Oct 13, 2026 · Comments ↓

Mental health first aiders are being asked to do the wrong job

HSE says there's no evidence mental health first aid improves how workplaces manage mental health. That was never the first aider's job to begin with.

The question keeps coming round: do mental health first aiders actually change anything? It’s a fair question, and I have a stake in the answer. I design and deliver the FAA First Aid for Mental Health qualifications, and I build the champion role into them, so first aiders aren’t only there for a crisis.

Critics point to the Health and Safety Executive. In 2018 it reviewed the evidence and found “no evidence that the introduction of MHFA training has improved the organisational management of mental health in workplaces”. When it looked again in 2023, it found nobody had measured this.

That’s a reasonable thing for an employer to ask. But it tests a few trained colleagues against how the whole organisation manages mental health, and that was never their job.

What are mental health first aiders for?

A mental health first aider notices when someone is struggling, has a proper conversation with them, and helps them find the right support. That’s the role, and it’s a specific one.

Nobody judges a physical first aider on whether the warehouse is safe. We judge the warehouse. With mental health we forget that, and treat a handful of trained people as the organisation’s whole response.

What the evidence says

The same HSE update found some evidence that the training improves people’s knowledge, confidence, attitudes and behaviour around mental health. Those are the things it’s designed to do. It also found limited evidence that people stay better at helping colleagues over time. That’s a fair challenge, and one the training has to answer.

In 2018 IOSH asked the University of Nottingham to look at how it works in practice. The researchers found most of the people they spoke to were positive about the training. But what was expected of the trained person varied a lot from one organisation to the next, and the boundaries of the role were unclear. One respondent described people giving out their personal numbers and being phoned in the middle of the night. Some wondered whether the training had been bought mainly to make it look as if mental health was being taken seriously.

The researchers found a few simple things helped: a clear reason for bringing it in, motivated coordinators, and a network of first aiders.

This year, researchers from the EMPOWER trial asked employees in England directly. They didn’t find people rejecting it. Participants “seemed to question whether it was being asked to solve issues that stemmed elsewhere in the organisation.” One person working in HR put it plainly:

“We are talking about well-being being very important; my team are helping bring in benefits to help support people, like access to Headspace meditation apps and all the rest of it. But we are not getting down to the root of the problem, which is just the way our work is organised at the moment…”

Where the training lets first aiders down

The critics have a point about the course itself. The Nottingham researchers called for a review of the standard two-day MHFA course’s “length, format and content”. How the course is delivered matters, and too much of it is still reactive. It prepares people to wait for a crisis and respond to it.

Too many trainers teach the first aider role on its own, without being proactive or being a champion for good mental health at work. That’s where the role does the most good. The first aid part is specific, but it needs wrapping in everyday things: chatting to people, being kind, noticing, talking about mental health in general. Good mental health, not only poor mental health.

That’s a problem with how the standard courses are built, and with the mindset of the people delivering them.

What I tell every group

At the end of every course I say the same thing: you’ve just finished a course, but you haven’t changed your working practices.

I expect people to go back and work on prevention. To stop being reactive. To stop expecting first aiders to be the solution, and to be brave enough to challenge bad practice when they see it. First aiders help people cope. They can’t fix a workplace that’s making people unwell. As I’ve written before, they’re the last line, not the first.

Every programme also needs someone who has the first aiders’ backs. Someone accountable for it, who supports them and stops the role being stretched into something it isn’t. The Nottingham researchers called for the same thing in 2018: a clear definition of the role, with boundaries and safeguarding around it.

The question to ask instead

So when someone asks whether mental health first aiders work, ask what they were asked to do. If the answer is “fix how the organisation is run”, they were set up to fail.

That job belongs to the people running it.

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