Keep Britain Working: Sir Charlie Mayfield on fear, mental health and the workplace

Ill health has quietly become one of the biggest reasons people leave the UK workforce. More than one in five working-age adults are now out of work and not looking for a job, often because of health problems. The economic impact is huge, but for Sir Charlie Mayfield, who led the government’s recent Keep Britain Working Review, the more urgent question is what this means for people, workplaces and communities.

Speaking to Thalamos, Mayfield reflected on nine months spent travelling the country, listening to employers, employees and local leaders. The thread that runs through almost every conversation is mental health, and how it shows up in the workplace long before someone reaches crisis point.

Fear on both sides of the desk

When asked what stood out most, Mayfield goes straight to one word: fear. For people experiencing a mental health problem, that fear is often about disclosure. If they are anxious, depressed or starting to struggle in ways they do not fully understand, telling a manager can feel like a huge personal risk. They may worry about judgement, career impact or being managed out altogether.

But fear sits with employers too, especially with line managers. Most want to do the right thing. They know health is personal and private. At the same time, today’s workplace is highly risk aware. Policies designed to prevent grievances or claims can end up discouraging managers from stepping in at all, for fear of overstepping or saying the wrong thing.

The result is a kind of polite distance. Everyone can see that someone is struggling, but no one feels quite confident enough to name it. That space between people can allow relatively manageable problems to grow into something far more serious.

The review identifies this culture of fear as one of the core barriers to healthier, more supportive workplaces, alongside limited support for employers and deep structural inequalities for disabled people.

Small firms, big responsibilities

There is a common assumption that large organisations are always better placed to manage health at work because they have more resources. Mayfield’s experience is more nuanced.

Bigger employers do have access to HR, occupational health and specialist services. But smaller organisations, he says, can have advantages too. They are often more like communities, where people know each other personally and informal support can be easier to offer. Those same close relationships can create complications, but the point stands: good handling of health is as much about behaviours and relationships as it is about budget lines.

That message matters for the thousands of smaller employers who may feel this agenda is only for major corporates. In reality, they are often closest to their people and best placed to notice when something is changing.

The workplace as an early warning system

Fear matters because work is often where early signs appear first. People spend much of their week at work. Changes in confidence, sleep, mood or motivation often show up as dips in performance, conflict with colleagues or unexpected absence.

“It’s natural that performance is the first thing a line manager will notice,” Mayfield said. But if all they feel able to do is “manage the performance,” they may miss the underlying issue and make things worse.

He is careful not to turn managers into amateur psychiatrists. Mental health is inherently complex, often irrational and frequently shaped by factors far beyond work. A person’s distress may have its roots in family life, money worries or past trauma, even as it plays out in a work environment.

The challenge, he argued, is not to find a magic solution, because there is not one. It is to create cultures where it feels safe for people to say something is wrong, and where managers have enough confidence and support to respond constructively.

This is especially important against a backdrop where mental health conditions have been rising for years. The review’s discovery phase showed an uptick in reported mental ill health from around 2014, particularly among younger people. COVID-19 intensified the issue and made it more visible, but it did not create it.

“There’s a danger,” he suggested, “that if we see this as a COVID story, we also assume it will pass.” In reality, employers are facing a sustained increase in mental health need that will not simply revert to an old normal.

VIDEO: Sir Charlie Mayfield reflects on why mental health issues are rising in the workplace and why simple checklists or one-off training can’t solve them. He explains the complex ways mental health shows up at work, how performance concerns can mask deeper issues, and why building cultures where people feel safe to speak up early is essential. This clip explores the next phase of the Keep Britain Working mission and the role employers, managers and government must play in creating supportive, human workplaces.

When absence becomes separation

Fear also shapes what happens when someone goes off sick. Mayfield described a familiar pattern. Someone is signed off with stress or another mental health issue. HR guidance is interpreted as “do not contact them,” for fear of being seen as intrusive or bullying. Weeks pass with little or no dialogue. The employee receives sick pay and time off, but not much else.

“Health does not work like a light switch,” Mayfield said. People do not disappear unwell and then reappear fully recovered. Without contact, the return is almost guaranteed to be harder.

He recalled a young retail worker with severe anxiety on the shop floor. After repeated short absences, she was signed off for six months with generous sick pay and virtually no treatment or contact. When she returned, she went straight back into the same environment. Within an hour she experienced another panic attack. The employer, having “tried everything,” ended her contract on ill-health grounds. The outcome, he says, was entirely predictable.

One of the review’s clearest recommendations is to make return-to-work planning a norm. After two to six weeks of absence, employers, employees and workplace health professionals should meet to agree a plan. This might include phased hours, adjusted duties or time to reconnect with colleagues before full responsibilities resume.

Mayfield likened it to “keeping in touch” days in maternity and paternity leave. Those were once a cultural shift; now they are simply how responsible employers operate. He believes a similar shift is needed for health-related absence.

VIDEO: Sir Charlie Mayfield discusses one of the most overlooked problems in workplace mental health: what happens when someone goes off sick. He highlights how fear stops employers from checking in, why silence during absence creates distance and how a lack of support can lead people to fall permanently out of work. He sets out the case for routine return-to-work planning and explains why the UK needs a cultural shift similar to maternity ‘keeping in touch’ days.

The hidden exclusion of disabled people

Alongside mental health, Mayfield is struck by the “shocking” level of exclusion faced by disabled people, particularly those with learning disabilities.

Across the UK, disabled people are far less likely to be in work than non-disabled people. For people with learning disabilities, the employment rate is around 5%. Behind those figures are people shut out of the everyday benefits of work: community, structure, income and belonging. The impact extends to families and carers too.

On his travels, he saw organisations proving it does not have to be this way. In Northern Ireland, USEL supports over 1,000 people with learning difficulties into sustainable employment through commercially viable contracts, including a province-wide document shredding service reserved for organisations employing a high proportion of disabled workers. In Denmark, municipal duties to provide participation opportunities have led to supported jobs in supermarkets, where specialist work coaches help teams employ dozens of people with learning disabilities.

These models show that with the right design, support and incentives, even entrenched exclusion can be turned into mutual benefit.

Why best practice is not enough

With a background in productivity and performance, Mayfield understands the appeal of “best practice.” But he is blunt about its limits. “What is best practice in one organisation may be irrelevant, or the wrong priority, in another,” he added. A checklist that feels empowering in one context can feel like a compliance burden somewhere else. For mental health, where causes and experiences are so varied, the limitations of a one-size-fits-all model are even sharper.

Instead, the review argues for an outcomes-driven approach. Employers should track what really matters, such as sickness absence, successful returns to work and the participation of disabled people, and work towards improving those outcomes in ways that fit their context. If the measures improve, it is a strong signal that more of the right conversations and practices are in place, even if they look different from organisation to organisation.

A major focus of the next phase will be to work with employers and employees to test which approaches actually move those outcomes, then support wider adoption.

Technology, data and the chance to do better

Technology sits in the middle of this story. It is part of the disruption, reshaping jobs and contributing to anxiety about work. But it could also be part of the solution.

Training line managers will always matter, Mayfield said, but it will never be enough on its own. Expecting every manager to handle the full spectrum of mental health challenges confidently is unrealistic.

Here he sees potential in digital tools: evidence-based chatbots or apps that feel more approachable to younger workers than a formal meeting; anonymous guidance for managers who are unsure what to do; digital case management that keeps track of absences and adjustments so people do not fall between the cracks.

Data is the other missing piece. Today, information on workplace health is patchy and fragmented. The review calls for better, aggregated data so that what currently feels intractable can become more manageable. If government is to incentivise good practice, it needs a clear evidence base for what works. Employers, too, need to see the impact of changing how they support people.

What happens next

The review has not been left to gather dust. Seventy-two major employers and six mayoral authorities have already committed to be part of the next phase. The government has backed the review’s three main recommendations and asked Mayfield to co-chair the work alongside the Secretaries of State for Business and Trade, Work and Pensions, and Health and Social Care.

A “vanguard phase” is due to launch next year. Behind the scenes, a small delivery organisation or “movement HQ” is being created to coordinate employer, mayoral and government efforts, and to make sure that enthusiasm is channelled into practical outcomes rather than unstructured discussion.

For individual employers, though, Mayfield is clear that action does not have to wait. “The first obvious point is we need you on the pitch,” he urged. “There is no way to solve this without employers.”

The second is to recognise that this is fundamentally about behaviour and relationships. “To some extent, what we need to do is re-humanise the workplace,” he argued. In risk-aware, procedural environments, opportunities for simple human conversations can erode. Looking for ways to rebuild those connections is something every organisation can start on now.

If that happens at scale, fewer people will reach mental health crisis. More will find that the place they spend much of their week is also a place where it is safe to say “I am struggling,” and to be met with understanding, support and a plan.