Signed Off Work With Stress or Burnout: What to Do With the Time

October 1, 2026

A fit note gives you time off work. It doesn’t tell you what to do with it, and a lot of people spend the first fortnight asleep, half-reading work email anyway, or feeling guilty because they aren’t ill in a way anyone can see.

This guide covers what being signed off means in 2026, what you are and aren’t allowed to do, what the research says about recovering from burnout, and when a residential stay is worth considering. The employment and sick pay details are for the UK.

The Short Answer

A fit note is a healthcare professional’s advice that you aren’t fit for work for a set period. It doesn’t confine you to the house. Acas says a worker can use paid holiday while off sick, and gives the example of someone who has “a mental health condition that might be helped by a holiday”.

Rest on its own helps, but the effect wears off quickly once you’re back at the same desk. In one study of 76 workers, burnout had returned to its pre-holiday level within three weeks of going back. The limited evidence there is leans towards combining treatment with a planned, work-focused return, rather than waiting for the fit note to run out.

A residential retreat may suit you if weekly therapy hasn’t shifted things, your time off covers at least a month, and you aren’t in crisis. It isn’t the right first step if you need urgent mental health care, medical supervision or detox.

What a Fit Note Means

For the first seven calendar days, weekends included, you can self-certify. After that your employer can ask for a fit note. These are no longer only issued by doctors: since 2022 nurses, occupational therapists, pharmacists and physiotherapists can issue them too.

The note says either that you are “not fit for work” or that you “may be fit for work” with some changes. Those changes are a phased return, altered hours, amended duties or workplace adaptations, which includes working from home. In the first six months of a condition, a single fit note can cover up to three months. After that, the guidance for healthcare professionals sets no fixed limit if it is clinically appropriate.

Three things people often don’t realise:

It is advice. The government’s guidance for employers tells them that with a “may be fit” note, “you are not obligated to agree” to the suggested changes. If they can’t make them work, the same note still counts as evidence for sick pay, and you don’t need a new one.
You can go back early. The same guidance says your employee “can return to work at any time, even if this is before their fit note expires”, without going back to the doctor first. Nobody needs to sign you back.
For Statutory Sick Pay, a fit note is enough. The guidance says “an employee cannot be required to provide further medical evidence beyond a fit note” for SSP, though your employer can still ask you to see occupational health.

The system is changing slowly. In May 2026 the government announced pilots in four areas of England testing personalised “stay in work” and “return to work” plans alongside or instead of the current note. Outside those pilots, the rules above still apply.

Pay, Holiday and Keeping in Touch

Statutory Sick Pay changed on 6 April 2026. It is now paid from the first full day you’re off sick, with no minimum earnings, at £123.25 a week or 80% of your normal weekly earnings, whichever is lower, for up to 28 weeks. Many employers pay more under their own scheme, so check your contract.

Holiday keeps building up while you’re off sick. Acas says workers “accrue” holiday as normal during sickness absence, and that an employer “cannot force a worker to take holiday while off sick”.

Your employer is expected to stay in contact, but it should be useful rather than overwhelming. Acas guidance says the employer and employee should agree “the purpose, type and level of contact”, and that if contact feels too difficult, the employer could check in with someone else instead. NICE’s guidance on long-term sickness absence recommends employers make contact within four weeks. A short, agreed check-in every week or two is usually easier than dreading the phone.

If you’re referred to occupational health, Acas says you don’t have to agree to the assessment, and the adviser must ask your permission before sharing the report. Outcomes can include more time off or a referral for counselling. Acas also points out that agreeing can help stop your employer making big decisions without important information.

Can You Go Abroad While Signed Off?

There is no law that keeps you at home while you’re off sick. What matters is whether what you do fits with getting better, what your contract and sickness policy say, and whether your employer knows.

The cleanest route for a short trip is the one Acas describes: ask to take it as annual leave. If your employer agrees, sick leave can be paused, you get holiday pay, and sick leave can carry on afterwards if you still aren’t well enough to work. Acas recommends putting whatever you agree in writing.

A longer stay for therapeutic support is a different conversation, and there isn’t one national rule that covers it. In practice it helps to:

tell your employer what you’re doing and why before you go
make sure the fit note, or agreed leave, covers the dates
talk it through with your GP. The Foreign Office’s guidance on mental health abroad suggests discussing travel plans with your doctor or mental health team.
get whatever you agree in writing

Some practical points for Thailand in particular:

Insurance. The Foreign Office warns that “some insurance companies will exclude cover for a mental health condition”. Declare your conditions, tell the insurer you’re signed off and travelling for therapeutic support, and check the policy covers a long stay.
Medication. Thailand limits ordinary medicines brought in for personal use to 30 days’ supply, and some medicines are controlled. Psychotropic medicines, which can include some sleeping tablets and anti-anxiety drugs, need a prescription or doctor’s certificate for up to 30 days’ supply and a Thai FDA permit, applied for at least 15 days before travel, for 31 to 90 days. Medicines classed as narcotics, such as some strong painkillers, need a permit whatever the amount (also applied for at least 15 days ahead, up to 90 days’ supply), and some medicines aren’t allowed in at all. Check every medicine with your prescriber and the Thai FDA before you book. The Foreign Office says hospitals and pharmacies in Thailand will usually accept UK prescriptions.
Visas. From 15 September 2026, visa-free entry for UK and most other Western passport holders dropped to 30 days. Longer stays need an extension or a tourist visa arranged in advance. Our visa guidance covers which applies to which length of stay.
Benefits. If you claim benefits, you must tell the office that pays them before you go abroad. GOV.UK says not doing so, “even if it’s just for a visit”, is benefit fraud. Universal Credit normally continues for only one month abroad, so check the rules for your benefit before you book.

What Rest Does and Doesn’t Fix

The World Health Organization describes burnout as “resulting from chronic workplace stress that has not been successfully managed”, with three parts: exhaustion, mental distance or cynicism about the job, and reduced effectiveness at work. It counts it as an occupational phenomenon, not a medical condition. That matters, because it puts the cause in the relationship between you and your work, and rest alone doesn’t change that relationship.

The research on holidays bears this out. A 2009 meta-analysis of seven studies found that time away had a small positive effect on health and wellbeing that soon faded once people went back to work. In the study of 76 clerks mentioned above, burnout dropped during the holiday, came part of the way back within three days of returning, and was back to where it started within three weeks.

So what does help? The evidence is thinner than anyone would like.

A 2017 review of treatments for clinical burnout found eight trials of mixed quality. Treatment may have got people back to work sooner, but it made no clear difference to whether they fully returned, or to exhaustion, depression or anxiety scores. The approaches that worked included advice from employment specialists and helped people start a conversation with their employer.
A 2020 Cochrane review of 45 studies in people with depression found that combining treatment with a work-focused intervention probably cuts sickness absence by around 25 days over a year. It didn’t change how many people were still off work after a year.
For less severe depression, NICE’s depression guideline lists psychological treatments such as CBT among the first-line options, matched to what the person wants, and says not to routinely offer antidepressants first unless that’s the person’s informed preference.

None of this research looked at residential retreats. What it does suggest is that, for getting back to work, therapeutic work combined with a deliberate plan for the return looks more promising than rest alone.

The First Few Weeks: A Practical Order

1. Rest without a project

Sleep, eat at regular times, get outside, move a bit. Turn off work notifications or hand your phone to someone for the evening. If that sounds impossible, notice that it does. The urge to check is part of what you’re recovering from.

2. Get support started early

If you haven’t already, see your GP about how you’re feeling rather than only about the note. In England you can also refer yourself to NHS Talking Therapies. The NHS says you don’t need a diagnosed mental health condition to do so. Waiting times vary by area, so it’s worth starting the referral early.

3. Agree how work will contact you

One named person, a set frequency, and what the contact is for. Write it down. Part of the dread of being off is not knowing when the next email will arrive.

4. Work out what caused it

The Health and Safety Executive’s Management Standards look at six areas of work: demands, control, support, relationships, role and change. HSE estimates that 964,000 workers in Great Britain had work-related stress, depression or anxiety in 2024/25. HSE’s most recent figures on causes come from surveys in 2009/10 to 2011/12, when workers most often cited workload pressure and a lack of managerial support. Some of what drove your burnout may be in the job, and some in how you work: perfectionism, saying yes to everything, tying your sense of worth to output. A therapist can help separate the two, which matters for what you change when you go back.

5. Start planning the return before you feel ready

A phased return, changed hours or different duties can all be suggested on a “may be fit” note and agreed with your employer. Acas says how long a phased return lasts depends on your circumstances and should be agreed between you. If you’re in paid work or returning within 12 weeks, and you live and work in England, Scotland or Wales, you may also be eligible for the Access to Work mental health support service. Support can include a plan to help you stay in work and one-to-one sessions with a mental health professional. You can only use it once, and you don’t need a diagnosis.

When a Residential Retreat Makes Sense

For many people, weekly therapy plus time off is the right place to start. A residential stay is a bigger commitment, and it makes more sense when:

you’ve had weekly therapy and it hasn’t moved much, or the week between sessions keeps undoing the last one
home is part of the problem: the laptop on the kitchen table, the colleagues who live nearby, the inability to stop
the burnout sits on top of something older, such as trauma, grief or long-standing anxiety. Our anxiety and depression retreat and trauma retreat pages cover those overlaps.
your fit note or agreed leave gives you at least a month, and ideally longer
you can afford it without that becoming a new source of stress

It isn’t the right first step if you are in an acute crisis, such as active psychosis, severe self-harm or acute suicidal thoughts. The same goes if you need 24-hour medical or nursing care, ongoing medical monitoring or medication management beyond what a GP can provide, or medical detox, or if you are in active substance dependency. Those need a different level of care first, and who this retreat is for sets out where we draw that line.

How a Stay Works at Silkworth Thailand

Silkworth Thailand is a residential therapeutic retreat. It is not a hospital, a rehab, a detox service or a crisis service, and we do not diagnose or prescribe. If you take medication, you keep taking it as your prescriber advises.

The minimum stay is one month and we recommend twelve weeks. A month covers settling in and stabilising. Twelve weeks leaves room for deeper work and for planning the return.
You have at least three 1:1 counselling sessions a week with a counsellor who stays with you from arrival to departure.
Where burnout sits on top of older trauma, EMDR can be part of the programme. Group sessions are optional. Mindfulness and meditation run through the day.
Meals, accommodation, airport transfers and the timetable are handled, which matters more than it sounds when making decisions has become exhausting.

The first month is £6,500 and each month after is £4,500, all-inclusive, so a twelve-week stay comes to £15,500. Flights, travel insurance and personal spending are on top. The pricing page lists what is and isn’t included.

We don’t tell anyone to quit their job. Some people go back to the same role with different boundaries, and some make bigger changes. Our burnout recovery retreat page covers how the programme approaches that, and what a 12-week programme looks like shows where planning the return sits in the final weeks.

Before you leave we work through an aftercare plan with you, including recommendations for therapy at home. UK guests also get a programme summary they can share with their GP.

Before You Book

Your fit note, or agreed leave, covers the whole stay and your employer knows where you’ll be.
Your GP or prescriber knows, and you have a plan for medication in Thailand.
Your travel insurance covers your declared conditions and the length of the stay.
You know which visa route applies to your dates.
You’ve agreed how much contact with work you’ll have while you’re away. For most people the answer should be very little.
You have a rough idea of what you want the return to look like, even if that changes.

If you’re also weighing up how long to come for, our guides on four, eight or twelve weeks and the full cost of a stay go through the trade-offs.

If You Are in Crisis

If you are thinking about ending your life or are at risk of harming yourself, this article is not the right help. In the UK, call Samaritans free on 116 123 at any hour, or call NHS 111 and select the mental health option in England or option 2 in Wales (NHS 24 on 111 in Scotland, or Lifeline on 0808 808 8000 in Northern Ireland), or 999 in an emergency. Elsewhere, contact your local emergency services or crisis line. Silkworth Thailand is not a crisis service and cannot provide urgent support.

Useful Guidance

Talk It Through

If you’ve been signed off and you’re wondering whether a longer stay would help, contact the Silkworth Thailand team. The admissions process starts with a confidential conversation about what’s happened, what you’ve tried and how much time you have. If we aren’t the right fit, we’ll say so.

Frequently Asked Questions

Can I go on holiday while signed off with stress?

Usually, yes. The simplest route is to ask to take it as annual leave. Acas says workers can request paid holiday while off sick, including where a mental health condition might be helped by a holiday, and if it is approved, sick leave can be paused while you get holiday pay. You can also travel while staying on sick leave if the trip fits your recovery and your sickness policy, but tell your employer first and agree it in writing.

How long can a GP sign you off for stress?

In the first six months of a condition, a single fit note can cover up to three months. After six months there is no fixed limit if it is clinically appropriate. You self-certify for the first seven calendar days.

Do I have to tell my employer if I go abroad while off sick?

No law requires it, but tell them before you go. Your sickness absence policy may require it, and if your employer comes to believe the absence isn’t down to illness, it may treat it as a conduct matter. Explain what you are doing and why, and agree in writing how the time is treated.

How much sick pay will I get in 2026?

Since 6 April 2026, Statutory Sick Pay is paid from the first full day of sickness with no minimum earnings, at £123.25 a week or 80% of your normal weekly earnings, whichever is lower, for up to 28 weeks. Your employer may pay more under its own scheme.

Can I go back to work before my fit note ends?

Yes. Government guidance says you can return at any time before the fit note expires, without going back to your doctor, and nobody needs to sign you back to work.

Can I take my medication to Thailand?

Thailand allows ordinary medicines for personal use up to 30 days’ supply. Psychotropic medicines need a prescription or doctor’s certificate for up to 30 days and a Thai FDA permit for 31 to 90 days, medicines classed as narcotics need a permit whatever the amount, and some medicines are banned. Check every medicine with your prescriber and the Thai FDA well before a longer stay. The Foreign Office says hospitals and pharmacies in Thailand will usually accept UK prescriptions.

Is a burnout retreat worth it?

The benefits of rest alone tend to wear off within weeks of going back to work, and the studies above didn’t test residential retreats. A retreat is more likely to be worth it when it combines therapy on what caused the burnout with planning the return, when weekly therapy hasn’t been enough, and when you have at least a month. It isn’t right for anyone in acute crisis or needing 24-hour medical care or detox.