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Presenteeism in the Workplace: The Hidden Cost of Turning Up Unwell

There is a quiet erosion taking place in many organisations.

People are present, but not well enough to work effectively. They attend meetings while exhausted. They answer messages while anxious. They remain on site with a migraine, work from home with depression, or push through a period of acute stress because taking time off feels impossible.

This is presenteeism in the workplace: working while physically or psychologically unwell, at a reduced level of capacity.

It is the less visible counterpart to absenteeism. Absence appears in reporting systems. Presenteeism in the workplace often appears only as delayed decisions, avoidable mistakes, strained relationships, lower concentration and people quietly withdrawing from their work.

For HR and senior leaders, the question is not simply, “How many days are people absent?” It is also: How many people are turning up when their nervous system is already overwhelmed? That is where presenteeism in the workplace becomes a culture and leadership issue, not only an individual health issue.

Presenteeism in the workplace: what it means and why it is missed

Absenteeism describes time away from work because of illness. Presenteeism describes being at work while illness, stress or poor mental health reduces a person’s ability to function.

The distinction matters because the two can follow the same pathway. Someone may initially work while unwell, then reach a point where their nervous system can no longer sustain the demands of the role. What looked like commitment can become burnout, long-term absence or an eventual decision to leave.

Presenteeism is under-measured for several reasons:

  • Employees may not disclose the underlying health issue.
  • Managers may interpret presenteeism as dedication or resilience.
  • Productivity loss is difficult to separate from workload, capability or performance concerns.
  • Remote working can make it possible to appear available while functioning at very limited capacity.
  • Employees may not recognise that they are working below their usual level.
  • Organisations often measure sickness absence without asking about people who worked while unwell.

The Enterprise Research Centre reported that 37% of employers had observed some level of presenteeism in the previous 12 months in its 2023 research, compared with 21% the year before. The research also identified business deadlines and financial pressure among the reasons employees continued working when unwell.

These are not simply individual choices. They are signals about the working environment.

What drives presenteeism in the workplace?

The causes are usually layered. A person’s mental health, physical health, personal circumstances and workplace culture interact with one another. Presenteeism in the workplace rarely has one simple cause.

Common drivers include:

  • Excessive workload: There is no realistic recovery time between demands.
  • Unclear expectations: Employees do not know what can safely be deprioritised.
  • Job insecurity: People fear that absence will affect their reputation, income or future prospects.
  • Fear of letting the team down: Particularly where staffing is tight or deadlines are inflexible.
  • Leadership behaviour: If senior people answer emails late at night and never take leave, this becomes a powerful cultural message.
  • Financial pressure: Some employees cannot easily absorb reduced income or the perceived risk of taking time away.
  • Caring responsibilities: Parents and carers may work while unwell because they have no spare capacity elsewhere.
  • Remote and hybrid working: The boundary between work and recovery can become blurred.
  • Presenteeism culture: Statements such as “we all push through” can make healthy boundaries feel disloyal.
  • Male-dominated workplace norms: In sectors such as construction, manufacturing, engineering, logistics, sport and financial services, emotional restraint and stoicism may be valued more openly than asking for support.

In these settings, distress may not look like sadness. It may appear as anger, withdrawal, risk-taking, overworking, emotional shutdown or a refusal to delegate.

The nervous system does not respond only to job titles and policies. It responds to perceived threat, uncertainty and pressure. When people believe that speaking up will carry a social or professional cost, they may continue working while unwell rather than disclose what they need. In many organisations, presenteeism in the workplace is a response to that perceived threat.

Rebecca Lisi delivering a keynote on workload, stress and workplace culture

The link with psychological safety

Psychological safety in the workplace means that people can ask questions, admit mistakes, raise concerns and discuss difficulties without fear of humiliation or punishment.

Google’s Project Aristotle identified psychological safety as the most important of five team dynamics associated with effective teams. This does not mean that psychological safety is a soft extra. It is part of how teams share information, manage risk and respond to problems early.

Are people able to say, “I am not working at my usual capacity today”?

Can a manager hear that without becoming dismissive?

Do employees feel valued as human beings, rather than only as sources of output?

Where psychological safety is low, people often conceal stress until the body or mind forces a clearer interruption. Where it is stronger, employees are more likely to ask for help, take appropriate time away, discuss adjustments and recover before difficulties become more severe.

I explore this relationship in more detail in my guide to Psychological Safety in the Workplace.

The cost picture for employers

Presenteeism in the workplace carries a human cost first. It can affect sleep, concentration, emotional regulation, relationships and physical health. It can also increase risk for colleagues and customers when someone is making decisions while significantly impaired by stress, illness or exhaustion.

The financial picture is substantial, although all figures should be treated as estimates rather than precise predictions for an individual organisation.

The UK Government’s Keep Britain Working technical note estimates that poor workplace health costs employers around £85 billion a year, including approximately £21 billion in lost productivity from presenteeism. Deloitte’s modelling has previously estimated that poor mental health costs UK employers tens of billions annually, with mental-health-related presenteeism accounting for a larger cost than absence in its model. In other words, presenteeism in the workplace is not a marginal issue. It is a significant organisational cost.

Deloitte has also reported an average return of approximately £5 for every £1 invested in workplace mental health interventions. This is a modelled estimate, not a guarantee. Outcomes depend on the quality, relevance and implementation of the intervention, as well as the organisation’s starting point.

The message is clear: supporting mental health is not separate from organisational performance. It is part of creating conditions in which people can thrive.

What actually reduces presenteeism in the workplace?

A meaningful response needs to address the drivers, not simply encourage individuals to become more resilient. If we want to reduce presenteeism in the workplace, we need to create environments where recovery, clarity and psychological safety are taken seriously.

1. Assess psychosocial risks

Use employee voice, surveys, absence data, exit interviews and focus groups to identify risks such as workload, low control, poor relationships, role ambiguity and organisational change.

2. Improve workload and job design

Ask what can be stopped, delayed, delegated or redesigned. A wellbeing message cannot compensate for permanently unrealistic work.

3. Build manager capability

Managers need practical skills to notice changes, begin supportive conversations, respond appropriately and signpost employees without attempting to diagnose or provide therapy.

This may include Mental Health Training for Managers alongside wider Corporate Mental Health Training.

4. Clarify flexibility and hybrid expectations

Make it clear when employees should rest, how sickness is reported, what availability means and how caring responsibilities can be discussed. Remote access should not become an expectation to work through illness.

5. Provide reasonable adjustments and phased support

Where appropriate, consider changes to hours, duties, location, communication or workload. Return-to-work conversations should focus on sustainable participation, not simply getting someone back to full output immediately.

6. Model recovery at leadership level

Leaders set the emotional climate. Taking leave, respecting boundaries and acknowledging limits are visible acts of culture-building.

7. Measure more than absence

Include questions about working while unwell, recovery, workload, psychological safety and confidence in speaking up. Segment findings carefully by team, role, location and demographic group to identify patterns without blaming individuals. Without that wider view, presenteeism in the workplace can remain hidden in plain sight.

Rebecca Lisi delivering practical employee mental health training to a group

What does not work on its own?

Surface-level perks rarely address the source of presenteeism. Free fruit, wellbeing apps or a single annual awareness session may be useful additions, but they cannot resolve excessive workload, insecure management or a culture that rewards self-neglect. When presenteeism in the workplace is being driven by chronic pressure, surface solutions rarely reach the root of the problem.

It is also unhelpful to treat presenteeism as an individual resilience problem. Personal coping skills matter, but the nervous system is affected by the environment in which people work. Asking employees to manage stress better while leaving the underlying stressors untouched can increase frustration and reduce trust.

A stronger approach combines policy, job design, leadership behaviour, employee voice and practical education. This is the difference between an isolated corporate wellness program and a genuinely integrated wellbeing strategy.

You may wish to explore the broader framework in my Employee Wellbeing Strategy guide, or consider Workplace Wellbeing Training and Employee Mental Health Training as part of a wider plan.

A practical conversation opener for managers

A manager does not need to know exactly what diagnosis or problem an employee may be experiencing.

They can begin with:

“I’ve noticed you seem to be carrying a lot recently, and I want to check how work is affecting you. How are you managing at the moment, and is there anything we should look at together?”

Then pause.

Listen without rushing to reassure, solve or compare. Ask what would make the next few weeks more manageable. Agree practical steps and arrange a follow-up conversation.

Training and consultancy are not therapy. A manager’s role is to create a supportive working conversation, consider work-related adjustments and signpost appropriate professional or clinical support where needed.

How to measure presenteeism in the workplace alongside absence

Start with a baseline. Review:

  • Sickness absence rates and duration.
  • Overtime, long-hours and out-of-hours communication.
  • Employee survey responses about working while unwell.
  • Workload, recovery and psychological safety scores.
  • Errors, incidents, customer complaints and rework.
  • Turnover, grievances and exit interview themes.
  • Use of occupational health or employee assistance services.
  • Requests for adjustments and phased returns.

Repeat the measures after an agreed period. Look for movement in both wellbeing and operational indicators. A reduction in absence is not automatically positive if people are simply working while unwell instead. To understand presenteeism in the workplace, organisations need to measure what people are experiencing, not only what appears in absence reporting.

As a Workplace Wellbeing Consultant, I help organisations connect these different sources of information and identify practical priorities. My approach is informed by my work as a qualified psychotherapist, MA MBACP, and bridges psychological insight with organisational action.

When presenteeism in the workplace becomes normalised, organisations often miss both the human strain and the operational warning signs. Addressing it well means looking at culture, workload, leadership behaviour and the conditions that help people regulate and recover.

This may involve bespoke training, leadership workshops, consultancy or a keynote delivered by a Corporate Wellbeing Speaker. Fees start from £5,000 nationally and £10,000 plus travel internationally.

To check availability, discuss bespoke content for your leadership offsite, or bring a corporate wellbeing speaker to your next corporate event, let’s start a conversation.

Authoritative sources