Employers face an estimated £51 billion a year in costs linked to poor mental health, with presenteeism accounting for almost half of that total.¹
When organisations think about employee wellbeing, absence is often the measure that gets the most attention.
It can be a clear sign that someone needs support, but it doesn’t always tell the full story.
Many employees continue showing up to work whilst managing stress, burnout, poor mental health or other difficulties. From the outside, they may appear to be coping. They’re attending meetings, getting through their workload and carrying on as normal.
But attendance isn’t always a sign that someone is doing well.
For some people, simply keeping up can require a huge amount of effort, especially when their needs have gone unrecognised or unsupported. This is known as presenteeism: being physically present at work whilst struggling behind the scenes.
Unlike absence, presenteeism is often hidden. Yet its impact can be significant for both individuals and organisations.
“For many organisations, monitoring sickness absence data is not always the most reliable metric for building a business case to implement a neurodevelopmental pathway. Many employees continue to work long before their struggles become apparent.
Showing up every day and meeting expectations can mask challenges that have yet to be recognised.
This highlights the importance of looking beyond attendance data. By creating environments where people feel able to speak openly and access support early, organisations can address difficulties before they become more complex and harder to manage.”
Stephen Hancock, Divisional Director, Melios
Understanding why employees continue working while struggling is an important first step in recognising the hidden impact of presenteeism.
What is presenteeism in the workplace?
Presenteeism happens when employees keep working even though they’re dealing with difficulties that affect their wellbeing, energy or ability to perform.
This may include:
- Stress, anxiety or burnout
- Mental health difficulties
- Sleep problems or ongoing exhaustion
- Caring responsibilities outside work
- Unrecognised or unsupported neurodevelopmental needs such as ADHD or autism
Presenteeism is often difficult to spot. Someone may seem to be coping on the surface while quietly working longer hours, putting in extra effort to stay on top of their workload or feeling increasingly exhausted by everyday tasks.
Many people continue working because they care about their role, don’t want to let colleagues down or feel they should be able to manage on their own. The problem is that without the right support, this can become difficult to sustain over time.
Presenteeism vs sickness absence: what’s the difference?
Absence is often easier to spot. When someone takes time away from work, it creates a clear signal that they may need support. Presenteeism is less obvious.
That’s why absence data only tells part of the story. Looking beyond attendance can help organisations identify support needs before problems become more difficult to manage.
Why do employees work whilst struggling with mental health or stress?
People don’t always make a conscious decision between taking time off and carrying on as normal. More often, they’re trying to balance work, responsibilities and whatever else is going on in their lives.
For some, taking time away from work can feel difficult. They may worry about falling behind, not wanting to let colleagues down, or feel that what they’re experiencing isn’t serious enough to justify time off. Others have simply become used to coping on their own.
This can be particularly true for people with unmet mental health needs or unrecognised neurodevelopmental differences. They may continue meeting expectations and showing up every day, even when they’re finding things increasingly difficult behind the scenes.
This is especially important for neurodivergent employees, whose experiences are not always reflected in traditional measures such as sickness absence.
How presenteeism affects employee wellbeing
When someone continues struggling without support, it can take a real toll on their wellbeing.
Recent research highlights the scale of the challenge, with 36% of respondents in AXA Health’s 2026 Mind Health Report reporting that they are currently experiencing mental health challenges.²
Over time, employees may experience:
- Increased stress and anxiety
- Emotional exhaustion or burnout
- Reduced confidence
- Difficulty concentrating or making decisions
- Lower job satisfaction
- Worsening mental health and wellbeing
What starts as a difficult few weeks can gradually become something much harder to manage. Many people eventually reach a point where they feel exhausted, overwhelmed or unable to keep going without help.
The impact of presenteeism on organisations
The effects of presenteeism in the workplace are not limited to individual wellbeing.
When employees are struggling, organisations may experience:
- Reduced productivity
- Increased errors or missed details
- Lower engagement
- Greater risk of burnout and future absence
- Increased staff turnover
- Additional pressure on managers and teams
When people are using most of their energy just to keep up, they have less capacity to contribute, collaborate and perform at their best.
That affects not only the individual, but the wider team and organisation too.
The impact of these challenges is increasingly recognised by employers. Recent research found that 92% of employers say stress, work-related anxiety and burnout are the conditions most likely to affect long-term workforce sustainability.³
When difficulties remain hidden, organisations may not recognise the need for support until challenges have already begun to affect performance, wellbeing and retention.
How unrecognised ADHD and autism can contribute to presenteeism
For some employees, presenteeism in the workplace may be linked to underlying neurodevelopmental needs that have not yet been recognised or supported.
Adults with ADHD or autism often develop strategies to manage workplace expectations. While these approaches can be effective, they may require significant effort behind the scenes.
Someone may appear highly productive while spending extra hours completing tasks, managing overwhelm or compensating for challenges with organisation, prioritisation or communication.
Over time, this can contribute to stress, exhaustion and burnout.
Without understanding what is driving these patterns, organisations may focus on performance outcomes rather than the support that could help individuals work more sustainably.
How employers can identify and reduce presenteeism in the workplace
Because presenteeism in the workplace is often hidden, creating opportunities for open and supportive conversations is important.
As one recent workforce report notes, “A healthy culture has a direct impact on levels of stress, burnout and presenteeism”.³
Organisations can help by:
- Encouraging regular wellbeing check-ins
- Training managers to recognise early signs of struggle
- Creating psychologically safe environments
- Providing access to mental health support
- Offering workplace adjustments where appropriate
- Supporting employees to access assessment pathways when needed
The goal is not to identify every challenge immediately, but to create a culture where employees feel able to discuss difficulties before they reach crisis point.
Why early intervention matters in the workplace
By the time someone takes extended time away from work, they may have been struggling for weeks, months or even years.
Earlier support can help prevent challenges from escalating and enable employees to access the understanding, adjustments or interventions that may make a meaningful difference.
The need for early intervention is becoming increasingly clear. Research shows that 87% of employers believe mental health and wellbeing will be the factor most likely to impact workforce health over the next five years, while 60% are prioritising investment in mental health and resilience initiatives.²
There is also a strong business case for early intervention. Research from Deloitte found that employers receive an average return of £4.70 for every £1 invested in workplace mental health support and wellbeing initiatives.¹
While the benefits are often measured in productivity and retention, the most important outcome is helping people access support before challenges begin to affect their wellbeing more significantly.
For some individuals, this may involve workplace adjustments or mental health support. For others, it may include exploring whether underlying neurodevelopmental needs such as ADHD or autism are contributing to their experiences.
As Lauren Lunniss of BNP Paribas explains: “Whatever the initial problem, the longer it goes untreated, the more it’s going to affect your wellbeing. That’s why getting early intervention is so crucial”.
Whatever the route, proactive support is often more effective than waiting until difficulties become impossible to ignore.
Looking beyond attendance: supporting employee wellbeing earlier
Attendance alone does not always tell the full story of employee wellbeing.
Many people continue showing up to work while managing significant challenges behind the scenes. Although this commitment is often viewed positively, it can sometimes mask the need for support.
By recognising the hidden impact of presenteeism in the workplace and creating pathways for earlier intervention, organisations can support healthier, more sustainable ways of working.
When employees feel understood and supported, both individuals and organisations are better placed to thrive.
Looking to better support employee wellbeing?
Melios works with organisations to provide ADHD, autism and mental health support that helps employees access the right understanding and support at the right time.
To learn more about our workplace services, get in touch with the team or book a conversation.
Sources
Deloitte – Mental Health and Employers: The Case for Investment
AXA Health – Mind Health Report 2026
REBA –The growing gap between employee needs and employer investment
