When ticking the box becomes the whole strategy
I’ve sat in enough boardrooms and HR meetings now to know the moment when a company decides it’s “doing something” about mental health. Someone books a two-day Mental Health First Aid course for a handful of staff, a certificate goes on the wall, and the box gets ticked. Job done.
Except it isn’t. And the evidence backing that up is a lot stronger than most people realise.
The uncomfortable numbers
Around half a million people in Britain have now done MHFA training. FTSE 100 firms have trained thousands of staff between them. On paper, this looks like a workforce that takes mental health seriously.
Dig into the CIPD’s own data and a different picture appears. Organisations are far more likely to train a handful of mental health first aiders than they are to train the line managers who actually manage the people day to day. A third of organisations openly describe themselves as reactive rather than proactive: they act once someone’s already off sick, not before. Half have no formal wellbeing strategy at all. They’re doing something, without doing it as part of anything.
That gap matters, because poor mental health is currently estimated to cost UK employers £51 billion a year, and over 22 million working days were lost to work-related stress, depression and anxiety in the last reporting year. This isn’t a nice to have wellbeing initiative sitting on the fringes of the business. It’s one of the biggest hidden costs most organisations are carrying.
Why “tick-box” isn’t me being cynical. It’s the industry’s own words
I didn’t invent this framing. It’s used openly by HR trade press, by wellbeing providers, and, tellingly, by former MHFA England board members themselves. The appeal is obvious: a training certificate gives you a clean audit trail. It looks like proof that something was done, whether or not anything actually changed.
And here’s the part that should give every HR director pause: there’s currently no legal requirement to appoint mental health first aiders. Physical first aid is mandated by law. Mental health first aid isn’t. Health and Safety Executive guidance was updated to nudge employers to think about mental health in their first aid planning, but it stops short of a duty. Without that legal weight behind it, training a few volunteers becomes the easiest, cheapest, most visible thing a company can point to, while the harder work of actually reducing workplace stress goes untouched.
The evidence is blunter than most people expect
This is the bit that tends to stop conversations in their tracks when I raise it with clients.
The Health and Safety Executive’s own 2018 research review found no evidence that MHFA training on its own leads to sustained behaviour change in the people trained, or to any measurable improvement in how organisations manage mental ill health more broadly.
A feasibility study out of Nottingham found something similar: organisations were often using the training to demonstrate they were taking mental health seriously, while giving trained first aiders no clear boundaries, no defined referral pathway, and no consistent way of even letting the rest of the workforce know who they were. Trained, certified, and functionally invisible.
Then, in 2023, Cochrane, about as rigorous a source as you’ll find, reviewed 21 trials covering over 22,000 participants and concluded that MHFA training, on its own, has little to no measurable effect on the mental health of the people around the trained first aider. The lead author was direct about it: if the goal is improving staff wellbeing, there’s currently no good evidence that MHFA training alone gets you there.
To be clear, none of this means the training is worthless. It raises awareness. It reduces stigma. People who take it come away more literate about mental health, more confident having the conversation. That part holds up. What doesn’t hold up is the idea that training a handful of people, on its own, changes anything about how an organisation actually functions.
The part nobody talks about: what it does to the first aiders themselves
This is the one I find hardest to sit with, because I’ve seen it up close.
When a company trains mental health first aiders and then gives them nothing else (no protected time, no supervision, no clear limits on the role, no support of their own) those people become the de facto emotional support system for the whole building. Family breakdowns, financial stress, suicidal ideation. Whatever walks through the door, walks through their door, because there’s nowhere else for it to go.
A mental health first aider isn’t a therapist, in the same way a physical first aider isn’t a paramedic. Their job is to notice, respond in the moment, and point someone toward proper support. But that third step, the signposting, only works if there’s somewhere real to signpost to. If the organisation hasn’t built that pathway, the first aider is left holding something they were never equipped to carry alone. Burnout, compassion fatigue, and real confidentiality and legal exposure follow.
A burnt-out first aider helps nobody. Least of all themselves.
What actually works
None of this is a call to abandon MHFA. It’s a call to stop treating it as the whole strategy when it was only ever meant to be one part of one.
The Stevenson/Farmer “Thriving at Work” review laid out what a serious approach looks like back in 2017: a proper mental health plan, genuine awareness building, a culture where people can actually talk about it, decent working conditions, line managers who are equipped (not just first aiders), and routine monitoring of how the workforce is actually doing. MHFA sits inside that framework. It was never meant to replace it.
In practice, that means:
- Start with a needs assessment, not a training booking. Find out what’s actually driving stress in your organisation before you decide how many people need a certificate.
- Train your managers, not just your first aiders. They’re the ones who control workload, deadlines and day to day working conditions: the things that actually cause most work-related stress in the first place.
- Build the infrastructure before you train anyone. Define the role clearly, protect time for it in the working week, and have a real referral pathway in place before the first course even runs.
- Look after the people you’ve trained. Monitor how much they’re carrying, give them their own access to support, and let them step back when they need to.
- Measure the right things. Not how many people have a certificate, but whether absence, presenteeism and stress levels are actually moving.
The question worth asking
If you’re an employer reading this and MHFA is the centrepiece of your mental health strategy rather than one part of it, the honest question is: what happens to the causes of stress in your organisation while your first aiders are busy managing the fallout?
Training people to respond to a crisis is worthwhile. Building a workplace that produces fewer crises in the first place is the actual job. Most organisations are still only doing the first one.
