10 Limitations of Mental Health First Aid (MHFA) Training

10 Limitations of Mental Health First Aid (MHFA) Training

Mental Health First Aid training has become a popular course across the UK.

It’s often supplied as a two day Mental Health First Aid (MHFA) course, with certification that is not formally regulated or recognised.

Many organisations then rely on their “certified” Mental Health First Aider as their primary control to mitigate all their psychosocial risks.

However, this approach misses many of the controls that should be considered when managing mental health, wellbeing, employee engagement and satisfaction.

As a result, the training often proves to be ineffective for organisations to manage psychosocial risks over the longer term.

In this article, we will be looking at 10 limitations of Mental Health First Aid training, including:

  1. Reaction over Proactivity
  2. Organisational Awareness
  3. Rapport and Trust
  4. Legal Obligations
  5. Lack of Psychosocial Framework
  6. Unqualified Therapists
  7. Over Informed
  8. Skills Retention
  9. Follow-On Support
  10. Not Scalable

Want to know more? Let’s get into the details…

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But First, What is Mental Health First Aid?

To answer this question, it is often easiest to start by considering Physical Health First Aid that organisations are more familiar with.

First Aid is the initial first line response in an emergency situation.

Physical Health First Aid may include CPR, putting pressure on a cut to stop bleeding, placing a person in the recovery position, turning off the electricity, etc.

For many years, organisations used to have a first aid kit, full of bandages and strapping.

That was until it was realised that people were putting bandages on too tightly and cutting off blood circulation.

We learnt that Physical Health First Aid needs to be done properly and to engage professional medical teams at the right time, to prevent further harm being done.

But what about Mental Health First Aid?

Mental Health First Aid is similar to Physical Health First Aid, but it is for emergencies relating to mental illness.

It’s all about providing that initial emergency support, and engaging or “signposting” the person to qualified professionals.

And What is Mental Health First Aid Training?

Mental Health First Aid Training is designed to educate people about how to engage a colleague in need and signpost them to qualified professionals.

It does not make those attendees a psychologist, psychiatrist, psychotherapist, counsellor, therapist, coach or medically qualified.

Their skills are not certified (their attendance may be) and they are not qualified professionals after the training.

Mental Health First Aid Training is offered by a wide range of organisations.

The training often provides a course that takes two days and costs typically range from £200 to £400, plus the cost of the attendees pay and lost productivity while they are on the training.

Mental Health First Aid Training courses do not have a recognised syllabus or standard.

The Health and Safety Executive (HSE) Statement On MHFA

In 2018, the UK Health and Safety Executive MHFA review reported on the outcomes of Mental Health First Aid training.

In the HSE MHFA report, they stated:

“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.”

This is a really important message for organisations to consider.

Let’s take a look in more detail at ten of the limitations of MHFA, which can help to explain why MHFA training resulted in limited benefit to those organisations.

10 Limitations of MHFA

The 10 limitations we often see, when speaking with organisations and workplaces with “certified” Mental Health First Aiders are:

Limitation 1 – Reaction over Proactivity

It is always better to prevent a crisis from happening, rather than having to deal with the aftermath.

Mental Health First Aid is designed as First Aid for Mental Illness.

It is designed as an emergency response.

It does not focus on Mental Wellness.

As such, Mental Illness First Aid does very little to prevent that emergency from happening in the first place.

It will always be more effective for Mental Health Managers to promote Mental Wellness, than providing emergency support for Mental Illness.

This approach is mirrored in the physical health and safety world, where preventative measures are used for dangerous objects (electrical cables, sharp objects, hazardous materials, etc) rather than waiting to help people with plasters, ambulances or medical referrals.

Even fire marshals were expected to perform more preventative duties, such as checking fire exits, extinguishers, doors and alarms; removing hazardous materials and performing fire drills.

Mental Health Management can help more than Mental Illness First Aid.

Limitation 2 – Organisational Awareness

When speaking with staff in organisations with trained Mental Health First Aiders, we often find those staff don’t actually know who the Mental Health First Aiders are.

They also don’t know what Mental Health First Aiders are there for and what they do.

In the days when most people worked from offices, many companies would have nominated fire marshals with brightly coloured safety clothing over the back of their chairs.

They had signs in the coffee areas stating who the health and safety officials and fire marshals were.

They had regular staff training sessions to inform them about who to contact, when and why.

But even if the nominated Mental Health First Aiders are advertised, it is still a long way from building strong and open relationships with the staff, where they feel comfortable to share their darkest secrets or concerns. It is made even harder for the individuals who actually need help, as they are likely to be in an emotionally difficult and vulnerable head space.

The effective management of mental health requires more of a holistic cultural approach than a few nominated supporters.

Limitation 3 – Rapport and Trust

Research into leading counsellors has shown that one of the most important skills for counsellors is the ability to build trust and rapport.

When working with organisations, once staff are aware of who the nominated Mental Health First Aiders are, we often hear that the staff are not comfortable raising concerns with those nominated individuals.

This is most noticeable if the First Aider’s broader job role also requires them to be involved in disciplinary action, employee disputes, pay decisions, redundancies, performance reviews or tribunals.

This can be a particular issue for HR teams, given many staff believe HR teams’ primary role is to protect the organisation rather than protect the individual.

Accordingly, those staff believe that disclosing mental health concerns will restrict their negotiating position with the organisation and may harm their own career.

This in turn can lead to mental health issues being supressed by the exact same people that the Mental Health First Aid is designed to help.

There is a risk that their issues, by being suppressed, could become more severe and harder to resolve in the longer term.

Limitation 4 – Legal Obligations

Health and Safety legislation and regulation applies to mental health as much as physical health.

The legal obligations include formal management of risk, including the use of policies and training.

Mental Health First Aid is only one small component of the wider framework that is required for legal compliance.

There is also the challenge of maintaining confidentiality and the challenge that is created by maintaining confidentiality.

If an individual has notified a colleague of a mental health issue, no matter what that colleague’s role in the organisation, they may have been deemed to have disclosed a disability to the organisation.

The organisation then has a legal obligation to make reasonable adjustments.

If the colleague doesn’t disclose the information, claiming reasons of confidentiality, there is a risk that the individual will be seen as being unfairly treated and discriminated against, and legal action may be taken against the organisation.

Courts often lean towards the individual, rather than the corporation, in such cases.

However, appropriate management of information relating to mental illness can help both the individual and the organisation.

Limitation 5 – Lack of Psychosocial Framework

As mentioned with legal obligations, Mental Health First Aid is only one small component of the wider framework that is required to support mental health, wellbeing, performance, satisfaction and employee engagement across the organisation.

Other aspects of psychosocial frameworks need to be considered, in order to reduce absence and costs, and increase productivity and returns.

Mental Health First Aid does not equate to effective management of mental health matters.

Limitation 6 – Unqualified Therapists

A little knowledge can be a dangerous thing.

Through conversations with organisations, we’ve found many Mental Health First Aiders adopting more of a counselling or psychotherapist type role.

In some cases, they were even facilitating group therapy sessions, without qualified or trained practitioners present.

That isn’t the intent of Mental Health First Aid.

The training typically advises attendees on a basic way to have a conversation with someone who may be suffering from a mental illness, and to provide them with options (signposting) to get help.

This is especially important in a crisis situation, when inappropriate actions could exacerbate the situation, the specifics of the training may not adequately cover such events, and even the specifics that are taught over the two days may have been forgotten.

We have also seen examples where a Mental Health First Aider had spoken with a colleague who was experiencing suicidal ideations. The First Aider stated that they had a really good chat with the colleague, and the colleague had gone away with a smile on their face, so they thought it would be OK.

Unfortunately, walking away with a smile means nothing about what will happen next. Suicidal ideations are unlikely to be resolved through a quick chat.

The risk may have actually just increased, along with the organisation’s liability.

Limitation 7 – Over Informed

Feedback that we often hear from certified Mental Health First Aiders, who had recently been on training courses, relates to the huge amount of information provided about different types of mental illness and the symptoms.

It takes considerable time from the attendees, and often detracts from that important focus on “detecting, engaging and signposting”.

This can drive the “underqualified therapist” issue we covered above, and also a “skills retention” issue we cover next.

It provides the individual with a lot of information about a lot of issues, without the information on how to effectively deal with those issues.

Limitation 8 – Skills Retention

While there’s a lot of information that can be presented over the two days of training, there are limits around how much information can be absorbed in that time.

The information that is absorbed will also deteriorate over time,

While many of the Mental Health First Aid training courses provide a huge amount of back up materials and a large book, it seems very rare for that book to be opened after the training.

We’ve also found very few Mental Health First Aid training courses that provide a test at the end to evidence what has been learnt, or to help retention of the information that was presented.

The MHFA certificate is a certificate of attendance, not a certificate of achievement or qualification.

Limitation 9 – Follow-On Support

For individuals experiencing Mental Illness, their return to work is a hugely important factor in how they will do going forwards.

It’s another necessary control within an organisation’s framework for managing mental health.

However, this appears to be missing from most Mental Health First Aid courses.

If the Mental Health First Aider has been able to establish trust and rapport, and provided the appropriate signposting, they are not provided with the resources to support that individual over the longer term.

Limiting the intervention to the emergency situation, with Mental Illness First Aid, lacks support for what should come before and what should come after that brief moment.

Limitation 10 – Not Scalable

The final limitation in this review considers the wider engagement that Mental Health First Aiders really have across the organisation.

Two days is a long time for colleagues to be spending on training.

Training a large network of Mental Health First Aiders, with each attendee losing two days of their time, becomes very expensive in terms of the time and costs involved.

Whereas organisations that train more people, especially staff and managers, on the core fundamentals of mental wellness, mental illness and support mechanisms, are more likely to experience a better return on their investment, in a multitude of ways.


To conclude, while we believe that organisations who train staff in Mental Health First Aid are likely to be doing better than organisations that do not address mental health matters at all, there are many other matters that need to be considered if an organisation is going to effectively manage mental health.

How To Help Your Organisation and Colleagues

The development of a mental wellbeing strategy and framework can help your organisation and colleagues perform better.

We’re here to help you achieve that.

Here at Managing Mental Health, we believe that all managers should be given the basic training to provide mental health first aid, but that can be done within a few hours rather than a few days. Mental health specialists can then be trained further, to develop the wider framework, including prevention and recovery measures.

For more information, simply call 0800 292 2126 or send us a message:

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