It’s the conversation every manager dreads. Paula from accounts has got her 1:1, and she’s been underperforming. You’ve been timing her toilet breaks, and sometimes they take 15 minutes or more. She’s been late on several occasions and sneaks off early at least twice a week.
Last month, there was that incident. The one where Clive from IT used her oat milk to make his coffee and she went bat shit. Paula’s 1:1 is not going to be pretty. You had to watch Rocky IV last night to psych yourself up.
But then, just as you’re about to give her both barrels, Paula quietly explains that she’s struggling with stress and anxiety. Her elderly mother has been put in a nursing home, her husband left her, and her cat has worms. How do you feel now, you bully? You should be ashamed of yourself. Poor Paula. Go and buy her an oat milk latte.
Of course, I’m exaggerating here, but it’s not unusual in the workplace for the line between accountability and empathy to feel like a tightrope strung across a legal and moral minefield.
How do you support someone’s well-being while addressing performance? How do you know if the stress is genuine, or if it’s unintentionally become a shield for avoidance? And, in a world where resilience is praised but stress is everywhere, how can managers even tell what’s ‘normal’ anymore?
And why was Clive having a coffee break anyway? He’d only just come back from lunch.
At Laughology, one of the biggest challenges we hear from managers and leaders is that when it comes to conversations about mental health, they are worried about getting it wrong, making someone’s mental health worse, or stepping into territory they don’t feel equipped to handle.
Understanding what’s normal
In his book, Head First: A Psychiatrist’s Stories of Mind and Body (also published as No More Normal), psychiatrist Alastair Santhouse explains how modern medicine and, by extension, workplaces, have over-medicalised common human struggles.
This doesn’t mean people are pretending to be stressed or anxious. It means our collective understanding has shifted, and we’re more likely to label ordinary difficulties as stress or anxiety.
In truth, stress, sadness, frustration, and even physical symptoms like headaches or tiredness are not always signs of illness. Sometimes, they’re just signs of life. People experience fatigue and pain that mimic disease symptoms when no identifiable disease is present.
The cause is life, not a pathology.
We’ve all been in situations where we genuinely feel so washed-out that we think we’re getting a bug, but we are fine the next day after a decent night’s sleep. That’s probably just exhaustion. Not all discomfort needs a medical explanation. That said, managers shouldn’t dismiss mental health concerns or skip making reasonable adjustments.
Santhouse suggests we need to hold two ideas at once: recognising genuine mental illness, while also acknowledging that tough periods, setbacks or pressures are part of being human.
The leadership challenge: accountability vs. empathy
Research from the Mental Health Foundation shows that one in six UK workers experiences mental health issues such as anxiety or depression. Yet data from Mind suggests many employees still fear stigma when opening up. No wonder leaders feel unsure when mental health is raised in the context of underperformance.
Are you being unfair if you push on performance? Are you exposing the company to risk if you ignore the disclosure?
In reality, you can care about someone’s wellbeing and still hold them accountable. In fact, clear communication about expectations is part of creating psychological safety. It’s about setting clear expectations early, discussing what can and can’t be adjusted, and ensuring both sides play a part.
If an organisation has a good performance framework, this can be a useful tool for open, honest, two-way conversations done with empathy and kindness.
Key points for leaders: navigating tough conversations
Prepare and separate the issues, and don’t go into a 1:1 unprepared. Be clear on which concerns are about performance (missed targets, poor quality, lack of delivery) and which relate to wellbeing (distress, disclosures, changes in behaviour). Address them carefully, but separately.
Listen first, don’t diagnose or feel pressured to have all the answers. Your role is to understand how their challenges are impacting their work and to explore together what support or adjustments might help.
You’re not a therapist, psychiatrist or doctor
If someone shares mental health challenges, thank them for their honesty. It’s not your role to decide if their stress is “real” or “serious,” but it is your role to understand how it’s affecting their work and to explore reasonable adjustments.
You can positively and gently separate questions about work from questions about health like this:
Questions about work performance or experience:
- How have you been feeling about your work lately?
- What tasks or projects have felt most challenging recently?
- Are there any parts of your role that feel more manageable or less manageable right now?
- What’s been helping you stay on track, and where are you finding it harder?
- What support would help you deliver on your current goals?
Questions about wellbeing or health (without crossing into medical territory):
- How are you feeling in yourself at the moment?
- Are there any particular stresses or pressures outside work you want me to know?
- What adjustments might help you feel more able to manage day-to-day?
- Have you been able to take regular breaks or find time to recharge?
- Would it help for us to explore flexible options, or would you like to discuss with HR or occupational health for extra support?
What’s fair and reasonable?
It’s fair to agree on adjustments together, keep clear records, and hold regular check-ins. But it’s also reasonable to expect that the individual takes responsibility for their wellbeing and for communicating openly, managing their workload within the agreed framework, and suggesting any additional adjustments that could help them.
Using open, non-judgmental questions to encourage conversation about what they’re doing to help themselves and what support they’re getting. We all have a personal responsibility for our own wellbeing too— and while the organisation can and should support people, individuals also play a role by doing their best to maintain healthy routines, such as taking regular breaks, getting rest and looking after themselves as best they can.
Of course, none of us is perfect, and life is messy sometimes. This isn’t about blame — it’s about working together, with kindness and fairness, to help people stay well and succeed in their roles.
Offer adjustments, not exemptions
Under the Equality Act 2010, you may need to make reasonable adjustments for a diagnosed mental health condition. This might include flexible hours, support for deadlines, or adjusted workload. But adjustments don’t mean the core job disappears.
- Set fair goals and explain how support will help them meet expectations.
- Keep notes and check in regularly
- Document conversations, agreed actions, and progress. Don’t wait for formal reviews. Regular check-ins help avoid surprises, build trust, and keep both sides on track. They also help you spot early warning signs before they escalate, such as changes in behaviour, drop-offs in quality, missed deadlines.
- Look after yourself too – Leaders carry emotional weight. Make sure you access peer support, supervision, or HR advice when navigating complex situations. Remember: you’re human too.
Regular conversations matter
One of the most common traps we see is when underperformance or wellbeing concerns only get raised at formal review points. Suddenly, during a mid-year or end-of-year review, issues are brought up that the individual is hearing for the first time — and this can feel unfair, confusing, or even like a personal attack.
Good leadership means getting ahead of challenges before they become problems. You do this through regular, ongoing conversations. Make time for regular 1:1 check-ins, even if they’re brief, where you’re genuinely asking:
- How are you getting on with your workload?
- What’s feeling good right now, and what’s feeling harder?
- Is there anything coming up where you’d like more support or clarity?
This helps you spot early warning signs — changes in behaviour, drop-offs in quality, missed deadlines — and approach them sensitively, long before they escalate.
If you know your team members well, you’ll notice when something isn’t right. A quiet, caring conversation in the moment can make a huge difference and may prevent the need for formal action later on.
Remember: formal reviews should never be the first time someone hears about a performance or wellbeing concern. Performance frameworks work best when they’re used as tools throughout the year — guiding continuous, two-way conversations, not just serving as a tick-box exercise every six months.
This approach also builds trust. It shows your team that you care about their progress and wellbeing, not just their results, and it creates a culture where people feel safe to raise concerns themselves, knowing they won’t be judged or blindsided.
Practical tips for great 1:1s on tough topics
- Create a calm space: Avoid rushed, pressured meetings. Find a private, quiet space.
- Ask, don’t assume: Use open questions like “What support would help you right now?”
- Balance empathy with clarity: Try, “I want you to feel supported, and we also need to explore how we can improve X together.”
- Offer choices, not ultimatums: Collaborate on solutions.
- Know your limits: Involve HR or occupational health if unsure.
- Use evidence-effect language: For example, “I’ve noticed you’ve missed three key deadlines this month, which has delayed the project. Can we discuss what’s been making this difficult for you and how we can address it together?”
Conclusion
Navigating underperformance when mental health concerns are raised isn’t easy, but with preparation, empathy, and sensitivity, it’s possible. The best leaders are those who can balance care with clarity and model the very resilience they want their teams to develop.
Feeling overwhelmed during busy periods, struggling after personal losses, or battling imposter syndrome in a new role are normal human reactions, not necessarily medical problems.
But that doesn’t mean they should be ignored. Leaders need to create cultures where people can talk about their struggles without needing a diagnosis. This includes building resilience, self-management and coping strategies across the team.
Sometimes stress is just part of life, but kindness, fairness and good communication are always part of great leadership.
At Laughology, we’ve supported various teams, workplaces, and organisations in developing inclusive cultures and helping people manage their mental health. If you want to talk to one of our experts, please get in touch with doug@laughology.co.uk.
