Hazards banner
       Hazards, number 141, 2018
Is Mental Health First Aid the answer? Depends on the question.
If your heart started misbehaving at work, you’d be glad there was a first aider on hand. So, a mental health first aider could be just the job if the problem is in your head, right? TUC’s Hugh Robertson says support for workers is a good thing, but mental health first aiders are not the only option and for union reps usually are not the best option.


Mental Health First Aid (MHFA) has been one of the fastest growing practices in the workplace in the past couple of years.

It has been taken up with gusto by some employers. And it has political support. The 2017 Conservative Party manifesto promised: “We will amend health and safety regulations so that employers provide appropriate first aid training and needs assessment for mental health.” Although the prospect of new regulations seems to have ebbed away, the government has since announced a £15 million programme with the aim of seeing up to 1 million people trained in basic mental health “first aid” skills (Hazards 140).

STANDARD RESPONSE  The October 2017 Thriving at work report commissioned by prime minister Theresa May included a call for wide-ranging action on mental health and recommended new ‘mental health core standards’. more

Given the importance of dealing with mental health issues in the workplace and the increasing popularity of this one approach – MHFA -  how should unions be responding?

Are employers just passing the responsibilities on to workers for their own failure to deal with mental health issues? Or is it a genuine solution to a serious problem?

What is MHFA?

Mental Health First Aid is exactly what it suggests, a first aid approach to mental health. It follows a training programme that teaches participants how to notice and support an individual who may be experiencing a mental health concern and provide help – often through connecting them with a route to help and support.

Once they are trained, the role of a Mental Health First Aider in the workplace is to be a point of contact for an employee who is experiencing a mental health issue or emotional distress.

This interaction could range from having an initial conversation through to supporting the person to get appropriate help. There can also be a proactive role in making sure that fellow workers have a better understanding of mental health issues.

MHFA is primarily overseen by non-profit bodies or the NHS, but the actual delivery in the workplace is often done by commercial bodies or consultants, who have to keep to the curriculum of the national body and use their materials.

In the decade from 2007, almost 200,000 Mental Health First Aiders were trained in the UK.

What do MHFAiders do?

MHFA trainees undertake a standard 12-hour course, usually delivered over two days or four half-days. It is pretty comprehensive, although there are MHFA-lite courses on offer as well. The training is intended to impart a deeper understanding of issues that impact on and relate to people’s mental health.

Standard courses include:

Common mental health problems
Attitudes and the ‘See Me’ anti-stigma campaign
The five steps of mental health first aid (ALGEE, below)
Symptoms of depression
Alcohol, drugs and depression
Crisis first aid for suicidal behaviour and depression
What are anxiety disorders
Crisis first aid for panic attacks and acute stress reaction
What are psychotic disorders (schizophrenia, bipolar disorder)?

The training is aimed to give a deeper understanding of the issues that impact on and relate to people’s mental health and teach practical skills that can be used every day. ‘MHFAiders’ are taught to spot the signs and symptoms of mental health issues and to feel confident guiding people towards support. They are encouraged to use the ‘ALGEE’ approach:

Ask about suicide
Listen non-judgmentally
Give reassurance and information
Encourage the person to get appropriate help and support
Encourage self-help strategies.

Courses typically cost between £100 and £200 but can be much more expensive. In Scotland the courses are often provided free. The Northern TUC Better Work Initiative provides the training at £25 a head.

Does MHFA work?

Does it work? Well, that depends on what you want to prove.

There is little evidence as yet about the impact of MHFA on individuals who experience problems at work. That is not surprising because it would be very difficult to prove that MHFA is responsible for any changes in a particular workplace, especially when it is often brought in along with other workplace initiatives.

There is though evidence that people who are trained in MHFA at work are more knowledgeable and supportive. An analysis of 15 evaluation studies found that MHFA training “increases participants' knowledge regarding mental health, decreases their negative attitudes, and increases supportive behaviours toward individuals with mental health problems.”

 If you are working age, then it is likely you take any mental health problems you have into work. Unions argue these workers need more than first aid, they need action to reduce the work-related pressures that could cause or exacerbate their condition.

What is not clear is whether this increased knowledge and change in attitudes is translated into action, and most of the evidence that does exist comes from the perceptions of those who have been trained, rather than those with mental health problems who have been in contact with them.

 There is, however, anecdotal evidence from individuals who say they have been helped by a mental health first aider.

Limits and concerns

MHFA training in the UK does deal with stress but not with prevention.

There is also a lack of recognition of the role that unions can play in supporting members with mental health issues, despite this being given considerable attention in union guides and training programmes. While MHFA is by its nature mainly reactive, it would be good to have some recognition of how unions are critical to helping prevent problems, especially when they are related to stress, bullying, harassment and workload.

CHECKLIST  Any employer who wants to address mental health issues in the workplace needs to look much wider than MHFA, and that is best done in co-operation with unions. more.

The MHFA England Line Managers Resource, published in 2016, only makes one mention of unions. That is limited to how managers can use them if an employee who is off sick does not want to be contacted by management. Clearly this is a big omission.

References in the MHFA course material to more controversial topics such as resilience are also a concern.  But the training does not place any great emphasis on the role of non-proven interventions such as resilience and mindfulness as a preventive measure, only as a way of helping those who actually have anxiety or depression.

Helping people deal with their mental health issues often has to include an element of empowering them. That is different from the idea of ‘resilience’, instead allowing people to understand some of the context of their issues and, when appropriate, to be angry about it. It also should ensure that employers are challenged when they refuse to make the necessary adjustments to support workers with a mental health condition or try to victimise them.

Another very big concern is that MHFA is a sticking plaster on the gaping wound that is mental health support in this country. The provision of services for those with mental health problems is appalling, with people having to wait months for a referral, and even then often being unable to access appropriate support and help.

Some mental health advocates have criticised MHFA as being far too ready to uncritically brand all mental health conditions as an “illness” that needs be treated, while often they are just a variation from the norm that needs understanding. Not all people with a mental health condition see themselves as being “ill”, nor do they see their condition as being a “problem”.  However, MHFA training does recognise this and emphasises what it calls the “mental health continuum”.

Many of the criticisms of MHFA, while valid, are more just an acknowledgement that MHFA has its limitations and that it has never claimed to be any more than a first aid approach to mental health. Very similar criticisms could be made of traditional first aid training which is not a substitute for employers preventing injury and providing access to occupational health support and does not seek to replace paramedics or doctors. Yet few people would doubt that first aid training has its uses, however limited.

Different countries have different emphases. While in the USA the course seems to deal more heavily with substance abuse, for example, the UK puts more emphasis on suicide prevention.

Other models at work

MHFA is now a recognised ‘brand’ with accreditation and certification and can have a useful role to play in the workplace - but employers and unions should also consider other approaches.

‘Mental Health Awareness’ training can be offered to either staff or managers. Courses are available in most parts of the UK, often through mental health charities. Frequently, they can be tailored to your workplace and could include a union input. In Wales, the Wales TUC is closely involved in supporting workplace training with ‘Training in Mind’. Mental health awareness training can run alongside MHFA.

Certainly, all employers should be considering training their line managers in mental health issues. Scottish Healthy Working Lives offers a course for line managers called ‘Mentally Healthy Workplace’ that includes good practice in promoting positive mental health and wellbeing, as well as offering practical examples of how to support employees experiencing mental health problems. Other organisations such as the Centre for Mental Health also provide training, as do several mental health charities.

For trade union representatives MHFA is probably not the most suitable training. This is because their role is not just to signpost individuals to a support service, but to try to resolve any workplace issues that may be contributing to their mental health problems. The union call also ensure the employer makes any necessary adjustments.

That is why mental health awareness training, which can be provided by the TUC, is often more appropriate for workplace representatives.  It will increase their awareness of how the workplace can affect mental health and help unions improve policies for their members. This approach puts more emphasis on prevention rather than just awareness. The course are run by the TUC nationally and by the Wales TUC.

Any employer who thinks they can deal with mental health concerns just by introducing MHFA, offered to a few handpicked ‘Mental Health Champions’, is very much mistaken. MHFA is not going to change the workforce on its own and should be seen as one of a range of initiatives that employers need to introduce.

MHFA, like traditional first aid, does not claim to be a solution to workplace mental health problems. First id trainers in the workplace are not an alternative to having an occupational health service and good prevention procedures in place. Nor do first aiders seek to replace paramedics.

The same is true of MHFAiders. Those who are trained in MHFA are not therapists or psychiatrists. Employers have a major role to play in prevention and providing support over and above just providing MHFAiders.

MHFA, like traditional first aid, is not about prevention. And ill-health prevention – mental or physical - is a priority unions will not ignore.


TUC workbook on mental health in the workplace.
TUC work and suicide prevention guide for activists.
TUC training.
Unionlearn mental health signposting guide for workplace representatives.
Workplace stress and mental health.
Work and suicide.
Insecure work.
PHE/BITC toolkit.
Mental Health First Aid England.
Workplace health: management practices (NICE Guidance).
HSE Line Manager Competency Tool.
ACAS Mental health in the workplace advice.

Mental health at work
Good practice checklist

Any employer who wants to address mental health issues in the workplace needs to look much wider than MHFA, and that is best done in co-operation with unions.
Public Health England and Business in the Community have produced a toolkit for employers on what they should do. This says a good policy will include:

High level commitment to challenging the stigma that surrounds mental health issues.
A recruitment policy that does not discriminate against those with mental health conditions.
A review of sickness absence policies to ensure they do not discriminate against those with mental health conditions.
Early access to occupational health services.
Training all staff on mental health (ideally jointly with the union).
Separate mental health awareness training for all line managers.
The provision of an Employee Assistance programme.
Strong anti-bullying and harassment procedures.
A stress management policy.
If there are MHFAiders, a system of support for them, including regular meetings.

Unions clearly must be involved both in working with their employer around mental health and supporting members with mental health problems, says the TUC. That includes challenging any stigma or discrimination.

The TUC adds that many unions have also run campaigns around mental health issues so always look on your union’s website for resources you can use.


Thriving at work?

The October 2017 Thriving at work report commissioned by prime minister Theresa May (Hazards 140) included a call for wide-ranging action on mental health and recommended  new ‘mental health core standards’. The report says these provide a framework for a set of actions all organisations in the country are capable of implementing quickly. These mental health core standards are:

Produce, implement and communicate a mental health at work plan;
Develop mental health awareness among employees;
Encourage open conversations about mental health and the support available when employees are struggling;
Provide employees with good working conditions and ensure they have a healthy work life balance and opportunities for development;
Promote effective people management through line managers and supervisors;
Routinely monitor employee mental health and well-being.”

The government has called on NHS England and the civil service to accept the report’s recommendations.

Thriving at Work: a review of mental health and employers, an independent report for DWP/DoH, 26 October 2017 [pdf].

Top of the page





Mental problems

If your heart started misbehaving at work, you’d be glad there was a first aider on hand. So, a mental health first aider could be just the job if the problem is in your head, right? TUC’s Hugh Robertson says support for workers is a good thing, but mental health first aiders are not the only option and for union reps usually are not the best option.

What is MHFA?
What do MHFAiders do?
Does MHFA work?
Limits and concerns
Other models at work

Related items
Mental health at work
Good practice checklist
Thriving at work?

Hazards webpages
Workplace stress and mental health
Work and suicide
Insecure work