For occupational health managers · DTHgroup
Mental ill health is now
the leading cause
of absence.
In the first half of 2026, mental health conditions overtook respiratory and musculoskeletal conditions in Germany for the first time. 184 days lost per 100 insured employees, up nine percent year on year. Anyone expected to manage that needs figures, not assumptions.
✗ What most programmes work with
Satisfaction surveys, participation rates, feedback from workshops. All self-reported – and it fails to reach precisely those who are most exhausted.
↓
✓ What HSflow works with
Objectively captured strain values across the entire workforce, documented over time. No self-assessment, no personal data, no psychodiagnostics.
10 min.per employee
anonymousno personal data
A note on jurisdiction
This page describes the German legal framework: the Works Constitution Act (BetrVG), the Occupational Safety and Health Act (ArbSchG) and the Social Code (SGB V, SGB IX). Other countries have equivalent bodies and duties under different names – the CSE in France, the RSU and RLS in Italy. The measurement itself is language-neutral and works in any jurisdiction; only the statutory hooks differ. This page is written for organisations with German operations.
German law
The data
This trend
will not reverse on its own.
All figures from the DAK health analysis for the first half of 2026, evaluated by the IGES Institute on the basis of around 2.2 million insured employees in Germany.
First place, for the first time
184 days lost per 100 insured employees due to mental health conditions – ahead of respiratory conditions (175) and musculoskeletal conditions (174).
H1 2026
Against the overall trend
While respiratory conditions fell by 21 percent, mental health conditions rose by nine percent. Overall sickness absence edged down to 5.3 percent.
+9 %
Long absences
The Barmer health report puts the average duration of a mental health case at 40 days. One fifth of all days lost falls into this diagnostic group.
Ø 40 days
Sources: DAK health analysis H1 2026 (IGES Institute) · Barmer health report · DAK Psychreport 2025
Why existing instruments fall short
They measure satisfaction.
Not strain.
Self-reporting has a blind spot
People under heavy strain do not complete surveys – or they play it down. Precisely the group that matters is missing from the data. Response rates of 30 to 50 percent are considered normal.
Bias
Snapshots, not trajectories
One survey a year shows a state, not a development. Whether a measure has worked cannot be derived from it – only asserted.
No trend line
No figures for the board
Health management competes for budget with investments that show a return. Without documented effect it stays a matter of negotiation rather than calculation – while every departure costs real money.
Budget pressure
What one departure costs
Germany’s Competence Centre for Employee Retention puts the total cost of a single turnover case at a minimum of 43,069 euros – exit, replacement, onboarding and lost productivity combined. The study dates from 2016; salaries have risen and the labour market has tightened since. Other sources cite ranges between 15,000 and 175,000 euros depending on the role.
These costs appear in no balance sheet line. They accrue quietly – including during the months in which an instrument is still being negotiated.
from €43,069 per case
These costs appear in no balance sheet line. They accrue quietly – including during the months in which an instrument is still being negotiated.
What HSflow delivers
Measure strain.
Evidence the effect.
01
Capture
Standardised measurement across the entire workforce – including production, shift work and the factory floor. Around ten minutes per person, no prior knowledge required, available in 24 languages.
Full survey, not a sample
No self-diagnosis
02
Locate
Results as aggregated indicators per area – never per person. What becomes visible is where strain arises, not who is strained.
Aggregated by unit
Minimum group sizes
03
Evidence
A second and third measurement show whether the measure taken has worked. An assumption becomes a documented change – auditable for the board and for external assurance.
Documented trajectory
Proof of effect
Statutory framework (Germany)
Four obligations,
one data basis.
HSflow is not an additional programme alongside your obligations. It provides the data basis that serves several of them at once.
§ 5 ArbSchG · Risk assessment of psychological strain
Mandatory for all employers in Germany since 25 October 2013. In practice often formally completed but not validly measured. HSflow provides a methodically documented assessment.
§ 20b SGB V · Workplace health promotion
German statutory health insurers are required to support workplace health promotion. For measures with documented effect, co-funding may be available.
§ 167 (2) SGB IX · Return-to-work management
Employers must offer structured reintegration once someone has been unable to work for more than six weeks within twelve months. With mental health cases averaging 40 days, that threshold is reached quickly. Prevention reduces the case count.
ESRS S1 · Social indicators in sustainability reporting
What you collect for health management is at the same time the data basis for own-workforce disclosures. One measurement, two audiences.
Employee representation
The works council
has a say.
In Germany, measuring psychological strain touches on co-determination rights under § 87 BetrVG. That is not an obstacle but the normal route – and HSflow is built for it.
What that means in practice
Implementation is governed by a works agreement setting out what is collected, who sees the results and which analyses are excluded. We provide the documentation your works council needs for that discussion.
§ 87 BetrVG
Conversation
You know your figures.
We supply the missing ones.
Whether a concrete project, insurer funding or a first orientation – we look forward to the exchange. Response within 48 hours.