Signed off work with stress: your rights and what happens next

Being signed off work with stress is more common than most people realise, and it is a recognised medical absence like any other. It is also a confusing position to be in: nobody hands you a leaflet explaining how long you can be off, what you will be paid, whether your boss is allowed to keep ringing you, or how you are supposed to go back.

This guide covers all of that. It is written for the person who is off, not for their employer.

What being signed off with stress actually means

It means a doctor has assessed that stress, or a related condition such as anxiety or low mood, is affecting your ability to work, and has certified that you are not fit for work for a period. Legally it is the same as being signed off with a physical illness. The Health and Safety Executive defines work stress as the adverse reaction people have to excessive pressures or other demands placed on them, and there is no separate category of sick leave for it.

Stress itself is not a medical diagnosis, which sometimes trips people up. What your fit note says might be “stress”, “work-related stress”, “anxiety”, “low mood” or something more specific, depending on what the doctor has assessed. All of them are valid reasons to be signed off.

The first week: you sign yourself off

For the first 7 calendar days of any absence you self-certify. That means you tell your employer you are unwell, and confirm the dates in writing when asked. No doctor is involved, and your employer cannot insist on a note during that week.

Those 7 days are calendar days – weekends and bank holidays count. So if you stop work on a Thursday, self-certification covers you to the following Wednesday.

You can write your own letter, or use our free self-certification letter generator to produce one in about a minute.

Getting a fit note

From day 8, your employer can ask for a fit note. You can get one from your own GP, and it is free when you have been off more than 7 days. Getting an appointment quickly is often the hard part, particularly when you are already struggling.

A fit note has two options. The doctor can say you are not fit for work, or that you may be fit for work with adjustments – reduced hours, different duties, or a phased return. For stress, the second option is used more often than people expect, because a change to the workload or the hours is sometimes what makes returning possible.

How long can you be signed off with stress?

There is no legal maximum. How long you are signed off is a clinical judgement, and it depends on how you are, not on a rule.

In practice a first fit note for stress is often two weeks, sometimes four. It can be extended, and for many people it is. Some useful markers:

The 28-week figure is about pay, not permission. You can be signed off for longer than that; it is just that statutory sick pay stops.

What you will be paid

Statutory Sick Pay changed in April 2026, and the changes help. SSP is now paid from your first day of sickness rather than the fourth, and the minimum earnings threshold has been removed, so part-time and lower-paid workers who previously got nothing now qualify.

The rate is the lower of £123.25 a week or 80% of your average weekly earnings, paid through payroll for the days you would normally have worked, for up to 28 weeks.

Many employers pay more than that under their own sick pay scheme – full pay for a set period is common, particularly in larger organisations. Check your contract or staff handbook, because the difference is substantial and it affects how much pressure you are under to go back quickly. Work out what you will be paid.

Can your employer contact you while you are signed off?

Yes, and within reason they should. Complete silence from an employer during a stress absence is its own kind of stressful, and reasonable contact is part of managing the absence properly.

What is not acceptable is contact that amounts to pressure or harassment: daily calls, demands that you attend meetings while signed off, or asking you to do work. There is no legal rule on frequency, which is why it is worth agreeing it at the start – who will contact you, how, and roughly how often. Email rather than phone is a reasonable thing to ask for if calls are difficult.

You are not obliged to answer work calls while signed off, and you are not expected to pick up tasks. If contact is becoming intrusive, say so in writing and ask for it to be less frequent.

Do you have to tell your employer it is stress?

For the first 7 days you self-certify, and a general reason is enough. You do not have to write “stress” if you would rather not – “illness” or “medical reasons” is acceptable on most self-certification forms.

From day 8 the position changes slightly, because a fit note states what the doctor has assessed. You cannot have a blank fit note. What you can do is discuss the wording with the doctor: there is a difference between a note that says “stress” and one that specifies a great deal more, and the note only needs to say enough to explain why you are unfit for work.

Beyond the note itself, you are not required to discuss your symptoms, your treatment or your personal circumstances with your manager. Health information is special category data under UK GDPR, and your employer should only collect what is genuinely needed to manage your absence and pay you correctly.

If the stress is caused by work

This is the part most guides skip, and it matters. Once an employer knows that work is contributing to an employee being unwell, they have duties. Under health and safety law employers must assess and manage risks to health, and the HSE treats work-related stress as a risk like any other – excessive workload, unclear expectations, lack of support, conflict, or a lack of control over how you work.

In practice that means an employer who has been told the absence is work-related is expected to take reasonable steps to identify and address the cause, not simply wait for you to come back. If your absence is work-related, it is worth saying so explicitly and in writing. It changes what your employer is expected to do, and it puts on record that they were told.

Can you be dismissed for being off with stress?

Not for being ill, and not for a single absence. But it would be dishonest to tell you it can never happen: an employer can eventually dismiss on capability grounds where someone has been absent long term and is not able to return.

To do that fairly they have to follow a proper process: consult you, obtain medical evidence, usually seek an occupational health opinion, consider whether adjustments would let you return, and consider how long they can reasonably hold the role. Skipping those steps makes a dismissal unfair.

There is an additional protection worth knowing about. Stress alone is not usually a disability, but a mental health condition can be if it has a substantial and long-term effect on your day-to-day activities – long-term generally meaning it has lasted or is likely to last 12 months. Where that applies, your employer has a legal duty to make reasonable adjustments, and dismissing without properly considering them can amount to discrimination.

Going back to work

Very few people go from signed off to full duties overnight, and they should not have to. A phased return – starting on reduced hours and building back up over a few weeks – is the normal way back after a stress absence, and it is one of the four adjustments a doctor can tick on a fit note.

Practical things that help:

• Propose something specific – a written plan with week-by-week hours is far more persuasive than asking for “a gradual return”. Build a phased return plan.
• Ask what will be different – if workload or a particular situation contributed, returning to exactly the same conditions is a reasonable thing to question.
• Get it in writing – whatever is agreed should be recorded, with a review date, on your return to work form.
• Expect a return to work conversation – it is a short, supportive check-in, not a disciplinary meeting.
• Say if it is too much – stepping back a stage is normal and far better than a second absence.

If it becomes long term

Absence beyond about four weeks is usually treated as long-term sickness. At that point your employer may suggest an occupational health assessment, which is worth accepting rather than resisting – it is an independent clinical opinion on what you need, and it often unlocks adjustments that a manager would not offer on their own.

You will need ongoing fit notes throughout, and if your absence approaches 28 weeks it is worth understanding what happens when statutory sick pay ends.

Getting the fit note itself

If you are past day 7 and cannot get a GP appointment in time, Health Works issues fit notes the same day after a short video consultation with a GMC-registered doctor. Get a fit note online.

Where to get support

If stress is affecting you badly, speak to your GP – it is exactly what they are there for, and treatment or support can make a substantial difference. If you are struggling to cope, Samaritans are available free, 24 hours a day, on 116 123. If you need urgent medical help, call NHS 111.