Work-related stress and poor mental health can affect people in any workplace. Stress is not an illness in itself, but sustained or excessive pressure can contribute to mental and physical ill health.
Employers must assess and manage work-related stress risks and provide appropriate support, as explained by the Health and Safety Executive (HSE).
One way employers can offer early, informal support is to appoint mental health first aiders as part of a wider approach to workplace mental health.
In addition to relevant learning, mental health first aiders need soft skills that help people feel at ease discussing their mental health. They also need clear boundaries, an understanding of confidentiality and the ability to recognise when urgent or professional help is required.
In this article, we outline the role of mental health first aiders in the workplace, explain how they can contribute to workplace support and look at the skills they need.
A mental health first aider is a colleague designated to offer initial, non-clinical support when someone may be experiencing poor mental health or emotional distress. They can listen without judgement, ask about immediate safety and signpost the person to appropriate workplace, NHS, emergency or community support. They are not therapists, counsellors or diagnosticians and should not provide treatment or ongoing case management.
Mental health first aiders can also promote awareness and, within confidentiality limits, feed recurring anonymised themes back to the organisation. The employer remains responsible for assessing and controlling work-related stress and other health and safety risks. A mental health first aider should only carry out a formal risk assessment if they are separately competent and appointed to do so.
Mental health first aiders should complement, not replace, competent managers, HR, occupational health, employee assistance programmes, professional care and organisation-wide action on work-related stress.
UK employers are not generally required to appoint someone with the specific title of mental health first aider. In Great Britain, HSE guidance says that, following their first-aid needs assessment, employers might decide it would be beneficial to have personnel trained to recognise possible signs and support someone experiencing a mental health issue. This is one possible measure alongside manager and employee information, occupational health services and employee support programmes.
In Great Britain, the Health and Safety at Work etc. Act 1974 requires employers to protect employees’ health, safety and welfare so far as is reasonably practicable. Employers must also assess and control work-related stress risks. Northern Ireland has separate legislation, including the Health and Safety at Work (Northern Ireland) Order 1978, as outlined by HSENI.
Employers should base their arrangements on the needs and risks of their organisation, define the mental health first aider’s role clearly and make sure appropriate referral and emergency procedures are in place.
The HSE estimates that 964,000 workers in Great Britain experienced work-related stress, depression or anxiety in 2024/25. These conditions accounted for an estimated 22.1 million working days lost that year.
A 2022 report by the Mental Health Foundation and London School of Economics and Political Science estimated that mental health problems cost the UK economy at least £117.9 billion each year. This was a society-wide estimate based on 2019 data, not a measure of sickness absence among workers alone.
Mental health first aiders need skills that help them offer calm, appropriate initial support. They may learn to notice possible warning signs, but they should not diagnose a condition or assume that a change in behaviour has a particular cause. Empathy, active listening, clear communication, sound boundaries, appropriate escalation and self-awareness are all important.
Communication is an important skill for mental health first aiders. Even with the best intentions, you may fail to help if the person does not feel heard or respected.
By being mindful of how they communicate, a first aider can talk to others in a way that puts them at ease. This can help the first aider understand what the person wants and whether they would like information or signposting.
Communication is about the relaying of information by a communicator, and the receiving of information by a listener or audience. For mental health first aiders in the workplace, good communication skills include being aware of their tone of voice, choice of language and how they offer information or signposting.
Speaking is, of course, very important for effective communication.
Your tone of voice is important. Tone involves the volume you use, the level and type of emotion that you put into your words and the emphasis that you place on words. Your tone of voice, the way you say certain words and the language you use can affect how a listener interprets what you say.
Not being mindful of your tone can lead to miscommunication. Speaking calmly, respectfully and without rushing can make the conversation easier for the other person.
How you say something is as important as what you say. Be concise. Stay focused on the purpose of the conversation and be clear and intentional when speaking. It may be appropriate to use someone’s name if they are comfortable with this. Avoid language that labels, minimises or blames them.
Active listening is when a person is fully engaged in understanding what is being said to them. It is the ability to hear something with thoughtful retention.
Good communication requires effective, active listening skills if the information is to be properly received and understood. Active listening is a skill that needs to be learned and practised. It requires effort and application.
Passive listening is a mechanical activity that requires minimal to no effort. When listening passively, we may have our minds on something else. Active listening ensures that your attention remains on the person speaking.
What you hear as a listener is as important as what is said. Miscommunication can occur when a speaker and listener interpret words differently, so reflect back what you have understood and ask the person whether you have understood them correctly.
Another key element to active listening is to demonstrate that you are paying attention. Someone who is struggling may find it difficult to explain something to you.
Use brief verbal and non-verbal encouragers, such as “I see” or a nod where appropriate. Reflect or summarise what the person has said. Ask clarifying questions rather than making assumptions. Validate their feelings without automatically agreeing with every belief or interpretation, and avoid interrupting them.
Poor listening leads to misunderstandings, potential conflict with colleagues and a lack of empathy with their situation. Important information about the person’s needs or safety may be missed.
A low-stress, private setting is key to encouraging good communication. A face-to-face conversation may suit some people, but ask what format and location they would prefer where possible.
With hybrid working now common, you may be helping people remotely by videoconference or phone. Whether you speak in person or remotely, reduce interruptions and check that the person is comfortable and cannot easily be overheard. Follow your organisation’s procedure if you become concerned about immediate safety or a remote connection is lost.
Mental health first aiders should be aware of their own non-verbal communication and notice possible changes in the other person without treating them as proof of how that person feels.
Body language has no fixed meaning. Eye contact, facial expression, posture and movement vary with the individual, situation, culture, disability, neurodivergence and past experience. For example, folded arms do not necessarily mean that someone is annoyed and avoiding eye contact does not necessarily mean that they are disengaged.
Aim for a relaxed, respectful manner and give the person enough physical space. Do not insist on eye contact, a smile or a particular posture. If a non-verbal cue concerns you, ask a neutral question rather than assuming what it means.
When you see someone who is emotionally or psychologically distressed, you may feel drawn to put your hand on their shoulder, hold their hand or otherwise touch them in a reassuring manner.
In some situations, gestures like these can demonstrate warmth, empathy and positive regard. But it is crucial to understand that not everyone finds touch comforting. Touch that is unexpected or uninvited may cause someone to feel uncomfortable, anxious or even angry. As a general rule, to avoid misunderstanding and confusion it is advisable to avoid touching people.
If you think a person may welcome touch and it is appropriate in your workplace, ask permission first and accept their answer. Comfort with touch varies between individuals and situations. Never infer someone’s preference from their gender, race, culture or appearance.
Mental health first aiders in the workplace must contend with various barriers that can lead to poor communication. The first barrier is our natural bias.
Humans have a natural tendency to judge each other. When we encounter situations that we are not familiar with, we start judging. For situations that we are familiar with, we assume we understand all the nuances involved before we actually do.
These tendencies stop the effective delivery of mental health first aid. Anyone who is feeling that they are being judged will not want to open up to you. You won’t form a clear picture of what they are experiencing, and they may not want your help.
Always treat people with respect and dignity, regardless of their situation or what they tell you. Support the person, don’t lecture them. Remember the problems they face are not due to weakness or laziness.
Self-awareness is crucial. Notice and question your assumptions so they do not shape the support you offer. Be mindful of your words, tone and facial expressions, and remain open to being corrected if you have misunderstood.
Explain that you will normally keep the conversation private, but do not promise absolute confidentiality. Follow your organisation’s policy and share only the information necessary with appropriate people if there is a serious risk of harm, a safeguarding concern or another lawful reason to disclose.
Where it is safe and practical, tell the person before sharing. The Information Commissioner’s Office provides guidance on proportionate information sharing in a mental health emergency at work.
Know and follow your organisation’s emergency procedure:
- If someone is in immediate danger or cannot be kept safe, call 999 or go to A&E. Stay with them, or stay connected remotely, until help takes over if it is safe for you to do so.
- If help is urgent but there is no immediate danger, use the relevant NHS urgent mental health service or contact an urgent GP service. In England, call NHS 111 and select the mental health option. See the NHS urgent mental health guidance.
- For confidential listening support at any time, call Samaritans on 116 123. Samaritans is not a substitute for emergency services where someone is in immediate danger.
Mental health first aiders need to recognise the limits of their role and capacity. They should not become someone’s sole or ongoing source of support. After a difficult conversation, use the organisation’s agreed supervision or debriefing arrangements without sharing unnecessary personal information.
Step back and seek support if the role is affecting your wellbeing, and refresh your knowledge and skills at appropriate intervals.
Relevant learning can help people recognise possible warning signs, start a supportive conversation, respond to urgent risk, maintain boundaries and signpost to appropriate help. It does not make a participant a clinician. Employers should select learning that meets their needs, define the role, establish referral routes and provide ongoing support and refresher learning.
Human Focus offers an online Mental Health First Aid course covering awareness, communication and initial support. The course provides knowledge and guidance, but completing it alone does not make someone competent, qualified or authorised to diagnose, treat or provide clinical mental health support. Employers should decide whether it is suitable for their organisation and put appropriate policies, support and referral arrangements in place.
