If you need time off work for depression, anxiety, burnout, epilepsy, migraine or another mental health or neurological condition, the rules are the same as for any illness. You can self-certify for the first 7 days. After that, your employer can ask for a fit note from a GP, nurse, pharmacist, occupational therapist or physiotherapist.
Statutory Sick Pay (SSP) is paid by your employer for up to 28 weeks. Since 6 April 2026, it has been paid from your first full day off sick, whatever you earn. As of 3 November 2026, it is £123.25 a week or 80% of your average weekly earnings, whichever is lower. Your contract may give you more.
A fit note can also suggest a phased return, so you can go back gradually. This guide is for employees in England, Scotland and Wales. Northern Ireland, which has its own law, is covered near the end.
Rates and rules were checked on 3 November 2026.
A fit note, officially the "Statement of Fitness for Work", is advice from a healthcare professional about how your health affects your ability to work. It is advice, not an instruction to your employer.
When you need one. You do not need one for 7 calendar days or less, including weekends and bank holidays. You self-certify for that time. If your employer wants it in writing, you can use form SC2. After 7 days in a row, your employer can ask for a fit note.
Who can issue one. A GP or hospital doctor, a registered nurse, an occupational therapist, a pharmacist or a physiotherapist. It should come from the professional treating you, after an assessment. That can be face to face, by video or phone, or based on another professional's report.
Cost. A fit note is free if you have been ill for more than 7 days. If your employer wants medical evidence for the first 7 days, the healthcare professional may charge. DWP guidance says the employer should cover that cost.
Format. It can be printed or digital. It must show the issuer's name, profession and practice address. The fit note belongs to you. Your employer can take a copy.
Length. In the first six months of a condition, a fit note can cover at most three months at a time.
What it can and cannot say
The fit note says either "not fit for work" or "may be fit for work". There is no option to say you are fit for work, and you do not need to be "signed back". You can go back whenever you feel able, even before the note ends, without seeing the professional again.
If it says "may be fit for work", the professional can tick one or more of these:
There is also a comments box. DWP guidance asks professionals to describe practical effects, such as "take regular breaks", rather than just a diagnosis.
Mental health on a fit note
Three points from DWP guidance matter here.
If you are not sure whether what you are dealing with is burnout, ADHD or depression, our guides to adult ADHD or burnout and autistic burnout may help you describe it.
Who qualifies
As of 3 November 2026, to get SSP you must:
You do not qualify if you have already had 28 weeks of SSP, or you are getting Statutory Maternity Pay. There are other exceptions. Your employer must tell you on form SSP1 if you do not qualify.
If you have more than one job, you may get SSP from each employer.
How much you get
SSP is paid for the days you would normally have worked. A day you work for even a minute before going home sick does not count as a sick day.
What changed on 6 April 2026
HMRC guidance sets out three changes from 6 April 2026:
If you were already getting SSP before 6 April 2026 and the new 80% rule would have cut it, HMRC says you keep the flat rate until you return to work or your SSP ends.
Repeated or long absences
If your condition fluctuates, you may have several short absences. These count as "linked" if each lasts at least one full working day and they are 8 weeks or less apart. Linked absences share one 28-week limit. A continuous series of linked absences lasting more than 3 years ends SSP eligibility.
If your employer will not pay
Ask your employer for the reason. If that does not resolve it, contact HMRC's Statutory Payment Disputes Team. DWP guidance also suggests a trade union or Acas can help.
Your employer may pay more than SSP under a company scheme. This is sometimes called occupational or contractual sick pay. Check your contract or staff handbook. An employer can pay more than SSP but never less.
Your statutory holiday keeps building up while you are off sick, however long you are off.
A phased return means building up gradually. Acas gives examples: reduced hours, different work, or a lighter workload. You and your employer should agree how long it lasts and review it regularly. Your fit note will usually suggest a length.
Pay on a phased return. You get your usual rate for the hours you work. For the hours you do not work, it depends on what you agree or your employer's policy. SSP is only paid for full days you do not work. If you work part of a day, Acas says you cannot get SSP for the rest of it.
If your employer cannot make the changes. The fit note's advice is not binding on your employer. If they cannot agree any changes, they can treat the same note as if it said "not fit for work". You do not need a new one for sick pay.
If you are disabled. A mental health or neurological condition can count as a disability under the Equality Act 2010, depending on its effect on you. If you have multiple sclerosis, you meet the definition from the day you are diagnosed. If you are disabled, your employer must make reasonable adjustments. Acas says employers should review adjustments when you return. Our guide to reasonable adjustments at work in the UK covers the test, examples, Access to Work and what to do if you are refused.
A return-to-work meeting is not a legal requirement. Acas says it is a good chance to agree support, and what colleagues are told about your absence.
Your employer must give you form SSP1:
You may then be able to claim Universal Credit, New Style Employment and Support Allowance (ESA), or both. New Style ESA depends on your National Insurance record, usually over the last 2 to 3 years. You can apply up to 3 months before your SSP ends. As of 3 November 2026, the assessment rate is up to £95.55 a week if you are 25 or over, usually for 13 weeks. You will need fit notes for the claim.
Benefit rules are complicated. Citizens Advice can check what you can claim.
SSP, the fit note and the GOV.UK rules above apply in England, Scotland and Wales. GOV.UK guides are available in Welsh. NHS occupational health and work support services differ by nation.
SSP in Northern Ireland is set by separate law, but the April 2026 changes were mirrored there. The Labour Relations Agency says that from 6 April 2026, SSP in Northern Ireland:
You can self-certify for 7 days. After that, a doctor, nurse, physiotherapist, occupational therapist or pharmacist can issue a fit note. For SSP disputes, ask your employer for written reasons; HMRC can decide. The Equality Act 2010 does not apply in Northern Ireland, so disability law there is different. Advice NI offers free, impartial advice.
If you live in Ireland, see our guide to sick leave and sick pay in Ireland.
If you feel you cannot keep yourself safe, call 999 or go to A&E. In England, you can call 111 and choose the mental health option. You can also call Samaritans on 116 123. Our guide to what actually works for depression covers treatment options to discuss with your GP.
Does stress or anxiety count for a fit note?
A fit note is for a health condition that affects your fitness for work. Anxiety, depression and stress-related illness can be. A fit note cannot be issued for a non-medical problem alone, such as a dispute at work. The professional decides after assessing you.
Do I have to tell my employer my diagnosis?
The fit note records the condition affecting your fitness for work. DWP guidance says the professional can use a less precise description if detail might harm your position. Ask them about the wording.
Can I go back before my fit note ends?
Yes. You can return whenever you feel able, with your employer's agreement. You do not need to see your GP first.
Can I get SSP on a phased return?
Only for full days you do not work. For part days, any pay for the hours you miss depends on your employer's policy or what you agree.
This article is general information about sick pay and fit notes in the UK. It is not legal, financial or medical advice. Rates can change, so check GOV.UK or nidirect before you act. For help with your situation, contact Citizens Advice, Advice NI, Acas or a trade union.
Reviewed by: Proco Team
Last updated: November 2026