Mental Health Training for Managers: Noticing and Talking to a Struggling Employee

Why does mental health training for managers matter? WHO recommendations, research findings, steps for talking to a struggling employee and training content.

The first person to notice that an employee is struggling is often neither the HR specialist nor the occupational physician; it is the direct manager who works on the same line, in the same office or on the same shift every day. A foreman, a team leader or a department head is in the best position to see a change in an employee's punctuality, error rate or mood at the earliest stage. Yet when most managers see such a change, they do not know what to say, how far their responsibility goes, or where to refer the employee. Mental health training for managers aims to fill exactly this gap. In this article I look at why this training is regarded as one of the workplace interventions with the strongest evidence, what research shows, and how managers can talk to a struggling employee.

Why Is Mental Health Training for Managers a Priority?

In its 2022 guidelines on mental health at work, the World Health Organization set out a series of recommendations for employers together with their levels of evidence. Most of these recommendations were "conditional" and the certainty of evidence was "low" or "very low", whereas providing mental health training for managers stood out with a strong recommendation and moderate-certainty evidence (WHO, 2022). The WHO also noted that it was making this recommendation for the first time. In other words, the best-supported step in workplace mental health is equipping managers on this subject.

The same guidelines made no recommendation on mental health screening programmes for all employees in the workplace, on the grounds that the balance of benefit and harm is uncertain. This distinction matters: the real goal for organisations is not to test everyone, but to build a management team that can notice a struggling employee, talk to them respectfully and refer them to the right resource.

The joint WHO and ILO policy brief also groups workplace mental health under three headings: prevent (managing psychosocial risks through organisational interventions), protect and promote (manager and employee training, early help-seeking) and support (reasonable adjustments, return-to-work programmes). Manager training sits right at the centre of this framework.

This subject is also particularly relevant for Turkey. According to Gallup's 2026 report, 66% of employees in Turkey say they experienced stress during a large part of the previous day, against a global average of 40%. Only 8% of employees are genuinely engaged with their work (Gallup, 2026; 2025 data). In such a widespread climate of stress, the small but regular touches of a manager on the shop floor can noticeably affect the overall climate of the team.

What Does the Research Say? Sick Leave and Return on Investment

One of the best-known studies examining the effect of manager training on work outcomes is a cluster randomised controlled trial in an Australian fire service. In this study, managers received 4 hours of face-to-face mental health training and their teams were followed for 6 months. Work-related sick leave in the teams of the trained managers was reported to have fallen by 18% compared with baseline, while it rose by 29% in the control group. According to the researchers' calculations, the estimated return was about £9.98 for every £1 spent (Milligan-Saville et al., 2017).

Although these findings are striking, they should be read with caution:

• The study was carried out in a single organisation and in a male-dominated occupational group.
• The follow-up period is limited to 6 months.
• The effect was seen only in "work-related" sick leave; total sick leave increased in both groups.
• The authors state that the results need to be replicated in other organisations.

So these figures are not a promise to any organisation but a research finding suggesting that manager training is promising. If you would like a broader look at cost and return, you can read the article on the return on investing in employee mental health.

The format of the training also affects the outcome. A meta-analysis of workplace resilience programmes showed that effects fade over time and that one-to-one and face-to-face group formats are more effective than computer-based formats (Vanhove et al., 2016). This finding points to a preference for interactive, hands-on training supported by reinforcement sessions, rather than a one-off online presentation.

Why Do Employees Stay Silent? Stigma and Barriers to Speaking

It matters not only that the manager notices a struggling employee but also that the employee feels able to speak. In a large European survey, 50% of employees said they thought disclosing a mental health problem would harm their careers. The proportion of those who said they would feel comfortable talking to their manager about mental health was 58% (EU-OSHA, 2022). In another European study, the biggest difficulty in managing psychosocial risks was identified as "reluctance to openly discuss these issues", at 59% (EU-OSHA, 2025).

In Turkey, this silence may run even deeper. Stereotypes such as "a real man doesn't talk about his troubles" or "only weak people see a psychologist" can make it harder for employees, especially on the production floor, to ask for help. This picture makes the manager's attitude decisive.

This is where the concept of psychological safety comes in. Edmondson's foundational study of 51 work teams in a manufacturing company defined psychological safety as team members' "shared belief that the team is safe for interpersonal risk taking" and showed that this belief is related to learning behaviour (Edmondson, 1999). A team that can report mistakes, ask questions and say "I'm struggling" stands on firmer ground for both mental health and occupational safety.

Noticing a Struggling Employee: Watch for Change

A manager does not need to memorise a list of diagnoses. What matters is that the person shows a marked change from their usual self. Signs to look out for include:

• Change in behaviour: Frequent lateness, unexplained absences, withdrawal from social settings
• Change in performance: A rise in errors, difficulty keeping up with work, trouble making decisions
• Change in mood: Appearing constantly tense, irritable, tearful or low
• Physical signs: Marked tiredness, insomnia, weight change, frequent physical complaints
• Change in what they say: Expressions of hopelessness such as "nothing means anything" or "it would be better if I weren't here"

These signs alone do not show that someone has a psychological disorder. The person may be dealing with a bereavement, a family problem, financial difficulty or a physical illness. For a general framework on how anxiety-related symptoms can look, the article on anxiety symptoms may give you an idea. But the manager's job is not to interpret the change but to notice it and make room for a conversation.

Imagine a team leader on an assembly line who has been known for years as reliable. For the past month this person has been making frequent mistakes, speaking to no one during breaks and has taken sick leave twice. An untrained manager might interpret this as "they're not taking the job seriously" and move towards a disciplinary process. A trained manager first recognises that something has changed, talks to the person in a calm setting, and only then addresses performance. The difference between these two approaches often determines whether the employee stays with the organisation.

How to Talk to a Struggling Employee: A Step-by-Step Conversation Guide

Many managers put off the conversation for fear of "saying the wrong thing". But you do not need perfect sentences; a sincere, respectful and structured approach is enough.

Preparation

• Choose a calm, private place and a time when you will not be rushed.
• Note the concrete changes you have observed; avoid general judgements.

Opening the conversation

• Share your observation without judgement: "For the last few weeks you've seemed a bit tired to me and I wondered how you are."
• Ask open-ended questions: "What's going on?", "Is there anything at work or outside that's making things hard for you?"

Listening

• Listen without interrupting; do not rush to offer solutions or talk about your own experience.
• Acknowledge the feeling: "That must be really hard to go through."
• If the person does not want to talk, do not push; let them know the door is open.

Support and referral

• Talk together about what might help on the work side: a temporary workload adjustment, flexible hours or a change of duties.
• Explain the support available in your organisation, including any confidential counselling service.
• Be honest about the limits of confidentiality; explain what will not be shared with anyone and in which situations you would have to seek help.

Follow-up

• Hold a brief check-in after a few days or a week.
• Do not make what was said a subject of gossip; protecting the person's trust is the condition for others being able to speak in the future.

What to avoid

• Making a diagnosis or using labels such as "You have depression"
• Dismissive comments such as "Everyone is struggling, just cope"
• Having the conversation at the same time as a performance warning
• Insistently asking about details of the employee's private life

Emergencies: If the employee talks about thoughts of harming themselves or ending their life, take it seriously, do not leave them alone and make sure they reach professional help without delay. If there is an immediate risk, 112 (emergency services) should be called.

A good manager is not the employee's therapist, but they are the first person who can say in a hard time: "I noticed, I'm here, and how can we support you?"

What Should the Content of Mental Health Training for Managers Look Like?

Effective manager training goes beyond transferring information and aims to build skills. It is useful for the programme to include the following topics:

• Basic mental health literacy: Clear, non-stigmatising information about stress, anxiety, depression, burnout and trauma responses.
• Recognising early signs: Observing changes in behaviour and performance.
• Conversation skills: Rehearsing difficult conversations through role plays.
• Boundaries and referral: What the manager will and will not do, and to whom to refer in which situation.
• Reasonable adjustments and return to work: Planning the return of an employee who has taken leave for mental health reasons.
• Psychological safety and team climate: A management style that encourages reporting mistakes, asking questions and asking for help.
• The manager's own mental health: According to Gallup, manager engagement is 22%, down 9 points since 2022 (Gallup, 2026). A manager who cannot manage their own load will find it harder to support their team.

Designing the training as an initial hands-on session followed by reinforcement meetings at regular intervals, rather than a one-off seminar, increases the likelihood that what is learned will be carried into the workplace. In facilities with shift work, scheduling sessions at times that suit different shifts also makes participation easier.

The subject of return to work also deserves attention. The WHO guidelines conditionally recommend that employees returning to work after leave for mental health reasons be offered work-focused support together with clinical care (WHO, 2022). In practice, this means that the manager has a brief conversation with the employee before their return, increases the workload gradually in the first weeks, and treats the return as an ordinary process without giving the team unnecessary detail. When managers know these steps in advance, the return is less tense for both the employee and the team.

How to Get Started in Your Organisation

Needs analysis: The number of managers, their levels, the shift pattern, and absence and turnover data are reviewed. Managers' knowledge and confidence on this subject are measured with a short pre-survey. The departments that are a priority are identified.

Programme: Depending on the need, short modules specific to the shop floor are planned for foremen and team leaders, and more comprehensive workshops for middle and senior management. The training should be designed together with the organisation's referral resources, because noticing alone is not enough if there is nowhere to refer people. You can look at the structure of such programmes on the corporate services page, and at the options for different organisation sizes in the packages section.

Measurement: Manager confidence before and after the training, employee surveys repeated at regular intervals, absence, turnover and the usage rate of the support service are tracked. This data shows to what extent the training is reflected in day-to-day management practice.

Frequently Asked Questions

Does mental health training for managers turn managers into therapists?

No. The aim of the training is not for the manager to diagnose or provide therapy, but to notice struggle, start a respectful conversation and refer the employee to the right resource. A manager who knows their limits protects both the employee and themselves.

How long should this training be?

Research has shown that even short face-to-face training can produce promising results. For a lasting effect, however, it is recommended that the initial training be supported by reinforcement sessions and integrated into day-to-day management practice.

What should I do if the employee does not want to talk?

Do not insist. Let them know you care and that they can talk when they need to, remind them of the support available in your organisation, and check in again after a short while. Sometimes simply being noticed makes it easier for a person to ask for help later.

Should I share what the employee tells me with HR?

As a rule, you should not share an employee's personal information without their consent. However, in urgent situations such as a risk of harm to themselves or others, the person's safety comes first; in such a case professional help should be sought and, if necessary, 112 called. Having a structure in place that your managers can turn to in advance for such situations makes things easier for everyone.

• #manager training
• #mental health awareness
• #psychological safety
• #human resources

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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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