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Mental health first aiders in the workplace - are they effective?

?The spotlight has been turned on mental wellbeing recently, not least through a world that is working in lockdown. Prior to the coronavirus crisis, many workplaces had begun taking the connect more seriously as part of a duty of care to employee’s general health and safety too.

Yet, mental health first aid (MHFA) training is, relatively speaking, a fairly new concept in the corporate world.

Developed in Australia two decades ago to challenge stigma and help the public identify signs of mental ill health in others, the idea was adapted for workplace settings and quickly spread globally, arriving on UK shores in around 2007.

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By 2016 its popularity in England was such that the Department of Health and Business in the Community (BITC) both recommended that employers should provide mental health first aid training and implement it as a key facet of their wellbeing strategies.

Just over a decade later and hundreds of thousands of volunteers have been trained, across businesses nationwide, in mental health awareness, support and first aid.

Training is now available from a plethora of providers, although the MHFA system, unlike employee assistance and occupational health programmes, remains as yet unregulated.

For this reason, it has come under fire for its potential lack of safeguarding, the possibility that some businesses may use it as a wellbeing strategy ‘quick fix’ and ultimately the fact that there is still little data about its true benefits.

Indeed, a review conducted by the HSE and published in 2018 concluded that while it found MHFA training did raise employees’ awareness of mental ill-health conditions, there was little showing it improved the ability of those trained to help colleagues with mental ill-health, and nothing showing it improved organisational management of mental health in workplaces.

So, what are businesses and trainers now doing to ensure that MHFA in the workplace is robust, beneficial and safe? Is it working? And how is it being measured?

MHFA England, the first and still the largest MHFA training provider in the country, has coached more than 4,000 instructors to deliver its courses with over 400,000 people undertaking its various workshops since 2009.

According to workplace lead for the organisation Vicki Cockman the key to success for any business implementing a MHFA strategy is to take a “whole organisation” approach.

“You have to be prepared to be honest about the state of the mental health openness in your organisation, the level of resources and how available they are to employees. Also, you need to look at things like healthy job design, fair and equal pay and flexible working practices,” she explains.

The company offers three key courses, Mental Health Aware, Mental Health Champion and Mental Health First Aid, half day, one day and two days respectively, each offering increasing levels of mental health knowledge to employees including listening, support and signposting skills as well as appropriate self-care.

Cockman stresses that MHFAs should be implemented only as part of a wider wellbeing strategy and never in isolation. “It is not the sole solution and organisations will struggle with the anticipated impact if they treat it like that,” she asserts.

With many organisations trying to find ways of accurately assessing the impact of their mental health first aiders, Cockman says the most useful markers come from four key areas: sickness absence and return to work rate; the number of conversations mental health first aiders are having and the support provided; uptake of support; and attraction and retention rates.

Sean Maywood, PricewaterhouseCoopers’ in-house MHFA instructor, has delivered the training across its workforce since 2016 and says that whilst anecdotally its strategy is working, gathering exact data is a challenge.

“Our approach to mental health is based on different levels: we have ‘e-learns’ based on improving people’s listening skills around mental health conversations; career coaches for everyone in the firm who also mentor and look out for their reports on a personal level; and then the full MHFA training which is aimed mostly at HR, partners and directors.

“Measuring it is a challenge. We do put out surveys and get varied results in terms of the degree to which people state that they have used the mental health support structure,” he explains.

Gathering and assessing the feedback is a work in progress he says but believes the multi-layered strategy adopted at PwC is robust and impactful, not least because of the focus placed on filtering the right people for the MHFA roles, as opposed to assigning anyone that applies, which has its own dangers. Likewise, the support network in place throughout the business for MHFA volunteers allows them to talk confidentially together, to ‘offload’ and to verify that they have offered the right support.

“It’s key to make sure the MHF aiders are well supported and protected,” he states. “We have people spread over a huge area, on- and off-site. So, it’s about making sure we keep everyone up to date and connected. It’s a continual process of providing support, not just a training programme and that’s it, we’re done.”

Similarly, at Deutsche Bank, which also piloted the MHFA England training in 2016, the strategy is multi-tiered and those heading the framework are now focussing on evidence gathering, working alongside the HR and benefits teams to drill into useful data.

“We’re looking at the numbers that are having conversations with mental health first aiders, what themes are coming up and in which locations,” explains operational lead UKI/EMEA, corporate bank people strategy, Andy Ward. “It’s important that we capture useful data without breaching confidentiality,” he adds.

At Deutsche Bank there are now over 110 MHFA volunteers across its Birmingham and London sites now. Ward, who himself led the 2016 pilot, outlines a number of facets that are key to running a successful MHFA framework in such a huge organisation

Firstly, he says, is the fact that although HR has been fully involved in the implementation of the initiative across the business, it is mostly administered by employees on the ground. Ward believes this adds a “grass roots feel” and is probably the reason so many people have engaged with them generating very positive feedback.

Deutsche Bank’s mental health champions all being senior managers is also very impactful, says Ward, as it demonstrates the importance placed on mental health across the business, which in turn promotes trust.

And, echoing Maywood’s approach to continuing support, Ward says its teams of mental health first aiders have a monthly group call and online group chat application to enable them to confidentially share experiences and best practice.

“We maintain that this is very much a voluntary role so if at any time our mental health first aiders need to step back and take a break or even stop, they know they can do that.

“We are also really looking at the concept of refresher training, to focus on how much more impact our mental health first aiders can have,” he adds.

“All these measures promote a committed and very proactive group that has gone the extra mile during the COVID-19 pandemic, compiling and sending out comms with tips and info to help teams maintain good mental health and wellbeing during this extraordinary time. Ironically, social distancing is really creating a stronger community,” he says.

The shop-floor to top-floor approach is a common theme when it comes to MHFA implementation, with senior leaders at water firm Severn Trent being particularly visible. Management at the West Midlands firm regularly join mental health discussion groups and also feature in campaign videos talking of their own personal struggles.

“We want people to know it’s ok not to be ok,” says group HR director Neil Morrison. “We get phenomenal feedback from it because there is nothing more powerful than personal stories.”

The firm has trained 360 MHF aiders since 2016, with another 1,500 and 300 completing the MH Aware and MH Champion training respectively and as well as assessing employee absences and qualitative feedback, the company regularly carries out in-house and MIND employee surveys, where it has seen a four-fold increase in how seriously people think it takes mental health.

Morrison says: “That’s an incredible reflection of what we’ve been doing. I strongly challenge any assertion that MHFA is a tick-box exercise. I think if you chose it to be it could be but I hear more stories every day from colleagues who say they have been really helped by a MHFA.

“The key is, it must be integrated into everything you do and not be a standalone. It has to be a way of being and be championed from the top.”

While tens of thousands of businesses are implementing MHFA practices nationwide others don’t subscribe to the growing phenomenon, choosing and offering different approaches to mental health.

“We are trying to move away from this way of thinking about mental health, the medicalised model, which is steeped in stigma and labels,” says Our Minds Work (OMW) founder and managing director Emily Pearson. “What mental health first aid does is train people to recognise signs and symptoms and label them with a diagnosis, which is not helpful.”

Through OMW, Pearson, who comes from a mental health background, delivers corporate training programmes focussed on cultural change and embedding good mental health practices. Pearson applies a ‘traffic light’ Continuum Model to her work, which is designed as an accessible and common language tool for all employees and leaders to recognise different stages of mental ill-health in themselves and others.

Pearson agrees that MHF aiders have helpful conversations and provide support. OMW offers support frameworks for businesses that have implemented MHFA volunteers to ensure they are supported whilst working within the boundaries of their roles, as well as guidance on evidence gathering for its clients.

“We worked with Emily to see what good questions would look like for gathering base-line data to understand if there have been any shifts,” says Thirteen Group senior HR business partner manager, Liz Thompson.

“For example, if they know where to go to get help in the company, if they feel comfortable talking to managers or others, if they understand the mental health advocate role and questions about mental health.”

Engagement surveys run in October 2019 were the first periodic testing of benchmark data since implementing the system at Thirteen Group, and she says “all responses had improved.”

For Thompson, who has overseen the implementation of OMW’s Continuum Model across the housing association, the key to success has been leadership buy-in and what she calls a top-down cascade. All line managers must undergo full training with OMW while all employees attend awareness training.

“Our strategy is two-fold: energised and healthy people and healthy working lives. We categorise our approach into three parts: treat, protect and improve. It’s about being really clear on your objectives and it has to be about your people. If it’s a tick box exercise they will know and they won’t have any faith in you,” she asserts.

While across the board there is still little hard data to prove the specific benefits of mental health first aiders and mental health first aid training, there can be no doubt that when implemented as part of a robust, multi-layered, holistic and sustained mental health strategy they certainly have a crucial part to play.

Businesses who use it are recording fewer absences and EAP and OH referrals. They have greater organisational openness and are starting to fine-tune their surveys, delving deeper both to prove their return on investment and to disprove the naysayers.

For Cary Cooper, professor of organisational psychology and health at Manchester Business School, the key to making MHFA work is simple: “It’s important for HR to understand, this has to be done correctly.

“Make sure you have a clear strategy, report it to the board, make sure someone is responsible for it, screen the applicants carefully, evaluate the interventions and change what doesn’t work.

“It’s no different from running a business. It needs a strategic approach.”

This piece appears in the May/June 2020 print issue. Subscribe today to have all our latest articles delivered right to your desk