When Conflict Makes People Ill, Who Deals With the Cause?

Occupational Health can support the employee. HR can manage the process. Neither automatically resolves the damaged working relationship that may be driving the absence, grievance or performance concern.

This is where apparently well-supported cases can remain stuck. Each professional does the job properly, yet the employee returns to the same mistrust, the manager resumes the same defensive conversations and the organisation continues to manage symptoms rather than cause.

The missing element is not always another policy or clinical intervention. Sometimes it is a safe, properly bounded way to address the conflict itself.

Conflict often arrives disguised as something else

Workplace conflict rarely enters an organisation carrying a neat label. It may first appear as repeated short-term absence, work-related stress, a request to avoid a manager, declining performance, an Occupational Health referral or a grievance about a decision that appears relatively minor.

By that stage, cause and consequence may be difficult to separate. A difficult relationship can contribute to stress, sleep disturbance, loss of confidence and absence. Ill health may also reduce a person's tolerance, concentration or capacity to manage an already strained relationship. Workload, unclear authority, organisational change and poor management may be affecting both.

The evidence shows a strong association, although it does not prove that conflict causes every reported health problem. The Acas 2025 survey of 4,558 working-age people in Great Britain found that 44% had experienced conflict at work in the previous 12 months. Among those reporting conflict, 57% reported stress, anxiety or depression as an impact, 25% reported reduced productivity and 10% reported sickness absence. Acas used a broad definition that included disagreements, disputes and difficult relationships, so the figure should not be read as the prevalence of severe or formal conflict.

The CIPD Good Work Index 2024 found a similar pattern from a different survey. A quarter of UK employees reported workplace conflict in the previous year. Those employees were more likely to report exhaustion and pressure, less likely to say work had a positive effect on their mental health and twice as likely to say they intended to leave their job. Again, this is survey evidence of association rather than a clinical diagnosis or proof of causation.

The practical point is not that every stressed employee requires mediation. It is that an organisation may miss a material work factor if it treats the health presentation and the employment procedure as two separate matters.

Occupational Health can identify the impact without deciding the dispute

Occupational Health occupies a particular and valuable position. It examines the relationship between health and work, assesses functional capacity and may advise on fitness for work, restrictions, rehabilitation, adjustments and return-to-work planning.

Its clinical independence and confidentiality are part of that value. The Information Commissioner's Office guidance on Occupational Health schemes reminds employers not to compromise confidential communications and explains that explicit consent will generally be required before health information is released to non-medical staff. An employer should usually receive the work-relevant advice it needs, not a transcript of the employee's medical history.

Government fit note guidance for employers and line managers makes a related distinction. Clinical advice concerns the functional effects of a condition and possible ways to support somebody to stay in or return to work. The employer and employee must then discuss what can be implemented.

That leaves a boundary. Occupational Health may record that the employee describes work conflict as contributing to ill health. It may advise that a change in contact, reporting arrangements or workload would support recovery. It is not ordinarily there to investigate competing accounts, decide whether a manager acted fairly, determine a grievance or negotiate the future relationship between the people concerned.

Asking it to do so risks weakening the very independence on which useful Occupational Health advice depends. A clinical referral should not become a covert disciplinary investigation or a request to certify which party is right.

HR can manage a fair process without repairing the relationship

HR has a different responsibility. It can advise on policy, legal risk, reasonable adjustments, absence management, grievances, discipline, performance and organisational consistency. It may arrange an investigation, guide a manager through an informal conversation or ensure that a serious complaint is handled promptly and fairly.

Those functions matter. A serious allegation cannot be wished into a confidential conversation because formal action feels uncomfortable. The CIPD's current guidance on bullying and harassment states that formal allegations should receive a prompt, thorough and impartial investigation. Where facts must be established or the organisation may need to act, a proper procedure is not bureaucratic ornament. It protects people and the organisation.

Process and resolution are not identical, however.

A grievance may determine whether a complaint is upheld. It may recommend training, a warning, a reporting-line change or no further action. It does not necessarily enable two people to understand how their working relationship deteriorated, what each now fears, which behaviours have become loaded with meaning or whether they can work together without repeating the same pattern.

The gap is visible in the CIPD's 2024 research on conflict procedures. Seventy per cent of surveyed employers said their procedures for resolving interpersonal conflict were effective, while only 36% of employees who had experienced conflict said it had been fully resolved. The employer and employee surveys were separate and the figures should not be treated as a direct matched comparison. They nevertheless expose a useful organisational question: is success being measured by whether a process concluded, or by whether the conflict actually stopped?

HR may also face a perception problem. It can act fairly and professionally while still being understood as part of the employer's management structure. Where HR advised on an earlier decision, commissioned an investigation or supported one party's manager, employees may not experience a later HR-led conversation as neutral. That does not make HR defective. It means the role has limits.

The referral loop can leave the underlying conflict untouched

A familiar pattern develops:

• The manager sees absence or reduced performance and refers the employee to Occupational Health.
• The employee tells Occupational Health that the manager or working environment is contributing to the problem.
• Occupational Health advises support, adjustments or discussion of the work factor.
• HR implements a process or asks the manager to consider the recommendations.
• The manager sees no upheld grievance or clear misconduct and treats the issue primarily as attendance or capability.
• The employee experiences this as proof that nobody has heard the real problem.

Everybody owns a piece. Nobody owns the relationship.

The organisation may then make sensible adjustments around an unresolved conflict. Remote working reduces immediate contact. A phased return reduces hours. A temporary reporting arrangement creates breathing space. These measures may be clinically appropriate and necessary.

They can also freeze the dispute in place if nobody addresses what happens when ordinary contact resumes. Colleagues absorb redistributed work. The manager feels unfairly blamed without having been heard. The employee interprets each routine management request as renewed threat. A temporary adjustment quietly becomes the organisation's only conflict strategy.

Three distortions commonly follow:

• Conflict is medicalised. A relational or organisational problem is treated principally as an employee health condition.
• Distress is proceduralised. The human impact is compressed into whether a policy step was completed or an allegation met a formal threshold.
• Organisational failure is individualised. Workload, role ambiguity, poor change management or conflicting instructions are reframed as a clash between two difficult personalities.

The Health and Safety Executive's Management Standards for work-related stress are a useful corrective. They identify relationships, demands, control, support, role and change as potential work factors. Its specific Relationships standard includes promoting positive working to avoid conflict and having systems to respond to unacceptable behaviour. Some cases therefore require organisational redesign or competent management, not simply treatment, procedure or mediation.

Not every difficult relationship needs a mediator

The counterargument deserves to be stated plainly. Managers should manage. HR should help organisations prevent conflict and intervene early. Occupational Health should not be used whenever a conversation feels awkward. A routine misunderstanding can often be resolved by a timely, fair discussion led by a capable manager.

Referring every disagreement to mediation can encourage managers to outsource ordinary responsibility. It may also make the issue feel more formal than it needs to be.

The first response should therefore be proportionate. Clarify expectations. Correct factual misunderstandings. Address workload and role ambiguity. Provide necessary health support. Give people a genuine opportunity to raise concerns. Investigate serious allegations.

Mediation becomes more relevant when reasonable management conversations have failed, trust has deteriorated, different accounts have hardened or the people need to agree how a continuing working relationship will operate. Independence becomes particularly valuable where neither participant sees the internal process owner as neutral.

Four different questions require four different answers

A joined-up response separates questions that organisations often collapse:

No single profession should be expected to answer all four. A strong pathway makes the boundaries explicit and permits more than one route to run in a coordinated way.

Mediation addresses the working relationship, not the diagnosis

Workplace mediation is a voluntary and confidential process in which an impartial third party helps participants examine the disagreement and explore mutually acceptable ways forward. The mediator does not diagnose illness, determine legal rights, decide whether an allegation is true or impose an outcome.

The Acas guidance on mediation at work identifies communication problems, personality clashes and relationship breakdowns as issues that mediation may address. It also makes clear that participation is voluntary and that mediation is generally not the route for deciding pay, dismissal or conduct issues.

In a case involving ill health or absence, mediation may create a structured opportunity to discuss matters that neither a clinical report nor a grievance outcome can settle alone:

• how contact should take place during absence or a phased return;
• what each participant understood to have happened before the relationship broke down;
• how feedback, workload allocation and management requests will be handled;
• what boundaries are required around language, tone and escalation;
• how agreed adjustments will operate without isolating the employee or overloading colleagues;
• which matters remain for management decision rather than participant agreement;
• when and how the working arrangement will be reviewed.

This is not therapy. It is not an Occupational Health assessment conducted without clinical notes. It is not HR with the minutes removed.

Its contribution is to provide a different kind of structure: one in which each participant can explain impact, test assumptions, hear the other account and take responsibility for workable future conduct without requiring the mediator to declare a winner.

The distinction was developed in a guest blog published by the Society of Occupational Medicine in October 2025. Written by workplace mediator Liz Kendall, it argued that early mediation can sit alongside Occupational Health and HR and bridge a gap where underlying workplace issues contribute to ill health or absence. This is a practitioner guest article hosted by SOM, not a formal SOM policy statement or clinical guideline. Its proposition is nevertheless useful: complementary services are most effective when each remains within its competence.

Mediation must not become a shortcut around difficult duties

Early intervention is often sensible, but "early" does not mean automatic.

Mediation may need to wait, be adapted or run alongside another process where:

• there is an immediate risk to health or safety;
• a serious allegation requires investigation or an authoritative decision;
• one participant wants a formal complaint determined;
• illness currently prevents somebody from participating safely or making voluntary decisions;
• the power imbalance cannot be managed sufficiently within the process;
• a proposed outcome would require authority the participants do not possess;
• the employer is attempting to use confidentiality to avoid scrutiny or suppress a legitimate concern.

The CIPD mediation factsheet cautions that mediation may be unsuitable when a right-or-wrong decision is required, a serious discrimination or harassment allegation needs formal investigation, health creates an obstacle to a joint meeting or the parties lack authority to settle the issue.

That is not a blanket rule that anybody experiencing mental ill health is unsuitable for mediation. Suitability should be assessed individually. Timing, breaks, separate preliminary meetings, representation or support, remote participation and the structure of any joint meeting may matter. Occupational Health advice may inform what participation is safe, while the employee retains control over confidential clinical information.

Mediation can also take place after an investigation or grievance. A formal process may decide what happened and what the employer must do; a later mediation may address how the participants will work together, communicate or separate responsibilities without renewed conflict.

Build a pathway, not a sequence of hand-offs

The answer is not to bolt mediation onto the end of every Occupational Health referral. It is to create a triage pathway in which health, procedure, relationship and organisational cause are considered deliberately.

A practical framework would include:

1. Ask about work factors without leading the answer. A referral can ask whether work, relationships, workload or change may be affecting health, while leaving clinical assessment to Occupational Health.
2. Separate information streams. Clinical information remains protected. HR receives only what is needed for lawful management. A mediator receives the information agreed for the mediation, not an unrestricted case file.
3. Explain each role to the employee and manager. People should know who advises, who decides, who facilitates and what will remain confidential.
4. Keep options open. An employee should not have to choose between health support and having a workplace concern taken seriously. Mediation should not remove the right to use a formal process.
5. Assess suitability rather than referring by label. "Stress", "bullying" or "personality clash" does not by itself determine the correct route. The nature, seriousness, safety, desired outcome and need for factual findings all matter.
6. Give managers responsibility for implementation. An agreement cannot cure excessive workload, contradictory roles or an unsafe system that only the organisation can change.
7. Coordinate timing. Adjustments, investigation and mediation may need to be sequenced or run in parallel. Delay should be a reasoned decision, not the result of departments waiting for one another.
8. Review the return to work as a relationship, not only an attendance event. Check whether contact, trust, workload and agreed behaviours are functioning after the employee returns.

The Acas estimate that workplace conflict costs UK organisations £28.5 billion a year is based on modelling of 2018–19 data and should not be presented as a newly measured 2026 figure. Its underlying lesson remains relevant: costs rise through presenteeism, sickness absence, formal procedures, resignation and dismissal, while early informal engagement is generally less costly than allowing conflict to harden.

The larger cost is not always visible in an absence figure. It is the employee who returns but no longer speaks openly, the manager who stops delegating, the team that works around two people who cannot communicate and the grievance that concludes without restoring a viable working relationship.

Occupational Health can help a person work safely. HR can help an organisation act fairly. Management must address the working conditions it controls. Mediation may help people confront the damaged relationship between them.

The organisation needs all four distinctions. Otherwise, it can provide support, complete the process and still send everyone back into the same conflict.

Questions for leaders

• When an employee reports work-related stress, how does the organisation distinguish workload, health, conduct and relationship issues?
• Are Occupational Health referrals being used to obtain clinical advice, or to answer management questions that belong elsewhere?
• Does the organisation measure whether grievances conclude, or whether the underlying conflict is actually resolved?
• Can an employee seek health support without feeling that their workplace concern has been medicalised?
• When HR has already advised on the case, is there a genuinely neutral space for the participants to address their future relationship?
• Who is responsible for correcting structural causes such as workload, role ambiguity, weak management or poorly handled change?

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