Europe has around 25 million small and medium-sized enterprises (SMEs) that together represent the backbone of Europe’s economy. These account for more than 99% of all businesses in the EU. SMEs are responsible for more than half of EU-28 GDP, employ around two-thirds of the European workforce and are responsible for 85% of job creation. According to the Annual Report on European SMEs 2018-2019, SMEs represent the majority of the increase in value-added. Thus, SMEs are considered key to ensuring economic growth, innovation, job creation, and social integration in the EU.

At all stages of development, SMEs struggle more than larger counterparts. Nonetheless, their survival is crucial due to their economic systemic impact. Given their often innovative and agile nature, SMEs are essential to creating the conditions needed for future growth. With this in mind, the EU provides tailor-made support to help them grow and innovate.

With the ongoing epidemic outbreak, a demand and supply shock is disrupting SMEs. SMEs tend to be more labour intensive and have thinner liquidity reserves, often lacking a large pool of financial alternatives.

The impacts of the COVID-19 pandemic are far-reaching and long-lasting for SMEs. They are much more exposed to the negative impacts following an epidemic outbreak. Besides the direct impacts on the business, this can have dramatic consequences on the mental health of business owners. These can produce negative spillovers at community levels, given that SMEs play a role in the well-being of local/regional communities.

Despite their importance for Europe’s economy and potential role in economic and social recovery, SMEs are particularly vulnerable to the impact of the COVID-19 pandemic. Evidence suggests that COVID-19 might have significant impacts on prevalent psychiatric disorders (depression, anxiety disorders, depressive symptoms), other aspects of mental health (stress, burnout, wellbeing, disturbed sleep patterns), self-medication, and, ultimately, lead to serious life-threatening complications among business owners. Added pressure on business owners might easily reflect itself on employees, creating a deadly snowball effect for SMEs.

The hypothesis is that the impact of pandemic and disease outbreak situations on SMEs can be measured by diagnosing the clinical and mental health status of SME owners (and potentially its employees), besides the “traditional” economic and financial status of the enterprises. Understanding and characterising the dynamics between the two is crucial. This analysis should look at individual mental health indicators and financial and economic company indicators. Additionally, it should also bring them together and try to understand the dynamics between them.

Mitigating future pandemic situations

To develop tools contributing to mitigate future pandemic situations, a truly multidisciplinary approach is required. This approach must involve professionals from basic and applied clinical research, including psychiatrists, psychologists, neuroscientists, physicists as well as economists, statisticians, political scientists, financial crisis specialists, SME business owners, entrepreneurs and policymakers. This diversity is necessary to address the inter-related dimensions of epidemics/pandemics and economic turbulences. Analysing the efficiency and comparing outbreak responses across Europe is also a key success factor. This should take into account the specificities of each country (cultural aspects, health systems, population traits, among other factors). Also, several European countries and representatives should be involved.

Policy guidelines

Guidelines that can contribute to policy measures for international organisations and European countries would help increase preparedness of the health and economic sector to deal with outbreak situations. Policy guidelines should tackle a broad range of interventions; from immediate communication actions to more long-term policies directed at economic fundamentals. Guidelines should take into account national, cultural, social and institutional specificities, to ensure feasibility and transferability. Guidelines should also ensure compatibility between health and economic policies, avoiding the risk of conflicting prescriptions and outcomes. Conflicting prescriptions might increase both the economic and mental distress of SME owners. The hereby proposed guidelines must be transversal and ensure a whole of government approach as they can range across sectors/áreas of government and scope of implementation (i.e. national, regional, etc).

Managerial recommendations and best practices

Managerial recommendations and best practices would also assist business owners, managers and employees handle this type of situations. Best-practice guides for SME owners have the potential to boost the well-being of their employees. These should address how to implement mitigating measures in the event of epidemics and pandemics. These measures could aim at achieving several different objectives. Mitigating the psychological impacts of isolation and social distancing, managing individual productivity, leading remote teams, among others, are examples of specific challenges business owners face. Managerial recommendations and best practices may vary greatly. They might very well be the usage of small culture artefacts or communication assets or revamping organizational structures and processes.

Clinical guidelines

Guidelines for mental health professionals (and eventually other, such as primary healthcare providers) is also a clear need. Clinical guidelines could help improve the resilience, well-being and mental health of this population (SME owners and employees). Aspects covered could include preventative measures like establishing new modes of work/life balance, giving advice about how to cope with social isolation, staying active indoors, avoiding self-medication for example with alcohol and ideally internet- and audio/video-based psychotherapeutic treatment possibilities but also medical treatments. A great example of an indicator that might be used for the development of these guidelines is sleeping problems. Sleeping problems are often associated with the development of other symptoms that may contribute to burnout, and be part of a depressive episode or anxiety disorder (depressed mood, reduced appetite, rumination, less motivation or even suicidal thoughts).

The current present lesson learned is that we were not prepared to handle this situation, thus many lives were lost and many SMEs did not survive. Thankfully, things could be very different in the future. These outputs and approach would contribute to a holistic preparedness of the health and economic sector (at a macro and micro level). Policy, clinical and managerial guidelines and recommendations have the potential of assisting in delineating responses to future disease outbreaks. Effective collaboration may help us fuse talents together to contribute towards creating best practices in pandemic scenarios. This is the only way forward to increase the resilience of health and economic systems across Europe. All countries in Europe are preparing, should there be another outbreak. The next time, we must all fare better.