Between support and uncertainty: employers’ perspectives on workplace inclusion of people with mental health problems

A qualitative study of 29 employers in Southern Germany found that workplace inclusion of employees with mental health problems was described as both supported and uncertain. Employers expressed willingness to employ and support affected workers, but their accounts repeatedly raised concerns about work organisation, team functioning, predictability and fairness. They also said that successful inclusion depended on employees being transparent about their limitations, taking responsibility for managing their mental health and disclosing their needs.

The study was the first qualitative phase of the participatory TAPE mixed-methods project, conducted from November 2022 to August 2023. It recruited organisational decision-makers from small and medium-sized enterprises across different sectors through regional networks, professional contacts, collaboration with partner organisations, media notices and direct contact. Purposive sampling sought variation in organisational role, company size, sector and previous experience of employing people with mental health problems. The 29 participants included managing directors, department heads and human resources professionals with responsibilities for recruitment, supervision or personnel management.

Researchers conducted semi-structured online interviews lasting 21 to 59 minutes. The interview guide addressed participants’ experiences with employees with mental health problems, attitudes toward labour market participation, perceived facilitating and hindering factors, and expectations of employees. Two researchers conducted the interviews, which were audio-recorded, transcribed verbatim and pseudonymised. Participants provided informed consent, and the study received ethics approval from the University of Ulm, committee reference 180/22.

All interviews and analyses were conducted in German. The researchers used structuring qualitative content analysis in MAXQDA 2024, beginning with deductive main categories based on the interview guide and then adding inductive subcategories as new material emerged. Coding decisions and interpretations were discussed in participatory workshops involving researchers with and without experience of mental illness. The team iterated the category system until consensus was reached, revisited coded passages to check consistency and continued recruitment until subsequent interviews produced no new substantive codes or categories.

Three main themes emerged: ambivalences and uncertainties; facilitating and resource-focused orientations; and employers’ expectations toward employees. Many participants described mental health problems as increasingly normalised and no longer taboo. At the same time, they expressed uncertainty about their prevalence within their organisations, how mental health conditions affect work, and how they should respond. Some employers described depression and burnout as comparatively manageable, while bipolar disorder, borderline personality disorder and schizophrenia were associated more strongly with unpredictability, risk, absence or disruption of the wider team.

Practical constraints were central to these accounts. Participants raised concerns about fluctuating capacity, frequent or prolonged absence, reintegration processes that could take months or years, staffing, scheduling and dependencies between colleagues. Some also described uncertainty about interacting with affected employees, including worry about behaviour that might breach workplace boundaries. Employers weighed individual support needs against the interests of the team, reflecting tension between inclusion and perceived fairness or collective functioning.

Supportive motives also featured prominently. Participants referred to social responsibility, the health-promoting role of employment, the value of retaining trained and experienced staff, and shortages of workers. Employment was described as providing daily structure, social integration and a sense of personal value. Several employers regarded experience of a mental health crisis as a possible source of self-confidence, resilience or sensitivity to boundaries. Positive previous experiences with an affected employee were also associated with greater willingness to hire or support such workers.

Workplace support was presented as conditional. Employers wanted practical information about an employee’s limitations rather than relying solely on a formal diagnosis. They expected employees to assess their needs realistically, seek treatment or stabilisation and take personal responsibility for maintaining their mental health, with workplace support viewed as supplementary. Disclosure was considered necessary for identifying support needs and arranging adjustments, although participants acknowledged the risk of stigma. Trust in supervisors and colleagues was described as a prerequisite for openness, and transparency about limitations could itself help build that trust.

The findings do not measure the prevalence of employers’ views or establish that any approach improves employment outcomes. The sample was confined to one region and consisted of small and medium-sized enterprises, limiting generalisation to other labour markets, organisational sizes and institutional settings. Self-selection may have favoured employers already interested in mental health. In addition, the study reports employers’ accounts rather than directly observing workplace practices, and it does not show how employees experience or negotiate the expectations attributed to them. The authors state that the qualitative phase was exploratory and that the subsequent quantitative phase was intended to examine the findings in larger samples and assess differences among employer groups.

Subject of Research: Employers’ perspectives on workplace inclusion of people with mental health problems

Article Title: Between support and uncertainty: employers’ perspectives on workplace inclusion of people with mental health problems

Article References: Krumm, S., Mayer, L., Feige, S., Stasch, N., Renz, L., Braun-Volkert, C., Kilian, R., & Almer, E. (2026). Between support and uncertainty: employers’ perspectives on workplace inclusion of people with mental health problems. BMC Health Services Research, 26(1), Article 1321. https://doi.org/10.1186/s12913-026-15665-x

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15665-x

Keywords: workplace inclusion, mental health, employer perspectives, qualitative research, employment, work organisation, employee disclosure, workplace support, organisational practice, Southern Germany, Between, support