If you are struggling with your mental health, is it better to come to work or stay off sick? You may think your employer would prefer you try to keep working, but many employers would prefer you take time off to feel better.
Presenteeism - going to work but being unable to perform at full capacity due to ill health - can sometimes be much more difficult for businesses to handle than absenteeism. And for small businesses with fewer resources to support mental health and wellbeing, these problems can become even more acute.
Small companies can be great places to work for reasons including close and informal working relationships and a family-like ethos. But the flip side of this is that they may lack human resource management expertise, occupational health access and staff capacity. There may also be few opportunities for the redeployment of employees experiencing mental health challenges.
Mental health and wellbeing at work have come into much sharper focus following the COVID pandemic. But most of the knowledge on supporting mental health in the workplace is based on the experience of larger organisations that typically have a lot of staff to handle these issues. Small businesses make up a significant proportion of the global economy, however. In the UK alone, half of private sector employment is in small businesses with less than 50 employees.
To find out how different it can be for a small business to respond to such challenges, we held in-depth interviews with 21 small business managers with direct experience of supporting numerous employees with mental health problems.
We found they did not necessarily use different approaches to larger organisations. The support they offered aligned with current understanding of good practice, including one-to-one support meetings, adjustments in hours and flexible approaches to work scheduling and location.
But our research also revealed a picture of small business managers "juggling on a tightrope" as they attempted to respond to the needs of unwell employees alongside concerns for the wider organisation. This challenge is felt more intensely in small businesses where line managers often occupy multiple roles.
As one manager told us:
I've got this fancy executive director role but I'm anything from the cleaner to the family support worker - I can step into any role - designer, the web editor! So you're conscious you're spinning a lot of plates, probably with insufficient resources and then, of course, you're looking at your own personal reserves in terms of your own mental health.
The presenteeism challenge
But that's not the whole story. These managers also told us that presenteeism could create a greater management challenge than absenteeism. This surprised us, as we expected sickness absence to be the bigger issue given the resource constraints for small businesses.
Work can be good for our health because it helps with maintaining routines, purpose and social connection. As such, an employee struggling with their mental health might choose to be at work for its health benefits, despite not being able to perform at their best.
But work that is "therapeutic" for an employee can be difficult for small businesses to accommodate, particularly in the long term. Some of the managers described how an unwell employee's emotional distress or concerning behaviour could create ripple effects throughout the workforce.
This can affect small businesses, particularly if employees are socially close and work in one location. It also creates a dilemma for managers that are committed to supporting an unwell employee, but struggling to balance this against the impact on co-workers.
The managers we spoke to were keen to do the right thing for employees experiencing mental ill health. Those who successfully managed presenteeism worked hard to understand the issues and initiate conversations at an early stage. They also engaged in a variety of support and adjustments that were tailored to the individual.
Nevertheless, effective support in this context needs to reconcile the needs of employees and employers in a manner that doesn't cause further distress to either party.
Presenteeism isn't necessarily a bad thing, but it can be restructured to become "functional presenteeism". This is when work is not making an employee's health worse and they are supported to perform well even as they experience mental health challenges.
Focus on wellbeing and mental health
It is positive to see workplace mental health and wellbeing moving up political and organisational agendas. This has shone a light on the importance of decent quality jobs, better line management, autonomy and flexible working.
However, a broad focus on workplace wellbeing must not overshadow the need to pay attention to the sharp end of mental health. Even in the most mentally healthy workplaces, there will inevitably be employees who experience significant difficulties in this area. And this can stem from issues entirely outside of the manager's control.
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There has also been a concerning rise in "training" employees to be more resilient in the workplace. This can put the onus on individuals to address wellbeing problems that stem from poor working conditions. It can also encourage harmful presenteeism.
Our research findings show that, beyond wellbeing policies, symptom recognition and workplace adjustments, mental health training needs to include a focus on managing and mediating the tricky areas of presenteeism and performance management.
Managers need training to help them conduct difficult conversations that explore support for the employee while recognising the needs of the wider organisation. This should include building management skills and confidence to support health and performance in tandem.
And don't forget about manager wellbeing. Balancing everyone's needs can take an emotional toll on managers themselves. In a small business, this can fall to one person who then finds themselves juggling on a tightrope.
Jane Suter, Senior Lecturer Human Resource Management, University of York
Annie Louise Irvine, Research Associate, King's College London
