Ask a person working in a small business how things are going and the question might prompt a mix of responses. On the one hand, work in a small organisation can be enjoyable, exciting and creative. On the other, it’s often lonely, hectic and stressful.
For Professor Ella Arensman, something about the nature of small and medium-sized enterprises (SMEs) – whatever the sector – makes their employees vulnerable when it comes to psychological and emotional wellbeing. Unlike bigger companies, SMEs often lack dedicated support in this area.
Small firms, big tests
Arensman is professor of public mental health at University College Cork and coordinator of the EU-funded MENTUPP project, which began in 2020 and runs through 2023. With partners from across Europe, the initiative is trailblazing a new approach to helping SMEs tackle worker mental-health troubles including depression.
"We hope MENTUPP can support people with their mental health," says Prof Arensman. "Then maybe the progression of depression can be reversed."
The EU is home to about 23 million SMEs, defined as business that have fewer than 250 employees and annual turnover of no more than €50m. Ranging from construction companies and hauliers to cafes and hairdressers, they make up more than 90% of EU businesses.
For four decades, Prof Arensman has led international work into self-harm, suicide, depression, anxiety, substance misuse and the stigma surrounding mental health at work.
She has observed a rising trend in such challenges faced by workers, with serious consequences for the individuals themselves and for wider society.
'Maybe the progression of depression can be reversed.' Prof Ella Arensman, MENTUPP
Depression and anxiety are now the most prevalent psychological and emotional troubles faced in the workplace. One in five workers reports poor mental health.
The problem has only been exacerbated by the Covid-19 pandemic that broke out in 2020. Add to this the current cost-of-living crisis caused by high inflation and the result is a perfect storm for mental health.
The knock-on cost to the economy through lost productivity and absenteeism is eye-watering. According to World Health Organization global estimates, $1tn (about €940bn) in workplace productivity are lost each year as a result of depression and anxiety.
Against this stark backdrop, attention at the EU level is now focused on intervention, which is where MENTUPP has a role to play.
Three vulnerable sectors
The project provides a free, online resource for SME employees. The goal is to plug a gap in wellbeing support in three sectors where workers are deemed particularly vulnerable: construction, health and information technology.
In 2019, Prof Arensman published a study on work-related risk factors associated with suicide. Since then, she has been on a mission to improve support.
"I just realised we needed to do much more work upstream before people get into these suicidal crises," says Prof Arensman.
The MENTUPP team is drawing inspiration from a suicide-prevention programme first developed in Australia to help construction workers open up about anxiety, depression and suicidal thoughts.
For the past decade 'Mates in Construction' (MIC) has been challenging stigmas surrounding mental health and raising awareness of techniques to boost wellbeing in a traditionally male-dominated sector where such conversations can be hard to foster.
Prof Arensman calls its work "exceptional" in breaking down barriers and increasing the number of workers accessing support.
A 2020 report by MIC and Melbourne University found that, since the 'Mates' programme was introduced, suicide rates among construction workers across Australia had declined by almost 8%, bringing the level closer to the male average for many Australian states.
Prof Arensman is now testing MENTUPP’s own online support system. This offers hundreds of evidence-based materials, ranging from suggestions for destigmatising conversations about mental health in the workplace to increasing wellbeing for SME employees.
In Barcelona, Spain, Dr Beatriz Olaya has diagnosed similar mental-health challenges faced by SME workers.
"When we went into these small businesses, we realised there was just a huge need," says Dr Olaya, a clinical psychologist. "People need psychological support and they very often don’t know how to access it."
She coordinates an EU-funded project called EMPOWER that tackles similar issues as MENTUPP and also began in 2020. Running until mid-2024, EMPOWER is an ehealth platform featuring a website, app, online video and text resources.
'People need psychological support and they very often don’t know how to access it.' Dr Beatriz Olaya, EMPOWER
After registering with the site or app, a person completes a series of questionnaires that help the project team to elicit details about current stress levels, depression, anxiety, sleep and psycho-social risk factors.
From there, the EMPOWER system creates a series of tailor-made tips to help people feel better. There is also support for those on sick leave as a result of mental-health problems.
When logging in each day, the user is prompted to indicate how he or she feels before being guided through psychological techniques to help lift spirits or keep the person on track. These include breathing and relaxation exercises plus popular daily goal-setting tasks to increase motivation.
"If you decide to run twice a week, by setting this new habit to improve your mood, the app reminds you and rewards you," says Dr Olaya.
Some of the tips are based on cognitive behavioural therapy, which teaches skills for coping with difficulties by focusing on how thoughts, beliefs and attitudes affect feelings and actions.
Dr Olaya and the team have developed EMPOWER with businesses in Finland, Poland, Spain and the UK. Multi-language versions of the app are now being tested with more than 600 people in the four countries.
"We want to show that it’s both low-cost and effective," says Dr Olaya.
As for MENTUPP, its support system also includes an app and the whole package is still being tested. Results are due later this year.
Prof Arensman then expects further improvements and refinements to be made before the system can be deployed much more widely. In a positive preliminary sign, she recalled how a small Irish construction company that has used the package was better able to support the mental wellbeing of one of its workers.
"They told us that, if they hadn’t had these resources, they would not have identified the warning signs," says Prof Arensman. "With these resources, they could better identify what was going on and intervene."
Feedback from other users in MENTUPP’s partner countries has been similarly encouraging. Prof Arensman is hopeful that the project will ultimately prove as effective as 'Mates' in Australia in reducing self-harm and suicide and increasing job satisfaction and productivity.
"We’re not there yet, but we will be very soon we hope," she says.