It’s undeniable that mental health problems are on the rise – but could the statistics that show this upward trend actually be telling us we’re making progress?

It’s hard to ignore the warning signs that the UK has a mental health crisis – it’s a dominant topic within the media, a clearly stated priority across political parties, and is the top priority on many corporate agendas. In fact, the latest figures show that almost half of businesses have a defined mental wellbeing strategy and half of those who don’t plan to introduce one at some point this year (REBA, 2018). And it’s no surprise they’re prioritising it – it’s widely reported that stress, depression and anxiety are now the leading cause of absence in the UK accounting for almost half of all working days lost (HSE). At the same time, 1 in 3 businesses say the length of absences related to mental ill health have gone up in the past three years (British Chambers of Commerce). This is taking its’ toll on businesses and the economy too, with poor mental health estimated to cost the UK 4.5% of GDP according to the OECD.

So, it’s clear that there’s a growing problem in the workplace, and the cost of this in terms of lost productivity and increased absence is set out in pounds and pence – not to mention the emotional stress and strain experienced. But do these figures paint a completely bleak picture? Are we in the depths of an unprecedented crisis, or is something else going on?

Why rising absence due to mental health could be a good thing

Mental health has occupied an ever-increasing presence in the media over the past decade, with high profile figures publicly acknowledging their mental health struggles, national campaigns gaining traction and initiatives like Mental Health First Aid becoming the norm in most businesses. What if all this awareness raising aiming to tackle the stigma around mental health and to make wellbeing conversations the norm is finally paying off? What if these statistics are proof positive that mental health is well and truly out in the open?

There’s a similar example from studying breast cancer rates in the USA which backs up this notion, led by psychologists Kathryn and Grant Jacobsen. In 2011, they found that the number of breast cancer diagnoses in the month of November increased during the mid-1990s.

One explanation, they suggested, was that cancer was becoming more common. People were becoming increasingly exposed to the associated risk factors, just as employees are being increasingly exposed to more stressful work environments – longer hours, increased financial pressures, lower job insecurity and an ever-closer relationship to jobs through technology – which in turn are all contributing to higher absence rates. Another explanation for the higher rate of cancer was that the National Breast Cancer Awareness Month (NBCAM) campaign – taking place in November – was actually working. The NBCAM movement was rapidly expanding across the US, and the researchers were able to prove that the awareness events were effective in increasing November diagnosis rates.

So on the face of it, cancer had gone up – and diagnoses of it had – just as mental health related absence has gone up. Yet on closer inspection, researchers showed this was because awareness campaigns were working and encouraging more and more women to come forward and be screened. Just like more and more people are now willing to report mental health as the reason for their absence from work and get vital support that they need.

The Jacobsen’s couldn’t prove that the awareness campaigns continued to directly influence November cancer diagnoses beyond the mid-1990s – but this was because screening for women was becoming more common. We reached a tipping point of people accessing screening and then accepting support if they were diagnosed. The rising figures ultimately created better health outcomes, as breast cancer incidence rates in the US began decreasing post-2000 after increasing for the previous two decades, and survival rates continued to improve ( So what could have been billed as a negative news story ultimately created long term health improvements.

It’s not to say that rising mental health-related absence means that we’re definitely going to see a drop in the future in the same way this research showed (there are almost certainly more causal factors contributing to mental health than for breast cancer), but we have an opportunity to try and make it happen. Awareness raising efforts so far – at the public health, charity, educational and corporate levels – means that the basis of a joined-up system to tackle the problem is forming. Spending is increasing, businesses are taking it more seriously and it’s certainly a priority for the government. Employers are arguably best positioned to make a dent in solving the problem, and the latest figures show that most have (or plan to have) a strategic plan to tackle it as a business-critical issue. That collective attention combined with growing resources and funding puts us in a strong position to repeat the trend of US breast cancer.

So, should companies just focus on reducing absence caused by mental health?

It’s important to tackle the root cause and not the symptom. There are policy-led ways to improve mental health related absence – such as introducing tougher monitoring or linking promotions to absence records – but in doing so businesses are not genuinely improving the wellbeing of employees even if they are saving absence costs in the short-term. In fact, if businesses rely on absence as a sole indicator of their employee’s wellbeing – without drawing on metrics such as wellbeing surveys, EAP usage or occupational health referrals – they are setting themselves up to fail. Taking this approach would merely solve one problem whilst simultaneously creating another, even bigger problem – presenteeism.

Presenteeism refers to employees coming into work whilst feeling ill, unable to perform their work to their normal standard. And when absence goes down, presenteeism goes up; as the average number of days sick has fallen to its lowest since ONS records began in 1999 (falling to 4.1 from 7.2 days per employee), the number of workers coming into work whilst ill has hit a record high – trebling since 2010. So ultimately, the only real way keep absence and presenteeism in good balance is to focus on creating good levels of underlying wellbeing and personal responsibility; so that the contract is clear to employees and they, themselves, are in a position to make sensible decisions about when they come to work or stay at home.

What does this mean for HR and wellbeing practitioners?

  1. Set realistic goals – don’t expect returns in year one of your wellbeing programme or strategy. It’s important to set realistic goals on improvements and for return on investment.
  2. Choose metrics wisely – choose the right metrics that help you to tell the story in the right way. Consider whether an increase or decrease in one metric will be directly related to the opposite trend in another, such as absence coming down but presenteeism going up.
  3. Don’t panic if figures are not moving in right direction – as well as being the right thing to do, businesses need to see things improving. Whilst any wellbeing strategy needs to focus on evaluation and continuous improvement, patience and sticking to the core principles of your approach are both fundamental to achieving success…it needs to become cultural.
  4. Consider where you are right now – every business has a different starting point when focusing on employee health and wellbeing. See the Seven Signs of Readiness to assess where your business currently is and guide your next steps.
  5. Get beneath your key performance indicators for wellbeing – whatever metrics you decide to use, whether that’s absence, retention, employer brand or presenteeism, consider how you are measuring at the level down from your outcomes. It’s important that businesses understand the levers that are driving those all-important KPIs so that they are in an informed position to influence the right ones at the right time.