Mental Health in the UK Workplace: Evidence Review & Strategic White Paper (2026)

Abigail Rogers
1 day ago
36 min read

Workplace mental wellbeing is no longer a peripheral concern for UK employers. It is a material issue affecting productivity, retention, absence, safety, leadership capability and long-term organisational sustainability.

National reviews, including Sir Charlie Mayfield’s Keep Britain Working report (2025)¹

make it clear that poor mental health is now one of the biggest issues affecting

productivity in the UK economy, driven by a combination of absenteeism,

presenteeism, staff turnover, and reduced performance.

Employers are already carrying this cost - through lost output, weakened teams,

increased management burden, and growing difficulty retaining experienced

people.

Despite unprecedented investment in wellbeing initiatives, mental wellbeing

outcomes continue to worsen rather than improve. The cost is becoming obvious,

overwhelming and unsustainable - and the UK economy is suffering, as a result.

This paper explores why that gap exists - and what the available evidence points to

as a more effective way forward.

It examines UK and international evidence on workplace mental health,

psychotherapy outcomes, and organisational wellbeing, with a particular focus on

what works in real-world settings - not just what performs well under tightly

controlled clinical conditions.

Drawing on national policy reviews, large-scale employer data, and decades of

psychotherapy research, the paper seeks to provide the “greater clarity on what

works” called for in recent national reviews.

Specifically, it sets out:

the scale and cost of the workplace mental health challenge
why existing systems often fail to deliver meaningful impact despite significant investment
the structural and psychological barriers that limit uptake and effectiveness of current workplace solutions
the characteristics of psychological support shown to improve engagement, functioning and performance
the evidence for a more effective, preventative model of workplace mental health support

The paper argues that how mental health support is delivered matters at least as

much as what is offered.

Approaches that engage people earlier, respect autonomy, focus on clear goals and restore confidence and real-world functioning are more effective, more efficient, and better aligned with the realities of modern work.

It proposes that well-evidenced, but often overlooked, solution-focused approaches

offer a pragmatic and scalable way of meeting these criteria - not as a replacement

for specialist clinical care where required, but as a highly effective first-line,

early-intervention and preventative option for the issues most commonly affecting

working adults.

For employers, insurers and wellbeing providers, this represents a clear opportunity:

to invest more confidently in support that delivers meaningful outcomes for

individuals, organisations and, ultimately, the wider UK economy.

Mental Health in the UK Workplace:

Challenges, Gaps & Strategic Solutions

Section 1: The Scale and Nature of the Workplace Mental Health Problem

1.1 A sustained rise in mental health and wellbeing issues

Mental health difficulties among working-age adults in the UK have risen steadily over the past 30 years and now affect a substantial proportion of the workforce.

In 1993, an estimated 15.5% of adults aged 16–64 experienced a common mental health disorder such as anxiety or depression. By 2023/24, that figure had risen to 22.6%, meaning more than one in five adults are now affected (NHS England, 2025)².

This trend accelerated sharply during the Covid-19 pandemic. A major UK longitudinal study found that the proportion of adults experiencing clinically significant mental distress increased from 18.9% in 2018–19 to 27.3% by April 2020 (Pierce et al., 2020)³. Subsequent data show that distress levels have remained elevated rather than returning to pre-pandemic baselines.

The economic impact of mental ill health is now profound. In 2022, the overall costs of mental ill health⁴ in England was estimated at £153 billion - double the NHS’s entire budget for that year. By comparison, the estimated economic impact of Covid-19 on the UK economy in 2020 was £260 billion - highlighting that poor mental health now represents an economic burden comparable to experiencing a pandemic-scale shock on a recurring basis.

Crucially, this trend does not reflect a simple rise in severe psychiatric illness. It reflects a growing number of people struggling to function well under sustained psychological and emotional pressure, across both their personal and professional lives.

1.2 The shifting landscape: the strain of mental health support

1.2.1 Changing attitudes

It is important to acknowledge, here, that attitudes towards mental health have shifted significantly over the past decade. Public and workplace conversations around mental health have become more open, particularly during and following the COVID-19 pandemic. This shift has contributed to increased awareness, a rise in help-seeking behaviour, and reflects how mental health is now more widely understood as part of an overall picture of balance, functioning and quality of life, rather than solely the treatment of illness.

National data reflects this cultural shift. In 2000, only 23.1% of people estimated to have a common mental health disorder were accessing treatment. By 2023/24, that figure had risen to 47.7% (NHS England, 2025)². While this represents meaningful progress, it has also placed increasing strain on systems that were already under pressure.

1.2.2 The limited impact of existing workplace provisions

EAPs remain the dominant workplace intervention, yet utilisation rates typically sit between just 3–5% (HCML, 2024)⁵, despite far higher levels of need. This leaves a substantial gap between what employers offer and what employees actually use or benefit from.

Existing workplace mental health support is frequently characterised as being:

accessed too late,
used by very few employees,
difficult to trust or navigate,
poorly integrated into working life,
focused on narrow, rather than more impactful human-centred objectives, and
overly reliant on overstretched external systems

Many initiatives also aim to help people cope with stress temporarily, rather than addressing the underlying psychological strain that undermines confidence, engagement and long-term performance.

Despite significant employer investment, over half of employees (52%) believe their employer could be doing more to support their mental health (HCML, 2024)⁵. This points to a persistent gap between employer intent and employee experience.

1.2.3 Public health - overstretched and underfunded

Many employers have implicitly become reliant on the NHS to act as a backstop for more serious mental health needs - in reality, this safety net is increasingly untenable.

The NHS is under unprecedented strain and, while essential for acute and specialist care, it is not designed to deliver early, preventative, or work-integrated psychological support, and is unable to act as a timely or preventative safeguard for working populations.

In 2024, mental health services in England received a record 5.2 million referrals - a 38% increase compared to 2019 (NHS England, 2025)².

Waiting times have lengthened accordingly. Analysis by Rethink Mental Illness (2025)⁶ shows that eight times as many people are waiting over 18 months for mental health treatment compared to physical health care.

Despite this, the Government’s recently-announced ‘Elective Reform Plan’ - designed to reduce waiting times for pre-planned and non-urgent treatment - explicitly excludes mental health care⁷, leaving around 1.6 million people without a clear route to timely support.

For employers, this creates a critical gap: employees are often waiting months - or years - while continuing to work under strain, deteriorating further, or leaving employment altogether.

1.3 The impact on the workforce

Taken together, these trends point to a workforce operating under sustained psychological pressure, as opposed to isolated episodes of illness.

Many employees are not “unwell” in a way that triggers crisis intervention, but they are:

chronically anxious,
emotionally exhausted,
struggling to recover from prolonged stress,
carrying unresolved psychological strain that undermines performance.

An important distinction has emerged in recent years: the absence of diagnosable mental illness does not equate to thriving. The concept of languishing versus flourishing (Keyes, 2002)⁸ highlights that many people may appear to be functioning, while experiencing diminished motivation, focus, confidence and emotional regulation.

In workplace settings, this often manifests not as clear clinical diagnoses, but as patterns such as:

rising short-term sickness absence
recurring “stress-related” leave
declining concentration or decision-making quality
disengagement, irritability or interpersonal conflict
increased turnover among experienced staff
technically capable leaders who are emotionally depleted

Almost half of UK workers (46%)⁹ report working despite not feeling physically or mentally well enough to perform their role effectively.

In 2022, employees lost an estimated 20.2% of working hours to unproductive time¹⁰ - equivalent to 51 productive days per employee per year. By 2023, the cost of presenteeism alone was estimated at £103 billion¹¹, an increase of £30 billion since 2018.

UK surveys consistently show that many employees delay seeking support until difficulties are well established - due to stigma, workload pressure, or doubts about whether available support will be helpful.

These delays matter: the longer difficulties persist without effective intervention, the more likely they are to escalate, become identity-defining “this is how I am”, and require longer, more intensive and more costly support later.

From an employer perspective, this creates a widening gap between where problems begin and when support is typically offered - usually as a remedial response rather than an early or preventative one.

1.4 The impact on employers

The Mayfield Review identifies poor mental health as a major contributor to lost productivity across the UK economy¹. “Employers lose on average £120 per day in profit from sickness absences, which are at a 15-year high, and face costs to replace staff which stretch into the tens of thousands each time. This causes disruption, lost capacity and unplanned costs”.

Independent analysis by Deloitte¹² estimates that poor mental health costs UK employers £51 billion per year, driven by absenteeism, presenteeism and staff turnover.

Health and Safety Executive (HSE) data show that stress, anxiety and depression account for around 52% of all work-related ill health cases and 62% of working days lost due to ill health¹³.

While absence figures are significant (9.4 days per employee per year (CIPD Health & Wellbeing at Work 2025), presenteeism represents the largest share of loss¹⁴. The Mayfield Review estimates that presenteeism costs employers the equivalent of 4–9 lost productive days per employee per year¹, through poor decision-making, extended recovery times and performance contagion.

The true cost is difficult to quantify. Presenteeism is less visible, often well-masked, and frequently persists for long periods. It erodes trust, weakens collaboration and increases management load, creating knock-on effects across teams and leadership structures.

In addition to the psychological and cultural impact, there are significant indirect costs associated with these issues: lost productivity; increased workload & strain for other employees; increased HR burden; staff turnover, training and recruitment; temporary staffing; impacted customer experience; reduced innovation & capacity.

Many employers have responded with increased investment in wellbeing initiatives, EAPs and mental health policies.

Awareness is higher than ever, stigma has begun to shift, and conversations about mental health are more visible. Yet employees still frequently report concealing the true reason for mental health-related absence - indicating that barriers to trust and engagement remain¹⁴.

The result is a widening gap between need, availability and meaningful impact. Despite investment and good intention, mental wellbeing continues to deteriorate, with tangible consequences for productivity, engagement, retention, organisational culture and long-term growth.

Section 2: Why Isn’t Workplace Mental Wellbeing Working?

2.1 The current status quo

Despite increased awareness of mental health at work and growing employer investment, engagement with workplace mental health support remains consistently low. This pattern is clear across utilisation data, employee surveys, and national service statistics.The Enterprise Research Centre (2024) reports that many workplace wellbeing initiatives have plateaued in their effectiveness and adoption¹⁵. Despite investments, organisations often struggle to translate awareness into sustained behavioural or organisational change. This reinforces the need for a step change in approach.

Most organisations now offer some form of mental health support, commonly through:

Employee Assistance Programmes (EAPs)
insurance-funded therapy pathways
signposting to NHS or private services
mental health awareness or resilience training
mental health first aid
digital platforms

While these initiatives represent progress and positive intent, evidence suggests that uptake and meaningful outcomes are often limited.

Common challenges include:

Low sustained engagement with EAP services
High drop-out rates
Limited therapeutic depth
Poor matching of support to employee needs
A focus on crisis management rather than prevention
Services being experienced as impersonal or overly clinical
Poor alignment with the realities of senior or high-pressure roles

Sir Charlie Mayfield’s review highlights that many employees either do not engage with available support or disengage early¹, particularly when services feel stigmatising, overly diagnostic, or disconnected from their working reality.

Where therapy is accessed, it is often constrained by:

fixed session limits
rigid treatment protocols
emphasis on diagnosis and symptom monitoring rather than functional improvement

For busy professionals and leaders, this misalignment can feel frustrating. They often seek relief, clarity, confidence, and the ability to function well - both at work and at home, rather than a clinical or pathologising experience.

These limitations have prompted growing interest in approaches that move beyond reactive support towards models that build psychological resources, resilience and sustained functioning.

2.2 Limited uptake of workplace support

Employee Assistance Programmes (EAPs) remain the most common form of workplace mental health provision in the UK, due to their relative low-cost, ease of implementation, and broad scope.

However, utilisation data consistently shows that EAPs reach only a small fraction of the workforce.

Across UK employers, 85% of organisations offering an EAP report utilisation rates of just 3–5% (HCML, 2024)⁵. This contrasts starkly with the many times higher proportion of employees experiencing mental health difficulties.

In practice, EAPs often function as crisis or last-resort services, rather than as accessible, trusted forms of early support. By the time employees engage, difficulties are often already entrenched, making effective intervention harder and slower.

The evidence suggests that the problem is not a lack of goodwill or intent, nor a wholesale rejection of support by employees. Rather, a complex set of access, trust, and design barriers prevent effective use - even when services are technically “in place.”

2.2.1 Stigma and fear of professional consequences

Although stigma has reduced overall, it remains a significant barrier - particularly in competitive or high-performance work environments.

Employees continue to report concerns that accessing therapy may be perceived as a sign of weakness, reduced capability, or poor stress tolerance. This fear is especially pronounced where:

performance is closely monitored,
progression is competitive,
or organisational cultures implicitly reward endurance over openness.

Evidence from the charity Mind^{16, 17}shows that fear of judgement and professional repercussions remains a significant deterrent to help-seeking, even where support is formally available.

Crucially, this means that availability alone does not equal needs being met.

2.2.2. Confidentiality and trust concerns

A further, well-documented barrier is lack of trust in confidentiality.

Employees often express concern that information shared through employer-linked mental health services could be accessed - formally or informally - by HR or management. Even when confidentiality policies exist, perceived proximity to the employer is enough to deter use.

Peer-reviewed research shows that confidentiality concerns significantly reduce engagement with workplace mental health programmes, particularly those accessed via internal portals or employer-branded platforms¹⁸.

From an employee perspective, the risk - however unlikely - often outweighs the perceived benefit.

2.2.3. Lack of clarity and visibility of support pathways

Another consistent finding is poor awareness of how to access support.

Many employees either:

do not know that therapy is available,
are unclear about what the service offers,
or do not know how to initiate contact.

Benefits information is frequently buried in HR systems, onboarding documents, or generic wellbeing pages, and is rarely reinforced through clear, human communication. HR Grapevine reports that this lack of visibility and clarity is a major reason employees fail to engage with support even when it exists¹⁹.

2.2.4 Capacity, timing and practical constraints

Even when employees attempt to access therapeutic support through their workplace, practical barriers often obstruct access²⁰. These include:

limited numbers of sessions,
long wait times,
inconvenient appointment hours,
and restricted availability for hybrid, shift, or frontline workers.

Research shows that limited capacity and delays significantly reduce follow-through and increase dropout rates. Employees who encounter barriers early are less likely to try again, particularly when already under pressure.

This mirrors the wider pressures facing NHS services and reinforces the reality that late-stage, limited capacity intervention is structurally mismatched to workplace needs.

There is also evidence that many employees do not believe the service will understand the realities of their working lives (Moore et al., 2023)²¹.

2.2.5 Organisational credibility and perceived intent

Employee engagement is shaped by how mental health support is perceived within organisational culture.

When wellbeing initiatives feel:

Reactive
Image-driven
Disconnected from everyday work practices

employees are less likely to trust them as genuine sources of support²².

Evidence suggests employees assess mental health provision not by its mere existence, but by how convincingly it is integrated into organisational values, behaviours, and decision-making²³.

Research also suggests that suspicion of employer motivations and fear of negative consequences can further deter employees from accessing support²¹.

2.2.6 Perceived effectiveness & relevance of support

A further barrier to engagement is employees’ perception of whether the support on offer is likely to be effective for them²¹.

Many workplace wellbeing initiatives focus on stress management, resilience training, or short-term coping strategies, and often include initiatives such as mindfulness sessions. While often valued and well-intentioned, these approaches are not typically designed to address the deeper psychological drivers of anxiety, burnout, or sustained performance decline - which may limit their perceived relevance for employees experiencing more entrenched difficulties²².

Where formal therapy is available through EAPs, provision is typically weighted towards generic counselling models and Cognitive Behaviour Therapy (CBT), reflecting NHS commissioning norms. However, outcome data indicates that these approaches are not effective for everyone. NHS Talking Therapies data shows that around 45–50% of patients do not meet recovery criteria following a course of treatment, and dropout rates of 20–30% are commonly reported²⁴.

Employees who have previously accessed therapy may therefore approach workplace provision with low expectations, particularly if their prior experience involved outcomes that did not translate into sustained improvements in daily functioning.

For individuals carrying chronic stress, trauma exposure, or persistent anxiety, support that feels generic, problem-focused, or time-limited may be perceived as insufficient or irrelevant. This perception reduces engagement before practical barriers such as access or capacity are even encountered.

Importantly, this does not indicate a lack of willingness to engage with mental health support. Rather, it reflects a mismatch between the type of support commonly offered and what many employees believe is required to create meaningful and lasting change²².

2.3 In Conclusion

While employer intent is high, the physical and psychological barriers detailed here frequently prevent support from being used early, confidently, or effectively. As a result, organisations can invest heavily, meet compliance expectations, and still see no meaningful improvement in wellbeing, engagement, or performance.

Section 3 will examine what the evidence suggests about the characteristics of psychological support that do achieve engagement and meaningful outcomes in working populations.

Section 3: What Effective Workplace Mental Health Support Requires

The evidence reviewed in Sections 1 and 2 shows that the problem facing employers is not awareness or intent, but impact. The question becomes not just what support looks like on paper, but what demonstrably improves psychological functioning, engagement and performance in real workplace conditions.

Across occupational mental health, psychotherapy research, and applied workplace studies, several consistent features emerge.

3.1 Therapeutic depth

Interventions that focus solely on managing stress or alleviating surface symptoms tend to produce short-term relief, but limited sustained change (Lambert, 2013; Cuijpers et al., 2014)^{25, 26}.

By contrast, approaches that address the underlying psychological drivers of anxiety, burnout, and disengagement are associated with more durable improvements in wellbeing and functioning.

In workplace contexts, these drivers commonly include:

prolonged threat or pressure without recovery
maladaptive stress responses
unresolved emotional load from cumulative stress or trauma-adjacent experiences
identity-level beliefs around responsibility, performance, or failure

Support that works at this level has been shown to reduce recurrence of distress and improve longer-term outcomes, rather than leaving employees cycling back through repeated interventions.

From an employer perspective, this distinction matters because temporary symptom relief does not reliably reduce absence, presenteeism, or turnover, whereas sustained psychological change does (Deloitte, 2022)²⁷.

3.2 Emotional regulation and burnout prevention

Research consistently shows that burnout and anxiety in working adults differ from presentations typically seen in clinical populations. Many employees remain highly capable and engaged, but experience internal strain that progressively undermines decision-making, emotional regulation, and resilience.

Workplace-relevant studies indicate that support is more effective when it:

engages with functioning and capacity, not just distress
supports emotional regulation under pressure
restores confidence and cognitive clarity
and helps individuals operate effectively in demanding roles

Interventions aligned to these needs are associated with improvements not only in self-reported wellbeing, but also in engagement, productivity, and retention - outcomes that directly matter to employers.

A large meta-analysis of workplace mental health interventions found that programmes with a psychological depth component showed significantly greater effects on wellbeing and work-related outcomes than education-only or stress-management interventions (Joyce et al., 2016)²⁸.

Notably, improvements were observed not only in distress measures, but also in work performance and engagement, indicating direct organisational benefit.

There is growing evidence that therapeutic support is most effective when accessed before employees reach crisis point or require absence from work.

Studies consistently show that:

earlier intervention leads to faster recovery
preventative psychological support reduces escalation into long-term sickness absence
and employees who receive timely, appropriate support are more likely to remain in work and re-engage fully

NHS data consistently shows that individuals presenting earlier in the course of anxiety or depression require fewer sessions and demonstrate higher recovery rates than those with more entrenched difficulties (NHS England, 2024)²⁹.

For employers, this reframes therapeutic support as a preventative investment, not a last resort. When embedded appropriately, therapeutic-level support functions as a means of protecting capacity, performance, and continuity - key drivers of organisational ROI.

This aligns with findings from the Mayfield Review¹, which emphasises prevention and early intervention as the most cost-effective levers available to employers.

3.3 Goal-focused, person-centred support

From an organisational perspective, engagement and retention within support programmes are prerequisites for impact. Interventions that employees do not use, or do not complete, cannot deliver returns.

To this end, evidence from both workplace mental health trials and psychotherapy outcome research shows that how support is delivered matters as much as the model itself.

Engagement and outcomes improve when individuals experience:

autonomy and choice
confidence in confidentiality
relevance to their working reality
flexibility around time and format
meaningful change

Rigid, protocol-led or heavily standardised models - while effective in controlled clinical trials - show higher dropout and lower perceived relevance in workplace delivery, particularly among senior or high-responsibility roles (Moore et al., 2023; Wampold & Imel, 2015)^{21, 30}.

In contrast, support that is adaptable, relevant, and respectful of working life is more likely to be used - and therefore more likely to deliver outcomes.

A robust body of psychotherapy and workplace research demonstrates that outcomes improve when individuals can:

articulate clear goals for change
experience early progress
and see tangible improvements in areas that matter to them

Goal-focused support - where individuals define what “better” looks like in functional terms - is associated with:

higher engagement
lower dropout
and stronger transfer of change into daily work behaviour(CIPD 2023; Joyce et al., 2016)^31,28

This is particularly relevant for professionals, who may disengage from support that feels open-ended, overly problem-focused, or disconnected from practical outcomes.

3.4 Implications for employers

Taken together, the evidence indicates that effective workplace mental health support needs to:

work at sufficient psychological depth
provide a sense of autonomy, goal-direction and ownership
be accessible, flexible, and at the earliest stage possible (i.e. preventative rather than reactive)
fit the realities of modern work
provide guaranteed confidentiality, or even non-disclosure

Support that meets these criteria is consistently associated with better outcomes for individuals and organisations alike.

Section 4 now examines how and why certain approaches meet these criteria more reliably than others, drawing on evidence around engagement, autonomy, early progress, retention, and real-world delivery - and what this means for employers seeking measurable return on investment.

Section 4: Why Common Workplace Interventions Struggle to Deliver Sustained Impact

Section 3 established the characteristics that effective workplace mental health support must meet: sufficient psychological depth, early and preventative access, autonomy and goal clarity, confidentiality, and fit with working life.

This section examines how commonly used workplace mental health interventions perform against these criteria. The purpose is not to dismiss existing provision, but to understand why many organisations continue to see limited impact despite significant investment - and what the evidence suggests is missing.

4.1 Awareness, education and training-based initiatives

Mental health awareness campaigns, resilience training, and manager education programmes have become widespread across UK workplaces. These initiatives have played an important role in normalising conversations about mental health, reducing stigma, and improving basic literacy around stress, anxiety and wellbeing.

Evidence suggests that awareness and education initiatives can improve attitudes and confidence in discussing mental health, particularly among managers (CIPD, 2023)³¹. They are therefore a valuable component of a broader wellbeing strategy, and signal organisational commitment to wellbeing

These outcomes matter. Reduced stigma and improved confidence are necessary preconditions for help-seeking and early intervention.

However, awareness does not equate to intervention. Education-based initiatives do not, on their own, provide psychological support capable of resolving distress or restoring functioning. Studies consistently show that while training can improve knowledge and attitudes, it has limited impact on mental health outcomes such as psychological distress, burnout or work functioning, unless paired with accessible therapeutic support (Joyce et al., 2016; NICE)^{28, 29}. Without follow-on support, gains tend to decay over time.

Crucially, awareness does not reliably translate into behaviour change or symptom reduction. Employees may better understand mental health, yet still struggle to access or engage with support that meaningfully addresses their difficulties.

As such, awareness-based initiatives are best understood as enabling conditions, not interventions in themselves: they can create awareness and readiness for support, but do not constitute that support.

4.2 Mental Health First Aid and peer-led approaches

Mental Health First Aid (MHFA) and peer support models aim to provide early identification and signposting, rather than treatment. Evidence suggests these approaches can increase confidence in recognising distress and encouraging help-seeking (CIPD, 2023)³¹.

However, research also highlights important limitations. MHFA does not provide therapeutic support, and peers are not equipped to address underlying psychological drivers of anxiety, burnout or trauma-adjacent stress.

Several studies caution that peer-led models can unintentionally increase detection without increasing resolution, particularly when appropriate follow-on support is limited or difficult to access. There is also evidence of role strain and emotional burden among trained peers when expectations extend beyond their competence or remit.

Mayfield’s review highlights this risk, noting that where support systems are fragmented, responsibility is often shifted onto line managers and peers without adequate backing - increasing pressure without reducing underlying problems.

MHFA is therefore best understood as a gateway, not a solution; most effective when embedded within a system that offers timely, credible, and effective referral into professional support.

4.3 Employee Assistance Programmes and employer-funded therapy & counselling

EAPs remain the dominant form of workplace mental health provision in the UK. They offer breadth, contractual simplicity, and perceived reassurance that “something is in place”.

The therapeutic approaches typically employed within EAPs and supported by insurer-funded provision are supported by extensive clinical research, and are supported by a substantial evidence base for symptom reduction in anxiety and depression. CBT, in particular, is well-evidenced under controlled conditions and plays an important role within NHS and private care pathways.

However, evidence from real-world delivery raises important limitations for workplace contexts. As discussed earlier, Widnall’s analysis of high-intensity CBT within NHS services found significant symptom reduction but limited movement from “languishing” to “flourishing” on wellbeing measures (Widnall, 2020; Keyes, 2002)³².

This distinction matters for employers. Reducing symptoms does not necessarily restore confidence, resilience, decision-making capacity or engagement under pressure - the capabilities most closely tied to performance and retention.NHS Talking Therapies data for CBT (often the ‘go to’ approach employed in EAP funded therapy) shows that approximately 45–50% of patients do not meet recovery criteria following treatment²⁴, with outcomes further constrained when individuals present later or with more complex stress profiles.

Outcome and engagement data raises questions about the effectiveness of standard protocols when delivered in workplace contexts.

Utilisation rates remain consistently low. As noted earlier, 85% of employers offering an EAP report usage rates of just 3–5% (HCML, 2024)⁵. Evidence suggests that employees often find EAPs difficult to access and question the quality, relevance or continuity of the counselling offered (Moore et al., 2023)²¹.

Dropout rates of 20–30% in NHS Talking Therapies further suggest that protocol-led approaches do not suit all individuals, particularly those seeking practical, forward-looking change rather than problem-focused analysis. And as discussed earlier in this paper, for professionals who have previously accessed similar therapies without experiencing meaningful or lasting improvement, confidence in workplace provision is often low - further reducing engagement.

Key challenges identified in the evidence also include:

variable quality and continuity of provision
fixed session limits that restrict depth
rigid protocols that limit personalisation
outcomes that do not consistently translate into improved work functioning

Mayfield reinforces this point, noting widespread feedback that occupational health and EAP provision lacks independence, misunderstands working contexts, and produces generic or ill-suited recommendations¹ - particularly for SMEs and high-pressure roles.

This may be explained by the typical design of most EAP, counselling and protocol-led therapy models: a clinician-led treatment framework, in which:

the therapist determines the structure, pace and focus of sessions
goals are often defined diagnostically or symptomatically rather than functionally
progress is measured against clinical criteria rather than workplace outcomes

While appropriate in many clinical settings, this model can feel misaligned for working professionals who are seeking clarity, agency, and tangible improvements in how they function at work and in life. Research consistently shows that engagement improves when individuals experience a sense of ownership over goals and direction, rather than being positioned as passive recipients of treatment (Wampold & Imel, 2015; Lambert, 2013)^{25, 30}.

Confidentiality is a further structural consideration. Workplace-funded therapy often sits within employer-linked systems that require some degree of disclosure, referral tracking, or reporting - even when anonymised. Evidence shows that perceived lack of confidentiality, rather than actual data sharing, is sufficient to deter engagement³². For senior employees and leaders in particular, the threshold for trust is high, and even minimal organisational visibility can inhibit early access.

Finally, most workplace therapy pathways are reactive by design. Access is typically triggered once distress reaches a threshold, rather than operating as a genuinely preventative or capacity-protecting resource - and fixed session limits further constrain the benefits of intervention.

Taken together, these delivery features help explain why established models - despite a strong evidence base in clinical contexts - often struggle to produce the engagement, continuity, and sustained performance improvements employers are seeking.

4.4 Digital and software-based wellbeing solutions

Digital mental health platforms, apps, and self-guided programmes have expanded rapidly, particularly since the COVID-19 pandemic. Their appeal to employers is clear: scalability, consistency, low marginal cost, and perceived accessibility.

They can support awareness, self-monitoring and light-touch stress management, and may appeal to employees seeking privacy or flexibility.

Evidence suggests that digital interventions can be helpful for:

mild or situational stress
psychoeducation and self-monitoring
short-term coping strategies
individuals who prefer anonymous, self-directed support

However, real-world engagement data consistently shows steep drop-off rates over time. While trial outcomes for digital CBT and wellbeing apps can appear promising, large-scale implementation studies reveal that sustained usage and completion rates are often low, particularly among individuals experiencing moderate to complex difficulties (NHS England; Cuijpers et al., 2014)^{24, 26}.

However, evidence highlights significant limitations when digital tools are positioned as substitutes for therapeutic support. Engagement with mental health apps is typically short-lived, and outcomes are highly variable. Where personalised or relational depth is absent, users often disengage once initial novelty wears off.

Concerns have also been raised regarding ethical standards, therapist verification, data use and client safety within some digital platforms³⁴. The growing use of generative AI within mental health apps further raises questions around regulation, accountability and efficacy³⁵.

Research suggests that lack of personalised, responsive support can negatively affect users who feel unseen or misunderstood, particularly when distress is more than mild or situational³⁶ .

These are precisely the issues most commonly affecting working professionals. Without relational engagement, adaptation, and psychological depth, many employees disengage or experience limited benefit.

The evidence therefore suggests that digital tools can play a complementary role within a broader strategy, but evidence does not support their use as standalone solutions for anxiety, burnout or trauma-adjacent stress and they are unlikely to deliver sustained psychological change or organisational return when relied upon as a primary intervention.

4.5 What this means for employers

Taken together, the evidence points to a familiar pattern across organisations:

multiple wellbeing initiatives in place
significant financial investment
low or inconsistent uptake
repeated use by a small subset of employees
limited impact on absence, presenteeism or retention
increasing frustration among HR and leadership teams

Employers frequently find themselves meeting compliance expectations and demonstrating visible commitment, yet continuing to see rising absence, presenteeism and disengagement.

The data suggests that this is not due to lack of concern, nor employee resistance to support. Instead, it reflects a structural mismatch between the types of support most commonly offered and the characteristics of interventions shown to deliver meaningful psychological and organisational outcomes.

As Mayfield argues, the priority is no longer more provision, but provision that is faster, effective, trusted and fit for purpose¹. The evidence suggests that approaches which combine therapeutic depth, autonomy, confidentiality, early access and real-world fit are more likely to meet this standard.

Section 5 now examines the evidence for approaches that meet these criteria more consistently, and why solution-focused models are particularly well aligned with the needs of modern workplaces.

Section 5: Solution-Focused Approaches as an Evidence-Based, Effective Model for Workplace Mental Health Support

The preceding sections outlined why many current workplace mental health initiatives struggle to deliver sustained impact, and the core characteristics that effective support must demonstrate. This section examines the evidence for solution-focused psychological approaches as a model that consistently meets these criteria - and why they are particularly well aligned with the realities of modern working life.

The focus here is on identifying an approach that combines genuine psychological depth with accessibility, engagement and real-world relevance - offering a more effective first-line and preventative response to the issues most commonly affecting working adults.

5.1 Psychological depth without clinical burden

A persistent misconception in workplace mental health is that interventions must choose between depth and practicality.

In practice, many widely used solutions err in one of two directions: either light-touch wellbeing initiatives that lack psychological depth, or clinical models that struggle to translate effectively into working life.

There persists an underlying assumption that meaningful psychological change must require detailed discussion of problems, past experiences, or trauma. The evidence does not support this view⁴⁰.

Solution-focused therapies are evidence-based psychotherapeutic approaches with a substantial research base across anxiety, depression, trauma-adjacent stress and functional outcomes. Their effectiveness does not arise from being superficial or informal, but from a deliberate focus on how people regulate emotion, make sense of their experiences, and move towards meaningful change. Rather than extensive problem analysis, solution-focused work supports change in beliefs, self-concept and behavioural patterns by strengthening psychological resources such as agency, confidence and adaptability.

At a clinical level, solution-focused interventions have demonstrated effectiveness across a wide range of presentations, including anxiety, depression, trauma-adjacent stress, and identity-related difficulties (Cockburn, Thomas & Cockburn, 1997; Joyce et al., 2016)^{37, 28}.

Crucially, this depth is achieved without requiring employees to adopt a diagnostic identity, revisit extensive problem histories, or frame themselves as unwell. For many working professionals - particularly senior employees and leaders - this distinction matters. Psychological support that feels overly medicalised, retrospective or problem-focused can feel misaligned with how they understand themselves, their roles and their ambitions.

Comparative research shows that, for many common difficulties, brief solution-focused approaches achieve outcomes comparable to longer therapies, often with fewer sessions and lower resource demands³⁸. And while capable of addressing these deep emotional, cognitive, and identity-level issues, they do not require individuals to disclose personal details, recount adverse experiences, or label themselves as unwell. This opens the door to support for a large group of professionals and leaders who do not perceive themselves as “needing therapy”; who would never seek to talk openly about their problems; and whose version of resilience has become “stay calm, stay functional, and keep going despite the strain”.

These are often highly capable individuals who continue to perform outwardly while carrying significant internal pressure - and who typically delay seeking support, even privately, until difficulties have escalated or become unavoidable.

For workplace delivery, this has clear advantages. Shorter, goal-directed interventions are easier to integrate with working life, reduce disruption, and improve completion rates.

They also avoid the need for extensive disclosure or organisational involvement, which significantly influences engagement, particularly among senior employees³⁹.

5.2 Emotional regulation, burnout prevention and sustainable functioning

Burnout, chronic stress and emotional dysregulation are among the most common drivers of reduced performance, disengagement and absence in modern workplaces. While often discussed in terms of workload or resilience, the evidence increasingly points to emotional regulation as a central mechanism.Most workplace mental health provision is currently reactive by design - however, the evidence strongly supports earlier intervention. Studies across occupational mental health and psychotherapy show that earlier access is associated with faster recovery, fewer sessions required, and lower risk of progression into long-term absence or more complex presentations (NHS England, 2024).

Effective workplace mental health support must therefore do more than reduce symptoms in the short term. It must help individuals regain a sense of internal stability, perspective and capacity - enabling them to function well under pressure, rather than relying on ongoing support.

Solution-focused approaches place emotional regulation at the centre of their work and are particularly well suited to preventative delivery. Meta-analytic evidence⁴⁰ indicates that solution-focused approaches support not only symptom reduction but also broader psychosocial functioning, including wellbeing, life satisfaction, self-efficacy, positive affect, and perceived control (Joyce et al., 2016)²⁸- outcomes which are correlated with enhanced resilience and lower risk of future mental health problems (Fredrickson, 1998)⁴¹.

They can be accessed before problems escalate, without requiring individuals to define themselves as “unwell” or to revisit past experiences in detail. This makes them compatible with working life, where employees may recognise strain, loss of confidence or reduced functioning long before they would seek traditional therapy. Rather than amplifying distress or reinforcing problem narratives, they help individuals stabilise, access personal resources, and re-establish a sense of control and competence. This helps reduce the likelihood of escalation to crisis, extended absence or long-term disengagement.They can also be applied with a therapeutic or coaching/personal development-based focus, and indeed align well with coaching - without losing therapeutic depth and impact.

Importantly, the aim is not dependency. A core principle of solution-focused work is that individuals leave therapy better able to regulate themselves, navigate challenges and maintain wellbeing independently. For employers, this aligns closely with the goal of sustainable performance rather than repeated cycles of intervention. It reframes mental health support as a capacity-protecting investment rather than a remedial cost - a point strongly echoed in the Mayfield Review’s emphasis on prevention and faster access as the most effective levers available to employers.

5.3 Autonomy, goal clarity and coaching-aligned delivery

One of the clearest findings across psychotherapy and workplace wellbeing research is the importance of autonomy. Engagement improves when individuals experience a sense of ownership over goals, direction and pace - and declines when support feels imposed, generic or externally defined^{30, 25}.The Consumer Reports study - the largest follow-up study of psychotherapy outcomes to date - found that clients who exercised choice and control over their therapy did better overall, while restrictions on therapist choice or treatment length reduced effectiveness (Seligman, 1995)⁴².

Solution-focused approaches are inherently autonomy-led. Goals are defined by the individual, framed in practical, future-oriented terms, and revisited collaboratively. Progress is measured not only by symptom change, but by improvements in focus, decision-making, relationships and day-to-day functioning - restoring confidence, clarity, emotional regulation and effectiveness in daily life.

This makes solution-focused work particularly compatible with coaching cultures and leadership development environments. Rather than requiring employees to “pause” performance or coaching work in order to address mental health, it integrates psychological support into the broader context of how people lead, work and live.For professionals who are highly self-aware and results-oriented, this alignment significantly increases perceived relevance - reducing the sense that therapy is something separate from, or disruptive to, working life, and positioning it instead as a positive tool for progress.

5.4 Engagement, access and real-world delivery - breaking down barriers

As discussed in Section 2, many barriers to engagement arise before employees ever attempt to access support. Timing, capacity, confidentiality concerns and practical fit all play a role.

Solution-focused interventions are well suited to overcoming these constraints.

5.4.1 Ease of access

They are typically deliverable online (which has been shown to work just as well as in-person delivery - NHS data support this), reducing logistical barriers and enabling earlier access. Session structures can be flexible, focused and time-efficient, making them easier to integrate alongside demanding roles.

Anecdotal evidence from workplace delivery also suggests that busy professionals value the ability to access support discreetly - for example, during a break in the working day or while working remotely - reducing both practical and psychological barriers to early engagement.

5.4.2 Confidentiality & non-disclosure

Confidentiality is a particularly important factor. Solution-focused therapy does not require disclosure of diagnoses, detailed histories or workplace specifics. When delivered independently by external, regulated professionals, it can operate without organisational visibility beyond aggregate utilisation data.For senior professionals and leaders - for whom perceived exposure, judgement or career impact remain powerful deterrents - this non-disclosure model materially lowers the threshold for engagement. The evidence consistently shows that perceived confidentiality, rather than formal policy, is what determines whether individuals access support early or wait until difficulties escalate.

By reducing friction at the point of access, solution-focused models increase the likelihood that support is used preventatively rather than reactively - a key determinant of both individual and organisational outcomes.

5.5 Credibility, governance and ethical delivery

Concerns about quality, professionalism and accountability are increasingly prominent in workplace mental health decision-making, particularly given the rapid expansion of digital and unregulated wellbeing offerings.

Solution-focused therapy is not an informal or unregulated intervention. When delivered appropriately, it is provided by trained, registered practitioners operating within established ethical frameworks, with requirements for supervision, continuing professional development and professional accountability.

This matters not only for clinical safety, but for organisational trust. Employers, insurers and HR leaders require confidence that interventions are ethically sound, professionally governed and defensible in procurement and governance terms.

At the same time, the delivery model avoids many of the structural features that undermine trust in traditional workplace pathways - including employer-linked reporting, diagnostic labelling or rigid protocol-driven frameworks. This combination of professional rigour and delivery independence is a key factor in engagement and perceived credibility.

5.6 What this means in practice

Taken together, the evidence suggests that solution-focused psychological approaches address many of the structural, psychological and practical barriers identified earlier in this paper.

They offer:

genuine psychological depth without over-medicalisation or disclosure
early, preventative access aligned with working life
strong engagement through autonomy and goal clarity
improved emotional regulation and burnout prevention
delivery models that protect confidentiality and trust
professional governance suitable for organisational investment
and fit the practical and cultural realities of modern work

They are supported by systematic reviews and meta-analyses across settings and populations⁴⁰.While outcome data varies by population and delivery context, several studies highlight the potential of solution-focused approaches in occupational and performance-critical settings. For example:

An online solution-focused hypnotherapy study involving police personnel reported recovery rates of 78% for anxiety and depression, with 88.9% achieving clinically meaningful improvement and no reported deterioration - substantially exceeding typical recovery benchmarks in standard pathways⁴³.

Cockburn, Thomas & Cockburn (1997) found markedly faster return-to-work outcomes following solution-focused rehabilitation, with 68% returning within seven days compared to 4% in standard care³⁷.

Business-context coaching research (Gerhát, Ocsenás & Münnich, 2025) demonstrated improvements in performance, self-efficacy, wellbeing and positive affect using solution-focused brief coaching, as measured through 360-degree evaluations⁴⁴.

While no single study is determinative, these findings reinforce the broader evidence that approaches combining psychological depth, autonomy and forward momentum may be particularly well suited to working populations.

These characteristics position solution-focused work as a pragmatic, evidence-informed and performance-aligned approach to workplace mental health support - particularly as a first-line and preventative option for working adults.

For employers seeking to move beyond visible provision towards meaningful impact, this represents a shift from asking “what support do we offer?” to “how is that support experienced, trusted and used?”

Section 6 now considers what this means for implementation, commissioning and investment decisions - and how organisations can translate this evidence into effective, scalable workplace mental health strategies.

Section 6: Implications for Employers, Commissioners and Insurers

The evidence reviewed in this paper suggests that the limitations of current workplace mental health provision do not stem from lack of awareness, intent or investment. Rather, they reflect a misalignment between how support is commonly designed and commissioned, and how it is experienced, trusted and used by working populations.

This section considers the practical implications of the evidence for employers, insurers and those responsible for commissioning workplace mental health support.

6.1 Increasing impact

A consistent finding across the evidence is that the presence of mental health provision does not, in itself, predict improved outcomes. Support that exists on paper but is not accessed early, trusted by employees, or completed at sufficient depth cannot reasonably be expected to reduce absence, presenteeism or disengagement.

A recurring theme throughout the evidence is that provision alone does not equal impact.

Support that exists on paper but is not trusted, accessed or completed cannot deliver meaningful returns.

This points to the need for a shift in emphasis:

from breadth of provision to likelihood of engagement
from visibility and compliance to perceived relevance, credibility and trust
from reactive access to early, preventative use
from symptom-based metrics to restored functioning, capacity and personally relevant outcomes

This shift does not require organisations to abandon existing provision. It does, however, require closer scrutiny of whether current models are structurally capable of delivering the outcomes they are intended to achieve - and can be used early, confidently and effectively by the people most at risk of burnout, disengagement or silent struggle.

6.2 Considerations for commissioning and procurement

For employers, HR leads, procurement teams and insurers, the evidence suggests that several factors should sit alongside traditional considerations such as cost, coverage and utilisation.

These include:

whether support is likely to be used by those in high-responsibility or senior roles, rather than a small subset of repeat users

whether delivery models minimise perceived organisational visibility, protect trust and provide perceived independence and confidentiality

whether interventions are capable of addressing emotional regulation, burnout and sustained functioning, not only acute distress

whether outcomes are defined in work-relevant terms rather than solely clinical benchmarks: confidence, decision-making and functional capacity

whether access is flexible, discrete and timely enough to support prevention rather than late-stage response

whether delivery is governed by appropriate professional, ethical and supervisory standards

When assessed against these considerations, the evidence reviewed in this paper suggests that solution-focused psychological approaches are particularly well aligned with the needs of working populations - especially as a first-line and preventative option.

6.3 Positioning within a wider system of support

Importantly, the evidence does not suggest a single “silver bullet” for workplace mental health.

Solution-focused approaches are not proposed as a replacement for specialist clinical care where this is required, nor as a substitute for awareness & wellbeing initiatives, leadership training, education or organisational change.

Instead, they appear to address a critical gap that persists in many current systems: timely, trusted, psychologically substantive support for working adults who are struggling to function optimally, but who may not meet thresholds for secondary care or be willing to engage with traditional workplace pathways.

In practice, this means that solution-focused interventions can:

complement EAPs, insurance-funded therapy and NHS provision
reduce pressure on escalation pathways by supporting earlier intervention
sit alongside coaching and leadership development rather than displacing or interrupting them
provide an accessible, psychologically safe entry point for individuals who would otherwise avoid support

This positioning aligns closely with the emphasis on prevention and early access set out in the Mayfield Review, and with evidence that earlier, trusted intervention is associated with better outcomes for both individuals and organisations.

6.4 Alignment with national reform priorities

The conclusions of this paper closely reflect the priorities set out in the Mayfield Review of workplace health and disability. Mayfield’s central argument is not that employers lack concern or investment, but that existing approaches have failed to deliver impact at scale - and that reform must focus on prevention, early intervention, and clarity around what works in real-world settings.

Specifically, the review calls for:

greater emphasis on early and preventative support
interventions that enable people to remain in, or return to, work
approaches that are trusted and used before difficulties escalate
delivery models that work alongside employment rather than outside it
better alignment between investment and outcomes

The evidence reviewed in this paper suggests that solution-focused psychological approaches are well aligned with these objectives.

By enabling access without diagnostic labelling or disclosure, supporting emotional regulation and functional recovery, and fitting the practical realities of working life, such approaches address many of the barriers that Mayfield identifies as limiting the effectiveness of current provision.

Importantly, they offer a credible mechanism for delivering the kind of first-line, preventative psychological support that the review highlights as missing - particularly for working adults who are not acutely unwell, but whose capacity, confidence or resilience is being steadily eroded.

As employers, insurers and policymakers explore the next phase of workplace health reform - including vanguard initiatives, pilots and system-level redesign - the evidence suggests that solution-focused models warrant serious consideration as part of a more effective, prevention-led mental health ecosystem.

6.5 Summary implications

The evidence suggests a significant opportunity for organisations willing to rethink how psychological support is positioned, commissioned and delivered.

Approaches that combine psychological depth with accessibility, autonomy, confidentiality and real-world relevance are more likely to be engaged with early, completed, and translated into sustained improvements in functioning and performance.

For employers, insurers and commissioners, this reframes workplace mental health support as a strategic, capacity-protecting investment rather than a reactive cost - with implications not only for wellbeing outcomes, but for productivity, retention and organisational resilience.

Evidence, Interpretation and Authorship

A note on perspective and transparency

This paper has been authored by The Better Brain Company, a UK-based organisation specialising in the design and delivery of solution-focused psychological interventions for working adults. The perspectives presented reflect our clinical and organisational experience, alongside the published evidence cited.Our work is grounded in the approaches discussed throughout this paper, and our perspective is shaped by direct experience of delivering solution-focused interventions within workplace contexts.

The intention of this paper is to contribute to informed discussion and decision-making around effective workplace mental health provision. It is not intended as a neutral review of all possible approaches, but as a transparent, evidence-informed articulation of why this model addresses persistent gaps that employers, insurers and policymakers continue to face.

We believe transparency strengthens credibility. Readers are encouraged to interrogate the evidence, explore alternative models, and draw their own conclusions about what best serves their people and organisations.

Author Details

This paper was compiled by Abigail Rogers, Founder & Therapist at The Better Brain Company, in February 2026. In house research by Caroline Brown, Partner, Strategy & Ops.

The Better Brain Company is a Bristol-based UK consultancy, specialising in mental health and wellbeing, leadership development, and cognitive performance solutions tailored to SMEs, corporate clients, and high-performance individuals.

Our neuroscience-based, solution-focused, ‘talk-optional’ therapeutic framework is individually tailored to reduce stress, burnout, anxiety, and disengagement, boost productivity, and help create psychologically safe foundations for sustainable growth and impact.

Find out more via our website www.betterbraincompany.com, or please feel free to get in touch via email abi@betterbraincompany.com.

Acknowledgements

We are indebted to SheStrategic Consultancy, part of the Leeds University Soul Project, for their painstaking work in collating much of the evidence cited in this paper. Particular thanks to our research team: Ane Lundy-Munoz, Hong Ha Linh Vu, Laxmi Shinde, Mariam Kone, Minna Watson and Sanaa Elcock.

References & Sources

This paper draws on peer-reviewed research, established clinical frameworks, and practitioner experience available at the time of writing. While care has been taken to ensure the accuracy and appropriate representation of referenced sources, this document is not intended as a formal scientific or systematic review. If you believe any reference has been misinterpreted or misrepresented, we welcome constructive feedback.

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