Anxiety and work: fit notes, adjustments and your options

Once someone has finally said out loud that work is making them ill, the next question is nearly always the same: "Can you sign me off?" It is a fair question, and usually the wrong first one. Being off work entirely is one option out of several, and often not the one that helps most.

You are not unusual in asking it. In 2024 to 2025 an estimated 964,000 workers in Great Britain were living with work-related stress, depression or anxiety, and 22.1 million working days were lost to it, accounting for 52 per cent of all work-related ill health.

The short version

• For the first 7 days off, you do not need a note from anyone. You certify yourself.
• A fit note has two settings: not fit for work, or may be fit for work with suggested changes. The second one is underused.
• If your anxiety has a substantial effect on daily life and has lasted or is likely to last 12 months, it may count as a disability, and your employer then has a legal duty to make reasonable adjustments.
• You do not have to be signed off to get help. Adjustments can happen while you are still at your desk.

The first week: you certify yourself

If you are off sick for 7 days or fewer, you do not need a fit note or any proof from a healthcare professional. Your employer can ask you to confirm on your return that you were off sick, which is called self-certification, and that is usually a short form or an email. Those 7 days are calendar days, so weekends and bank holidays count.

A fit note becomes necessary if you are off for more than 7 days in a row. It is free at that point. If you ask for one earlier than that, a healthcare professional can charge you a fee.

What a fit note actually says

Fit notes are not only issued by GPs. A hospital doctor, registered nurse, occupational therapist, pharmacist or physiotherapist can also issue one, as long as they have assessed your fitness for work.

There are two options on the form.

Not fit for work

Straightforward. In the judgement of the person assessing you, your health is stopping you working at the moment.

May be fit for work

This is the one people rarely ask about, and the one I reach for most. It says you could do some work while you recover, and it lets the assessor suggest how. The usual suggestions are a phased return, altered hours, amended duties, or changes to your workplace or workstation. For anxiety that might mean coming back three days a week for a month, dropping the client-facing part of the role for a while, or starting later so you are not doing the worst commute of the day on four hours of sleep.

Two things are worth knowing. Your employer does not have to agree to what is suggested. And if they genuinely cannot make it work, you are simply treated as not fit for work, and you do not need a second note to prove it. So asking for "may be fit for work" costs you nothing: the worst case is that you end up where you would have been anyway.

A fit note is a medical opinion, not an instruction. It opens a conversation with your employer rather than settling it.

Reasonable adjustments, and why they matter more

Adjustments are the part most people do not know they can ask for, and they do not depend on being off sick at all.

Under the Equality Act 2010, a mental health condition can count as a disability if it has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities. Substantial means more than minor. Long-term means it has lasted, or is likely to last, at least 12 months, or the rest of your life. Importantly, a condition that comes and goes can still count, which matters for anxiety, where good months and bad months are the norm.

If that applies, your employer has a legal duty to make reasonable adjustments. Acas lists plenty of examples used for mental health: more frequent short breaks, flexible or reduced hours, paid time off for appointments, breaking work into shorter tasks, reducing the most stressful responsibilities such as cold calls, a quieter workspace, an agreed communication method so you are not ambushed by spontaneous phone calls, and flexibility around absence trigger points.

One catch: your employer can only be expected to make adjustments if they know about the condition. Somebody has to say something, which is the hard part. How to talk to people you love about your anxiety gives you the general shape of that conversation to adapt.

And even if your anxiety does not meet the legal definition of a disability, adjustments are still worth asking for. Employers can make them regardless, and most sensible ones would rather adjust your week than replace you.

The appointments problem

Paid time off for appointments is on that Acas list for a reason. The commonest reason people give me for not starting therapy is not cost or scepticism, it is the diary: a fifty minute session plus travel eats most of an afternoon, every week, and asking for that repeatedly feels like a bigger favour than most people want to ask. It is part of why we built brightloaf around 20 minute sessions. A short session fits in a lunch break, which quietly removes the need to negotiate for it at all.

Occupational health, and the GP conversation

Your employer may refer you to occupational health, and can ask for a report from your doctor, though only with your permission. Occupational health works for the employer, but it is not against you. Their job is usually to recommend the changes that keep you working.

If you are still weighing up whether any of this is a GP conversation, when to see your GP about anxiety covers the thresholds and how to get the most from a short GP appointment covers what to bring. Say early on that you want to talk about work. It changes what I can offer you.

This article is general information about how the system works in the UK, not personal medical or legal advice, and it is no substitute for a conversation with your own clinician. If you are in crisis or feel unsafe, contact 999 or NHS 111, or call the Samaritans free on 116 123. brightloaf is not a crisis service.