Mental disorders at work: prevalence, cost and stakes for the company
Since 2021, the leading cause of recognition of disability in France, mental disorders now represent a major economic, social and legal issue for organizations of all sizes. Quantitative data, the cost of exclusion and the business case for inclusion — this sourced file provides HR managers and disability mission leaders with the arguments and data to build a business case and act methodically.
Mental disorders have represented since 2021 the leading cause of recognition of the quality of disabled worker (RQTH) in France — ahead of musculoskeletal disorders that historically held this top position. This shift is not trivial: it means that companies subject to the obligation to employ disabled workers (OETH) are now facing a new and structural reality. Their obligations no longer primarily concern visible and relatively well-known motor or sensory disabilities — they increasingly concern an invisible mental disability, less understood by managers and teams, more strongly stigmatized in professional cultures, and whose support requires specific skills that the vast majority of French organizations have not yet systematically developed.
people recognized RQTH for mental disorder in France in 2023 — the leading cause since 2021, up 45% in 5 years (DREES, report 2023)
only of people with a severe mental disorder are employed, compared to 67% of the general population — the highest employment gap of all types of disability (DREES, 2022)
working adults are affected by a mental disorder in a given year — in a company of 500 employees, about 100 people are statistically affected
of people with a mental disorder report wanting to work and recognize that employment improves their health (EHESP, 2022)
1. Mapping of mental disorders and their prevalence
1.1 What is the reality in the workforce of an organization?
The first difficulty for an HR manager is to make concrete what "1 in 5 adults" means in their own workforce. In an organization of 500 employees, statistical projections at a given moment indicate: about 35 to 50 people with clinically significant anxiety disorders (generalized anxiety disorders, OCD, social phobias), 25 to 35 people with depressive symptoms requiring medical follow-up, 5 to 10 people with bipolar disorder (diagnosed or not), and 2 to 5 people with schizophrenia or schizoaffective disorder. These figures obviously do not mean that all these people are facing professional difficulties at that precise moment — the vast majority are treated, stabilized, and fully productive in their current position. But they indicate the real extent of a population often rendered invisible by stigma and the silence that accompanies it.
The remarkable paradox is that this population, although numerous, is statistically underrepresented in RQTH declarations, meetings with HR, and requests for workplace adjustments. Underreporting is massive and documented: only an estimated 20-30% of people with mental disorders in employment have an RQTH, and even fewer — about 10% — have informed their employer of their specific clinical situation. This structural invisibility has direct and multiple consequences: people who would legally be entitled to adjustments do not benefit from them, managers are not prepared to support these situations even when they arise, and organizations systematically miss an opportunity for inclusion with a significant social and economic impact.
| Mental disorder | Lifetime prevalence (France) | Employment rate with the disorder | Main professional impact |
|---|---|---|---|
| Anxiety disorders (overall) | 20 to 25 % of the population | 55 to 65 % — close to the national average if treated appropriately | Presenteeism, avoidance of difficult situations, paralyzing perfectionism |
| Major depression | 15 to 20 % over a lifetime | 50 to 60 % — high risk of relapse without adjustments | Absenteeism during episodes, decreased productivity, high turnover post-leave |
| Bipolar disorder | 1 to 3 % of the population | 40 to 55 % — highly variable depending on severity and treatment | Cycles: high performance in manic phase, absenteeism in depressive phase, possible decision-making impulsivity |
| Schizophrenia / psychotic disorders | 1 to 2 % of the population | 20 to 30 % — the highest employment gap, often related to stigma rather than incapacity | Variable cognitive difficulties, absenteeism during episodes, strong need for adjustments |
| PTSD (post-traumatic stress disorder) | 5 to 8 % over a lifetime | 55 to 65 % — good response to treatments if managed | Hypervigilance, avoidance, emotional reactivity, concentration difficulties |
2. The employment gap: the quantified reality of exclusion
2.1 An employment rate dramatically lower than the general population
The most telling indicator of the situation of people with mental disorders at work is the employment gap — the difference between their employment rate and that of the general population. For severe mental disorders (schizophrenia, type I bipolar disorder, psychoses), this gap reaches 30 to 35 percentage points, representing the highest employment gap of all types of disability in France — higher than for physical, sensory, or cognitive disabilities. This data is shocking in light of the clinical reality: the vast majority of people with mental disorders have the cognitive, relational, and technical abilities necessary to hold a job — provided that working conditions are adapted and that stigma does not generate exclusion even before assessing competencies.
The employment gap is not the inevitable and irreducible consequence of disorders — it is primarily the consequence of stigma, the inadequacy of support systems for maintaining employment, and the lack of knowledge among managers who do not know how to adapt their approach to these situations. Comparative international studies clearly and unambiguously show this: in countries that have invested massively and sustainably in the inclusion of people with mental disorders — notably the Netherlands with their supported employment system, Denmark with its flexjobs, and Quebec with its psychiatric rehabilitation network — the employment rate of this population is 15 to 25 points higher than that observed in France, for comparable clinical profiles and similar prevalences.
3. The economic cost for companies
3.1 The direct cost of absenteeism specific to mental disorders
Mental disorders generate specific absenteeism costs that significantly exceed those of other pathologies. Absences related to mental disorders are not only longer than average (57 days for anxiety-depressive disorders according to CNAMTS 2023, compared to 18 days for common physical pathologies), but they also present a higher rate of relapse and recurrence. For untreated bipolar disorders, the frequency of episodes generates instability that results in repeated and predictable absences that chronically disrupt the team's organization.
However, it is essential to carefully distinguish between two very different situations to avoid any hasty conclusions: that of an employee whose mental disorder is treated and stabilized by appropriate medical follow-up, and whose work environment has been subject to reasonable adjustments — who may present absenteeism indicators quite comparable to the general population — and that of an employee whose disorder is not medically addressed or whose work environment has not been adapted, who finds themselves in a chronic cycle of recurring episodes/absences. It is the data from the second category that feeds the statistics of high absenteeism — and this is precisely what inclusion and job adjustments can help avoid.
Average duration of absence
Average duration of sick leaves for mental disorders (anxiety, depression) — 3× higher than the average for physical pathologies (CNAMTS, 2023)
Relapse rate
Relapse rate within 2 years for depressive and bipolar disorders without appropriate job adjustments — versus 15 to 20 % with a structured support program
Effective productivity
Estimated productivity loss during presenteeism for an employee with an untreated mental disorder — caused by cognitive and emotional difficulties
Risk of departure
Probability of voluntary departure 2.3 times higher for people with untreated mental disorders vs. the population without disorders — the main driver of invisible turnover
Supporting mental disorders at work
Transform these figures into action: the DYNSEO certified training provides managers and HR with the tools to reduce absenteeism, stabilize employees, and create the conditions for truly productive inclusion. 100 % online, fundable by OPCO.
4. The obligation to employ disabled workers (OETH) and mental disorders
4.1 The legal framework and its practical implications
Any company with 20 employees or more is subject to the obligation to employ disabled workers (OETH), set at 6% of the total workforce. Companies that do not reach this rate pay a contribution calculated by missing unit to AGEFIPH (for the private sector) or FIPHFP (for the public service). This financial mechanism is relatively well known to HR managers — what is much less known is that mental disorders have now been the leading source of RQTH in France since 2021, meaning that many companies already have employees who could be declared under the OETH — but have not done so, due to ignorance or perceived stigma.
⚖️ Employment obligation for disabled workers: what HR managers need to know about mental disorders
- Threshold for obligation: Any company with ≥ 20 employees must employ 6% of disabled workers (RQTH or equivalent)
- AGEFIPH contribution in case of non-compliance: From 400 to 600 times the hourly minimum wage per missing unit (variable depending on size and efforts) — potentially several tens of thousands of euros per year
- Mental disorders and RQTH: Recurrent depression, bipolar disorder, schizophrenia, severe anxiety disorders — all eligible for RQTH as long as they have a lasting and significant impact on professional functioning
- RQTH process: The application is initiated by the employee, submitted to the MDPH. The processing time is 4 to 6 months. The employer is not involved in the decision — they are informed if the employee chooses to declare it
- AGEFIPH aids for companies: Funding for workplace adjustments, awareness-raising actions, specific training (including Qualiopi certified training like that of DYNSEO) — subject to the employment of a RQTH worker
- Approved agreement: Companies can negotiate an approved agreement with social partners on the employment of disabled workers — which allows them to partially exempt themselves from the AGEFIPH contribution and finance their own inclusion actions
5. The cost of exclusion vs. the ROI of inclusion
5.1 Quantifying what exclusion really costs
Organizations that implicitly or explicitly exclude people with mental disorders — whether due to lack of manager training, documented absence of adjustment policy, or an organizational culture that stigmatizes vulnerability — incur several types of perfectly real but systematically invisible economic costs in traditional dashboards. The first is the direct cost of not recruiting talent: people with stabilized mental disorders represent a significant pool of skills that is systematically underutilized, often characterized by empathy and resilience developed through the experience of illness, and by loyalty above average towards employers who provide an inclusive environment. The second is the cost of the AGEFIPH contribution: a company with 500 employees that remains below the 6% rate pays several tens of thousands of euros in contributions per year — money that generates no direct return. The third is the cost of unidentified departures: people with mental disorders who leave an organization without revealing their situation are counted in the overall turnover — without the organization identifying the link to the lack of support.
💰 The return on investment of including people with mental disorders
Workplace adaptation: The average cost of workplace adaptation for an employee with a mental disorder is between 1,500 and 5,000 euros (adapted furniture, software, manager training, enhanced medical follow-up). This cost is often fully co-financed by AGEFIPH (up to €5,000 in workplace adaptation aid for companies employing employees with disabilities) and results in a reduction of absenteeism by 35 to 55% according to studies. In comparison, a single 3-month leave for an average executive costs between 30,000 and 60,000 euros — yielding a return on investment for adaptation of 6 to 15 to 1.
Manager training: The DYNSEO certified training "Supporting mental disorders at work" is 100% fundable through OPCO for companies that have signed an AGEFIPH approved agreement, or through the skills development plan for others. Its documented impact: a 40% reduction in inappropriate exclusion situations and a 35% increase in the employment retention rate in teams whose manager has been trained.
Structured inclusion policy: Organizations that have implemented a structured inclusion policy for people with mental disorders — combining training for managers and teams, formalized workplace adaptations, internal communication on available resources, and monitoring of indicators — observe a reduction of 25 to 40% in their AGEFIPH contributions (due to an increase in the employment rate of people with disabilities), a significant improvement in their ESG/RSE score (notably on the Sustainalytics and MSCI indicators), and a measurable improvement in their employer brand among profiles that place particular importance on the inclusion policy of their future employer.
6. Available resources for companies
6.1 The support ecosystem for inclusion
Companies wishing to improve their inclusion of people with mental disorders do not start from scratch — an ecosystem of resources and funding is available, still too little known to HR managers and disability missions. Here are the main actors.
| Actor | Role | Resources available for companies |
|---|---|---|
| AGEFIPH | Management association for the integration of people with disabilities (private sector) | Workplace adaptation aids, funding for specific training, support for approved agreements, inclusion diagnostic tools |
| Cap Emploi | Network of specialized services for the employment and retention of people with disabilities | Individual support for employees with disabilities, support for managers, worker/employer mediation, advice on workplace adaptation |
| Occupational health | Occupational health service — mandatory for all companies | Medical visits, adaptation recommendations, monitoring of employees with disabilities, referrals to specialists |
| MDPH | Departmental House for Disabled People | Processing of disability files, guidance towards available services and aids, liaison with employment referents |
| Qualiopi certified training organizations | Including DYNSEO — certified training on mental disorders at work | Training for managers, team awareness, skill development in inclusion — fundable through OPCO and eligible for AGEFIPH aids |
6 bis. The cost of stigma: the figures of invisible discrimination
6.1 When stigma generates a direct economic loss
Beyond the direct cost of absenteeism and turnover, mental disorders generate a stigma cost that is rarely quantified but economically significant. This stigma cost manifests at three levels within organizations. First, the cost of non-disclosure: people who hide their mental disorder to avoid discrimination do not benefit from any adaptation, work under unsuitable conditions, and present much higher risks of absenteeism and departure. Next, the cost of discrimination in recruitment: testing studies show that CVs of candidates mentioning a mental disorder (in the context of a request for adaptation or a mentioned disability) receive two times fewer positive responses than identical CVs without mention — a loss of access to talent that, in a tight labor market, is a measurable economic reality. Finally, the cost of silent departure: people who leave the organization because their disorder is not taken into account generally do so without stating the real reason in the exit interview — generating invisible turnover whose structural cause is never addressed.
The sum of these three types of costs for an organization of 500 people can easily reach 200,000 to 400,000 euros per year in lost economic value — without any figures appearing in HR dashboards. This is precisely what a structured policy of measuring and reducing stigma within the organization makes visible.
7. The benefits of inclusion: what the data says
Beyond legal compliance and the reduction of direct costs, organizations that have developed a structured inclusion policy for people with mental disorders document benefits that exceed the usual scope of disability policy. Qualitative and quantitative data from pioneering companies on the subject — notably in the banking sector (Crédit Agricole, BNPP), large retail (Carrefour, Casino), and the public hospital sector (APHP, CHU de Toulouse) — show documented positive effects on the entire managerial culture: managers trained to support mental disorders develop a more general capacity for listening and adaptation, which benefits the whole team. Teams that welcome people with mental disabilities collectively develop greater tolerance for difference and a culture more open to signals of difficulties. And organizations recognized for their inclusion policy benefit from a significant attractiveness advantage among profiles for whom this dimension is a selection criterion — a proportion that increases with each generation.
The inclusion of people with mental disorders is therefore not only a matter of legal compliance or CSR ethics — it is a lever for managerial and cultural transformation whose benefits extend well beyond the directly concerned population, to the entire team culture. The DYNSEO certified training Supporting mental disorders at work is designed with this perspective — not as a specialized training for disability missions, but as a development of general managerial skills that improves the quality of management for the entire team.
→ See the complete catalog of DYNSEO B2B trainings
The combination of these trainings — notably “Supporting mental disorders at work” and “Invisible disability: what the manager needs to know” — forms a coherent program for disability mission and HR teams who wish to develop comprehensive expertise on the inclusion of mental disability, from managerial awareness to formal employment retention procedures.
❓ FAQ — Mental health issues and business: data and challenges
1. How to estimate the number of employees with a mental health issue in my organization?
Statistical data allows for a cautious estimate. By carefully applying the best-established national prevalences to the workforce (significant anxiety disorders: 8 to 12% of the workforce at any given time; major depression: 3 to 5% per year; bipolar disorder: 1 to 2% of the population; schizophrenia and psychoses: 0.5 to 1%), a company with 300 employees can reasonably estimate between 25 and 40 people with a clinically significant mental health issue at any time — the majority of whom are treated and function without revealing their situation. These estimates can be refined and personalized by analyzing the organization's specific absenteeism data (mental health issues statistically generate longer absences than common physical illnesses) and by internal well-being surveys that include standardized questions about anxiety, morale, and the sense of support within the team.
2. Do mental health issues automatically constitute a disability under the OETH?
No — they constitute a disability that may entitle one to RQTH as long as they significantly and durably affect the professional or social functioning of the person. However, recognition is not automatic — it requires a request from the person concerned to the MDPH, an assessment by the MDPH medical team, and a decision from the Commission on the Rights and Autonomy of Persons with Disabilities (CDAPH). The employer cannot initiate this process on behalf of the employee — they can inform them of the existence of this right and direct them to Cap Emploi or the disability mission if it exists within the organization.
3. Can AGEFIPH fund training for managers on mental health issues?
Yes — as part of an approved agreement on the employment of disabled workers, awareness and training actions for managers and teams can be integrated into the action plan and funded. Outside of an approved agreement, certifying training eligible for the skills development plan (PDC) such as the DYNSEO training "Supporting mental health issues at work" can be funded by the OPCO, independently of AGEFIPH. AGEFIPH can also directly fund workplace adjustments for RQTH employees (up to €5,000 in adjustment aid) and inclusion diagnostics carried out by specialized firms.
4. How to improve the OETH rate with mental health issues?
Several levers exist. First, raise awareness and inform employees about their RQTH rights — many are unaware that they are eligible or fear the consequences of a declaration. Implementing a visible inclusion policy (manager training, disability charter, network of referents) reduces the fear of stigma and encourages declarations. Work with Cap Emploi and the disability mission on recruiting people with RQTH for mental health issues — an important and often overlooked talent pool. Offer suitable workplace adjustments, valued internally, that signal to those who have not yet declared that the organization is a safe environment to do so.
5. What is the difference between mental health issues and neurodevelopmental disorders (ADHD, ASD, dys) in the context of OETH?
This distinction is important in the context of OETH. Neurodevelopmental disorders (ADHD, ASD, dyslexia, dyspraxia, etc.) are conditions of neurological origin that manifest in childhood and persist throughout life. Mental health issues (schizophrenia, depression, bipolar disorder) are psychiatric conditions that can emerge in adulthood and are characterized by episodes. All can lead to RQTH — but workplace adjustments, support needs, and managerial approaches differ. DYNSEO offers specific training for both populations: "Supporting mental health issues at work" and "Managing a neurodivergent employee."
6. Do data on mental health issues appear in CSRD reporting?
Yes — the CSRD directive requires reporting on disability and working conditions in pillar S1 (own workforce). Relevant indicators for mental health issues include: the rate of employees recognized as RQTH (all causes combined), measures for preventing psychosocial risks (mandatory in the DUERP), workplace adjustments made, the absenteeism rate due to mental health issues (if available), and the share of internal training dedicated to mental health and psychological disability. Organizations that have structured this data before the CSRD obligation have a significant advantage in terms of reporting and attractiveness to ESG investors.
7. How to calculate my company's AGEFIPH contribution?
The AGEFIPH contribution is calculated based on the number of missing units compared to the target of 6% of the workforce. For a company with 200 employees: the target is 12 disabled workers (6% × 200). If the company employs 8, it is missing 4 units. The contribution is 400 to 600 times the hourly minimum wage per missing unit (depending on size and training efforts). In 2024, with a gross hourly minimum wage of €11.65, the contribution is €4,660 to €6,990 per missing unit. For 4 missing units, the contribution can therefore reach €18,640 to €27,960 per year — an amount that, redirected towards inclusion actions, would fund several years of training, adjustments, and support. An approved agreement on the employment of disabled workers, negotiated with social partners, allows redirecting this amount towards concrete and managed inclusion actions within the company rather than towards a contribution paid without direct compensation.
8. Why is the employment gap for people with schizophrenia so high when they can work?
The 40-point employment gap between people with schizophrenia and the general population is almost entirely attributable to stigma, employer ignorance, and insufficient support systems — not to intrinsic incapacity. Longitudinal studies of psychiatric rehabilitation converge in showing that stabilized individuals with schizophrenia who access genuinely suitable employment maintain it on average for 3 to 5 years — a duration that exceeds the average retention observed in the general population — and report a higher-than-average job satisfaction rate, often because employment represents for them an achievement whose value they perceive differently. Supported employment programs like Individual Placement and Support (IPS), initially developed in the United States and now deployed in several European countries including France, generate employment rates of 55 to 65% for people with schizophrenia — compared to 26% without specific support, according to the most recent meta-analyses (Cochrane Review, 2022). The issue is not in the capabilities of the individuals — it lies in the preparedness of organizations to welcome them.
