Why we need to put mental and physical first aid on an equal footing

At the turn of the 11th century, a group of religious knights trained to be able to provide basic medical treatment. Known as the Order of St John, they used their skills on the battlefields of the crusades, assisting the injured as a first port of call.

Fast forward to 1878 in Victorian Britain. Surgeon-Major Peter Shepherd delivers the first ever first aid course in the hall of a Presbyterian school in central London. The idea spreads across the globe and within a decade thousands of St John first aid certificates have been awarded over four continents.

A century later, the principle is enshrined in workplace law and today the Where’s Your Head At? campaign is calling for the same to happen again. But this time, for our mental health.

Just as a physical first aider might know how to use CPR to save a life, or put someone in the recovery position, a mental health first aider (MHFAider) also uses a set of skills to guide a person who is struggling or in crisis to a place of safety and support.

Mental health first aid (MHFA) began life in Australia in the year 2000. Trauma nurse Betty Kitchener was out walking her dog in Canberra late one evening when the idea came to her. Together with her husband, Professor Tony Jorm, Betty went on to found MHFA Australia. Their vision was of a training course that could break stigma around mental health and empower people to be a listening ear and a guiding hand to professional support.

Working with mental health professionals and people with lived experience of mental illness, Betty and Tony developed a skills-based educational course. It was designed to give people knowledge and skills to recognise warning signs of common mental health issues, offer reassurance and signpost to the next level of support.

Since its inception, the idea has been taken up in 24 other countries. There are now nearly three million people trained worldwide, as well as a substantial body of evidence speaking to MHFA’s effectiveness.

The programme came to England in 2007 under the then-Labour government and grew out of the Department of Health to become an independent organisation, MHFA England, in 2009. Nearly a decade on and over 300,000 people have been trained – from armed forces personnel, to teachers, firefighters, nurses, and office workers.

Thanks to nearly two decades of intense campaigning, communities all over England are changing the way they think and act about mental health. And the workplace is no exception.

Private and public sector employers alike are waking up to the reality that neglecting their people’s mental health is costing them dear – in staff retention, productivity, and sickness absence. The Centre for Mental Health estimates this to the tune of around £35bn a year, with data from the HSE showing that 15.4 million days are lost due to work-related stress, depression or anxiety.

For the more important cost, the human cost, neat quantifiers are a hollow metric. The stories of people falling out of work and of careers delayed often remain in the shadows. But we can go some way to reducing this human cost if our workplaces are set up to be supportive around mental ill health.

There is no golden bullet for putting these structures in place, or indeed for creating a mentally healthy workplace. The ingredients are not a mystery but the implementation will never be a tick-box, one-size-fits-all approach.

For over 15,000 organisations across the country, MHFA is one of the ingredients and it’s having a real impact.

Thames Water is one of the employers leading the way and has trained over 350 MHFAiders. On the ground this means that its employees have someone in their teams trained to spot the signs and symptoms of mental ill-health. Someone who is confident to broach topics like suicide and self-harm. And perhaps most importantly, someone who knows where to signpost a colleague to if they need further support.

True, these MHFAiders are not knights in shining armour, or even surgeon-majors. But they don’t need to be. MHFA was founded on the principles of people helping people, demystifying mental illness and normalising talking about mental health.

People with MHFA skills are listeners and communicators there to offer reassurance and signposting and are not therapists or counsellors.

Thames Waters’ MHFAiders are also just one part of its wider strategic approach to health and wellbeing. But in the five years since it first introduced this approach, the organisation has seen a staggering 75 per cent reduction in work-related stress, anxiety and depression.

It’s impact like this that has prompted more than 50 leaders from across business, education and mental health to sign an open letter calling for the government to bring our outdated health and safety legislation up to speed.

The issue has been on the political agenda since Norman Lamb MP tabled an Early Day Motion in 2016. The Conservative Party’s 2017 manifesto then included a pledge to “amend health and safety regulations so that employers provide appropriate first aid training and needs assessment for mental health, as they currently do for risks to physical health”.

Now, following a 200,000-strong petition on the issue delivered to Downing Street by fellow campaign leaders Bauer Media and Natasha Devon MBE last month, leading employers including PwC, WHSmith, Mace, Royal Mail and Ford are joining the public’s calls for the government to follow through on this, and protect mental health in the workplace.

Updating this legislation will create an important baseline to ensure that no one is left behind, wherever they work. It won’t immediately revolutionise workplace wellbeing, but will ensure that everyone has access to someone with MHFA skills.

Good intentions and guidance can only do so much to shift the dials. In this mould, often only the most enlightened organisations take meaningful action to support their employees’ mental health. The rest lose out – both their people and their bottom lines.

So today we call not for an overhaul, but simply for common sense and sustainable change.