The Hidden Costs of Presenteeism and Poor Mental Health in the Workplace

Presenteeism, where employees work while unwell, is a hidden yet increasingly costly issue. When employees do not prioritize their health, it can result in lost productivity and reduced work quality, even if the employee is physically present at work. Studies show that the costs of presenteeism are substantially higher than the costs of absenteeism. A report by the Global Corporate Challenge found that while employees were absent from work an average of four days a year, they admitted to being unproductive for more than 57 days a year.¹

Mental health issues rank in the top three most common symptoms employees experience while engaging in presenteeism, next to cold/flu symptoms and sleep problems.² In a survey by The Conference Board of Canada, almost 60 percent of employers indicated that stress, anxiety, and/or depression or other mental health issues were the primary cause for employee absences, yet only 12 percent of employees indicated that they had taken time off for this reason. When mental health concerns are not addressed, they can lead to more negative outcomes, including burnout, diminished functional ability, and aggravation of health conditions.

To keep employees not only at work, but highly engaged at work, employers should continue to invest in mental health supports and create organizational policies that allow employees to manage their health more effectively.

What Does Presenteeism Look Like?

Presenteeism occurs when employees are on the job but not performing at full capacity. There are two types of presenteeism that organizations may be experiencing. The first is sickness presenteeism, which is when employees continue to work while unwell (e.g., coming to work with a cold or flu or returning to work too early after surgery). The second is impaired work function presenteeism, which is when employees have difficulty performing tasks due to functional challenges that require accommodations in the workplace (e.g., the employee has a physical or mental disability).³

Recent research has also distinguished between “functional presence” and “presenteeism.”⁴ Functional presence refers to working while unwell that may benefit the employee and organization. This may include employees who are almost at full capacity, want to work, and can continue to recover while completing at least some of their job duties. It can also include employees who are performing well below maximum productivity but gain some sort of benefit by being at work, such as returning to work with modified hours and duties after illness.

Treating actual presenteeism involves different strategies. For someone with sickness, medications, medical intervention, or adhering to sickness policies would be the intervention. For someone with impaired work function, an Occupational Therapy accommodation assessment would be the best intervention.

Presenteeism may be harder to spot that absenteeism, but here are some potential signs⁵:

• Declining productivity and standard of work
• Disinterest in results or project goals
• Turning work in late or not at all
• Lack of engagement with colleagues and managers, including being more isolated and not engaging in online or in-person communication
• Working long hours or weekends to catch up
• Making more mistakes than usual
• Irritability and frustration
• Displaying signs of burnout, such as loss of motivation, detachment, self-doubt, or a decreased sense of accomplishment

Mental Health and Productivity

Unaddressed mental health conditions can make a huge impact on an employee’s productivity levels. Research shows that employees with mental health disorders are seven times more likely to experience “decreased effectiveness” at work.⁶ Mental health conditions are often associated with cognitive deficits that can affect an employee’s productivity. Some affected areas of function can include selective and sustained attention, memory and recall of information, critical thinking, analysis, and categorization, organization of information, problem solving, and psycho-motor speed. As a result, employees with mental disorders are more likely to struggle with time management, mental functioning, and interpersonal communication and have lower work output than those without mental disorders.⁷

Even those without a diagnosed mental health condition can experience presenteeism – life and work stressors can impact how we move along the mental health continuum, as can the strategies we have to manage stress and reach out for help. On one end of the continuum are healthy employees who might move into a reaction stage when they begin to experience stress. These employees may become irritated or distracted and might procrastinate or present low energy. If stress continues to build, employees may move into an injured state where they display negative attitudes and have poor performance and concentration. Employees whose mental health is not addressed can become mentally ill; at this point, they can no longer perform their duties, control their behaviour, or concentrate at work.

Workplace Factors that Impact Presenteeism

Employees surveyed by The Conference Board of Canada reported that over the last 12 months, the most influential reasons in their decision to work despite feeling mentally or physically unwell were organizational policies about time off, personal feelings of guilt, not feeling “sick enough,” and staff shortages.¹

Organizational policies and practices have a significant impact on whether employees feel comfortable taking time off to improve their wellness. When employees perceive limitations within their workplace policies and practices, they are more likely to show up at work when they feel unwell, rather than taking time off. Strict absence policies, low levels of paid sick leave, and a lack of absence days available without medical certification are all associated with higher levels of presenteeism.¹

Stigma around mental health and fears of consequences in the workplace also play a contributing factor. In a survey of Canadian employees, 63% reported that their decision to work while feeling mentally unwell was influenced by their assumption that feeling mentally unwell wasn’t a good enough reason to take time off. ¹ Feelings of guilt about overburdening coworkers or fears about financial insecurity may also push employees to work when they should be recovering. A poll by the American Psychiatric Association in 2019 revealed that over one-third of workers were concerned about retaliation or job loss if they sought mental healthcare.⁸

Workplaces characterized by high workloads and long working hours are more likely to witness presenteeism. The pressure to meet demanding workloads, coupled with the expectation of long hours, can lead employees to continue working despite being unwell. Burnout, often linked to presenteeism, has been on the rise, particularly since the pandemic. The Conference Board of Canada’s survey revealed that fully on-site employees have higher presenteeism for mental health reasons than do remote workers.¹ Other workplace factors that have been reported to impact presenteeism include disengagement, a lack of role clarity, a lack of autonomy, workplace culture, poor leadership, physical health issues, and work–life balance challenges.¹

How to Manage Stay at Work and Presenteeism

Here are some strategies to help address impaired work function presenteeism:

1. Develop a strong psychological health and safety program. Ensure that employees have what they need to manage their workloads, raise concerns, have clear and fair job expectations, and have a supportive environment where they feel comfortable discussing their wellbeing.
2. Create a culture that discourages presenteeism. Discourage employees from working while ill. Foster a culture that values mental and physical well-being over long, rigid work hours. Consider polices that allow for flexible working to enable staff to have more control over their working patterns while caring for their health.
3. Train supervisors. Managers play a crucial role in identifying early signs of stress and health conditions among their teams. Providing training to supervisors on recognizing these signs and coaching them in facilitating well-being conversations with staff can be instrumental in early intervention. Leaders should learn how to have inclusive conversations about accommodations when employees are struggling and be able to notice signs that presenteeism is in play.
4. Provide individualized resources and strategies for employees. Provide training for employees on stress management, resiliency, and burnout. For employees working from home, provide guidance on boundary-setting and withdrawing from work communications when not working or off with illness.
5. Review your benefits. Expand your offerings into include more mental health professionals and consider offering access to mental health services during the workday. Offer workers generous employee benefits so they don’t need to worry about lost wages.
6. Review your accommodation processes and programs. Provide the tools, strategies, environment, and work processes to allow employees to meet the outcomes of their job. Make sure that your accommodation procedures are clear and that you have educated employees on their responsibilities for accommodation.
7. Access resources.  Engage an Occupational Therapist to support objective assessment of the worker, work, and work environment to find sustainable strategies for accommodation or return to work planning. An Occupational Therapist can complete workplace accommodation assessments, provide mental health coaching, perform cognitive demands analyses, and more. Contact us to learn more or make a referral today.

Resources

[1] Smith, S. (2017, March 29). Presenteeism costs business 10 times more than absenteeism. EHS Today. https://www.ehstoday.com/safety-leadership/article/21918281/presenteeism-costs-business-10-times-more-than-absenteeism 

[2] The Conference Board of Canada. Why Employees Choose Work Over Wellness. (2023, August 9). https://www.conferenceboard.ca/wp-content/uploads/2022/10/why-employees-choose-work-over-wellness_2023.pdf 

[3] Ishimaru, T, Y Mine, and Y Fujino. "Two definitions of presenteeism: sickness presenteeism and impaired work function," Occupational Medicine, Volume 70, Issue 2, March 2020, Pages 95–100, https://doi.org/10.1093/occmed/kqaa009

[4] The HR Director. Current perceptions of presenteeism in the workplace are fundamentally flawed. (2023, November 5). https://www.thehrdirector.com/business-news/hr_in_business/current-perceptions-presenteeism-workplace-fundamentally-flawed/ 

[5] Lyra Health. Presenteeism: The Hidden Productivity Killer in Your Workplace. (2019, December 12). https://www.lyrahealth.com/blog/what-is-presenteeism/ 

[6] National Library of Medicine. Druss BG, Marcus SC, Olfson M, Tanielian T, Elinson L, Pincus HA. Comparing the national economic burden of five chronic conditions. Health Aff (Millwood). 2001 Nov-Dec;20(6):233-41. doi: 10.1377/hlthaff.20.6.233. PMID: 11816664. https://pubmed.ncbi.nlm.nih.gov/11816664/

[7] Burton, Wayne et al. “The Association of Medical Conditions and Presenteeism,” Journal of Occupational and Environmental Medicine, Volume 46, Number 6, June 2004, https://psyflex.com.au/wp-content/uploads/2015/12/medical_conditions_and_presenteeism.pdf

[8] American Psychiatric Association. About Half of Workers Are Concerned about Discussing Mental Health Issues in the Workplace; A Third Worry about Consequences if They Seek Help. (2019, May 19). https://www.psychiatry.org/news-room/news-releases/about-half-of-workers-are-concerned-about-discussi