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

The iceberg on your company’s horizon

Many leaders these days navigate their businesses like inexperienced sea captains on the North Atlantic: while experts warn of a steady rise in presenteeism, they see what appears to be a small-scale problem, a manageable blip on the radar screen. They often can’t yet fully grasp how profoundly destructive presenteeism can be – both for their organization and the individuals affected.

Just for starters, 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. 

Indeed, 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 the UK alone in 2021. Frequently a precursor to burnout, researchers on the topic have called presenteeism an ‘800-pound gorilla’ because of the tremendous costs associated with it, which include those of an eventual burnout, as well as “impaired workability, and productivity loss” (presenteeism can cut individual productivity by a whopping one-third or more!). 

What is presenteeism?

Simply put, presenteeism is when employees go to work while feeling unwell and don’t perform at their full capacity – they’re present, but more in “name” than in “brain”. 

While an employee dragging themselves into the office with a nasty bug is often a very visible form of presenteeism, other forms of presenteeism are more subtle and potentially much more harmful. Employees may be suffering from mental health issues and still be coming into work – indeed, research shows a strong link between presenteeism and mental health disorders, in particular depression. 

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

This puts the onus on leaders to spot mental health-related presenteeism before its effects damage their organization – and, critically, the health and wellbeing of valued employees. 

Common causes of presenteeism

At the organizational level:

Company culture can also fuel presenteeism in several ways:

  • A 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, to the extent that they sacrifice their own health for the sake of the group. 

At the individual level:

A study published this year by researchers at Trinity College Dublin 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”.

On a similar note, researchers have 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 on the psychological level: “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 might eventually 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, those with unhealthy diets, and who don’t exercise very much
  • People with poor psychological wellbeing, including depression

Note that many of these categories may be tied to mental health struggles or an undiagnosed mental health condition, suggesting that building a mental health-friendly organization could be a powerful way to defend against presenteeism.

Our “Corporate Sanity Guide” offers a handy step-by-step guide to adopting and implementing 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’s what to look out for:

  • Unhealthy appearance
  • Working longer hours than usual or reporting to work late and leaving earlier
  • Shutting down suggestions from other teammates
  • Additions to their workload seem unbearable
  • Having less enthusiasm for things that would usually excite them
  • Talking less in meetings
  • Reacting more sensitively to feedback 
  • Complaining of tiredness
  • Being less responsive (on instant messaging, email or in person) 
  • Delivering a lower quality of work (e.g. fewer creative ideas, sloppiness, making more mistakes than normal)

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

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