Sustainable Workplace Mental Well Being for Sustainable SMEs: How?

: Sustainable mental health and wellbeing (MHW), as addressed under SDG3, is crucial for achieving sustainable development, notably for sustainable SMEs growth. MWH is speciﬁcally interlinked with SDGs 8, 9 and 11: Economic growth and prosperity, sustainable communities, innovation, and jobs. Studies show over 200 million workdays are lost due to poor MHW each year, referring to the global cost of $1 trillion/year in lost productivity and it is increasing every year. Poor workplace MWH is almost an epidemic after COVID-19. It will be a signiﬁcant challenge for a long time, in particular for SMEs which are hit hardest by the pandemic, as MHW problems have been shown to be a COVID side effect among 1:5 people. Despite the multifactorial aetiology of MHW (individual, social, environmental, and organizational), interventions for workplace MHW mostly refer to ‘one size ﬁts all’ and top-down solutions, primarily asking for the commitment and behaviour change of employees; that has shown to be ineffective. The main assumption underlying the present work is the need for a proactive and tailored MHW frameworks that can be blended to organizational policies. The objective which corresponds to the main purpose of the paper is to provide a 5-staged MWH model, stemming from our evidence-based studies, that may speak for the identiﬁed need. We also discuss how the Model can provide a route map on how SMEs can implement and measure SDGs relevant to their business in synergistic interaction with SDG3.


Introduction
The Sustainable Development Goals (SDGs), endorsed by all United Nations member states in 2015, refer to ambitious targets to achieve a better and more sustainable future for all by the year 2030. Mental health and wellbeing (MHW) are specifically addressed under SDG 3 ("Good Health and Well-being") as sustainable MHW is crucial for achieving sustainable development. A systematic review published by the Lancet [1] figures out the multidimensional aetiology of mental health, showing how SDG 3.4 (improving mental well-being) is interrelated with other SDGs. For example, MHW is closely interlinked with the Goals 8, 9 and 11: Economic growth and prosperity, sustainable communities, innovation, and jobs. According to the Business Health Group in their 2021 Large Employers' Health Care Strategy and Plan Design Survey [2], over 200 million workdays are lost due to mental health conditions each year ($16.8 billion in employee productivity). This 2021 BHG Large Employers' Survey solicited information about employer approaches to health care and benefits in the midst of the COVID-19 pandemic, providing a window into leading ways that employers are addressing COVID through their benefit plans, programs and overall workforce strategy outlook. Also, a recent WHO-led study estimates its costs to the global economy US $1 trillion each year in lost productivity and it is increasing every year [3]. In alignment with that, most recent analysis by Deloitte, finds that poor mental health costs UK employers up to £45 billion each year [4]. In high-income countries, individuals with mental health problems die earlier than the rest of the population (men on average 20 years earlier while women 15 years) [5]. This is a huge loss of the workforce-which is only one aspect of the excessive costs of poor mental health. Poor mental health is also shown to be both a consequence of and risk factor for unemployment; thus, increasing the risk of living in poor conditions [6].
How do you know that your well-being is sustainable when you cannot even be sure what is coming up tomorrow?
The World Health Organization (WHO) declared COVID-19 as a pandemic in March 2020 [7]. Then, the governments all around the world implemented some regulations for the social and work-life such as staying at home, working from home, and only going outside for food, health reasons or essential work. Being isolated, both living and working at home, anxiety due to uncertainty of the future and concerns for the beloved ones, double the burden of stress. After a difficult 3rd wave, by end of June 2021, restrictions were started to be eased internationally so that we could be almost totally back to our traditional work environments by September. However, even at the onset of a post-pandemic era, now we might be asked to work from home wherever possible. All these restrictions, new regulations and 'uncertainty and ambiguity' have negatively affected the mental well-being of employees.
A recent review by the Lancet shows the negative psychological effects of quarantine (the "restriction of movement of people who have potentially been exposed to a contagious disease") including post-traumatic stress symptoms, confusion, and anger due to the stressors such as longer quarantine duration, infection fears, frustration, inadequate supplies, financial loss, and stigma along with long-lasting effects [8]. On the other hand, prolonged isolation such as working home for a long time can lead to staying longer in the stressed zone-long-term "fight-or-flight" mode-which can affect negatively immune system functioning, and lead to poor health and well-being as well (sleeping problems, weakened immune system, and increased risk of cardiovascular diseases, diabetes, and obesity) [9]. Quarantine and prolonged isolation are what many of us have experienced so far. What is the impact of these on workplace mental health?
New research by MYOB yielding 1250 responses from small business owners in Australia reveals 66% of them feel COVID-19 has impacted their mental wellbeing, with 58% revealing the pandemic has negatively impacted their business, while it has been found that 83% of the UK small business owners suffer from anxiety due to COVID-19 [10]. The international figures are not different such that employees in Australia, France, Germany, New Zealand, Singapore, the UK, and the US reported at least 44% decline in their mental health due to COVID-19 [11].
Most recently, a new threat to mental wellbeing has been notified that it will impact not only workplaces but also societies for a long run: Long Covid. The potential for mental health problems during or after an acute COVID-19 infection, especially for people with "long covid" is becoming clear; research has found that 1:5 of those diagnosed with COVID-19 received a psychiatric diagnosis within the following three months [12]. "It's becoming clear that the impact of COVID-19 on our mental health will be felt for years after the virus has been brought under control" Adrian James, president of the Royal College of Psychiatrists [13].
These many observations and studies converge towards reasonable assumptions that are underlying the present paper. In essence, they can be considered as twofold need for a proactive and at the same time tailored MHW frameworks that can be blended to organizational policies. The objective that will be detailed in the coming section is to provide a 5-staged MWH model, stemming from our evidence-based studies, that may speak for the identified need.

Multi-Faceted Approach
Despite the prevalence and its impact on social, individual, and financial well-being, interventions for workplace MHW are not a common practice and they mostly refer to 'one size fits all' and top-down solutions, primarily asking for the commitment and behaviour change of employees. These approaches mainly speak for the short-term solutions which are standardized and static with a specific focus on fixing the problem at the presence, not being prevention-oriented and proactive [14]. The Harvard Business Review study recommends a multi-faceted approach, stating that HR departments or check-the-box solutions like employee assistance programs are not enough and essentially there is a need for an accepting culture starting from the top, with training and support [15]. However, the question is what kind of culture and support is needed? See Figure 1 below.

Multi-Faceted Approach
Despite the prevalence and its impact on social, individual, and financial well-being, interventions for workplace MHW are not a common practice and they mostly refer to 'one size fits all' and top-down solutions, primarily asking for the commitment and behaviour change of employees. These approaches mainly speak for the short-term solutions which are standardized and static with a specific focus on fixing the problem at the presence, not being prevention-oriented and proactive [14]. The Harvard Business Review study recommends a multi-faceted approach, stating that HR departments or check-thebox solutions like employee assistance programs are not enough and essentially there is a need for an accepting culture starting from the top, with training and support [15]. However, the question is what kind of culture and support is needed? See Figure 1 below.

Dynamics and Needs
The Lancet review shows that MWH is strongly socially determined, referring to social [1], workplace, and economic conditions. Also, research shows that the common work-related factors that can add to mental well-being before and during the pandemic and it has already been shown that workplace MWH has multifactorial aetiology (man-agerial, organizational, individual, social, and environmental). So, there is a need for a cultural change in organizations through implementation of proactive and tailored MHW frameworks integrated into organizational policies with sustainable, integrated strategies that assess, identify, and improve these multidimensional factors. As addressed by the WHO, MWH policies should be tailored, separate and in synergistic interaction with other policies in an organization.
Therefore, the aim of the present paper is twofold: (i) to discuss in detail the need for a proactive and tailored MHW frameworks that can be blended to organizational policies (ii) to provide a 5-staged MWH model, stemming from our evidence-based studies, that may speak for this need.
Our 5-Staged Resilience and Agility Building Model for MHW Management, stemming from the findings of our previous two research [16][17][18][19]. It aims to enable specific organizational framework that focus on 3 dynamics and needs: 1.
Stress, a major underlying factor for poor MHW, can be contagious-catch the mood of people we spend time with, even if we're not verbally communicating with that person- [20]; a stressed individual will negatively affect the other person in the same household.

2.
MHW is a dynamic and personal phenomenon, underlying different social, environmental, work-related, and individual factors; those highlights need for tailored behavioural change management focused approaches.

3.
At the time being, many individuals experience COVID-19 stress that will affect future and next generations in terms of poor MHW with severe implications-those addresses need for sustainable futuristic approaches. (Figure 2) stems from the findings of a triple international award-winning coaching project and a national project. The Model is designed to improve the well-being, agility and resilience of managers and their teams. Implementation of the model refers to structured workshops, regarding the 5 stages in sequence, that are facilitated by the coach. The workshops follow the sequence of Creating Self-Awareness, Self-Management (How to Put Self-Awareness in Action), Life-Style Management as a catalyst for Effective Management, Powerful Connections (How can I better connect with my Team), Higher Purpose (How can WE together serve for a higher purpose).

5-Staged Resilience and Agility Building Model for MHW Management
The systematic research over 11,000 databases by Felicitas Stuber et al (2021) has shown that interventions that address leadership are the most promising strategies to address mental health in health care employees [22]. They highlight mental health-oriented The Model is designed to improve the well-being, agility and resilience of managers and their teams. Implementation of the model refers to structured workshops, regarding the 5 stages in sequence, that are facilitated by the coach. The workshops follow the sequence of Creating Self-Awareness, Self-Management (How to Put Self-Awareness in Action), Life-Style Management as a catalyst for Effective Management, Powerful Connections (How can I better connect with my Team), Higher Purpose (How can WE together serve for a higher purpose).
The systematic research over 11,000 databases by Felicitas Stuber et al. (2021) has shown that interventions that address leadership are the most promising strategies to address mental health in health care employees [22]. They highlight mental health-oriented leadership approaches have the potential to combine organizational and behavioural strategies for the promotion of mental health. In alignment with these, Public Health England highlights several key factors for success in improving health and wellbeing in the workplace: 1. Greater employee participation in decision-making 2. Line management training 3. Effective leadership and good relationships between leaders and their employees 4. Engaging employees, ensuring employees are committed to the organisation's goals and motivated to contribute to its success [23]. Our Model speaks for the points highlighted by these references; it provides a structured framework-step by step guideline-on how managers can improve their leadership skills while they are connecting powerfully with their employees and they as a team can co-design and implement organizational strategies both for high team performance and better mental wellbeing. Implementation of each stage of the Model requires facilitation and empowerment by coaching skills, referring to involvement of a coach -thinking partner, offering fresh, objective support.
The Model provides a measurable and sustainable framework with tools through 5 interconnected pillars: 1.
Self-awareness, the foundation of the Model, is about exploring and clarifying individual and organizational missions along with values and how they align with each other. It enables employees to connect the organizational big picture with daily goals and achievements, rather than being trapped in a heavy sequence of tasks and routines. This step is about building a sustainable and achievable shared organizational picture through mutual trust, respect and being connected with each other among managers and their teams. 2.
Self-management is about how you control and manage yourself and your emotions, inner resources, and abilities sustainably to achieve your goals; in other words, it is about acknowledging yourself and taking actions about how you could do better next time. In terms of workplaces, employees take the ownership of the present and ownership of the future, so they become active participants in achieving the shared goals. a. Self-management does not exist in a vacuum, but rather within the context of other people and influences, so it is not all about self. It is also about using what you become aware or know about yourself to manage them in such a way as to generate positive and sustainable interactions with others and motivate yourself for sustainable actions. Fundamental to its success at workplaces are the relationships between the employees, managers, and other stakeholders. b.
Self-management has a wide range of areas to work on, for example, 'How to act rather than react?' That refers to a manager and employee's learning together how to listen actively and become open to feedback from each other during meetings rather than being reactive to the critics.

3.
Lifestyle Management: How can you have a lifestyle management plan that will support you on your self-management journey? Sleeping properly, eating healthy, drinking enough water, daily exercise. Which one is our priority now? a.
It is well known that healthy lifestyle choices improve mental health, more precisely, studies show that lifestyle can have a positive effect on symptoms of depression and anxiety, self-perceived general mental health, and work satisfaction [24,25]. b.
Setting up and maintaining a positive lifestyle is one of the major personal management challenges, and its strong interconnection with self-awareness and self-management is usually disregarded, leading many lifestyle interventions to fail in the long run. c.
Individuals make hundreds of thousands of lifestyle decisions during their lives. What kind of food will I eat? How will I get to work in the morning? When will I sleep? How will I spend my spare time? The list is endless. How we choose to answer these questions, in other words the lifestyles we end up living, have a profound impact on our planet, affecting everything from how our economies grow to the health of our environment. Workplaces can have a significant impact on these decisions through training and organisational culture, such as promoting cycling to work and/or eating healthy lunches, group exercises. All these activities can be part of organisational sustainable goals such as improving the mental well-being of employees through enabling them to have healthy diets and regular exercises. The Model facilitates shared decision making via active involvement of employees and managers.

4.
Social awareness and management How to connect with others, how to support and help them through positive emotions, how to spread positive values such as compassion?
a. Social awareness and management refer to unlocking the personal ability and developing certain skills to use awareness of personal emotions and behaviours and those of others to manage interactions successfully and work synergistically. b.
Positive social interactions contribute to positive wellbeing, which, in turn, has a positive impact on employee engagement. Organizations with higher levels of employee engagement indicate lower business costs, improved performance outcomes, lower staff turnover and absenteeism, and fewer safety incidents. For example, a report by Gallup shows that those teams who score in the top 20% in engagement realize a 41% reduction in absenteeism, and 59% less turnover [25]. The report also finds that the most successful organizations make employee engagement central to their business strategy through provision of clear expectations and the tools and support to do their best work. Engaged employees show up every day with passion, purpose, presence, and energy.

5.
High level of fulfilment (social, spiritual & environmental contribution): how to set up sustainable goals to achieve the 'big picture'. Which sustainable goals will enable the organization to contribute to a fairer, healthier, and more sustainable future while achieving its mission? This is about collectively defining the pathway to the big picture by managers and their teams.

Discussions
Then the question arises: "How can companies make employees engaged so that they will become happier and more productive?" as addressed by CB Bhattacharya (the Pietro Ferrero chair in sustainability and director of the Center for Sustainable Business) [26,27]. He highlights in an interview that the initial step is to successfully implement a sustainable business model that puts environmental and societal considerations front and center along with growth and profits. He mentions that there is not a one-size-fits-all or cookie-cutter solution for every organization to set up a sustainable business, however he emphasizes bringing the personal goals and values of individual employees together with the values and goals of the organization. Implementing SDGs in the business goals can become a good catalyst in implementing such a framework. Successful practices by companies such as Unilever have been shared at this interview. It is a scarce known fact that these successful business companies such as Unilever, Ikea, Starbucks, IBM, use an extensive coaching approach for employee engagement and to build a healthy and sustainable culture. It is relevant to note that many of these companies, and notably Unilever, have been successful in integrating the SDGs in their organisational culture, directly impacting employee's engagement.
Coaching lies at the heart of our model, connecting all these pillars through One for All methodology, referring to addressing the multidimensional character of MHW [28]. See Figure 2 above. With our coaching facilitated 5-staged Model for MHW management, organisations can develop sustainable, proactive, and tailored solutions and interventions through active engagement and motivation of all employees where MWH management will work synergistically with the organizational policies. This is essentially important; as COVID 19 outbreak has shown us, the crisis is unexpected and complex, and we all need to be mentally resilient and agile to deal with the short and long-term consequences of the crisis, as highlighted by the United Nations. As shown by the latest research by coaching can enhancing the well-being and performance of managers and their teams during the pandemic [29]. If employees have poor MHW, especially a stressed mind, then the solutions will be harder to find or work out in a crisis environment [29]. Coaching enables blended and interconnected solutions, while tackling challenges in every pillar of the "5-dimensions of Stress Management Approach"; the connected pillars respond to the complexity and multi-faceted dimensions of MWH. Through its SDGs, the UN calls for shared responsibility and global solidarity for sustainability; that requires a calm and creative mindset and positive well-being through synergistic interaction of self-awareness, self-management, social awareness, and higher purpose, where empowerment by coaching lays at the heart.

Conclusions
While some large organizations/corporates have made progress in awareness of and support for mental health in the workplace, the SMEs are only just beginning. Even at the country level, research on the prevalence of mental health challenges and stigma, specifically in the workplace setting, is limited. Prevalence is often measured either through diagnosable conditions or general stress levels, which does not fully capture the breadth of the mental health experience. But today's leaders no longer have a choice about whether to advocate for mental health in their organization. They need to address the issue, describing their own challenges and potential solutions and/or SDGs, while urging team members to seek help if they feel hyper-lonely from self-isolation or excessively anxious about the spread of COVID-19 or the impact of Covid-19 on their families. The required changes in the culture need not to be addressed single handily in a top-down process and organizationwide collaboration, inclusion, resilience, and agility go a long way toward reducing the stigma and setting the tone for wellbeing and sustainable goals achievement.
In these challenging times for so many of us, the words of the Russian Poet, Apollon Maykov, are having their full meaning: "The darker the night, the brighter the stars". So, let's all make sure the star of mental wellbeing is shining toward showing the sustainable way to the SMEs.