Rethinking Mental Health First Aid: A Solution, or Just a Starting Point?
Mental health challenges in the workplace aren’t new—but their impact is growing, with 1 in 6.8 people experiencing mental health issues in the workplace (Lelliot et al, 2008). Research by the OECD found that mental health problems cost the UK economy between £70 billion and £100 billion annually.
In response, organisations across industries have been investing in solutions — one of the most prominent being Mental Health First Aid (MHFA) training, now carried out across many industries in the UK and beyond. But while the adoption of Mental Health First Aid (MHFA) is widespread, this article explores why it is not necessarily the silver bullet it it's often made out to be.
What is Mental Health First Aid training?
Now implemented across the world, MHFA is a course designed to equip people with…
the skills to spot signs of poor mental health,
the confidence to start a conversation
the knowledge to provide appropriate mental health support
Mental Health First Aid Action Plan
MHFA aims to increase knowledge regarding mental health, encourage open communication, and reduce stigma towards mental illness. There are now over half a million Mental Health First Aiders in England, everyone from teachers to managers to police, and across the general public (MHFA England Impact Report).
MHFA is not a form of therapy or treatment. It’s a mental health literacy intervention designed to equip everyday people with the knowledge and confidence to respond to mental health challenges. Much like physical first aid, MHFA adopts a first responder mindset—it doesn't aim to "fix" the problem but provides critical early support and helps direct someone to professional care.
Credit: Anthony Jorm and Betty Kitchener: Mental Health First Aid Manual (2002).
A success story?
Evidence from over 70 peer-reviewed studies in the U.S. shows that MHFA trainees are…
Better at recognising the signs and symptoms of mental health
Know how to connect people with appropriate professional and self-help resources.
Experience reduced stigma and increased empathy.
More confident and more likely to take action when someone is in distress.
A study by Narayanasamy et al. (2018) found similar positive outcomes of MHFA trained employees. As shown in the infographic from MHFA England.
A success story, Thames Water have seen a ‘cultural revolution’ due to the implementation of widespread MHFA training. With the capacity to better manage and support people experiencing mental health issues, Thames Water have seen an increase in referrals to the occupational health team and an 80% reduction in work-related illness absence over 5 years. By fostering a more supportive and empathetic environment, companies may see improved communication, stronger employee engagement, and potentially even lower absenteeism and turnover.
Credit: Edu-c8 Mental Health & Wellbeing: Reasons to invest in mental health in the workplace (https://edu-c8.co.uk/about-mhfa-england/reasons-to-invest/).
Some potential cons…
Becoming a okenistic, box-ticking exercise
The risk of MHFA training becoming a performative is of real concern, particularly if made a legal requirement, as proposed in the UK by MP and MHFA board member Dean Russell. Critics warn that this could lead employers to treat MHFA as a token gesture rather than part of a meaningful and holistic mental health strategy. Without accessible support systems, regular, high-quality training, and following-up, MHFA can risk being symbolic rather than substantive.
Safeguarding
MHFA-trained individuals may be expected to take on responsibilities similar to those in formal safeguarding roles - without the years of experience, training, or legal protections. Confusion around roles creates a grey area around liability, confidentiality, and expectations, especially if unintentional emotional harm is caused. Narayanasamy et al. (2018) provide key recommendations to deal with this issue, including...
Appointing a formal MHFA coordinator.
Formulating and disseminating company guidelines surrounding the role and responsibilities of MHFA trainees.
Ensuring safeguarding procedures are in place for trainees, for example through debriefing sessions after MHFA experiences.
Big, misleading claims about MHFA’s impact on mental health
Despite its popularity, current research is questioning its impact on mental health outcomes. Meta-analyses, such as one by Forthal et al (2022), have found little to no evidence that MFHA enhances the quality of skills or support provided by trainees or benefits the mental health of those receiving help. Similarly, Morgan et al (2019) found that while MHFA training for parents improved their mental health literacy, it had no impact on the mental health of the children who received support from their parents.
The lack of rigorous, standardised, long-term studies tracking mental health outcomes as a result of MHFA training means claims that it directly improves mental health should be viewed with caution until further research is conducted.
To conclude…
While Mental Health First Aid training plays a valuable role in increasing awareness and encouraging conversations around mental health, it is not a silver bullet. Its growing popularity should not overshadow the need for more comprehensive, holistic approaches to mental health support—especially in the workplace. If organisations rely solely on MHFA as their mental health solution, they risk adopting a surface-level, performative approach that does little to address the root causes of poor mental health.
For MHFA to be genuinely effective, it must be embedded within a broader, sustained commitment to wellbeing—supported by clear policies, professional care pathways, and ongoing evaluation. Only then can it contribute meaningfully to tackling the mental health crisis we face today.
Additional Resources:
Mental Health First Aid England
St. John Ambulance Mental Health First Aid Training courses
Mind.org: Guide for employees: Wellness Action Plans
Mental Health and Wellbeing in the Workplace: A Practical Guide for Employers and Employees, by Gill Hasson and Donna Butler
Report: The value of Occupational Health and Human Resources in supporting mental health and wellbeing in the workplace
References:
[1] Morgan AJ, Ross A, Reavley NJ (2018) Systematic review and meta-analysis of Mental Health First Aid training: Effects on knowledge, stigma, and helping behaviour. PLoS One 13. Available at: https://pubmed.ncbi.nlm.nih.gov/29851974/
[2] Maslowski AK, LaCaille RA, LaCaille LJ, et al. : Effectiveness of mental health first aid: a meta-analysis. Mental Health Review Journal, 2019
[3] Forthal, S., Sadowska, K., Pike, K. M., Balachander, M., Jacobsson, K., & Hermosilla, S. (2022). Mental Health First Aid: A Systematic Review of Trainee Behavior and Recipient Mental Health Outcomes. Psychiatric Services (Washington, D.C.), 73(4), 439–446. https://doi.org/10.1176/appi.ps.202100027
[4] Narayanasamy, M., Geraghty, J., Coole, C., Nouri, F., Thomson, L., Callaghan, P., & Drummond, A. (2018). MENtal health first aid in The wORkplace (MENTOR): A feasibility study. https://nottingham-repository.worktribe.com/output/1417702/mental-health-first-aid-in-the-workplace-mentor-a-feasibility-study
[7] Lelliott, P., et al (2008) Mental health and work. Royal College of Psychiatrists, London, UK. Available at: https://assets.publishing.service.gov.uk/media/5a7c194640f0b645ba3c6af5/hwwb-mental-health-and-work.pdf
[9] Morgan, A. J., Fischer, J.-A. A., Hart, L. M., Kelly, C. M., Kitchener, B. A., Reavley, N. J., Yap, M. B. H., Cvetkovski, S., & Jorm, A. F. (2019). Does Mental Health First Aid training improve the mental health of aid recipients? The training for parents of teenagers randomised controlled trial. BMC Psychiatry, 19(1), 99. https://doi.org/10.1186/s12888-019-2085-8