Every month has a mental health day in it now. Posters go up, a pastel banner appears on the intranet, someone senior sends an email about how much the organisation cares. Then the week ends, the workload is the same, and the person who was struggling on Monday is still struggling on Friday.

Mark McCollum, a psychologist and disability advocate, wrote a piece last October called The Commodification of Compassion. His argument is that the mental health movement has become an industry, and that awareness days and mental health first aid training exist to keep an unwell system running rather than to fix it. He ends by inviting you to join what he calls the mental health circus.

I run a mental health first aid business. So I have read it more than once, and I think most of it is right. Most of this post is where I agree with him. The last part is where I don’t.

The awareness day is a ritual, not a change

McCollum calls awareness days corporate rituals. Opportunities to display virtue. The script is always the same: the posters, the ribbon, the carefully worded email. And the conditions that produce the distress stay exactly where they were.

I have been watching this all my working life, and the people who come on our courses describe it without being asked.

One learner put it better than I can, in a written course reflection: “so many of us have gotten used to the idea that putting up with more and more workplace stress is just expected and that the onus is always on the employee.” That is the awareness day in one sentence. It asks the employee to be aware. It does not ask the employer to change anything.

Compassion is now a market, and the numbers prove it

Here is the uncomfortable part for my own industry. The case for workplace mental health is usually made in money. Deloitte’s report for employers found poor mental health costs UK employers up to £45 billion a year, and that employers get back an average of £5 for every £1 they spend on it. I have quoted those figures myself.

McCollum’s point is that the moment compassion has a return on investment, it has become a commodity. And once it is a commodity, it is bought for the return, not for the person. That is how you end up with a wellbeing app on the intranet and a resilience webinar at lunchtime, because those are the cheapest things on the menu that still let you say you invested.

The £5 figure also hides something. Deloitte’s own range runs from 40p back per pound to nearly £11. The high returns come from large, preventative, organisation-wide changes. The low returns come from the cheap, individual, bolt-on things. The market buys the bolt-on things. So the industry, on average, sells what works least.

Mental health first aid teaches the symptom, not the cause

This is the part of McCollum’s argument that hits mental health first aid hardest, and he is not wrong about the version of it he describes.

Standard MHFA teaches people to spot signs and symptoms. Low mood, withdrawal, changes in sleep. It gives colleagues a vocabulary. What it does not do, in most deliveries, is ask why the people in this building keep showing those signs. The distress gets located in the person. The training equips you to notice it and signpost it. The workplace that produced it is out of frame.

McCollum’s phrase for this is that MHFA gives people the language of care but not the politics of care. I would put it more plainly. It teaches you to help someone who is drowning. It does not teach you to ask who keeps filling the pool.

We count work-related stress every year and we stopped asking why. Nearly a million people in Britain reported work-related stress, depression or anxiety last year. If your training does not touch that number, it is a palliative. That is his word, and it is the right one.

Where I part company with him

McCollum’s answer is the social model of mental health, which asks “what has happened to you?” instead of “what is wrong with you?”, and then asks what kind of workplace makes this much distress normal. I agree with every word of that. The difference is what I think you do about it on a Tuesday.

His conclusion is irony. Book him for your next session and he will nod through the slides. I understand why he ends there. But I do not have that option, because people keep asking me for the training, and the choice in front of me is not whether it happens. It is what is in it.

So this is what is in mine, and why I think it is the alternative rather than more of the same.

Everyone does it, not a few champions. The standard model trains a handful of first aiders and calls the job done. Those people then carry the whole thing. We train every member of staff, either the awareness qualification or the full first aid one. When everyone has done it, the culture is the thing that changed, not a rota.

The workplace is in the course. Our learning platform teaches the causes, not just the signs. The HSE’s management standards, which have said for twenty years that stress comes from demands, control, support, relationships, role and change. The legal duties employers already have and mostly ignore. The same learner I quoted earlier wrote that they had not realised employers had more legal obligations than they thought, and that the onus was not all on the employee after all. That is the social model doing its work inside a first aid course.

Noticing, not diagnosing. We spend real time on over-pathologising. Some feelings are normal responses to intolerable situations, and a label does not help. A learner wrote that this was the part that mattered most to them, that “some feelings and behaviours may be normal responses to stressful situations, rather than the need for a label.” That is a line McCollum would recognise.

I don’t teach resilience. Resilience training asks the wrong person to adapt. I teach people to notice what their colleagues are carrying and meet it with kindness, and I teach organisations that the carrying is the thing to look at.

None of that makes me innocent of his critique. I sell a product in a market that mostly buys the wrong thing. But a first aid course that sends people back to ask what is happening in their workplace is not a circus act. It is the beginning of the question he wants asked.

What to ask before you book anything

If your organisation is about to put money into mental health, three questions will tell you whether it is compassion or a commodity.

Does it change anything about the work, or only about the worker? A course, an app or an awareness day that leaves workloads, hours, management and security untouched is a palliative, whatever it costs.

Who is being trained, and what are they being trained to see? A few first aiders trained to spot symptoms will help a few people. Everyone trained to see the causes changes what the organisation is willing to tolerate.

And who decided the budget, and are they in the room? The system already knows what to do. The people signing off the wellbeing spend are usually the same people who set the workload it is meant to soften.

McCollum is right that the show goes on because it cannot afford to stop. The way to stop it is not to walk out of the tent. It is to make the training itself the place where people learn to look at the tent poles.

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