Anita Malster: Why mental health training should never be seen as a tick-box exercise

When it comes to mental health training and workplace suicide prevention, employers have a statutory duty to implement policies and procedures that protect their staff. Under the HSE management standards, employers can use several risk assessment templates to identify and reduce stress among workers.

But despite the growing numbers of mental health first aiders in the UK (the national training body Mental Health First Aid England alone has provided mental health first aider training to 20,000 businesses), there is a silent epidemic of workplace stress which is continuing to cost businesses thousands of pounds every year in lost productivity.

The HSE’s own statistics have confirmed that “there were an estimated 914,000 cases of work-related stress, depression, or anxiety in 2021/22” and “an estimated 17 million working days were lost due to work-related stress, depression, or anxiety.”

Clearly, something isn’t working if the number of employers investing in mental health first-aiders has increased with no reduction in reportable cases of stress or anxiety.

While it’s great that so many more employers are actively recognising that mental health issues should be addressed in the workplace, could more be done to ensure the training that firms are investing in is effective?

Is mental health training seen as a nice-to-have activity?

Employers welcome the fact that training can be used to tick a compliance box because it provides a clear audit trail of what is being done to promote a healthier workplace. But in reality, firms may not actively use that training to drive a sustainable change that offers lasting benefits.

Often, companies will invest in off-the-shelf training, and they might have the best intentions, but often, after a few weeks the information and skills people have learnt through their training are forgotten. Unfortunately, this makes the training ineffective, and workers are left still feeling unsupported, anxious or overwhelmed, despite all efforts being made on paper to address the situation.

Mental health training workshops and the introduction of mental health first aiders should be seen as one part of a wider culture change. One that needs to be continuously re-visited and benchmarked to monitor progress. When a culture starts to shift for the better, firms should see greater staff retention, improved employee satisfaction and morale, reduced sick days and increased productivity. People need to feel seen, heard and valued.

But how can employers truly tackle this issue?

There are four crucial areas that employers should be focusing on if they wish to achieve systemic change following any mental health training.

1. Creating mentally healthy and psychologically ‘safe’ workplaces where people aren’t afraid to seek help (this starts from the top with visible senior leadership buy-in)
2. Investing in training for line managers and HR professionals to allow them to spot signs of stress and know how to conduct supportive conversations
3. A suicide prevention and postvention strategy
4. Good signposting routes that are visible and easy to access

Creating mentally healthy and psychologically ‘safe’ workplaces

To tackle the growing issue of workplace stress, senior management teams must pay close attention to any problems that workers report. Suggestions and feedback need to be taken seriously and listened to. Often, when workers talk about workplace issues, the things that individuals do not say can be just as informative as the things that they do talk about.

It can be easy for senior management teams to invest in mental health first aiders, but are they always choosing the right people for the role? Having someone that others feel comfortable talking to and opening up to is crucial if the role is to be a success. Similarly, senior leadership teams should demonstrate visible buy-in to any mental health initiatives, showing that individuals will have adjustments made or time off allocated if they report an issue. Too many workers are reluctant to admit to feeling overwhelmed with their workloads or unsure how to tackle a problem because they fear the consequences.

This is a real problem and could hold many people back.

While talking about mental health no longer has the stigma it once did, there’s still a way to go, especially within a work environment. Staff need to feel reassured that if they admit to feeling overwhelmed, it won’t count against them later down the line, perhaps in terms of promotion opportunities and career development. Some may even feel worried that they could lose their jobs if they admit to feeling burnt out.

Senior managers should be striving to create a workplace which feels psychologically safe. One where employees feel comfortable to open up knowing their issues will be handled without judgement.

A useful tool to benchmark how mentally healthy your workspace is, is the Human Givens Institute emotional needs audit.

This tool can identify what might be causing someone distress, both inside and outside of work. Through regular use, the tool can be used to help employees focus on areas where their basic needs aren’t being met. If areas of work are contributing to unmet need, or causing distress, this is helpful for employers to know.

Spotting the signs of stress

One of the issues with stress, anxiety and burnout is the recognition that we often don’t recognise that they are becoming an issue until it’s too late.

Therefore, employers should concentrate on learning how to spot the signs that someone is suffering before they escalate into a bigger problem. This could be managed through better internal communication – such as posters in common areas like the kitchen or toilets, or through regular reminders of how stress can physically manifest itself.

There are clear physical and emotional signs that tell us when someone is stressed, but we don’t always know how to read them. That’s because we typically look at each period of physical illness in isolation instead of trying to understand what the body is trying to tell us, whether that’s over the course of a few weeks or even a few months.

The challenge for senior management teams is to get the word out to all of their employees about these signs so that everyone, from the top to the bottom, can spot signs of stress.

Some of the physical signs of poor mental health, anxiety, or stress are:

• Changing appetite
• Drinking or smoking/vaping more than usual
• Flare-ups of skin conditions such as Eczema or Psoriasis
• Headaches
• Insomnia or other sleep issues

If someone is stressed out, we could also expect changes in how they act and feel.

• Becoming argumentative with co-workers
• Becoming withdrawn or quieter than usual
• Being more exuberant than normal in an attempt to hide feelings of distress
• Being more reactive or irritable than usual
• Reluctance to participate in usual site banter or conversations
• Signs of aggression or having a short fuse
• Withdrawal from regular social events

Each sign might not be a big deal on its own, but if someone is having trouble with a number of these physical or emotional problems, it could indicate an underlying issue that needs to be explored.

In an ideal world, all line managers should be provided with training that teaches them to spot these physical indicators and helps them start a conversation. Some line managers may be reluctant to talk to workers about their thoughts and feelings or take them at face value if an employee says they feel fine.

If you’re trying to embrace a new working culture, it can take time for employees to feel that they are in a safe space. It’s not uncommon for workers to be reluctant to open up, especially when talking to their direct line manager or someone senior. They might not be ready to articulate how they are feeling, or they could be worried that admitting to a vulnerability could put their job at risk.

That’s why you can’t just have one conversation and say you tried.

Instead, you might have to show someone you care several times before they feel comfortable honestly answering the question ‘Are you OK?’

Do you have a suicide prevention and postvention strategy?

At the moment, suicides within the workplace are not RIDDOR reportable. This means employers only have to report a death if it was caused by an accident at work and not if the person died by suicide. The default assumption is that the suicide is caused by personal problems, not stress at work. Unfortunately, this means we can’t track work-related suicides right now.

And without knowing how common they are, no legal steps can be taken to solve this huge problem.

We don’t want to make reporting mandatory just so that employers can be prosecuted. In reality suicide is usually a combination of life events, but work-related stress and difficult working environments are often contributory factors. Until we better understand the role that work environments play in someone’s decision to take their own life nothing will change.

If employers are serious about creating healthy workplaces, they need to include suicide prevention within their mental health strategies. As well as heavily focusing on clear preventative solutions, it’s also essential to think about postvention support for colleagues and co-workers who could be affected by someone’s death. This could include signposting to further help and support (such as The Samaritans) or investing in employee health insurance so that employees can gain swift access to virtual GPs or counselling services.

From a postvention perspective, it’s essential to have thought in advance about how to support those bereaved by suicide, whether this is work colleagues or the family of the deceased. Being proactive is crucial to any mental health strategy because the evidence shows that people who have been bereaved or affected by suicide are almost three times more at risk of suicidal ideation*

Sign posting to further support

Right now, the role of the mental health first aider is still relatively new to many workplaces and is potentially misunderstood. Mental health first aiders are not trained therapists and are only limited in what they can do – much like a physical first aider isn’t a paramedic. But they are there to ensure visible signposting is in place to guide individuals to further help and support.

That support could be about pinpointing access to national charities such as The Samaritans or CALM, or it could be about raising awareness of local initiatives and community groups who are there to help or just offering a non-judgemental, listening ear.

Businesses should understand that mental health training is often about knowing when to guide people towards additional help and support rather than delivering the support directly.

This is often where mental health training falls away from being an active tool to being something that’s ticked off a list. It’s great that companies are putting up posters with phone numbers or adding details of support services to their intranet. But in reality, those visible signposting routes become background noise. People tend to forget that they are there. But suppose looking after our mental health becomes part of our culture. In this scenario sending regular reminders to staff about useful tools or initiatives or actively talking about positive mental health during company-wide meetings and calls would become second nature.

Ultimately, any effective mental health initiative needs to be ingrained into the wider business culture by the senior leadership team.

Visible buy-in and support are essential to move away from a tick-box compliance process into a valuable resource that can transform your organisation.