Oct 15, 2026 · Comments ↓

Mandatory mental health first aid is the wrong fix

Making mental health first aid a legal requirement sounds like parity with physical first aid. It isn't. The standard worth making law is ISO 45003.

I train mental health first aiders. I don’t think the law should make every workplace have them.

That might sound odd coming from me. There’s been a push for years to give mental health first aid the same legal footing as physical first aid. The Where’s Your Head At campaign, run by MHFA England, Bauer Media and Natasha Devon, puts it in its manifesto: “every employee has a right to mental health first aid just as they do physical first aid.”

I understand why. Physical first aid has its own regulations and a kit on the wall. Mental health first aid gets a poster and, if you’re lucky, a name on it. That isn’t equal, and it isn’t right.

But mandatory mental health first aid wouldn’t fix it. What would come much closer is making ISO 45003, the international standard on psychological health and safety at work, a legal requirement.

Why mental health first aid isn’t like physical first aid

Physical first aid works because of what it’s for. Someone falls, cuts themselves, collapses. A trained person steps in, keeps them safe and gets them to help. Most of what it deals with happens in a moment, and so does the first aid.

Distress doesn’t usually work like that. It builds over weeks and months. And a lot of the time, the thing building it is the work itself. The workload, the manager, the restructure nobody’s explained, the job that might not be there next year.

A mental health first aider can notice that. They can start a conversation, listen, and point someone towards help. That matters, and I’ll keep teaching it. But they can’t change the workload. They can’t fix the manager. They don’t decide the restructure.

I already see organisations treat first aiders as the answer. Train the minimum number. Put their names on a poster. Tick the box. Then wonder why nothing’s changed. Make them a legal requirement and I think we’d see more of that, not less. I’ve written about how first aiders are being asked to do the wrong job, and a law could lock that in.

The law already says employers must deal with stress

Mental health is already in the law. It’s just not working.

In Great Britain, employers have a legal duty to protect workers from stress at work. HSE puts it plainly: assess the risk and act on it, the same as any other health and safety risk. If you’ve five or more workers, you have to write it down. HSE’s Management Standards set out the six areas to look at: demands, control, support, relationships, role and change.

HSE even updated its first aid guidance in 2024, to say employers should take account of mental health when they work out their first aid needs.

And still, 964,000 workers reported stress, depression or anxiety caused or made worse by work in 2024/25. We count the damage every year. When HSE finally took enforcement action over stress at the University of Birmingham, it was one of the first cases of its kind, and it took a union complaint, a four-day inspection and 24 focus groups to get there. I’ve written about that too: the system knows what to do, it just won’t do it.

So a legal duty on its own hasn’t done it. Another duty, to train first aiders, would be one more thing to tick and not enforce.

What ISO 45003 asks for

ISO 45003 came out in 2021. It’s the international standard on psychological health and safety at work, and it sets out how to manage what it calls psychosocial risk: the things about how work is organised, run and led that harm people.

It asks organisations to do what they should be doing anyway. Find the hazards in how work is designed. Control them. Check the controls are working. Involve the people doing the work.

That’s prevention. It starts with the workload, not with the person buckling under it.

At the moment it’s guidance. Nobody has to follow it. That’s what I’d change. If we’re going to use the law to put mental health on an equal footing with physical safety, this is the standard to use. It goes after the causes. First aid, however good, starts after the harm.

Make it a condition of doing business

So how would a mandatory standard be any different from a duty that’s already being ignored? Two things.

First, tie it to money. If a company wanted a public contract, a place in another company’s supply chain, or public funding, it would have to show it was managing psychological risk to the standard. Businesses already ask each other for quality and safety certificates before they sign anything. This would sit alongside them. ISO 45003 is written as guidance, so it would need to become something organisations can be audited against.

Second, check it’s actually working. That’s the hard part, and it’s where the current duty falls down. The regulator doesn’t have the people. HSE’s core funding fell from £228 million in 2010 to £126 million in 2019, and by 2022 it had 18% fewer inspectors than in 2010, according to research by the union Prospect. You can’t enforce a law with nobody to enforce it.

And those cuts weren’t an accident. For decades the thinking has been that free markets sort themselves out, regulation gets in the way of business, and less of it is always better. So the regulator was cut back, employers were left to check themselves, and anyone struggling got sent on a resilience course. That thinking got us here. It isn’t going to get us out.

So resource the accountability properly. Otherwise businesses will keep getting away with it, whatever the law says.

Where mental health first aid fits

None of this means first aiders don’t matter. I wouldn’t do this work if I thought that. Trained well, they’re the people who notice the colleague who’s gone quiet, and who start the conversation instead of waiting for a knock on the door. They’re often the first to hear what’s actually causing the harm, too.

But they belong inside a system that’s managing the risk, with someone accountable for the programme and for the first aiders themselves. Not standing in for one.

Make the right thing mandatory

A law on its own won’t change how a company is run, or who it’s run for. I’ve said that before and I still think it. But if we’re going to put something in law, it should be the thing that stops people being made unwell in the first place.

Mandatory first aid would deal with the harm once it’s done. A mandatory standard for managing psychological risk would go after what’s causing it.

Physical first aid and mental health first aid were never the same thing. It’s time we stopped asking the law to treat them as if they were.

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