Executive Summary
Workplace exhaustion during return-to-work support is not an individual failing — it stems from three structural factors: uneven workload distribution, information asymmetry, and excessive emotional labor by managers. Workplaces reporting employees who took leave or resigned due to mental health issues account for 12.8% of all establishments, reaching 10.9% even among those with 30–49 employees (Ministry of Health, Labour and Welfare, 2025a). If exhaustion among those welcoming returning workers is left unaddressed, it triggers secondary mental health issues and turnover, ultimately collapsing the return-to-work support system itself. Even companies with fewer than 50 employees can address this through systems rather than goodwill, by leveraging free public resources such as Regional Occupational Health Centers (Chiisanpo) and Occupational Health Promotion Centers.
Definitions and Current Landscape
Definition: Workplace exhaustion in return-to-work support refers to the phenomenon in which operational and psychological burdens structurally concentrate on colleagues, managers, and HR staff during the process of welcoming back a worker recovering from mental health issues, thereby impairing the physical and mental health of those on the receiving side.
The vast majority of information on return-to-work support focuses on "how to support the returning employee," while structural analysis of the burden on the receiving side remains scarce. The Ministry of Health, Labour and Welfare's guidelines explicitly state in Step 5 (Follow-up) that "care should be taken to ensure that excessive burden does not fall on colleagues and supervisors" (MHLW, 2012), yet concrete methodologies are insufficiently developed.
The following three structures cascade to exhaust the entire workplace:
- Uneven workload distribution — Work reduced for the returning employee concentrates on specific colleagues
- Information asymmetry — Privacy protection creates a "told nothing" state that breeds distrust
- Excessive emotional labor by managers — Managers are consumed by serving as the sole coordinator among the returning employee, colleagues, and upper management
Warning Signs of Receiving-Side Exhaustion — Checklist
- Chronic overtime increase from absorbing the returning employee's reduced workload
- Comments like "Why does that person get special treatment?" circulating in the workplace
- The manager handling the return has no one to consult about their struggles
- No timeline for when the accommodation period will end has been shared with colleagues
- No support framework (allowances, performance evaluation adjustments, consultation channels) exists for the receiving side
Data and Evidence
Prevalence of Leave and Resignation Due to Mental Health Issues
| Indicator | Figure | Source |
|---|---|---|
| Percentage of workplaces with employees who took leave or resigned | 12.8% (FY2024) / 13.5% (FY2023) | (MHLW, 2025a) / (MHLW, 2024) |
| Percentage with employees on leave for 1+ consecutive months | 10.2% (FY2024) / 10.4% (FY2023) | (MHLW, 2025a) / (MHLW, 2024) |
| Percentage with employees who resigned | 6.2% (FY2024) / 6.4% (FY2023) | (MHLW, 2025a) / (MHLW, 2024) |
| Percentage of workers on leave for 1+ consecutive months | 0.5% (FY2024) / 0.6% (FY2023) | (MHLW, 2025a) / (MHLW, 2024) |
| Percentage of workers who resigned | 0.2% (FY2024 & FY2023) | (MHLW, 2025a) / (MHLW, 2024) |
By Establishment Size: Percentage with Employees on Leave
| Establishment Size | FY2024 | FY2023 | Source |
|---|---|---|---|
| 1,000+ employees | 88.2% | — | (MHLW, 2025a) |
| 50–99 employees | 24.8% | 22.9% | (MHLW, 2025a/2024) |
| 30–49 employees | 10.9% | 10.5% | (MHLW, 2025a/2024) |
| 10–29 employees | 4.2% | 5.1% | (MHLW, 2025a/2024) |
Mental Health Measures: Implementation Status
| Indicator | Overall | 50+ | 30–49 | 10–29 | Source |
|---|---|---|---|---|---|
| Implementation rate (FY2024) | 63.2% | 94.3% | 69.1% | 55.3% | (MHLW, 2025a) |
| Implementation rate (FY2023) | 63.8% | 91.3% | 71.8% | 56.6% | (MHLW, 2024) |
| Stress check implementation rate (FY2024) | 65.3% | 89.8% | 57.8% | 58.1% | (MHLW, 2025a) |
| Occupational health activity rate (FY2023) | 87.1% | — | — | — | (MHLW, 2024) |
Worker Stress Levels
| Indicator | Figure | Source |
|---|---|---|
| Workers reporting high stress levels | 68.3% | (MHLW, 2025a) |
| Top stressor: Volume of work | 43.2% | (MHLW, 2025a) |
| 2nd: Mistakes at work / responsibility | 36.2% | (MHLW, 2025a) |
| 3rd: Quality of work | 26.4% | (MHLW, 2025a) |
| 4th: Interpersonal relationships (incl. harassment) | 26.1% | (MHLW, 2025a) |
| Stress prevalence among workers aged 40–49 | 73.0% | (MHLW, 2025a) |
Institutional Framework for Return-to-Work Support
| Item | Content | Source |
|---|---|---|
| Basic framework | 5-step process (care during leave → attending physician's assessment → return-to-work decision & plan → final decision → follow-up) | (MHLW, 2012) |
| Step 5: consideration for receiving side | "Care should be taken to ensure that excessive burden does not fall on colleagues and supervisors" | (MHLW, 2012) |
| Premise of return | "Acceptance in a state that is not a full return" | (JOHAS, n.d.) |
| Scope of physician's assessment | Based on recovery in daily living; does not necessarily indicate recovery of job performance capacity | (MHLW, 2012) |
| Principle of returning to original workplace | Return to original workplace preferred, as adapting to a new environment requires time and psychological burden | (MHLW, 2012) |
| Program communication | Must be communicated to earn trust from all workers, not just those on leave | (JOHAS, n.d.) |
Examples of Work Accommodations and Return Criteria
| Work Accommodation Examples | Return-to-Work Criteria Examples |
|---|---|
| Shortened working hours | Sufficient motivation present |
| Assignment to light / routine tasks | Able to commute safely and independently |
| Prohibition of overtime / night shifts | Able to maintain attendance on scheduled days and hours |
| Travel restrictions | Able to perform tasks required for the role |
| Shift work restrictions | Fatigue sufficiently recovers by the next day |
| Restrictions on hazardous work, driving, elevated work, customer-facing / complaint-handling duties | Attention and concentration have recovered |
| — | Appropriate sleep-wake rhythm established |
| — | No daytime drowsiness |
(MHLW & Japan Industrial Safety and Health Association, 2012)
Privacy Protection and Information Sharing Framework
| Item | Content | Source |
|---|---|---|
| Status of health information | Particularly sensitive among personal information; should be strictly protected | (MHLW, 2012) |
| Scope of workplace sharing | Minimum necessary information on condition and functioning, centered on accommodation requirements | (MHLW & JISHA, 2012) |
| Sharing of diagnosis name | Specific diagnosis name is not necessarily included | (MHLW & JISHA, 2012) |
| Prevention of prejudice | Misunderstandings and prejudice tend to arise regarding mental health issues; prevention efforts are necessary | (JOHAS, n.d.) |
Guidelines for Colleague Interactions
| Item | Content | Source |
|---|---|---|
| Recommended approach | Welcome them naturally: "Good morning," "Glad to be working together again" | (Kokoro no Mimi, n.d.) |
| Approach to avoid | Prying into their situation | (Kokoro no Mimi, n.d.) |
| Supervisor's responsibility | Clearly communicate work accommodation requirements to colleagues | (Kokoro no Mimi, n.d.) |
| Basics of depression treatment | Pharmacotherapy, psychotherapy, rest (resting body and mind to restore energy) | (Kokoro no Mimi, n.d.) |
Support Systems for Establishments with Fewer Than 50 Employees
| Item | Content | Source |
|---|---|---|
| Return-to-work support framework | Health promotion officer or safety and health promotion officer serves as the point of contact, utilizing external resources such as Chiisanpo | (MHLW & JISHA, 2012) |
| Regional Occupational Health Center (Chiisanpo) | For establishments with fewer than 50 employees; provides free mental health consultations and on-site guidance | (Kokoro no Mimi, n.d.) |
| Chiisanpo coverage areas | One per Labour Standards Inspection Office jurisdiction | (Kokoro no Mimi, n.d.) |
| Chiisanpo services | Long-hours worker interview guidance, health consultations, on-site visits, occupational health information | (Kokoro no Mimi, n.d.) |
| Occupational Health Promotion Centers | Mental health promotion staff visit workplaces to provide free assistance in developing return-to-work programs | (JOHAS, n.d.) |
| Mandatory stress checks for all workplaces | Enacted as Act No. 33 of 2025; enforcement expected around 2028 | (MHLW, 2025b) |
Analysis and Implications
Technical keywords: emotional exhaustion, depersonalization, emotional labor, cognitive dissonance, psychological safety, duty of care, line care, presenteeism, secondary traumatic stress, learned helplessness
Axis A: Mechanism Analysis — Psychological and Social Structures Behind Receiving-Side Exhaustion
The Cascade of Uneven Workload Distribution
Work accommodations for returning employees — shortened hours, overtime prohibition, limitation to light duties — are medically justified (MHLW & JISHA, 2012). However, the reduced workload does not disappear. At establishments with 30–49 employees, securing replacement staff is difficult, so the burden concentrates on specific colleagues in the same department — those with high skill levels or those in positions where they cannot refuse.
Despite the fact that return-to-work decisions are based on "recovery in daily living" (MHLW, 2012) and the premise is "acceptance in a state that is not a full return" (JOHAS, n.d.), this premise is often insufficiently communicated to colleagues. When "when will things go back to normal?" remains invisible, feelings of unfairness convert into emotional exhaustion, creating a vicious cycle that degrades the receiving side's own performance.
In a company of 30 people, when one person takes six months of leave, the remaining members' workload increases by roughly 3% in simple terms. However, specialized tasks (design, development, sales, etc.) are difficult to generalize, and the actual burden far exceeds this figure. This "invisible burden" is the heart of the problem.
Cognitive Dissonance Born from Information Asymmetry
Health information is "particularly sensitive among personal information" (MHLW, 2012), and privacy protection is both a legal and ethical imperative. However, when the "told nothing" state persists, colleagues begin interpreting the situation based on speculation. JOHAS notes that misunderstandings and prejudice easily arise regarding mental health issues (JOHAS, n.d.), and the absence of information amplifies this tendency.
Cognitive dissonance develops within colleagues: they understand they "should be considerate" while simultaneously feeling "this is unfair," and must process this contradiction without information. Voicing this contradiction risks being perceived as "cold," so dissatisfaction goes underground and psychological safety declines. Because it never surfaces, the organization cannot recognize the problem, and response is delayed.
Conventional wisdom holds that "protecting privacy is sufficient," but the reality on the ground is more complex. What must be protected are diagnosis names and treatment details. Operational information — "what work accommodations are needed" and "for how long" — should in fact be shared, as withholding it breeds distrust. Privacy protection and operational information sharing are compatible, and must be made compatible.
Exhaustion from Managerial Emotional Labor
Managers must listen empathetically to the returning employee, reassure disgruntled colleagues, and deliver optimistic reports to upper management — continuously expressing different emotions in three directions. This emotional labor is layered on top of the playing manager's daily workload, accumulating as an "invisible burden" that appears in neither overtime hours nor performance metrics.
Line care — the practice of managers attending to subordinates' mental health — is promoted at many companies. But few companies have an institutional answer to the question: who cares for the managers who deliver line care? Data showing that stress prevalence peaks at 73.0% among workers aged 40–49 (MHLW, 2025a) — the age group most likely to hold management positions — underscores this structural problem.
The harder someone pushes through, the more desensitized they become to their own pain. The belief that "I'm a manager, so I should tough it out" delays recognition of their own emotional exhaustion. In EAP practice, we have repeatedly seen cases where signs of depersonalization are already present by the time awareness arrives.
Axis B: Institutional and Environmental Analysis — Systemic Challenges Surrounding the Receiving Side
Scope of the Duty of Care
The duty of care (Article 5, Labour Contracts Act) extends not only to the returning employee but also to surrounding colleagues. If overtime becomes chronic for colleagues as a result of accommodating the returning employee, and those colleagues develop mental health issues, the company may face liability for breach of its duty of care. Companies with fewer than 50 employees tend to have low awareness of this risk, precisely because they have no appointed occupational physician.
Limitations of the Guidelines
The Ministry's guidelines (revised 2012) present a standard five-step framework for return-to-work support and explicitly mention consideration for the receiving side in Step 5 (MHLW, 2012). However, concrete methodologies — workload distribution design, manager burden reduction strategies, information-sharing scripts — are insufficiently developed. For establishments with fewer than 50 employees, the guidance is limited to "utilize Regional Occupational Health Centers," with minimal detail on how to do so.
Impact of Mandatory Stress Checks for All Workplaces
Under Act No. 33 of 2025, the stress check system has been made mandatory for all workplaces, including those with fewer than 50 employees (MHLW, 2025b). Enforcement is expected around 2028. Currently, stress check implementation rates at sub-50-employee workplaces stand at only 57.8–58.1% (MHLW, 2025a), making it urgent to build mental health infrastructure. Developing return-to-work support systems also serves as preparation for this legislative change.
Axis C: Impact Analysis — Consequences of Receiving-Side Exhaustion
Impact on Individuals
The greatest risk to colleagues and managers on the receiving side is secondary mental health deterioration. Workers reporting high stress levels reach 68.3% overall (MHLW, 2025a), and the leading cause — "volume of work" (43.2%) — directly increases when they absorb the returning employee's duties. "Interpersonal relationships" (26.1%) also ranks high, corresponding to the distrust generated by information asymmetry.
Impact on Organizations
When receiving-side exhaustion is left unaddressed, secondary turnover occurs — the colleagues who were providing support leave first. Data showing that 6.2% of workplaces had employees resign due to mental health issues (MHLW, 2025a) demonstrates that mental health deterioration directly leads to turnover. Furthermore, the loss of collegial support directly increases the risk of relapse. The returning employee's recovery depends on everyday workplace engagement; when that is lost, the foundation of return-to-work support itself collapses.
Recommended Actions
Phase 1: Initial Response (From Return-to-Work Decision to Return Date)
Workload Distribution Design
- Create a phased workload transition schedule aligned with the returning employee's gradual return (e.g., "Month 1: 50% → Month 3: 80%")
- Identify colleagues bearing concentrated burden and design allowance and evaluation adjustments
- Document "who takes on what, until when" and share with all stakeholders
Information Sharing Design
- Reach explicit agreement with the returning employee on "what to share and what not to share" with colleagues
- Limit shared content to operational accommodation requirements; exclude diagnosis names and treatment details
- Prepare communication scripts in advance (e.g., "Ms./Mr. ___ is returning. Workload will be gradually restored over the coming period. We plan to return to normal operations in approximately three months.")
Phase 2: Ongoing Response (Months 1–6 After Return)
Manager Care Framework
- Establish regular reporting lines for return-to-work progress (as a system, not "just tell me if something comes up")
- Share part of the return-to-work management duties with HR staff and health promotion officers
- Ensure managers know they have access to external consultation channels
Overall Monitoring
- Regularly check receiving-side overtime hours and health changes
- Continuously update and share the accommodation period end-date outlook with colleagues
Role-Specific Action Steps
| Role | First Step |
|---|---|
| **Business Owner** | Don't leave return-to-work management entirely to the front line — consult with a Chiisanpo or Occupational Health Promotion Center as the company |
| **HR Staff** | Don't shoulder it alone — leverage external resources and build a response framework based on systems, not goodwill |
| **Manager** | Communicate your own state to superiors — secure regular reporting routes and make the burden visible |
| **Colleague** | Don't deprioritize your own care — speak up to your supervisor or an external consultation service when it feels like too much |
Sample Phrases for Consultations
- Business owner → Chiisanpo: "We have an employee returning from leave, but we don't have an occupational physician — I'd like to discuss how to proceed."
- Manager → Supervisor: "Between managing the return-to-work process and my regular duties, I'm reaching my limits. I'd like to discuss support arrangements."
Resource Guide
Public Consultation Services
| Service | Target | Cost | Contact |
|---|---|---|---|
| **Regional Occupational Health Center (Chiisanpo)** | Establishments with fewer than 50 employees | Free | Located in each Labour Standards Inspection Office jurisdiction; appointment required |
| **Occupational Health Promotion Center** | All establishments | Free | Located in each prefecture |
| **Kokoro no Mimi Telephone Counseling** | All workers | Free | 0120-565-455 (Weekdays 17:00–22:00, Weekends 10:00–16:00) |
| **Yorisoi Hotline** | General public | Free | 0120-279-338 (24 hours) |
Support Systems to Leverage
- Mental Health Promotion Staff at Occupational Health Promotion Centers: Visit workplaces to provide free assistance in developing return-to-work programs (JOHAS, n.d.)
- Consulting labor and social insurance consultant (sharoushi): If you already have a consulting contract, they can serve as a resource for return-to-work program development and related guidance
Conclusion
Exhaustion among those on the receiving side of return-to-work support is a structural problem in which the absence of systems transforms goodwill into depletion. Uneven workload distribution, information asymmetry, and excessive managerial emotional labor — these three structures are interconnected, and addressing only one will not resolve the issue.
If the supporters collapse, return-to-work support itself breaks down. Protecting the receiving side ultimately protects the returning employee. Even companies with fewer than 50 employees can take the first step toward building systems by consulting their Regional Occupational Health Center.
First step: Call your Regional Occupational Health Center (Chiisanpo) and consult on how to manage the return-to-work process. If your establishment has fewer than 50 employees, the service is available free of charge.
Frequently Asked Questions (FAQ)
Q: Is it necessary to tell colleagues the returning employee's diagnosis?
No. The Ministry's guidelines require that information shared in the workplace be "the minimum necessary, centered on accommodation requirements" (MHLW, 2012). What should be communicated is "what work accommodations are needed" and "for how long" — not the diagnosis name or treatment details.
Q: Without an occupational physician at a company with fewer than 50 employees, who leads the return-to-work process?
The health promotion officer or safety and health promotion officer serves as the point of contact, utilizing external resources such as the Chiisanpo (MHLW & JISHA, 2012). Chiisanpo provides free mental health consultations and on-site guidance, and can also advise on return-to-work procedures.
Q: What should be done when the colleague absorbing the returning employee's workload is overburdened?
The first step is to create a workload transition schedule and share the outlook on "by when and to what extent" the burden will be reduced. The guidelines explicitly state in Step 5 that "care should be taken to ensure that excessive burden does not fall on colleagues" (MHLW, 2012), and leaving workload concentration unaddressed also poses risk from a duty-of-care perspective.
Q: When does the mandatory stress check for all workplaces take effect?
The amendment was promulgated in May 2025, with enforcement expected around 2028 (MHLW, 2025b). Under the current system, stress checks are a best-effort obligation for establishments with fewer than 50 employees, but the amendment makes them mandatory for all workplaces.
Q: Where can a manager who is exhausted from handling the return-to-work process seek help?
Chiisanpo also handles consultations for managers. The Kokoro no Mimi telephone counseling service (0120-565-455) is open to all workers, including consultations about managers' own stress. Acknowledging one's limits is not a sign of weakness — it is a necessary decision to protect the team.
Sources and References
Government Publications
- Ministry of Health, Labour and Welfare (2012), "Guide for Supporting the Return to Work of Workers Who Have Taken Leave Due to Mental Health Issues (Revised Edition)." https://www.mhlw.go.jp/content/000561013.pdf
- Ministry of Health, Labour and Welfare (2025a), "Results of the FY2024 Survey on Industrial Safety and Health (Workplace Conditions)." https://www.mhlw.go.jp/toukei/list/dl/r06-46-50_gaikyo.pdf
- Ministry of Health, Labour and Welfare (2024), "Results of the FY2023 Survey on Industrial Safety and Health (Workplace Conditions)." https://www.mhlw.go.jp/toukei/list/dl/r05-46-50_gaikyo.pdf
- Ministry of Health, Labour and Welfare & Japan Industrial Safety and Health Association (2012), "Return-to-Work Support Guidelines Pamphlet." https://www.mhlw.go.jp/new-info/kobetu/roudou/gyousei/anzen/dl/101004-1.pdf
- Ministry of Health, Labour and Welfare (2025b), "Act to Partially Amend the Industrial Safety and Health Act and the Working Environment Measurement Act" (Act No. 33 of 2025). https://www.mhlw.go.jp/content/11303000/001543076.pdf
- Japan Organization of Occupational Health and Safety [JOHAS] (n.d.), "Return-to-Work Support Program." https://www.johas.go.jp/Portals/0/pdf/johoteikyo/return_program.pdf
- Kokoro no Mimi, Ministry of Health, Labour and Welfare (n.d.), "Support for Return to Work: Are You Being Considerate? — For Supervisors and Colleagues." https://kokoro.mhlw.go.jp/attentive/atv007/
- Kokoro no Mimi, Ministry of Health, Labour and Welfare (n.d.), "Regional Occupational Health Centers (Chiisanpo)." https://kokoro.mhlw.go.jp/health-center/
Related Content and Author Information
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Reset Method
"It's okay to stop. Every time you start walking again, that step changes the future." — It's okay for the supporters to pause, too. Acknowledging your limits is itself a step toward protecting your team.
About the Author
Kazuhiko Ehara
Occupational Counselor (certified by the Japan Industrial Counselors Association). Director of Kazuna Research Institute. After approximately 25 years in corporate roles (engineering positions at IT companies), he became independent in 2018. He practices Brief Coaching grounded in SFBT (Solution-Focused Brief Therapy) to support workers' mental health. Drawing on his own experience of 200+ hours of monthly overtime and a later realization of his desensitization to distress, he continues to advocate the message "It's okay to stop." Through his involvement in return-to-work support in EAP practice, he identified the structural problem of receiving-side exhaustion and conducted the analysis presented in this briefing.