Executive summary
Wellbeing has moved from a benefits line item to a board-level question, and a new title has arrived with it. The chief wellbeing officer now sits in health systems, law firms, professional services firms and large employers, holding a mandate that used to be split between human resources, benefits, health and safety and the medical director. The role is real and the evidence behind it is real. It also inherits one blind spot on the day it is created: the wellbeing of the executives who created it.
About 15 percent of working-age adults live with a mental disorder at any point in time, and depression and anxiety remove an estimated 12 billion working days from the global economy each year,01 which has pushed wellbeing out of the benefits function and into governance.
Programs are designed for the workforce and measured on utilization, so they systematically miss the senior tier, three quarters of whom were seriously considering leaving for a role that better supported their wellbeing.07
A written mandate with named domains, a measurement standard the senior tier cannot disappear inside, and a confidential clinical route that reaches every level of the organization including its own leadership.
The wellbeing function gains a population it can actually see, and the board gains a control on key-person risk it did not previously have.
The problemA new title, an old blind spot§
The chief wellbeing officer is not a rebranding exercise. It is a governance response to a measured problem. About 15 percent of working-age adults live with a mental disorder at any point in time, and depression and anxiety alone cost the global economy roughly one trillion dollars a year in lost productivity.01 In the United States, some 23 percent of adults live with a mental health condition.13 Among workers, 76 percent report at least one mental health symptom and 84 percent say workplace conditions contributed to at least one mental health challenge.03 Numbers of that size do not fit inside a benefits renewal cycle, and boards have started asking who owns them.
The answer, in most organizations, is nobody in particular. Clinical access sits with benefits. Working conditions sit with operations. Psychosocial risk sits with health and safety, when it sits anywhere. Manager capability sits with learning and development. Wellbeing is therefore reported as a set of utilization statistics rather than as a condition of the organization, and the reporting fails in one specific and expensive direction. More than three in four executives surveyed by Deloitte believed their workforce's wellbeing had improved, while the workforce itself reported it flat or worse.07 The McKinsey Health Institute measured the same shape at scale: an average 22 point gap between what employers believe about workplace mental health and what employees report, with employers rating every dimension more favorably.09 A chief wellbeing officer exists to close that gap. The question this paper asks is whether the role, as it is currently drawn, can close it for the people who drew it.
A wellbeing function that cannot see its own executive tier is not measuring the organization. It is measuring everyone the executives can see. CEREVITY Clinical Whitepaper Series, 2026
The evidenceWhat the research shows§
The case for an executive wellbeing mandate rests on four bodies of evidence: population prevalence, the direction of travel in the professions that adopted the role first, the size of the perception gap between leaders and everyone else, and what senior leaders report about themselves when they are asked directly. Read together they describe a function with a well-mapped workforce and an unmapped top. The mechanism that keeps the top unmapped is concealment, which is set out in detail in CEREVITY's analysis of why chief executives conceal strain from their own boards.
75%
of C-suite respondents were seriously considering quitting for a role that better supports their wellbeing
Deloitte, 2023
22 pts
average gap between employer and employee views of workplace mental health
McKinsey Health Institute, 2022
$1T
annual global cost of depression and anxiety in lost productivity
World Health Organization, 2024
46%
of US health workers reported burnout often or very often in 2022, up from 32 percent in 2018
CDC Vital Signs, 2023
01, 03, 06, 07, 08, 13 Office of the U.S. Surgeon General (2022), Framework for Workplace Mental Health & Well-Being.
Deloitte and Workplace Intelligence (2023), Well-Being at Work Survey, n=3,150.
CDC (2023), Vital Signs: Health Worker Mental Health.
Gallup (2026), State of the Global Workplace.
Baselines: CDC (2024), About Mental Health; WHO (2024), Mental health at work.
Taken together the four figures establish a pattern rather than four separate facts. Prevalence is high enough that any large workforce contains a clinically significant population by default. The perception gap means the instruments most organizations use to detect that population report back what leadership already expects to hear. The sector that adopted the wellbeing officer role first, medicine, shows the condition worsening on the measures it tracks most closely: burnout among health workers rose from 32 percent to 46 percent between 2018 and 2022, workplace harassment went from 6 percent to 13 percent, and the share who trusted management fell from 84 percent to 78 percent.06 And the tier making the decisions reports the highest intent to leave of any group surveyed.07 That is a measurement problem with a clinical population inside it, which is what CEREVITY's leadership mental health index was built to track.
06 CDC (2023), Vital Signs: Health Worker Mental Health. Quality of Worklife Survey, United States, 2018 and 2022.
| Wellbeing domain | Usual owner before a CWO | Reaches the executive tier? | What the evidence shows |
|---|---|---|---|
| Clinical access and treatment | Benefits and the assistance program | Rarely, for confidentiality reasons | About half of US adults with any mental illness received treatment in the past year12 |
| Working conditions and job design | Operations and line management | Partly, through the same policies | Toxic workplace behavior predicted more than 60 percent of the global variance in burnout and intent to leave09 |
| Psychosocial risk and safety | Health and safety, where it exists | No | WHO guidance places organizational interventions ahead of individual ones02 |
| Measurement and reporting | People analytics and the engagement survey | Aggregated away as too small to report | More than three in four executives wrongly believed workforce wellbeing had improved07 |
| Manager capability | Learning and development | No, managers report upward | Global manager engagement fell nine points, reaching 22 percent in 202508 |
| Social connection and isolation | Nobody, in most organizations | No | Loneliness-related absenteeism costs US employers an estimated 154 billion dollars a year04 |
| Executive and senior-leader care | Nobody, in most organizations | No | 75 percent of the C-suite were seriously considering quitting for better wellbeing support07 |
The frameworkA model you can name and own§
A mandate that cannot be drawn on one page gets renegotiated in every budget cycle. The model below names four rungs that wellbeing mandates climb in practice, running from the most visible and least durable to the least visible and most durable. It is a schematic rather than a measured progression, and it is offered so that a board can locate its own organization on it and name the next rung instead of approving another program. Most organizations that appoint a chief wellbeing officer are climbing from the second rung to the third. Very few reach the fourth, which is where treatment for isolation at the top stops being a private matter for the individual leader and becomes part of the mandate.
CEREVITY model
The Wellbeing Mandate Ladder
A four-rung description of how a wellbeing mandate matures, from visible benefits to organizational parity. Each rung names what the function owns, what it measures, and how far up the organization its reach actually extends.
Perks
Visible, voluntary and optional. Owned by benefits and measured by uptake. Reach is broad and shallow, and the executive tier participates least, because participation is observable.
Programs
Structured provision: an assistance program, training, screening. Owned by human resources and measured by utilization. Utilization is a weak proxy for need, and it under-counts exactly the people whose use would be noticed.
Policy
Workload, job design, manager capability and psychosocial risk. Owned jointly with operations and measured by working conditions rather than by uptake. This is the rung WHO's 2022 guidance prioritizes, placing organizational interventions ahead of individual ones.02
Parity
One standard of confidential clinical access at every level, including the level that signs the budget. Owned at the executive level and measured by whether the senior tier is genuinely covered rather than nominally eligible.
SCHEMATIC Schematic, not measured data.
CEREVITY clinical model, 2026. Illustrative shape only, drawn from published guidance and clinical practice.
The ladder is useful because it turns a vague ambition into a next step. An organization on the second rung does not need a larger program; it needs a policy owner with the authority to change working conditions. An organization on the third rung has usually done the hard structural work and still has a covered workforce reporting to an uncovered leadership group. Naming the fourth rung is what moves an executive wellbeing conversation out of the perks column and into governance.
By professionHow it presents across roles§
The role did not appear everywhere at once. It appeared first where the cost of professional attrition was measurable, where a regulator or professional body was already asking questions, and where the workforce was licensed. Three sectors account for most of the mandates now in place, and each one inherits the same blind spot in a different shape.
Corporate C-suites and boards
The corporate version of the role usually arrives after a board asks a question the people function cannot answer from its existing reporting. What the function can produce is program utilization. What the board wants is exposure. The gap between those two is where the mandate gets written. The evidence on this group is unusually consistent. Three quarters of C-suite respondents in a 3,150 person survey said they were seriously considering leaving for a role that better supported their wellbeing, up from 69 percent a year earlier, and more than three in four executives believed their workforce's wellbeing had improved when it had not.07 Those two findings belong together. A leadership group under sustained strain reads the organization through its own coping, and the instruments available to it confirm the reading. Federal guidance for employers is built around parity, accommodation and job-protected leave,17 none of which reaches a chief executive who has disclosed nothing to anyone. The clinical pattern at this level is rarely acute. Across the network it presents as a long, well-managed decline in recovery, sleep and tolerance for ambiguity, held together by competence, with the first visible failure appearing in relationships rather than in output. Consider a hypothetical scenario in which a chief executive has been sleeping four hours a night for eleven months, is still hitting every number, and has quietly stopped returning calls from the one peer who would have noticed. Nothing in that picture triggers an assistance program, and nothing in it shows up in an engagement survey.
Individual a room where nothing reaches the board
Organizational an executive mental health benefit at company level
Physician leaders and health system executives
Medicine created this role and still runs the most developed version of it. The National Academy of Medicine's 2019 consensus report recommended that health care organizations create, at the executive level, a leadership role and function responsible for improving and sustaining professional well-being across the organization.05 That sentence is the origin document for most chief wellness officer appointments in United States health systems. The measurement problem is severe even so. A systematic review of 182 studies covering 109,628 individuals across 45 countries found physician burnout prevalence estimates ranging from 0 to 80.5 percent, a spread driven almost entirely by differences in definition and instrument.11 The National Academy of Medicine's own working estimate is that between 35 and 54 percent of United States nurses and physicians carry substantial symptoms of burnout.05 Between 2018 and 2022 the share of health workers reporting burnout often or very often rose from 32 percent to 46 percent, reported harassment more than doubled, and trust in management fell.06 Physician leaders sit in a particular bind. They are usually the people who built the wellbeing program. They hold a license that makes any documented mental health episode a credentialing question. And they are senior enough that using the internal route is visible to the people they lead. The result is a wellness officer who can describe the distribution of distress in their organization with real precision, and who is nowhere in their own data.
Individual confidential care for doctors worried about credentialing
Organizational a physician wellness program for medical groups
Law firm leadership and managing partners
Legal reached the wellbeing mandate through its regulators and its own attrition data rather than through a consensus report, and the structure is different from a corporate one. Partners are owners rather than employees, which removes most of the levers an employer normally has, and confidentiality concerns are sharper because a bar admission and a professional liability record are both in play. The prevalence data is strong and specific. A 2021 study of 2,863 licensed United States attorneys found that 55.9 percent of women and 46.4 percent of men drank at risky levels, with hazardous drinking at 34.0 percent and 25.4 percent respectively, and that 25 percent of women and 17 percent of men had contemplated leaving the profession because of mental health, stress or burnout.10 Those are attrition numbers as much as clinical ones, and inside a partnership they land directly on revenue. Firm wellbeing leads report the same structural problem as their medical counterparts, in a sharper form. The assistance program is used by associates and by staff. It is not used by the equity partner whose review those associates report into, and it is not used by the managing partner who signed the contract for it. A confidential external route with no shared record is not a preference at that level. It is the only structure a clinician can honestly recommend when a bar license is part of the calculation.
Individual clinical care for attorneys
Organizational an attorney wellness program for firms
The stakesThe cost of inaction§
Boards do not fund a mandate because the argument is sound. They fund it because the alternative carries a number. Three categories account for most of the cost of leaving the executive tier outside the wellbeing function, and all three are already measured elsewhere in the business under different names. The workforce-level mechanism is covered in CEREVITY's analysis of what burnout does to productivity; the categories below concentrate on what it costs at the top.
Attrition where replacement is slowest
75 percent of C-suite respondents said they were seriously considering quitting for a role that better supported their wellbeing, up from 69 percent a year earlier.07 Intent runs the same way in licensed professions: 25 percent of women and 17 percent of men in a study of 2,863 attorneys had contemplated leaving the profession over mental health, stress or burnout.10 Senior roles take longest to fill and carry the widest downstream disruption, and the labor market offers no slack, with 3.2 million quits recorded in a single month in mid 2026.16
Lost productivity, undercounted at the top
Depression and anxiety cost an estimated one trillion dollars a year globally in lost productivity.01 Gallup puts the cost of low engagement at roughly 10 trillion dollars, about 9 percent of global GDP, with manager engagement down nine points to 22 percent in 2025.08 Loneliness alone accounts for an estimated 154 billion dollars a year in stress-related absenteeism for US employers.04 A senior leader who is present and impaired appears in none of those lines, which is precisely why the tier is undercounted in all of them.
A mandate that loses its evidence base
The wellbeing function's authority rests on its data. Exclude the executive tier and the data has a hole in the exact place where decisions are made, so the function's reporting starts confirming leadership's assumptions instead of testing them. That is the 22 point employer to employee perception gap in operational form.09 It is expensive in a way that never appears on a benefits invoice, because it costs the function the credibility it needs to change working conditions. Federal occupational safety guidance puts the return at about four dollars in productivity for every dollar spent on employee mental health, and that return only materializes if the spending is aimed at the real distribution.14
07, 10 Deloitte and Workplace Intelligence (2023), Well-Being at Work Survey, n=3,150, with the prior-year figure as reported.
Anker, J. and Krill, P. R. (2021), PLOS ONE, n=2,863 licensed US attorneys: contemplated leaving the profession because of mental health, stress or burnout.
The solutionWhat effective care looks like§
Effective care for a senior leader is not a different therapy. It is the same evidence-based clinical work delivered under conditions the role can actually accept. Three conditions matter more than the rest. The first is confidentiality that is structural rather than promised, which in practice means care that generates no insurance claim, no diagnosis code and no record inside an employer system. The second is a clinician who already understands the pressures of the role, because a leader who spends six sessions explaining what a board does will not come back for a seventh. The third is flexibility of format, because the binding constraint at this level is almost never motivation and almost always the calendar. That reasoning is what shapes how the clinical model is structured, and it is why the 50-minute format is offered as one option rather than as the only one.
CEREVITY is a nationwide network of independent licensed clinicians, matched to the person and delivered by secure video on a private-pay basis that keeps the work confidential. Sessions run in three formats. The weekly hour is the default. 90-minute extended work suits people whose material does not fit an hour and who cannot come back twice in a week. single-block intensive work runs as a 3-hour intensive and is used where a leader can protect one half day but not a recurring slot. For a chief wellbeing officer the relevant property is simpler than any of that: one confidential route can be offered at every level of the organization, including their own, without the organization learning who used it.
ImplementationHow to put it into practice§
A mandate becomes real when it has a scope, a measure, a budget line and a route to care that works for every level it covers. The four steps below are the sequence that survives contact with a board.
- 01
Write the mandate as a list of domains, not a mission
Name the domains the role owns, in the language the organization already uses. The seven in the table above are a workable starting set. For each one, record the current owner and whether that owner's reach extends to the executive tier. The National Academy of Medicine's recommendation is the model: create, at the executive level, a leadership role and function responsible for improving and sustaining professional well-being across the organization.05 Across, in that sentence, includes the executive floor.
- 02
Fix the measurement before expanding the program
Engagement surveys aggregate the senior tier into a category too small to report, which is how a population of forty people disappears from a report on forty thousand. Add a measure that does not depend on self-identification inside the organization: anonymized utilization of an external confidential route, reported at network level with no individual attribution. Set the baseline before any new spending, because the first year of a new mandate reliably produces a rise in reported distress that reflects better detection rather than deterioration.
- 03
Give the senior tier a route that is not the employee route
An assistance program that a leader's own direct reports also use is not a confidential route for that leader, whatever the policy document says. The workable pattern is a separate, externally held, private-pay route with no claim, no code and no shared record, offered as a benefit rather than as an intervention. Where a professional license or a credentialing question is involved, that stops being a preference and becomes the only honest recommendation.
- 04
Put the mandate on the board calendar
Wellbeing survives budget pressure when it reports on a fixed cadence against a named risk. Key-person risk is the usual home, because the board already accepts that the departure or impairment of a small number of people carries disproportionate consequence. Report twice a year on domain coverage, working conditions and route utilization, and report the executive tier's coverage as a line of its own rather than folding it into the workforce total.
RecommendationsWhere to start§
Clinical
Treat concealment as the presenting problem
At senior level the first clinical task is usually not symptom reduction. It is building a setting in which the person stops managing the impression they are making. Concealment is adaptive in a role where visible strain has consequences, and it is why the tier looks healthy in every instrument the organization owns. Structured care for this population, including clinical treatment for executive burnout, starts by naming the concealment rather than treating it as resistance.
Clinical
Match on role pressure, not only on modality
Modality fit matters, and so does whether the clinician has already sat with the pressures of the role. A network model makes that a matching question rather than a referral lottery. Keep the population baseline in view while doing it: roughly 23 percent of US adults live with a mental health condition, and only about half of adults with any mental illness received treatment in the past year.12 The senior tier is not exempt from either figure. It is simply harder to count.
Structural
Report executive coverage as a separate line
A single wellbeing number for the whole organization hides the tier this paper is about. Report coverage, working conditions and route utilization for the senior group separately, with no individual attribution. If that number cannot be produced without identifying people, the route is the wrong shape and should be replaced before it is measured.
Structural
Buy conditions before you buy content
WHO's 2022 guidelines place organizational interventions ahead of individual ones,02 and the Total Worker Health approach makes the same argument by integrating protection from work hazards with the promotion of worker well-being rather than funding them separately.15 Around 65 percent of US workers surveyed from 2019 to 2021 described work as a very significant or somewhat significant source of stress.14 Resilience content bought instead of workload change is the most common way a new mandate spends its first year and its credibility together.
FAQCommon questions§
What is a chief wellbeing officer?
What does a CWO do?
How do companies support executive wellbeing?
How does private-pay billing work?
How is my privacy protected?
MethodologyHow this paper was built§
Methodology
This paper was assembled between June and August 2026 from public, retrievable sources only. The search covered World Health Organization materials on mental health at work, the United States Surgeon General's workplace and social connection advisories, National Academy of Medicine consensus work on clinician wellbeing, Centers for Disease Control and Prevention Vital Signs and National Institute for Occupational Safety and Health publications, National Institute of Mental Health prevalence statistics, Bureau of Labor Statistics turnover releases, Occupational Safety and Health Administration workplace stress guidance, Department of Labor employer guidance, and peer-reviewed literature indexed in JAMA and PLOS ONE. The date range for included evidence is 2018 to 2026, with two deliberate exceptions retained for their scope: the JAMA systematic review of physician burnout covers publications from 1991 to 2018, and the National Academy of Medicine report was published in 2019 and remains the primary citation for the executive wellbeing role in health care. Sample sizes for the principal quantitative sources are stated where they are cited. The Deloitte and Workplace Intelligence Well-Being at Work survey drew 3,150 respondents across four countries in March 2023, split evenly between C-suite, managers and employees. The McKinsey Health Institute survey drew roughly 15,000 employees and 1,000 human resources decision makers across 15 countries between February and April 2022. The attorney data comes from a 2021 PLOS ONE study of 2,863 licensed United States attorneys. The JAMA systematic review covered 182 studies and 109,628 individuals across 45 countries. Gallup's figures come from its 2026 global workplace report on 2025 data, and the health worker figures from the Quality of Worklife Survey for 2018 and 2022. Limitations are material and are stated rather than smoothed over. First, no source located in this search reports a reliable prevalence figure for the chief wellbeing officer title itself across the general employer population, so this paper makes no claim about how many organizations have appointed one. Second, several of the strongest executive-tier figures are self-reported intent rather than observed behavior, and intent to leave consistently overstates departure. Third, the C-suite and attorney measures in Figure 4 answer related but not identical questions and should be read as a pattern rather than as a like-for-like comparison. Fourth, the survey populations behind Figure 1 differ in country mix, occupation and year, so that exhibit describes relative magnitude rather than one measured population. Fifth, the four-rung model in section 03 is a schematic drawn from clinical practice and published guidance, is labeled as such on the figure, and has not been empirically validated. No CEREVITY internal intake data is reported in this paper: every quantity above is external and carries a numbered citation.
References
- 01World Health Organization. (2024). Mental health at work (fact sheet). who.int
- 02World Health Organization. (2022). WHO guidelines on mental health at work. Geneva: WHO. who.int
- 03Office of the U.S. Surgeon General. (2022). The U.S. Surgeon General's Framework for Workplace Mental Health & Well-Being. U.S. Department of Health and Human Services. hhs.gov
- 04Office of the U.S. Surgeon General. (2023). Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General's Advisory on the Healing Effects of Social Connection and Community. U.S. Department of Health and Human Services. hhs.gov
- 05National Academies of Sciences, Engineering, and Medicine. (2019). Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: National Academies Press. ncbi.nlm.nih.gov
- 06Centers for Disease Control and Prevention. (2023). Vital Signs: Health Worker Mental Health. Quality of Worklife Survey, United States, 2018 to 2022. cdc.gov
- 07Deloitte and Workplace Intelligence. (2023). Well-Being at Work Survey. Deloitte Insights. Survey of 3,150 respondents fielded March 2023. deloitte.com
- 08Gallup. (2026). State of the Global Workplace. gallup.com
- 09McKinsey Health Institute. (2022). Addressing employee burnout: Are you solving the right problem? Survey of about 15,000 employees and 1,000 HR decision makers in 15 countries. mckinsey.com
- 10Anker, J., & Krill, P. R. (2021). Stress, drink, leave: An examination of gender-specific risk factors for mental health problems and attrition among licensed attorneys. PLOS ONE, n=2,863. journals.plos.org
- 11Rotenstein, L. S., Torre, M., Ramos, M. A., et al. (2018). Prevalence of Burnout Among Physicians: A Systematic Review. JAMA, 182 studies, 109,628 individuals. jamanetwork.com
- 12National Institute of Mental Health. Mental Illness (2022 National Survey on Drug Use and Health estimates). Accessed August 2026. nimh.nih.gov
- 13Centers for Disease Control and Prevention. (2024). About Mental Health. cdc.gov
- 14Occupational Safety and Health Administration. Workplace Stress. U.S. Department of Labor. Accessed August 2026. osha.gov
- 15National Institute for Occupational Safety and Health. (2024). Total Worker Health. Centers for Disease Control and Prevention. cdc.gov
- 16U.S. Bureau of Labor Statistics. (2026). Job Openings and Labor Turnover Summary, June 2026. bls.gov
- 17U.S. Department of Labor. Mental Health at Work. Accessed August 2026. dol.gov
PhD, Licensed Psychologist
Emily Carter, PhD is a clinical psychologist licensed in California, New York and Massachusetts, seeing clients by telehealth through CEREVITY's nationwide network of independent licensed clinicians. She works with executives, attorneys, physicians and entrepreneurs on burnout, perfectionism and imposter syndrome in high-achieving professionals, on anxiety in high-stakes roles, and on relationship strain. Her clinical work draws on cognitive behavioral therapy, psychodynamic work, emotionally focused therapy and mindfulness-based interventions.
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