Mental health reasonable adjustment request template

Template for an employee to use if they want to request a mental health reasonable adjustment. Free to use.

You can copy and paste the template text into an email or document.


[Today's date]

Dear [name of manager / employer / HR manager],

I'm writing to make a reasonable adjustment request.

I'm currently finding it difficult to manage my health and work.

[Give details of how your health impacts work. Or how your work impacts your health. You do not need to disclose your mental health problem if you do not want to. For example:

  • I've been diagnosed with anxiety
  • I'm receiving treatment for my mental health condition
  • I'm finding it difficult to concentrate at the moment and I'm concerned that without changes to my work I might have an accident]

My current working pattern and role is [give details].

To help me manage my work and mental health I ask that [give details of the reasonable adjustments you would find helpful and why. For example, a later start time so you can miss the rush hour because you're finding it difficult to be around lots of people].

This would mean that I can [give details of any benefits to the employer. For example, this means that you can arrive at work calm and clear headed ready for work].

To deal with any effects the change could have on my work or the organisation, I suggest [give details of how you and your employer could deal with any effects. For example, you'll work later in the evening].

Please could we meet to discuss what reasonable adjustments could help me to manage my health at work, and at the same time contribute effectively to the business.

I look forward to your reply.

Yours sincerely,

[Your name]

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