Leadership burnout: Inside the silent epidemic

There is a silent epidemic stalking the upper echelons of British business. MT explores the fear, the recognition, the consequences and the steps necessary to prevent it.

by Bill Borrows
Last Updated: 05 Dec 2022
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TW: This piece discusses serious mental health issues including suicidal thoughts.

“Why don't you ask him if his wife knows he’s having an affair?” was one of the more encouraging responses from a senior business journalist when Management Today began casting around for a chief executive prepared to go on the record about their personal experience with leadership burnout.

He continued: “Or you could take his tax accountant for lunch. Or maybe he’ll just let you listen in to his calls for a couple of weeks? Seriously, the top people are never going to talk to you about burnout – that’s what happens to the other guy. They’ve made it into the CEO role because they don’t do burnout.”

That might be the official version for the benefit of all relevant stakeholders, but there is a silent mental health crisis stalking the upper echelons of British business. Major changes and disruptions caused by a global pandemic, looming economic uncertainty, logistical challenges, hybrid working, profit warnings and complications arising from the Great Resignation are all helping to fill the waiting rooms and diaries of bespoke business gurus, psychiatrists and life coaches all over the world.

The hot topic is burnout: the recognition of it, the fear of it, the actuality or consequences of it and, increasingly, taking the steps necessary to help prevent it.

These conversations are happening discreetly, because society seems to believe that if someone is “successful” – highly paid, in a position of power – they don’t deserve sympathy. So not only are leaders saddled with the responsibility for setting the prevalent culture within their business to prevent their staff from burnout, they must also remain somehow immune from the stress and strain of their high-pressure jobs for fear of being seen as “weak”, dismissal and failure.

Not officially recognised as a disease, although professionals in the field are calling for that to happen, burnout was included in the World Health Organisation’s 11th Revision of the International Classification of Diseases (ICD-11) earlier this year as an “occupational phenomenon”.

It defined it as: “A syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions: 1) Feelings of energy depletion or exhaustion; 2) Increased mental distance from one’s job; or feelings of negativism or cynicism related to one’s job; and 3) Reduced professional efficacy. Burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”

Last year, The Burnout Epidemic by Jennifer Moss calculated that burnout costs the global economy almost $1tn in productivity each year, $190bn in healthcare outlays and the lives of 120,000 workers in the US alone, but that is across every sector and strata of business life. One 2021 study by Benenden Health in the UK revealed that 61% of managers were suffering from exhaustion and burnout since the beginning of the pandemic with 20% thinking about quitting their job due to the strain put upon their mental wellbeing.

MT did find two leaders, one in situ pre-pandemic and one derailed in the midst of it all, who were prepared to discuss their experiences, albeit anonymously so names have been changed. (Trigger warning: this feature discusses suicidal thoughts.) Both leaders are no longer in post and have had time to reflect – burnout, like addiction, is something that lends itself to denial in the moment. But it should be noted that, anecdotally at least, these experiences are by no means exceptional.

It’s time to end the professional omertà surrounding burnout. People’s lives depend on it.



Surround yourself with good people

Learn to delegate. If you have the right senior leadership team in place (ie. trusted and competent work colleagues who would feel free to bring up key issues on a one-to-one basis), you will feel comfortable sharing the workload.

Plan your day

Prioritise your tasks and don’t allow yourself to be deviated. Unexpected events are one of the major triggers of stress, which in itself is a huge contributor to burnout, so try to plan for every eventuality.

Lead a healthy lifestyle

Make time to exercise. Cycle to work if possible, go to the gym at least twice a week. Keeping fit will increase the oxygen levels in your blood and help you stay alert. Avoid caffeine and carbonated drinks. Stay hydrated.


“I can't remember where I was going but I pulled in to a service station. I’ve got a weird thing about not letting the tank drop below halfway so I suppose I was going to put about £40 in but after about 10 seconds I just stopped and pulled the nozzle out.” 

James, then a 56-year-old CEO with an international logistics company, now 10 years older and semi-retired, pauses as he casts his mind back. “We had a major issue with one of our insurers and I couldn’t think my way round it. It wasn’t an existential crisis, for the business at least, but after a few weeks I was getting by on two or three hours sleep a night. I’ve no idea what tipped me over the edge at that moment but I just found myself on the forecourt muttering aloud, ‘What is the f****** point?’ Not ‘What is the point of filling the tank?’, just ‘What is the f****** point?’ Then I thought, because I still had the nozzle in my hand and a lighter in my pocket, what would happen if everything just went up in flames, myself included? Problem solved.

“I was visualising this actually happening when I realised I was shaking quite violently so I got back in the car, locked the doors and burst into tears. I’ve no idea how long I was in there but I do recall two people banging on the windows. The next thing I remember is my (now) ex-wife driving me home.” James calls it his “mini-breakdown” but he did not mention it to anybody at work (“Who was I going to tell?”). He went to see a doctor who diagnosed “exhaustion”, took a one-month sabbatical (“Sick leave for cracking up? Forget it, people talk”), began seeing a therapist in another part of the country and, as he puts it now, “started looking for an off ramp”. He found one – his passion, antiques – but it was too late to save his marriage.

Marcus, as the 35-year-old CEO of a successful start-up going into its second round of funding, was at the other end of the career ladder but under no less pressure. He listens to James’ story. “That could have quite easily been me,” he says. “I’m not sure I’d have let it get to the stage where I was having suicidal thoughts but who knows? Those close to me have said I changed completely in the time between quitting my old job to get the start-up off the ground and my business partner and I going our separate ways after the first funding round. I was left holding the baby but the pressure didn’t just double, it started to overwhelm me. Problems that might seem trivial looking back kept me awake at night – and I mean all night, or it felt that way. I also began drinking far too much until, one night, I passed out on the Tube and was woken by a member of the Underground staff. I was absolutely mortified to discover that I’d wet myself but that was one stop sign I still drove straight through. Another was when my partner moved out of our house he’d had enough. And then the pandemic arrived.

“In retrospect, and ironically, I suppose it might have saved my life. We were in the hospitality space and, as you know, that was virtually wiped out. Covid brought everything to a halt for me by early 2021. I was exhausted trying to plan around the constantly changing situation on my own, trying to look after the staff we’d taken on when I couldn’t even really look after myself, and so I took the decision to close the business. It was not as difficult as it might sound because I’d fallen out of love with it by that stage. It actually felt like leaving an abusive relationship.”

After a few weeks “watching Netflix, sleeping and eating properly”, he went back to a senior executive role in somebody else’s company. “From this distance it is obvious to me I was experiencing some kind of burnout,” he reflects. “But at the time I would have just said I was totally stressed out.”

Dr Stephen Pereira, a leading psychiatrist and cognitive behavioural specialist, would be more likely to call that a “state of not just stress, but distress”. In the 27 years his busy professional specialist clinic in London Bridge has been dealing with those in the City, he has seen hundreds of CEOs and high-flying professionals (including ITV News at Ten anchor Tom Bradby, who went public to discuss the help that he received to overcome insomnia). 

So it was little surprise when Pereira was invited to mentor the then 47-year-old António Mota de Sousa Horta-Osório, the CEO of the government bailed-out Lloyds Banking Group, by Chancellor of the Exchequer George Osbourne and the board when the Lisbon-born banker told his chairman he was not coping just a few months after taking the job in March 2011.

With the taxpayer having a huge holding in the company, both Horta-Osório and his travails soon became news. The fact he remains the poster boy for leadership burnout a decade later speaks to the existing code of silence surrounding burnout. But, thanks to his honesty and transparency, it also makes his case particularly revealing and important.

He could not sleep. He had anxiety. These were the two problems Horta-Osório was able to self-diagnose. There were others, doubtless related, that he couldn’t. “I remember vividly that in meetings, the numbers were not making full sense to me. Previously, I’d been able to look at a page and understand it in seconds,” he revealed in 2017. “When you are in those circumstances and you feel you have a problem, you don’t want to show weakness. I kept telling myself, ‘This is going to pass.’ But it didn’t pass. It was endless. You wake up very, very tired and you have to go to work and when you go back home at night, you already know that you are not going to be able to sleep properly. It becomes a vicious cycle and I did not know how to solve it. When sleeping pills didn’t work, quite frankly I didn’t know what else to do.”

He told the chairman he needed to sleep, went back to Portugal where he failed to do so and saw a doctor who immediately admitted him to hospital before he checked into The Priory for nine days rest and chemically induced slumber.

The Evening Standard called his absence from work “due to exhaustion” the most high-profile sick leave in the City and most seriously doubted his ability to return to his previous role. But return he did in January 2012 while implementing major lifestyle changes including, at the request of the Lloyds board, regular appointments with Dr Pereira, who told him he “had to be more like a palm tree and less like an oak. When the storm comes, the palm tree bends but then comes back up again. An oak tree tries to resist the storm and can break.”

By May 2017, Horta-Osório was in a position to boast that not only had he brought Lloyds back from the brink of financial collapse (the PPI bill alone had been £17.4bn) but that he was the only CEO of a bailed-out UK bank to fully refund the UK taxpayer – his stated intention at the time he took the job and one of the major reasons, he believes, for the extra pressure loaded on to himself and the subsequent health issue that almost “broke him”.

As a consequence of his well-documented and very public struggle and the demonstrable success of his managed return, Horta-Osório went on to work with Dr Pereira to develop a programme to support the mental health of his colleagues, the Optimal Leadership Resilience Programme.

“He was the first leader who could see the value of doing that,” says the psychiatrist now. A 12-month programme was introduced with 200 top-level executives encouraged to undertake it – it now runs between six and nine months and has taken 2,500 leaders from outside Lloyds and the UK. This, however, is a preventative measure that emerged as a reaction to one high-profile CEO’s personal journey – the causes of the burnout are as pertinent as ever because the systemic and institutional factors behind it remain.



Sleep deprivation/exhaustion

Insomnia is the most common symptom of the executive who takes work home with him/her and cannot turn off. This is one of the most debilitating aspects of the vicious circle that accompanies burnout and exacerbates all extant problems. It can also lead to other health complaints such as headaches and stomach or bowel problems.

Over-indulgence/uncharacteristic risk-taking

You are running away from something or seeking to replace the adrenaline that got you to the top position in the first place. There are obviously attendant health issues here – both mental and physical.


If drivers such as pride, ambition, challenge and even money now seem unimportant or even meaningless, then you are heading for burnout. If thoughts of “chucking it all in” are becoming commonplace, then you may be about to make a catastrophic life decision and should take a break.


If burnout has a patron saint it is almost certainly Dr Christina Maslach, the 76-year-old American psychologist who has dedicated much of her life to studying the phenomenon and, in 1981 with Susan E Jackson, co-authored the Maslach Burnout Inventory – a tool to assess a person’s individual experience of occupational burnout that is widely, although not exclusively, regarded as the gold standard for doing so.

In a 2019 blog, and after decades of research, she identified the six main causes as: workload; perceived lack of control; lack of reward or recognition; poor relationships; lack of fairness; and values mismatch.

These indicators affect the general workforce. Maslach appears to conclude that organisational culpability is more of a factor than personal responsibility when it comes to burnout. It is certainly hard to argue with the manifold examples of executive mismanagement and misalignment she uses to reinforce her case. For example, she refers to the analogy of canaries in the coalmine, pointing out: “When they stop singing, you don’t ask why they made themselves sick – the mine is making the birds sick.”

However, in the rush to apportion blame for the conditions in the mine, which often lands at the feet of the leaders, it might be forgotten that Maslach’s six main causes can also affect those in leadership positions:

Workload – Long and anti-social hours come with the territory. According to a Harvard Business Review study in 2006, leaders worked 9.7 hours per weekday, on average. They also conducted business on 79% of weekend days, putting in an average of 3.9 hours daily, and on 70% of vacation days, averaging 2.4 hours daily.

Perceived lack of control – Seeking to satisfy demands from (and frequent interactions with) diverse stakeholders can lead to a CEO’s depersonalisation from the strategic process.

Lack of reward or recognition – Even in a recognition-rich culture that supports employee engagement and retention, executives tend to receive the least recognition.

Poor relationships – A poor level of trust between the board chair and the CEO will often lead to a “them and us” dynamic between the CEO/executive team and the non-executive directors.

Lack of fairness – Punishments and deductions not contingent upon personal performance and driven by other factors may contribute to a reduced sense of personal accomplishment.

Values mismatch – “For senior leaders, fit matters more than skill” (as the Harvard Business Review put it in 2014). Of the 40% of leaders hired from outside each year, almost half fail within the first 18 months.

These issues, at a time of unprecedented shareholder and media scrutiny and in an environment where Norway’s £1.2tn oil fund, having already voted against executive packages at Intel, Apple, IBM, Harley-Davidson and General Electric this year, is warning that their focus is shifting from top US companies to those in Europe, are exacerbated by what one clinical psychologist refers to as an “Inability to test one’s perceptions and a tendency to lose touch with reality… [leading to] stress, alienation, loneliness and emotional turmoil. These may lead to health problems and negatively affect social and familial relationships as well.”

In other words, a kind of fundamental dissatisfaction on almost every level and nobody to talk to about it. A major indicator and cause of burnout. It’s lonely at the top.

People are often on the verge of making horrendously huge decisions in their life, from leaving their wife and kids to leaving their jobs, and it is because they are burned out

For those that recognise they need assistance, a life and mindset coach like Paul Bell is increasingly the go-to option. “They come to me after personal recommendations,” he says of the CEOs and managing directors he has worked with over the past 10 years. “But before we can get anywhere, they have to truthfully accept what’s going on – the pressures, sadness, lack of confidence, occasional panic attacks, loneliness, whatever it is. There’s so much bravado and bullshit in the corporate world, they have to strip away a huge coat of armour in front of me but also in front of themselves. They won’t be speaking about these things and in this way to anyone else, including their wives, partners, friends, family or work colleagues.”

This boardroom ennui and, even, despair is nothing new. He has encountered it many times with business clients here and abroad. “Two immediately spring to mind,” he says. One from a few years ago, and one ongoing. They are about 15 years apart in age, but they both had a real sense of unhappiness with where they were at in their life. They were even reluctant initially to think that their actual work might be part of that. “Their immediate short-term fix before I started working with them had been drugs and alcohol. Habits had developed very quickly. That led to sleepless nights and sleeping pills. Then when you added the work pressure, perhaps making the wrong decisions at work or being afraid of making wrong decisions, even clichéd stuff like office affairs, this is where it gets really serious… I hear them saying things like, ‘I’m going to pack it all in and go and live on a farm.’ I’m telling you from experience, people in this position are often on the verge of making horrendously huge decisions in their life, from leaving their wife and kids, even if there’s not an affair involved, to leaving their jobs and it is because they are burned out.”

It’s what Dr Pereira means when he says: “Humans have a finite bandwidth but there isn’t a defined criteria for what that bandwidth is. Some people, on account of learning how to manage themselves, have a wider bandwidth, and some people who are not so good at managing their various priorities have a narrow bandwidth.” While describing “burnout” and “leadership burnout” to be “conversational, not clinical, terms”, the City psychiatrist believes the syndrome we are discussing goes to the heart of the human condition.

“It is any individual in any profession,” he says. “When anybody is exerting themself and overstretching on a multitude of fronts, and then they try and balance responsibilities not only in their professional life but also in their personal life, it causes distress. Some people can sustain that for a period of time but, if you do that continuously, when you have just the one additional, or two additional, issues that come along that are beyond the normal zone of managing, then you have a problem.”

“Fatigue, exhaustion, irritability, insomnia, running on empty, eating sugary foods, drinking sugary drinks and drinking too much alcohol,” remembers Emma Mainoo, listing the signs she chose to ignore on the road to burnout as a high-performing senior marketing professional leading teams and dealing with multimillion-dollar budgets.

“Over-working was a big part of my life. Work was the one place that I felt like I could hide in plain sight so I didn’t have to think about feeling depressed and the difficult thoughts I was having… but at the same time, working too many hours and all the culture that went with it wasn’t healthy. My body was whispering to me on an ongoing basis.”

Having quit her dream job (“The C-suite woman who hired me had no joy in her life and I could see that that is what was next for me”), Mainoo recovered, retrained and now has an enviable perspective as a partner and head of mental health at Utopia, an award-winning culture change business that works with multinationals such as Google, Spotify and Coca-Cola. Her experience throws light on an under-reported aspect of a phenomenon that itself tends to go under the radar.

“We know white men in leadership are the majority and there are only a handful of female CEOs in Britain’s top 100 companies,” she explains. “But if you want to slice that even further and look at the experiences of black women, they’re just not getting to CEO or chair level. And so, when you are reaching the most senior level in a business, on the track to the boardroom, and you are not represented and nobody has come before you, you feel a responsibility to pave the way for others and that’s a huge extra pressure to show that you can lead a business forward.

“At that point, it’s incredibly hard to say ‘Actually, I’m struggling’ or to scale down the responsibilities. The pressure to be in that role and to be able to endure whatever is thrown at you as a leader is really harmful and leads to burnout.”

It was a situation made worse during the pandemic. “There was a lot of blurring between work and home life, a lot of extra responsibility, and a lot of guilt for women,” continues Mainoo. “Statistically, women are far more likely to experience emotions like guilt, they feel they have to be everything to everyone, and so burnout is another thing that will arise more easily for women and also employees of colour in any organisation.”



Seek medical help

Ideally you do not want to be at this stage but if exhaustion/insomnia/despair/suicidal thoughts are beginning to overwhelm you, then you should see a qualified medical professional ASAP. Nothing is more important than your health. The path to recovery is only that important step away.

Take time away

You need a break and time to both reassess and recalibrate. It might be assisted sleep in a rehabilitation environment or an extended period of leave away from the everyday stressors associated with the business.

Engage a good life coach (or similar)

Ideally, this is something you would do to help prevent burnout, as somebody to talk to in complete confidence who is not associated with the business or entangled in your private life and who has experience of talking to others who have been in a similar situation can often be a godsend. If you are past that point and have actually suffered burnout, then this person can help you rebuild and recover.


The pandemic was a game changer in so many ways – not least for female executives who disproportionately found themselves having to also manage childcare. Lockdown provided a chance for some business leaders to take stock and for others like Tom Blomfield, the founder of $1bn digital-only Monzo bank, to step away (“Right now, I’m technically unemployed,” he told this magazine last year. “Which is great. I don’t miss having a diary that’s packed out from 8am to 8pm. As CEO, I never switched off. I found it impossible to stop thinking about the latest problem. I stopped sleeping. The pressure was exacerbated by lots of press attention and the increased responsibility that comes as you scale. And then Covid hit – and that was the straw that broke the camel’s back”).

According to Dr Pereira, lockdown had another profound impact. “There’s physiological resilience in terms of physical health with sleep, exercise, diet and all the rest of it, and there’s a psychological resilience in looking at how you manage your mind,” he explains. “But people forgot there is social resilience and because they could no longer bond in working communities, or in the local churches, or five-a-side football or wherever, it made people aware of mental wellbeing issues in a very sharp manner.”

He adds: “Many CEOs want to control the uncontrollable. When they feel that control is outside of them in an unpredictable world, that’s when difficulties come about.” Learning and knowing what is within your grasp, and being able to manage that in a compassionate but highly productive and efficient manner, is useful – but also knowing what it is that you cannot control and making some peace with that is a very important part where you can reduce some of the dread and apprehension ahead of an AGM for example, he says.

“The difference between us and animals is our ability to think, but thinking can be a gift or it can be a curse. Many of the senior people that I see in the City have difficulties with sleep and anxiety, so learning strategies to manage the mind, learning how to deal with others’ different and often unhelpful patterns of thinking becomes very important,” he adds.

Bell concurs and believes that within 10 years, coaching in this country will catch up with the $1bn industry in the US: “I will go out on a limb here. But I think there’s way more leadership burnout happening than has been officially recognised and many more leaders who are working with coaches than you might expect. I think a lot of people experiencing burnout now are hoping to somehow just about get through – they might get to an early retirement or some exit strategy on some kind of financial deal. But I think there’s a lot of people in huge positions, who are under what they deem to be a lot of pressure, and they’re genuinely not enjoying their work or their career. And it impacts every single area of their life. So, yes, I do think it’s increasing.”

As far as Mainoo is concerned, her work involves “trying to smash down stigma and create healthy cultures where everyone feels like they can talk about their mental health and thrive in a working culture without a human cost” – and demand for her services has never been higher. Indeed, Dr Pereira says: “There is still that degree of stigma in dealing with the mind. Because it’s still seen as a sign of weakness.”

So the question is, does this indicate some kind of endemic crisis in the boardroom that is not going away or does this new appreciation of mental health among the senior business class, more use of coaches and psychiatrists and business culture change gurus, mean that more leaders are taking steps to deal with burnout before it reaches crisis point?

The truth is, until more inspirational figures like Horta-Osório come out and talk about their experience, until the stigma surrounding mental health is erased, until leaders feel confident enough to model healthy behaviours in order to inspire others in their organisation, it’s impossible to say. Talking about it can’t hurt though.