Let’s talk about entrepreneurs’ mental health

Being an entrepreneur is not easy. More than 9 out of 10 businesses fail, with up to 50% failing by year three. As the stats show, entrepreneurship – even for eventually successful founders – is more often about failure than success. The stress that this brings can affect significantly an entrepreneur’s self-belief and can have an impact on an entrepreneur’s mental health. In this post, entrepreneurs share their experiences of the emotional rollercoaster that running a start-up often entails, we get some tips from an entrepreneur coach on how to recognise mental health issues and prevent the need for therapy, and LBS alumni experts highlight some methods to help you manage.

Research by NHS England shows that one in four adults experience mental illness. Being an entrepreneur increases your risk further. According to research by Michael Freeman, entrepreneurs are 50% more likely to report having a mental health condition, with certain conditions being more prevalent amongst founders and character traits that make them more susceptible to mood swings.

According to Freeman’s findings, entrepreneurs are:

  • Twice as likely to suffer from depression,
  • Six times more likely to suffer from ADHD,
  • Three times more likely to suffer from substance abuse,
  • Ten times more likely to suffer from bipolar disorder,
  • Twice more likely to have suicidal thoughts.

“People who are on the energetic, motivated, and creative side are both more likely to be entrepreneurial and more likely to have strong emotional states,” says Freeman. Those states can include depression, despair, hopelessness, worthlessness, loss of motivation, and suicidal thinking.

Entrepreneur's mental health

Impact on female entrepreneurs

1 in 5 women reported having common mental health disorders in comparison to 1 in 8 men, and this does not include the impact from COVID 19 on them. Being a female entrepreneur certainly increases the likelihood to suffer from mental health issues as women are confronted with gender-based obstacles such as gender bias in the medical system, biological influences (e.g., menstrual cycle, postpartum depression, menopause, etc.), gender-based violence and challenging working conditions ( e.g., gender pay gap, sexual harassment, longer working hours, aesthetic labour, etc.), as highlighted in The State of Female Entrepreneur Mental Health report by resurgo.

“The pandemic has had a disproportionate economic impact on women, and I can see that coming through in my work, too. The demands on women from various angles are adding to the pressure, and it’s not surprising that is being felt”, says Yolanda Saez Castello, an LBS alumna who is herself an entrepreneur, mental health expert and EFT tapping practitioner.

But she does think more people are opening up about it today, especially women because they are more likely to talk about their feelings than men. She says, “I am seeing an increase in awareness about mental health issues, which is as welcome as it is needed. Every solution starts with recognising we have a problem. People are opening up more about getting help, and the more people see it as no different from receiving any other kind of support, the more minds will get into a better state.”

Yolanda notes that it is particularly important for founders to remain mentally healthy as they are the drivers of success and their wellness has a great impact on the entire enterprise. “Poor mental health cost the UK £45 billion in 2019”, she points out, “but my message is one of hope. There are extremely effective approaches and you do not have to suffer for any length of time.”

The entrepreneurship rollercoaster

“Entrepreneurship can be exhilarating, like a rollercoaster. And, as in all rollercoasters, there are ups followed quickly by very sudden downs. I had lived through a few during my corporate life. I thought I was prepared to face any unforeseen unknowns and especially, as a former skydiver, the ‘downs’ at high speed”, says Corrado Accardi, who is currently involved in three start-ups.

After a successful entrance into entrepreneurship, with an award-winning business plan and fundraising records, Corrado soon found out that adversity could hit hard and quickly. Less than a year after launch, with the business having grown rapidly, it faced a huge cashflow crisis that required an urgent capital injection. He shares his experiences here.

“For two months uncertainty did not allow me to be sure on any given Thursday morning if the business would be open after the weekend. The burden from this level of uncertainty was made much heavier by the not negligible issue that I had to wear a smiling face with my staff (whose families depended on their salary), with the customers (who wanted what they paid for, regardless of the behind-the-scenes), with the shareholders (who would not take lightly collapse within one year of the initial fanfare) and, last but not least, with a wife who had been very supportive but was never ‘in love’ with my business.

“In short, I had the longest two months of my life, sleeping just over two hours per night and using the hours ‘saved’ from sleep to over-exercise, walking at night, trying to escape the weight on my shoulders, the wounded pride, and the black hole of uncertainty. Even smiling felt almost hypocritical.

“Looking back at that time, perhaps seeking some external help would have made things easier. I didn’t and I was lucky to get out of it without lasting damage. I saved the business, which then thrived for another three years. Then a new crisis, caused by a combination of external issues that could not be controlled, resulted in the company literally folding in a matter of hours – from talking in good faith about leasing a new venue and launching franchising in Japan on a Friday morning to calling the administrators the following week.

‘Rock bottom became the solid foundation on which I rebuilt my life.’

J K Rowling

Reframed mindset

“And yet, after the experience of the previous crisis, my capacity to cope with pressure had escalated to another level, in particular with respect to looking at problems from the right perspective: it was just business, and nobody would really get hurt. This time, my sleep was not disrupted – gone were the days of the nightly walks and workouts. Also smiling was easier.

“The bad news was an unexpected shock to staff, suppliers, customers, and shareholders alike. The most positively surprising reaction was from staff and some of the largest investors, with personal support and promises to reinvest in my future businesses. Of course, there was some bad press and a few of the smaller investors were particularly aggressive, but knowing that I had given the company my best was sufficient to have neither remorse nor regrets.

“It’s now over three years since this happened. And entrepreneurship has grown on me so much that I was not lured back to corporate life. Instead, I have been involved in a number of start-ups, two of which I am particularly proud of and ready to launch in the impact space. The lessons have been instrumental not only in the creation of compelling business cases but also in avoiding feeling burdened in the moments of uncertainty or outright crisis, including supporting other members of the team to reframe their perceptions of the issues we faced. As Mandela once said: ‘I never lose. I either win or learn’. The lesson I learned was to enjoy the rollercoaster.”

The pressure to show strength

As Corrado’s story shows, being an entrepreneur means risking more than being an employee. You feel like everything depends on you, and your start-up takes priority over your basic human needs, such as sleep, food, security, family and health. You risk burnout.

The last year has been particularly difficult for everyone, with people suffering from the effects of the pandemic, including increasing sleeplessness, anxiety, stress and depression.

Founders have also had to deal with the significantly increased risk of losing their businesses and feeling responsible for their employees. It can be a very lonely journey at the best of times, and founders, in particular, can be afraid to ask for help from fear of losing their business. They feel they can’t share their feelings with others as they don’t want to be perceived as weak or having problems. Instead, they feel pressure to motivate their team and to be seen as optimistic in front of them and the investors. They are under even more pressure to show strength.

The barrage of decisions

Elisabeth Kohlbach, agrees with Corrado about the emotional rollercoaster. She says, “As a sole founder, in the early stages in particular, the endless barrage of decisions that need to be made can feel draining as well as empowering. This was something I never even thought about before becoming a founder, especially as it runs counter to the typical aspiration of rising to the top of the ranks in any organisation.

“For me, the biggest help and support in difficult times came from other founders at the same stage of venture. Being able to vent and seek counsel from others who are going through the same journey and often share your struggles has been invaluable and far more helpful than any structured mental health programme could ever be.

“Having said that, incubators and accelerators as well as investors seem to be waking up to the need of supporting not just the fledgling businesses, but also the people behind them. Outside capital brings validation, help from experienced operators, insider market knowledge and valuable connections, but investment can also be an additional source of stress as it drives you to raise your game and deliver results fast. 

“Similarly, the LBS incubator programme gave me business resources from accounting to branding, but the most valuable support for me was 1-on-1 sessions with an excellent entrepreneur coach (Stuart), giving me a safe space to voice insecurities and help me overcome any first-time-founder impostor syndrome.”

Yolanda adds, “Excessive worrying or fear, feeling excessively sad or low, confused thinking, and problems concentrating, learning, or making decisions might all be signs that your state of mind is declining. But fortunately, it does not have to stay that way.”

Recognising the signs

“It is a sad fact that those who have reached the point of burnout are less likely to realise they need help,” says Stuart Hillston, who works with entrepreneurs as a coach and psychotherapist, and sometimes both. As a former entrepreneur and professional investor, he has taken the entrepreneurial journey many times and experienced burnout more than once.

He reveals: “When working as a therapist, the most common presenting issue is anxiety – this is as true for entrepreneurs as it is for anyone else. This is closely followed by stress and then by depression ­– all common mental injuries. I call them ‘injuries’ because you need to know that you can recover and resume life as you like it. In simplistic terms, anxiety is about the future, stress is about the present and depression is about the past.

“If the issues are the same for entrepreneurs as most people, the causes are different. The three top issues that entrepreneurs identify as the triggers for their feelings are co-founders, investors and relationships (whether at work or at home).

“We know that entrepreneurial life is pressured, stressed and risky. That is the rational understanding of the life we choose. The emotional burden is harder to understand until you experience it. Learning to recognise the signs of burnout, for instance, might just help you to help yourself early enough to avoid more unpleasant consequences.”

Take the Hillston test

Stuart recommends answering these questions to evaluate whether it’s time to make changes or seek support, taking care not to sugar-coat the answers. Compared to three months ago do you:

  1. Sleep better, worse, the same.
  2. Sleep more, less, the same.
  3. Socialise more, less, the same.
  4. Work shorter hours, longer hours, the same.
  5. Exercise more, less, the same.
  6. Eat healthier, less healthy, the same.
  7. Take time out without a plan more, less, the same.
  8. Think about work issues less, more, the same.
  9. Feel stressed less often, more often, the same.
  10. Drink alcohol less, more, the same.

Score 1 for every first answer, -1 for every second answer and 0 for every third answer.

If your score is below zero you should ask yourself: Am I heading for burnout? If your score is below -5, you should really think about seeking support from those around you or seek professional help to change your habits.

What can you do?

Stuart advises: “If you burn out, you will take quite some time to recover and it will significantly affect your business and all those who depend on it. You will be more effective and make better decisions if you are well-rested, eat well, exercise your body and your mind regularly, and regulate your working time (and thinking).”

“You need to tell yourself now why this is important and remind yourself often so that, when you spot the early warning signs, you can take action early. I mean this kindly, but I really hope I don’t see you in my therapy room with burnout. If I do, I will naturally help you. You can also help yourself.”

Tips to help you manage

While some entrepreneurs may turn to therapy after a turning point, not all want or can afford to do so, especially if they are in the early stages of a start-up. So, what can they do? Yolanda has some tips:

· Don’t be afraid to test-drive

I don’t think people do enough test-driving in life. Entrepreneurs are good at that, and lead the way for many others. Give yourself permission to test-drive. You won’t die if this car isn’t your best or your last. The same is true of your business idea.

· Avoid disruptive thoughts

When you are an entrepreneur, mindset is key, and occasionally, your own noisy thinking will derail you, be it self-doubt, procrastination, or something else. No one can complete a complex project plan while sitting in the middle of Times Square; notice the stories in your thinking; while you can’t stop the noise from happening, you don’t have to listen to it.

· Try out Tapping

If you suffer from stress, anxiety, panic attacks depression, or trauma, consider using the Emotional Freedom Technique (EFT) tapping, an evidence-based, self-help therapeutic method. It is proven to reduce stress hormones as well as blood flow to the amygdala, the part of the brain that triggers the fight-or-flight response. Research shows that using tapping can significantly reduce anxiety (−40%), depression (−35%), post-traumatic stress disorder (−32%) pain (−57%), levels of the stress hormone cortisol ( -37%), and increase happiness. It is self-administered and can be a life-saver. (See more from Yolanda on how to do EFT in the video below and the tapping points card and step-by-step instructions here.)

Yolanda Saez Castello MSc from Tap It Better shows you the basic EFT Tapping Sequence that you can use to relieve stress, anxiety and many other mental health discomforts.

Connecting with nature

Another life technique to deal with the stress that being an entrepreneur can entail that is effective, scalable, accessible, free and Covid-safe is to connect with nature. Emmett Phil Coriat, Founder at Natural Leadership, experienced burnout due to a combination of work stress (particularly focusing too much on performance at the expense of his health) and external factors, and nature was his saviour. The COVID 19 pandemic has highlighted the need to reconnect with nature, which is one of the most accessible therapies for everyone (in recognition of this the theme of Mental Health Awareness Week this year is also about connecting with nature).

Emmett, himself a forest bathing expert, says it ticks all the boxes: “Science now provides us with a detailed understanding of how nature’s health benefits work. The evidence is so compelling now that physicians in the US, UK, and Canada (www.parkprescriptions.ca) have started to prescribe nature. But it’s not a new concept – forest bathing originates from Japan and is used there as a therapy against burnout.

“Humans come from nature and our brain developed for thousands of years in nature to what it is today. With urbanisation and progress, we have forgotten that nature is our home, that we are nature. Dis-connection from nature causes dis-ease.

“The biophilia hypothesisthat humans are hardwired in their DNA for connection with nature – was formulated by Harvard biologist Edward Wilson in the 1980s. It is based on the restorative effect of nature on urban people’s health.

“The effect works through our senses. Each one recognises ‘active ingredients’ in nature that don’t exist in urban environments. Health benefits start with simply seeing nature – this calms the amygdala in the brain – and it has been shown that each sense has specific active ingredients that reciprocate with nature, resulting in health benefits.

Entrepreneur's mental health

“Nature is unique in that it is effective on both physiological stress and behavioural stress. Rest and relaxation are effective in physiological stress recovery, but not against behavioural stress. When we are fully ‘present’ to our senses in nature (e.g., through forest bathing), our brain effortlessly goes into alpha wave mode, called flow or soft fascination, and this allows us to restore our executional attention. Beyond mental health, alpha wave mode allows us to unlock our intuition and enhance multiple executive and leadership skills.

Forest bathing: step by step

” To benefit fully from nature’s benefits, you need to immerse your senses. In organised group forest bathing, the guide proposes simple games (invitations) to immerse your senses through deep play. After each invitation, the group shares their individual experiences. Without a guide, here are a few tips to immerse your senses:

1. No devices at all (no music).

2. Slow down a lot (your body and your mind, if you can).

3. Try equal count breathing: inhale for 4 seconds and exhale for 4 seconds – more if you can while staying comfortable. This relieves anxiety.

4. Focus on what you are seeing, hearing, smelling.

5. Touch and explore all the textures that ‘call’ you.

6. Do not try to identify or label what you encounter. No cognitive stimulation – just stay in your senses.”

As Robert Louis Stevenson said: “It is not so much for its beauty that the forest makes a claim upon [our] hearts, as for that subtle something, that quality of air, that emanation from old trees, that so wonderfully changes and renews a weary spirit.”

With thanks for the contributions from our LBS alumni and expert coaches:

Corrado Accardi, Co-founder and Director of U2K International Ltd and Rialair Ltd.

Elisabeth Kohlbach Head of Product at Intent HQ and Co-founder of SKWIRE.

Yolanda Saez Castello MSc Mental Health Coach, and Advanced Tapping Practitioner at Tap It Better.

Stuart Hillston, Psychotherapist, Coach and Counsellor at The Mindful Entrepreneur.

Emmett Phil Coriat, Lead Partner Innovation at AEC and Founder at Natural Leadership.