TERRIBLE: The Physical and Mental Health of the American WorkForce
You may not realize how many employees are managing chronic medical conditions. In 2018, 51.8% of U.S. adults—129 million people—had at least one of ten chronic conditions, including arthritis, cancer, asthma, diabetes, hypertension, heart disease, stroke, hepatitis, chronic obstructive pulmonary disease, or kidney disease. More than one-quarter—68 million people—had two or more. 1
Mental health conditions can also affect attendance and performance. Employees who reported fair or poor mental health missed an average of nearly 12 unplanned workdays annually—almost five times the 2.5 days missed by other employees. 2 Gallup also found:
23% of working women reported fair or poor mental health, compared with 15% of working men.
For workers under the age of 30, 36% of women, and 27% of men, reported fair or poor mental health.
40% of U.S. workers said their jobs had an extremely negative (7%) or somewhat negative (33%) effect on their mental health.
Effective managers do not need to become medical experts. They need to recognize changes in performance, listen without prying, protect confidentiality, explain available resources, involve Human Resources when appropriate, and treat chronically ill employees fairly and respectfully.
Respond to Performance Problems—Not Assumptions
If an employee’s performance declines, do not assume you know why. The employee may be managing a chronic illness, a mental health condition, a death in the family, a divorce, or another personal crisis.
Meet privately with the employee and focus on observable facts:
“I’ve noticed that several assignments have recently been late and contained errors. This is different from your usual work, and I’m concerned. Is there anything affecting your ability to do your job that we should discuss?”
Do not press the employee for a diagnosis or detailed personal information. In most circumstances, disability-related questions must be job-related and consistent with business necessity. Any medical information disclosed by the employee must be treated as confidential. 3
Listen with empathy, but do not attempt to diagnose the employee, become their counselor, or solve their personal problems. Concentrate on job requirements and the assistance available through the organization.
Know When to Involve Human Resources
If the employee indicates that a medical condition is affecting their work—or asks for a change that may help them perform the job—contact Human Resources. The employee may be requesting a reasonable accommodation, even if they never use that term.
Depending on the employee’s needs and the essential duties of the position, possible reasonable accommodations may include:
A modified work schedule
Periodic breaks
Remote work, when appropriate
Changes to nonessential duties
Specialized equipment or an adjusted workspace
Medical leave
Eligible employees may also qualify for job-protected leave under the Family and Medical Leave Act. Leave for a chronic condition may sometimes be taken intermittently or through a reduced schedule. 4 Managers should involve Human Resources rather than attempting to determine eligibility themselves.
Employees must meet legitimate performance and conduct standards. However, managers should consider whether an accommodation or protected leave applies before taking action connected to a known medical condition.
Make Employees Aware of Available Assistance
Regularly remind all employees about available mental health and wellness resources. Do this for the entire workforce rather than singling out employees who appear to be struggling.
An Employee Assistance Program (EAP) is an employer-sponsored program that generally offers confidential assessments, referrals, and short-term counseling for concerns such as stress, grief, family difficulties, and alcohol or substance misuse. 5 If your organization does not offer an EAP, refer the employee to Human Resources for information about other available resources.
A Health Wellness Program is an organization-sponsored program that offers employees and their family members a variety of ways to improve their health, which increases employee retention and reduces health care costs.
Wellness programs help employees and their families improve their physical, mental, and emotional well-being. A useful program might include stress-management resources, preventive screenings, mental health services, fitness support, and education about chronic illnesses.
In a Society for Human Resource Management survey, 62% of respondents said an organization’s wellness program was “extremely or very important.” 6
This is just the tip of the iceberg. The No-Nonsense Manager’s Playbook addresses 33 subjects managers must understand to lead effectively—all in one practical resource. 7
1 Peter Boersma, Lindsey I. Black, and Brian W. Ward, “Prevalence of Multiple Chronic Conditions Among US Adults, 2018,” Preventing Chronic Disease 17 (2020), https://doi.org/10.5888/pcd17.200130.
2 Dan Witters and Sangeeta Agrawal, “The Economic Cost of Poor Employee Mental Health,” Gallup, updated December 13, 2022, https://www.gallup.com/workplace/404174/economic-cost-poor-employee-mental-health.aspx.
3 U.S. Equal Employment Opportunity Commission, “Enforcement Guidance on Disability-Related Inquiries and Medical Examinations of Employees Under the ADA,” July 27, 2000, https://www.eeoc.gov/laws/guidance/enforcement-guidance-disability-related-inquiries-and-medical-examinations-employees.
4 U.S. Department of Labor, “Fact Sheet #28P: Taking Leave from Work When You or Your Family Member Has a Serious Health Condition under the FMLA,” https://www.dol.gov/agencies/whd/fact-sheets/28p-taking-leave-when-you-or-family-has-health-condition.
5 U.S. Office of Personnel Management, “Employee Assistance Programs,” https://www.opm.gov/policy-data-oversight/worklife/employee-wellness-programs/employee-assistance-programs/.
6 Stephen Miller, “SHRM Benefits Survey Finds Renewed Focus on Employee Well-Being,” Society for Human Resource Management, September 12,2021, https://www.shrm.org/topics- tools/news/benefitscompensation/shrm-benefits-survey-finds-renewed-focus-employee-well.
7 Garry Stanberry, The No-Nonsense Manager’s Playbook: A Guide for Leaders Who Need Answers Now! (Oakton, VA: Stanberry Books, 2026).