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Issues with workplace mental health first aid

26 November 2018

DAYS AFTER a plea was issued to Government for ‘mental health first aid’ (MHFA) to become mandatory, new research highlights “significant issues around the lack of clarity with boundaries and potential safety concerns”.

A feasibility study, published by the professional body for occupational safety and health, sheds fresh light on widespread use by companies of employee training to address workplace mental health issues, such as depression, anxiety, self-harm and substance misuse.

University of Nottingham researchers funded by IOSH found both positives and areas for concern, including inadequate boundaries for employees and a lack of proof that MHFA is effective.

Principal investigator from the School of Health Sciences at The University of Nottingham, professor Avril Drummond said, “We found examples of excellent practice in rolling out the mental health first aid training where there were clearly strategies in place to support staff who felt confident in their role. 

“However, we also found examples where staff felt unsupported and where, for example, they had co-workers contacting them outside working hours: there were significant issues around lack of clarity with boundaries and potential safety concerns for the trained person.”

Head of advice and practice at IOSH Duncan Spencer said, “Mental Health First Aid has become a prominent way of training individuals to recognise signs and symptoms of mental health problems and to select appropriate responses. But how successful is it in the workplace? What impact does it have? 

“IOSH calls for a ‘prevention first’ approach incorporating MHFA as part of an organisation’s overall efforts to protect their workforce from mental health problems. 

“Appointing staff in a volunteer capacity to support colleagues with mental health problems must be part of a bigger management system including preventative controls to remove or reduce risks.  

“The results of our study will be discussed today at a meeting of industry and safety, health and wellbeing representatives. This will inform advice for employers on managing psychosocial risks in the workplace.”

The research team investigated the implementation, use and utility of MHFA in workplaces, surveying people from 81 UK organisations, 89.9% of whom had taken part in MHFA training and also conducted interviews with key workplace representatives. 

“We became interested in this topic as we were aware of the amount of publicity and resources being put into Mental Health First Aid training despite very little research to support it,” added Professor Drummond. 

“Our research found that, while MHFA appeared to be a useful “vehicle” for raising awareness around mental health issues, we do not know whether it is the best or only means of doing so or indeed whether it is cost-effective.

“There were wide variations in expectations of the responsibilities of the trained person within different workplaces.”

One respondent described how there had been: “…a few situations where people have given personal contact details, and somebody’s phoning them in the middle of the night and it’s got completely out of hand.” 

Where MHFA is used well in workplaces, the researchers identified several ‘active ingredients’ for success. These include:

  • clear vision and rationale for introducing the course and managerial support
  • enthusiastic coordinators who encourage support, champion the programme within the organisation and post-training, deal with issues and concerns, and lead a network
  • mandatory recording of formal interactions 
  • a community or network of active trained members 

The Nottingham team recommends further research and evaluation into the effectiveness and cost-effectiveness of MHFA training, and a clear definition of the trained person’s role within the organisation, with guidelines for roles, boundaries and safeguarding procedures.

They suggest MHFA training should incorporate more evaluation opportunities at different times after training has been given; a review of the standard adult MHFA two-day course, its length, format and content; and the provision of refresher training to trained members, to give them the opportunity to refresh skills, knowledge and awareness.

Chief operating officer at MHFA England Fionuala Bonnar said, “We welcome this new study into the effectiveness of Mental Health First Aid training in the workplace. Time and time again Mental Health First Aid is shown to be effective in increasing knowledge, confidence and skills necessary to support someone with mental health issues.  

“It’s encouraging to see that this latest piece of research adds to our evidence base and the report recommends that more could be done to strengthen the boundaries of a Mental Health First Aider in the workplace. This is something we will enhance as part of our existing course content and supporting materials and we will also be launching a refresher training course in early 2019 to ensure that skills are kept up to date at regular intervals.

“More widely, the Health and Safety Executive announced this week that First Aid guidance has been updated to explicitly include mental health. So now there will be an even clearer focus on how the role of the Mental Health First Aider fits into a ‘whole organisation’ approach to mental health and wellbeing.

“As part of our organisational objective to further build the evidence base around Mental Health First Aid, we will use the MENTOR findings to inform a new piece of research we are commissioning through the Centre for Mental Health. This will further investigate the impact of Mental Health First Aid in the workplace, including the experiences of employees who have received support from a Mental Health First Aider.”

This study’s limitations must be considered. All data collected were from UK-based organisations and individuals who had an interest in MHFA.