Presenteeism: The most expensive mental health issue—10 warning signs

Imagine an office of zombies. Everyone is technically there, but their brains are offline, their bodies just going through the motions. This might be a silly image, but it’s also an accurate visualization of presenteeism – the profoundly destructive force in our offices.

The iceberg on your company’s horizon

A recent Deloitte study found that presenteeism is the largest contributor to employers’ mental health-related costs, amounting to a total of £24-28 billion in 2021 in the UK alone. In this article we explain what presenteeism is, why it’s so costly for organizations and what signs to watch for in your employees.

Mental health-related presenteeism costs roughly four-and-a-half times more than mental health-related absenteeism and three times more than ordinary sick leave. 

What is presenteeism?

Simply put, presenteeism is when employees go to work while feeling unwell and don’t perform at full capacity.

While an employee going into the office with a nasty bug is a very visible form of presenteeism, other forms of presenteeism are more subtle—and potentially much more harmful—with research showing a strong link between presenteeism and mental health disorders, in particular depression.

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Having a mental health condition or battling stress can bring up feelings of shame and vulnerability that make people less inclined to admit they’re struggling, especially if mental health is taboo or “powering through” is championed at the workplace.

This puts the onus on leaders to spot mental health-related presenteeism before it damages their organization and the health of valued employees. 

Common causes of presenteeism:

Company culture also fuels presenteeism in several ways:

  • Lack of healthy role-modeling by management or a bullying culture can mean employees feel afraid to take a day off for fear of being branded as weak or uncommitted.
  • Poor communication can demotivate employees and even impact their mental health.
  • Placing a heavy emphasis on teamwork and a “super positive” attitude can result in employees not wanting to let their teams down. 

Why is presenteeism harmful?

Because of its links to burnout and the alarming costs associated with it, some researchers have called presenteeism an ‘800-pound gorilla’. The outsized costs to employers include those of an eventual burnout, as well as “impaired workability and productivity loss”—indeed, presenteeism can cut individual employee productivity by a whopping one-third or more!

Researchers at Trinity College Dublin recently found that “employees who are unwell only engage in presenteeism when they have not met their daily work goals”. What’s more, they found that,

“Working on a day when you feel ill drains mental energy which cannot be recovered the next day.”

Researchers have also found that exhaustion and presenteeism are reciprocal, thus: “when employees experience exhaustion, they mobilize compensation strategies, which ultimately increases their exhaustion.”

The resulting feelings of failure or inadequacy often also kick off a vicious cycle: “an employee gets sick but still goes to work, they produce a lower quality of work, their self-esteem and confidence gets damaged…and then they produce an even lower quality of work”—all while struggling to reclaim their mental and physical energy. It’s easy to see how this can lead to burnout.

Who is most likely to engage in presenteeism?

According to a report from the UK’s Institute for Employment Studies, “those who are most vulnerable to presenteeism cut across the whole organization in terms of seniority and job role”—these include:

  • Managers who feel they should set an example
  • People with high sickness absence who are under pressure to reduce this
  • People with financial problems
  • Workaholics
  • Insomniacs
  • Older workers
  • People with unhealthy lifestyle choices including smoking, unhealthy diets and lack of exercise
  • People with poor psychological wellbeing, including depression

Note that several points may be tied to mental health struggles or an undiagnosed mental health condition, suggesting that building a mental health-friendly organization could be the most powerful way to defend against presenteeism.

Our “Corporate Sanity Guide” helps you implement policies and procedures to support mental health across your organization. 

10 warning signs of presenteeism

No one enjoys feeling unwell. Nevertheless, when people are worn out or feel under pressure to support their team, they can easily lose sight of what the best course of action is to steer themselves back towards health. Always approach employees you think may be engaging in presenteeism with compassion, empathy and your very best listening skills. 

Here are 10 indicators to watch out for:

  1. Unhealthy appearance
  2. Working longer hours than usual or reporting to work late and leaving earlier
  3. Shutting down suggestions from other teammates
  4. Responding negatively to any additions to workload
  5. Having less enthusiasm for things that would usually excite them
  6. Talking less in meetings
  7. Reacting more sensitively to feedback 
  8. Complaining of tiredness
  9. Being less responsive
  10. Delivering a lower quality of work

Now that you know the dangers of presenteeism, its causes, and how to spot the signs, let’s look at the 5 ways to “presenteeism-proof” your organization.

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