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Implementing mental health first aid

1. Mental Health First Aid Standards.  Your Legal Obligations

The main regulations covering health at work, including mental health, are:

  • The Health and Safety at Work etc., Act 1974.
  • The Management of Health and Safety at Work Regulations 1999.
  • The Equality Act 2010.

These regulations require you to:

  • Know.  That your employee’s attendance and / or performance is being affected by a health condition or that their health is at risk whilst working when you could reasonably have been expected to do so.
  • Assess.  The degree of effect or risk using an adequately trained person.
  • Adjust / Control.  For the effect or risk taking all reasonably practical steps.
  • Monitor.  The continued adequacy of adjustments and controls.

Your organisation will have structures in place to ensure compliance with these requirements where day to day responsibility is typically delegated to line managers, supported by policies and procedures and with access to appropriately trained resources from; HR, Occupational Health, Health & Safety and Legal.

Now consider the consequences of introducing mental health first aid into your organisation.

Mental health first aid is not a legal requirement, it is a discretionary investment in the wellness of your employees.  It has value because it is provided outside of your compliance structures; by volunteers, in confidence and without leaving a record of; knowing, assessing, controlling or monitoring.  This value can be be inferred from a survey of armed forces peacekeepers1, where nearly 100% shared their experiences with peers and partners but just 10% shared through their organisational structures (chain of command, medical and welfare services).

So, the very reason why mental health first aid can be so valuable, because colleagues can use it without fear of organisational consequences, also places compliance at risk.  The Work Wellness Implementing Mental Health First Aid service will help carefully position mental health first aid within your existing structures to minimise the risk of reduced compliance whilst helping you maximise your return from the investment.

2. Mental Health First Aid Standards.  How Often to Recertify Your Mental Health First Aiders

MHFA England recommend that Mental Health First Aiders attend a refresher training course every 3 years to renew skills and to update knowledge and practice.  This is consistent with recommendations from MHFA organisations in other countries such as Australia and Canada.

Some training providers recommend a Mental Health First Aider refresher and recertification regime which is similar to physical first aid, i.e., attend a refresher course every year and re-attend a full training course every 3 years.

Work Wellness’ experience is that:

  • If you are a practicing Mental Health First Aider then attending a refresher course every 3 years is just about right. We have not seen course content change significantly over the last 3 years, so there’s not much new to learn.
  • If you are inactive and want to start practicing then your knowledge and practice skills may have become rusty.
    • If you have been inactive for less than a year then you could attend a refresher course and also work through your original course manual before you start practicing.
    • If you have been inactive for a year or more then you could re-attend the full training course.
  • If you are either of the above but have any doubts about your confidence and proficiency then also consider Support for Mental Health First Aiders.


As we briefly touched upon physical first aid, you might be wondering how similar or different the recertification requirements are compared to mental health first aid?

Whilst certification for both mental health and physical first aid lasts for 3 years, the obligations for physical first aid are stronger:

  • The Health and Safety (First Aid) Regulations 1981 define a minimum set of requirements for physical first aid provision.  Every workplace must have an appointed person to take charge of first aid arrangements and if workplace hazards are deemed sufficient, then at least one employee should also be a Physical First Aider.
  • For Mental Health First Aider certification it is sufficient to have attended a training course.  For Physical First Aider certification, an end of course examination also needs to be passed.
  • Physical First Aider recertification requirements are mandated by the Health and Safety Executive who advise Physical First Aiders to:
    • Attend a half day refresher course every year.
    • Attend a two day recertification course, at least ninety days prior to expiry.
    • Re-attend the full three day course and examination if certification has lapsed by more than thirty days.

3. Mental Health First Aid Standards.  Selecting Employees to be Mental Health First Aiders

The ideal employees for training as Mental Health First Aiders are:

  • Committed to supporting the aims of mental health first aid.
  • Supported by their line management and wider organisation to make the commitment.
  • Able to help others (e.g., they relate well to others, are mature, non-judgemental and can be trusted implicitly to maintain confidentiality).
  • In positions where colleagues perceive little fear of consequences from confiding to them.  This might exclude some staff who:
    • Work in human resources or compliance.
    • Are more senior than colleagues likely to seek their help.
  • Are able to provide mental health first aid to colleagues outside of their line management span control (it is very difficult to align the responsibilities of a Mental Health First Aider with those of a line manager).

An additional consideration are employees who volunteer because they have or have had a mental health condition themselves.  If they have the ideal attributes listed above, then they can be excellent candidates because they also have their own lived experience to draw upon.  If they do not have the ideal attributes then they might have volunteered because they need help themselves.

Work Wellness can help you identify and select the most appropriate staff for training as mental health first aiders.  For example, click here to view a checklist used by Work Wellness to encourage self-selection of ideal candidates.

4. Mental Health First Aid Standards.  Helping Your First Aiders to be Active and Visible

Equipped with 2 days of training and a course manual, your Mental Health First Aider returns to the workplace to occupy an exposed position between:

  • Emotionally distressed colleagues in need of safeguarding and support.
  • Mental health support services to whom they need to provide appropriate signposting.

MHFAider positioning

Having placed your Mental Health First Aider in this exposed position, you have a duty of care to:

  • Monitor and control for any increased risk to their physical and mental health and safety.
  • Help them be confident, active and visible to their colleagues, deploying practice skills including:
    • Recognising the signs and symptoms of a colleague in need.
    • Initiating and maintaining non-judgemental conversations to encourage disclosure and to avoid adverse reactions.
    • Handling sensitive, distressing, crisis situations involving anger, regret, talk of suicide and intoxication.  For context, Occupational Health Practitioners are required by regulation and medical codes of practice to undergo years of training and clinical supervision in order to perform a similar safeguarding role for employees2

The challenge of satisfying this duty of care is yours.  Work Wellness can help you meet most of this challenge with our Support for Mental Health First Aiders package.

5. Mental Health First Aid Standards.  Implementing Mental Health First Aid in Your Organisation

The shared experience of a number of practitioners is that:

  • Mental Health First Aiders are often unclear how their role dovetails into existing company structures.  A fear of contradicting line managers, HR and Occupational Health results in a reticence to become visible to employees in need.
  • Employees are often unsure what to expect from Mental Health First Aiders and what will happen as a consequence of seeking support from them.  Employees may not know who their Mental Health First Aiders are.

The reason does not appear to be related to the training itself as those trained, personally benefit from the experience3 4.

IOSH Mentor.The reason is more to do with how mental health first aid is implemented in the organisation.  An Institute of Occupational Safety and Health report describes significant implementation issues5 including;

  • Not defining the role, e.g.,
    • All conversations are confidential involving no disclosure back to HR or to managers
    • It does not provide diagnosis, counselling, treatment and follow-up support, the role signposts to support services who do that.
  • Not communicating the role of mental first aiders across the organisation and who the Mental Health First Aiders are.
  • Not defining the boundaries with other staff and departments who might be involved in managing and supporting the colleague or assessing wider workplace mental health risks identified by a situation.
  • Safety issues, both inside and outside of work.

Effective wellness strategy

Research by the Institute for Employment Studies for the cross-government Health Work and Wellbeing Executive6 concluded that an effective wellness strategy requires:

  • Comprehensive steps to address organisational and individual level enablers (or barriers) such as: knowledge, culture and policies.
  • Communication, co-operation and shared goals between the employer, employees, occupational health providers and primary care professionals.

2018 HSE.The Health and Safety Executive list a few ‘ingredients for success’ including3:

  • Have a clear vision and rationale for introducing mental health first aiders.
  • Managerial support for the mental health first aiders themselves and advocacy for the support they can offer to others.
  • Create an active community or network of mental health first aiders.
  • Appoint enthusiastic coordinators who encourage support and champion the programme within the organisation and post-training, deal with issues and concerns.
  • Mandatory but anonymous, recording of situations they have handled for use in monitoring how the mental health first aiders are coping and performing and to help better understand wider workplace mental health related risks.

Just 13% of organisations are believed to share these ingredients7.

Work Wellness can draw upon:

  • Our daily experiences of providing occupational health support across many organisations.
  • Both formal and informal feedback from the mental health first aiders we support about what good and bad implementation looks like.
  • Our practical programme and project management expertise.

To assist you in Implementing Mental Health First Aid in your organisation.

  1. Managing Traumatic Stress: Evidence Based Guidance for Organizational Leaders.  Professor Neil Greenberg.  21st April 2020[]
  2. Mental health first aid can have negative impacts.  HR Magazine.  8th August 2019[]
  3. Summary of the evidence on the effectiveness of Mental Health First Aid (MHFA) training in the workplace.  Health and Safety Executive.  2018.[][]
  4. Systematic review and meta-analysis of Mental Health First Aid training: Effects on knowledge, stigma, and helping behaviour.  The University of Melbourne.  May 2018.[]
  5. Mental health first aid in the workplace: A feasibility study.  Institute of Occupational Safety & Health.  2018.[]
  6. What Works at Work.  Institute For Employment Studies.  2007.[]
  7. The 2018 Stress Report.  Cascade HR. 2018.[]