Return on Investment in Employee Mental Health: Absenteeism, Productivity and Engagement Data

What does investing in employee mental health bring a business? Read the data on absenteeism, presenteeism, engagement and ROI, with its limitations.

In budget meetings, the return on spending on machine maintenance, energy efficiency or a new production line is usually calculated clearly. Employee mental health, on the other hand, is still seen in most organisations as a "well-meaning but unmeasurable" item. Yet data published in recent years by bodies such as the World Health Organization, the International Labour Organization, Gallup and Deloitte show that mental health is directly linked to absenteeism, productivity, staff turnover and workplace safety. In this article, for employers, factory managers and HR professionals, I bring this data together and look at the research on return on investment and the limitations to bear in mind when reading these figures.

Why Is Employee Mental Health a Business Issue?

For a long time, mental health was regarded as an individual's private matter. But global data show that this view is no longer sufficient. According to the World Health Organization, an estimated 12 billion working days are lost every year worldwide to depression and anxiety, at a cost in lost productivity of about 1 trillion US dollars a year (WHO, 2026). An estimated 16% of working-age adults had a mental disorder in 2023.

According to a report published by the International Labour Organization in April 2026, psychosocial risk factors such as workload, work organisation and social relationships lead to more than 840,000 deaths a year through associated cardiovascular disease and mental disorders. The economic impact of this is estimated at 1.37% of global gross domestic product a year (ILO, 2026).

These figures may seem abstract, but in every business they have concrete counterparts:

• An operator who often takes sick leave and whose work someone else constantly has to cover
• A quality control employee who is physically at work but whose error rate rises because their attention is scattered
• An experienced craftsperson, trained over years, who then burns out and resigns
• A near-miss incident for which fatigue and loss of attention laid the groundwork

The Invisible Cost: Absenteeism, Presenteeism and Staff Turnover

The cost of mental health problems to a business can be grouped under three main items.

Absenteeism: An employee being unable to come to work is the most easily seen cost. Sick leave, medical certificates and unplanned absences directly affect production planning.

Presenteeism: This is when an employee comes to work but cannot work at full capacity. This item is often overlooked, yet research shows the biggest cost lies here. According to Deloitte's UK data, the annual cost of poor mental health to employers is 51 billion pounds, and the largest item, at about 24 billion pounds, is presenteeism (Deloitte, 2024).

Staff turnover: Finding, hiring and training a replacement for an employee who leaves is a serious cost. According to Deloitte's 2022 report, about 40% of the costs of staff leaving in the UK are attributed to mental health problems (Deloitte, 2022). In industrial areas where skilled craftspeople and technicians are hard to find, this item becomes heavier still.

The occupational safety dimension should be added to these. A systematic review examining burnout showed that burnout predicts, alongside absenteeism and presenteeism, serious injuries later on (Salvagioni et al., 2017). I discuss this in detail in the article on preventing employee burnout.

Suppose that in a medium-sized metalworking factory, three experienced employees in one department have resigned in the past year, those who remain have taken more sick leave and the scrap rate has risen. In the accounting records this picture does not appear as a "mental health cost"; it is spread across scattered items such as overtime payments, recruitment adverts, training time, scrapped material and late deliveries. Seeing the cost of mental health therefore often begins with bringing these scattered items together.

The Picture in Turkey: Stress and Engagement Data

In Turkey there is no official national estimate in Turkish lira of the cost of workplace mental health. But comparative international data show how much attention the situation needs. According to Gallup's 2026 report (2025 data):

• 66% of employees in Turkey say they experienced stress for much of the previous day. This is markedly above the Middle East and North Africa average of 48% and the global average of 40%.
• The proportion of employees truly engaged in their work is only 8%. The global average is 20%.
• The proportion who are actively disengaged, that is, markedly detached from their work, is 24%.
• The proportion who say they experience anger daily is 36%; the global average is 22%.

Gallup calculates the cost of low employee engagement to the global economy at about 10 trillion dollars, or 9% of global gross domestic product (Gallup, 2026). Engagement is not always a direct indicator of mental health; but the combination of high stress and low engagement points to a weakening of the relationship employees have with their work.

The high cost of living, long working hours, long commutes in big cities and the marks left by the 6 February 2023 earthquakes are also part of the load carried by employees in Turkey. In these conditions, steps for mental health can be thought of not merely as a "benefit" but as part of a strategy for protecting the workforce.

How Much Is the Return on Investing in Employee Mental Health?

There is no single, definitive answer to this question; but research at different levels gives an idea.

At the societal level: A modelling study covering 36 countries, led by the World Health Organization, calculated the economic return on scaling up treatment for depression and anxiety. According to it, at the societal level every 1 dollar invested in treatment turns into about 4 dollars in health and labour-force gains; when only economic returns are counted, the ratio is between 2.3 and 3.0 (Chisholm et al., 2016). This is not an employer calculation but a national health system model.

At the employer level: According to Deloitte's calculation, screening 26 sources published in the UK after 2011, an average productivity return of 4.70 pounds is achieved for every 1 pound an employer spends on employee mental health (Deloitte, 2024). In the same organisation's 2022 report, this average was given as about 5 pounds.

Manager training: In a randomised controlled study at a fire service in Australia, after managers were given 4 hours of mental health training, work-related sick leave in their teams was reported to have fallen by 18% from baseline, and the estimated return was about 9.98 pounds for every 1 pound (Milligan-Saville et al., 2017). This was a study carried out in a single organisation and followed for 6 months; for details you can look at the article on mental health training for managers.

Employee assistance programmes: In a report covering 24,363 counselling cases from 28 countries, about 3 months after counselling, presenteeism had fallen by 26% and absenteeism by 27% compared with before counselling (Attridge et al., 2019). This is a before-and-after observation; that is, improvement was seen in employees who used the support programme, but it cannot be said that all of that improvement came from the programme.

The right question is not "will investing in mental health pay for itself?" but "which investment are we making, for which need, and how are we measuring it?"

Reading the Figures Correctly: Limitations

Although return on investment figures may look convincing, the following points need to be borne in mind when making a decision for a business:

• Differences in country and context: The Deloitte figures are literature averages specific to the UK. They cannot be transferred directly to a factory in Turkey; pay levels, leave systems and health services are different.
• An average is not a guarantee: These figures are averages of studies of varying quality; they are not the result of an independent, peer-reviewed meta-analysis. In some organisations the return may be higher, in others lower.
• National and organisational levels should not be confused: The WHO's "4 dollars for every 1 dollar" finding concerns a country's investment in treatment; it should not be presented as the return on a single company's spending.
• The control group problem: Much of the data on support programmes are observations without a comparison group; they cannot separate improvement that happens on its own over time.
• Short follow-up periods: A significant proportion of studies rely on results over a few months; long-term effects are less well known.

Another important point is that the absence of data does not mean the absence of a problem. In a broad study covering workplaces in Europe, the workplaces that reported none of the psychosocial risk factors were most often in the manufacturing and agriculture sectors; the researchers evaluated this as a finding that could point to a lack of awareness (EU-OSHA, 2025). That your factory has received no complaints on this subject may show not that everything is fine but that it is not being talked about.

These limitations do not show that the investment is worthless. On the contrary, they show why it is important for every organisation to collect its own baseline data and track its own results.

Which Interventions Deliver Higher Returns?

Research shows that the type of intervention matters at least as much as the budget.

• Preventive and organisation-wide interventions: Deloitte states that early, organisation-wide interventions such as culture change and training deliver higher returns than the intensive support needed once a problem has grown (Deloitte, 2024). In other words, rather than merely reacting after the problem has appeared, preventive investment looks more efficient.
• Manager training: In the WHO's 2022 guidelines, the recommendation with the strongest evidence is mental health training for managers (strong recommendation, moderate-certainty evidence).
• Cognitive-behavioural stress management: In a meta-analysis examining workplace stress management programmes, the average effect was found to be medium to large, and cognitive-behavioural programmes showed consistently larger effects than other approaches (Richardson and Rothstein, 2008).
• Managing psychosocial risks: Organisational arrangements that address sources such as workload, shift patterns, role ambiguity and communication. The ILO stresses that individual measures should complement organisational measures, not replace them (ILO, 2026).
• Accessible individual support: Confidential counselling. In Europe, only 38% of employees say they have access to psychological support at work (EU-OSHA, 2022).

One-off motivational seminars, on the other hand, show limited effect. A meta-analysis of resilience programmes showed that the effect was small and declined markedly after the first month (Vanhove et al., 2016). The same study found that one-to-one and face-to-face group formats were more effective than computer-based formats. This finding suggests that, when planning a budget, small steps that are spread across the year and complement one another may be more sensible than a single big event. Participation is also one of the most important factors that increase the return on investment: employees knowing the service exists, trusting its confidentiality and being able to reach it at times that suit their shift pattern ensure the programme does not stay on paper.

How to Get Started in Your Organisation

To be able to see the return, you first need to know what you will measure. A three-stage approach is recommended:

Needs analysis: A snapshot of the current situation is taken. Absence days by department, the resignation rate, overtime, records of workplace accidents and near misses, and an employee survey with protected confidentiality make up this baseline data. You can find information on how this data can be collected in the corporate needs analysis section.

Programme: Priorities are set according to the analysis results. For example, manager training and workload adjustment in a department where absence is concentrated, crisis support for a team affected after an accident, and cognitive-behavioural workshops in a unit reporting high stress may come to the fore. You can explore how such programmes can be structured on our corporate services page.

Measurement: The monitoring indicators recommended by the ILO are absenteeism, resignations, reports of violence and harassment, use of support services and employee surveys (ILO, 2026). These indicators are repeated at regular intervals and compared with the baseline data. In this way, alongside the question "how much did we spend," the answer to "what did we change" is added.

Frequently Asked Questions

Does investing in employee mental health really pay for itself?

According to literature averages in the UK and some controlled studies, the return is generally above the spend. However, these results cannot be transferred directly to every business; collecting your own baseline data and tracking the results is the most reliable way of seeing the real return for your organisation.

Is there return-on-investment data for Turkey?

In Turkey there is no official national estimate of the cost of workplace mental health or of return on investment. International data can therefore be used as a guide, but it becomes even more important for the organisation to measure its own indicators.

Does investing in mental health make sense for a small business?

Yes, it is possible with steps suited to the scale. Manager training, a review of workload and, where needed, access to external support are steps that can be started without large budgets. In small businesses, even the loss of a single experienced employee can create a proportionally large cost.

Which indicators should we monitor?

Absenteeism, resignations, overtime, records of workplace accidents and near misses, use of support services and regular employee surveys are the basic indicators. Monitoring these indicators by department and at regular intervals lets you see which step is working; seeking professional support from outside is also always an option in this process.

• #return on investment
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• #presenteeism
• #employee engagement

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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