Reasonable adjustments make it easier for employees with mental health conditions to stay in work. Examples, confidentiality principles and steps for employers.
An accountant with an anxiety disorder finds it hard to concentrate because of the noise and constant interruptions in the open-plan office. A production operator receiving treatment for depression struggles to make the morning shift because the tiredness that comes with the first weeks of medication persists. A sales representative who has had a panic attack is afraid of having another in crowded meetings. All of these employees are fully capable of doing their jobs; what they need is small but meaningful changes to their working conditions. Reasonable adjustment means exactly this: changes made in the workplace, without placing a disproportionate burden on the business, so that an employee with a mental health condition or disability can do their job, stay in work and support their recovery. In this article I look at why reasonable adjustments matter, which examples can be applied, and how you can structure this process in your organisation.
What Is a Reasonable Adjustment?
A reasonable adjustment is an individual adaptation to the work environment, hours, tasks or methods so that the employee can meet the essential requirements of the job. Three concepts are important here:
- Individual: The adjustment is determined not by the diagnosis but by the person's concrete need. Two employees with the same diagnosis may have very different needs.
- Joint decision: The adaptations that work best are those that the employee and employer find by thinking together. A solution dictated from above, however well meant, may not fully meet the employee's need.
- Reasonable: The adjustment should be of a kind that does not disrupt the running of the business or require a disproportionate cost. Most adjustments cost far less than people think; they usually consist of flexibility, communication and small organisational changes.
This kind of adaptation is not a privilege or a case of "pulling strings". Its purpose is to reduce the disadvantage arising from the employee's health condition so that they can work on equal terms with other employees. Nobody calls it a "privilege" when someone who wears glasses works with their glasses; reasonable adjustments can be thought of with similar logic.
Why Do Reasonable Adjustments Matter?
Evidence and international recommendations
The WHO's workplace mental health guidelines, published in 2022, classify reasonable adjustments for employees with mental health conditions as a strong recommendation. Although the certainty of the evidence was rated "very low", the recommendation was strongly supported in terms of equity, human rights and the employee's ability to remain in work (WHO, 2022). The joint WHO and ILO policy framework also recommends that employers approach employees at the levels of prevention, protection and promotion, and support; reasonable adjustments and return-to-work programmes are at the centre of the support level (WHO/ILO, 2022).
Work outcomes
An estimated 16% of working-age adults worldwide had a mental disorder in 2023 (WHO, 2026). An estimated 12 billion working days are lost each year to depression and anxiety, and the productivity cost of this is calculated at around US$1 trillion a year (WHO, 2026). This picture shows that practices that make it easier for employees with mental health conditions to stay in work are meaningful from both a human and an economic point of view.
When the necessary adaptations are not made, common consequences are: repeated sick leave, presenteeism (being at work but unable to work productively), the departure of experienced employees and rising tension within the team. An analysis in the UK reported that the largest item in the cost to employers of employees' poor mental health was presenteeism (Deloitte, 2024).
Fear of disclosure
In a survey in Europe, 50% of workers think that disclosing a mental health problem would harm their career; the proportion who say they would feel comfortable talking to their manager about mental health is 58% (EU-OSHA, 2022). In other words, many employees hesitate to voice their needs. Designing the reasonable adjustment process to be open, respectful of confidentiality and non-punitive is the most important way of reducing this hesitation.
Examples of Adjustments That Can Be Applied in the Workplace
Adjustments can be very varied, depending on the nature of the job and the employee's needs. The examples below are intended to give a starting idea:
Working hours and duration
- Flexible start and finish times (for example because of the morning effect of medication or therapy appointments)
- Temporarily reduced working hours
- More frequent but shorter breaks
- Flexibility with leave for therapy and check-up appointments
- A shift change where possible (for example a day shift instead of a night shift that disrupts sleep patterns)
Work environment
- A quieter work area or noise-cancelling headphones
- A desk location with fewer interruptions
- A calm space that can be used for a short rest
- The possibility of partial remote working for suitable jobs
Tasks and work organisation
- Prioritising tasks and giving clear written instructions
- Breaking large projects into small steps
- Temporarily handing high-stress tasks to someone else during certain periods
- One-to-one meetings instead of crowded meetings, or sharing meeting notes in writing
- Naming a particular colleague as a "support person"
Management and communication
- Regular, short and supportive feedback conversations
- Giving feedback in writing and in concrete terms
- Expressing expectations clearly and consistently
- Giving advance notice of changes; avoiding sudden shift or task changes as far as possible
Making an adjustment does not mean expecting less of the employee; it means finding together the conditions in which they can do their best.
The Legal Framework
Under the Occupational Health and Safety Law No. 6331, when assigning tasks to employees the employer takes into account their fitness for the work in terms of health and safety (Art. 4). When risk assessments are carried out, the situation of groups requiring special policies, such as young, older, disabled, pregnant or breastfeeding employees, is also taken into account (Art. 10). On return to work after repeated absences for health reasons, a health examination is carried out if the employee requests it (Art. 15).
Matters such as the rights of disabled employees, the prohibition of discrimination, changes of duty and the processing of health data are governed by different laws and regulations. In these areas, I recommend consulting a lawyer who specialises in employment law or personal data protection to get definite information about the obligations and limits specific to your business. In connection with this subject, you can also look at the article on disabled employees.
How Should the Reasonable Adjustment Process Be Run?
A well-functioning process both meets the employee's need and gives the business predictability. The steps I recommend are:
- Make requesting easy. Announce clearly to whom and how employees can submit an adjustment request. Allowing the request to be made to the manager, to HR or to the occupational physician gives flexibility.
- Talk about the need, not the diagnosis. Instead of questioning the employee in detail about their diagnosis in the meeting, ask in which areas they struggle while doing their job and what might help. An open-ended question such as "What is making your work hardest for you at this time?" is a good start.
- Look for solutions together. Listen to the employee's suggestions; often the employee knows the most workable solution. If necessary, and with the consent of the occupational physician and the employee, obtain the view of the treating specialist.
- Put the decision in writing. Record the agreed adjustment, its duration and its review date in a short note. This ensures continuity in situations such as a change of manager.
- Protect confidentiality. The reason for the adjustment does not have to be shared with the team. Only the information necessary regarding the organisation of the work is given to the team.
- Review regularly. Needs can change over time. At set intervals, evaluate together whether the adjustment is working.
Say that at an automotive supplier factory, a quality control technician has started treatment for anxiety symptoms and has told their manager that night shifts disrupt their sleep, which in turn worsens their symptoms. Together with HR and the occupational physician, the manager agrees that for a period of three months the technician will work the day shift, be able to leave early twice a month for therapy appointments, and have a short weekly check-in. The team is informed only of the change in the shift plan. At the end of the three months the adjustment is reviewed and updated according to the technician's situation. In this process the factory has not lost an experienced technician, and the technician has not been cut off from their job while continuing treatment. None of the solutions in the example requires a major investment; what is needed is a timely conversation, a willingness to think together and recording the decision.
A similar approach can be applied to office employees. For example, for an employee who experiences intense anxiety in crowded meetings, simple adjustments such as sharing the meeting agenda in advance, giving presentations in small groups or submitting views in writing allow the employee to keep making their contribution visible.
Practical Tips for Managers
- When an employee voices a need, thank them first; this is the foundation of a trusting relationship.
- Do not say "no" straight away; ask for time to weigh up the options together.
- Do not present the adjustment as a "favour"; make it feel like a natural part of working together.
- Keep an eye on the perception of fairness in the team; manage the distribution of workload transparently.
- Know your limits: you are not a therapist; your role is to arrange working conditions and to direct people to specialist support when needed.
Common mistakes
Even well-intentioned managers can fall into certain mistakes in this process. The most frequent are:
- Deciding on the employee's behalf: Reducing the employee's responsibilities without asking their view, saying "let's not tire you out", can create a sense of exclusion and worthlessness even if well meant.
- Forgetting the adjustment: The agreed flexibility stops being applied after a few weeks, and a new shift supervisor is unaware of the situation. A written record and a review date prevent this problem.
- Breaching confidentiality: Even insinuating remarks such as "You all know about his situation" can seriously shake the employee's trust.
- Confusing it with a performance meeting: Turning a support conversation into a performance warning stops the employee from voicing their needs next time.
- Trying to solve everything with a single adjustment: Sometimes the first attempt does not work. This is not a failure but an opportunity to try a new option.
These mistakes show why it is important not to leave the process to personal initiative but to tie it to a written procedure. A procedure protects both the employee and the manager and prevents practice from varying from person to person.
Training is important so that managers can develop the right attitude in this process. In the WHO's workplace mental health guidelines, mental health training for managers stands out as the recommendation with the strongest evidence (WHO, 2022).
How to Start in Your Organisation
1. Needs analysis: Review your current practices. To whom can employees communicate a health need? Are previous adjustments on record? Among repeated sick leave and resignations, are there patterns that may be related to mental health? In an anonymous survey, ask employees how comfortable they feel opening up to their managers when they have a health problem.
2. Programme: Prepare a written adjustment procedure: the request channel, the steps of the conversation, decision and record, confidentiality rules and a review timetable. Train managers and the HR team in how to run this process. Consider the procedure together with your return-to-work programme after long-term leave.
3. Measurement: Monitor anonymously the number, duration and outcomes of adjustments made. The retention rate of employees for whom adjustments are made, absenteeism and employee satisfaction are indicators that can be tracked. The ILO recommends absenteeism, turnover, use of support services and employee surveys as monitoring indicators (ILO, 2026).
You can find corporate support options for building an adjustment procedure and training managers on the corporate services page.
Frequently Asked Questions
Is it necessary to ask for a diagnosis document for a reasonable adjustment?
The basis of the adjustment is usually not the diagnosis itself but the concrete work-related need. In some cases the occupational physician's assessment can be a guide. It is advisable to consult a lawyer on which documents can be requested and how health data are to be processed.
What should be done if other employees see these adjustments as unfair?
It is important to manage the distribution of workload transparently and to share not the reason for the adjustment but how the work is organised. Making it known that reasonable adjustment is a principle that applies to everyone in the organisation reduces the perception of unfairness.
Should adjustments be permanent?
No; most adjustments are temporary and are reviewed at set intervals. In some cases, though, long-term adjustments may be needed. What matters is that the decision is made together with the employee and updated according to need. Setting the review date from the start reduces uncertainty for both employee and manager and prevents the adjustment from being quietly forgotten.
Can a small business make reasonable adjustments too?
Yes. Most of these adjustments are low-cost practices such as flexible hours, task prioritisation and regular short check-ins. Whatever the size of the business, enabling an employee to stay in their job is often less costly than hiring someone new.
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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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