For years, conversations about mental health at work have focused on absence.
How many employees are off work? How many days have been lost? What is the impact on productivity?
Those numbers matter but they only tell part of the story. We need to pay equal attention to the people who are still showing up.
Many employees are continuing to work while struggling with their mental health. They’re keeping all the plates spinning, but at an increasing personal cost.
They’re meeting deadlines, attending meetings and appearing productive, yet behind the scenes they’re battling stress, burnout and other pressures.
This year’s Bupa Wellbeing Index highlights a worrying trend.
While workplace sickness absence is at its highest level in 15 years, nearly three-quarters (71%) of employees told us they had gone to work knowing they were experiencing mental health issues.
More than two in five (41%) said they had worked through illness rather than taking sick leave.
On paper that might sound positive. Employees are staying in work rather than leaving it but look more closely and a different picture emerges.
Being present at work is not always a sign that someone is well. Often, it’s a sign they’re pushing through.
More than half of employees say the cost of living is negatively affecting their mental health, while 44% cite financial pressures as the main reason their mental health is affecting their ability to work.
Workload pressures, caring responsibilities and the desire to keep performing mean many people keep going when they’re struggling.
By the time they seek help, what could have been addressed earlier has become more difficult to manage.
A warning sign for the next generation
We often view Gen Z as the most open generation when it comes to mental health. They’re more willing to talk about it and challenge the stigma from previous generations.
However, our research suggests that awareness is not always translating into action.
Recent comments from the chair of the government’s mental health review highlighted that young people are “not snowflakes”, pushing back against stereotypes about Gen Z in the workplace. Our findings support that view.
Rather than avoiding work, many younger employees are continuing to show up while struggling.
Nearly nine in 10 employees aged 18-24 have attended work while knowingly experiencing mental health challenges. More than seven in 10 have delayed seeking help because they did not want to take time away from work, and mental health is now affecting the ability to work of 41% of people in this age group – significantly higher than among older generations.
For all the progress we’ve made in talking about mental health, many younger employees still feel that asking for support is letting the side down.
For employers, that should be a wake-up call. These people are the future leaders and innovators of British business.
The business cost of pushing through
When left unaddressed, the challenges driving presentism can develop into more serious health concerns.
When employees continue to work while struggling with their mental health, those issues don’t disappear. Without the right support, they can get worse over time, leading to higher levels of sickness absence and an increased need for treatment.
Our research found approximately 150 million working days are lost to sickness every year. Almost 18 million of those days are linked to mental health, costing the UK economy £6.1bn each year.
That growing need is reflected in demand for mental health services.
Bupa data shows the number of mental health claimants has increased by 42% over the past five years, while mental health treatment has increased by 67%. In 2025 alone, we recorded more than one million mental health claims.
Turning insight into action
There is increasing recognition across government, employers and the health sector that tackling workforce ill health requires collective action.
That’s why it’s positive to see organisations from across the sector, including ourselves, contributing to the Keep Britain Working review.
Employers have a critical role to play in creating environments where people can access support quickly before issues escalate.
This starts with training managers to spot when someone is struggling, creating a culture where asking for help is encouraged, and making support easy to access during the working day.
We’re continuing to invest in workplace health support for our own people, including expanding our Mindplace mental health services and introducing on-site GP access in our offices.
While every organisation is different, bringing support closer to where people work can help remove barriers to seeking help early, before challenges reach crisis point.
We should celebrate the progress we’ve made in bringing mental health into the workplace conversation, but the challenge is constantly evolving.
The greatest risk facing businesses today might be the colleague who never takes a day off, never misses a deadline and never asks for help.