Mental Health Governance: Board Responsibilities and Oversight

Mental Health Governance: Board Responsibilities and Oversight

Mental health is no longer just an HR issue—it's a board-level governance responsibility with legal duties, material risks, and strategic implications. Here's what boards need to know about governing mental health effectively.

By Craig Fearn •

The board chair who asked for my advice had just learned something uncomfortable. One of their organization’s long-serving managers had experienced severe mental health crisis. Multiple people knew he was struggling. Nobody felt empowered to intervene. When he finally took extended leave, it emerged that warning signs had been visible for months.

“We have mental health policies,” the chair told me. “We’ve trained managers. We offer support services. How did this fall through the cracks? And more importantly—what’s our liability here?”

Good questions. Uncomfortable ones. But increasingly necessary as mental health moves from HR concern to board-level governance issue.

After seventeen years working at board level and through my work as an FRSPH Fellow, I’ve watched this evolution. Mental health governance is no longer optional. Boards have legal duties, face material risks, and need proper oversight frameworks. Most haven’t figured this out yet.

Let me walk through what boards actually need to know about mental health governance—the legal reality, the oversight requirements, and how to govern this properly rather than just delegate it to HR and hope for the best.

Start with legal reality. Many board members think mental health is nice-to-have. It’s not. You have statutory duties.

The Health and Safety at Work Act 1974 Section 2 requires employers to ensure, as far as reasonably practicable, the health, safety, and welfare of employees at work. This explicitly includes mental health, not just physical safety.

The Management of Health and Safety at Work Regulations 1999 impose duty on employers to conduct “suitable and sufficient” risk assessments for health and safety. This includes mental health risks—stress, burnout, psychological harm.

Acas guidance makes clear: employers must treat mental and physical health as equally important. This isn’t aspirational. It’s legal requirement.

So when boards ask “do we need to govern mental health?”—yes. You’re legally required to. The question is whether you’re doing it properly.

Why Most Board Oversight Falls Short

Despite legal duties, most boards don’t govern mental health effectively. Several patterns explain this.

Treating it as HR responsibility. Yes, HR implements mental health programs. But duty of care sits with the board. Risk management is board function. Just as you wouldn’t delegate financial risk purely to finance team or cyber risk purely to IT, you can’t delegate mental health governance purely to HR.

Focusing on programs rather than outcomes. Boards get reports about mental health training delivered, employee assistance program usage, wellness initiatives launched. These measure activity, not effectiveness. Do they actually reduce mental health risk? Improve organizational health? Prevent crises? These outcome questions often go unasked.

Not assessing actual risk. How many of your people are at high risk of mental health problems? Which parts of the organization have highest stress? What working patterns or management practices create psychological risk? Most boards can’t answer these questions because they’re not getting the right data.

Assuming compliance equals effectiveness. You have policies. You’ve done training. Legal boxes are ticked. But policy existing doesn’t mean it’s implemented. Training delivered doesn’t mean practices changed. Compliance and effectiveness aren’t the same thing.

Not connecting mental health to business performance. Mental health affects absence, turnover, productivity, decision quality, innovation, customer experience—all areas boards care about. But many boards don’t make these connections explicitly, so mental health stays siloed rather than integrated with business oversight.

Lacking expertise. Most boards don’t include members with public health or mental health expertise. How do you govern something you don’t understand? External expertise becomes necessary.

These gaps leave organizations exposed—legally, operationally, and reputationally.

What Effective Mental Health Governance Looks Like

Boards that govern mental health effectively approach it differently. Here’s what that looks like practically.

Clear board-level accountability. Someone at board level—often through a committee—has explicit responsibility for mental health governance. They understand the duty of care, know what good looks like, can challenge management appropriately.

Risk assessment that actually assesses risk. Not superficial tick-box exercises. Genuine assessment of where mental health risks exist in your organization. High-stress roles. Toxic team dynamics. Management practices that create psychological harm. Organizational changes creating uncertainty. These risks need identifying and managing.

Meaningful reporting. The board needs data that enables proper oversight. This typically includes:

  • Stress-related absence trends
  • Mental health-related turnover
  • Utilization of support services (and barriers to utilization)
  • Early warning indicators (like presenteeism, overtime patterns, manager concerns)
  • Analysis of risk hotspots
  • Evaluation of intervention effectiveness
  • Progress against mental health strategy objectives

Not just activity reports. Data that enables governance.

Integration with operational governance. Mental health connects to many areas boards oversee. Workload management. Organizational change. Leadership quality. Culture. Bullying and harassment. Performance management. These aren’t separate from mental health governance—they’re integral to it.

Proper due diligence on programs. When management proposes mental health initiatives, the board should ask: Is this evidence-based? How will we measure effectiveness? What problem is this actually solving? Just as you’d challenge any significant investment, challenge mental health spending to ensure it’s targeted effectively.

Crisis response protocols. When mental health crises occur—and they will—does the organization respond appropriately? Are managers equipped? Is duty of care met? Can you demonstrate you acted reasonably? Having protocols and practicing them matters.

Cultural leadership from board. If board members and senior executives model always-on culture, ignore their own wellbeing, and glorify overwork, mental health initiatives won’t land. The board sets organizational tone. What you model matters more than what you fund.

The Duty of Care Reality

Let’s talk specifically about duty of care because many boards misunderstand the standard.

Duty of care doesn’t mean you prevent all mental health problems. That’s impossible. People bring existing mental health conditions to work. Personal life affects mental health. You can’t control everything.

But duty of care means you must do what’s “reasonably practicable” to protect employee mental health. Courts assess this by asking: Could you reasonably have foreseen the risk? Did you take appropriate steps to manage it? When problems emerged, did you respond appropriately?

So if working patterns in a particular team are obviously unsustainable and you do nothing, that’s failing duty of care. If a manager is known to create high stress through bullying behavior and you don’t intervene, that’s failing duty of care. If you ignore multiple warning signs that someone’s struggling, that’s potentially failing duty of care.

The standard isn’t perfection. It’s reasonable action based on what you know or should know.

This means boards need to ask: Are we aware of significant mental health risks in our organization? Are we taking reasonable steps to address them? If problems occur, can we demonstrate we acted appropriately?

If you can’t answer yes to these questions, you’re exposed.

Material Risk and Business Impact

Beyond legal duty, mental health represents material business risk that boards should govern for strategic reasons.

Deloitte’s research quantifies poor mental health cost to UK employers at £51 billion annually. That’s absence costs, presenteeism, turnover, reduced performance. For individual organizations, these costs are substantial and often preventable.

High-performing people burning out. Critical talent leaving. Teams becoming dysfunctional under stress. Decision quality degrading when leaders are exhausted. Innovation declining when people lack mental space for creativity.

These aren’t abstract risks. They affect operational performance, strategic execution, and organizational capability.

Organizations with good mental health governance see reduced absence, improved retention (especially of key people), better performance and productivity, enhanced ability to attract talent, stronger resilience during change and uncertainty, and reduced regulatory and litigation risk.

Those without effective governance accept preventable costs, operational risks from workforce issues, talent challenges, and potential legal and reputational exposure.

This business case should matter to boards even if legal duty doesn’t motivate them.

Building Mental Health Governance Capability

If your board recognizes mental health governance gaps, how do you build proper oversight?

Start with board education. Most board members lack expertise in mental health, public health, or psychological safety. Bring in expert briefing. Understand the evidence base, legal duties, what effective governance looks like. My own work combines FRSPH Fellowship credentials with board experience—this combination enables briefings that are both evidence-based and practically relevant for boards.

Conduct baseline assessment. Where are you now? What risks exist? How effective are current approaches? What are the gaps? This baseline creates clarity about what needs addressing. An organizational wellbeing audit that includes mental health assessment provides this evidence.

Establish appropriate governance structure. Where does mental health oversight sit? Typically in risk committee, audit committee, or increasingly a dedicated people/wellbeing committee. Ensure clear terms of reference, appropriate frequency, and access to needed information.

Define what you’re governing toward. Not vague aspirations. Specific, measurable indicators of organizational mental health. Reduced stress-related absence. Improved early intervention. Better manager capability. Stronger risk management. These become your governance targets.

Build reporting that enables oversight. Work with management to develop board reporting that provides genuine insight, not just reassurance. Leading indicators, trend analysis, risk assessment, intervention evaluation.

Get external expertise if needed. If the board lacks mental health and public health expertise, access it externally. Through advisory relationships, through board advisory support focused on wellbeing governance, or by recruiting board members with relevant expertise.

Create accountability for outcomes. Not just program delivery. Actual improvements in organizational mental health. Someone owns these outcomes. Progress gets reviewed regularly.

Review and adapt. Mental health governance isn’t set-and-forget. Regular review of approach, metrics, and effectiveness ensures you’re actually governing rather than just monitoring.

ESG and Stakeholder Implications

Mental health governance increasingly matters beyond legal compliance and operational performance.

ESG (Environmental, Social, Governance) frameworks now include workforce wellbeing. Investors assess how you treat people. Social impact investors want evidence of good employment practices. Your mental health governance—or lack of it—affects ESG ratings and stakeholder confidence.

Customers, particularly in B2B, increasingly evaluate supplier practices during due diligence. Strong governance signals you’re well-run. Poor governance raises concerns.

Employee expectations have shifted. Talented people want to work for organizations that genuinely support wellbeing. Weak mental health governance affects recruitment and retention.

Forward-thinking boards recognize these stakeholder implications and govern mental health accordingly—not just for compliance but for competitive advantage.

Common Board Questions

Several questions boards frequently ask about mental health governance.

“How much should we spend on mental health?” No universal answer. Depends on organizational size, risk level, current state. Better question: Are we investing resources where evidence shows they’ll be effective? Mental health spending should be targeted investment, not just cost.

“How do we know if our programs work?” Measure outcomes, not just activity. Are relevant metrics improving? Absence declining? Retention improving? Early warning signs reducing? If you can’t demonstrate program effectiveness, question whether you’re spending wisely.

“What’s our liability if someone develops mental health problems at work?” Depends on whether you met duty of care. Could you reasonably have foreseen risk? Did you take appropriate steps? Documentation matters—ability to show you conducted risk assessments, implemented controls, responded appropriately when issues emerged.

“Should mental health governance sit with HR or the board?” Both. HR implements. Board governs. Just like any other material risk or strategic priority.

“Do we need specialist expertise?” Most boards benefit from access to public health and mental health expertise, whether through board composition, advisory relationships, or external consultancy. Hard to govern what you don’t understand.

Where I Can Help

My work supporting boards on mental health and wellbeing governance combines public health expertise (FRSPH Fellowship), organizational psychology understanding, and seventeen years of board-level experience across sectors.

This enables support that’s evidence-based, practically grounded, and tailored to board-level needs—whether through governance frameworks development, board briefings and education, wellbeing audit and assessment, ongoing governance support, or advisory relationships for chairs and NEDs navigating these issues.

If you’re working through how to establish effective mental health governance or want to understand your organization’s current state, a conversation about your specific situation can help clarify the path forward.

The Governance Gap

Here’s what I’ve observed. Organizations with effective mental health governance consistently outperform those without. Better retention. Lower absence. Higher performance. Stronger cultures. Enhanced resilience.

Organizations treating mental health as HR box-ticking exercise struggle with preventable problems. High costs. Talent losses. Crises that could have been prevented.

The gap between these isn’t about good intentions. Both types of organizations usually want to support employee mental health. The gap is about governance—whether boards exercise proper oversight or just delegate and hope.

That governance—or lack of it—shapes organizational outcomes profoundly. As board member, you can’t avoid this anymore. The question is whether you’ll govern mental health properly or wait until crisis forces you to.

The legal duty exists. The business case is clear. The stakeholder expectations are rising. What boards do with this reality determines whether their organizations protect people appropriately while building competitive advantage, or accept preventable risks and costs while hoping problems don’t surface publicly.

That choice—to govern properly or not—sits squarely with boards. Where it’s always belonged, even when many boards didn’t recognize it.

References

About the Author

Craig Fearn is the founder of Lighthouse Mentoring. He holds two Fellowships (FCMI and FRSPH) and serves as an IoD Ambassador. With 17 years of board-level experience across NHS, technology, financial services, and manufacturing, Craig provides strategic guidance on board governance, executive coaching, and organizational wellbeing.

Learn more about Craig →

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