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

Abstract Background Despite increasing awareness of mental health in the workplace, people with mental health problems continue to face substantial barriers to labour market participation. While stigma-related explanations have been widely addressed, less is known about how employers respond to mental health problems within the constraints of everyday organisational practice. This study explores employers’ perspectives on workplace inclusion, with a particular focus on ambivalences, facilitating orientations, and expectations towards employees with mental health problems. Methods This study reports findings from the first, qualitative phase of a participatory mixed-methods research project conducted in Southern Germany. Between November 2022 and August 2023, we conducted 29 semi-structured interviews with employers from companies across different sectors. Data were analysed using structured qualitative content analysis. Results Employers described ambivalent orientations towards the inclusion of people with mental health problems. While mental health issues were seen as increasingly normalised and framed within broader societal developments, employers reported uncertainties regarding work organisation, team functioning, and predictability. Facilitating orientations included social responsibility, recognition of the health-promoting role of employment, pragmatic responses to labour shortages, and positive prior experiences. At the same time, workplace participation was often described as depending on employees’ transparency regarding work-related limitations, individual responsibility for managing mental health, and disclosure as a prerequisite for employers’ support and mutual trust. Discussion Workplace inclusion of people with mental health problems appears to depend not only on employers’ attitudes but also on practical considerations related to work organization and team functioning. Employers’ perspectives reflected ambivalence, balancing commitments to participation with concerns about predictability, fairness, and collective functioning. Expectations regarding disclosure, responsibility, and transparency were central to perceived feasibility of support. Conclusions Addressing these organisational dynamics may help inform more context-sensitive strategies to promote sustainable labour market participation.