Occupational health assessment: what it means when it is for your mental health

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An occupational health assessment is a confidential conversation with an occupational health adviser, a health professional whose job is to look at how your health and your work affect each other, about what is going on and what support might help, and it ends in a report that only goes to your employer with your permission. Nothing in the way ACAS describes it is disciplinary, it is not a test you can fail, and when the reason for it is stress, anxiety or low mood it works in exactly the same way as it would for a bad back.

That is the short version. The rest of this piece covers why an employer refers someone, whether you have to go, what you will be asked, what ends up in the report and who reads it, and how to handle the nerves. It also holds the line a health guide has to hold: the parts about your contract, your pay and your rights belong with ACAS, Citizens Advice, a union rep or your HR team, not here. If you are earlier in the process and still working out the basics of being off sick, how to get a sick note for work for your mental health is the companion guide and covers self-certification and fit notes. The workplace side here is drawn from ACAS guidance, and the mental health side from the NHS and Mind.

What occupational health actually is

ACAS, the UK's workplace advice service, describes occupational health as a type of medical service an employer might use to help them make decisions. The list of reasons it gives is worth reading slowly, because none of them are about catching anyone out: a worker who is struggling with their physical or mental health, the right reasonable adjustments for someone who is disabled, someone who has been off sick for a long time or is coming back after sickness absence, reducing the amount of time people need off sick, keeping to health and safety rules, and managing risks to mental health such as too much pressure at work or bullying.

It might be the employer's own in-house service or an outside agency. Many organisations have a written occupational health policy that sets out when a referral can be made, how an assessment is carried out and what happens afterwards, and ACAS suggests checking whether yours has one. Smaller employers might have no scheme at all, in which case ACAS says the employer should communicate with you and, only with your permission, your doctor.

Is an occupational health assessment a bad sign?

No. A referral to occupational health is a sign that your employer wants information about how to support you, not a sign that you are in trouble, and none of the reasons ACAS lists for using it have anything to do with discipline. Mind's guidance on returning to work goes further and suggests you can ask to be referred yourself, because occupational health can help you and your employer put together a back-to-work plan that sets out the support you need.

It is easy to read a referral as a judgement, particularly if you have been off with stress or anxiety and are already braced for what people think. The NHS guidance on returning to work after a mental health problem names that exact worry and then frames a meeting with your employer or an occupational health adviser as the place to raise it and to talk through things like flexible hours, support from a colleague, or somewhere to go for a break.

Do I have to go to an occupational health assessment?

No, you do not have to agree to an occupational health assessment, but ACAS is clear that it is usually in your interest to go. Its guidance lists what an assessment can do for you: help you get the support you need to feel better and do your job, help you return to work safely and more quickly, and stop your employer making big decisions about you without important information.

ACAS makes the same point about medical reports generally: without one, an employer falls back on what you have told them and what is on your fit note. An assessment is your chance to put your side into that picture in a structured, confidential way, and it is also the route through which a phased return or adjustments to your role tend to get suggested. Whether you are paid for the time at the appointment should be written into your organisation's policy, so check, and if it is unclear that is a question for HR or the ACAS helpline rather than something to guess at.

What happens in the assessment

The meeting itself is usually a conversation, and ACAS describes the ground it tends to cover: your health, any treatment you are having, and any concerns you have about returning to work or carrying on in your role. The adviser is trying to understand how your job and your health are affecting each other, which ACAS says is what makes an assessment a useful addition to a fit note, because a fit note does not go into that.

Sometimes the adviser will want more detail from your GP. If so, ACAS says you should be told why and asked to sign a consent form, and you have the right to see your doctor's report before it goes to the adviser. If a doctor carries out the assessment, your employer must tell you in writing about your rights under the Access to Medical Reports Act 1988, which ACAS sets out in plain language on its site.

A little preparation helps more than people expect. Before the meeting, think about what has actually been hard, which tasks, times of day or situations make things worse, and what you have already tried. Then think about what would help. Mind's list of workplace changes is a good source of ideas: using voicemail if answering the phone makes you anxious, communicating by email where face-to-face contact is stressful, flexible hours, a quieter workspace, or permission to take a few minutes out when you are struggling. Mind also notes that even if you are not covered by the Equality Act, your employer should still support you within what is reasonable for your role. The adviser will find it far easier to write something useful if you arrive with a clear picture.

What goes in an occupational health report, and who sees it?

The report contains the adviser's recommendations about how you do your job and how the job might be affecting your health, and the adviser must ask your permission before sharing it with your employer. ACAS describes the kinds of things an employer and worker might then agree: more time off, a referral for an appropriate course of therapy such as counselling, adjustments to your workspace, or a phased return to work on reduced hours or lighter duties. Depending on the health issue, the adviser may recommend a further review before anything is settled.

Two things are worth knowing plainly. First, your employer does not get your medical records. ACAS is explicit that an employer will never get access to a worker's full records, and that a doctor's report only contains the information needed to support your health at work. Second, the report is confidential once it lands. ACAS says the employer must keep it confidential, share it only with people who genuinely need it, which might mean your line manager and HR, and tell you how it is being stored and used and how to withdraw your consent if you later want to.

It is then up to your employer to decide whether to act on the recommendations, informed by the needs of the organisation but also by its legal obligations to you. Where a mental health problem counts as a disability, the NHS and ACAS both note that employers must by law make reasonable adjustments. What counts as reasonable, and whether the law applies to you, are exactly the questions this article cannot answer, and ACAS, Citizens Advice, a union rep or Mind's legal rights pages are the right places to take them.

Handling the nerves before the meeting

The waiting is often worse than the meeting. If you notice yourself rehearsing worst-case versions of the conversation, that is a recognised feature of work-related stress: the NHS Every Mind Matters guidance lists automatically jumping to the worst-case scenario, blaming yourself when things go wrong and avoiding certain tasks among the ways stress at work shows up, and it suggests working out what specifically you find stressful and separating what you can change from what you cannot.

For the physical side, the same NHS guidance recommends slow breathing, one hand on your chest and one on your stomach, in slowly through your nose and out slowly through your mouth, and notes you can use it before a situation that makes you nervous, like a meeting. It also encourages talking to someone you trust, whether that is a colleague, a friend or family member, or your workplace wellbeing team. You do not have to walk in alone with all of it.

Wobble sits in the gap between the sleepless night before and a full course of therapy. Wobble's therapists work to the Wobble response framework, a structured framework built for short, practical, single-response support, so you can describe the meeting you are dreading and get one clear, doable next step back rather than a list. When Wobble was tested with real people, 96% said they felt better after a single video, which for a one-off event like an occupational health appointment is often all that is needed.

What happens afterwards

Once the report is with your employer, the next step is usually a conversation about what changes, if anything. Mind suggests treating the weeks that follow as something to manage actively: agreeing a schedule with your manager so you know what to expect, regular catch-ups about what is and is not working, and checking whether your employer offers other support such as an employee assistance programme. If you need more help than adjustments alone can give, the NHS points to Access to Work, a government scheme that can pay for practical support so you can carry on doing your job, with the details on GOV.UK.

If something goes wrong, for example the recommendations are ignored or you are unhappy with how your confidential information has been handled, ACAS says to raise it with your employer, informally first, and its helpline is there for questions. If your time off is running longer than you expected, maximum time off for stress in the UK covers how fit notes extend.

When to see your GP

An occupational health assessment runs alongside your own care, not instead of it. Book a GP appointment if your mental health has been low or strained most days for a few weeks or more, if it is affecting your sleep, your work or your relationships, if it is getting worse rather than better, if you are leaning on alcohol or other substances to cope, or if self-help has not shifted anything. A GP can talk through your options, and if you are off work they are the person who assesses whether you are fit for it and issues a fit note. You do not have to justify being there.

In England you can also refer yourself to NHS Talking Therapies at nhs.uk/talk without going through your GP, though waits vary widely, and in Scotland, Wales and Northern Ireland the GP route is the standard one. Seek urgent help if you are having thoughts of suicide or self-harm or feel you cannot keep yourself safe. NHS 111 has a 24/7 mental health option, Samaritans (116 123) are there day or night, and Shout (text 85258) is there if calling feels like too much.

Quick summary

An occupational health assessment is a confidential conversation with a health professional who specialises in work, about how your health and your job affect each other and what support would help, and it is used for mental health reasons in exactly the same way as physical ones. None of the reasons ACAS gives for using it are disciplinary, you do not have to agree to it, but going usually helps, because it puts your side into the picture and is how phased returns and adjustments tend to get suggested. The report only goes to your employer with your permission, never includes your full medical records, and must be kept confidential. Your employer decides what to act on within its legal obligations, and anything about rights, pay or adjustments belongs with ACAS, Citizens Advice, a union rep or HR. Your GP remains the right person for the health side throughout.

For the stage before this one, see how to get a sick note for work for your mental health. For what a gradual return looks like, see phased return to work.

Sources and further reading

• ACAS: Using occupational health at work (acas.org.uk)
• ACAS: Occupational health assessments (acas.org.uk)
• ACAS: Getting a doctor's report about a worker's health (acas.org.uk)
• NHS: Returning to work after mental health issues (nhs.uk)
• NHS: Work-related stress, Every Mind Matters (nhs.uk/every-mind-matters)
• NHS Talking Therapies self-referral (England): nhs.uk/talk
• Mind: Returning to work (mind.org.uk)
• Mind: Getting support at work (mind.org.uk)
• GOV.UK: Access to Work (gov.uk/access-to-work)
• Citizens Advice (citizensadvice.org.uk)
• Samaritans: 116 123 (samaritans.org)
• Shout: text 85258 (giveusashout.org)

This article is for information only and does not replace advice from a qualified medical professional, and it is not legal advice. If your mental health is affecting your daily life, please speak to your GP or contact NHS 111. For questions about your rights at work, contact ACAS or Citizens Advice. If you are in crisis, please call 999 or go to A&E.

If you are in crisis or feel unsafe, please call 999 or go to A&E. For urgent mental health support, call NHS 111 and select the mental health option. Samaritans (116 123, free, 24/7) and Shout (text 85258) are always available.