Occupational health referral: what it means and what happens next

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An occupational health referral is your employer asking a health professional who specialises in work to advise them on how to support you, and when the reason is stress, anxiety or time off for your mental health it is a request for information, not a disciplinary step. ACAS, the UK's workplace advice service, describes occupational health as a type of medical service an employer uses to help it make decisions, and none of the reasons it lists for using one is about discipline.

That is the short version, and it is the thing most people need to hear in the first hour after the email lands. The rest of this piece covers what occupational health actually does, why an employer refers someone, whether you have to agree, what you should be told and asked along the way, and how to handle the nerves between the referral and the appointment. It deliberately stops at the door of the assessment itself, because what happens in an occupational health assessment has its own guide covering the meeting, the report and who gets to see it. It also stops short of your contract, your pay and your legal rights, which belong with ACAS, Citizens Advice, a union rep or HR rather than a health guide. If you are earlier in the process and still working out how being off sick works, how to get a sick note for work for your mental health 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 does occupational health actually do?

Occupational health looks at how your health and your work affect each other, and advises your employer on what would help. ACAS describes it as a type of medical service that an employer might use to help with decisions about a worker who is struggling with their physical or mental health, about the right reasonable adjustments for someone who is disabled, about someone who has been off sick for a long time or is coming back after sickness absence, about reducing the amount of time people need off sick, about keeping to health and safety rules, and about managing risks to mental health such as too much pressure at work or bullying.

Read that list again if you are braced for bad news. It is a list of ways to support people and to keep a workplace safe, and the mental health reasons sit on it alongside the physical ones. The service might be your employer's own in-house team or an outside agency, and ACAS notes that some smaller employers have no occupational health scheme at all, in which case the employer should communicate with you and, only with your permission, with your doctor. Whether the referral goes to a big national provider or a single adviser your employer contracts in makes no difference to what it is for.

Why has my employer referred me to occupational health?

Most referrals for mental health reasons happen because you have been off sick, because your absences have added up, or because your employer can see you are struggling and wants advice on what to change. Those are all on the ACAS list above, and Mind's guidance on getting support at work puts it plainly: your employer might refer you to an occupational health adviser for advice on how best to support you.

It helps to know that you can set this in motion yourself. Mind's guidance on returning to work suggests asking to be referred to occupational health, because occupational health workers can help you and your employer put together a back-to-work plan that sets out your condition and the kind of support you may need. If the referral has come from your manager rather than from you, that does not change what it is. The NHS guidance on returning to work after a mental health problem describes a meeting with your employer or an occupational health adviser as the place to talk through your concerns and any recommendations from your GP, and it names the worry most people carry into that room, that colleagues will react badly or that you will not cope, before pointing out that many people find going back to work a positive step with the right support.

Is an occupational health referral a disciplinary matter?

No. An occupational health referral is not a disciplinary process. ACAS describes occupational health as a medical service used to help an employer make decisions, and the reasons it gives for using one are about support, safety and managing absence rather than discipline. It is a way for your employer to get informed advice rather than guessing, and ACAS says one of the benefits of agreeing to an assessment is precisely that it helps avoid your employer making big decisions without important information.

That last point is worth sitting with, because the fear behind the question is usually that the referral is step one of being managed out. The picture ACAS paints is the reverse. Without a report, an employer is left with what you have told them and what is on your fit note. With one, they have a professional's view of what would help you do your job, and they have to keep it confidential and share it only with the people who genuinely need it, which ACAS says might mean your line manager and HR. If you are being referred at the same time as some other process at work is going on, that is a question for ACAS, Citizens Advice, a union rep or HR, and it is exactly the kind of question they exist to answer.

Do I have to agree to an occupational health referral?

No. ACAS is clear that you do not have to agree to an occupational health assessment, and equally clear that it usually helps to. Its guidance says agreeing can help you get any support you need to feel better and be able to do your job, and can stop your employer making big decisions without important information.

ACAS makes a similar point about medical reports in general: where a worker declines, the employer has to fall back on what the worker has told them and what is on their fit note. That is a thinner picture than the one an assessment produces, and it is worth weighing before you decline. The assessment is also the part of the process where your side of the story gets written down by someone whose job is to understand how your health and your work affect each other. If you do go ahead and want to know what the conversation covers and what goes in the report, the occupational health assessment guide walks through it.

What should I be told and asked when I am referred?

Some of the referral process is written down in ACAS guidance, and knowing it takes a lot of the mystery out. ACAS suggests checking whether your organisation has an occupational health policy, which should set out when a referral can be made, how an assessment is carried out, what the employer and the worker are each responsible for, and what happens afterwards. If your employer has one, ask HR for it before the appointment.

On consent, ACAS says that if the occupational health adviser wants information from your GP, they should explain why and ask you to sign a consent form first, and you have the right to see your doctor's report before it goes to the adviser. If a doctor is carrying out the assessment, your employer must tell you in writing about your rights under the Access to Medical Reports Act 1988. Once the assessment is done, the adviser must ask your permission before sharing the report with your employer. And whether you are paid for the time you spend at the appointment should be written into your organisation's policy, so that is a fair thing to ask about.

Those are the documented points. Anything beyond them, whether your employer has handled the referral fairly, what happens to your job if you are off for a long time, whether the Equality Act applies to you, is not something a health guide can answer, and ACAS, Citizens Advice or a union rep are the right places to take it. Mind's legal rights pages are also worth reading if you want to understand the ground before you ask.

Handling the wait before the appointment

The gap between the referral and the appointment is often the hardest stretch, because there is nothing to do but imagine it. If you notice your mind jumping to conclusions without the facts, making the problem feel bigger than it is, or blaming yourself for being in this position, the NHS Every Mind Matters guidance on work-related stress lists all three among the ways stress at work shows up, and it suggests working out what specifically is stressing you and separating what you can change from what you cannot. You cannot change the fact of the referral. You can change what you walk in with.

Practically, that means writing down what has been hard, which tasks or situations make it worse, and what would help. Mind's list of workplace changes is a useful prompt, from flexible hours and a quieter workspace to communicating by email where face-to-face contact is stressful and being able to take a few minutes out when you are struggling, and the NHS adds support from a colleague and a place to go for a break to the same list. Arriving with that picture makes the adviser's job easier and yours calmer. The same NHS guidance recommends talking to your manager, a trusted colleague, HR or someone at home about how you are feeling, and slow, deep breathing to settle the physical side when the dread rises.

This is also where Wobble fits. If you were signed off with stress or anxiety, the piece on how to get signed off work with stress covers the road you have already travelled, and this is the next bend in it. Wobble's therapists work to the Wobble response framework, a structured framework built for short, practical, single-response support, which suits a one-off event like a referral you are dreading. You describe the meeting that is coming and get one clear, doable next step back rather than a list of things you already know.

When to see your GP

An occupational health referral 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. If you are off work, your GP is also 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 refer yourself to NHS Talking Therapies at nhs.uk/talk without going through your GP, though waits vary widely, and elsewhere in the UK your GP can point you to the local route. Seek urgent help if you are having thoughts of suicide or self-harm or feel you cannot keep yourself safe. Call NHS 111 and select the mental health option, Samaritans (116 123) are free and there day or night, and Shout (text 85258) is there if calling feels like too much.

Quick summary

An occupational health referral is your employer asking a health professional who specialises in work for advice on how to support you, and for stress, anxiety or sickness absence it works exactly as it would for a physical problem. ACAS describes occupational health as a medical service used to help employers make decisions, and none of the reasons it lists are disciplinary. You can ask for a referral yourself, you do not have to agree to one, and ACAS says it usually helps to, because without it your employer decides on a thinner picture. Along the way you should be asked for consent before your GP is contacted, told in writing about your rights if a doctor is doing the assessment, and asked for permission before the report goes to your employer. Questions about your rights, pay and your job belong with ACAS, Citizens Advice, a union rep or HR, and your GP remains the right person for the health side throughout.

For what happens in the meeting itself and what goes in the report, see occupational health assessment for mental health. For the stage before this one, see how to get a sick note for work for your mental health.

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)
• 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.