Business leaders and their mental health

At the time of writing (February 2019), the IoD has engaged in two campaigns to promote concern for mental health in the workplace. Supporting the mental wellbeing of both themselves and their employees helps make directors and their companies better. There is also a sound business case for action – The Stevenson-Farmer Review (2017) stated that UK employers suffer a direct cost of £33 billion to £42 billion a year because of poor mental health at work.

As an organisation of company directors, the IoD takes a particular interest in the mental health of business leaders. The pressure and responsibility of being a business leader can be a greater risk to mental health. At the same time – and for a variety of reasons – business leaders tend to be less forthcoming about their own mental health.

An IoD survey published in support of Time To Talk Day 2019 showed that half of the 500 respondents had experienced poor mental health that was in part connected to factors such as a lack of work life balance and heavy workloads. The survey also revealed that although most business leaders had been approached by staff about mental health problems, almost half said mental health and wellbeing was not actively promoted in their organisation, while only a quarter were able to offer mental health training for management.The main reason for this was a lack of appropriate information and guidance, outstripping lack of time and lack of financial resources put together, and fewer than a quarter felt there was enough clear support available for employers.

Mental health – only for employees?

Even if a company is making progress on mental health at work, the chances are that the focus will be on supporting employees rather than company directors. Research the reasons why and it soon becomes obvious that business leaders are expected to be stronger, more resilient and more capable than those they employ. The greater reward for executive directors is sometimes used to justify the stress to which a business leader may be exposed. In 2011, Lloyds Banking Group chief executive Antonio Hórto-Osório admitted that he had thrown himself “in too much” to the Lloyds top job, and he needed to step back to overcome extreme fatigue. This did not sit well with 54 per cent of respondents to a Guardian website poll, who believed he was “paid well enough to take it”.

Fear of being removed from office

Both business leaders and their employees often say that being open about a mental health issue will adversely affect both their current role and career prospects. Business leaders are likely to feel this pressure to conceal a mental health issue more than most. In the United Kingdom, the founding Articles of Association of most companies will contain a clause stating that a director may be removed if a qualified medical practitioner declares them incapable of making decisions because of a physical or mental health condition. It is important to note that a director can no longer be removed automatically on mental health grounds following reforms contained in the Mental Health (Discrimination) Act 2013.

The benefits of hard work and (some) pressure

The IoD recognises that hard work and a certain amount of pressure are inevitable in the life of a business leader. In fact, a considerable volume of research suggests that working under pressure brings out the best in us.

The Williams Pressure Performance Curve (1994) is often cited when discussing pressure at work. According to the Williams Curve, we work at our best in the ‘Stretch’ zone, which tests our knowledge, skills and stamina over a defined period of time, after which we reflect and recharge. Beyond the stretch zone lie two negative working states ‘Strain’ is marked by fatigue, poor judgement and poor decision making. Personal productivity and effectiveness – which peak in the Stretch zone – both decline in the Strain zone. The next stage is ‘Overwhelmed’, in which physical and/or mental health symptoms will become more acute. In business circles, overwhelmed is a precursor to ‘burnout’ – a non-medical description of physical and mental collapse to which driven high-achievers are prone. It’s worth noting that the Williams Curve also states that personal productivity is lower when we are in the Comfort zone performing tasks we know well, and there is even a Boredom zone in which personal performance trails off.

It is important to repeat the point concerning the fall in personal effectiveness if a director keeps working in a state of stress. Perhaps they expect it of themselves, perhaps because others expect it – either way, stress damages a business leader, and business performance will suffer as a consequence.

Realising there is an issue, and doing something about it

To protect both themselves and their business, it is important for a director to recognise the difference between pressure and stress. But is the entrepreneurial personality the best judge? Entrepreneurs and directors are often risk-takers, who accept short-term personal sacrifice for long-term gain – not always the best qualifications for knowing when to stop and take stock. As IoD member Alison Charles observes in the Q&A below, it is often a family member who convinces a business leader of the need to seek help.

Most workplace mental wellbeing programmes respect an organisation’s reporting lines. If an employee has a good relationship with their line manager, they tell the line manager. Another option is to contact the human resources department. If the employee prefers not to use in-house channels, an external employee assistance programme will often be available.

But if you are at the top of a management structure, who do you talk to?

Many business leaders who experience mental health issues opt to self-refer for treatment by a clinical practitioner outside of their business. Recent years have seen an increase in professional mental wellbeing consultants – many of whom have personal experience of the situation a business leader may be trying to deal with. The desire for discretion and not ‘going public’ at work is understandable, although concerned organisations such as the mental health charity Mind encourage business leaders to be open about their own mental wellbeing issues as an example to both more junior colleagues and other business leaders.

Expert view: Alison Charles, wellbeing consultant, IoD member

The IoD Information and Advisory Service (IAS) met up with wellbeing consultant and IoD member Alison Charles to discuss business leaders and their mental health.

Have you worked with business leaders to address their mental wellbeing?

AC: Yes. Most of my work involves helping companies with wellbeing policies and practice, but I am involved in one-to-one work with company directors and senior managers.

How do they find you?

AC: Many relationships begin at networking events – especially if I present at the event. Afterwards a director may ask for a quiet word, or hand me their business card.

Are the mental health issues experienced by business leaders caused exclusively by the stress of their role?

AC: In most cases it is a combination of issues in both a director’s professional and personal life that causes the issue. The people I work with are juggling lots of balls, so to speak, and it might not necessarily be something major that chucks in the extra ball they can’t cope with…then there is a general collapse as all the balls fall down.

It sounds like this build-up of stress and other negative factors may be hard to detect…

AC: Yes, it can be. Very often it is family member or close friend who tells the person that they need to seek help.

Why doesn’t someone at work tell them?

AC: Business leaders and entrepreneurs are typically alpha personality types, and they are at the top of a company’s structure. For these reasons an employee may not feel confident or entitled to tell their boss that there is an issue, unfortunately.

What advice can you give to help business leaders recognise deteriorating mental health?

AC: I need to put this into context. Everybody experiences stress…life can be stressful! Everybody’s tolerance of stress is different, so the important thing is identifying when it’s too much for the individual concerned. There’s no one size fits all approach. You have to be aware of your own way of being, and check in with yourself about how you’re coping. But if you are at a point at which you notice:

  • Your sleep is broken when previously it was not;
  • You are feeling overwhelmed, when previously you did not;
  • Not being able to focus when previously you could.

Many people near their breaking point report a ‘fuzzy head’ sensation.

When a business leader needs to access help or support, what are their options?

AC: Most of the options are not specific to company directors. The first step should be to consult with your GP, followed by a referral to a specialist. Hopefully there will be in-company options – an Employee Assistance Programme or perhaps a private medical scheme. Either of these will include access to confidential care and support. But – and I must emphasise this – it is vital that the person takes that first step, whether it be structured support or opening up to someone they trust.

Some business leaders decide to take their issue completely ‘off line’ and away from company support channels…

AC: Employment Assistance Programmes and company doctors are secure confidential options. But I understand if a senior business person prefers to make their own arrangements. Emotional intelligence is higher among business leaders these days…they understand that they need to access external expertise to deal with a range of issues. Many leaders make use of executive coaches, who can refer to other specialists if required. Many of the people I have worked with have come to me for a one-to-one relationship – they haven’t wanted their situation known about in their own organisation.

However, leaders and senior managers in larger organisations are coming round to the idea that as they invest in wellbeing, leading by example is really important. If you look at the EY’s, the IBM’s and the Shell’s of this world, senior people are starting to share their personal stories. Many organisations concerned with mental wellbeing at work are engaging with larger companies, getting company leaders and senior managers to recognise the benefit of sharing their own stories to open up dialogue throughout the company.

Do you agree with the argument that the culture of an organisation is determined, or least significantly influenced, by the example and personality of their leaders?

AC: Absolutely.

With that in mind, is there a higher duty incumbent on a business leader who experiences a mental health issue to be open about it?

AC: Yes, I think so. But I do understand that a moment of health crisis is not the best time to share their story because they are too busy dealing with it. But it’s what happens after. The important time is when a leader or senior manager returns to work. If the leader does not share their experience, how can you expect junior employees to speak openly to their line manager? Wellbeing has to start in the boardroom. There should be a wellbeing strategy aligned with the main business strategy. A wellbeing strategy is becoming increasingly important in attracting and retaining the best talent. Concern for wellbeing is also a moral obligation.

In ten years’ time, how will mental health be regarded in the workplace?

AC: (Pause) I don’t have a short answer! Certainly we are becoming more emotionally intelligent with our fingers on the pulse of human interactions. I think concern for mental wellbeing will be more accepted. Let’s face it – human beings are the greatest resource in a business. A business cannot function without people. Why wouldn’t you take care of your greatest resource? You want your staff to be the best version of themselves so your business is more productive and achieves the highest return on investment.

We’ve been talking about how a business leader deals with a personal mental health issue – but prevention is always better than cure. A business that commits to protecting the physical and mental wellbeing of all employees will reap many benefits. Absence will be lower, productivity will be higher. So it goes for business leaders – learn to respect your physical and mental wellbeing to maintain best performance.

What do you think about the image of the ‘Indestructible CEO’?

AC: It’s right up there with the ‘stiff upper lip’! I think we all need to accept we are human, and we sometimes need help in our lives. But you can’t force people…they have to come to that conclusion themselves.


IoD Mental Health Hub

A collection of policy statements and practical guides supporting positive wellbeing at work

Mental Health At Work Gateway

Mental health charity Mind has created a portal through which a range of resources supporting mental health at work can be accessed

International Stress Management Association

The ISMA website provides many resources to help business leaders recognise and deal with stress. There is an extensive list of symptoms to watch out for.


The InsideOut project encourages business people to be open about experiences of mental illness. In March 2019, InsideOut will publish its LeaderBoard of senior business people who have shared their stories.

IoD members can also access relevant factsheets maintained by the IoD Information and Advisory Service:

Stress management

Balance business and family responsibilities

Making a start – What is mental wellbeing at work?

How to measure the mental health of your workplace

A mental health policy for your company

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Browse valuable mental-health resources from the IoD.
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