mental health-related absenteeism^[14]. There is also research based on data from the United States, showing the positive impact of worker wellbeing on the productivity and performance of companies. The research clearly shows that companies with high levels of worker well-being outperform standard benchmarks in the stock market. Higher levels of well-being generally predict higher firm valuations, higher return on assets, higher gross profits, and better stock market performance^[21].

Understanding the link between work and mental health

The development of mental health problems is the result of a complex interplay between biological (e.g. genetic characteristics and disturbance of neural communications), psychological (e.g. coping) and social/environmental factors (such as, poverty, urbanisation, education level, and gender)^{[22] [23]}. One social context that can play a significant role in mental health problems is the workplace. The current section seeks to outline some of the key risks and protective factors for mental health found in the working environment.

There is evidence to indicate that the poor organisation and management of work plays a significant role in the development of mental health problems. Across research findings, exposure to psychosocial risks (such as lack of job control, low decision latitude, low skill discretion, job strain, and effort reward imbalance) have been found to be associated with the risk of depression, poor health functioning, anxiety, distress, fatigue, job dissatisfaction, burnout and sickness absence^{[24] [25] [26] [27] [28]}.

Systematic reviews (e.g. ^[29] and ^[30] and ^[31]) show that work-related psychosocial risk factors such as effort-reward imbalance, high job demands and job insecurity are associated with a higher risk of mental disorders. A longitudinal study conducted in the UK into the causal relationship between work characteristics and the development of mental disorders^[32] showed that work demands increase the risk of mental disorders, whilst social support and high decision authority decrease the relative risk. Additionally, high efforts and low rewards at work were found to be associated with the increased risk of mental disorders. 

Based on data from the OSH Pulse survey the EU-OSHA report Mental health at work after the COVID-19 pandemic – What European figures reveal^[33] found significant associations between mental health and five key psychosocial risk factors: severe time pressure or overload of work; violence or verbal abuse from customers, patients, pupils, etc.; harassment or bullying; poor communication or cooperation within the organisation; lack of autonomy, or lack of influence over the work pace or work process. The strongest association was found with time pressure. There was also an association between reported poor work-related mental health and risk factors related to digitalisation, such as an increased workload and reduced autonomy, although this was somewhat weaker^[33].

The impact of risk factors in the workplace has been observed to vary across different workplaces, occupational groups and cultures. A study of 3142 managers, nurses and paramedical staff, and professionals from four organisations was conducted by WHO^[23]. Results indicated that feeling overworked was a contributing factor across all three occupational groups. However, among nurses and paramedical staff the pressure associated with decision-making was identified as a key risk factor; whilst, in contrast, for professionals and managers poor relationships with superiors were identified as key risk factors. Additionally, evidence indicates that the impact of risk factors may vary across genders^[34]. In addition, sociodemographic and socioeconomic indicators do play a role in how exposure to psychosocial risk factors affect the worker (they mediate the effect), showing higher vulnerability for workers with lower sociodemographic or socioeconomic indicators^[35]. Contractual instability (e.g. precarity and job insecurity) and financial strain (e.g. income insecurity) can increase exposure to other psychosocial risk factors, thereby contributing to decreased well-being^[35]. Analysis of data from the OSH Pulse survey^[33] suggests a gender gap, with women experiencing lower work-related mental wellbeing and less favourable psychosocial working conditions than men. Furthermore, women were more likely to report an increase in work-related stress during the pandemic and were less likely to be adequately protected by OSH measures. They also reported experiencing more violence and verbal abuse at work and having less autonomy than their male colleagues.

Addressing mental health in the workplace

The workplace can provide a social context in which to develop a mentally healthy environment that is supportive to all workers. Contemporary frameworks for mental health no longer concentrate exclusively on the prevention and management of psychosocial risks; but instead follow a holistic approach including the promotion of well-being and enhancing functioning paired with the preventative measures^[36]. Broadly, the aim of mental health promotion is not restricted to solely preventing mental health problems; but has a wider range of health, social, and economic benefits. Mental health promotion can be viewed as a process of enhancing the protective factors that contribute and support good mental health, always being based first of all on identifying and addressing key risk factors^[37].

It is important to note, that effective promotion of mental health in the workplace should be only one critical component of an overall strategy to improve well-being at work^[38]. Measures to promote better mental well-being and addressing risk factors to prevent mental ill health and work-related stress should be fully integrated into an overarching framework being based on proper psychosocial risk management to start with^[38] [39]. 

Evidence for the economic argument and cost effectiveness of interventions aimed at protecting and promoting mental health continues to grow^{[40] [41] [42]}. For example, a report published in 2012^[40] examined the cost-effectiveness of different types of interventions aimed at mental health promotion and mental disorder prevention. This report observed for every €1 of investment in workplace interventions there was an associated net economic benefit of up to €13.62 annually. It is important to note that these figures are based on a selection of European countries and, therefore, caution should be exercised when generalising these findings. A financial analysis by Deloitte (2022) found that employers in the UK can expect to achieve an average return of £5 for every £1 spent on measures to improve the mental health of their workers^[14].

Organisational level measures

Actions aimed at the organisational level to promote and protect mental health, have a strong emphasis on: taking early action to prevent the development of stress and poor mental health; providing an environment that is supportive for workers who have experienced poor mental health; and, finally, implementing measures to help make it easier for people with enduring mental health problems to enter and/or return to work38. The following are examples of organisational measures that aim to cultivate a psychologically safe, healthy and supportive workplace^{[41] [43] [44]}:

• identification of workplace risk factors and, in turn, the modification of the physical and psychosocial work environment to eliminate and/or reduce identified risks;
• the full integration of mental health into workplace health and safety policies and initiatives;
• clear job descriptions defining tasks, roles and responsibilities, regular team/work meetings where workers can discuss their tasks/roles/responsibilities, communication on changes, providing possibilities to raise concerns about role conflicts;
• clear policies and procedures to set a no-tolerance-approach to harassment and sexual harassment;
• multi-level workplace improvement programmes that seek to address role clarity and expectations;
• awareness raising and training for OSH representatives, human resources staff and managers on psychosocial risks and mental health in the workplace;
• measures to improve communication between employer/management and workers, like open door policies and regular meetings to discuss aspects that affect mental health;
• job design, including job modification/task enlargement, job rotation and career development;
• improving decision autonomy, promoting worker control and pride over end products;
• flexible working hours;
• ensuring rewards and recognition for good performance;
• measures to facilitate return-to-work by work adjustments, gradual return to work, individual support and counselling, etc.
• support for daily life challenges (e.g. access to childcare, bicycle parking facilities at the workplace, etc); and
• possibilities for adaptation of work arrangements during major live events, like bereavement, divorce, etc.

Strategies and initiatives to promote mental health and well-being should be developed and implemented in a co-ordinated effort by those responsible on all levels, including employers, managers, supervisors, and workers. In addition, the meaningful active participation of groups targeted by the intervention should be central to any approach adapted to promote positive mental health in the workplace. The participation of workers is a concrete enactment of job control, demonstrates organisational fairness and justice, builds mutual support among workers and between workers and supervisors and ensures that measures fit best to the needs of the workers. These concepts are fundamental and at the core of the development of a psychologically healthy and supportive work environment.

Individual level measures

Actions taken at the level of the individual to promote mental well-being aim to take a salutogenic perspective towards the prevention of stress and poor mental health provide individuals with resources and support to help maintain their wellbeing and cultivate a sense of coherence to affected workers, to make use of the supports when required^[38]. A number of examples of measures targeted at the individual to address mental health in the workplace include^[38] [44]:

• access to support services, such as counselling, employee assistance programs, or mental health professionals;
• free psychological counselling and specific psychological support;
• relaxation and meditation training;
• mindfulness training;
• biofeedback;
• physical exercise programmes;
• stress management training; and
• time management training; as well as
• communication and conflict resolution training. 

Evidence for effectiveness

There is clear evidence that workplace mental health interventions are effective ^{[45] [46] [47] [48] [49] [31]}. Kuoppala and colleagues^[50] examined evaluations of the effectiveness of interventions delivered in the workplace to promote better mental health and well-being. They concluded that interventions aimed at workplace mental health promotion are valuable to workers' well-being and work ability; and are productive in terms of decreasing sickness absences. However, they highlight that education and psychological interventions when applied alone have limited effectiveness in the long-term and therefore need to be based on organisational-level measures that target both physical and psychosocial environments at work^[50]. Aust et al.^[47] conducted a systematic review of the effectiveness of organisational-level interventions in improving the psychosocial work environment and workers’ health and retention. They found strong or moderate quality of evidence for the effectiveness of several organisational interventions including changes in working time arrangements and influence on work tasks or work organisation47. A meta-analysis by Sin and Lyubomirsky^[51] showed that mental well-being can be enhanced and depressive symptoms reduced through positive interventions. This meta-analysis examined evidence derived from interventions across different social contexts, including the workplace. Within the context of the workplace, this can be achieved by establishing positive leadership practices, ensuring work is meaningful, and building a positive organisational climate^[52] [53]. 

Measures to address mental health in the workplace are heavily related to the nature and content of interventions and numerous studies emphasise the importance and value of comprehensive approaches to managing and preventing work-related stress and other associated psychosocial issues. Comprehensive intervention approaches use a combination of organisational and individually-focused intervention strategies^[54] .

A systematic literature review of published systematic literature reviews was performed by Friberg and Lytsy in 2020 to map the knowledge on psychosocial interventions at the workplace^[55]. The review concludes that much of the existing evidence indicates that psychosocial workplace interventions may promote individual and organisation health and can have a beneficial effect on sickness absence. 

Measures taken by companies

Data from ESENER 2024^[56] show that in 39% of workplaces in the European Union there is an action plan to prevent work-related stress. These figures vary between Member States with more than 74% in Sweden and 11% in Czechia (figure 1). 

Comparing these figures with the data from ESENER in 2019, there has been an increase at European level by 6%^[57]. When tackling the risk factors associated with work-related health problems, measures taken by companies include:

• Reorganisation of work in order to reduce job demands and work pressure (measure taken by 46% of all establishments);
• Confidential counselling for employees (44%);
• Training on conflict resolution (38%);
• Intervention if an employee works excessively long or irregular hours (30%);
• Allowing employees to take more decisions on how to do their job (70%)^[56].

Supporting practices

There are plenty of guidance and supporting initiatives available in the different Member States. At EU level EU-OSHA offers a practical e-guide to managing psychosocial risks that is particularly designed to respond to the needs of employers and people working in small enterprises^[58]. Furthermore, EU-OSHA published a practical guide to well- being at work - Healthy workers, thriving companies (2018)^[59]. The guide suggests a straightforward five-step process for improving the work environment to tackle these work-related psychosocial risks and musculoskeletal disorders.

Policy initiatives

Ensuring a psychologically safe and healthy workplace is not only a moral obligation and good business practice, but also a legal requirement under the EU Framework Directive 89/391/EEC on Occupational Safety and Health (OSH)^[60]. While the Directive does not explicitly mention psychosocial risks, it establishes employers’ general duty to protect workers against all types of risks. An interpretative document[61] further clarifies that these obligations extend to psychosocial risk assessment and mental health protection.

As a framework law, the Directive sets a baseline that all Member States must implement in their national OSH legislation. This allows flexibility but also results in significant variation in how psychosocial risks and mental health are addressed across countries^[62] [2]. 

More detailed information about specific Member State approaches with regard to policy and legislation on psychosocial risks can be found in a policy brief published in 2025 by EU-OSHA^[63] as well as in the list of publications that are available online based on the Commission's Peer Review on legislative and enforcement approaches to address psychosocial risks at work in the Member States^[64].

At the strategic level, the EU has taken further steps to put mental health high on the agenda. In 2023, the Commission launched its Comprehensive Approach to Mental Health1, which includes occupational safety and health as one of six key areas with a strong prevention-oriented focus^[62]. The Strategic Framework on OSH 2021–2027 also prioritises psychosocial risks, especially in relation to technological and organisational change^[62].

International standards also shape the EU agenda. The ILO Violence and Harassment Convention (C190, 2019)^[65] establishes commitments on eliminating violence and harassment at work. In March 2024, the Council adopted decision 2024/1018/EU^[66] inviting Member States to ratify the Convention, thereby making its provisions binding.

EU-level social partner agreements further complement legislation and offer guidelines for managing mental health at work: agreements on work-related stress (2004)^[67], workplace bullying and violence (2007)^[68] and digitalisation (2020)^[69], which addresses issues such as work–life balance, isolation, and psychological safety in relation to new technologies^[62].

Conclusion

Work can play an important role in the mental health of individuals. In that it can contribute to the development of mental ill health through poor working conditions and, conversely, can provide individuals with purpose, sense of self-worth/self-esteem, financial resources and a source of identify. In general, mental health problems have been a highly under-recognised issue among employers and managers, despite their high prevalence among the working population. However mental health problems have been shown to have a significant direct impact on the quality of life and functioning of individuals but also have been found to have an impact on the productivity and resilience of enterprises. The workplace is an important social context in which to prevent mental ill health and, moreover, promote the optimal mental and physical health and well-being of workers.