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No. 07Workforce Mental Health · 2026For HR, Benefits, and People Leaders

The stress your team can't name.

Cumulative, non-acute stress is the hardest pressure to lead through. It rarely becomes a case, so existing benefits miss it — and managers are carrying most of it.

  • 6 sections
  • 14 min read
  • august 13, 2026
  • Written by Alexa Varsavsky
~12

Average direct reports per manager, a nearly 50% increase since 2013

Gallup

22%

Manager engagement in 2025, down from 31% in 2022

Gallup 2026

54%

Of Americans in their 40s are caring for both a parent 65+ and a child or adult child

Pew Research Center

43%

Say lack of time is the leading barrier to getting support

Spring Health 2026

00Executive Summary

The pressure that doesn't become a case

A stretch at work that won't let up. Something at home that needs attention. A run of bad sleep making both harder. None of it is a crisis. All of it is happening at once. If that describes your last few months, it probably also describes several people on your team.

That is what makes this hard to lead through. Someone has been slightly off for a few weeks — not enough to raise or name. You ask how they're doing, they say "fine," and you believe them, because what else is there to go on. Meanwhile, you are carrying your own version of the same thing, with less room than you had a year ago.

The problem is not any one pressure. It's the cumulative effect of several ordinary pressures across work and life — none significant enough on its own to prompt formal support, but together more than someone can carry. With no single problem to point to, the pressure goes unaddressed and stays below the threshold utilization reports detect.

01The Manager Load

Managers are carrying most of it

The manager role has changed faster than the support around it. Gallup's span-of-control research shows how far the job has stretched, alongside Korn Ferry's 2025 workforce data:

~12

Average direct reports per manager, a nearly 50% increase since 2013

Gallup

13%

Of managers oversee 25 or more people

Gallup

97%

Of managers carry individual contributor work alongside managing

Gallup

41%

Of employees say their company has removed management layers

Korn Ferry 2025

Gallup's 2026 State of the Global Workplace report shows the result: manager engagement fell from 31% in 2022 to 22% in 2025, while employee engagement barely moved. Managers' longstanding engagement advantage has disappeared.

Coverage thins exactly where teams are largest. The manager overseeing twenty-five people is the one least able to work the playbook.
02The Pileup

Why pressure piles up

Workplace mental health reporting separates stressors into categories: workload, finances, caregiving. People experience the pileup.

Pew Research Center found that 54% of Americans in their 40s have a parent aged 65 or older and are either raising a child under 18 or supporting an adult child financially. That overlaps with much of the management layer. Financial strain compounds the load: Spring Health found that it affects the mental health of 74% of employees. Sleep — employees' most commonly named mental health challenge — often becomes the downstream cost of all three.

It's also why fine is such a common answer. When there are too many things to name, it starts to feel better left unsaid.

03The Support Gap

Why existing support misses it

Workplace mental health support has solved real problems: broader networks, better matching, shorter waits, stronger manager training, clearer referrals, and clinician consultation. But it still activates when a problem becomes serious enough to name and act on. This kind of cumulative stress rarely does.

People don't raise it

Deloitte's 2025 global survey found 62% of Gen Z and 64% of millennials comfortable discussing mental health with their manager. But among those actually under sustained strain, the picture flips. In Deloitte's 2024 Mental Health Deep Dive, 62% of Gen Z who felt stressed or anxious all the time felt unable to raise work-related problems for fear of negative consequences.

They don't use the benefit

Traditional EAP utilization remains in the 2% to 5% range. Modern digital programs do better, but NAMI's 2025 research found that barely half of employees know how to access mental health care from their employer.

They still face barriers to care

Spring Health's 2026 research found that lack of time was the leading barrier to getting support at 43%, just ahead of cost at 42%. Privacy concerns were cited by 30%, slightly more often than long wait times at 29%. The constraint isn't only whether care is available. It's whether people have the time and privacy to use it.

This isn't a minority problem to spot and route. It's likely distributed across a team rather than concentrated in one person, and almost none of it is visible.

Managers meet it twice: carrying their own stack with no reserve while being responsible for eleven people whose strain rarely surfaces. Every available tool asks managers to do more: spot the change, prepare for the conversation, have it, refer, follow up, loop in HR. Each step is reasonable; together they depend on the very capacity that has disappeared.

Asking managers to watch more closely isn't a strategy. It leaves support reactive — delivered after strain becomes visible, by the layer with the least left to give.

04The Signal

What in-the-moment support reveals

The missing layer is support before strain becomes a case: before someone can name what's wrong, find an hour for an appointment, or tell a manager.

At Thoughtful, guided AI sessions sit alongside provider care in a blended model. People can start immediately and privately, without an appointment, referral, or clearly defined problem.

To see what employees and managers actually bring to Thoughtful, we analyzed AI sessions across our employer customers. We found:

  • Roughly 70% of sessions focus on cumulative, non-acute pressure.
  • When workplace stress appeared, nearly three quarters of conversations also touched another major area of life — relationships, caregiving, finances, health, or sleep.

Workplace stress rarely arrives as work stress alone. And people rarely call it burnout. They describe:

  • falling behind or struggling with unclear expectations
  • self-doubt and feeling undervalued
  • difficulty disconnecting or feeling stalled in their career

Some employees use sessions to process feedback, clarify what they need, or decide what they want to say before talking to a manager. Others arrive soon after a difficult meeting or interaction, creating a window to process the reaction and choose what to do next. Managers bring their side of the experience too: coverage gaps, organizational change, and more priorities than they can finish. Some sessions hold both sides of the role: managing and being managed. Nobody had to notice first.

The low-pressure space matters. Some users said they didn't want to burden others, didn't know who to talk to, had difficulty trusting people, feared judgment, or simply wanted someone who would listen.

A survey from one enterprise customer reinforced that finding. When asked what mattered most, users most often cited immediacy, privacy, and low pressure, followed by help putting words to what they were feeling. Asked what they would have done without Thoughtful, their leading response by a wide margin was to handle it on their own. The leading alternative wasn't another form of support. It was no support at all.

For organizations, this is where early support becomes workforce impact. The pressures may be non-acute individually, but together they erode the capacities work depends on: handling difficult emotions, remaining engaged, and recognizing when more support would help.

A randomized controlled trial Thoughtful conducted with Spring Health found improvement across nearly every measured dimension of well-being and functioning. Emotional self-efficacy, behavioral activation, and help-seeking attitudes improved, while experiential avoidance fell. Those changes matter before strain becomes visible through missed work, leave, or turnover.

05The Implication

What this changes for managers and benefits leaders

If you manage a team

The useful thing isn't another framework for spotting distress. It's knowing your people have somewhere to go without deciding their situation is serious, booking anything, or telling you first. That includes the person who says they're fine because they can't summarize what's wrong. It includes you, too.

If you own the benefits strategy

The impact of carrying these overlapping stressors doesn't get filed as a mental health cost. It gets filed as leave, backfill, missed deadlines, and turnover. Three questions are more useful than asking whether managers have been trained:

  1. What does the program offer someone carrying four ordinary things at once, none of which they'd book an appointment for?
  2. Can you see utilization by seniority band? If not, you can't tell whether managers are covered.
  3. Which line item would move first if employees had support for these pressures before they became acute? Leave and presenteeism are measurable places to look.

Both audiences arrive at the same conclusion: support that reduces overwhelm has to reach people before the overwhelm has a name.