A healthy approach to mental health at work can be the difference between anticipating problems before they begin and letting them spiral out of control. But there are some problems that are harder to detect than others – especially in smaller businesses. In the UK, one of the most persistent is presenteeism.
A pattern of behaviour so commonplace it often goes unnoticed, presenteeism describes what happens when people show up to work despite being physically unwell, mentally struggling, or both. It can look like the employee who sits through every meeting while mentally exhausted, the manager who replies to emails at midnight rather than admit they need a break, or the team member who logs on while sick because taking the day off feels worse than pushing through. But as commonplace as these coping mechanisms seem, they come with a cost.
According to the CIPD, a quarter of UK workers say their job is actively harming their mental health. Most of them are still showing up. Employment Hero’s research found that 28% of UK workers have used sick days for mental and emotional recovery rather than physical illness. But the harder, less visible problem belongs to those who never take a day off at all.
The Damage Presenteeism Does
Mental health issues like anxiety, depression and chronic stress do not disappear when someone arrives at work. “They impair concentration, memory and decision-making, making it harder for people to focus, prioritise and maintain confidence in their work,” says Dr Felicity Baker, Clinical Psychologist and Co-Founder of Ultimate Resilience, a consultancy that provides evidence-based psychological support, resilience training and supervision to help HR professionals and organisations build healthier, more resilient workplaces.
She points out that, left unaddressed, mental health struggles can push people into exactly the kind of behaviour that makes things worse: “Many become highly self-critical and worry they are letting colleagues down or appearing incapable, which can make taking time off feel risky or even like a personal failure,” she says.
“Instead, they try to compensate by working longer hours, overchecking work or pushing through exhaustion. This creates a vicious cycle where working harder increases stress and cognitive overload, further affecting performance and recovery.”
From the outside, Felicity adds, “it can easily be mistaken for disengagement or underperformance rather than a mental health issue”.
When Illness Gets Mistaken for Underperformance
That inability to detect what’s happening beneath the surface is where presenteeism becomes most damaging.
“Presenteeism is easy to misread because the employee is physically present and may still be meeting some expectations,” Felicity says. “Managers tend to notice missed deadlines, irritability, slower output or reduced initiative before they notice distress. Without psychological safety and good line-management training, the default interpretation can become ‘capability issue’ rather than ‘health signal’.”
The consequences of that misidentification go beyond a missed opportunity for support. A struggling employee who is managed as though they’re underperforming won’t improve. Instead, they’ll face even more pressure at exactly the moment they need less of it.
Why Presenteeism Hits Smaller Businesses Hardest
“In small businesses, people are more visible but not always properly supported,” Felicity points out.
“There may be no HR function, no occupational health route, no formal wellbeing data and fewer staff to absorb workload. That closeness can make presenteeism seem like the best or only way of coping, particularly when everyone else is normalising pushing through.”
Gill Wetherill, Founder of Full Circle HR, which provides strategic and operational HR support to small and growing businesses, recognises these patterns.
“People can be so far stretched,” she tells Employment Hero. “Especially in start-up businesses, people can be doing a number of different roles, carrying a number of hats.”
That strain can be even more pronounced for those in leadership positions, which can have a trickle down effect in terms of inadvertently ushering in an unhealthy workplace culture.
The Signals Most Managers Miss
As easy as it is to fly under the radar, there are some useful ways to spot presenteeism before it snowballs – especially when a person’s usual behaviour shifts. “Taking longer to complete familiar tasks, making more mistakes, withdrawing from informal conversations, working excessive hours, reduced creativity, indecision, emotional flatness, over-apologising, or consistently saying they are fine – these are all indicators,” says Felicity.
“One of the most overlooked signs is when a high performer continues to meet expectations, but only through sustained and ultimately unsustainable effort,” she adds. “In these cases, the wellbeing problem emerges long before the performance problem, meaning managers often miss the warning signs unless they pay attention to the extra hours, emotional effort and overcompensation happening behind the scenes.”
Gill, meanwhile, argues that context matters as much as observation. “Recognising that people all have different things going on outside of work – for some staff, they might have started their day at five o’clock in the morning, got three children ready for school, checked in on an elderly parent before arriving in the office. And they could be absolutely shattered by the time they get there.”
The signal that matters, she says, is a shift from someone’s usual demeanour. “If somebody’s gone a little bit quieter than normal, it allows you to ask some questions – not just ‘how are you’, but: ‘I noticed you were quite quiet in that meeting. Is everything all right? What’s going on for you right now?’”
When No One Checks In on the Person in Charge
Leaders aren’t immune to presenteeism, but unlike their employees, there’s often nobody above them paying attention to shifts in their behaviour, or unhealthy coping mechanisms.
Gill was once in that predicament. After months of working 16-17 hours a day in a scaling organisation, she wasn’t aware of the signs of burnout until she’d reached her limit.
“What really took me by surprise was when it started affecting me physically. Looking back, I wished that someone had made me take time off, because I recognise now that that would have been the only way I would have stopped pushing on.”
High performers, Felicity notes, are at greater risk precisely because their strengths obscure the problem. “Their drive, reliability and emotional investment in work can lead them to take on excessive and unsustainable workloads.” Organisations also tend to reward competence with more responsibility – what Felicity calls “performance punishment.” Many high performers “break quietly,” she says, meaning they’re less likely to admit they’re struggling, more likely to internalise stress and work hard to maintain a calm, dependable image even when depleted.
The Ripple Effects You Might Miss
The risk that presenteeism goes undetected runs deepest when the people responsible for spotting it in others are struggling with it themselves. Felicity’s research at Ultimate Resilience, drawn from more than 3,000 HR professionals over three years, consistently finds that around three quarters of those HR professionals report symptoms of anxiety and depression. Only 13% say they feel well supported at work.
“When the people responsible for holding others together are struggling themselves, the organisation loses an early-warning system,” Felicity says. “If they are depleted, problems are more likely to escalate, decisions become more reactive, and the culture quietly teaches everyone that suffering in silence is part of the job.”
While mental health awareness has improved in recent years, practice, as Felicity notes, “has not always caught up.” Though there are numerous challenges that can make it hard to remedy these issues, there is a clearer path towards creating the sort of healthy work environments that businesses – and their employees alike – thrive on. That means paying attention to the people who never ask for help.
