Like the majority of SME business owners, you know the importance of ensuring adequate, timely mental health support in the workplace, and having a robust package in place. However, also like the majority of SME business owners, you find it hard to know where to start.
Here we consider the question: what should mental health support in the workplace include? What support package would best promote employee well-being for your business?
We present a stepped care model for employee mental health, based on the latest evidence about what works. This is based on the top layer being able to address more people in your company but not suiting those with higher clinical need, and the bottom layer targeting less people but focusing on those with higher clinical need, and everything in between. We will break down options at three different levels that you may wish to consider in choosing a package.
1) Â Cultural Support
We know that organisational culture can be a helpful or harmful factor in employee's stress. A culture of openness, care and compassion can support people to come forwards with concerns, enabling early identification, recognition and ultimately treatment of any work-related or unrelated mental health concerns. A culture too focused on performance in lieu of employee well-being, silence about mental health or blame can reduce the likelihood that people will come forward.
That is why our first-line of intervention is to think about the organisational culture, as this will influence every single employee's well-being, and enable a culture of openness and support to facilitate identifying and addressing mental health early at work.
A recent review study by Paterson and colleagues (2024 - see here) helpfully looked at all the available research on the facilitators and barriers to successfully implementing workplace mental health support in SMEs. Here is our summary of their key findings across their four main themes:
What the activities involved in the intervention were
Interventions that were accessible, participatory, had a sense of ownership by those involved, that were delivered by credible, experienced instructors, and that facilitated a culture of openness all promoted engagement. Interventions that were not able to facilitate openness, that had long gaps between sessions, and were not involving an active, participatory component were less likely to be engaged with in SMEs.
How the intervention was implemented
Managerial buy-in, support and communication about the offerings at all levels using various channels helped increase uptake for mental health interventions in the workplace. Having clearly defined roles and responsibilities for who is leading and overseeing the intervention, and having alignment with organisational policies, values and culture were also facilitators to successful delivery.
What the business context was
Facilitators for uptake were organisations which allowed employees time to attend, which had clear attention and focus on the impact of mental health difficulties on their workforce, and had suitable physical arrangements for interventions to take place. Those with higher workloads, less flexibility in allowing employees the time and space to attend, and those with less open and mental health aware cultures were found to be barriers to implementation.
How the employees and leadership understood the intervention
Studies identified that stigma against mental health was a barrier to implementation, as was the extent to which employees and business owners perceived the intervention to be useful and meaningful to them. Previous knowledge and experience of mental health issues was a facilitator, while previous negative experiences of workplace mental health interventions was a barrier.
So what does this tell us?
Organisational culture is key. As a business owner or manager, you are a role model for your employees; they will learn what is okay and not okay from your behaviour. They will react to implicit messages or biases that hint that struggling or being open is not okay. If they see frequent mentions of mental health, signs of support being available and accessible, and hear you and those around you openly sharing worries, concerns or struggles when they arise, they will be more likely to come forwards.
Interventions like coaching or consultation for managers can support the skills to do this; company-wide workshops or training around this such as Compassionate Leadership; and listening events, wellbeing days and feedback sessions are all helpful to embed these practices into your company’s culture.
Workplaces are a leading arena for employees and others to identify and address mental health concerns early, so getting the culture to enable this right is vital. Any further interventions won't fit into a culture that doesn't enable them to land.
2)Â Â Â Â Â Structural Support
Next, we can think about specific interventions. Mental health support can be embedded into the structure of your company. Consider the below image as an example of where employee mental health concerns may be identified through opportunities to talk. Think about how your employees move through your business: where are there opportunities to model a culture of openness, to de-stigmatise mental health, and to offer opportunities to speak up about any challenges with no judgement or blame?
For example, having regular check-ins with employees where ‘how are you?’ is a regular feature on the agenda; having monthly, open ‘listening’ sessions, facilitated by someone outside of management to reduce the power dynamic; regular mental health workshops or skills training; having access to a helpline or email inbox to reach out for support; access to mental health technologies such as self-help materials, videos or apps. These can all provide opportunities for any concerns with mental health to be identified.
Mental health awareness training as an organisation, whether live in person, pre-recorded or e-learning packages, can also help increase mental health literacy. For example, did you know that the physical signs of depression and anxiety can be identified? Did you know that there are characteristic patterns of behaviour in most types of anxiety that can be noticed? Did you know that there are helpful and unhelpful ways to respond to someone struggling that may, at worst, inadvertently worsen their symptoms? These are all addressable by your company being aware of some of the signs and symptoms.
3)Â Â Â Â Â Individual support
Last up is individual support. Research shows that psychological therapy for those in need - statistically speaking every one in five employees at any one time are likely experiencing a clinical level of need - is effective. Yet studies also show that 70% of people working in SMEs may not access adequate psychological support in a timely manner.
On a positive note, research suggests that in SMEs adequate psychological support can be offered in various formats and work well, such as group-based interventions, individual therapy, drop-in style support, and self-help materials combined with access to a therapist. Having accessible self-help materials is known to be better than nothing at all, so having robust, high quality, evidence-based resources for common mental health problems is a great start. Group-based interventions run the risk of less confidentiality which may be a barrier to taking them up, so having access to regular workshops, training and skills-based sessions can be a lighter-touch but effective option.
For individual therapy, be aware of what your provider can do; CBT (or Cognitive Behavioural Therapy) is the front-line recommended therapy for most mental health problems, and has been found to be effective at improving depression and anxiety in the workplace in the aforementioned formats. The therapist should therefore be qualified to Masters or Doctorate level and accredited in CBT (e.g. with the BABCP or the HCPC – see our other blog to come on this). Counselling may draw upon elements of CBT, but will likely not be regulated up to the evidence-based standard, and may be more suited for other concerns. Timely access to evidence-based therapy in the workplace is wonderful, especially given long NHS waiting times.
Summary
Here are our top take-away points:
·      Packages can target your individual employees, your company’s structure, and/or your company’s culture – most SMEs have at least one type
·      Reflect on where your ‘pinch points’ are to highlight what package(s) would best meet your needs – how open is your culture? How aware are you and your employees about mental health? How skilled are your employees are coping? How accessible is direct support if needed currently?
·      Consider an initial consultation regarding what you have versus what you need; this might help to navigate ensuring you have an evidence-based package to meet your needs
If any or all of the above options are of interest, feel free to reach out for an initial 20 minute free consultation today to discuss what mental health workplace solutions we can offer you here. You can look at our packages which include workshops, e-learning and providing assessments and therapy.
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