Manager's Guide to Employee Mental Health

Manager Guide · 01

When an Employee Is Visibly Struggling: What to Say, and What Not to Say

The most common situation. The most avoided conversation. This guide gives managers the exact language, a step-by-step framework, and realistic scenario scripts to handle it confidently — without overstepping, creating legal risk, or making the employee feel worse.

8 min read6-step framework4 scenariosLanguage guide

Why This Conversation Feels So Hard

Most managers are not avoiding this conversation because they do not care. They are avoiding it because they do not know what to say. They worry about overstepping, saying the wrong thing, making it worse, creating legal risk, or making the employee feel singled out or stigmatised. These are legitimate concerns. But the consequence of not having the conversation is almost always worse than the conversation itself.

In Refill Health's 2025 Manager Survey, 61% of managers reported observing a team member show signs of distress in the past year but not raising it directly. Of those, 74% cited “not knowing what to say or do” as the primary reason. This guide gives you what those managers were missing.

The Core Rule: Observe, Don't Diagnose

The single most important principle: the distinction between what you have observed (behaviour, patterns, changes) and what you conclude from it(diagnosis, labelling). Your job is to notice and name the former. It's not to do the latter.

You can say: "I've noticed you seem quieter than usual lately." That is an observation. You cannot say: "I think you're depressed." That is a diagnosis. You are not a clinician. Your job is to open the door - not to walk through it and deliver a verdict.

The 6-Step Framework

Find a private moment — not in public, not over chat

Ask if they have 10 minutes. Take them somewhere private. Never have this conversation in writing — it removes your ability to read how they are responding.

Name what you have observed — specifically, without labelling

"I have noticed you seem quieter in team meetings over the past couple of weeks." Avoid: "You seem stressed out" (labels their experience).

Ask one open question — then stop talking

"How are you actually doing?" Then wait. Count to ten in your head. The silence is not awkward — it is giving the person space to respond.

If they share something, acknowledge it first

Do not go into problem-solving. Just: "Thank you for telling me that." "That sounds really hard." That acknowledgement does more than any advice.

Mention the support available — once, without pressure

"We have a mental health programme — confidential, no connection to HR." Then stop. Do not ask if they will use it. Do not follow up asking "did you contact them?"

Follow up next week — briefly, informally

"Just wanted to check in, how are you doing?" Most managers skip this step. Most employees notice. It signals you meant it.

Language Guide: What Not to Say — and What to Say Instead

Both columns say something kind. The difference is whether the phrasing accidentally minimises, diagnoses, or closes down — versus opening up and staying with the person's experience.

✗ Do not say this

✓ Say this instead

"I know exactly how you feel."

"That sounds really difficult. I appreciate you telling me."

"You need to see someone." / "You should go to therapy."

"There's support available if you ever want to explore it — no pressure at all."

"Everyone goes through this kind of thing."

"This sounds like a lot to be carrying. You don't have to manage it alone."

"You just need to take a break / get some rest."

"What would feel most helpful for you right now — is there anything I can do?"

"Don't worry — everything will be fine."

"I don't have all the answers but I'm really glad you said something."

"Have you tried meditation / yoga / exercise?"

"Is there anything about work that's making things harder that I should know about?"

"You seem fine to me — I hadn't noticed anything."

"I'm glad you're talking about it. I want to understand."

"Is it a relationship / family / financial thing?"

Let them tell you what they want to tell you. Don't probe for specifics.

"Just let me know if you need anything." (without specifics)

"I'll check in with you next week. And the door is genuinely open."

Four Scenarios — With Full Dialogue

The most common response — and the most misread. "I'm fine" usually means one of three things: they genuinely are fine, they're not ready to talk, or they're testing whether you'll accept the surface answer.

Mgr

"I've noticed you've seemed a bit quieter recently. Just wanted to check in — how are you doing?"

"I'm fine. Just tired, you know — busy period."

Emp

Mgr

"I hear you — it's been a heavy few weeks. I just wanted to make sure. If at any point you did want to talk about anything, the door's genuinely open. No judgement, nothing goes anywhere. And there's a support programme if you ever want to know more about it."

"Thanks. I'll be okay."

Emp

Mgr

"Okay. I'll check in again next week. Take care of yourself."

What happened: The manager accepted the answer without abandoning the conversation. They made the door visible. They planted the seed. They committed to following up.

What to Do After the Conversation

Do not document the conversation in writing→unless the employee has disclosed something that creates a duty of care obligation (see Crisis Protocol below).

Do not tell HR what the employee said→unless you have explicit permission or a genuine duty of care issue.

Do follow up next week→briefly and informally. "How are you doing?" That's it.

Do make any practical adjustments you offered→The follow-through is what makes the conversation real.

Crisis Protocol: If an Employee Discloses Thoughts of Self-Harm or Suicide

This is a different situation. Do not apply the general conversation framework. Follow these steps immediately, in order.

Stay calm and stay with them

Do not leave the employee alone. Say: "Thank you for telling me. You're not in trouble. I want to help you right now."

Call Refill Health's crisis line immediately

Call while the employee is present. Say: "I have an employee with me who needs urgent support." Hand the phone to them if willing.

Contact your HR lead — in parallel

Text or call your HR contact. This is one of the limited situations where you must involve HR without consent — genuine duty of care.

Do not leave them alone until support arrives

Confirm with the navigator before stepping away. If neither clinical nor HR support has arrived, stay.

After: Write a factual record immediately

Within the hour — what was said, when, who was present, actions taken. Share with HR. This is a safeguarding record, not a disciplinary one.

When an Employee Is Visibly Struggling: What to Say, and What Not to Say

8 min read6-step framework4 scenariosLanguage guide

The conversations your managers need before they happen - Series 1

When an Employee Is Visibly Struggling: What to Say, and What Not to Say

Why This Conversation Feels So Hard

The Core Rule: Observe, Don't Diagnose

The 6-Step Framework

Language Guide: What Not to Say — and What to Say Instead

Four Scenarios — With Full Dialogue

What to Do After the Conversation

Crisis Protocol: If an Employee Discloses Thoughts of Self-Harm or Suicide

Manager training is built into every
Refill programme.

The conversations your managers need before they happen - Series 1

When an Employee Is Visibly Struggling: What to Say, and What Not to Say

Why This Conversation Feels So Hard

The Core Rule: Observe, Don't Diagnose

The 6-Step Framework

Language Guide: What Not to Say — and What to Say Instead

Four Scenarios — With Full Dialogue

What to Do After the Conversation

Crisis Protocol: If an Employee Discloses Thoughts of Self-Harm or Suicide

Manager training is built into every
Refill programme.

The conversations your managers need before they happen - Series 1

When an Employee Is Visibly Struggling: What to Say, and What Not to Say

Why This Conversation Feels So Hard

The Core Rule: Observe, Don't Diagnose

The 6-Step Framework

Language Guide: What Not to Say — and What to Say Instead

Four Scenarios — With Full Dialogue

What to Do After the Conversation

Crisis Protocol: If an Employee Discloses Thoughts of Self-Harm or Suicide

Manager training is built into everyRefill programme.

The conversations your managers need before they happen - Series 1

When an Employee Is Visibly Struggling: What to Say, and What Not to Say

Why This Conversation Feels So Hard

The Core Rule: Observe, Don't Diagnose

The 6-Step Framework

Language Guide: What Not to Say — and What to Say Instead

Four Scenarios — With Full Dialogue

What to Do After the Conversation

Crisis Protocol: If an Employee Discloses Thoughts of Self-Harm or Suicide

Manager training is built into everyRefill programme.

Manager training is built into every
Refill programme.

Manager training is built into every
Refill programme.