Exploring the mental health landscape within SMEs

Francoise Woolley , Acas head of mental health and wellbeing

Francoise is the head of mental health and wellbeing for Acas, leading on enhancing staff engagement and productivity through improved mental health and wellbeing. She also works with external stakeholders to influence policy, debate and practice on mental health in the workplace.

We approach the end of another tough year, and the wide-ranging effects of the pandemic on organisations and working lives continue to be felt. The state of mental health in the UK is a worrying one, with ONS data showing that average ratings of wellbeing have deteriorated across all indicators, including happiness and feeling that the things done in life are worthwhile.

But 1 silver lining of the pandemic is that many businesses have woken up to the importance of mental health. My colleague, Adrian Wakeling, spoke of this 'road to enlightenment' in a previous Acas discussion paper which focused on the experiences of larger organisations. Can the same be said for small and medium-sized enterprises (SMEs)?

Acas recently chaired a roundtable with SMEs and partner organisations to understand the current challenges and good practice in managing mental health at work. Our findings, outlined below and in a series of upcoming blogs, will help shape future Acas guidance and support for SMEs in this area.

What are the main challenges facing SMEs?

Many of the current issues facing SMEs are sadly all too familiar. Organisations told us how mental ill health was the leading cause of sickness absence in their workplace and described the significant knock-on effects on finances and service quality.

The pandemic, of course, brought with it some unique challenges, with many workers juggling caring responsibilities, and experiencing bereavement and ill health of loved ones. The prevalence of poor mental health was particularly notable in frontline sectors.

Social care sector

Concerns around vicarious trauma and moral injury, as well as an increase in stress and burnout due to high staff turnover.

Hospitality sector

A mix of longer working hours, staff shortages and abuse from customers "who have been more demanding" has had a significant impact on workers' mental health. The sector has also seen high rates of drug and alcohol misuse which were thought to compound this situation.

Retail sector

Similarly, high absence rates were the result of employee burnout, mental ill health and stress from the effects of customer abuse when attempting to enforce rules such as social distancing and the wearing of masks.

Working from home

The situation for those able to work from home has also been testing, with evidence of presenteeism and individuals 'working too hard' to prove their productivity. Participants also described growing tensions around returning to the workplace due to health and safety concerns, and a general desire to maintain their new working arrangement.

What are the barriers to supporting employees?

Acas's framework for positive mental health emphasises the shared responsibility of employers, managers and individuals in promoting wellbeing at work. Our roundtable uncovered some of the primary issues facing each of these important workplace actors.


The noticeable boom in social activities at work at the beginning of lockdown appeared short-lived, and we heard similar stories at our event. Participants recalled that as time progressed, support from senior leaders began to diminish as focus shifted to other business priorities.

There were also a number of longstanding issues. For example, time and financial constraints, both associated with the lack of a dedicated HR function, occupational health provider or employee assistance programme (EAP). And fundamentally, despite a desire to support, a gap in knowledge of the 'how'.

For others, there was concern that some SMEs defaulted to the legal minimum – how to avoid an employment tribunal – as opposed to adopting a proactive approach. Indeed, organisations noted a lack of integration of mental health and wellbeing into all aspects of working life.


Line managers often lack the confidence to manage absences caused by mental ill-health. Some commented on how the formal processes were harder to use than those relating to physical ill-health. One of the trickiest areas involved trying to keep in contact with employees who did not wish to.

Remote and hybrid working is also having an impact. For example, the family-orientated dynamic within many SMEs, where warning signs can be spotted quickly, is no longer so noticeable when staff are not so visible. This was particularly the case for new staff being onboarded remotely.

It was recognised that a manager needs the right people skills to be effective. Unsympathetic managers were certainly a barrier to supporting mental health. An example was given of a staff member talking about their serious mental ill health symptoms and a manager being dismissive and asking them to take a few deep breaths. Another example involved a manager stating that they'd had enough of a staff member, that they had sent a link to the EAP and a wellbeing webinar and why had they not watched it and why were they not okay now?


Some organisations observed a tension between employers and staff arising out of conflicting positions on returning to the workplace. For others, self-care was often the "first thing to go" when facing time pressures. For instance, those working in caregiving professions found themselves putting their own wellbeing aside in order to take care of others: "When you are in caregiver mode, it's hard to take a step back and look after yourself".

Such sentiments extended to leaders and managers too. There was clear acknowledgement of the huge pressures facing business owners and managers in responding simultaneously to the personal and organisational impacts of the pandemic, and often with limited resources. In some cases, SMEs were seeing signs of compassion fatigue and diminished emotional capacity to support others. 

Looking ahead

Over the coming weeks, guest bloggers will look at how we can respond to the challenges facing SMEs. These will focus on the importance of nurturing the right kind of culture and how we can provide the right guidance and support in the right formats.