Mental health first aid is a divisive topic. Emily Pearson outlines three reasons why she thinks the move to make MHFA training mandatory is unwise.
With an MP recently introducing a private members’ bill to make mental health first aid training mandatory for employers, the debate over whether this is a good idea rages on.
For me, working in health and social care for over 20 years, I have noticed three significant areas of concern that are being ignored. This is worrying, as governments and organisations continue to invest millions into the practice.
Mental health first aid is not the ‘gold standard’ employers think it is.
1. Lack of evidence
Over two decades’ worth of evidence suggests that mental health first aid (MHFA) is ineffective. There are no studies that demonstrate MHFA succeeds in helping individuals with mental illness improve their mental health or receive appropriate treatment or services.
A study by the Manhattan Institute into the efficacy of MHFA reviewed 46 publications. Notably, 16 publications were by the programme creator, Mental Health First Aid International. The MHFA official website highlights 13 case studies that purportedly show the effectiveness of the programme, but the strongest evidence it provides is still weak, however.
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No study has been able to demonstrate evidence that MHFA serves its intended purpose of helping individuals with mental illness in crisis, whether to connect them with treatment or improve their symptoms.
In addition, an intervention like MHFA relies on employees approaching a mental health first aider with their concerns, which takes courage. Having MHFAs does not automatically mean they are utilised.
2. Lack of regulation
Having MHFAs with little or no service infrastructure, safe recruitment process, governance, safeguarding, monitoring, reviewing, ongoing support or development begs the question: why are we trying to reinforce this approach through statute when there is no regulation to safeguard people and organisations from hazards already known?
There is no regulating body for MHFA. It is not within the remit of the Health and Safety Executive (HSE), which regulates for health and safety including physical first aid.
Employers already have a legal duty to prevent work-related stress. However, we are a long way off getting this right and preventing the causes of psychological injury in the workplace, or this being enforced by HSE.
Why do we think that bringing in something that is unregulated, underused and ineffective is going to make any difference to employees’ mental health?
The MHFA bill is actually old news, as the first reading in Parliament took place in March 2021; it has taken this long to move to its second reading.
Why do we think that bringing in something that is unregulated, underused and ineffective is going to make any difference to employees’ mental health?”
3. Monopolisation and a barrier for the evolving field of mental health
There is also the risk that it could block the progression of mental health interventions. This is because its content is based on the Diagnostic and Statistical Manual of Mental (DSM) disorders model. This has been the reference book on mental health and brain-related conditions and disorders, and has been the accepted orthodoxy on approaches to mental health.
DSM is a school of thought representing the views of a particular group of psychiatrists who label specific symptoms to medicate people. This orthodoxy is being challenged by psychiatry itself and the “drop the disorder” movement has already begun to change how mental health professionals are working with people experiencing mental distress.
Psychiatry is trying to move away from labelling disorders toward a formulation approach that promotes the understanding of the damage that is often done by psychiatric diagnoses and the vested interests in perpetuating them.
Many experts in the field cite generalised ‘labelling’, which is what DSM leads to, as a problem that moves the individual away from the real source of their distress. Often this is very specific to the individual, rendering a label unhelpful for many. Mental health assessment is now more a formulation based on the personal meaning of circumstances and interaction.
How can we progress further in this field if there is a legal requirement to train people in the existing conventions of approach that the mental health profession is beginning to move away from?
The legislation is unlikely to pass
I personally will be very surprised if the government took a risk by passing this law. Lives can be saved with the many more interventions that are provided by organisations that are not MHFA England or those that provide MHFA-based content.
The promotion given to MHFA has done the job of bringing mental health in the workplace into the public discourse, but the issue is bigger than responding in crisis and providing education based only on the psychiatric model.
Culture is one of the root causes of workplace mental illness and this won’t be changed by one specific approach over another. The issue is too complex, nuanced and unique to each organisation and individual.
Culture is one of the root causes of workplace mental illness and this won’t be changed by one specific approach over another.”
We all would love to find a silver bullet that tackles issues like work-related stress, depression and at its most tragic, suicide, but I’m afraid a one-size-fits-all approach is unlikely to come. With an estimated 10% of suicides in the UK being caused by work, it’s a topic that needs action and not simply sending a handful of staff on an MHFA training course.
Employers hold awareness days and events which are often based on mental illnesses and aimed at individuals. They’re often delivered without safety nets in place for employees if they are struggling with the topic of that month’s campaign. Work is often the root cause of poor mental health in the first place, meaning the issue can only be tackled if the employer is prepared to undergo significant culture change.
Delivering a strategic approach to improving mental health and wellbeing requires a best practice framework that embeds culture change and doesn’t simply tick a box.
One of the problems with mental health strategies is that most companies don’t have one. At most, they will have invested in MHFAs, and then wonder why only a limited number of employees are talking to them.
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We know from our own experience, and that of clients, that MHFA is an approach that blames poor mental health on the individual. There are more effective initiatives aimed at providing crisis support.
Organisations that shift their thinking towards what they can do to help their people thrive will see the biggest impact and return on investment.
