Presenteeism: Working while sick or burnt out? SA psychiatrist explains why it’s a bad idea

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  • Working while burnt out or physically ill can negatively impact the country's economy as well as your own health.
  • A local psychiatrist and lecturer at Stellenbosch Business School says it's important to 'switch off' from work.
  • She offers tips to combat 'presenteeism' for both employers and employees.

Do you often work despite being physically sick, stressed, or burnt out? It is called ‘presenteeism’, and research shows that it comes at a greater economic cost than absenteeism.

According to one expert, employees who show up and attempt to work despite their poor mental health costs South Africa almost seven times as much in lost productivity as employees who are absent due to depression. 

“In ‘normal’ times, poor mental health and various personal and work stress factors are key underlying causes of presenteeism, with people often feeling pressured to show up even though they are not fit for work,” said psychiatrist and head of the MBA in Healthcare Leadership programme at Stellenbosch Business School, professor Renata Schoeman.

She added: “Now, in the era of Covid, with increased fears of job security and heightened scrutiny by managers of remote working employees, the pressure to be virtually, if not physically present, to be ‘always on’ and prove that one is productive while working from home is even greater.”

Sadly, many people are also experiencing increased financial stress, and juggling home and childcare responsibilities. This is making it harder to "switch off" and set clear boundaries between their work lives and their home and personal lives.

The cost of mental health-related presenteeism alone has been estimated at R235 billion (4.2% of GDP), versus R33 billion annually for absenteeism.


Speaking during Corporate Wellness Week, which runs from 4–8 July and aims to improve wellness practices in the workplace, Schoeman said that there has been a sharp increase globally in stress levels, a decreased sense of wellbeing, and mental health conditions such as depression and anxiety.

In March this year, the World Health Organization (WHO) indicated that the pandemic triggered a 25% increase in the prevalence of anxiety and depression worldwide, and said that this was a wake-up call to countries to step up their mental health services and support.

Similarly, the American Psychological Association noted that during this time, burnout and stress were at all-time highs across professions, due to longer working hours and increased demands at home.

But there are solutions to presenteeism, said Schoeman. These include addressing organisational culture and toxic working environments which prize working longer hours and employees being “always on”.

Instead, what should happen is the modelling and valuing of healthy behaviour, logging off and having a better work-life balance. 

She also recommended the following:

  • Flexible working hours for illness 
  • Reviewing sick leave policies
  • Implementing work-from-home absenteeism policies
  • Valuing output over time input

In the UK alone, presenteeism was the largest contributor to mental health costs to employers – at approximately £26 billion (R500 billion) in 2021 – a recent report revealed. That figure is around 4.5 times the cost of absenteeism, which shows the urgent need for the above suggestions to be implemented in the workplace.

What to look out for

There are certain signs that an employee is engaging in e-presenteeism, related to the Covid-19 pandemic and the rapid shift in working patterns. These include:

  • Lower levels of productivity 
  • More mistakes or a lower standard of work 
  • A lack of care about results and output
  • Starting late or finishing early 
  • Putting in more hours but producing less 
  • Looking tired in virtual meetings 

Importantly, presenteeism can have serious effects, especially in the physical work environment, where it can lead to accidents or spreading disease when people who are physically ill come to work, said Schoeman. 

“At lower levels, people are often working with dangerous machinery, working night shifts or working as long-distance drivers. Stress, anxiety and depression affect their ability to concentrate and so they are more prone to accidents, with potentially costly or even fatal results,” she explained. 

People who work at an executive level may suffer compromised judgement and decision-making abilities because of poor mental health, and this can have serious consequences for the organisation, she added. 

Schoeman has a couple of helpful tips for employers and managers to avoid e-presenteeism:

Reassure staff that their health and wellbeing are a priority

If they are genuinely ill, they should take the necessary time off, even if they are working from home.

Have regular one-on-one check-ins with employees

This can also be a virtual check-in. Employees should feel comfortable speaking about their wellbeing and stress levels. If there is a trusting relationship between employers and employees, the latter will be more likely to disclose any mental health challenges that they are struggling with before they develop into more serious conditions.

Encourage employees to ‘switch off’

Once their shift has ended, employees should be encouraged to sign off, close their laptops and take time for a leisure activity at the end of the remote working day.

Review sick leave and absence policies and procedures

Where needed, employers should consider giving employees a mental health day over and above formal sick leave.

Ensure that sick leave policies and pay are adequate

This will help curb presenteeism caused by the financial worries of losing income. Says Schoeman: “Consider the cost of adequate sick pay against the cost of an unproductive 'presentee' employee.”

Train and encourage managers to lead by example

Managers should promote healthy working habits and boundaries rather than an "always on" culture, adding:

If managers don’t switch off themselves when they are not well, staff will also feel pressured to work when they shouldn’t be.

Reward and recognise output and results

Focusing on this rather than the hours worked will lead to better employee wellbeing.

Encourage employees to take their annual leave

Taking leave is important. You might feel that you are indispensable, but postponing certain tasks or projects is preferable to suffering an eventual breakdown. 

Review workplace wellness initiatives

These could include discounts on gyms and fitness programmes or online fitness and healthy living apps; mental health “first aiders” for first-line counselling or talks and workshops on work-life balance; and resources to manage physical, mental and financial wellness.

READ | Gratitude towards co-workers can help them manage stress and work pressure better

READ | Imposter syndrome isn’t all bad – there’s a surprising benefit, research suggests

READ | Mental health in the workplace: A third of South Africans resign from their jobs because of a bad boss

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