Mental health at work is an area where an employer can do real good and real harm with the same good intentions. The World Health Organization’s 2022 guidelines on mental health at work rate none of their recommendations as resting on high-certainty evidence, and they decline to recommend, for or against, screening staff for mental health problems. WHO’s 2022 guidelines strongly recommend two things every employer can do: train managers to support workers’ mental health, and make reasonable work accommodations for people with mental health conditions. The limit is just as clear: managers should not diagnose or treat mental health conditions, which is a clinician’s job.¹

Roughly in order of evidence, that gives an employer five first moves:

1. Train the people who manage people.
2. Make adjusting the work a routine process.
3. Plan returns to work with the person, not around them.
4. Tackle the working conditions behind the strain.
5. Keep health information private and help routes visible.

For the wider picture, including why working conditions come before perks, start with what employee wellbeing is and the dimensions that matter.

What WHO’s 2022 guidelines ask of employers, strongest first

WHO’s 2022 guidelines give each recommendation two separate grades, and for an employer’s own staff only two steps get a strong one: training managers and adjusting the work for people with mental health conditions. The strength of a recommendation says how confident the panel is that benefits outweigh harms; the certainty of evidencecertainty of evidence: A rating of how confident we can be that a body of research has an effect about right, graded high, moderate, low or very low. It grades the evidence, not the stakes: low certainty means little is known, not that little is at risk.Full entry in the glossary says how sure it is about the size of the effect. Accommodations show the difference: strong, on very low-certainty evidence, because the panel leaned on the right to reasonable accommodation in the United Nations Convention on the Rights of Persons with Disabilities as well as on the studies.¹

Everything else sits lower. Changing working conditions to reduce psychosocial risks, training all workers in mental health awareness, and stress-management courses are conditional recommendations, on low or very low certainty. Picture a company with a modest budget weighing three offers: a mental health questionnaire for all staff, a meditation app, and a half-day course for team leaders. By WHO’s grades, the course has the best-supported case, the app falls in the conditional group, and the questionnaire received no recommendation at all. The practical lesson is to fund in that order, and to check the evidence behind any product before buying it, as WHO’s implementation remarks advise.¹

Why training managers is the best-supported step

Manager training is the only step whose recommendation WHO grades on moderate-certainty evidence. In the controlled trials WHO reviewed, trained managers scored clearly higher on mental health knowledge and slightly lower on stigmatizing attitudes than untrained ones, but the effect on the mental health their staff reported was very small. Managers matter because they set workloads and deadlines, and WHO notes that direct supervisors play a critical role in supporting workers. WHO describes the training as helping them recognize distress, talk with the person, adjust job stressors and point to support, and counts better help-seeking by workers among its aims.¹

Take an analyst who has always been punctual and starts missing deadlines. An untrained manager may open with a performance warning. The training WHO describes prepares a manager to ask privately how things are going, move a deadline, and mention the employee assistance program or a doctor. The work changes, and the manager never plays therapist.

One cluster randomized controlled trialrandomized controlled trial: A study that assigns participants to the treatment or the comparison group at random, so the groups start out alike and a difference in what happens next can be put down to the treatment. Random assignment makes the two groups comparable; it does not make the people in the trial representative of anyone else.Full entry in the glossary in a large Australian fire and rescue service found that after a 4-hour course for managers, work-related sick leave among the staff they supervised fell over 6 months, while it rose among staff whose managers’ training was deferred; standard sick leave showed no clear difference. It was a single trial, funded by NSW Health and Employers Mutual, a workers’ compensation claims manager, and its authors call for confirmation in other workplaces.²

Budget for it as a program, not a one-off workshop. WHO adds that one-time training effects may fade after about 6 months, so refreshers may be needed, and that training should preferably run in paid working hours, with checks on whether managers apply it.¹

Adjusting the work for someone with a mental health condition

Reasonable work accommodations are changes to how, when or where someone works so that a mental health condition does not shut them out of the job. WHO’s 2022 guidelines strongly recommend them on very low-certainty evidence: no direct evidence was found, and the review behind the recommendation summarized mostly observationalobservational study: A study in which researchers record what people already do or are exposed to, rather than assigning anyone to anything. It can show that two things go together, not that one causes the other, because the groups being compared may differ in other ways as well.Full entry in the glossary studies, chiefly from the US and in people with severe mental health conditions.¹

The review behind the recommendation found four kinds: in communication, such as regular supportive meetings or written instructions; in scheduling, such as more frequent breaks or extra time; in the job description, such as a gradual return to tasks or job-sharing; and in the physical space, such as a private place to rest. Workers who received accommodations tended to stay in their jobs longer, though a link like this cannot show cause, and in one qualitative study some felt overprotected or patronized. A critical barrier is disclosure: people who fear stigma or repercussions may not ask. WHO notes that accommodations can be put in place without telling colleagues why, or in whatever way the worker prefers.¹

In practice, an adjustment is often small. A support worker whose medication makes early starts hard might move to a later shift; a developer who struggles in an open-plan room might get a quiet desk and written briefs. Ask the person what would help rather than guessing, and review the change together, because what works can shift as mental health changes.³

What the law already requires, in the US and Great Britain

In the US and Great Britain, adjustments can be a legal duty, not a gesture. In the US, the Equal Employment Opportunity Commission’s 2016 guidance on the Americans with Disabilities Act of 1990 (ADA) says workers with conditions such as depression or PTSD may have a legal right to reasonable accommodations, which the employer must provide unless doing so involves significant difficulty or expense. The same guidance lets an employer ask medical questions, including about mental health, only in four situations, such as when an employee requests an accommodation, and anything disclosed must be kept confidential, even from co-workers.⁴ The ADA’s employment rules apply to employers with 15 or more employees.⁵

In Great Britain, the workplace advice service Acas says, in guidance last updated in 2025, that a mental health problem can be a disability under the Equality Act 2010, and that employers must then make reasonable adjustments.³ That act covers England, Wales and Scotland but not Northern Ireland.⁶ Britain’s Health and Safety Executive, in guidance updated in 2026, adds a separate duty: employers must assess the risk of work-related stress and act on the findings, and those with five or more workers must write the assessment down.⁷

These summaries are general information for two countries, not legal advice. Elsewhere, national disability, equality and health-and-safety laws apply, and an employment lawyer or the relevant regulator can say what they require.

Returning after depression: work changes plus treatment

For employees with depression, the strongest evidence on sick leave points to a partnership: changes at work combined with treatment from a clinician. A 2020 Cochrane systematic reviewsystematic review: A review that fixes its question and its rules for including studies in advance, then searches out every study that fits and weighs them together. Some systematic reviews pool the results into a meta-analysis; others describe what the studies found without combining the numbers.Full entry in the glossary of randomized trials found that this combination probably reduced days of sick leave.⁸

The study

Moderate evidence

Job changes and treatment together: what 45 depression studies found

Combining a work-directed intervention, such as changed tasks or hours or a graded return, with a clinical one probably reduced sickness absence in the first year, by about 25 days on average (moderate certainty). It did not lead to more people being back at work after a year or longer (high certainty). A specific work-directed intervention on its own may not beat usual work-directed care, and the review could not say which combination works best.⁸

That is a meaningful difference for one person and noticeable across a team, but it is an average across varied programs, not a promise for anyone.

WHO’s 2022 guidelines point the same way: for people off work with mental health conditions, they conditionally recommend considering work-directed care plus evidence-based clinical care, or clinical care alone, on low-certainty evidence mainly from depression and adjustment disorders. They add two conditions an employer controls: the worker’s preference decides who is involved, and no program should be made a condition of coming back.¹ The employee’s side of that conversation is covered in how to plan a return to work after burnout.

Where mental health at work stops being the employer’s job

The employer’s part stops at diagnosis and treatment. WHO’s 2022 guidelines say managers cannot and should not diagnose or treat mental health conditions. On screening, WHO found no clear evidence that benefits outweigh harms and raised concerns about confidentiality, false results and people hiding symptoms, so it made no recommendation either way. Where regulation requires screening in some jobs, it asks for impartial qualified providers, privacy, and follow-up care for anyone who screens positive.¹

Myth

Screening every employee for depression or anxiety is the responsible first step.

Fact

WHO's 2022 guidelines made no recommendation for or against workplace screening, and raised concerns about privacy, false results and under-reporting.

Resilience courses and wellbeing apps are a second limit. A large 2024 cross-sectionalcross-sectional: Describes a study that measures everyone in its sample at a single point in time. Because the possible cause and the outcome are recorded together, it can show that two things occur together but not which of them came first.Full entry in the glossary study of survey data from UK workers found that people who took part in resilience training, mindfulness or wellbeing apps appeared no better off on several self-rated wellbeing measures than those who did not; the author reads this as such offers failing to answer the demands of the job.⁹ A single survey cannot show cause, so read it as a caution, not a verdict: a course may sit alongside changes to the work, but should not stand in for them.

Confidentiality is the third limit. Keep health details with HR or occupational health, share only what a change to the job requires, and let the person decide what colleagues hear.¹

1. The employer: adjusts workload, schedules and tasks, trains managers to notice and respond, and keeps health information private
2. The doorway: points people to help: an employee assistance program, occupational health, a doctor or a crisis line, with the person deciding who is involved
3. The clinician: assesses, diagnoses and treats; WHO says managers should not diagnose or treat mental health conditions

Putting the five moves into practice

The legal duties above are the floor. These steps are general management practice, not clinical or legal advice.

1. Train the people who manage people

Choose training with published evaluations, run it in paid time, book refreshers, and later ask managers what they have actually used.

2. Make adjusting the work a routine process

Tell staff, in one findable place, how to ask for an adjustment and who handles it, and set a review date for each change. Explore adjustments even where a condition may not count as a disability in law.

3. Plan returns to work with the person, not around them

Agree a phased plan with the person, bringing in their doctor or occupational health only with consent, and never make a program a condition of return.

4. Tackle the working conditions behind the strain

Look first at workload, control over the work, schedules and bullying, the psychosocial risks the guidelines name.

5. Keep health information private and help routes visible

Keep records confidential and put crisis and support routes where every employee can find them.

WiserHours

An employer's first steps on mental health

• Book evidence-based mental health training for every manager, in paid time
• Publish how to request a work adjustment and who decides
• Write a return-to-work process that the employee helps shape
• Review workload, schedules and bullying reports for the teams under most strain
• Keep health information with HR or occupational health, not in team files
• Post the help routes: assistance program, doctor, NHS 111 (England), 988 (US), local emergency number

Find this checklist online:
https://wiserhours.com/employee-wellbeing/mental-health-at-work/#checklist-mental-health-at-work-first-steps

The evidence behind the main steps, as WHO and the Cochrane review grade it:

Urgent and everyday routes to professional help

Adjusting the job supports people but treats nothing. The routes below are from the US National Institute of Mental Health (NIMH) and the NHS in the UK; sorting them by urgency, and the notes for other countries, are our own signposting.

• Now: in the US, NIMH advises calling 911 or going to the nearest emergency room in a life-threatening situation, and calling or texting 988, the Suicide & Crisis Lifeline, for suicidal thoughts or emotional distress.¹⁰ In the UK, the NHS says to call 999 or go to A&E if someone’s life is at risk or you cannot keep yourself or someone else safe, and lists Samaritans on 116 123.¹¹ Elsewhere, call your local emergency number. Managers told that someone on their team may be at risk should turn to these routes too.
• Soon: in England, for urgent help that is not an emergency, the NHS suggests NHS 111, online or by phone with the mental health option, or an urgent GP appointment.¹¹ In the US, NIMH notes that a primary care provider can do a first mental health check and refer on.¹⁰ Elsewhere, see a family doctor.
• Routine: for strain that keeps returning, raise it at an ordinary appointment. Separately, NIMH points to employee assistance programs, which it describes as free and confidential and paid for by the employer; HR can say whether one exists.¹⁰

The bottom line

An employer’s best-supported moves on mental health are unglamorous: train managers, adjust the work for people who need it, and plan any return with the person and their clinician. Managers adjust the work and point to help; diagnosis, treatment and screening are not theirs. Start with manager training and a clear way to ask for adjustments, and judge every other offer by whether it changes the work.