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MHFA not linked to wider workplace mental health management, says HSE

There is no evidence that the introduction of Mental Health First Aid (MHFA) training programmes has improved the management of mental health in workplaces, according to a research report by the UK Health and Safety Executive (HSE).

MHFA not a ‘sticking plaster solution’ for mental ill-health

Summary of the Evidence on the effectiveness of Mental Health First Aid (MHFA) Training in the Workplace is based on the examination of 29 research studies and reviews of such research published between January 2000 and July 2017, and the analysis of UK-based MHFA training providers to ascertain whether they had modified their services to specific professions. 

The researchers said they were unable to state whether “the introduction of MHFA training in workplaces has resulted in sustained actions by those receiving the training or that it has improved the management of mental health in the workplace”. 

They note this finding may be due to a lack of research so far. 

Improved management, the report says, includes the development by employers of health and wellbeing policies to tackle mental ill-health, creating positive workplace cultures where managers are responsible for maintaining staff mental wellbeing, the provision of support systems such as occupational health services and employee assistance programmes, and treatment interventions.  

The evidence review found employees who had received MHFA training had increased knowledge of mental health issues, including signs and symptoms, and confidence to offer support to those with a mental health problem. They also had a better understanding of where to find information and professional support.

The researchers cite a study conducted in Denmark, which found that “positive changes were sustained six months after the training”, including improved positive attitudes and reduced stigma towards people with a mental health problem. However, it notes that “these attitudinal changes were limited” and there was no increase in “helping behaviours” six months after the training.

The report says: “It is not known (even in studies by the MHFA course providers) whether the MHFA training leads to sustained improvement in trainees’ ability to help colleagues experiencing mental ill-health.” 
In addition, the HSE researchers found little evidence that MHFA trainers consider the size of the organisation, its sector or its current needs and culture when delivering courses to the workforce. They found that, while published research noted the importance of tailoring training to specific organisations, they failed to present robust evidence for how this could be achieved.  

One study with limited insight into the design and delivery of MHFA training in workplaces suggested courses should be modified to address barriers such as confidentiality concerns and fear of being judged for discussing mental ill-health. 

In addition, of the 28 training providers evaluated for the research report, “only a few specifically mentioned tailoring the MHFA training for workplaces”. 

Again, there is currently a lack of studies in this area. Researchers at the University of Nottingham recently launched a study to evaluate the application of MHFA in workplaces and identify those most in need of support and to provide early interventions to employees before long-term sickness absence or “presenteeism” (people attending work when sick) occurs. A report is due out later this year. 

The research report concludes: “A number of knowledge gaps have been identified in this evidence review that mean it is not possible to state whether MHFA training is effective in a workplace setting. There is a lack of published occupationally-based studies, with limited evidence that the content of MHFA training has been considered for workplace settings. 

“There is consistent evidence that MHFA training raises employees’ awareness of mental ill-health conditions. There is no evidence that the introduction of MHFA training in workplaces has resulted in sustained actions in those trained, or that it has improved the wider management of mental ill-health.”

The Hazards Campaign, a network of workplace safety and health campaigning groups, activities and union safety reps, said: “The Hazards Campaign has warned against employers adopting MHFA as a sticking plaster solution to the suppurating sore of anxiety, depression and worse caused by insecure work, low pay, excessive workloads, impossible targets, long hours, bullying, harassment and lack of support at work.” 

Dr Joanna Wilde, a member of the HSE’s Workplace Health Expert Committee, wrote on Twitter that the results of the HSE evidence were “unsurprising” and called MHFA an “individualistic response to a systemic problem”.

Fionuala Bonnar, chief operating officer of training provider Mental Health First Aid England, told IOSH Magazine: “We are confident that MHFA, as a mental health awareness and skills development course, sits on a solid and growing evidence-base – both nationally and internationally. Research consistently shows the MHFA course, delivered in 24 countries globally, improves knowledge and confidence in supporting someone experiencing mental ill health, including people in the workplace and wider community.
“MHFA England works with hundreds of organisations who are adopting MHFA training as part of their overall approach to mental health and wellbeing in the workplace and the overriding message from these employers is that making staff more aware about mental health and skilled to support others, creates mentally healthy working environments. Large employers, including Unilever, Deloitte, EY, Mace, Lendlease, Ford, WHSmith, Skanska, Civil Service, Public Health England and NHS England are all choosing to train staff in MHFA because they can see the positive impact it has within their organisations. 

“Whilst it is accepted that research on workplace wellbeing interventions is at an early stage, Public Health England and RAND Europe evaluated the evidence base for over 100 workplace wellbeing programmes and last month published a study which aimed to determine the confidence employers can have that an intervention will have a positive impact. MHFA was ranked as having the second strongest evidence base according to the Nesta Standards of Evidence, out of 117 different interventions assessed. 

“To help address the gap identified by the HSE’s rapid review in evidence base of how MHFA addresses mental health in the workplace, MHFA England CIC is currently working with the Centre for Mental Health on the development of new research which will further look into the impact of MHFA on the person trained and those they support in the workplace. We will also welcome the findings from the University of Nottingham MENTOR study, commissioned by IOSH, which examines the impact of MHFA training in the workplace.”



Keeley Downey is acting deputy editor of IOSH Magazine. She is a former editor of Biofuels International, Bioenergy Insight and Tank Cleaning Magazine


  • Purely having the presence of

    Permalink Submitted by Rick Smith on 24 August 2018 - 12:13 pm

    Purely having the presence of someone in the workplace who is trained to look out for the symptoms and who has an awareness of the correct response and or interventions can only be a positive. The more awareness regarding this subject can only help to remove the taboos and stigma around mental health issues that are far more prevalent in our society than current practices accept.

  • Mental health issues are very

    Permalink Submitted by Jeremy Rowland on 24 August 2018 - 12:14 pm

    Mental health issues are very special problems in their own right and should be dealt with by highly trained health specialists in the NHS and not by for want of better words 'First Aiders' at work. I see this as little more than the government or people who pull the strings trying to shift mental health care down the line. The human race cannot cure many diseases or physical afflictions with all the specialist doctors and surgeons that we have let alone cure mental issues; while there should be no stigma attached to discussing these issues it should not fall within the remit of businesses to be landed with this extra unwanted problem.

  • This is like stating that

    Permalink Submitted by Paul Hay on 24 August 2018 - 03:01 pm

    This is like stating that there is no evidence that having physical first aiders at work reduces the risk of injuries!!! I feel that the authors of this report are missing the point - MHFA is designed to help individuals recognize the signs and symptoms of mental health issues and help support those who may be suffering not to prevent it in the first place (although education, of course, has massive benefits). MHFA should, obviously, be a part of a much bigger strategy to tackle this issue in the same way physical first aid would be a small part of an overall strategy to deal with H&S. I wonder if this has come out as a reaction to the call for MHFA to mandated by law?

  • For 40 years or more since

    Permalink Submitted by Nigel Biney on 24 August 2018 - 05:34 pm

    For 40 years or more since HASWA, the HSE has significantly failed to address the issues of health in the workplace. In recent years it has used initiatives to promote and facilitate the attention being drawn to dermatitis, silicosis and others. Mental health has yet to be addressed by them (excluding the stress toolkit). MHFA ought to be seen as an elemental part to strategy in raising awareness and breaking down barriers, and is not the whole story. MHFA is one of a number of initiatives along with ASIST to curb the male suicide rates, it is not diagnostic, but it attempts to draw attention to workplace policy and procedures on MH issues at work. Where will we see HSE research into NHS Bullying? It is by no means perfect, but it is a positive step that is active in doing something! Time HSE, IOSH, IIRSM, BSC and others now did the same and took proactive steps to speak up, raise awareness and put something in place to train, inform and advise on the cases facing employers and employees alike on mental health.

  • We should treat Mental Health

    Permalink Submitted by jason raggett on 25 August 2018 - 01:47 pm

    We should treat Mental Health Illness in a company the same as we treat any incident, investigate and find the root cause and deal with that, this should be part of your health and safety management system.

  • Paul Hay hits the nail on the

    Permalink Submitted by Catherine on 27 August 2018 - 12:49 pm

    Paul Hay hits the nail on the head entirely. Let's get back to the point of MHFA and it's 'outcomes' which if HSE had understood clearly would realise that 'sustained actions' and 'improvement of wider management' are not in there whatsoever.

    In the report which states "There is consistent evidence that MHFA training raises employees’ awareness of mental ill‐health conditions, including signs and symptoms", that is exactly what it's there to do. After that you need to move onto other actions and plans that are not part of MHFA.

    These two "There is limited evidence that MHFA training leads to sustained improvement in the ability of those trained to help colleagues experiencing mental ill‐health and There is no evidence that the introduction of MHFA training has improved the organisational
    management of mental health in workplaces", sit outside of MHFA's remit and to have even considered these within this review shows that the wrong questions are being asked about MHFA. MHFA is a very 'small' part of mental health literacy and education in the workplace and that's exactly where it sits. If anything, it helps organisations consider the 'what next' step and gets people talking about what needs to change.

  • I fear Dr Wilde is right in

    Permalink Submitted by Clive Griffiths on 27 August 2018 - 02:21 pm

    I fear Dr Wilde is right in too many cases. In organisations where the culture is a mess, and the management style borders on the abusive, throwing in MHFA will at best make the resilience gangplank a little longer - but the staff will in evitably fall off into burnout or breakdown. And yes those organisations do exist and are probably more widespread than is admitted.

  • The headline to the article

    Permalink Submitted by Oscar Radford on 23 September 2018 - 08:36 pm

    The headline to the article is not truly reflective of the report itself, is misleading and is geared at attracting negative attention. As with any training it can never be a 'one hit' wonder and must be followed up and reinforced at all levels of the organisation if positive consideration and management of MH is to become embedded in any Company. What is clear is that there is not sufficient follow up research and findings that provide definitive evidence as to the effectiveness of the introduction of MH First Aiders. Rather than having sensationalist headlines maybe we should recognise that the management of MH within an organisation has to start somewhere and that whilst we may not get it totally right immediately we are heading in a direction which is more positive than previously was the case. Lets wait for 'real' facts and evidence before causing 'rabbits to run'.....


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