Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

The recommendations in this guideline apply to micro, small, medium-sized and large organisations equally, although some recommendations may need to be tailored to specific organisations and circumstances.

1.1 Strategic approaches to improving mental wellbeing in the workplace

1.1.1 Adopt a tiered approach to mental wellbeing in the workplace by using organisational-level approaches as the foundation for good mental wellbeing (the first [bottom] tier), followed by individual approaches (the second [middle] tier) and targeted approaches (the third [top] tier).

1.1.2 Adopt a preventive and proactive strategic approach to mental wellbeing at work in your organisation. Take into account:

1.1.3 Proactively promote mental wellbeing by ensuring that it is embedded in the overall business strategy of all organisational policies and practices. Take into account the recommendations in the section on supportive work environment.

1.1.4 Ensure that a stress risk assessment is carried out for each role as required by the Health and Safety at Work etc Act 1974, for example using the Health and Safety Executive's risk assessment template:

1.1.5 Ensure that systems are in place to provide support for employees for whom external factors are influencing their mental wellbeing. See the section on training and support for managers.

1.1.6 Monitor and evaluate the support you provide at least on an annual basis using a relevant evaluation tool. Public Health England's evaluation in health and wellbeing provides a list of resources and summarises what they are used for.

1.2 Supportive work environment

1.2.1 Foster a positive, compassionate and inclusive workplace environment and culture to support psychological safety and mental wellbeing by:

  • ensuring active leadership and management support and engagement

  • increasing mental health literacy

  • encouraging and facilitating peer support (for example, using mental health champions and peer mentoring or 'buddying')

  • supporting people who manage and support employees

  • encouraging employees to recognise and take action to prevent discrimination in the workplace, for example by establishing and supporting staff networks

  • being aware that mental wellbeing in the workplace also depends on factors beyond the workplace itself (such as physical health, domestic relationships, home environment and financial circumstances) and also on societal discrimination (such as racism, homophobia and sexism)

  • promoting good communication and engagement with employees

  • including mental health awareness in manager training (see the section on training and support for managers).

1.2.2 Develop policies, processes and ways of working with staff that are equitable and inclusive, and that encourage a fair and supportive workplace environment and culture, in order to maximise employee wellbeing. Take into account:

1.2.3 Offer employees a private space and protected time to engage with interventions, taking into account the need for confidentiality.

1.3 External sources of support

1.3.1 Use external expertise in the local authority (see the section on local and regional strategies and plans), Department for Work and Pensions and other agencies (for example, from the voluntary, charity and social enterprise sector or chambers of commerce) to access support for employees, including action plans and toolkits (for example, from What Works Wellbeing, Business in the Community, Mind and the Health and Safety Executive).

1.3.2 Make employees aware that if they have mental health problems, they can use the Department for Work and Pensions' access to work mental health support service. NHS and social care staff can use the staff mental health and wellbeing hubs (and other national health and wellbeing support offers).

1.3.3 Use local and national resources, and advice from a variety of evidence-informed sources, such as the local Improving Access to Psychological Therapies services offer, the employee's GP, professional bodies, unions and trade organisations (for example, Federation of Small Businesses, ACAS and the Chartered Institute of Personnel and Development [CIPD]).

See also the section on early intervention in NICE's guideline on workplace health: long-term sickness absence and capability to work.

1.4 Organisation-wide approaches

1.4.1 Involve employees and workplace representatives in identifying and minimising sources of stress at work. (See also the section on job design in NICE's guideline on workplace health: management practices.)

1.4.2 Consider using workplace accreditations or charters, such as guidance to improve the organisation-wide workplace environment and culture (for example, the Workplace Wellbeing Charter, Mindful Employer and Mind's Workplace Wellbeing Index).

1.4.3 Tailor interventions to meet the needs of the organisation and its employees (for example, according to the industry sector or the size of the organisation).

1.4.4 Refer to existing guidance and best practice on job quality, work design and organisation to identify and reduce work stressors, such as Health and Safety Executive's Management Standards for work-related stress, Mindful Employer or COVID‑19-specific advice (for example, from the CIPD).

1.4.5 Consider using staff surveys or other engagement approaches, for example working with employee representative organisations (such as trade unions or staff networks), to determine whether tailored solutions are needed to improve mental wellbeing in the workplace (for example, What Works Wellbeing's employee wellbeing snapshot survey).

1.4.6 Consider giving all employees free access to an employee assistance programme and occupational health services, and raise awareness of them if they are offered (for small and medium-sized enterprises). (See also the section on making this guideline relevant for small and medium-sized enterprises [including micro-enterprises]).

1.4.7 Have a plan for responding to unexpected traumatic events affecting employees, such as the death of a colleague, a pandemic or a terrorist attack. This should include supporting people socially and with their mental wellbeing. For example, see the UK Health Security Agency's course on COVID-19: psychological first aid or NHS England and NHS Improvement's guidance on responding to the needs of people affected by incidents and emergencies.

See also the section on monitoring and evaluation in NICE's guideline on workplace health: management practices.

1.5 Training and support for managers

1.5.1 Offer systematic support for managers. Include training, and regular refresher training, in:

  • line management

  • communication skills (the ability to listen, communicate clearly, understand and empathise).

1.5.2 Equip managers with the knowledge, tools, skills and resources to:

  • improve awareness of mental wellbeing at work

  • promote mental wellbeing and prevent poor mental wellbeing

  • improve employees' understanding of and engagement in organisational decisions

  • improve communication between managers and employees.

    This should include managing people remotely.

1.5.3 When offering mental health training for managers, consider including:

  • how to have a conversation on mental wellbeing with an employee, including at times of crisis

  • information about mental wellbeing

  • how to identify early warning signs of poor mental wellbeing

  • resources on mental wellbeing, including knowing where to go for further help or support in complex situations

  • awareness of the stigma associated with poor mental wellbeing

  • ongoing management and monitoring of mental wellbeing in the workplace

  • topics suggested by managers.

1.5.4 Ensure that all managers have time to attend relevant training sessions.

1.5.5 Empower managers to make necessary adjustments to workload or work intensity for their employees, for example flexible or hybrid working.

1.5.6 Encourage managers to address their own mental health needs as well as those of their employees, for example by peer-to-peer support for managers on mental wellbeing.

1.5.7 Consider a group approach to deliver mental health training. Training could be delivered either face to face or using online formats.

1.5.8 Evaluate how mental health training for managers affects employee outcomes (for example, by surveying employees and managers or focus groups) and feed the results back into future training and strategy.

See also the section on training in NICE's guideline on workplace health: management practices.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on training and support for managers.

Full details of the evidence and the committee's discussion are in:

1.6 Individual-level approaches

1.6.1 Do not use individual-level approaches to replace organisational strategies for reducing work stressors, or for the main purpose of increasing productivity.

1.6.2 Encourage managers to create opportunities for fostering good relationships with (and between) employees, for example by socialising with them at work (in person or virtually). Create opportunities to talk with them about their general health and wellbeing.

1.6.3 Encourage managers to discuss mental wellbeing with employees, and employees to discuss any mental wellbeing concerns they may have with their manager or another relevant person (for example, another manager, a mental wellbeing champion or a union representative):

1.6.4 Offer all employees (or help them to access) mindfulness, yoga or meditation on an ongoing basis. This can be delivered in a group or online, or using a combination of both.

See also the section on supporting employers in NICE's guideline on physical activity in the workplace.

1.7 Approaches for employees who have or are at risk of poor mental health

1.7.1 Ensure that confidentiality is discussed when talking with someone about their mental health (see recommendation 1.2.2), and be clear about when confidentiality will and will not be respected (that is, when the employee is considered at risk to themselves or others because of their mental health).

1.7.2 Offer organisational support to employees identified as having or being at risk of poor mental health. This may include flexible working hours; changes to the job, workplace or culture to minimise any risks to mental wellbeing; or maintaining supportive line management relationships. (See recommendation 1.5.5 and recommendation 1.6.3.) Remind them that they can visit their GP for further assessment and support.

  • Consider working with them to create a wellness action plan (see Mind's guides to wellness action plans).

  • Assess whether this has highlighted if changes need to be made at an organisational level.

1.7.3 Discuss with the employee if they would like to:

  • have further support and, if so, whether they prefer a particular type of support

  • have ongoing regular, confidential discussions about their mental health support needs.

1.7.4 For employees who want further support, offer (or provide access to):

  • cognitive behavioural therapy sessions or

  • mindfulness training or

  • stress management training.

    If employees choose not to have an intervention now, tell them that the offer will still be available in the future if they reconsider.

1.8 Organisational-level approaches for high-risk occupations

The following recommendations are aimed at organisations, workplaces or workforces where employees are likely to experience traumatic events in the normal course of their work (such as the emergency services). See also recommendation 1.1.4.

1.8.1 Regularly review organisational-level policies and protocols on how to support employees in high-risk occupations after an occupational traumatic event. Use data such as reasons for absence and staff turnover to ensure that support is targeted in the right way.

1.8.2 Ensure that practice is consistent with established best practice (for example, Mind's Blue Light Programme).

1.8.3 Offer task-focused skills training (for example, through imagery, simulation and skills training) before deployment for employees in high-risk occupations (such as emergency services) to ensure that they have the skills needed to deal with predictable and stressful occupational events.

See also NICE's guideline on post-traumatic stress disorder.

1.9 Engaging with employees and their representatives

1.9.1 Work with employees and their representative organisations (for example, trade unions and staff networks; see recommendation 1.2.1) to consult about how, when and where mental wellbeing interventions are offered and delivered, for example through staff surveys.

1.9.2 Take account of the following potential barriers and facilitators when consulting with employees about interventions:

  • workplace culture (including the concern that raising issues can impact negatively on staff roles or job security)

  • workload

  • concerns that employers and employees may have about mental health, including stigma, and how this may affect their ability to discuss any difficulties or engage with certain forms of support

  • timing of the intervention and the option of delivering it in and outside the workplace and work hours

  • specific needs and preferences of employees

  • specific reasonable needs of the employing organisation.

1.9.3 Ensure that factors associated with an employee such as contract type, income level, protected characteristics and job role are not barriers to accessing interventions. Do this by:

  • monitoring intervention uptake and identifying groups where uptake is relatively low

  • having a mechanism to identify, understand and overcome barriers to participating in the intervention.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on engaging with employees and their representatives.

Full details of the evidence and the committee's discussion are in evidence review F: barriers and facilitators to the implementation and delivery of interventions to improve and protect mental wellbeing at work.

1.10 Local and regional strategies and plans

These recommendations are for local and regional authorities.

1.10.1 Take a leadership role in championing mental wellbeing and preventing poor mental wellbeing at work as part of the local authority role in public health and wellbeing.

1.10.2 Engage with local and regional employers, employee representatives, chambers of commerce, local enterprise partnerships and voluntary, charity and social enterprises to develop and promote health and wellbeing strategies to include mental wellbeing at work.

1.10.3 Integrate mental wellbeing at work into local and regional public health activities and strategies.

1.10.4 Raise awareness among the general public and employers of the importance of mental wellbeing at work, for example through social media.

1.10.5 Identify and address local barriers and facilitators to employer engagement with local mental wellbeing at work initiatives. This could include, for example, working with employers to ensure they know about resources or services that can help them improve the mental wellbeing of their employees and minimise the resource impact that this will have, especially for micro, small and medium-sized enterprises.

1.10.6 Offer support to help local employers improve the mental wellbeing and prevent poor mental wellbeing of their employees. This support could include advice on enablers of mental health and on developing action plans towards accreditation (see recommendation 1.4.2) or setting up a Local Workplace Health Accreditation Scheme.

1.10.7 Curate or work with local business support organisations to list local and national sources of support for employers and employees, such as Mind, Mental Health at Work, the Department for Work and Pensions' access to work mental health support service and, for NHS and social care staff, staff mental health and wellbeing hubs (and other national health and wellbeing support offers).

1.10.8 Explore and evaluate the value of incentives or pilot incentive programmes to promote uptake of support and encourage employers to participate in accreditation schemes (see recommendation 1.4.2).

1.10.9 Use contracting and ethical procurement arrangements to strongly encourage supply chain organisations to promote mental wellbeing among their employees (for example, public sector organisations must use the Public Services [Social Value] Act 2012).

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on local and regional strategies and plans.

Full details of the evidence and the committee's discussion are in:

1.11 Making this guideline relevant for small and medium-sized enterprises (including micro-enterprises)

1.11.1 Business owners and owner-managers should address their own mental health needs as well as those of their employees.

1.11.2 Take a preventive approach to mental wellbeing at work, for example using mental health and communication skills training to foster positive mental wellbeing, as well as tackling poor mental wellbeing. Refer to the Mental Health at Work website for curated resources and toolkits on how to improve the mental wellbeing of your employees.

1.11.3 Seek advice and support from local authorities; local enterprise partnerships; voluntary, charity and social enterprises; trade unions and other bodies; and, for NHS and social care staff, staff mental health and wellbeing hubs (and other national health and wellbeing support offers), on how to prevent poor mental wellbeing in your employees, and how to support employees through mental ill health.

1.11.4 Think about signing up to the Mental Health at Work Commitment to help achieve better mental health outcomes for employees.

1.11.5 Think about accessing employee assistance programmes and occupational health services. See the Department for Work and Pensions' access to work mental health support service as an example of a low-cost service (see recommendation 1.11.2).

Terms used in this guideline

This section defines terms that have been used in a particular way for this guideline. For other definitions, see the NICE glossary and the Think Local Act Personal's Care and Support Jargon Buster.


Everyone aged 16 or over in full- or part-time employment, including people on permanent, training, temporary or zero-hours contracts, those who are self-employed and volunteers.

Mental health literacy

A person's knowledge and beliefs about mental health problems and how to look after their own mental health. It includes knowing how mental health problems are managed and treated, how to seek information about them and how to recognise them.


For the purposes of this guideline, organisation refers to any size of workplace, including micro, small and medium-sized enterprises.

Psychological safety

A person's desire and need to feel comfortable and safe in the workplace to express themselves and communicate openly.

Role autonomy

A person's ability to influence what happens in their work environment, in particular to influence matters that are relevant to their personal goals and the way in which they carry out their work.

Staff networks

Groups of employees who come together in a safe environment for discussion and support, and from which they can be a voice for change in the workplace. This includes raising awareness of issues in the wider organisation. They are commonly groups of people who identify as an under-represented group or who have a protected characteristic in the Equality Act 2010.


The Health and Safety Executive (HSE) guide on working together to reduce stress at work defines stress as the adverse reaction people have to excessive pressures or other types of demand placed on them.

  • National Institute for Health and Care Excellence (NICE)