Mental health first aid – a ticking time-bomb in the workplace?

Putting in place mental health first aid (MHFA) is seen by many employers as a practical, relatively easy way to be supporting employees with stress, anxiety and other mental or emotional health issues. But if MHFA is not backed up with proper training, leadership and oversight it can end up doing more harm than good, argues Emily Pearson.

To think that a near-miss in the workplace only relates to physical health and safety is naïve, even dangerous.

Mental health first aid programmes are not a one-size-fits-all solution to mental ill health at work. Of course, the rise of workplace mental health awareness for the most part is positive; raising awareness, educating people and reducing stigma can help us all.

About the author

Emily Pearson is founder of corporate mental health consultancy Our Mind’s Work

Providing individuals with the opportunity to proactively look after their own mental health, access professional support much earlier and provide employers with the tools to implement constructive culture change must also be good.

However, in many workplaces I believe there is a ticking time-bomb here that can get overlooked if you’re not careful.

Friday afternoon emergency

It is a Friday afternoon, commonly the time of the week when emergencies can happen. The office phone rings and I answer it.

The caller is an HR director from a global organisation. He sounds very worried and asks for my advice. His company has implemented a mental health first aid programme. One of its appointed MHFAs has been providing listening and signposting support for a colleague who has indicated they wanted to kill themselves during the course of their conversation.

Now, as a trained mental health and social care professional I have worked in the field for over 20 years. In that time I have had this conversation with hundreds of people in crisis.

As you would expect, I’ve had comprehensive training. I have close knowledge of policies and procedures in the workplace for this exact scenario. And I understand safeguarding for individuals at risk of significant harm.

However, in the situation highlighted by the HR director none of this has been provided. He has an MHFA who has insufficient training to deal with a safeguarding incident, no existing policy or procedure in place, no experience of safely managing such a critical incident. Of course, this leaves both employer and employee at risk of a tragic incident unfolding.

The inexperienced MHFA with no guidance from their workplace chose not to breach confidentiality after their colleague then retracted their suicidal thoughts admission.

No report was filed and no contact with a crisis team was made to allow a proper assessment to be carried out. How is the MHFA supposed to know that, in this situation, correct procedure would actually be to break confidentiality, in view of the high risk of harm or self harm?

As a result, an attempted suicide could have occurred. Luckily for everyone, the colleague in crisis chose then to go and tell their line manager that they were still thinking about killing themselves. That manager then breached confidentiality and escalated things to HR, hence the phone-call to me from one seriously concerned HR director.

Potential dire consequences

This near miss could not only have resulted in a preventable loss of life. The impact this would have had on the MHFA’s mental health, and the resulting investigation into the responsible business could have had dire consequences for all concerned.

Just because mental health first aid has become so visible, with more than 400,000 registered in the UK alone, does not mean that mental ill health has been addressed and resolved risk-free.

Organisations training people on a two day-course then placing them back in the workplace with no structure, professional support or guidance on how to safely implement this new role, need to take stock.

Ignorance leading to over confidence that a solution has been found to mental health issues in the workplace is potentially creating more risk than not having MHFAs in the first place.

This is why support and guidance is needed from professional mental health practitioners such as myself.

There needs to be a reality check and continued collaboration between all professional groups, including the Health and Safety Executive (HSE), IOSH (The Institution of Occupational Safety and Health) and organisations such as the BACP (the British Association for Counselling and Psychotherapy) to ensure the efficacy of industry research and concerns about workplace safety produce solutions to effectively address these foreseeable risks. At a practical workplace level, if an organisation uses an occupational health provider, then that service should also play a pivotal leadership and oversight role.

On balance, it is fantastic that mental health is now far more widely talked about and recognised as a real issue in the workplace.

But this has led to a position where there is a real risk of employers misunderstanding the role of MHFAs. They are not, to repeat, a one-size-fits-all solution to mental health issues. MHFAs are also not professional counsellors, and, crucially, an MHFA programme does not negate the need for proper policy, procedure and process to put be in place to accompany it.

If anything, the prevalence of mental health programmes being implemented in the workplace actually makes it more imperative that correct systems, training, leadership and support exist so that all parties fully understand their role and competence.

At a glance

Here are my five pointers for implementing mental health advocates or first aiders effectively within the workplace.

  1. Clear communication. Clearly communicate on what the role of the mental health advocate service is and what it isn’t.
  2. An emphasis on compliance. Ensure you have a clear safeguarding and confidentiality policy and procedure in place.
  3. Robust recruitment. A safe recruitment process should be followed, taking into consideration the possibility that employees expressing an interest in an MHFA role may already have “lived experience” of mental ill health or even an existing mental health problem. This can of course be a strength for the role. But it also means that, as an employer, it is vital you take responsibility for keeping them safe and that their own health and safety is at the forefront of the way any MHFA service is set up.
  4. Effective, ongoing training and support. Supporting your mental health advocates or first aiders through ongoing training and support is essential to ensure they feel confident and supported in their role.
  5. Data collection and monitoring. Data collection will provide your MHFA service with properly evidenced outcomes. However, it may be self-evident but this is nevertheless important to reiterate – remember the data should be anonymous and confidential.

2 Responses to Mental health first aid – a ticking time-bomb in the workplace?

  1. Avatar
    Mark Smith 4 Apr 2020 at 9:25 pm #

    MHFA is not perfect, but it’s a lot better than the stigma that arises from ignorance.

    The acronym ALGEE – E for encourage professional support.

    The crisis plan taught in MHFA from suicidal through a and behaviours is to stay with the person or alert someone who can – so a person trained MHFA knows not to keep suicidal conversations confidential.

    Regular First Aid does not replace a doctor, it preserves life until one can be accessed.

    MHFA does the same thing for a person who need psychological or psychiatric support.

    I totally disagree with the premise of this article.

    • Avatar
      Chris Stein 8 Apr 2020 at 2:19 pm #

      I agree with Mark above. As a trainer in MHFA, I stress from the beginning to the end that in the event of a person proving a risk of harm to self or others, the first aider must never agree to keep “secrets”.

      I too have more than 15 years working with vulnerable people and would always state openly and honestly that all conversations are confidential subject to the rules of safeguarding as stated above.

      Even if another trainer were not as experienced or conscientious as me, the same statements are made in the slides and in the supporting manual.

      I also disagree with the premise of this article.

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