How do you balance support for mental health with a drive for performance?

Startups are expected to foster dynamic, high-performance cultures. At the same time, they’re also told they need a culture of progressive, positive attitudes towards mental health. Balancing these ideas can feel like walking a tightrope – especially if you’re working with a small team, where every employee is absolutely indispensable.

I’ve been running small teams for over a decade, at multiple companies – and I’m still running one at Charlie. Here’s a situation that I think many founders will recognise:

You become aware that a crucial member of your team is falling behind. Their performance has been crippling the team’s ability to achieve some important goals. Others are having to work longer and harder hours to keep on track. You know you need to take action quickly.

But you’re also aware that they haven't seemed their usual self recently. A conversation reveals your instinct is correct. They explain they’ve been suffering from a bout of depression that’s been affecting their ability to concentrate and work effectively.

You want to be a good person, and this person is your friend. You want to be there to support them. Yet you also know you have a responsibility to the company to deliver on pressing results.

What do you do?

Welcome to one of the most unpleasant dilemmas you can face as a founder. We are encouraged to create workplaces that support the mental health of our employees – and yet at the same time, running a business has pressing demands.

For early stage startups, it's not an exaggeration to say the future of the company could be on the line. This isn’t something to take lightly: you’re dealing with the livelihoods of everyone on your team.

We explored an approach with some experts – whose feedback we will cover more broadly further down this piece – and established a approach to navigate this scenario.

1 - Your immediate response

This is the critical first step. Do this right, and you’ll be able to show them that you care and create a safe space for you to directly discuss their performance issues with them – but it’s best to split this off into a second conversation a day or so later.

Before you do that:

• Thank the team member for trusting you with their sensitive information. Often, it’s hard enough for people to admit their problems to themselves, let alone to their work colleagues. It’s important you recognise that doing so is brave and you’re grateful that they can be open with you.
• Listen. It’s easy, particularly in a work context, to jump into “solution mode”. Taking the time to listen will not only build greater trust but also help you to really understand and appreciate what they’re going through.
• Remind them they are a priority. Ensure they understand that you and the business cares about them as a human being, not just as an employee of the company. Their openness has now afforded you the opportunity to help, and that’s a really positive step for everyone.
• Find out how the company can support them. Do they need to take some time off? Are they getting the professional support they need? Ask questions first. Let them tell you what would help. Don’t force ideas on them, and if they need a day to think on it then give them that time.

You can read more about keeping your conversations positive and supportive in our series on world-class one to ones here.

“You’re not their therapist or their counsellor. You’re someone they work with. The complexities of each individual’s mental health are so varied that giving advice is at best hit-or-miss, and at worst, downright dangerous. Ask questions, gain information and be there for them”. Gavin Dhesi, co-founder of Spill a message-based therapy service which organisations can use to make sure their employees are getting the support they need to deal with the problems in their lives.

2 - The second conversation: discussing their performance

This conversation is extremely delicate, and, if handled incorrectly, can leave someone who is already in a vulnerable position feeling isolated and targeted. Here are our guidelines on handling this situation in the best possible way.

• Recognise the impact their health is having on their work. This won’t be a surprise to them, and they will likely be relieved that you want to work through how to resolve for it. The stress of underperforming - and the knowledge of letting others down - may well be making their condition worse.
• Make the conversation about performance, not personality. Focus on ways that their behaviour is impacting performance, not how it might be frustrating or irritating their team.
• Be specific with examples of where they are falling short. This clearly identifies the areas that need a remedy and also helps to depersonalise the feedback. If you've prioritised creating an effective performance management system from the very beginning, this bit will be much easier.
• Suggest that they share what they’re going through with their immediate team. Transparency and openness is a positive thing - as you’ve hopefully demonstrated above - and encouraging them to be candid with their struggle will enlist more support from their colleagues. Remember to respect their privacy though, as what they share and with whom is their decision.

To find out more about how to tackle underperfomance issues in a way that's both compliant and fair on your team members, download our free guide.

You can also have a look at the list of performance review questions you can throw their way to help.

3 - Next steps

Finally, you need a plan to move forward. Work together on this so it’s a collaborative effort but don’t be afraid to be firm - the plan must be effective in its attempts to resolve the underlying issues, and everyone must have faith in its success or you risk a confidence knock which could make things worse.

The key guiding principle is to treat their mental illness as you would any physical illness.

“We need to move away from cordoning off “mental health” and “physical health”. We now know that plenty of conditions – such as eczema or IBS – can be linked to mental triggers. We need to move to a more holistic understanding: health is health”. Laura Stembridge, CEO of InsideOut, an on-demand mental health therapy platform for businesses, delivered as an employee benefit.

Everyone is different, and every case is unique, so we mustn’t pretend there is a blanket solution. Instead, work with the individual and, if relevant, professional advisors to help design a plan. In the same way that a broken leg needs a physio to help rebuild its strength, identify the right people to help understand what’s required. Be prepared that a sensible option may involve a period of time off – from short stints which last less than a week, to considerably longer periods where they can really focus on recovery. In the latter case, feel free to ask for a doctor’s note if that helps put you and the company at ease.

If people are lying about their mental health problems to get time off, then you have some issues, some big issues. Most people are good people and do not want to do that. If you, the employer, think that's what people will do, then you have some real trust issues yourself. James Routledge, founder of Sanctus. Sanctus is a startup on a mission to inspire people to treat mental health like physical health, and create spaces in the workplace for people to work on their mental health with Sanctus Coaches.

It’s best to try and commit to what’s required for a full recovery. Do not agree for them continue to come to work and underperform. If they don’t want to take time off – scale back their responsibilities and remove them from high pressure projects for a period, but don’t let them run the risk of losing the respect of their colleagues and undermining their own confidence in the process.

Importantly, ensure you have a sound policy for how to handle long term illness. If they need time off, you need to consider the company’s appetite for covering payroll before placing them on statutory sick pay. As much as we would all love to support people indefinitely, it’s just not practical for most small businesses, and you need to find a comfortable medium that’s fair to everyone.

While the example above is a real challenge, it is made considerably easier by the employee’s willingness to be open about the health struggles they’re facing. Without that honest communication – and the ensuing commitment to work together to resolve them – it becomes very difficult very fast. If a good and honest conversation isn’t forthcoming, the only route forward is to manage it as you might any performance problems, and if that involves letting that person go then that’s the only fair route forward. But it feels really grim to kick someone when you can feel they’re already on the floor.

Culture is key

Effectively managing these scenarios starts long before they appear, by building the right attitudes and cultures around mental health in your team.

“The best time to start building a progressive culture towards mental health is on day one... If you didn’t start on day one, start now!” Gavin, Spill

We’ve collected some key tips for creating an open and honest culture that encourages the team to recognise the importance of their mental health, and open up discussions early for anyone who is struggling and needs support.

Lead by example. If you have struggled with any mental health issues (no matter how small - and we all have insecurities), talking about them in front of the company sets an extremely powerful example. Team members will find it much easier to bring up issues about their own mental health if they’ve seen you talk about your own experiences. Allowing yourself to be vulnerable will give them the permission to do so too.

"A core component of any well functioning business or team is trust and psychological safety. Talking about mental health in the workplace is aligned to showing vulnerability and creating intimacy and deep connections at work – also known as highly functional teams." James, Sanctus

Create specific times and spaces where people can discuss their mental health. It can be hard for someone to know when there’s a “good time” to bring up an issue with their mental health. Avoid this by scheduling times where mental health is explicitly defined as a potential conversation topic, such as one to one catch-ups. If you’re interested in digging deeper into having supportive, productive one to one conversations, check out this post by Ben, our COO.

Enlist support from professionals. There are brilliant organisations that are making access to professional support more accessible. We invested in training for our leadership team so we can be confident they have a good understanding of mental illness and how to manage it. We buy Spill across the organisation so everyone can quickly and easily access its counselling service. Don’t just pay lip service to the cause: champion it as an important part of the company’s beliefs and identity.

Strive for prevention rather than cure. There are lots of ways to encourage your team to build defences and resilience - to exercise our mental health just like we would our physical health - and you can tie that into the way you work. Promote a healthy lifestyle, practice gratitude and take the time to get to know each other properly. Even small lifestyle changes – such as building regular exercise into your daily routine – can enormously benefit your mental health.

Be consistent. Your policies and belief system in mental health should extend throughout all areas of the business. Different teams or departments cannot have different rules or different standards. All leaders must fully commit - if for no other reason than they will be the ones with a much harder job on their hands if they don’t make the investment upfront.

Avoid falling into the trap of micromanagement – it's easy to fall back on anxiety when things are going wrong with your team member, but make sure you support them instead of piling more surveillance and pressure onto them, as it's likely to make the situation worse and hinder their potential for recovery and getting back to work.

Put together performance management resources for the team so they know how to handle any situation. Of course, a mental health training would be ideal, but that's not it. You can put together performance development plans, add a learning and development budget to your expenses and put together good performance reviews that include 360 feedback.