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It Doesn't Have To Be Lonely At The Top: Why Entrepreneurs Need To Take Charge Of Their Mental Health We've survived the ultimate personal and professional stress test, and this has led to a lightbulb moment for many entrepreneurs, with a dawning realization that a refocus on physical and mental health can reap untold lifetime benefits.

By Eduardo Greghi

Opinions expressed by Entrepreneur contributors are their own.

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The Kusnacht Practice

For every entrepreneur on the cusp of launching, or running, a startup company, the journey is invariably a rollercoaster of exhilarating highs and challenging lows. In any "normal" year, the drive to succeed is intense, and the pandemic scenario of the last two years has only amplified the myriad of pressures placed on entrepreneurial shoulders.

According to global studies from, among others, Johns Hopkins Medicine in the US, and the UK's NHS, around one in four adults is believed to suffer from mental health issues, but it's even more prevalent among entrepreneurs. Back in 2015, Michael A Freeman, Clinical Professor of Psychiatry at the University of California San Francisco School of Medicine, and an acknowledged expert on research and issues related to the mental health of entrepreneurs, undertook a study that found that 49% of startup founders suffer from one or more mental health conditions during their lifetimes. Over the last six years, this figure has only continued to rise. More recent research, conducted in 2020 by the US National Institute of Mental Health, noted that up to 72% of entrepreneurs are either directly or indirectly affected by mental health issues, versus just 48% of non-entrepreneurs.

Freeman's study also revealed that a number of noted conditions were particularly prevalent, with entrepreneurs displaying specific character traits that make them inherently more susceptible to mental health issues. He found that entrepreneurs are twice as likely to suffer from depression, three times more likely to indulge in substance abuse, twice as likely to have suicidal thoughts, 10 times more likely to suffer from bipolar disorder, and six times more likely to have ADHD. Without denigrating the mental health challenges faced by other company CEOs, business leaders or, indeed, any individual, the mindset of an entrepreneur is naturally allied with "strong emotional states," says Freeman. Negative emotional states can include depression, despair, loss of motivation, and a sense of hopelessness or worthlessness.


It's lonely at the top, and entrepreneurs carry the weighty burden of having to be the smiling, confident face of their business, both to employees and the outside world: family, investors, other business stakeholders. Behind the scenes, however, they may be furiously paddling to maintain the impression that all is well. At this point, basic human needs often fall by the wayside, whether it's eating properly, getting enough sleep, spending time with family, or just enjoying some much-needed downtime.

In a 2021 study, Kings College London found that only 50% of surveyed entrepreneurs whose businesses had been impacted by the COVID-19 pandemic found enough time to recover from the stresses of work, with 44% also reporting inadequate sleep. There is also a knock-on effect on loved ones. A 2020 study by the US National Institute of Mental Health noted that 23% of entrepreneurs have family members also dealing with mental health issues, compared to just 16%of non-entrepreneurs. Perhaps unsurprisingly, over the last two years, we at The Kusnacht Practice have seen an apocryphal rise in entrepreneur clients reporting severe insomnia, heightened levels of anxiety, overwhelming stress, and increased propensity to depression.

The Kusnacht Practice, Image Courtesy: Johann Sauty

A major sticking point, and one that doesn't only affect entrepreneurs, is the historic stigma associated with mental health issues. It's not easy for anyone to put their vulnerabilities on show, and many entrepreneurs feel that team members or investors may misinterpret public acknowledgment of this as personal or professional "weakness." Mind Share Partners' 2021 Mental Health at Work report examined stigma pre- and during the pandemic in US businesses, and found that C-suite and executive level survey respondents were more likely than other team members to report at least one mental health symptom. This represents something of a sea change at this level of business leadership, opening the gateway to acceptance that it's okay to not be okay.

One positive factor to emerge from the pandemic has been a greater normalization of mental health challenges. We have all struggled at some point during the COVID-19 crisis, and the business world has slowly begun to acknowledge that this is a real, and pervasive, issue that deserves empathy and action. In the traditional workplace, companies are instigating mental health days, offering reduced working weeks, onsite support, access to mental health support apps, and more. But, what about the person sitting alone at the top? How do they manage both their stakeholders, whilst getting the support they desperately need, while avoiding the potential onset of feelings of shame, failure, or insecurity.

Numerous high-profile entrepreneurs have bravely – and publicly- shared their struggles. Tesla CEO and serial entrepreneur Elon Musk, for example, has secretly battled depression and a bipolar diagnosis for years, and chose to broach the topic via Twitter.

Related: UAE-Based Takalam Aims To Promote Mental Wellness In The Arab World By Offering Accessible Online Counseling

The Kusnacht Practice, Image Courtesy: Johann Sauty


Burnout is a brutal term, but it is often the precursor or a compounding factor in identifying a mental health condition. If not proactively managed, the cumulative effect of excessive and prolonged stress linked to running a startup can have serious long-term health implications– both mental and physical.

Entrepreneurs have a tendency to internalize their own wellbeing needs and tune out the signs, in favor of focusing wholly on the needs of the business. This can prompt a descending cycle of anxiety, stress, and depression– a domino effect that leads them deeper down the rabbit hole of negative mental health. However, if we are aware of the signs and take note, we can address issues before they spiral out of control. These signs may include:

1/ Negative feelings Facing up to negative feelings and thoughts and acknowledging them is a great starting point. It is helpful to jot them down, and spend some time thinking about the root causes.

2/ Stress triggers Is it financial uncertainty, the sheer volume of work, feeling out of your depth, or worries about not spending enough time with family? Again, simply by identifying triggers, we take a step towards addressing them.

3/ Physical indicators Consider how long you've been suffering from insomnia, working longer hours, socializing less, eating less healthily, drinking more, stressing more, etc. In identifying and acknowledging the physical signs, this can be a catalyst for change.

The Kusnacht Practice, Image Courtesy: Johann Sauty

Professional help and support, such as our treatments at The Kusnacht Practice, is readily available, but entrepreneurs can also draw on their own inner strengths and external resources to regain control of their emotional wellness. A few examples of small steps are:

- It can be as obvious as taking the bull by the horns and reaching out to fellow entrepreneurs, many of whom are undoubtedly having similar experiences; to share thoughts, and seek support from the peer community.

- As well as connecting to like-minded entrepreneurs, it's also important to build a strong support network across friends, family, colleagues, and mentors to counter self-imposed social isolation, and explore opportunities outside of the office.

- Mindset is paramount. There is an inner gremlin inside each of us who likes to whisper negative thoughts in the hope that they become entrenched in our psyche. The ability to effectively tune out or confront disruptive thoughts, and tear them down, is incredibly powerful.

- Entrepreneurs also have a tendency to embed their own self-worth within their business success, and separation of personal and professional identity –and value– is critical for effective self-care.

- We all benefit from putting down digital tools and reconnecting with ourselves and nature. It may be a cliché, but nature is the ultimate stress reliever. Research by the UK's Mental Health Foundation confirmed that spending time outdoors was a key stress reliever during the pandemic, with 45% of UK residents reporting that being in green spaces was an invaluable coping mechanism. And it's not simply a walk in the park, it's about taking time to listen to and observe nature, to connect with our breathing, to slow down our heartrate and step away from the world.

The Kusnacht Practice, Image Courtesy: Johann Sauty


The UAE, and the broader Middle East, has always been a magnet for innovators, creatives, and business visionaries with an entrepreneurial mindset. As economies continue to get back on track following the events of the last two years, entrepreneurship is once more on the rise. A 2021 study by LinkedIn named entrepreneurship as the fastest-growing "job," year-on-year in the UAE, with an annual growth rate of 98.3%. But while the figures are impressive, the dialogue around entrepreneurial mental health must not be forgotten.

The pandemic has changed the way we view the world. We've survived the ultimate personal and professional stress test, and this has led to a lightbulb moment for many entrepreneurs, with a dawning realization that a refocus on physical and mental health can reap untold lifetime benefits.

Simply put, presence is more important than productivity. And while there is relatively little we can control in the world, we are responsible for our own actions. At The Kusnacht Practice, we believe that truly being present –in all aspects of our lives- is essential for positive mental health. And it doesn't have to be lonely at the top.

Related: You're Not Alone: Entrepreneurs Need To Talk About Their Mental Health Battles

Eduardo Greghi

CEO and Chairman of the Board of Directors, The Kusnacht Practice

Eduardo Greghi has been CEO and Chairman of the Board of Directors of The Kusnacht Practice, the world’s most exclusive and personal treatment center, since November 2018. He is an entrepreneur, business leader, and ambassador for his company, and has had an impressive and varied career. Greghi combines his great work ethic with a relaxed approach; he believes in being a warm-hearted motivator and role model for his team. 

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