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Workplace Mental Health Support Plan

A fictional collaborative support plan with practical adjustments, confidential access, review dates and an escalation route, without requiring diagnosis disclosure or waiving rights.

Jurisdiction: England and Wales - completed fictional worked example

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Important: This sample provides general legal information only and is not legal advice. Check the law, prescribed forms and signing requirements that apply to your exact jurisdiction and circumstances before use.

# Workplace Mental Health Support Plan

Date: 19 October 2026

Parties and reference: Employee: Robin Hayes, Project Coordinator. Employer: Willow Design Ltd, 4 Garden Court, Nottingham NG1 6PX. Manager: Leah Stone. HR contact: Imani Cole. Plan EXAMPLE-MH-19.

## 1. Agreed purpose and employee preferences

This plan records our private discussion on 16 October and starts on 19 October 2026. Robin reports that frequent unplanned calls and several simultaneous urgent deadlines have increased anxiety and difficulty concentrating. Robin prefers written task priorities and predictable check-ins, and does not wish to share a diagnosis with colleagues. This is a support plan, not a disciplinary warning, medical diagnosis, fitness certificate or agreement that the employee has or does not have a statutory disability.

## 2. Adjustments and named responsibilities

Leah will provide one prioritised task list each morning, limit urgent work to one agreed task at a time and review competing deadlines before reallocating work. Non-emergency calls will be scheduled by message. Robin may use the quiet room for focused work and take an additional paid ten-minute break in each half-day without reducing pay or requiring extra hours. A paid 15-minute check-in will take place at 09:15 each Monday and Thursday. Workload will be adjusted so breaks and check-ins do not simply add to the same deadlines.

## 3. Support and difficult days

Robin may message Leah to request a private conversation or a short pause if early warning signs arise. If Leah is unavailable, contact Imani. We will agree whether to reprioritise work, use a quiet space or arrange safe travel home; normal sickness reporting remains available without treating use of this plan as misconduct. Occupational-health advice may be requested with a clear explanation of its scope and appropriate medical confidentiality safeguards. The employee assistance service is optional and not a substitute for needed clinical or emergency help.

## 4. Confidentiality and legal protections

The plan is held in a restricted HR record accessible to Robin, Leah and Imani. Colleagues receive only necessary practical cover instructions, not health details. Before other sharing, discuss purpose, lawful basis and access with Robin, except where a necessary legal duty or serious safety concern requires action; share the minimum and explain when safe. HR applies its special-category health-data safeguards and retention schedule. Consent is not assumed to be the only possible data-protection basis. Equality Act duties, where applicable, and all grievance and employment rights remain intact.

## 5. Review and acknowledgement

Review on 2 November and 30 November, or sooner at Robin's request or if arrangements are not working. Consider workload, usefulness and any further support rather than demanding a symptom-free outcome. Adjustments do not automatically expire at review; discuss any proposed change and continue necessary reasonable support. Concerns can go privately to Imani or through the grievance procedure without retaliation. Signed 19 October: Robin Hayes and Leah Stone; HR record acknowledged by Imani Cole. Signing confirms the agreed arrangements, not disclosure permission beyond this plan or waiver of legal rights.

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