Mental Health First Aid in the Workplace: Why the Training Isn’t the Strategy

An organisation decides it needs mental health first aiders. It sends 10 or 20 people on a course, they get their certificates, and everybody feels like the job’s done.

Andy Griffiths, our founder, sees it differently.

For me, that’s actually where the job starts.

This article looks at what mental health first aid in the workplace really involves: what the law expects, who you choose, what happens after the course, and how you decide how many first aiders you need.

This article is part of our practical guide to workplace mental health training for UK employers.

Is mental health first aid a legal requirement?

Not at the moment. MPs have put forward bills to make mental health first aid a legal requirement in UK workplaces, but none has become law.

That doesn’t mean mental health sits outside your duties. The Health and Safety Executive’s first aid guidance says that, following your first aid needs assessment, “you might decide that it will be beneficial to have personnel trained to identify and understand symptoms and able to support someone who might be experiencing a mental health issue.”

Employers also have wider responsibilities, including assessing the risk of work related stress and making reasonable adjustments under the Equality Act. Our guide to what the law actually requires of you covers this in more detail.

So the question isn’t really whether you have to. It’s whether what you put in place will actually help when somebody isn’t okay.

The training is not the strategy

The most common mistake Andy sees is treating the course as the finished article. Mental health first aiders aren’t people you send on a course. They’re part of a system, and the system is what makes them useful.

Who you choose matters

One of the first things to ask is: who have you chosen?

Sometimes an email goes out asking, “Who wants to be a mental health first aider?” The people who volunteer aren’t necessarily the people their colleagues would naturally go to. That doesn’t make them the wrong people. But you have to think about trust.

• Who do people already talk to?
• Who is approachable?
• Have you got somebody on the night shift? In the warehouse? In the office?
• What about remote workers and different locations?

Be clear about what they are, and what they’re not

Mental health first aiders are not therapists. They’re not there to diagnose people, and they’re not there to carry somebody’s mental health on their shoulders.

Their job is to notice when something feels off, start a conversation, listen, understand the level of concern, know when something needs escalating and help that person towards the right support.

What happens on Monday morning?

This is the part organisations sometimes forget. Before the course, or straight after it, you need answers to questions like these:

• Where are the first aiders visible, and how does somebody contact them?
• What happens if somebody discloses suicidal thoughts?
• What happens if a first aider is concerned but doesn’t know whether to involve a manager or HR?
• What happens around confidentiality?
• Who do they speak to after a difficult conversation?

If we haven’t answered those questions, we’ve trained some people. We haven’t necessarily created anything useful.

Who looks after the first aiders?

We spend a lot of time talking about how mental health first aiders support everybody else. We don’t talk nearly enough about who supports them.

Somebody might tell them their marriage has fallen apart. Somebody might disclose abuse, or be struggling with alcohol, or tell them they’re having suicidal thoughts. Then we expect that first aider to finish the conversation, go back to their desk and get on with their day.

They’re still a human being. What they’ve heard might stay with them, or touch something in their own life. Afterwards they might wonder: did I say the right thing? Should I have done more? Should I tell somebody? Have I broken their confidence?

So first aiders need a structure around them:

• Somebody they can go to.
• Opportunities to debrief without breaching the other person’s confidentiality.
• Refreshers and ongoing conversations.
• Permission to say, “Actually, I’m not in the right place to have this conversation today.”

Without that, Andy has seen three things happen. Some first aiders stop because they lose confidence. Some start taking too much responsibility for people. And some become the person everybody brings everything to, until they’re carrying far more than they were ever trained or expected to carry.

Looking after the first aiders isn’t an optional extra. It’s part of making the whole thing safe.

There’s more on this in our article on how to support your mental health first aiders so they don’t burn out.

Stopping the training becoming an echo chamber

This is where I probably become a pain in the backside with organisations, because I keep asking, “What happens next?”

You can have a brilliant training day. Everybody’s engaged, there are great conversations, and people leave saying it was really useful. Then six months later, nothing. The certificates are in a folder, there might be a poster somewhere with some names on it, and nobody really knows what the first aiders are supposed to be doing.

That’s what an echo chamber looks like. People have been trained to have supportive conversations, but the organisation around them hasn’t changed. So the work is in what sits around the training:

• What are your policies and procedures?
• Where does the first aider’s responsibility stop?
• When does something go to a manager, and when does HR get involved?
• When might occupational health become involved?
• What’s the route if somebody is in crisis?
• What support is available internally and externally?
• How are conversations documented, if they need to be?

And, importantly, do the first aiders actually know any of that?

I don’t want somebody remembering slide 47 from a training course when they’ve got a distressed colleague sitting opposite them.

Instead, Andy wants them thinking: I know what my role is. I know what I can do. I know what I can’t do. And I know where we go next. Our article on how EAP, occupational health and first aiders fit together goes into that in more depth.

Visibility matters too. Keep talking about the first aiders, refresh their skills, give them chances to practise and check in with them. And make mental health conversations part of what managers do as well. Otherwise you end up with a handful of people trained to talk about mental health while the rest of the organisation carries on exactly as it did before.

How many first aiders, and at which level?

Everybody wants a number, and that’s understandable. HR needs something to put into a plan and a budget. But Andy would never start with a ratio. He’d start with the organisation.

You’ve got 300 employees. Where are they? Are they all in one building, or spread across six sites? Are people working shifts, or remotely? What happens at two o’clock in the morning? Who do people actually trust? What risks exist in that workforce, and what support already exists?

Ten brilliantly positioned, well supported people could be much more useful than 30 names on a spreadsheet.

Not everybody needs the same training either. A large group of people may simply need mental health awareness: recognising when something doesn’t seem right, starting a basic conversation and knowing where support exists. Others will need stronger practical skills because they’re more likely to be having those conversations. And managers carry different responsibilities again, such as absence, performance, reasonable adjustments, confidentiality and return to work, which is what our mental health training for managers is built around.

Anyone can take any level of our First Aid for Mental Health training. What matters is the role someone will take on, not how senior they are. Our guides to how many mental health first aiders you need and choosing between Level 1, 2 or 3 help with both decisions.

And if you’re working out a budget, our guide to mental health first aid training costs sets out what to expect and what to look for.

That’s why we ask a lot of questions before recommending anything. If you ring us and say, “We’ve got 500 employees, how many people should we put on your course?“, we genuinely need to know more.

I’d rather ask you ten questions before I sell you anything.

Because the question isn’t really “How many mental health first aiders do we need?” It’s this:

How do we make sure that when somebody in this organisation isn’t okay, there’s somebody they trust who notices, knows how to start that conversation, and knows what happens next?

Common questions