Mental Health Is a Leadership Task: Spotting Warning Signs Early and Responding Well

October 10 is World Mental Health Day, and in Germany the Week of Mental Health runs until October 20 under the motto "Together instead of side by side". For leaders and HR, this motto deserves a closer look. Hardly anyone notices changes in a person's behaviour as early as the people who work with them every day. The question is whether we can make sense of what we see and know what to do next.

Why mental health belongs to leadership

The numbers are clear. According to a reply from the German federal government to a parliamentary inquiry, there were around 147 million days of sick leave due to mental illness in 2024. In 2014 there were about 70 million, so the figure has more than doubled in a decade.

Duration adds to this. According to analyses by AOK Baden-Württemberg for 2025, a case of illness with a mental health diagnosis lasts 28.1 days on average. That is the longest duration of any diagnosis group. For comparison, respiratory illnesses average around 5 days and musculoskeletal conditions around 15.

Those who look early can shorten absences or even prevent them. And this is exactly where leadership has its opportunity: we are close enough to notice when something is different.

How to recognise strain early

Psychological strain rarely announces itself with a loud signal. Most often it shows up as a change from what is normal for that person. Typical signs in everyday work:

• Withdrawal: someone who used to be engaged hardly takes part in conversations anymore.

• Irritability or sharpness that wasn't there before.

• A drop in performance, more mistakes, tasks that pile up.

• Lasting exhaustion, even after days off.

• Cynicism: the attitude toward work or colleagues tips into dismissiveness.

• Strikingly frequent sick days, or the opposite: constant overpresence.

A single signal says little. A pattern over several weeks is a reason to seek the conversation. Burnout research describes a similar pattern with exhaustion, cynicism and reduced sense of efficacy (Maslach Burnout Inventory), which appears early and often intensifies gradually.

What matters: you don't have to diagnose anything. You only have to notice that something is different, and speak about it.

The early warning system starts with you

If you want to perceive others well, you need a view of yourself. When am I more irritable than usual? When do I withdraw? What signals does my body send? The yogic tradition has a term for this, Svadhyaya, self-study, and counts it among the Niyamas, the guidelines for how we treat ourselves. Translated into leadership practice: those who know their own patterns of strain recognise them in others sooner and respond more calmly when they meet them.

First aid for the mind: the ROGER framework

What do you do when something catches your eye? The Mental Health First Aid (MHFA) programme, developed around the year 2000 in Australia, offers a simple orientation. In the German-language course it is called ROGER:

R for React. Approach the person before the feeling sets in that nothing can be said. Choose a quiet place, stay with what you have concretely observed ("I've noticed that you've seemed tired a lot over the last few weeks"), and assure confidentiality.

O for Open and unbiased listening. Listen to understand. You don't have to solve or judge anything. A "That sounds heavy" often achieves more than quick advice.

G for Give support and information. Show empathy, convey confidence without playing things down, and share reliable information if the person asks for it.

E for Encourage them to seek help. Talk together about who can help: a GP, a psychotherapy practice, counselling services, workplace support. Encouraging means offering and accompanying, not pushing.

R for Reactivate resources. Ask what has helped the person so far and who in their life can support them. This strengthens the sense of being able to make a difference themselves.

If there are signs of acute danger, such as remarks about suicidal thoughts, the person's safety comes before any conversation guide. Stay with the person, say openly and directly what you perceive, and get professional help immediately. In case of immediate danger, call the emergency services.

What MHFA delivers

MHFA first aiders are not therapists. They do not diagnose and they do not treat. Their role is that of a first point of contact who looks closely and paves the way to professional help.

What does research say? A meta-analysis by Morgan, Ross and Reavley (2018, PLOS ONE) evaluated 18 controlled studies with almost 6,000 participants. After the training, knowledge about mental illness, the ability to recognise it, and confidence in dealing with it were clearly better. Participants also supported more people afterwards. Prejudice decreased slightly. These effects held for up to about six months after the course; for the period after that, the evidence is unclear.

What organisations can do in addition

Individual first aiders do not replace a culture. The topic takes effect when several things come together:

• Conversations about strain are normal and modelled by leadership.

• People know whom they can turn to, internally and externally.

• Leaders are trained to address changes without diagnosing.

• Workload is discussed regularly, not only when someone drops out.

Together instead of side by side begins in everyday life, with a single question: "How are you, really?"

When did you last ask this question and take the time to hear the answer?

Sources: Reply of the German federal government to a minor interpellation by the parliamentary group Die Linke (Bundestag document 21/3464) on days of incapacity to work due to mental illness; AOK Baden-Württemberg, Fehlzeiten-Bilanz 2025 (WIdO analysis); Maslach & Jackson (1981), Maslach Burnout Inventory; Morgan, Ross & Reavley (2018), Systematic review and meta-analysis of Mental Health First Aid training, PLOS ONE; MHFA Ersthelfer Deutschland, ROGER framework.