CEOs are expected to perform under pressure – and to do so without visible strain. Admitting to struggle has long been seen as a leadership flaw. And these unrealistic expectations and the stigma they engender is a key reason why fewer senior execs want the top job, as revealed in a Warren Partners report. But if leaders are supposed to be the last to falter, what happens when they’re the first to run on empty?

That’s the question more businesses are beginning to ask — not just behind closed doors, but at board meetings and shareholder updates. Because while organisational wellbeing initiatives have increased, there’s a lingering blind spot at the top: the mental health of the people making the biggest decisions.

And the need is clear. According to Deloitte, poor mental health cost UK businesses £51bn in 2024, driven by rising presenteeism and a spike in attrition. The Centre for Mental Health goes even further: factoring in lost productivity, health costs and lost income, it puts the total economic burden at £300bn a year. That’s the rough equivalent of a pandemic, every year.

But even with the data in black and white, the problem remains fuzzy. Some leadership teams see mental health as an operational issue – something for HR to fix or for managers to “be more mindful” about. Meanwhile, the C-suite is left to carry the same loads, with fewer places to talk about them.

As Kirsty Dougan, MD of Warren Partners, says: “Senior leaders are not immune to mental health problems and stigma at the top can be one of the hardest to break. If you want psychological safety to be more than a buzzword, someone must model it. And the C-suite are perfectly placed to do that.”

Back in 2002, Virgin Money CEO Jayne-Anne Gadhia opened up about her struggle with post-natal depression, garnering widespread support for her candour. But few have since followed her lead. Yet by showing vulnerability, senior leaders can help others feel less alone – and make it safer to speak up. Research by the Anxiety Disorders Association of America shows that only one in four employees report their battles with persistent stress and anxiety and an encouragement to do so should start at the top.

That doesn’t mean board meetings need to become therapy sessions. But it does mean leaders – Chairs, NEDs, CEOs – must look harder at the signals their culture sends. Is the cost of high performance being counted in private burnout? Are metrics around wellbeing measured?

A culture that protects performance – and the people behind it

At Warren Partners, for example, the move to train Mental Health First Aiders wasn’t driven by policy. It was driven by culture. These are colleagues trained to spot early signs of poor mental health, listen without judgement and signpost professional help. It’s become an essential element of the company’s corporate culture.

“The MHFA initiative helps to ensure that employee wellbeing is prioritised and embedded as part of the organisation’s day-to-day operation,” says Dougan.

It’s an approach that many other businesses use to help change the tone from the top. Not with pizza Fridays or platitudes. But with intent.

Because no amount of employee support schemes will work if people still fear that showing vulnerability is a career risk. And no wellbeing budget will deliver impact unless the most senior people in the business use it – and back it.

The C-suite can’t be an exception to the rules it sets. When mental health becomes part of how performance is understood, not hidden from it, companies don’t just protect their people – they protect their future.