There is a quiet pressure on many employers to “do something” about mental health.

In response, mental health first aid at work is often one of the first interventions purchased. It is visible, relatively straightforward to organise and easy to explain to employees. It gives an organisation trained people, a named initiative and a practical way to begin conversations.

That matters.

But it also raises an important question: what problem are we actually asking mental health first aiders to solve?

As a psychotherapist and workplace mental health consultant, I see real value in the role. I also see the risks when a first aider is expected to carry responsibilities that belong to managers, HR, occupational health or clinical services.

Mental health first aid at work can be useful. It cannot be the whole mental health strategy.

Why employers often start with mental health first aid at work

For HR, People and L&D teams, the first aider model can feel like a practical entry point into a complex subject. It offers:

A defined training programme.
A network of visible points of contact.
A way to reduce stigma and introduce shared language.
A route into early listening and signposting.
A tangible response to employee concerns.
A programme that can reach people beyond the usual HR channels.

This is particularly relevant in male-dominated, high-hazard and shift-based workplaces. Employees may be working nights, moving between sites or operating in environments where formal support feels remote from everyday working life, which is one reason mental health first aid at work is often seen as an accessible starting point.

A colleague may be more approachable than HR. A trusted supervisor or peer may notice that someone has become unusually withdrawn, irritable or exhausted. The nervous system often communicates distress through changes in behaviour before a person can describe what is happening internally.

A first aider can create an accessible bridge.

That bridge is important. It is not the destination, and mental health first aid at work works best when it is connected to a wider support system.

What a well-run first aider role genuinely adds

A good mental health first aider is not there to provide therapy. Their contribution is more immediate and practical.

1. Confidence to begin a conversation

Many employees want to help a colleague but fear saying the wrong thing. They may avoid mentioning a change in behaviour because they do not want to intrude, appear weak or make the situation worse.

Training can give people simple language:

“I’ve noticed you seem under pressure. How are you doing?”
“You don’t have to talk about anything you don’t want to.”
“Would it be helpful to look at what support is available?”
“This sounds like something worth discussing with a professional.”

These are not clinical interventions. They are human responses that can reduce shame and help someone move from isolation towards support.

2. Everyday language around mental health

In some workplaces, mental health is still discussed only after a crisis, an absence or a serious incident. A first aider network can make the subject more ordinary and less threatening, which is one of the clearest benefits of mental health first aid at work.

That matters for psychological safety. Are people able to say that they are struggling before they reach breaking point? Do they feel valued as people, rather than only assessed through attendance, output or operational performance?

Language alone does not create psychological safety. But it can make honest conversations more possible.

3. Early signposting

A first aider can help someone identify a suitable next step. That might include an EAP, occupational health, a GP, NHS Talking Therapies, a manager conversation or a specialist charity.

The value is often in reducing friction. When someone is distressed, executive functioning can be affected. Finding the right phone number, website or internal process may feel harder than it appears from the outside.

A calm conversation can help a person take one manageable step.

4. A known point of contact

In a large, operational or dispersed organisation, a first aider may be the only accessible route to support. This can be especially important for men who would never describe themselves as needing help, or who would not approach HR because they fear judgement or professional consequences.

The first aider does not need to become a counsellor. They need to be approachable, appropriately trained and connected to a reliable support system so that mental health first aid at work stays within safe and useful boundaries.

Rebecca Lisi delivering workplace mental health training on helpful listening responses

What mental health first aid at work cannot do

This is where honesty matters.

The Health and Safety Executive’s evidence review of Mental Health First Aid found that training can improve knowledge, awareness and confidence among those who complete it. However, the review found limited evidence that it changes wider organisational outcomes or produces sustained improvements for the people receiving support.

That distinction is central.

Awareness is not the same as capability. Confidence is not the same as clinical competence.

A first aider cannot:

Assess or diagnose a mental health condition.
Provide therapy or ongoing psychological treatment.
Make a clinical judgement about risk.
Manage a colleague’s recovery.
Take responsibility for workplace adjustments.
Replace a line manager’s duty to respond appropriately.
Resolve excessive workload, bullying or unsafe work design.
Act as a crisis service or 24-hour helpline.

Mental health first aid is a first response. Therapy is a structured clinical relationship with a different purpose, level of training and accountability.

Confusing the two can create risk for everyone involved.

The single-trained-individual risk

One of the most common weaknesses I see in mental health first aid at work is the “one willing person” problem.

An employee volunteers for training because they care about colleagues. They become known as the person who can help. Gradually, people begin approaching them with increasingly complex concerns.

There is no protected time. No supervision. No clear escalation route. No cover during annual leave or night shifts. No guidance on what should be recorded. No one is checking whether the role is affecting their own wellbeing.

The individual then becomes the de facto wellbeing function.

This is not a sustainable model. It can place an emotional load on the first aider and create an inaccurate impression that the organisation has adequate mental health provision when it does not.

Volunteers need boundaries, support and permission to step back.

Confidentiality, records and disclosure

Before introducing mental health first aid at work, employers should be clear about how conversations will be handled.

Employees need to know:

What the first aider can and cannot keep confidential.
When information may need to be escalated because of immediate risk.
Whether any information will be recorded.
Who can access records.
How safeguarding concerns will be managed.
How anonymous trends may be reported without identifying individuals.
What happens if the concern relates to a manager or senior leader.

First aiders should not keep informal case files in personal notebooks or email accounts. Organisations should establish proportionate processes that respect privacy and follow relevant data protection requirements.

Confidentiality should be explained at the beginning of a conversation, not after a disclosure has been made.

How to set the role up properly

A responsible mental health first aid at work programme should sit inside a wider system of support. At minimum, employers should establish:

Clear scope

Write down what the first aider role is for, what it is not for and how employees can access it. Make clear that first aiders are not therapists, managers or emergency responders.

Escalation and safeguarding

Provide a simple route for concerns involving immediate risk, safeguarding, violence, serious deterioration or inability to keep someone safe. Everyone should know what happens out of hours.

Supervision and support

First aiders need regular opportunities to reflect on difficult conversations. This may include structured supervision, peer support, debriefing and access to confidential professional support.

Rotation and cover

Avoid relying on one person. Build a network that reflects different sites, shifts, departments and demographics. Make sure there is cover for holidays, sickness and changing roles.

Refreshers

Skills fade when they are not used. Refresher training should revisit listening, boundaries, signposting, confidentiality and crisis procedures so that mental health first aid at work remains consistent, safe and credible over time.

Visible formal routes

EAP, occupational health, manager support and NHS routes should be easy to find. A first aider cannot signpost effectively to services that employees cannot access or do not trust.

Manager capability

Managers need to know how to respond when someone discloses distress. They need to understand workload, adjustments, return-to-work conversations and the difference between support and performance management.

This is why mental health first aid at work should complement, not replace, mental health training for managers and broader workplace mental health training.

Why it fails in isolation

The nervous system responds not only to personal circumstances but also to the environment in which someone works.

If workloads are persistently excessive, shifts are poorly designed, people have no control, bullying is ignored or managers respond punitively to disclosure, mental health first aid at work cannot make the workplace psychologically healthy on its own.

This is where a first aider programme must connect with:

Psychosocial risk assessment.
Workload and job design.
Supportive management.
Reasonable adjustments.
Occupational health.
Employee consultation.
A wider employee wellbeing strategy.

It should also sit alongside work on psychological safety training and psychological safety in the workplace. People are more likely to seek help when they believe they can speak honestly without being punished, labelled or overlooked.

If employees are physically present but emotionally depleted, first aid alone will not address the underlying conditions. The same applies to presenteeism in the workplace: signposting may help an individual, but leaders must also examine why people feel unable to rest, recover or ask for support.

The World Health Organization estimates that one in seven working-age adults are living with a mental health condition, which is why the organisational conditions around work matter as much as the individual support route.

Rebecca Lisi speaking to an audience about workload, stress and burnout

How to measure whether mental health first aid at work is working

Attendance and post-training satisfaction are useful, but they do not tell you whether the role is making a meaningful difference.

Consider reviewing the programme at:

30 days: Are first aiders clear about their role, boundaries and escalation routes?
90 days: Are employees aware of the network? Are people accessing support earlier? Do first aiders feel supported?
180 days: Are there changes in workforce confidence, signposting patterns, manager responses or recurring psychosocial concerns?

Measure carefully. Do not treat an increase in signposting as evidence that mental health has worsened. It may indicate that people finally know where to go, which can be a sign that mental health first aid at work is becoming more visible and trusted.

Useful indicators might include:

Workforce confidence in discussing mental health.
Awareness of EAP, occupational health and NHS routes.
Time between concern being noticed and support being accessed.
First aider confidence and perceived capacity.
Manager confidence after an employee disclosure.
Themes emerging from anonymised conversations.
Whether the organisation has addressed recurring workload or culture concerns.

The purpose is learning, not surveillance.

A realistic conclusion

Mental health first aid at work can reduce stigma, increase confidence and create a human point of contact where formal support feels distant. In a high-hazard or shift-based workplace, that access may be genuinely valuable, especially when mental health first aid at work is introduced with clear boundaries and realistic expectations.

But it is not therapy. It is not diagnosis. It is not crisis care. It is not a substitute for capable managers or responsible psychosocial risk management.

The strongest programmes treat first aiders as one part of a connected system. They support the people who volunteer, protect confidentiality, provide clear escalation routes and address the working conditions that influence the nervous system every day.

That is how we move beyond a visible initiative towards a culture where people can seek support early and continue to thrive.

For organisations considering how this fits into a wider leadership, culture or wellbeing programme, my Corporate Wellbeing Speaker work brings psychological insight into practical conversations for leaders and teams.

To check availability, discuss bespoke content for your leadership offsite, or bring a corporate wellbeing speaker to your next corporate event, let’s start a conversation.

Safety note

Mental health first aid is not therapy or clinical assessment. If someone is in immediate danger or needs urgent medical help, call 999 or contact NHS 111. For confidential emotional support at any time, call Samaritans on 116 123.

Reflections

Mental Health First Aid at Work: What It Can and Cannot Do