How Mental Health First Aid became a tick-box exercise
Samuel Roberts
Wrote this on, January 2, 2026
Over the past decade, Mental Health First Aid became one of the most widely adopted approaches to support workplace mental health.
For many, it marked an important shift that mental health is acknowledged at work, and that colleagues should be supported, not ignored. That progress matters. But alongside it, a more uncomfortable reality has emerged. Increasingly, the people working closest with it, such as Wellbeing Leads, HR and H&S teams, and instructors themselves, are asking the same question: Why isn’t this having the impact we hoped for?
Most concerning is the evidence now behind this question. In its 2018 review, the HSE found no evidence that Mental Health First Aid improved the management of mental ill-health. This was echoed by Cochrane, which concluded there is no reliable evidence to suggest Mental Health First Aid is effective, with existing studies carrying a high risk of bias.
Good intentions aren’t the problem
This isn’t because people don’t care.
Across workplaces, there is genuine commitment, energy and goodwill invested in mental health support. People volunteer their time, step into emotionally demanding roles, and want to help colleagues feel safer at work.
The problem lies elsewhere. In practice, Mental Health First Aid often struggles because of a combination of structural issues:
- A one-and-done training approach
- No clear way of measuring impact or effectiveness
- Safety concerns, with no proactive oversight or support built in
- A lack of frameworks to embed the programme into day-to-day operations
- No engagement or sustainability plan to keep networks active over time
In most businesses, people complete the training, receive their certificate, and return to their role with little ongoing management or structured follow-up. There is no regular skills practice, no on-hand support for difficult conversations, and little visibility of what is actually happening across the network.
Over time, a familiar pattern emerges. Supporters lose confidence. Conversations are avoided rather than mishandled. The role exists in name, but not always in practice.
This is what happens when mental health is treated as a one-off intervention, rather than something embedded into the operations and strategy of the business. This is where the model begins to unravel, and why, for many organisations, it eventually becomes a tick-box exercise.
Mental health conversations without practice are unsafe
Mental health conversations at work are difficult. With stress-related absence now the leading cause of time off, they’re also happening every day. Skills like active listening, emotional regulation, effective signposting and staying confident in uncertain, high-pressure situations are demanding and perishable.
Without active management and reinforcement, they fade. When confidence drops, people hesitate to step in, and proactive strategies quietly fall apart. This isn’t a failure of character or commitment. It’s a predictable outcome of how human skills work.
One of the most consistent issues we see is the gap between theory and reality.
On paper, many people who’ve completed Mental Health First Aid can describe what to do in a crisis. They can recall steps, models and guidance. But when faced with a real person, a real conversation and real emotion, those frameworks often fall away.
That gap exists for three critical reasons.
First, safeguarding is rarely taught.
Protecting adults from harm requires judgement, boundaries and escalation, not just good intentions. When safeguarding isn’t properly embedded, supporters are left exposed in situations that carry real risk.
Second, there is no structured learning.
Without a clear progression beyond initial training, skills aren’t revisited or reinforced. There’s little opportunity to practise real conversations, reflect on experience, or build confidence over time.
Third, supporters are often left without support themselves.
When someone encounters distress or crisis, there is rarely immediate guidance, supervision or backup. In those moments, uncertainty can quickly turn into hesitation.
This matters.
Without regular, applied skills practice:
- Conversations are poorly navigated and boundaries are broken
- Supporters second-guess their judgement
- People default to avoidance rather than action
Practising these skills isn’t about perfection. There is ALWAYS grey area in the realm of mental health, that’s why a proactive support model is key. However it is about familiarity, confidence and reducing fear. When practice doesn’t happen, even well-intentioned supporters disengage, not because they lack commitment, but because they don’t feel equipped to act safely.
Recruiting the wrong individuals creates risk
Another uncomfortable truth is how supporters are recruited.
In many organisations, people step into mental health roles for the wrong reasons or are placed there without enough thought. Sometimes it’s because the role looks positive on a CV. Sometimes because they’re already close to HR. Sometimes because someone needed to fill the seat.
Over time, this can lead to:
- Poor conduct in conversations, damaging trust
- Employees feeling the network is “owned” by HR
- People choosing not to disclose at all
The question that’s rarely asked is also the most important:
Why are we recruiting supporters, and what are we actually asking of them?
Not everyone is suited to this role. And even those who are need clear boundaries, protected time, and ongoing backing. Without that, recruitment becomes tokenistic, and tokenism damages both culture and trust.
Mental Health First Aid is a reactive model
Mental Health First Aid is, by design, a reactive model. It focuses on recognising signs of distress and responding when someone is already struggling, often when pressure has reached a critical point.
That focus has value. But when support is built mainly around reaction, it limits the impact organisations can have earlier, when issues are more manageable and less risky. Most workplace mental health challenges don’t begin with crisis. They develop gradually… through sustained workload, poor recovery, lack of control, constant change or low psychological safety. By the time someone reaches a point of crisis, multiple opportunities for earlier support have already been missed.
Interdependence is missing, not simply ‘more training’
Effective workplace mental health support can’t sit with supporters alone.
It depends on interdependence between supporters, managers, leaders, HR, workload design and organisational culture. When mental health is treated as the responsibility of a small, trained group, supporters become the last line of defence rather than part of a wider system.
This is where many models fall short. They train individuals, but don’t equip the organisation to hold the responsibility collectively.
How our approach is different
Our approach is different. We do not rely on reaction alone. We embed systems that surface issues and support action sooner:
- Every conversation is logged.
Supporter conversations are logged alongside key data points, allowing organisations to identify patterns in stressors, working environments and emerging risks, not just isolated incidents. - Networks stay active vs inactive.
Ongoing engagement and visibility mean supporters remain motivated and proactive, so conversations happen earlier, not only when things reach breaking point. - Supporters are never left on their own.
Our on-hand 1:1 support team is available during working hours to help supporters think through situations as they emerge, reducing uncertainty and enabling timely, confident action.
The result is a shift to early intervention, and from isolated individuals to a connected, supported system. Without proactive structures in place, mental health becomes something that’s “dealt with” rather than something that’s continuously supported.
The missing strategic and guidance gap
Another challenge raised repeatedly is the lack of clear guidance around implementation and continuation.
Many Wellbeing Leads are left asking:
- What does “good” look like after training ends?
- How often should supporters practise or refresh?
- How do we measure confidence, not just attendance?
- How do we keep networks alive over time?
Without this strategic guidance, businesses are left to improvise and ‘figure it themselves’, knowing that the stakes can be high.
The shift away from Mental Health First Aid has already happened
Mental Health First Aid didn’t fail because people didn’t care. It fell short because of the way it’s designed.
It was moulded into a workplace solution where one-off training creates risk. Reactive models concentrate responsibility too late. And without structure, visibility and reinforcement, even the strongest intentions fade over time. This is a shift from a programme to an ongoing systems that’s embedded within the business. To learn more about how businesses have moved on from Mental Health First Aid, why not read some of their stories just here.
