Counting On U: Towards Better Mental Health

The financial state of a business and the mental health of the business owner are closely related. Thus, the devastating impact of COVID-19 on businesses means small-medium enterprises (SMEs) owners are particularly vulnerable to experiencing depression, anxiety and other mental health conditions (MHC). However, there is a tendency for SME owners to seek help about their financial concerns, rather than their mental wellbeing. For this reason, trusted business advisors (accountants, bookkeepers, coaches) who engage with their SME clients on a regular basis, are well-placed to provide advice about both the financial and mental health concerns of their SME clients.

To provide business advisors with the skills they need to have a conversation with their clients about their mental wellbeing and to encourage help-seeking where appropriate, mental health first aid (MHFA) training will be offered. And to help the business advisor forge a more trusting relationship with their client and provide higher quality advice that may alleviate their financial stresses, Relationship Building Training (RBT) will also be provided. Thus, the aim of this randomised control trial is to assess the additional benefit of combining RBT with MHFA compared with MHFA alone on the financial wellbeing of SME clients and the quality of their relationship with their business advisor.

The widespread lockdown of broader society experienced around the world due to the COVID-190 pandemic is unprecedented. Businesses in a variety of sectors such as manufacturing, retail, and hospitality were closed due to lockdown rules, a decrease in demand, health concerns or other factors. Many of the closures are permanent because of the inability of business owners to pay ongoing expenses and market uncertainty.

Small to medium enterprises (SMEs) account for 99% of all businesses in Australia and at least 95% of enterprises in all OECD countries. SMEs provide an important contribution to Australia's growth in employment, with small businesses (including micro businesses) employing approximately 4.72 million people and accounting for 41 per cent of total employment. To help citizens survive the pandemic, the Australian government provided financial support to employees via Job Keeper and cash flow boosts to eligible businesses. Nevertheless, some SME owners reported losing up to 90% of their income and continue to face ongoing challenges, including market uncertainty, loss of international skilled workers, lending restrictions, extensive legislative reform. At the same time that they're dealing with an increasingly difficult external environment, SME owners also have to content with running a business including monitoring cash flow, managing staff, and ensuring the smooth administration of the business.

Of the challenges faced by SME owners, financial pressure represents a major source of psychological distress and is likely to explain why SME owners generally experience higher levels of stress and mental health disorders compared with the broader population. In Australia, 1 in 3 SMEs rated their mental health as poor to fair during the pandemic. Identifying the symptoms of depression early and encouraging help seeking are therefore critical and cost-effective methods for protecting and promoting wellbeing.

Mental health literacy programs have emerged as a key strategy for the early identification of diagnosable mental health problems. The strategy has proved to be popular in the frontline human service sectors (e.g., health care, social work) where MHFA can be used to help colleagues and members of the public who may be experiencing the signs of depression, anxiety and other mental health conditions (MHC's). However, little is known about the effectiveness of mental health literacy programs where SME owners are concerned. Reaching vast numbers of owner-managers in a systematic way is thought to be particularly difficult, partly because of the absence of viable intermediaries that have ongoing contact with this group, but also because of the typical characteristics of the SME owner's role (e.g., long working hours, burden of responsibility, isolation, obligation to work when sick), coupled with their lack of financial resources.

One sector that has the potential to act as an intermediary between small business and mental health services are business advisors, who include accountants, financial planners and financial counsellors. Business advisors are an important source of support for SME owners as their expertise is sought on a regular basis and clients can develop trusting, long-term relationships with their accountant. Previous work in this sector by Bond and colleagues has shown that MHFA training is an effective way of improving financial counsellors' ability to recognise mental health problems among clients and to provide appropriate support for help-seeking.

Despite the importance of mental health prevention programs like MHFA, these strategies are designed to reduce the impact of mental health conditions (i.e. secondary and tertiary prevention) rather than prevent them from occurring in the first instance (i.e., primary prevention). Longitudinal evidence causally implicates adverse psychosocial working conditions (e.g., excessive workloads, inadequate support) in the development of MHCs, such as depression. Thus, if business advisors can work to alleviate these stressors, they may also help prevent the onset of MHCs.

Therefore, the aim of the current project is to assess a new approach to undertaking MHFA training by incorporating a client-centred, Relationship Building Training (RBT) program that is designed to help business advisors better understand the business and personal needs of SME owners. If they better understand their needs, the business advisor can provide higher quality advice and in turn, reduce the financial stress of the SME owner. For any of this to happen, there needs to be a degree of trust generated between the business advisor and their SME client. According to Manister's trust equation, trustworthiness can be increased by improving how credible, reliable, and intimate you are and by decreasing your self-orientation. Thus, the RBT aims to equip the business advisor with the skills they need to enhance their intimacy and decrease their self-orientation. It is proposed, that if the business advisor builds a more trusting relationship with their clients that: i) it will reduce information asymmetry between the business advisor and client, enabling a better understanding of the SME's needs that leads to more personalised, tailed advice. In turn, this will alleviate the SME's financial stress and help prevent the onset of MHCs; and ii) it will allow the SME to feel more comfortable disclosing any financial concerns and/or mental health problems and when combined with the MHFA, the business advisor will better recognise the signs of MHCs and encourage them to seek help where appropriate.

Thus, this study represents a crucial next step in protecting the mental health of SME owners by assessing the incremental effectiveness of combining a primary prevention strategy (RBT) with the tertiary and secondary-level prevention approach of MHFA on the prevention of MHC's. It will be the first to assess the effectiveness of the approach through a randomised control trial (RCT) using a national sample of practising business advisors and their SME owner clients. Combined with the effectiveness trial, a process evaluation will be employed to identify the programs strengths and areas for improvement and to inform the expansion of this program to other sectors.

Eligibility Criteria:
Inclusion Criteria:

* Any qualified business advisor from Australia or New Zealand who provides business advice to a small-medium enterprise client (SME). Business advice refers to the information, guidance and/or assistance provided by an external adviser that either directly or indirectly helps to prevent/reduce the financial pressures experienced by SME owner-clients.
* The SME client must be the owner-manager/operator with 1-199 employees, including the owner-manager themselves.
* The business advisor must be in contact with their SME client at least 3 times a year.

Exclusion Criteria

* Any business advisor who has completed Mental Health First Aid within the last two years.