Mental health first aid can have negative impacts


As a MHFA instructor it’s obviously concerning to hear this. I recommend any organisation asks for feedback from previous courses that an instructor has delivered and implements ...

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While mental health first aid (MHFA) can bring many benefits to the workplace, some firms could risk employee wellbeing if it is not implemented properly

Poorly-understood and badly-delivered MHFA programmes in the workplace could have negative consequences, according to Emily Pearson, founder of corporate mental health consultancy Our Mind's Work.

Mental health first aiders have not been given the same level of support and training as others working in safeguarding roles, she said: “These are people who are dealing with extremely sensitive, confidential and distressing information. People in occupational health roles require years of training to support someone; how are mental health first aiders supposed to do this [after] two days' [training]? Ethically and legally there could be [...] ramifications for mental health first aiders themselves, and businesses if they are found liable.”

MHFA programmes have become increasingly popular within organisations in recent years as employers seek to tackle mounting mental health pressures facing their workforces.

Such initiatives are relatively low cost, taking just two days for an employee to become a mental health first aider. Training focuses on being able to recognise and support colleagues who are facing a mental health difficulties in the workplace. More than 400,000 people across the UK are now operating as mental health first aiders.

A Mental Health First Aider is taught to identify, understand and help someone who may be experiencing a mental health issue and address. While MHFA is not designed to be a substitute for therapy or other forms of healthcare, it aims to give people the skills to listen and respond to someone who may be experiencing an issue with their mental health and potentially stop a crisis.

Research by the The Institution of Occupational Safety and Health (IOSH), working with researchers at the University of Nottingham found that these schemes can be effective in helping to improve and facilitate discussion around mental health. Almost all (91%) of employees in organisations with MHFA surveyed said there had been an increased understanding of mental health issues in their workplace as a result of the training, and 87% said that more mental health conversations were happening at work as a result of the training.

However, there were also concerns about some firms operating flawed MHFA programmes that lack the rigours of clearly set-out policies, procedures or the necessary training to avoid safeguarding issues.

When its research was released back in November 2018, Duncan Spencer, head of advice and practice at IOSH, stated: “Mental health first aid has become a prominent way of training individuals to recognise signs and symptoms of mental health problems and to select appropriate responses. But how successful is it in the workplace? What impact does it have?

“IOSH calls for a ‘prevention-first’ approach incorporating MHFA as part of an organisation’s overall efforts to protect its workforce from mental health problems. Appointing staff in a volunteer capacity to support colleagues with mental health problems must be part of a bigger management system including preventative controls to remove or reduce risks."

Despite the concerns, the benefits of properly-administered MHFA should not be entirely discredited, Pearson conceded. “Mental health first aid has been around for a very long time now. It started outside of the workplace, and being able to get an ordinary person to help someone in a time of crisis is a brilliant thing,” she said.

“You can be there for someone, anyone, in the street or in a supermarket, who is at a point of crisis in the same way as you would with another emergency. It’s perfect, and easily marketable, in that you can walk away and you never have to see that person again. And with mental health issues exploding in the workplace in recent years, you can see why employers would want to implement it.”

To tackle safeguarding issues with MHFA, Our Mind’s Work has put together a framework setting out best practice for employers. Several organisations have already signed up, including Northumbrian Water Group, Suffolk Water, law firm Muckle, and global automotive technology firm ZF.

Commenting on the news, Simon Blake, chief executive of Mental Health First Aid stressed that mental health first aiders were provided with the skills and training needed to ensure they could support people: “Our Mental Health First Aiders are part of a community of over 450,000 people in England and 2.6 million people worldwide trained to recognise mental ill health and help people find the support they need to stay well," he said.

“Keeping safe and well is a key element of being a Mental Health First Aider. Both the training and the support materials, which includes downloadable guidance on implementing Mental Health First Aiders into the workplace, toolkits, self-care tips and other content provided by MHFA England, spotlight this. Supporting and developingMental Health First Aiders in their roles is key to embedding MHFA England training into an organisation, and ensuring those trained use their skills and perform their role safely and effectively.'

Blake added that acknowledged that MHFA is only part of tackling mental health: “Importantly, we recognise that Mental Health First Aid is just one part of the solution. We encourage employers to evaluate the support they have in place before implementing MHFA England training. This ensures signposting to supports (EAPs, Occupational Health Teams, self-help information, local services) is effective and pathways to support are clear," he said.

“All organisations should have a mental health and wellbeing strategy in line with the government’s Thriving at Work recommendations. This approach should include measures for the prevention of workplace mental ill health, early intervention plans, and support – within which Mental Health First Aid is one important element.”


Mental Health awareness training has been around at least a decade, and it is interesting that it has been productised almost to a point of exclusion of all other awareness programs. There are a number of ways to approach awareness and support that includes things like champions, advocates, user groups. What Is really important is that employees feel comfortable and safe to talk to someone, and this needs to be confidential. But those who support can be vulnerable themselves and may even be overwhelmed. Their interest in the role may derive from lived experience of mental health. They should be properly supported themselves, and their work supervised to some extent so that they are not overburdened, and that boundaries are set with a role expectation. Signposting must be fully understood and not drift into counselling. Rarely do I see employers fully monitoring such supporters and indeed reporting on the type and number of issues seen. Managed well a peer type support program is a huge asset.


With the development of MHFA in the corporate marketplace it has seen to expose many areas where there are gaps to be filled and correct prevention, intervention and support be applied. Just training people is simply not enough particularly if the training is substandard or delivered by someone who is just a trainer with very little hands on practical knowledge of mental health. There has to be an integrative joined up approach that is both ongoing and supportive but also proactive in preventing mental health conditions appearing or reappearing. I provide training and complete thorough ongoing support with correct intervention and further proactive measures. The evolution of MHFA has also exposed existing EAP's in failing to resolve some mental health conditions. Support with CBT and psychotherapeutic intervention alongside EAP's or part of should be a requisite element.


As a MHFA instructor it’s obviously concerning to hear this. I recommend any organisation asks for feedback from previous courses that an instructor has delivered and implements supervision/refresher training. MHFA alone won’t fix mental health issues and needs to be considered in the wider context of the strategy and culture of the organisation.


MHFA England training is evidence based and internationally supported. I chose it many years ago as a viable alternative to bespoke ‘woolly’ mental health awareness training - well before it became popular as a training initiative. It’s worth considering why MHFA England training has became so popular. Because it works. Never has anyone said that this will be the entire solution, nor that trained staff should be replacing professionals or other appropriate support - anymore than physical first aiders should. I agree it should be regulated - so let’s regulate it!


It is indeed concerning to read this, however, if you get a good instructor like we did, you will be advised during the delivery of the course that the MHFAiders are not there to fix the problem. They are there to be somebody a troubled employee can talk to and seek some guidance from, which is supplied in the materials from the course. Following the training, we implemented a mental health champions team that meet regularly to gain support from each other. If there is a particularly difficult situation they are trying to help with, since the trainer of the course is a practising mental health specialist, we are able to bring them in to provide supervision and give more guidance and support.


My question is who is there to protect the mental health first aider who is exposed to something traumatic? Is there a follow up system? What does a mental health first aider do with a safeguarding concern or someone with suicide ideation?


The first problem with MHFA is that they're not actually First Aiders at all are they?! We associate first aid as a 'diagnose and treat' service - if you cut or burn yourself at work, the first aider will assess, diagnose and treat appropriately... Mental health first aid is a peer to peer support service there to listen and signpost, they are not there to diagnose or treat an individual at all. This misconception, even by the first aiders themselves in many instances, is massively dangerous and can create huge risks to both the individual and also the company (I could give some shocking examples). One could argue that it can be safer to offer no peer2peer support at all, which is not ideal but it needs to be done properly, and there are some extremely effective alternative courses available to that of MHFA. MHFA are not given enough follow-up support or any ongoing training. There is no structure around how companies commit to using the MHFA. In most cases I feel like it seems as much a box-ticking exercise than anything else and can often be the only thing that a company has implemented around mental health at all.

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