Fit notes and mental health: what employers need to consider

Recent findings have highlighted growing pressure on the UK’s fit note system, particularly in relation to mental health absence. Research suggests that most GPs rarely refuse requests for fit notes linked to mental health concerns, raising important questions for employers about how absence is being managed in practice.

Over 11 million fit notes were in 2025 last year, with mental health now the most common reason for employees being signed off work. This trend is increasing, and many GPs report feeling caught between supporting patients and acting as gatekeepers to sickness absence.

Time pressures, difficult conversations and the risk of complaints can all influence decision-making, meaning that, in some cases, issuing a fit note becomes the path of least resistance.

For employers, this creates a challenge. A fit note is medical evidence, but it is not a definitive instruction that an employee must remain off work. It reflects a GP’s view at a particular point in time, often based on limited information about the workplace itself.

In many cases, fit notes simply state that an employee is “not fit for work”, without offering detail on the underlying condition or what adjustments might help them return. Reports suggest that a significant proportion of fit notes do not specify the reason for absence at all, leaving employers with limited clarity on how best to respond.

This is particularly important in the context of mental health. While the need for support is often genuine, prolonged absence can make return to work more difficult. Evidence shows that the longer someone remains off work, the less likely they are to return, with a significant drop in return rates after extended periods of absence.

Employers should therefore be cautious about relying solely on fit notes as the basis for decision-making. Instead, the focus should be on active absence management and early intervention.

That starts with having clear absence management processes in place. Return-to-work conversations, trigger points and regular check-ins are essential to understand what is driving the absence and what support may be needed. These conversations should be handled sensitively, particularly where mental health is involved, but they should not be avoided.

There is also a growing need to involve occupational health at an earlier stage. Unlike GPs, occupational health professionals can assess how a condition impacts an employee in the context of their specific role and workplace. This can help identify practical adjustments that support a return to work, rather than defaulting to continued absence.

Employers should also look at the wider support available within the business. This may include employee assistance programmes, access to counselling, flexible working arrangements or trained mental health first aiders. The aim is to remove barriers to support, rather than relying on the fit note system alone.

It is also worth noting that changes to statutory sick pay are likely to increase short-term absence levels, placing further pressure on employers to manage attendance proactively and consistently.

Ultimately, the fit note system is only one part of the picture.

Employers who take a structured, proactive approach, focusing on communication, early support and practical adjustments, are far better placed to manage absence effectively and reduce long-term risk. Contact us at enquiries@121hrsolutions.co.uk and we can discuss and further queries you may have on this subject.

Fit notes and mental health: what employers need to consider

121 HR Solutions Ltd