Working Well

Executive Summary

For many people, work provides a purpose to life, not just the means to live. It can be a source of fulfilment and meaningful relationships, as well as offering wider social and economic benefits. However, a growing number of people are exiting the workforce, or are unable to return to work, due to mental ill-health. This report from Imperial College London’s Institute of Global Health Innovation and Mental Health Innovations explores this challenge, and identifies opportunities to address it. 

To inform this report, we surveyed 2,500 people who contacted the Shout text message support service, to ask them about the barriers and enablers to work. They told us that, after mental ill-health, the most common reason they were out of work was because of their lack of confidence. 

We worked in partnership with a group of people with lived experience of work-related mental ill-health (the Mental Health Voice Group). Members of the group described poor workplace practices which had worsened their health, leaving them daunted by the prospect of starting a new job. 

We interviewed people from across government, the National Health Service (NHS), industry and charity sectors, to understand how workplaces can both help and hinder people’s mental health. They told us that workplace mental health initiatives can be ‘tokenistic’ if not accompanied by a genuine investment from employers in people’s wellbeing.  

We also heard how employers and industry partners are innovating to support people’s mental health in sectors such as entertainment and hospitality. This included setting up peer support networks, ensuring meaningful engagement with employee assistance programmes, and delivering effective educational, training and coaching programmes for employees and the next generation of talent. Such approaches can help offset the estimated annual £51 billion cost to employers of presenteeism, sickness absence and staff turnover caused by mental ill-health. 

Based on our work, and building on recent reports and commissions on this topic, we conclude that there is an opportunity for employers to address the often-neglected challenge of supporting people’s confidence to return to work following a period of mental ill-health. We have therefore created a practical guide for employers to help reduce some of the barriers to employment for this group of people. 

Co-produced with our Mental Health Voice Group, the guide includes practical suggestions that employers could implement, typically at little or no cost, to ensure a positive and inclusive recruitment and onboarding experience. This can support employers to tap into a diverse, experienced and skilled cohort of commonly overlooked and under-served people who would make fantastic candidates for roles, and make a broader societal contribution in the process.  

Our recommendations in full: 

• Employers can create more inclusive and supportive recruitment, onboarding and workplace practices that support people affected by mental ill-health to return to work and all employees to stay well in work (see our employer example). 
• Industries should consider how they can better prepare and support people entering high-stress industries through educational, training and coaching programmes (see our industry examples).  
• Innovators should consider how technology-based health and work support tools could complement existing services, to help people to stay in work, or return to work. 
• Researchers and evaluators should consider partnering with employers to build evidence on the effectiveness of mental health interventions in the workplace. 

1.1 Introduction 

This is the second in a series of reports that builds on the long-standing partnership between Mental Health Innovations (MHI) and the Institute of Global Health Innovation (IGHI) at Imperial College London.

MHI is a charity that delivers scalable, innovative digital services and insights to transform the mental health of the nation. IGHI utilises its multi-disciplinary team of clinicians, scientists, policy makers and public involvement specialists to break traditional research silos to tackle some of the greatest global health challenges facing the world today.  

Our first report explored access to MHI’s Shout text messaging support service. The report found that Shout was highly valued and addressed an unmet need across large sections of the population (see Box 2). This second report focuses on the relationship between mental health and work. It uncovers fresh insights into the factors that keep people in and out of work from a mental health perspective, drawing on: 

• A nationally representative survey of 1,500 adults, and responses from 2,500 individuals who completed a post-conversation survey after contacting Shout for support. 
• Meetings of our Mental Health Voice Group (see Box 3) which brought a range of experiences of mental ill-health related to work. 
• Interviews with key stakeholders from across government, NHS, industry and charity sectors. 

For many people, work is an invaluable source of purpose and relationships in their lives, and brings wider benefits to the economy and society. However, the number of people reporting a work-limiting health condition, leaving employment entirely due to ill-health, or facing significant barriers to return to work, is growing. While the causes of these trends are complex, it is clear that the rising incidence of mental ill-health is a major contributing factor.  

This report seeks to improve understanding of mental-ill health among working age people (aged 16-64) by: 

• Examining the available data and recent reports on the relationship between mental ill-health and work – see Part 2. 
• Understanding the mental health-related barriers and enablers to people finding and staying in work – see Part 3. 
• Identifying opportunities to support the mental health and wellbeing of working age people – see Part 4. 

1.2 What we did

We worked in partnership with a Mental Health Voice Group to conduct this work. The group included people with a wide range of lived experiences where their mental health affected, or was affected by, work (see Box 3). We conducted desk research to synthesise insights from published work, and analysed publicly available data sets. MHI developed questions for a post-conversation survey for Shout service users, and incorporated survey questions into the MEL quarterly omnibus (see Box 4). We also conducted interviews with stakeholders to understand the perspective of employers, industry bodies, charity and advocacy organisations, NHS and Government. This included interviews with organisations who partner with MHI to provide mental health support to their audiences. 

A note on language: This report refers to both ‘mental health’ and 'mental ill-health’ throughout. We use the term mental ill-health to refer to specific conditions or episodes that people may experience, such as anxiety or depression. We use the term mental health to refer to the full spectrum of psychological and emotional wellbeing, which can include positive and negative feelings and behaviours. In the context of this report, it is helpful to see mental health in its broadest sense, to consider the factors that can maintain people’s wellbeing in work or when looking for work, not just the factors that can cause periods of mental ill-health. 

In 2019, 2.8 million working age adults in England and Wales (one in 13) claimed disability or incapacity benefits. This figure is now four million (one in 10), representing a real terms increase of £12 billion in welfare payments. A survey by the Department of Work and Pensions (2025) found that 86% of claimants report having a mental health condition.  

In March 2025, to stem this rising welfare bill, the Government announced major changes to the benefits system. The changes focused on stricter tests for Personal Independence Payments (which help people with extra living costs arising from their health condition or disability), reductions in some incapacity payments, and additional incentives to work. 

Set in the context of these changes, this part of the report analyses the available data on mental ill-health among working age people, and how it affects people both in work and out of work.  

2.1 Mental ill-health among working age people

Analysis of several data sources by the Institute for Fiscal Studies concluded that the mental health of the working age population is getting worse. In the mid 2010s, around 8-10% of working age people reported having a mental health condition – in the most recent data, this figure was around 13-15%.  

The Health Foundation reported that the greatest increases in mental health conditions have been seen in younger people (aged 16-34), with rates doubling across multiple data sources over the past two decades. The report of the Government’s Keep Britain Working Review found that young people with mental health conditions were nearly five times more likely to be ‘economically inactive’ (see Box 5) compared to others in their age group.  

The Youth Voice Census is an annual survey of around 5,000 people aged 11-30, conducted by Youth Employment UK. The 2024 census report found that three in five young people reported feeling anxious, and were more worried about their (lack of) skills and opportunities than in previous years. Anxiety features in the top three barriers to finding work, with two in five young people reporting it as an issue. 

2.2 Work-limiting mental health conditions 

According to the Office for National Statistics (ONS), the largest reported cause of economic inactivity because of long-term sickness was ‘depression, bad nerves or anxiety’. This was 53% (1.35 million) in 2023, compared to 48% in 2019. 38% reported having five or more health conditions – up from 34% in 2019 – illustrating the complexity and interaction of physical and mental health issues for many people (Figure 1). 

Figure 1 - Incidence and impact of mental health issues on economic activity (Office for National Statistics)

The Commission for Healthier Working Lives reported in 2025 that people who left the workforce due to health reasons were nearly three times less likely to return to employment compared to those without health conditions. Workers who spend two years or more out of employment face on average a 25% loss in pay if they do return to work, often moving into lower-paid and lower-skilled jobs. This problem is expected to worsen, with research by the REAL centre projecting a 17% rise in the proportion of people aged 20-69 living with major illness by 2040. 

Box 5: Economic inactivity

The ONS uses the Labour Force Survey of UK households to collect data on people who they define as ‘economically inactive’, meaning people of working age who are neither employed nor actively seeking work. Reasons for people being economically inactive include being in full-time education, caring for someone, or retiring from work, as well as those with a long-term illness. 

Members of the Mental Health Voice Group spoke of a strong desire to re-join the workforce, but faced barriers to doing so which are not adequately captured in these data categories. One member described being scared to return to work, for fear of becoming unwell again, and having to leave the job and let people down. This was compounded by the prospect of potentially having to re-apply for disability and incapacity benefit, a process currently felt to be complicated, drawn-out and opaque. 

Members of the group described feeling unfairly portrayed in the media as “freeloaders”, despite facing significant barriers to working. Some had been victimised at work for having to take time off for their mental health, or for having adjustments made in their role. Others described how their mental health worsened during time off work, due to delays in accessing the NHS care they needed to be ready to work again.  

2.3 Sickness absence from work

The ONS collects data on sickness absence, which it defines as the percentage of working hours lost due to sickness or injury. ONS analysis found that the sickness absence rate in 2022 rose to 2.6%, the highest rate since 2004. This equated to an estimated 185 million working days lost. ‘Mental health conditions’ was the fourth most common reason for absence from work, behind minor illnesses, musculoskeletal problems, and respiratory conditions.

The sickness absence rate for people with long-term health conditions (one that lasts for 12 months or more) was 4.9%, the highest since 2008. The data show that overall sickness absence rates were not evenly spread. For example, they were higher for:

• Public sector workers.
• Part-time workers.
• People working in the caring, leisure and service occupations.

2.4 Stress and burnout from work

Burnout in a work context refers to feelings of exhaustion, mental distance from one’s job, and a decline in performance at work. Burnout is different from stress, as it tends to be long-term and accompanied by feelings of detachment and demotivation, leaving people feeling hopeless about changing their situation.

In a YouGov survey of working adults across the UK (2023), almost two thirds (63%) of respondents reported feeling at least one of the characteristics of burnout, 59% of whom said it was somewhat, largely or entirely due to personal mental health and wellbeing-related issues. A poll by Mental Health UK found high levels of stress, but also a culture of silence and presenteeism put people at risk of burnout. It reported:

• 91% experienced high or extreme levels of stress in the previous year.
• 21% felt their productivity or performance at work was impacted, but didn’t adjust their hours or take time off work.
• 19% said they chose not to disclose their high levels of stress to their employer.

Mental Health UK also found that 28% of people aged 18-24 had to take time off work due to health challenges while waiting for NHS treatment. The Youth Voice Census (2024) found that three in five young people reported an increase in pressure and stress at work, and seven in 10 reported an increase in their responsibilities, over the previous year.

While the World Health Organization defines burnout as an occupational phenomenon, it can be caused or exacerbated by other life pressures, such as caring responsibilities (see Box 6) which was experienced by some members of our Mental Health Voice Group. Carers are defined as people who provide unpaid care and support to someone who is disabled, has an illness, or who needs additional help as they get older.

Feedback from the group emphasised the impact of caring on their mental health and ability to cope:

Box 6: Mental health of working age carers

Interview with Melanie Crew, Research and Policy Manager at Carers UK.

Research has estimated the value of care in the UK to be £184 billion, but many carers feel undervalued and unrecognised for what they do. A third (35%) of carers reported having ‘bad or very bad’ mental health in 2024, often caused by a lack of social care support. This can mean that carers are unable to prioritise their own health, and are forced to miss health appointments, for example. 40% of carers providing high levels of care have had to give up work:

“If somebody is struggling with their finances, that then has an impact on their health, and that then impacts on their ability to stay in paid work, so you can see how those issues compound one another.”

Employers can play a crucial role in supporting the approximately 3 million carers in the UK to remain in employment. This includes providing paid carers leave, supporting home and flexible working arrangements, or establishing internal peer support groups. 230 organisations are now part of the Employers for Carers forum, covering 2.9 million employees, which provides support to retain and manage employees with caring responsibilities. Carers UK is also campaigning for caring to be classed as a protected characteristic:

“Caring responsibilities are not talked about enough in the workplace. Carers are entitled to unpaid carers leave, and in some cases employers offer paid carers leave, but many carers feel judged by managers or colleagues, and some have faced discrimination in the workplace.”

2.5 Understanding the trends

While it is difficult to generalise about the causes of the decline in working age mental health, most analyses attribute it to a combination of greater recognition of the challenges people face, and growing economic, social and cultural pressures. The changing nature of work is also a factor, for reasons ranging from increasing work demands and job intensity, to job insecurity and irregular working patterns.

The multiplicity of factors, and interaction between mental ill-health and other circumstances, makes the potential solutions necessarily far-reaching and long-term. Recent commissions and a government white paper (see Box 7) recommend three shifts that are necessary to address the challenges associated with health and work more broadly:

• Placing a greater emphasis on supporting people into employment, training or apprenticeships, and supporting employers to recruit, retain and develop staff.
• Moving to a system of health creation which includes a shift from work that harms health to work that creates it.
• Moving to a model of early intervention and proactive support to prevent people from having to leave the workforce in the first place.

Box 7: Get Britain Working White Paper

The White Paper, published in November 2024, sets out the UK Government’s plans to tackle rising levels of economic inactivity. This includes several commitments to improve employment outcomes, particularly for people experiencing mental ill-health:

• An additional 8,500 mental health professionals and 40,000 elective NHS appointments each week will aim to reduce waiting lists in areas with the highest levels of health-related economic inactivity.
• A series of place-based ‘trailblazers’ will test new joined-up local work, health and skills offers, with three ‘accelerators’ working with their local NHS Integrated Care Systems (see Box 8) to proactively identify and support people with mental health and other conditions.
• Access to expert employment advisers, as part of treatment and care pathways, will be expanded for mental health services in particular (see Box 11).

Part 3 of this report builds on the themes presented so far using data and insights generated through the Shout and MEL surveys, interviews with stakeholders and discussions with our Mental Health Voice Group.

3.1 Experiences of being out of work due to mental ill-health

Individuals who text Shout for support are invited to participate in an optional survey after their conversation. They are asked questions around their experience of the service and their demographics, such as their employment or education status. Between December 2024 and March 2025, texters who responded that they were unemployed were additionally asked about their perceived barriers to finding work and support needed to overcome these barriers. Texters who responded that they were employed, were asked whether they had ever been signed off work for their mental health, about workplace support for their mental health, and the factors that help them stay in their jobs.

More than 2,500 texters responded to these questions (around 800 unemployed texters, and more than 1,800 employed texters). A breakdown of respondents is shown in Table 1 below, categorised by age group, employment status and whether they were seeking work:

Table 1: Shout post-conversation survey respondents' employment status by age group

Texters aged 18-24 were less likely to be employed compared with other age groups, due to many respondents stating they are at university or college. Likewise, in the 55+ age group, many respondents told us that they are retired. Texters aged 18-24 who are unemployed are the most likely age group to be looking for work. Texters over 25 are more likely to be unemployed and not looking for work.

3.1.1 Reasons why people are not working

Unemployed texters who responded to the survey cited being signed off with mental illness (40%) as the main reason why they were not working. This was followed by having a disability (28%) and job-seeking difficulties (20% were looking for work, 17% were unable to find work). Physical illness (16%), parenting (7%), caring responsibilities (5%) and personal choice (3%) were also factors, with a small proportion noting they were on a gap year or career break (2%) (Figure 2). Reasons people gave under “Other” included dealing with grief, trauma, difficulties in finding a stable home and legal or immigration issues.

Figure 2 - Reasons why people are not working (Shout post-conversation survey, December 2024 - March 2025)

The data were subset to explore differences in reasons for not working, based on whether individuals reported being unemployed and seeking work, or unemployed and not looking for work. Those not looking for work were more likely to report health-related difficulties. Over half (55%) of this group were signed off sick with a mental illness, compared to 15% of those seeking work. Similarly, 23% were signed off due to a physical illness, compared to 4% of those seeking work. Disability was also more commonly reported among those not looking for work (37%) than among those actively seeking work (12%) (Figure 3).

Figure 3 - Incidence of mental illness, disability and physical illness of those looking for work and not looking for work (Shout post-conversation survey, December 2024 - March 2025)

A theme that emerged from our interviews with stakeholders was how people’s mental ill-health was linked to challenges with work, as well as their physical health or disability. For example, people may cite their mental health as the reason for not working, but the inability to find suitable work can also compound their mental ill-health. Similarly, a decline in someone’s physical health can be closely correlated with periods of low mood or depression, which can make exercise and social connections – known factors to support wellbeing – more difficult to keep up. As a result, potential solutions to mental health-related economic inactivity are necessarily holistic.

One example is the new series of place-based 'trailblazers' to create a joined-up work, health and skills offer, testing new interventions and learning what works, to help people not currently working. In three areas, work is being carried out with the local NHS Integrated Care System, developing whole person support. This will include developing targeted prevention programmes where people’s mental ill-health is related to their other health issues, such as musculo-skeletal or cardiovascular conditions (see Box 8).

Box 8: South Yorkshire Mayoral Combined Authority and Integrated Care System

Interview with Christine Joy, Chief People Officer at South Yorkshire Integrated Care System.

South Yorkshire was selected as one of eight mayoral combined authority trailblazer sites to reduce economic inactivity by 2,000 people in the year, with a particular focus on people who have been economically inactive for 2 years or less, young people and those with health conditions. It is also one of three health and growth accelerator sites, aiming to prevent around 1,000 people per year from falling out of employment. Work began on both programmes in April 2025, building on the foundations of the previous Pathways to Work commission in the region to reduce economic inactivity through system-wide change.

Around 35% of economic inactivity in South Yorkshire is due to poor health. The focus is on prioritising support for people experiencing mental ill-health, and musculo-skeletal conditions. Often people will experience both issues, alongside other conditions. Proactive identification of people will utilise data from the Department for Work and Pensions (such as benefits data) and from clinical searches (such as people meeting fit-note criteria).

South Yorkshire ICS are developing a range of interventions that will be personalised for every individual. They are planning to work with primary care networks that have particularly high rates of economic inactivity, testing and learning different approaches:

“We haven’t got this fantastically innovative intervention that we're going to deploy here. While we’ll be looking to use AI to help identify the right services for people and digital therapeutics… this is largely about using the resource we already have, stitching them together, focusing on the whole person, personalising it, and activating employers.”

3.1.2 Barriers to finding work

Individuals who responded to the Shout survey were also asked what they perceived to be the barriers to them finding work. Whilst 7% reported no barriers, 70% cited their mental health as their main barrier (Figure 4). While it may be expected that people contacting Shout would be experiencing problems with their mental health, it is worth noting that such a large majority of people underscore this as a barrier to finding work. Research into people’s lived experiences suggests that this may even be an underestimate, as individuals do not always fully appreciate the full extent of their health conditions, and how it affects their work.

The survey also found that 39% of respondents highlighted their lack of confidence as a barrier. Mental health issues such as anxiety and depression can lead to self-doubt, while repeated job-seeking rejections can lower self-esteem and make individuals hesitant to apply in the future:

“The fear of failure was the thing that was stopping them from choosing a qualification, or choosing a job. It was not that their mental health was so bad they weren't getting out of the bedroom. It was that, ‘because I have mental health and anxiety, I don't want to make a wrong move, and so I'm choosing nothing’.”
- Laura-Jane Rawlings MBE, Youth Employment UK.

Some can fear discrimination, or worry about handling workplace pressures, especially if they have been in toxic work environments before. Research has shown how past experiences of stigma, based on mental ill-health or disability, can discourage people from disclosing their health conditions at work, or seeking the help they need.

Disability (31%), physical illness (26%) and lack of skills/experience (21%) were also highlighted by survey respondents as three further barriers. Support systems, discrimination, caring responsibilities, and transport issues affect a smaller but notable portion, with practical barriers like job availability, fair wages, criminal records, technology or good English literacy impacting a minority.

Figure 4 - Barriers to finding work (Shout post-conversation survey, December 2024 - March 2025)

The story of a member of the Mental Health Voice Group, shared in Box 9, illustrates the very real ways in which these barriers impact people’s lives.

Box 9: Dominic's story

3.2 The journey to work

3.2.1 Preparing people for work

Several stakeholders highlighted the importance of providing proactive support and guidance to people to ensure they feel better prepared for work, and to build confidence and resilience once in a role. This work can begin by building relationships between employers and local schools and colleges, such as through work experience. Research shows that if a young person has met an employer three or four times while they’re in education, they’re 25% less likely to become NEET (Not in Employment, Education or Training) “because they’re building that confidence”. But only around a third of young people had work experience in the previous year (Interview with Laura-Jane Rawlings MBE).

Resilience refers to someone’s ability to withstand and recover from setbacks and other difficulties. Headstock – a music and mental health social enterprise (see Box 13) – delivers talks to young people studying music in college to help prepare them for what can be a challenging industry to work in:

"One of the challenges is [that] mental health has quite negative connotations… But actually, there’s a positive side to mental health as well, in the same way there’s a positive side to physical health… [so] what we can do is try and make people more resilient.”
- Atheer Al-Salim, Headstock.

The Burnt Chef Project – a community interest company supporting wellbeing in the hospitality sector (see Box 14) – has delivered training to more than 180 colleges around the world to try and create more meaningful, long-term change:

“The education we do might take 10 years to come into effect… because we understand that if they’ve got a good, strong, fundamental understanding of mental health, stress, how to identify culture and how to have healthy boundaries, then they bring that into the industry with them and start to create a new way of thinking and a new process.”
- Kris Hall, The Burnt Chef Project.

The Burnt Chef Project has partnered with one company to support an 18-month management apprenticeship, training 20 managers so far “to be emotionally intelligent, empathic leaders”, providing them with the skill sets that they need in order to be able to manage the business effectively and also help their team members. This is complemented by leadership and coaching support to their executive teams, and training to frontline teams in areas including resilience and how to have effective conversations about mental health and wellbeing. This has led to an increase in their staff retention rates, and supported the company’s efforts to expand.

Serco works in partnership with healthcare providers to support high quality healthcare services in prisons (see Box 10). This includes providing education, training and work experience to help ensure prisoners are ready for employment upon their release – “the key to reducing reoffending is getting people into meaningful employment” (Interview with Hayley Peek, Serco). In one prison, people with severe and enduring mental health issues create and sell paintings. Serco also provides education to improve reading ability, CV writing and interview skills, and supports prisoners to attend job fairs:

“I think the real link for me around that is the identification of something meaningful, and that's something that gives you purpose, which obviously has an impact on your mental health.”
- Hayley Peek, Serco.

Box 10: Supporting the prison population

Interview with Hayley Peek, Health and Social Care Director at Serco.

The most robust study of mental illness in the over-16 prison population showed that 90% had at least one mental health or related problem. A significant challenge for prisoners in managing their mental health is that, unlike in the general population, they cannot easily access the usual coping mechanisms, such as speaking to a friend. This is where Serco’s Shout service helps.

Serco embarked on a unique partnership with Shout to enable prisoners to have text conversations with Shout volunteers using Smart TVs in prison cells. Given many of the prison population are under-30, and Shout can be used silently, prisoners often prefer text conversations to phone calls – “prisoners will tell us, the walls have ears”. Shout enables prisoners to reach out for support sooner, helping those who were not on the prison’s radar for more serious mental health issues.

3.2.2 Supporting people to work

Our Shout post-conversation survey questions asked individuals for their views on the Government’s proposals to tackle unemployment, which include providing a coach or mentor to support someone to find work. 39% said they neither support nor oppose the proposals. This may suggest that people don’t feel strongly one way or the other, or they may not have enough information to form an opinion. Some members of the Mental Health Voice Group expressed interest in initiatives like work coaches, to both offer advice to people struggling at work, and to help signpost or navigate people through the health and care system.

In May 2024, the Government announced 15 WorkWell pilot schemes across England, to provide “a single, joined-up assessment and gateway into both employment support and health services locally”. This programme supports existing efforts to combine health and employment support, which includes employment advisers in NHS Talking Therapy services in England (see Box 11).

Box 11: NHS Employment Adviser Service

Interview with Kevin Jarman, Health Employment Services Project Advisor, Department for Work and Pensions/Department of Health and Social Care.

When people refer themselves, or are referred to, NHS Talking Therapy services in England, they have an option to access employment support as part of their therapy, if they feel their mental ill-health is related to work. Since its introduction in 2008, employment advice has been available in some NHS Talking Therapies services. Since 2017, an expansion programme has ensured that more than 1,000 employment advisers are embedded in all NHS Talking Therapy services across England. In 2024/25, more than 90,000 people received employment support through NHS Talking Therapies services.

Around three quarters of people who access support are currently in work, while one in five people with severe mental illness are in work. Employment advisers are trained to guide people through situations ranging from managing toxic working environments to retraining for new careers. Advisers work to support clients to put together manageable programmes of support (which may include CV writing and mock interviews) to help people build their confidence and resilience, and take a strengths-based approach to have a more positive outlook on their situation.

An evaluation of the service (2022) reported that more than two thirds (68%) of clients surveyed experienced a positive employment outcome between entry to the service and 12 months later. That is, they had either remained employed and in work (31%), moved into employment (16%) or returned to work after being on sick leave (21%). It is important to note that gross change is not necessarily attributable to the employment advisors; some changes may be attributable to the therapists, and some would have occurred without any intervention:

“We have been very successful in taking a group of people who saw themselves when they were assessed initially as unable to work, by the time they've completed their treatment and employment support are actively looking for work. Now that is the type of cultural change that is really important.”

Our Shout survey questions asked individuals that were currently out of work what other forms of support would help them to overcome barriers to finding work. The broad areas they mentioned were:

• Improved support for their mental health and wellbeing.
• Improved support for their physical health and disability (e.g. health and social care).
• Greater assistance in finding job opportunities.
• Developing job-related skills, and receiving guidance on applications and interview preparation.
• More accessibility in the workplace and the opportunity to work from home.

Some members of our Mental Health Voice Group called attention to this, suggesting that they would value some sort of agreement with a potential employer, in case they began to struggle with their mental health in their new role:

3.2.3 Opportunities for employers

Over the course of two meetings, we discussed with the Mental Health Voice Group the role that employers can play in supporting people to return to work following a period of mental ill-health. The output of these discussions is summarised in Figure 5 below. It includes practical suggestions that employers could implement, typically at little or no cost, to ensure that people are supported to apply for roles and have a positive and inclusive recruitment experience, regardless of the outcome. This can support employers to tap into a diverse, experienced and skilled cohort of often overlooked or under-served people that can make fantastic candidates, making a broader societal contribution in the process:

“How am I going to persuade the HR directors to think of themselves as part of the economic environment of the place in which they're an employer? How are they going to play that part? It's our anchor responsibilities, isn't it.”
- Christine Joy, South Yorkshire NHS Integrated Care System.

Figure 5 - Guide for employers, co-produced with the Mental Health Voice Group, April - May 2025

A range of other recommended workplace practices, and resources, complement the ideas set out above. These include:

• Working with key charities to identify suitable candidates from populations that may struggle with employability and recruitment processes. For example, Wagamama has worked with Key for Life and Only a Pavement Away for this purpose. Key for Life partners with business to give young offenders a path to employment, and Only a Pavement Away supports people facing homelessness into employment in hospitality.
• Values-based recruitment, to align candidates’ values with those of the organisation. It is an approach that gives more attention to the behaviours and beliefs of candidates, as well as skills gained through lived or other transferable skills, than solely formal qualifications and directly related work experience. While smaller organisations may not have explicit sets of values, the aim of this approach is to focus on people’s potential, not just their past performance. It has been applied to a range of sectors, such as adult social care, and can be particularly beneficial in industries struggling to recruit and retain staff.
• Wellness Action Plans, which are used to identify what keeps people well at work, what causes people to become unwell, and how mental health problems at work can be addressed. They are personalised, practical tools to be developed and used proactively through dialogue between an employee and their manager or supervisor. The experience of one member of the Mental Health Voice Group highlighted how, as with all such interventions, they need to be used consistently, and to be truly invested in by the employer and manager.
• Good Youth Employment standards, developed by Youth Employment UK. Organisations that commit to meeting the standards can access a range of resources on best practice in recruiting and retaining young people, and benchmark themselves against other organisations. The standards include topics such as induction and onboarding, inclusive opportunities and work environments, and pay and benefits:

“It’s about transparency. It's about offering as much information up front as possible… So if you're a young person and you're applying for a job, what does the process look like? What happens next? What are the criteria you're going to be [assessed] on… this stuff isn't hard or expensive, but it's about just taking the care to think about young people as an individual.”
- Laura-Jane Rawlings MBE, Youth Employment UK.

3.3 Creating healthy workplaces

3.3.1 Quality of work

Work is vital to supporting people’s wellbeing and mental health, but it is important to distinguish between good and low-quality work. As noted in the report of the Commission for Healthier Working Lives, the quality of work has, in some ways, improved in recent decades. This is evident, for example, in the rise in flexible working practices, which can support people with long-term conditions to remain in their role. However, such opportunities are not always possible for people working in frontline jobs. Increasing job insecurity and job intensity levels, and working practices such as zero-hours contracts (with no guaranteed working hours), have also created new challenges and pressures for people.

Our interviews with employers and industry partners highlight some common factors that contribute to mental ill-health at work. They include issues around very low pay, irregular and unsociable hours, and the inability to form meaningful connections (see Box 13), alongside high stress environments, poor culture and leadership, and inadequate support for newly appointed managers (see Box 14).

Our survey questions asked individuals that were currently in work, what supports them to stay in their job. The most common responses centred on financial compensation, flexibility and job security. These practical and stability-related factors were seen as more important than career development or mental health support:

“Some [organisations] have very good policies and procedures, like training staff to become Mental Health First Aiders. But what's also needed is, when someone is going through a mental health crisis at work, their salary or statutory sick pay should be ring-fenced, so it doesn't have a detrimental effect on them while they're off sick. So, if you're off sick, then you get your full pay, rather than half pay or no pay at all. It can be quite emotional and distressing when you come back to work knowing that you don't have any money, and you may not have enough savings to cover your expenses.”
- Lloyd, Mental Health Voice Group.

Other reasons given in our survey focused on flexibility at work, support from others and meaningful work, highlighting the growing importance of relationships, work-life balance and personal fulfilment at work.

3.3.2 Workplace mental health and wellbeing interventions

In response to our survey questions in MEL Research pro-bono omnibus, 78% of participants mentioned that their workplace offers some form of mental health and wellbeing support. 22% said that this wasn't available to them.

Specific workplace mental health interventions can play an important role in both attracting people to roles, and keeping them well once they start employment. These interventions can broadly be categorised into:

• Physical activity interventions, to improve wellbeing in the workplace e.g. yoga, exercise.
• Contemplative interventions, to change people’s cognitive processes e.g. meditation, mindfulness.
• Resilience training, to adjust how people respond to potentially stressful situations.
• Cognitive-behavioural therapy-based (CBT) interventions, to change people’s beliefs and assumptions to support changes in behaviour.
• Organisational interventions, to address the culture or ways of working of an organisation to reduce stressors on employees e.g. job redesign, flexible working.

Findings from a YouGov survey (2025) for the Commission for Healthier Working Lives showed that only around a third (35%) of employers rank workforce health among their top three business priorities. While half (51%) of employers reported expanding or introducing workforce health initiatives in the previous year, a significant portion felt their investments were not effective (for example, 31% in the case of health apps and technology). Research for the commission found that employers reported a lack of real-world examples and evidence on business outcomes to guide effective action on such initiatives.

Respondents to our survey questions in MEL Research pro-bono omnibus stated they never use workplace mental health support (33%) or say it isn’t available to them (22%). One in three respondents (32%) reported using it rarely or sometimes, and just 8% used it often (Figure 6). Where support wasn’t used, half of the respondents felt they did not need support and a mix of trust issues, practical barriers and doubts about their effectiveness were the key reasons for people not engaging with workplace mental health support further.

Figure 6 - Use of mental health and wellbeing support in the workplace (MEL Research pro-bono omnibus, March - April 2025)

Among those who access support at work, the most commonly cited reason (34%) was that it feels safe and confidential, followed by it helping people feel supported and understood (28%) and it being easy to access (25%) or easier to access than other support, like NHS care (25%).

When asked what type of support people would like their workplace to offer, the most common response was access to counselling or therapy (35%). 30% of respondents wanted to see workplace policies or initiatives, such as mental health days and trained mental health first aiders.

The evidence on the effectiveness of specific interventions is limited, with no clear conclusion that one type of intervention is more effective than another. We also heard in our interviews, and through feedback from our Mental Health Voice Group, that such interventions can feel “tokenistic”:

“I think there's a big difference between organisations who talk about mental health and put on different initiatives for their employees, but it's almost a tick-box exercise… versus organisations who are truly invested in the mental wellbeing of their staff.”
- Atheer Al-Salim, Headstock

“You can put these strategies in place and spend money on them, but there has to be a clear intent of further progression and further support… People are doing it for the right reasons, but there has to be an understanding that it’s a marathon, not a sprint, and more effort needs to be spent on preparing those individuals and supporting them…There’s an element of tick-boxing.”
- Kris Hall, The Burnt Chef Project

We heard from several people about the benefits of peer support groups and networks. Peer support involves people with similar experiences providing mutual support to each other. It can take many forms, such as online forums, support groups or one-to-one support, but research has shown that all forms can be effective in improving people’s wellbeing. For example, Headstock set up Behind The Scenes, in partnership with the charity Music Support, to enable people in the music industry to connect and share similar experiences, when they wouldn’t ordinarily have the opportunity to do so:

“The reason why we set the peer support group up is it offers a safe place to connect, to share experiences, to offer mutual support, but also to realise that… there's a lot of people going through similar challenges, so you don't have to face the challenges on your own.”
- Atheer Al-Salim, Headstock

The Burnt Chef Project has also established a peer support network, which now consists of more than 250 volunteers globally. It is a “community of like-minded individuals” who, with some support and education, can “improve their ability to safeguard themselves and handle difficult conversations”.

Employee Assistance Programmes (EAP) illustrate how the effectiveness of workplace wellbeing interventions can be determined by the intent of those providing them. EAPs are a confidential service providing employees with support and resources – such as counselling – to address issues affecting their wellbeing. We heard that EAPs can be offered by employers as a perk, with little further investment of time or energy to support people to use it. Average engagement with EAPs is typically less than 1% of employees, but through ongoing support and signposting, organisations working with the Burnt Chef Project have seen employee engagement rates of between 12-35%.

One of these organisations is Wagamama, which has ensured their general managers are aware of the support available and encourage their use. This includes EAP services as well as Shout, who Wagamama has partnered with since February 2024. All staff are encouraged to save the Shout number (85258) to their phones in case they (or someone they know) need it. Wagamama’s focus on employee wellbeing has led to increased employee satisfaction and retention, with clear benefits to the organisation’s finances as a whole (see Box 12).

Box 12: Wagamama wants people to love coming to work

Interview with John Conyers, Kaizen Culture Lead, Wagamama

Wagamama is proud of their commitment to, and reputation for, prioritising team wellbeing. The organisation makes five commitments to their staff as part of their “people promise”:

1. “All on one bench”: to make people feel part of one team.
2. “Celebrate difference”: to allow people to be themselves at work.
3. “Walk the walk”: to have real conversations, where staff’s thoughts are welcomed and encouraged.
4. “Nourish and flourish”: to invest in staff wellbeing.
5. “Supportive of your side hustle(s)”: to provide flexibility for activities outside of work.

Wishing to go above and beyond the standard workplace support for its staff, including its EAP, Wagamama partnered with Shout in February 2024:

“We launched our partnership with Shout in February 2024, and they were really the perfect charity for us. A lot of our team are between the ages of 16 and 25, many struggle to pick up the phone to ring in. If they are unwell to come in for a shift they would prefer to text. For us, Shout really aligns with our team and our values.”

The organisation has worked hard to build a culture of “real conversations”, where managers are encouraged to make time for team members, listen to their concerns and, if needed, point them to support either through the EAP or Shout. While the EAP offers formal help (e.g. up to six counselling sessions with a trained psychotherapist), there is an additional layer of anonymity that makes Shout attractive to staff. The organisation makes a point of not tracking Shout usage by its staff to ensure this anonymity is absolute.

As part of Wagamama’s partnership with Shout, the organisation encourages members of staff to become Shout Volunteers. While this is a way for staff to give back to the community, it also means the team bring their mental health training back into the organisation.

Wagamama has also encouraged the training of 160 Mental Health First Aiders (MHFAs) across the business. They consult with the MHFAs to understand what trends they are seeing, and how they are using their skills. This culture of continuous improvement has led to the establishment of an anonymous reporting system (“safe sanctuary”), which allows staff to report issues online. These reports are picked up by their People Services Team, which are available seven days a week.

The focus on staff wellbeing has had a significant impact on the business. Since launching their “people promise” in February 2023, staff satisfaction survey results have improved, there has been a reduction in staff sick days, and staff turnover has halved.

3.3.3. Psychological support at work

One member of the Mental Health Voice Group raised the issue of lack of adequate support for people in work who had experienced trauma. In their work in the health and care sector, they experienced things that would trigger them, but were unable to access the support they needed. Another group member described the challenges they experienced volunteering in the NHS:

At Serco, they recognised the difficult environments their staff were working in, often working with prisoners with mental-ill health or behaviours of concern, so they decided to “level up our staff and prisoner offer”. They supported staff to access Shout, but also commissioned an online counselling service, and developed some therapy services - “it's like trying to look at a range of things, because not everyone's the same.” They also became one of the first organisations in the world to be certified for the International Standard 45003 (ISO 45003).

The Health and Safety at Work Act (1974) first established what is required in a workplace to keep people physically safe and prevent health issues. However, ISO 45003 builds on this, to set out how organisations can maintain psychological health and safety at work. Although ISO 45003 certification is not mandatory, some countries have gone further to establish a code of practice.

“…the analogy I've got is that if you turned up to work in a kitchen, and there was heat coming from around the corner, and you realised the kitchen was completely on fire. You wouldn't walk in because you knew you would get burned. Yet those flames aren't there from a physical level. They're there from a psychological level, and yet we walk into those flames every single day. So, I think it's getting people to understand that just because it can't be seen doesn't mean it can't be measured and attacked.”
- Kris Hall, The Burnt Chef Project.

Declining mental health is preventing an ever-increasing number of people from entering, remaining in, or returning to the workforce. Fresh insights from our surveys, stakeholder interviews, and Mental Health Voice Group highlight that many people who have experienced mental ill-health want to work, but feel daunted by the prospect, either from a loss of self-esteem or from being harmed by poor workplace practices in the past. This challenge is particularly evident amongst young people, underlining the urgency of the issue.

To help address this commonly-overlooked challenge, we co-produced a guide for employers with our Mental Health Voice Group. It sets out a range of positive, practical steps that employers can take to help people into employment following a period of mental ill-health. While these steps are typically low or no-cost, they require a genuine investment of time and intent in supporting people’s mental health and wellbeing. We encourage employers to explore these opportunities, as a means of tapping into an often overlooked and under-served group of talented individuals, who would make excellent candidates across a range of job roles and industries.

Alongside our guide for employers, we set out the opportunities for further work and development that arose from our research. We look forward to collaborating with partners from across these stakeholder groups to realise the potential of these ideas:

• Employers can create more inclusive and supportive recruitment, onboarding and workplace practices that target people who have been off work due to mental ill-health (see our employer example).
• Industries should consider how they can better prepare and support people entering high-stress industries through educational, training and coaching programmes (see our industry examples).
• Innovators should consider how technology-based integrated health and work support tools could complement existing services, to help people to stay in work, or return to work.
• Researchers and evaluators should consider partnering with employers to build evidence on the effectiveness of mental health interventions in the workplace.

Limitations of this report

Our research could not cover topics and issues relevant to all groups. This includes, for example, people whose work does not give them access to workplace support, or small businesses who are not yet in a position to invest in workplace initiatives. Our research also did not explore the factors faced by many under-served groups, such as those experiencing homelessness or where English is not their first language. As noted previously, one limitation of our survey is that, by its nature, it is over-representative of people experiencing, or who have experienced, mental ill-health.

Acknowledgements

This report was jointly produced by Imperial College London’s Institute of Global Health Innovation and Mental Health Innovations. It was funded by Mental Health Innovations, in part through a grant from the Jensen and Lori Huang Foundation.

The authors would like to thank the experts who kindly shared their views to inform this work: John Conyers, Atheer Al-Salim, Christine Joy, Hayley Peek, Kevin Jarman, Kevin Ryan , Kris Hall, Laura-Jane Rawlings MBE, Lloyd Curtis, Mary Mancini, Melanie Crew, Nat Farley, Somana Malik and all the members of our Mental Health Voice Group, who shared their stories and provided invaluable insight into the guide for employers and the report’s recommendations.

Thank you to the team within Mental Health Innovations, who provided guidance and support throughout this process: Emily Beattie, Amy Cowley, Grace Liley, Rosie Martin and Caroline Westley.

Thank you to the team within Imperial College London who reviewed and supported the production of the report: Georgia Butterworth, Jodie Chan, Esmee Huguenin, Waheeda Zafar, Robyn Lowe, Valentina Massimi, Steve McAteer, Kieran Miller, Victoria Murphy, Wiktoria Tunska and Erin Walker.

Suggested citation

Illingworth J, Jarvis J, Lawrence-Jones A, Leis M, Lawrance E, Howitt P, Ungless M, Bolton C, Darzi A. Working well: Improving mental health in the workplace. Imperial College London (2025).