You can't outsource workplace mental health

Workplace mental health was never meant to rest on one individual's shoulders, nor to become solely the NHS's responsibility.

For years, the go-to solutions have been familiar: recommend a GP visit, or send the person on a resilience course. There is value in both, but neither forms a system. What is needed is a shared undertaking, as the government's Keep Britain Working review now makes clear.

What the Keep Britain Working review found

Delivered by Sir Charlie Mayfield, the former chairman of the John Lewis Partnership, in November 2025, and most recently updated on 3 July 2026, the Keep Britain Working review spells out the challenge plainly. There are now 2.8 million people economically inactive due to health conditions - 800,000 more than in 2019, with projections showing another 600,000 by 2030 without action.

These numbers carry real costs. Employers lose £120 per day per sick employee, face recruitment costs exceeding £11,000 per replacement, and are experiencing sickness absence at a 15-year high - costing them £85 billion annually. The state faces costs of £212 billion per year - equivalent to 7% of GDP or nearly 70% of all income tax collected - through lost output, additional welfare payments and increased NHS burden. For individuals, the cost can be staggering: a 22-year-old leaving work due to ill health can lose over £1 million in lifetime earnings.

In the sectors I work with - finance, law and infrastructure - sustained, high-stakes cognitive performance is the job. Health there rarely fails overnight. It is the steady wear and tear that goes unnoticed until, by the time it becomes a fit note, most of the chances to intervene have already passed.

The shift the review is asking for

The most important takeaway in the review is not a statistic but a change in mindset: a fundamental shift from a model where health at work is largely left to the individual and the NHS, to one where it becomes a shared responsibility between employers, employees and health services. It names both of the places we have been outsourcing the problem to.

Leaving it to the NHS means waiting until someone is unwell enough to see a doctor, and then handing them a piece of paper. The review notes that 93% of fit notes are marked "not fit for work", isolating employees and excluding employers. As Health and Social Care Secretary James Murray has said, a piece of paper that so often closes doors is no substitute for a plan that opens them.

Leaving it to the individual means placing the burden solely on personal capacity - build your resilience, take the course, book the EAP session. These things matter, but on their own they relocate the problem inside the person and leave the demands, the environment and the management that produced the strain untouched.

Employers, Sir Charlie Mayfield says, need to be "on the pitch". They are uniquely placed to do prevention: to pick up early signs, have candid conversations and adjust the conditions of work itself. The NHS remains a vital partner, especially for assessment and treatment, but it cannot be the front line for challenges that start within teams, workloads and a manager's inbox.

Why this is a behavioural problem before it is a clinical one

Among the review's three root causes is a culture of fear, felt by employees and, differently, by employers, especially line managers. It creates distance between people and discourages safe and early disclosure just when support is needed most.

That is a behavioural finding, not a medical one. An employee who is struggling calculates the cost of saying so. A line manager calculates the cost of asking - the fear of saying the wrong thing, or of opening a conversation they do not feel equipped to finish. Both stay silent, the strain compounds, and the first formal signal the organisation receives is an absence.

This is exactly where the Accountability and Performance pillars of The People Code sit. Accountability is about clarity of ownership, not blame. Across many organisations, the early stage of a mental health problem is effectively owned by no one. HR owns the policy, occupational health owns the referral, the GP owns the fit note, the individual owns their resilience - and the line manager, the person with the most day-to-day visibility, often owns nothing but the anxiety of getting it wrong.

Likewise, performance is more than output. Sustainable performance depends on workload that matches capacity, relationships that allow honesty, and leaders able to hold a difficult conversation without flinching. Treat those as optional extras and you will keep paying for them in absence, attrition and replacement costs.

Better data, and what it will expose

The July update confirms a new Workplace Health Intelligence Unit, which will collect standardised data from employers and providers across the UK. The government's own assessment is that sickness absence is tracked inconsistently and return-to-work outcomes are rarely measured. The Unit is intended to enable benchmarking and give government a stronger evidence base - evidence the review has signalled will inform how incentives are aligned in future.

What gets measured gets compared. Organisations that have treated workplace mental health as a wellbeing budget line should expect it to be treated increasingly as a performance outcome. With more than 250 employers, providers and organisations now working with the programme, alongside 10 mayoral authorities and all 3 devolved administrations, the direction is unmistakable.

What shared responsibility actually looks like

Shared responsibility is easier to agree with than to put into practice. In practical terms it means consistent, sometimes unglamorous actions: line managers trained and trusted to start early conversations rather than only to escalate, stay-in-work plans agreed before someone goes off rather than reconstructed after they return, outcomes measured rather than policies counted, and employees engaging as partners, because shared responsibility runs in every direction.

None of this replaces the role of the NHS, nor does it lessen personal agency. It simply stops asking either of them to carry a load that was never theirs alone.

Mental health at work is not a personal failing to be fixed or a clinical problem to be referred. It is a shared outcome of how work is organised.

This echoes the central argument of Rebuilding the Village: wellbeing depends less on individual psychology in isolation than on the adults, relationships and systems around a person - the structures that notice early and respond well. Workplaces are one of those villages. The Keep Britain Working review is, in effect, asking employers to start acting like one.

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