The Unacknowledged Cost

Conversations about mental health at work often focus on the people who take a day off. When someone calls in sick or takes a mental health day, they see that a project slows down and deadlines get tight; it is an obvious and measurable cost when a person is not there. 

But the bigger problem with the even greater cost often flies under the radar: presenteeism. This is when employees show up even when they are not well (physically, mentally, or emotionally). Sure, they sit at their desks and log in to calls, but they are not able to bring their best. They go through the motions and don’t perform at their usual level. They may even become a liability. By the time someone finally takes a day for mental health, research shows they have often been dragging themselves through weeks of low energy, poor focus, and lost productivity.

What It Looks Like in Real Life

Presenteeism is hard to spot because no one announces, “I am only running at 60% today.” It takes time for both the team member and the leader to notice. At first, it might look like small delays, slower responses, or work that is not up to the usual standard. Over time, the changes become more visible: irritability where there used to be patience, skepticism where there used to be optimism, fatigue weighing down someone who was once full of energy – the presentation is similar to burnout, although the cause might be different.

Often, the root isn’t even inside the workplace. It might be a sick parent, financial strain, childcare challenges, or grief. We like to believe people can leave it at the door, but the truth is, life always comes with us to work. Those stressors sit right beside us, tugging our focus and energy away from the job.

Why It Matters for the Whole Team

Some leaders assume presenteeism is a personal issue, and because the root cause is often outside work, it is on the individual to manage. That is not true. There’s a ripple effect that hits the whole team. When one person isn’t operating at full capacity, the workload does not disappear; it shifts. This means there’s a colleague who needs to pick up the slack, deadlines get redistributed, and before long, the whole team feels the pressure. Presenteeism is not just a hidden drag on productivity. Research by Harvard Business Review estimates it costs U.S. companies more than $150 billion each year. Another useful guideline: for every one day of absenteeism due to poor mental health, there have already been at least 7 days of lost productivity.

Presenteeism doesn’t stay contained. When it’s left unaddressed, it builds toward burnout and eventually leads to absenteeism anyway. At that point, the costs are higher for both the individual and the team. What starts as one person struggling ends up chipping away at the energy and well-being of everyone around them.

Why People Push Through

If presenteeism is so costly, why do people keep showing up when they are not well? The reasons vary. Sometimes it is the workload: “If I take a day off, I will fall behind.” Other times, it is cultural: “If I call in sick, people will think I am weak.” Often, it is personal: loyalty to the team, fear of letting others down, or a sense that life outside of work already feels overwhelming.

No matter the motivation, the outcome is the same… people are present, but not really there.

What Leaders Can Do 

Leaders aren’t powerless here; they can help reduce instances of presenteeism or help their team through it. 

How? Start with care. When you notice a change in your teammate, show that you care and open the door for conversation. Even a small check-in can make it easier for someone to share what they are going through.

From there, look for ways to reduce stress. No employer can solve every personal challenge, but flexibility during a house move, time off after a loss, or adjusted hours for childcare can make a real difference. Those gestures often build enormous loyalty in return.

At the same time, simplify the work. If someone has only got 75% to give, help them use it wisely. Clear away distractions, cut down on multitasking, and keep their energy focused on what matters most.

Most importantly, do not wait until people are at the breaking point. Encourage time away before they are completely depleted. Make it a habit to talk openly about workloads, and make the workplace about connection. One of the strongest antidotes to poor well-being is meaningful relationships.

Reality Check

Presenteeism results in lost productivity, but it also has a hand on the wheel when it comes to an erosion of trust, energy, and well-being. Unfortunately, presenteeism will never disappear. We’re human, not machines, and no one operates at 100% all the time. Leaders can still make a difference by spotting the signs early, normalizing conversations about mental health, and building flexibility and connection into the way teams work.