Mental Health Stigma at Work: Why Is It Still Hard to Talk About?

Mental health stigma at work silences employees and worsens problems. Learn its causes, its business impact and the concrete steps organisations can take.

A production planning specialist has not been sleeping for months, and getting to work gets harder every day. When their manager says "you've seemed distracted lately", they brush it off with "it's nothing, just a busy period". In fact they want support; but they are afraid that if word gets out they will be taken off the promotion list and seen as "weak". The name of this silence is very often stigma: a person who is going through a psychological difficulty being negatively labelled, excluded or seen as less valuable because of it. In this article, for business owners, HR managers and OHS specialists, I look at how prejudice towards mental health at work forms, how it shows up in the business and what organisations can do.

What Is Mental Health Stigma at Work?

Stigma appears on three levels, and in organisations the three are usually intertwined:

• Social and institutional prejudice: Widespread beliefs such as "someone who sees a psychologist can't do their job" or "depression is an excuse for laziness". These are carried into the workplace as jokes, gossip or a quiet distance.
• Structural stigma: The organisation's rules and practices putting people with mental health difficulties at a disadvantage, even when that is not the intention. For example, leave for psychological reasons being read as "unreliability" in performance reviews, or a reporting process whose confidentiality is unclear.
• Self-stigma: The person internalising these prejudices and applying them to themselves: "I have to be strong; if I ask for help, I lose."

There is an important distinction here: stigma is different from the mental health problem itself. An employee experiencing anxiety or low mood is nobody's fault; but an environment in which they cannot say so is a condition that the organisation can shape.

Why Is Stigma Still So Strong?

In recent years, conversations about mental health have become far more visible on social media and in corporate communications. Even so, the data show that the gap between rhetoric and lived experience has not closed. In a survey of more than 27,000 employees in Europe, 50% of employees think that disclosing a mental health problem would harm their career, while only 58% say they would feel comfortable talking to their manager about it (EU-OSHA, 2022). On the business side the picture is similar: in Europe, the biggest difficulty in managing psychosocial risks is reported as reluctance to openly discuss these issues, at 59% (EU-OSHA, 2025).

In Turkey there is no reliable workplace-specific measurement on this subject. However, some factors can feed prejudice:

• A culture of "being strong": Especially in male-dominated field and production environments, talking about feelings can be seen as weakness. This makes asking for help even harder.
• Small, close-knit communities: In Anatolian cities, a colleague may also be a neighbour or a relative. The fear that "word will get around" can be more decisive than in big cities.
• Job security worries: In times of economic uncertainty, employees fear that looking "problematic" could mean ending up on the list of people to be let go.
• Uncertainty about confidentiality: If employees do not know who will get to hear what they tell the workplace physician or HR, they choose to stay silent.
• The wrong language: Everyday expressions such as "are you mad?" or "don't act bipolar" quietly send the message that the environment is not safe.

Signs of prejudice in your organisation

Prejudice is rarely voiced openly; it is read more from behaviours and silences. The signs below may suggest that mental health is still an "unspeakable" area in your organisation:

• There is an employee helpline or psychological counselling service, but it is hardly ever used.
• Sick notes for psychological reasons are obtained with physical reasons such as "back pain" or "flu".
• When the subject of mental health comes up, a joke is made in the meeting or the subject is changed quickly.
• After an employee returns from a long leave, comments such as "he's not the same any more" circulate in the corridor.
• Managers say they do not know how to talk to an employee who is struggling, or leave the subject entirely to HR.
• The word "burned out" comes up often in exit interviews, but the employee never said so during their time in the job.
• Questions about stress and workload in employee surveys are left blank, or the open-ended comment field is hardly ever filled in.

One or two of these signs on their own do not amount to a conclusion; but when several occur together, there is strong reason to think the problem lies not in individuals but in the climate. The good news is that a climate can be changed much faster and on a much wider scale than individual experiences. A change in one manager's attitude can make dozens of employees feel safer at the same time.

Different faces in blue-collar and white-collar settings

Prejudice does not look the same in every environment. In production and field teams it is more often intertwined with talk of "toughness" and "manliness"; a person who says they are struggling fears being seen as "unable to do the job". In office environments it takes a subtler form: nobody says anything openly, but the employee fears being quietly moved away from critical projects. Taking this difference into account when designing your programme makes it easier for the message to reach both groups.

The Effect of Stigma on Work: The Invisible Cost

Prejudice is not only an individual pain; it is a risk factor that feeds directly into business results. The mechanism is simple: when a problem cannot be talked about, it is not noticed early, and a problem not noticed early grows.

• Presenteeism: The employee comes to work but cannot work at full productivity. In the UK, the annual cost of poor mental health to employers has been calculated at £51 billion, and presenteeism, at about £24 billion, has been reported as the largest item (Deloitte, 2024). This is UK data, but the invisibility of employees who come to work and struggle is universal. This item is often overlooked because it does not appear in payroll or absence records.
• Absenteeism and turnover: An employee who gets no support may at some point go on long-term sick leave or quietly leave the job. According to Deloitte's 2022 report, about 40% of turnover costs in the UK are attributed to mental health problems.
• Occupational safety: The distraction of a sleepless, anxious or burned-out operator is a direct accident risk in factories. When the employee cannot say so, preventive measures such as adjusting shifts or changing tasks cannot come into play either.
• Misdiagnosed performance problems: A manager may treat mistakes that are in fact the result of psychological strain as a disciplinary matter. This starts a cycle that wears down both the employee and the organisation.

Globally, an estimated 12 billion working days are lost every year to depression and anxiety (WHO, 2026). In Turkey, 66% of employees say they spent most of the previous day under stress, against a world average of 40% (Gallup, 2026; 2025 data). In an environment of such widespread stress, every problem that cannot be talked about is a cost accumulating for the organisation.

Legal Framework: Where Does the Employer's Responsibility Begin?

The word "stigma" does not appear in Turkish legislation; however, the employer's framework is quite clear.

• OHS Law No. 6331, Article 5/f: The employer is expected to develop a coherent prevention policy covering the effects of factors related to work organisation, working conditions and social relationships. A climate that makes mental difficulty impossible to talk about is part of these social factors.
• Risk Assessment Regulation, Article 8: It requires psychosocial sources of hazard to be identified and recorded. In an environment where employees cannot report their problems, this assessment will not produce sound data. Reducing prejudice is therefore also a precondition of a sound risk assessment.
• Code of Obligations No. 6098, Article 417: The employer is obliged to protect and respect the personality of the employee. If an employee experiencing mental difficulty encounters ridicule, exclusion or pressure, this can be evaluated within the scope of that obligation.

At the international level, the WHO's 2022 guidelines on mental health at work present reasonable accommodations for employees with mental health conditions as a strong recommendation. The recommendation with the strongest evidence in the guidelines is mental health training for managers (strong recommendation, moderate-certainty evidence). It is therefore unsurprising that managers are the most effective lever in tackling prejudice.

What Can Organisations Do to Reduce Stigma?

Awareness posters and a once-a-year "mental health day" event do not change prejudice on their own. Change happens when policy, manager behaviour and everyday language change together. Practical steps are as follows:

1. Make confidentiality rules written and understandable. When an employee approaches the workplace physician, HR or the employee helpline, it should be clearly written who will receive the information and under what conditions. Being honest about the limits of confidentiality (for example, a serious safety risk) creates more trust than a promise of unlimited confidentiality.
2. Train managers. Noticing an employee who is struggling, talking without judgement and directing them to the right resource are learnable skills. I have gone into this in more detail in the article on mental health training for managers.
3. Make support channels visible. If options such as the employee assistance programme, the workplace physician, an external psychologist or, on the public side, ALO 170 (Turkey's labour hotline) are not known, they are not used. Repeat the information at induction, on notice boards and in shift meetings.
4. Review leave and return-to-work processes. Check whether leave for psychological reasons reflects negatively on performance reviews. Offer a phased plan and reasonable adjustments on return to work.
5. Change the language. Prepare a communication guide in which stigmatising expressions are not accepted even as jokes. Leaders being able to say, where appropriate, "I got support myself during a hard time" is a very powerful signal.
6. Position mental health as part of health and safety. If fatigue, sleep and stress are also discussed in safety meetings, the subject moves from the realm of "personal weakness" to the realm of "working condition".
7. Don't settle for individual solutions. The ILO stresses that individual measures should complement organisational measures, not replace them (ILO, 2026). Offering only a "helpline" without changing workload, unclear roles and oppressive management can reinforce the message that the problem belongs to the individual.

Employees begin to trust the organisation not when they are able to talk about their mental health, but when they see that nothing bad happened to them after they did.

A short conversation guide for managers

Suppose a shift supervisor notices that an employee on their team has withdrawn in recent weeks and is making frequent mistakes. A non-stigmatising approach might look like this:

• Choosing a suitable, calm and private moment.
• Sharing the observation without judgement: "I've noticed you've seemed a bit tired lately, how are you?"
• Avoiding diagnosing or comments such as "I think you're depressed".
• Listening and not imposing solutions.
• Reminding them of the support options and the confidentiality rules.
• Asking what might help in how work is arranged, and checking in again a few days later.

If the employee mentions thoughts of harming themselves, the situation should be treated as an emergency; 112 (emergency services) should be called and the person should not be left alone.

How to Get Started in Your Organisation

Working with prejudice produces results when it is planned as a process with measurable goals.

1. Needs analysis: First understand the current situation. With a short survey in which confidentiality is guaranteed, ask employees how far they agree with statements such as "If I had a mental health problem I could tell my manager" and "If I get support, it won't affect my career". Evaluate together the usage rates of support channels, the trend in leave for psychological reasons and the expressions used in exit interviews. I have discussed the issue of survey trust separately in the article on trust and anonymity in employee surveys.

2. Programme: Based on the findings, build a three-layer plan: policy (confidentiality, leave, return to work), manager training (noticing, talking, directing) and employee awareness (mental health literacy, support channels). Plan reinforcement sessions rather than a one-off seminar. You can browse the corporate service options on the corporate services page.

3. Measurement: Repeat the same survey questions at six and twelve months. Monitor support service usage, absenteeism and turnover indicators. A note of caution here: an increase in support use after the programme is not a failure; it is more often a sign that trust has increased.

Frequently Asked Questions

Are stigma and discrimination the same thing?

They are related but not the same. Stigma is prejudice at the level of attitudes and beliefs; discrimination is when this prejudice turns into concrete decisions such as promotion, assignment or dismissal. Reducing prejudice also helps to cut off discriminatory practices.

Does an employee have to tell the employer about a mental health problem?

In general, no; health information is special-category personal data, and whether to share it is the employee's decision. However, in situations that directly affect the safe performance of the work, the workplace physician's assessment is important. The organisation's job is to create an environment in which an employee who chooses to share will not be harmed by doing so.

Do we need to work on stigma in a small business too?

Yes; in small businesses, because everyone knows each other, confidentiality worries can be even more pronounced. The owner's attitude, a few simple written rules and an external, independent support channel can make an important difference even on a small scale.

Is awareness training enough on its own?

Generally it is not. Awareness training for employees appears in the WHO guidelines as a conditional recommendation, while manager training stands out as a strong recommendation. Training gains meaning when it is applied together with a confidentiality policy and improvements in working conditions.

• #stigma
• #mental health
• #organisational culture
• #manager training

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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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