Being signed off work with stress can bring a strange mix of feelings. There's often relief, because something that wasn't sustainable has finally stopped. Then come the questions: what you have to tell your employer, whether you'll be paid, how a phased return to work works, and what you're meant to do with the time.
This article covers the practical side first, then what tends to help recovery, and finally what to expect when you go back. The rules described here apply in England, Scotland and Wales; Northern Ireland has its own system.
What being signed off actually means
The first seven days: self-certification
If you're off sick for seven days or fewer, you don't need a fit note or any proof from a healthcare professional. When you return, your employer can ask you to confirm you were ill, usually through a form or an email. This is called self-certification.
After seven days: the fit note
If you're off for more than seven days in a row, your employer can ask for a fit note (what used to be called a sick note). The seven days include non-working days such as weekends and bank holidays. Fit notes are free once you've been ill for more than seven days.
A fit note can be issued by a GP or hospital doctor, a registered nurse, an occupational therapist, a pharmacist or a physiotherapist, after they've assessed you. Your employer can take a copy, but you keep the original.
"Not fit for work" or "may be fit for work"
A fit note says one of two things. "Not fit for work" means just that. "May be fit for work" means you could work if some changes were made. The healthcare professional can tick one or more of four options:
A phased return to work: gradually building up your hours or duties.
Altered hours: changing when you work or for how long.
Amended duties: changing what you do to take account of your condition.
Workplace adaptations: changing aspects of the workplace, which can include working from home.
This advice isn't binding on your employer. If they can't make the suggested changes, you're treated as not fit for work and the same fit note is used as evidence for sick pay, so you don't need a new one.
In the first six months of a condition, a single fit note can cover at most three months. You can go back to work before your fit note runs out, and you don't need to see the healthcare professional again first.
Talking to your employer
What you have to share
Beyond providing a fit note when one is needed, you don't have to go into detail about your health. Acas, the government-funded employment advice service, is clear that a worker doesn't have to tell their employer anything about the cause of their absence, although talking openly can make it easier for them to support you. You can also say what you'd like colleagues to know and what you'd like kept confidential.
Keeping in touch
Acas recommends that you and your employer agree how you'll stay in contact while you're off: how often, by what method (email, phone or in person) and with whom, whether that's your line manager, another manager or HR. For absence related to mental health, contact should be agreed so that it isn't overwhelming. If direct contact is too much, Acas suggests someone else, such as a family member or close friend, could check in on your behalf.
It's worth agreeing this early. A short, predictable arrangement, say a brief email every week or two, is usually easier to live with than calls that arrive without warning.
Sick pay
Most employees who are off sick are entitled to Statutory Sick Pay (SSP). GOV.UK says you qualify if you're classed as an employee, have done some work for your employer and have been ill for at least one full working day. SSP is paid by your employer for up to 28 weeks, at whichever is lower: a flat weekly rate set by the government or 80% of your normal weekly earnings. The current rate is on GOV.UK.
SSP is the legal minimum. Many employers pay more through their own sick pay scheme, so check your contract or staff handbook, or ask HR.
Using the time off well
Time off on its own doesn't always fix stress. It removes the pressure, which matters, but if nothing else changes you can find yourself going back into the same situation with the same habits, and the stress returns within weeks.
In the first days, rest is the priority. Many people feel they should be "doing something useful" with the time, and feel guilty when they aren't. Sleep, eating regularly, getting outside and seeing people you like are not indulgences; they're the groundwork for everything else.
Once you have a little more energy, it's worth taking stock. What, specifically, was driving the stress? Was it the volume of work, a particular relationship, a lack of control over how you worked, or your own expectations of yourself? Some of these are about the job, and some are about how you respond to pressure, such as finding it hard to say no or to switch off. Both are worth understanding before you go back.
It's also worth asking whether this is stress or something closer to burnout. Stress usually eases once the pressure lifts; burnout often doesn't, even after a long break. My article Burnout or stress? The signs, and how to recover covers the difference and what helps with each.
This is also a good time to get support. Therapy during time off can help you understand what led here and plan a return that doesn't simply repeat it.
A phased return to work
A phased return means building up gradually to your normal work, rather than going straight back to full hours and a full workload. It might involve reduced hours, different duties or a lighter workload. Your fit note may recommend one, or you can ask for one.
The return-to-work meeting
Acas suggests your employer has a conversation with you as soon as possible after you return. It's often an informal chat: a chance to check you're ready, catch up on what's changed, talk about any support you need, and agree a plan. Your employer may also suggest a referral to occupational health, a medical service that advises on what adjustments might help.
How long it lasts
There's no set length. Acas says you and your employer should agree how long it will be, taking account of any advice on your fit note, and review progress regularly. It can be extended, or the duties changed, if needed.
An example
Every phased return is different, but a four-week plan might look something like this:
Week 1: three half-days, focusing on catching up and lower-pressure tasks.
Week 2: four half-days, gradually taking back some routine work.
Week 3: four days, with a lighter workload and no new major responsibilities.
Week 4: full hours, with a review meeting to agree what happens next.
This is only an illustration. A good plan is built around what you need and what the role involves, and it's reviewed as you go rather than fixed in advance.
Pay during a phased return
According to Acas, if you're doing your usual work on reduced hours you're paid your usual rate for the hours you work. Pay for the hours you don't work depends on what's agreed or set out in your employer's policy: it might be full pay, company sick pay, or SSP if you're eligible and neither of the others applies. SSP can only be paid for whole days you don't work, not for the rest of a day you work part of. If you're doing a lighter workload, your pay should be agreed with your employer, ideally in writing.
Reasonable adjustments
Under the Equality Act 2010, employers must make reasonable adjustments for disabled employees. Stress isn't automatically a disability, but a mental health condition can be one. The legal test is whether you have a physical or mental impairment that has a substantial (more than minor) and long-term adverse effect on your ability to carry out normal day-to-day activities. Long-term means it has lasted, or is likely to last, at least 12 months. The effects don't have to be constant, and you don't have to think of yourself as disabled for the law to apply.
The duty applies where your employer knows, or could reasonably be expected to know, that you're disabled, or where your absence is linked to a disability. Examples Acas gives include:
changing working patterns, or spreading breaks more evenly through the day
flexible working, including home or hybrid working
paid time off for medical appointments and treatment
a phased return to work after absence
one-to-one support, for example help with prioritising work
What counts as "reasonable" depends on the situation, including whether the change would help, whether it's practical and affordable, and whether it affects others' health and safety. Your employer pays for reasonable adjustments.
Even if you're not covered by the Equality Act, it's still worth asking for changes. Many employers will agree to them because it makes a successful return more likely.
Access to Work
Access to Work is a government grant scheme for people with a physical or mental health condition or disability. It can help pay for practical support at work, and it doesn't have to be paid back. It also offers mental health support, which can include a tailored plan to stay in work and one-to-one sessions with a mental health professional, provided through Able Futures or Maximus (you apply to one, not both). Access to Work doesn't replace your employer's duty to make reasonable adjustments.
For managers and HR teams
How the first few weeks of an absence are handled has a big effect on whether someone comes back well. Agreeing light, predictable contact, making the return-to-work conversation a genuine discussion rather than a formality, and treating the phased return plan as something to review rather than a fixed timetable all make a difference. The Acas guidance on managing absence is a good starting point.
I also work with organisations on workplace mental health. If you'd like to talk about supporting a member of staff, or about stress in your team more widely, get in touch.
When to get more support
If the stress isn't easing, if you're dreading going back, or if you've been off before and found yourself in the same place again, it's worth talking to someone. Your GP is a good first step, and therapy can help you understand what's keeping the stress going and plan a return that lasts.
If you ever feel unable to keep yourself safe, or are having thoughts of ending your life, please contact Samaritans on 116 123 (free, any time), or call 999 or go to your nearest A&E.
Working with me
I'm a Counselling Psychologist, registered with the HCPC and a Chartered Member of the BPS. I work with people dealing with workplace stress and burnout, in person in Fitzrovia, central London, and online, using CBT and schema therapy. You can read more about therapy for work stress, or book a free 15-minute consultation.
