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The missing pieces of mental health first aid

Mental health first aid (MHFA) training has been rolled out in many workplaces across the UK, but without holistic wellbeing support, businesses could be missing crucial pieces to the puzzle. Chartered occupational psychologists Susannah Robertson-Hart and Sheena Johnson find out what it takes.

What’s new

The literature exploring MHFA in the workplace is very limited (see Health and Safety Executive (HSE), 2018) for the most recent summary), mainly due to the challenges of studying such interventions.

It is a divisive topic with employers and practitioners expressing mixed views about its use and effectiveness.

Our study builds on the sparse workplace MHFA studies available. Focusing on individuals who had actively received MHFA support differentiates this study from previous studies which collected data from ‘potential recipients’ of MHFA. We also expand the limited data available on the impact of becoming a mental health first aider (MHFAider).


Key findings: Is workplace MHFA effective?

This depends on the outcomes in question. Our study shows many positive outcomes; however, we identify the need for more research, especially with MHFA recipients.

We found that MHFA trainees’ mental health-related knowledge, confidence and intentions to provide support significantly increased post-training compared to the control group. This supports previous findings (Health and Safety Executive (HSE), 2018) and is a good foundation for building a culture of care and support.

The ultimate goal of MHFA however is to improve, or prevent a decline in, the mental health of individuals receiving support. Measuring this is incredibly challenging, hence previous research has focused on outcomes for employees who have access to a mental health first aider.

By contrast, our interview study included employees known to have received MHFA support, with consistent benefits reported in terms of mental wellbeing, developing coping strategies and resources, reduced absence, and improved productivity. MHFA appeared to be an important catalyst for improving mental health or averting a crisis.

Importantly, the perceived benefits of MHFA depended on the individual’s broader experience in the workplace, i.e., their manager’s support for mental health, the level of stigma in the organisation. This highlights the importance of a holistic approach to workplace mental health.

While the study reported some compelling benefits to MHFA recipients, it must be noted that this was one small study, in one specific organisation.

More research is needed to elaborate on these findings further exploring, at repeated time points and within different organisational contexts, the experiences of MHFA recipients and the impact on the organisational management of mental health.


Is there a risk of recruiting employees into an emotionally demanding role which exacerbates their own mental health issues?

It is reasonable to suggest that MHFA training may attract people with lived experience of mental health issues, who want to help others, but who could be vulnerable in terms of their own mental health.

The organisation studied adopted a volunteer approach to recruitment, with extensive information about the role requirements available to interested individuals. We found that MHFA trainees had significantly higher levels of mental wellbeing and more positive attitudes at baseline compared to the control group.

It may be that through this ‘informed consent’ approach, individuals who felt the role may compromise their own mental wellbeing didn’t progress to training. This provides support for taking a carefully considered approach to MHFA recruitment.


Could the MHFA role put volunteers’ wellbeing at risk?

Concern has been expressed by some employers and practitioners that MHFAiders’ wellbeing may be threatened, whether through additional workload and/or the ongoing emotional burden of supporting others in distress. Although more research is needed, this risk is not strongly supported in the research to date.

Our study found that while MHFAiders didn’t always maintain role boundaries (sometimes going beyond initial assistance and signposting), their mental wellbeing and attitudes did not significantly decline (or improve) post-training.

Aligned with previous research in work and non-work settings (e.g. Maslowski et al, 2019), this suggests that becoming a MHFAider is neither beneficial nor detrimental to the trainees’ mental wellbeing.

The study also found largely positive perceptions from MHFAiders three months after training. The majority said that becoming a MHFAider had enriched their role (86%), they found interactions rewarding (89%) and had used MHFA knowledge and skills to help them perform better (96%).

The workplace context where MHFAiders operate is likely to be an important factor in terms of experiences. In our study, the organisation had a large MHFA network, managed and supported by a mental health specialist, and MHFAiders could safely leave the role if needed.

Support for this approach was found, with levels of engagement with the network positively linked to MHFAiders’ mental wellbeing.

Although not measured, in organisations where MHFAiders are left to their own devices post training, less positive perceptions may be found.

Interestingly, with managers who became MHFAiders, perceptions of productivity improved post training, however job satisfaction decreased. The reasons for this are unclear, but it’s possible managers got involved in more mental health issues post-training and therefore felt productive, but potentially experienced role overload or role conflict as a result, contributing to lower satisfaction.

Understanding the experiences of managers who become MHFAiders is a key future research area and it’s important for employers to consider the unique needs of managers who become MHFAiders.


Is MHFA training suitable for the workplace?

In England, the two-day adult MHFA course (available to the general public) is typically delivered in the workplace. The training covers specific mental health conditions but, at the time of the research, didn’t include work stressors or other issues which may affect peoples’ mental health at work.

In our study, stress was the top reason for providing MHFA support. The impact of a workplace event or bullying and harassment were also common. The training was therefore not aligned with the situations commonly faced by workplace MHFAiders.

Changes to workplace MHFA programmes are needed to ensure more meaningful content and approaches (see also Narayanasamy et al, 2018).


Should MHFA be a legal requirement?

In 2021 a bill was proposed to make workplace MHFA a legal requirement in the UK. We argue against this as it’s too narrowly focused and prescriptive.

MHFA is only one option for support and evidence into its effectiveness is still limited. We believe employers should focus on a holistic and proactive approach to supporting mental health, tailored to their organisation. One size does not fit all and an enforced intervention in isolation is likely to be inadequate.


From research to reality

If you are considering MHFA provision in your workplace, we propose the following key messages:

1.Think about what you want to achieve in relation to mental health peer support. Do you want people trained to respond to mental health emergencies? Or is the need broader in terms of equipping employees to be supportive and caring colleagues on a daily basis?

MHFA is one programme, with a specific remit. It’s important to choose your learning products/programmes according to your organisation’s needs and aims around peer support.

2. Take a cautious and considered approach if implementing MHFA.

● Integrate MHFA as part of a holistic strategy, so employees aren’t going back into an environment full of unmanaged workplace stressors and lacking in support. Any benefits from MHFA will be eroded if this is the case.

● Consider the training recruitment strategy to ensure potentially vulnerable employees are not exposed to unnecessary risk.

● Clearly define the MHFA role in your workplace.

● Monitor and support MHFAiders to deliver against your requirements. A managed network, overseen by a workplace mental health specialist, is recommended.

● Collect meaningful data to help you understand and monitor the impact of, and engagement with, MHFA. Different groups may experience the MHFA role differently, e.g., in our study manager’s job satisfaction reduced. Collecting data is the best way to have insight into specific risks and opportunities.

3. Don’t rely on MHFA training as a tool for enhancing trainees’ mental wellbeing. Instead use appropriate mental health and wellbeing training programmes for this.

4. Be aware the research into workplace MHFA is still limited. More workplace studies are needed to explore the various issues surrounding the implementation, effectiveness and impact of MHFA.


Susannah Robertson-Hart is a chartered occupational psychologist and workplace mental health expert. She provides consultancy and support to organisations through her company, Healthy Work Psychology.

Sheena Johnson is a chartered occupational psychologist and professor of work psychology and wellbeing at the Alliance Manchester Business School. Her expertise focuses on the health and the wellbeing of the workforce.

This piece was first published as a PhD thesis and was peer-reviewed during the authors' viva.


This article appeared in the January/February 2024 print issue of HR magazine.

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