The IOSH-funded MENTOR study explored the role of mental health first aid and barriers to its success. Three years on from its publication, in the midst of a pandemic, how has mental health support progressed?
At the beginning of the year, nurse-led wellbeing service RedArc announced specialist support for mental health first aiders (MHFAs) after a successful programme was rolled out internally.
RedArc’s monthly online networking groups enable MHFAs to share their experiences confidentially and raise concerns with specialist mental health nurses.
Experienced in a wide range of conditions, such as chronic depression, stress and anxiety, trauma and bipolar disorder, the nurses also monitor the MHFAs to ensure they don’t stray beyond the boundaries of their role.
MHFAs and nurses can also meet remotely between sessions if more support is needed.
‘Mental health nurses know the workings of the NHS, what is available and what isn’t, and how best to access specialist support,’ says Christine Husbands, managing director of RedArc. ‘Organisations have access to expert mental health advice on an indirect basis through the MHFAs.’
Mental health first aid is one of many training programmes designed to raise awareness of mental ill health in the workplace. It trains volunteer employees to recognise the signs and symptoms; they can listen and advise and, when required, point employees to professional services.
RedArc’s decision to develop its service came about after a large cohort of MHFAs highlighted unclear boundaries and issues relating to the scope of their work.
The IOSH-funded MENTOR (MENtal health first aid in The wORkplace) study, run by the University of Nottingham, had highlighted many of the same concerns after investigating the use of MHFAs in 2018 (see Resources, below).
The study comprised three parts: a scoping review of workplace training courses, a survey of organisations in which at least one person had attended MHFA training, and an interview study.
One of its main recommendations was for employers to provide a clear definition of the trained person’s role, supported with clear guidelines, boundaries and safeguarding procedures.
‘When people put themselves forward to be MHFAs, I make it very clear what the role entails,’ says David Day CMIOSH, UK health, safety and environment (HSE) manager at ABB.
‘Importantly, it’s about understanding and observing changes and attitudes in human behaviour. You are not there to act as a counsellor, a psychologist or as a psychotherapist. You are there to guide and signpost.’
IOSH’s position is clear: MHFAs should only be employed as part of a wider mental health control strategy, underpinned by an effective wellbeing culture. Preventative steps should be prioritised over proactive measures (see Prevention first, below).
The MENTOR research underlined the difficulty of evaluating MHFA interventions. Anecdotally, however, MHFAs make a positive contribution.
‘It is changing people’s views. I’d love to say there is no stigma around mental health, but I’d be lying,’ says Matthew Riley TechIOSH, HSE officer at the Binding Site, who has added mental health and wellbeing to his OSH remit.
‘For example, someone came to see me last year regarding depression. They had never spoken to anyone about it before and we gave them professional support. If we hadn’t done all our communications, they would never have spoken to us.’
COVID-19 has arguably exacerbated mental health conditions, not least because the emphasis on preventing infection may have resulted in a perception among some sufferers that treatment for mental ill health is less of a priority for highly stretched health services.
The pandemic has significantly disrupted traditional work patterns, but what is less clear is the impact on mental health.
According to Mary Ogungbeje, OSH research manager at IOSH, COVID-19 has led to a wide spectrum of experiences.
Some employees, she notes, have coped quite well, while a smaller number has even registered an improvement in their mental health, having achieved a better work/life balance as well as savings on travel and other living costs.
For a significant number, however, mental health has deteriorated. As Mary explains, there are many contributing factors, which include taking on new responsibilities for vulnerable people, coping with bereavement in lockdown, and increased loneliness and anxiety.
That’s why it is important that employers put in place an effective culture of wellbeing to support not only vulnerable employees but also MHFAs.
‘There is a real difference in how organisations have introduced MHFAs in the workplace, so there is no consistent approach,’ Mary explains.
‘The MHFA may not have a support group or a coordinator. They may not have a buddying system and there may not even be an employee assistance programme, one that any employee can tap into, let alone the MHFA.’
Avoiding harm: Prevention first
A founding principle of OSH is that organisations should prioritise a preventative approach to avoid harm in the first place. To preserve and promote mental wellness, organisations could:
- Produce localised assessments of risk based on stressors present in the workplace and ensure relevant managers regularly review them so they reflect changes in operational demand, organisational structure or changes in competency levels brought by new or temporary workers, and any role responsibility modifications.
- Ensure the mental wellness of employees is monitored during intense working periods and develop a suite of controls that can be implemented effectively to drive the right behaviours. Leadership may need to sanction these controls, which will be critical to delivering a culture of wellbeing.
- Develop a training programme that includes educating workers and managers in emotional hygiene techniques that help to develop personal resilience. Provide managers with tools to identify workers who are struggling to cope, help to destigmatise mental ill health and encourage open discussions between workers and managers.
- Introduce an active programme of health promotion ideas and interventions, which includes advising on good lifestyle choices and supporting workers to take them.
Spreading the word
To facilitate this culture, particularly at a time when teams are physically distanced, requires regular employee engagement at all levels, says Shaun Howard CMIOSH, safety, health, environment and quality manager at Powerday.
‘Like many other businesses, we have made use of media platforms such as Microsoft Teams and Zoom to stay in touch with our staff, and managing directors regularly communicate with staff to notify them of resources available. This is something we intend to continue even when lockdown restrictions are eased.’
As the coordinator of an expanding MHFA team, Matthew uses a confidential online reporting system, which he uses to track the volume of meetings that MHFAs have with employees.
He also rotates MHFAs so they aren’t always on duty and stops them from offering support if he thinks they are struggling.
David is in the process of setting up a buddying network. ‘What we advise MHFAs is to contact a fellow MHFA and, maintaining confidentiality, run through the situation, explain what they did and discuss whether they think they did the right thing,’ he says.
Like all the MHFAs interviewed, David’s employer, ABB, has an employee assistance programme that provides a wealth of resources for advice on critical issues such as bereavement and finances. He anticipates a spike in its use in the second or third quarter, as a direct effect of the most recent lockdown.
Having worked as an MHFA at his previous employer, Steve Brown TechIOSH lobbied for an enhanced mental health support structure when he joined C-Plan Telecommunications as its environmental manager and health, safety and quality adviser.
Since joining in 2018, he’s qualified as an MHFA trainer. The business has also trained managers so they can better supervise mental health. ‘The course is designed for managers so they know what to look out for, how to help people and what to do,’ he says.
As IOSH’s white paper on workplace wellbeing demonstrates, the manager’s role is critical to the process.
To better equip managers, IOSH has designed its Managing Occupational Health and Wellbeing training course, which covers practical considerations, such as how to carry out a health needs assessment.
IOSH has also published a wealth of supplementary material for employers. These include benchmarking questions, which offer advice on how to create an effective culture to manage mental health and wellbeing in an organisation, and workplace considerations (see Resources, below).
‘Regardless of COVID-19, these are principles that an organisation should be thinking about when introducing an MHFA,’ explains Mary. ‘The only thing that might change is how it is now delivered.’
Big issues in SMEs
One of the most hard-to-reach groups is small- and medium-sized enterprises (SMEs).
Still in its early stages, the EU-funded research project MENTUPP (Mental Health Promotion and Intervention in Occupational Settings) will develop, implement and evaluate a multilevel intervention designed to improve mental health and reduce suicide in SMEs across the construction, healthcare and information and communications technology sectors in Europe and Australia.
MENTUPP consists of 17 partners in 14 countries, although not all are intervention countries and will assist instead with the project’s evaluation.
IOSH is on its advisory panel and will be helping to recruit SMEs from the nine participant countries for a large trial starting in mid-2022.
IOSH members with links to SMEs are encouraged to help recruit participants to the trial, which aims to investigate ways to achieve effective mental health support in firms with fewer than 250 people (see Resources, below).
As the project’s coordinator Professor Ella Arensman explains: ‘By 2023, we would like to be able to convey to the European Commission and to all important stakeholders what we can reliably say about what works and what doesn’t in terms of improving positive mental health but also suicide prevention.’
Professor Arensman says that a blended approach is the most effective way to put the interventions in place but, because of the pandemic, MENTUPP has had to deliver its resources online, although some interactive interventions are included.
COVID-19 has changed the world of work for good. However the workplace looks once we return to normality, Mary’s take-home message is this: ‘It’s really important to carefully consider the relevance of each mental health and wellbeing intervention that is in place, why it’s relevant, and how it can effectively promote positive health and wellbeing in the organisation.’
Image credit | Alamy | Getty
- IOSH, Mental health first aiders – workplace considerations: bit.ly/IOSH-MHFA-considerations
- IOSH and University of Nottingham publication, Mental health first aid in the workplace (MENTOR): a feasibility study: iosh.com/MHFAworkplace
- IOSH benchmarking questions on mental health in the workplace: bit.ly/IOSH-mental-health-benchmarking
- IOSH white paper, Workplace wellbeing: the role of line managers in promoting positive mental health: bit.ly/IOSH-workplace-wellbeing
- Managing Occupational Health and Wellbeing training course, which covers practical considerations, such as how to carry out a health needs assessment: bit.ly/IOSH-managing-wellbeing
- EU-funded research project MENTUPP: mentuppproject.eu
- Contact researchers to contribute: bit.ly/IOSH-MENTUPP-recruit