Managing Presenteeism Related to Mental Health

Managing Presenteeism Related to Mental Health

Organizations with low rates of absenteeism may think that their employees are healthy, but these numbers do not reflect the number of employees who continue to work while unwell. Presenteeism (continuing to work while unwell) is a much harder measurement to track than absenteeism yet is showing to be far more costly as mental health concerns rise. According to Statistics Canada, 8.7% of employed Canadians had a mental heath-related disability in 2021, up 2.3 percentage points from 2019.

As the link between mental health and presenteeism becomes apparent, it becomes more and more costly for organizations to overlook the mental well being of their employees. To keep employees not only at work, but highly engaged at work, employers will have to continue to invest in mental health supports that help employees manage the psychological demands and stress of their jobs.

What Does Presenteeism Look Like?

Presenteeism occurs when employees are on the job but not performing at full capacity. The term does not refer to employees slacking off or pretending to be sick to avoid working but includes employees who may struggle to stay productive due to physical or mental health conditions.

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. 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. The type of presenteeism will determine the different strategies the employer needs to take.

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

  • Declining productivity
  • Disinterest in results or project goals
  • A declining standard of work
  • 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. (Lyra Health, 2019)

Mental Health Impacts on Cognition and Productivity

Mental health conditions are often associated with cognitive deficits that can affect an employee’s ability to work. 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.

Research shows that employees with mental health disorders, particularly depression, are more likely to struggle with time management, mental functioning, and interpersonal communication and have lower work output than those without mental disorders (Journal of Occupational and Environmental Medicine, 2004). They are reportedly seven times more likely to experience “decreased effectiveness” at work (National Library of Medicine, 2001).

In addition to loss of productivity and engagement, there are other indirect costs of presenteeism including lower employee satisfaction and morale, which further impact absenteeism, disability, and turnover.

Presenteeism and the Mental Health Continuum

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 in our toolbox to manage stress and reach out for help when we need it.

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. 

Workplace Factors that Impact Presenteeism

Organizational policies, personal factors, and occupation are all factors that impact presenteeism. Workplaces with higher workloads, long working hours, short staffing, and stigma around sick leave are more likely to have presenteeism (Occupational Medicine, 2020). Those working in helping professions, such as nurses and first responders, commonly experience additional pressures to work while ill because of their sense of duty and responsibility. Other factors such as financial insecurity, job insecurity, guilt about overburdening coworkers, and working from home, have become even more apparent over the course of the pandemic.

With the rise of remote work, we also now have “digital presenteeism” (Lyra Health, 2019). Employees working remotely may find it difficult to draw the line between home and work with technology allowing them to be accessible 24/7. Working longer hours without definitive expectations around availability can contribute to mental health issues and burnout and make it difficult to work effectively.

How to Manage Stay at Work and Presenteeism

  1. Develop a strong psychological health and safety program. Ensure that employees have what they need to complete their jobs, raise concerns, and have clear and fair expectations.
  2. Train supervisors. Help staff learn how to identify and address early signs of stress and train them in coaching techniques to facilitate critical well-being conversations with staff, whether working from home or externally.
  3. Provide improved individualized resources for employees. Provide employees with training on stress management, resiliency, and burnout. Find training resources at
  4. Review your benefits programs. Expand your offerings into include more mental health professionals and Occupational Therapists and consider offering access to services during the workday.
  5. Provide mental health walk-in clinics. Have access to an Occupational Therapist either virtually or in person for proactive work-focused strategies. Book a consultation to learn more.
  6. Provide strategies to work from home. Providing guidance on how to do so in a healthy and sustainable way is urgently required, with particular focus on boundary-setting and withdrawing from work communications when not working or off with illness.
  7. Implement flexible working strategies. Enable staff to have more choice and control over their working patterns and encourage employees to get the job done no matter the time or place.
  8. 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, precise and that you have educated employees on their responsibilities for accommodation requests.
  9. Access resources.  An Occupational Therapist is a regulated health professional with the ability to understand the health condition, workplace demands in the context of the work environment and determine tools and strategies to support function on the job. They 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.

Works Cited

“The Association of Medical Conditions and Presenteeism,” Wayne Burton et. al, Journal of Occupational and Environmental Medicine, Volume 46, Number 6, June 2004,

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.

“Mental health-related disability rises among employed Canadians during pandemic, 2021,” Statistics Canada, March 4, 2022,

“Presenteeism: The Hidden Productivity Killer in Your Workplace,” Lyra Health, December 12, 2019, T Ishimaru, Y Mine, Y Fujino, Two definitions of presenteeism: sickness presenteeism and impaired work function, Occupational Medicine, Volume 70, Issue 2, March 2020, Pages 95–100,

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