Zak FentonWorking notes

· Evidence review · in progress

Mental health first aid at work: what the evidence supports

The note this review supportsMental health first aid is sold to the workforce and taken by volunteers

Mental health first aid is sold to employers as a workplace wellbeing programme and taken up mostly by volunteers. This review sets out what the evidence shows at each step, from why employers buy it to what changes for the workforce. It supports the note on mental health first aid.

How this was checked

The question was split into parts: why employers buy it, how it is sold, who goes on it, what trainees learn and do, what happens to the people around them, what changes for the organisation, and use, harms and cost.

Each part was searched in reviews, trials and guidance, then graded with GRADE logic. Randomised trials start high and lose grades for risk of bias, inconsistency, indirectness and imprecision. Material from the programme owner was recorded but never allowed to set a grade. Whether each study had links to the course’s developers was noted.

The search and first grading were done on 18 October 2026 by AI agents. A seeded random 30 per cent of the 82 sources cited was reopened by separate verifiers. One check failed through a mapping error in the verification, not in the findings, and eight needed corrections, which are applied. Every passage in the ledger was reopened and copied from its source on 18 October 2026. Where only an abstract could be read, the ledger says so. Every grade here is provisional.

The headline

In the one study that asked, the most common reason given, by about a third of respondents, was that their organisation recognised existing or potential mental health problems among staff C31. The programme owner pitches it as benefiting people and business C38. The course is taken up mostly by volunteers. It improves what they know for some months.

Where studies measured the workforce around the trainees, wellbeing did not improve:

StudyWho was measuredResult
Cochrane review, 2023People around trainees, mostly in schools and communitiesMay make little or no difference, very uncertain C6
UK workplace cluster trial, 2026All employees in nine organisationsLower formal help-seeking and lower social wellbeing in organisations that adopted it C12
NICE guideline review, 2022EmployeesThe evidence did not show any effect on mental wellbeing C19
WISE schools trial, 2021All teachers in 25 schoolsNo evidence of a difference in mental wellbeing C37

All of this is very low certainty. On present evidence, mental health first aid has not been shown to improve the wellbeing of a workforce.

What employers buy it for

The one study that asked found that the most common main reason, given by 45 of 139 respondents, was that they felt training had been organised in recognition of existing or potential mental health problems among staff C31. Its authors concluded that many organisations wanted to improve staff wellbeing, with a productive workforce as the underlying drive C32. The respondents were mostly people involved in the training, describing what they thought their organisation wanted.

How it is sold

The programme owner calls the course one of the most powerful tools an organisation can put in place, for people and business C38. Its campaign page calls for it to be mandated in every organisation, like physical first aid C39. In October 2026 its chief executive wrote that the position is to build the evidence before asking government to legislate C40.

Its workplace page cites Deloitte for a return of £4.70 for every £1 spent on staff wellbeing C26. That figure is an average across employer spending on mental health and wellbeing, and the Deloitte report does not mention mental health first aid C27. Its own claims of effect are examined below.

HSE describes a legal duty to assess the risk of work-related stress and act on it C29. Its first aid guidance presents mental health trained first aiders as one option an employer might choose C30.

Who goes on the course

In the UK feasibility study, the most common route was an invitation to all employees C42, which leaves the choice to staff. An interviewee observed that the people on the course had generally volunteered for it C33, and some organisations capped places C34.

The reasons people give are mostly work and interest. In the first workplace trial, the most common were being “just interested”, workplace reasons and duty as a citizen C35. In a French survey of civil servants, most gave professional reasons and over half wanted to support family or friends C44. In that first trial, trainees’ own mental health before the course was about half a standard deviation below population norms C41, so many were dealing with mental health problems themselves.

No study found here compared volunteers with colleagues who did not sign up, on the same measures, before training. The French authors said self-selection could not be ruled out C43. Whether volunteers are mostly people who already championed mental health is untested.

How many it reaches

The schools trial was designed to train 8 per cent of staff C36, and 8.6 per cent completed the two-day course C46. A year on, 6.1 per cent of teachers said they had used the peer support service C47. Peer supporters reported helping about 1.7 colleagues a fortnight, about half of whom they would not have helped before training C48. In the oncology organisation’s survey, six of 21 first aid officers had no interactions in a year C22, and all said most or all of their interactions were with people they already knew C49. In the UK workplace trial, few employees reported direct support from a first aider C13.

What trainees get

The largest meta-analysis included 18 trials with 5,936 participants C1. Knowledge improved moderately to strongly straight after the course, and the gain shrank at six and twelve months C2. In 2018 only two trials had followed people beyond six months C3. The longest workplace trial followed Australian public servants for two years, and its authors concluded that knowledge, attitudes and intentions to help stayed improved C11. Six in ten participants were missing by then C10. The first workplace trial, in 2004, randomised 301 people to the course or a five-month wait C9. Both were run by the course’s developers.

The trials randomised volunteers. The gains are real for people who chose to take part, and they say nothing about people who would not have signed up. Knowledge is also measured by questionnaires the trainees fill in knowing they have been trained.

What trainees do

Trainees report giving a little more help, with no clear change in its quality C4. An independent review found insufficient evidence that the training improves helping behaviour or the mental health of the people helped C5. HSE’s 2018 review found limited evidence of a lasting improvement in trainees’ ability to help colleagues C17. No workplace study found here observed the help or asked the people who received it.

The workforce around them

The Cochrane reviewers could not draw conclusions on any of their primary outcomes C7. In the UK workplace trial, employees in organisations that adopted the course were less likely to seek formal help C12, and few reported any direct support from a first aider C13. That trial had nine organisations and six months of follow-up, and only its abstract could be read here, so the direction of its result needs replicating before anyone leans on it.

In the schools trial, teacher-reported absence was about 4 per cent higher in intervention schools, with weak evidence of a difference C21. The course was one part of a package there.

What changes for the organisation

HSE concluded in 2018 that it was not possible to say whether the training works at improving how organisations manage mental ill health C16. Its 2023 update found that nobody had measured it C18. NICE chose not to make a recommendation either way C19. For long-term absence, return to work, turnover, employee relations cases and insurance or employee assistance claims, nothing was found. Nobody has measured these, so the evidence says nothing either way.

Use, harms and cost

In one international oncology organisation, six of 21 first aid officers who answered a survey had had no interactions in a year C22, and two had done a refresher C23. In the UK trial, interviewees questioned what the role was for C14, and some saw it as treating the symptoms of workplace stress rather than its causes C15. NICE’s qualitative evidence includes people who saw it as “being seen to be doing something” C20.

No published data on harms were found C8. No study has tested whether the course takes the place of stress risk assessment. The recommended price of the adult course is £325 a person C24, and no cost-effectiveness study was found.

Claims that do not hold up

“Proven to make a lasting difference” C25 is fair for trainee knowledge over some months and goes beyond the evidence for workplaces C16C17C18. The return of £4.70 for every £1 is attributed to Deloitte accurately C26. It is an average across employer spending on mental health and wellbeing generally, and the report does not mention mental health first aid C27. “89% believe MHFAiders save lives” is a survey of what first aiders believe C28.

Why the findings fit together

Two explanations were considered. One is selection: the course attracts people who were already supportive, so it adds little. That is untested C43, and the evidence on who attends only partly fits it C35C41C44.

The other is reach, and the evidence fits it better. The course goes to a small share of staff C46, and few colleagues go to the people it trains C47C22C13. The schools trial is the closest test. It trained the colleagues others nominated as suited to the role C45, rather than volunteers, and teachers’ wellbeing still showed no difference C37. In the one trial that trained nominated colleagues, the workforce did not move, and few of the workforce went to them. This is an interpretation of indirect evidence, not a measured finding.

Limits

Most of the trial evidence covers the original Australian course and its online versions. The MHFA England course has one UK workplace trial, read here at abstract level. No controlled study of the half-day or champion courses, or of refreshers, was found. Most positive trials of knowledge and intentions were run by the course’s developers. The reviews that tested for this did not find developer-led trials reporting bigger effects, though that test is weak. The search was not exhaustive for grey literature, so a gap here means only that nothing was found.

What would change these grades

A study surveying a whole workforce before the course is offered, then comparing those who take it up with those who do not. A network survey asking who staff would go to, before training, would show whether trainees were already the people colleagues turn to.

Employers keeping anonymised counts of approaches to each first aider, so reach can be related to outcomes.

An independent cluster trial of the MHFA England course in a few dozen UK organisations, measuring the wellbeing and help-seeking of the whole workforce at six, twelve and twenty-four months, and identifying and asking the people actually helped.

A trial linked to employer records, with fit notes, long-term absence, return to work, turnover and employee assistance use, plus an economic evaluation.

A head-to-head trial against a cheaper mental health literacy course, and a study of whether stress risk assessments are completed less often after organisations adopt the course.

Claims ledger

Each claim is worded exactly as it was checked. Assessed claims show the source, passage, limits and date checked. If a source could not be checked, the entry records what was attempted and why. Claims still being checked are marked in review.

  1. C1Supported

    A 2018 meta-analysis of mental health first aid training included 18 trials with 5,936 participants.

    Source
    Morgan AJ, Ross A, Reavley NJ (2018). Systematic review and meta-analysis of Mental Health First Aid training: effects on knowledge, stigma, and helping behaviour. PLoS One, 13(5), e0197102. Open source (full text read)
    Passage
    A total of 18 trials (5936 participants) were included.
    Where
    Abstract, Results
    Limits
    Trials in any adult setting, not only workplaces. The authors work at the Australian centre where the course was developed, and several included trials were run by its developers.
    Checked

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  2. C2Supported

    Trainees' mental health first aid knowledge improved moderately to strongly straight after the course, and the gain was smaller at six and twelve months.

    Source
    Morgan AJ, Ross A, Reavley NJ (2018). Systematic review and meta-analysis of Mental Health First Aid training: effects on knowledge, stigma, and helping behaviour. PLoS One, 13(5), e0197102. Open source (full text read)
    Passage
    There was a moderate-to-large significant improvement in MHFA knowledge at post-intervention (d = 0.72), which was smaller at 6-month follow-up (d = 0.54) and 12 month follow-up (d = 0.31), with no heterogeneity.
    Where
    Results
    Limits
    Knowledge was measured with questionnaires completed by the trainees, who knew they had been trained. The twelve-month figure rests on one study.
    Checked

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  3. C3Supported

    Only two trials in the 2018 meta-analysis followed trainees beyond six months, so how long the effects last is unclear.

    Source
    Morgan AJ, Ross A, Reavley NJ (2018). Systematic review and meta-analysis of Mental Health First Aid training: effects on knowledge, stigma, and helping behaviour. PLoS One, 13(5), e0197102. Open source (full text read)
    Passage
    Only two studies have thus far examined MHFA training effects beyond 6 months [16, 47], hence the persistence of effects in the longer-term is unclear.
    Where
    Discussion
    Limits
    Describes the trials available in 2018. Later trials with longer follow-up are covered separately in this review.
    Checked

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  4. C4Supported

    Trainees reported a small increase in the amount of help they gave someone with a mental health problem, and no clear change in the quality of that help.

    Source
    Morgan AJ, Ross A, Reavley NJ (2018). Systematic review and meta-analysis of Mental Health First Aid training: effects on knowledge, stigma, and helping behaviour. PLoS One, 13(5), e0197102. Open source (full text read)
    Passage
    There were small improvements in the amount of help provided to a person with a mental health problem at follow-up (d = 0.23) but changes in the quality of behaviours offered were unclear.
    Where
    Abstract, Results
    Limits
    The help was reported by the trainees themselves. No included study observed the help given or asked the people who received it.
    Checked

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  5. C5Supported

    A 2022 systematic review found insufficient evidence that the training improves trainees' helping behaviour or the mental health of the people they help.

    Source
    Forthal S, Sadowska K, Pike KM, Balachander M, Jacobsson K, Hermosilla S (2022). Mental Health First Aid: a systematic review of trainee behavior and recipient mental health outcomes. Psychiatric Services, 73(4), 439-446. Open source (abstract only)
    Passage
    The findings indicate that there is insufficient current evidence that MHFA improves the helping behaviors of trainees or the mental health of those receiving helping behaviors.
    Where
    Abstract, Conclusions
    Limits
    A narrative synthesis without a pooled estimate. Independent of the course developers. Covers all settings, not only workplaces.
    Checked

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  6. C6Supported

    Compared with no training, the course may make little or no difference to the mental health of the people around trainees at six to twelve months, and the evidence is very uncertain.

    Source
    Richardson R, Dale HE, Robertson L, Meader N, Wellby G, McMillan D, Churchill R (2023). Mental Health First Aid as a tool for improving mental health and well-being. Cochrane Database of Systematic Reviews, CD013127. Open source (abstract only)
    Passage
    When MHFA training was compared with no intervention, it may have little to no effect on the mental health of individuals at six to 12 months, but the evidence is very uncertain (OR 0.88, 95% CI 0.61 to 1.28; 3 studies; 3939 participants).
    Where
    Abstract, Main results
    Limits
    Any setting, with no workplace subgroup. Most of the people measured were students and school communities, not adult colleagues.
    Checked

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  7. C7Supported

    The Cochrane reviewers could not draw conclusions on their primary outcomes because good quality evidence was lacking.

    Source
    Richardson R, Dale HE, Robertson L, Meader N, Wellby G, McMillan D, Churchill R (2023). Mental Health First Aid as a tool for improving mental health and well-being. Cochrane Database of Systematic Reviews, CD013127. Open source (abstract only)
    Passage
    We cannot draw conclusions about the effects of MHFA training on our primary outcomes due to the lack of good quality evidence.
    Where
    Abstract, Authors' conclusions
    Limits
    The primary outcomes were the mental health of people around trainees, their use of services, and adverse effects. Trainee knowledge was a secondary outcome and was not graded.
    Checked

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  8. C8Supported

    The Cochrane review found no published data on adverse effects of the training.

    Source
    Richardson R, Dale HE, Robertson L, Meader N, Wellby G, McMillan D, Churchill R (2023). Mental Health First Aid as a tool for improving mental health and well-being. Cochrane Database of Systematic Reviews, CD013127. Open source (abstract only)
    Passage
    We did not find published data on adverse effects.
    Where
    Abstract, Main results
    Limits
    No harms data were reported, so whether the training causes harm is unknown.
    Checked

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  9. C9Supported

    The first randomised trial of the course in a workplace randomised 301 participants to immediate training or a five-month wait.

    Source
    Kitchener BA, Jorm AF (2004). Mental health first aid training in a workplace setting: a randomized controlled trial. BMC Psychiatry, 4, 23. Open source (full text read)
    Passage
    Data are reported on 301 participants randomized to either participate immediately in a course or to be wait-listed for 5 months before undertaking the training.
    Where
    Abstract, Methods
    Limits
    Australian government employees. Run by the course's developers. Outcomes were self-reported and the comparison was a waiting list.
    Checked

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  10. C10Supported

    In a two-year Australian workplace trial of online and blended versions of the course, 40 per cent of participants had data at two years.

    Source
    Reavley NJ, Morgan AJ, Fischer JA, Kitchener BA, Bovopoulos N, Jorm AF (2021). Longer-term effectiveness of eLearning and blended delivery of Mental Health First Aid training in the workplace: 2-year follow-up of a randomised controlled trial. Internet Interventions, 25, 100434. Open source (full text read)
    Passage
    There were 272 participants (44.7%) with data at 1-year follow-up, 243 participants (40.0%) at 2-year follow-up, and 325 (53.5%) with data at either follow-up point.
    Where
    Results
    Limits
    Developer-led. With six in ten participants missing at two years, the longer-term results could be biased by who stayed in.
    Checked

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  11. C11Supported

    The authors of that trial concluded that both versions improved knowledge, attitudes and intentions to help over the longer term.

    Source
    Reavley NJ, Morgan AJ, Fischer JA, Kitchener BA, Bovopoulos N, Jorm AF (2021). Longer-term effectiveness of eLearning and blended delivery of Mental Health First Aid training in the workplace: 2-year follow-up of a randomised controlled trial. Internet Interventions, 25, 100434. Open source (full text read)
    Passage
    Both blended and eLearning MHFA courses led to significant longer-term improvements in knowledge, attitudes and intentions to help a person with a mental health problem.
    Where
    Abstract, Conclusions
    Limits
    Intentions are not behaviour. The comparison group took a physical first aid course. See C10 on follow-up.
    Checked

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  12. C12Supported

    In a UK workplace cluster randomised trial, employees in organisations that adopted the course were less likely to seek formal help than employees in control organisations.

    Source
    Atanda O, Reavey P, Durcan G, Carter T, O'Shea N, Brown S, Wood K, Vangeli E, White S, Callaghan P (2026). A cluster randomised controlled trial of mental health first aid (MHFA) in UK workplaces. Journal of Public Mental Health. Open source (abstract only)
    Passage
    A regression model with a fixed treatment effect showed employees based in clusters that adopted MHFA were significantly less likely to seek help, AOR = 0.34 (95% CI: 0.12, 0.95, p = 0.039), reported lower social well-being (95% CI: −0.40, −0.03, p = 0.024) and higher self-efficacy-knowledge (95% CI: 0.74, 3.06, p = 0.001).
    Where
    Abstract, Findings
    Limits
    Nine organisations, six months of follow-up, and only the abstract could be read. The help-seeking outcome covers all employees, not only those a first aider helped. Treat the direction as a warning to replicate, not a finding.
    Checked

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  13. C13Supported

    In the same trial, few employees reported receiving direct support from a mental health first aider.

    Source
    Atanda O, Reavey P, Durcan G, Carter T, O'Shea N, Brown S, Wood K, Vangeli E, White S, Callaghan P (2026). A cluster randomised controlled trial of mental health first aid (MHFA) in UK workplaces. Journal of Public Mental Health. Open source (abstract only)
    Passage
    Few employees reported receiving direct support from a mental health first aider.
    Where
    Abstract, Findings
    Limits
    The abstract gives no count. The trial's companion material reportedly puts it at six people, which was not checked here.
    Checked

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  14. C14Supported

    UK workers interviewed alongside the trial questioned what mental health first aid was for and where its limits lay.

    Source
    Atanda O, Vangeli E, Brown SD, Callaghan P, Durcan G, Wood K, Carter T, O'Shea N, White S, Reavey P (2026). Mental health first aid in the workplace: a reflexive thematic analysis of UK workers' experiences. International Journal of Qualitative Studies on Health and Well-being, 21(1), 2706909. Open source (full text read)
    Passage
    Participants questioned the purpose, boundaries, and organisational value of MHFA, contributing to reluctance to engage.
    Where
    Results
    Limits
    Interviews in the trial's organisations. Describes how people saw it, not what it did.
    Checked

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  15. C15Supported

    Some of those workers saw mental health first aid as addressing the symptoms of workplace stress rather than its causes.

    Source
    Atanda O, Vangeli E, Brown SD, Callaghan P, Durcan G, Wood K, Carter T, O'Shea N, White S, Reavey P (2026). Mental health first aid in the workplace: a reflexive thematic analysis of UK workers' experiences. International Journal of Qualitative Studies on Health and Well-being, 21(1), 2706909. Open source (full text read)
    Passage
    As a result, some saw MHFA as addressing the symptoms of workplace stress rather than its underlying causes.
    Where
    Results
    Limits
    A perception reported by some interviewees. No study has measured whether the course displaces stress risk assessment.
    Checked

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  16. C16Supported

    The Health and Safety Executive's 2018 evidence review concluded that it was not possible to say whether the training is effective at work in improving how organisations manage mental ill health.

    Source
    Health and Safety Executive (2018). Summary of the evidence on the effectiveness of Mental Health First Aid (MHFA) training in the workplace. Research Report RR1135. Read through the UK Government Web Archive capture of 8 December 2024. Open source (full text read)
    Passage
    Based on the published research, it is not possible to state whether MHFA training is effective in a workplace setting to improve the organisational management of mental-ill health.
    Where
    Conclusions
    Limits
    The conclusion is inconclusive, so it says nothing either way. The review predates the UK cluster trial and the Cochrane review.
    Checked

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  17. C17Supported

    The same review found limited evidence that the training leads to a lasting improvement in trainees' ability to help colleagues.

    Source
    Health and Safety Executive (2018). Summary of the evidence on the effectiveness of Mental Health First Aid (MHFA) training in the workplace. Research Report RR1135. Read through the UK Government Web Archive capture of 8 December 2024. Open source (full text read)
    Passage
    There is limited evidence that MHFA training leads to sustained improvement in the ability of those trained to help colleagues experiencing mental ill-health.
    Where
    Key findings
    Limits
    As C16.
    Checked

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  18. C18Supported

    HSE's 2023 update found that nobody had measured whether introducing the training improves how organisations manage mental health.

    Source
    Health and Safety Executive. RR1135 research report page, section 'Further literature review, 2023'. Read through the UK Government Web Archive capture of 6 December 2024. Open source (full text read)
    Passage
    nobody has measured whether the introduction of mental health first aid training has improved the organisational management of mental health in workplaces
    Where
    Further literature review, 2023
    Limits
    A short summary on a web page, not a full report. The live HSE page could not be reached, so the archived copy was read.
    Checked

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  19. C19Supported

    NICE's committee chose not to make a recommendation on mental health first aid in its 2022 guideline on mental wellbeing at work, noting that it can be expensive and that the evidence did not show an effect on mental wellbeing.

    Source
    National Institute for Health and Care Excellence (2022). Mental wellbeing at work (NG212). Evidence review A: organisational universal-level approaches. Open source (full text read)
    Passage
    However, the committee noted that mental health first aid can be expensive, and the evidence did not show that it has any effect on mental wellbeing; therefore, they chose not to make a recommendation around mental health first aid.
    Where
    Committee discussion of the evidence
    Limits
    The committee made no recommendation in either direction.
    Checked

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  20. C20Supported

    Some participants in the qualitative studies NICE reviewed saw the training as a way of being seen to do something.

    Source
    National Institute for Health and Care Excellence (2022). Mental wellbeing at work (NG212). Evidence review A: organisational universal-level approaches. Open source (full text read)
    Passage
    In some cases, MHFA training was offered as part of a wider organisational approach to mental wellbeing, though some participants saw it as ‘being seen to be doing something’.
    Where
    Qualitative evidence, part of a wider organisational approach
    Limits
    A view held by some participants in UK qualitative studies.
    Checked

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  21. C21Supported

    In a UK secondary school trial where the course was combined with a staff peer support service, teacher-reported absence was about 4 per cent higher in intervention schools, with weak evidence of a difference.

    Source
    Kidger J, Turner N, Hollingworth W, et al. (2021). An intervention to improve teacher well-being support and training to support students in UK high schools (the WISE study): a cluster randomised controlled trial. PLoS Medicine, 18(11), e1003847. Open source (full text read)
    Passage
    There was weak evidence of a difference between groups in self-reported teacher absenteeism over the course of follow-up; in the adjusted model, the number of days of absence was 4% higher in those teachers in the intervention group compared to those in the control (unadjusted ratio of geometric means 1.03, 95% CI 0.98, 1.07, p -value 0.308 and adjusted ratio of geometric means 1.04, 95% CI 1.00, 1.09, p -value 0.042).
    Where
    Results
    Limits
    Schools, not general workplaces. The course was one part of a wider intervention, given to a minority of staff, so this cannot be read as the effect of the course alone. Independent and NIHR-funded.
    Checked

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  22. C22Supported

    In a survey of 21 trained mental health first aid officers in one international oncology organisation, six had no interactions in the previous year.

    Source
    Summerfield et al. (2025). An evaluation of Mental Health First Aid Officer utilisation across an international, interdisciplinary oncology group. Journal of Medical Radiation Sciences. Open source (full text read)
    Passage
    Six respondents (29%) reported zero interactions.
    Where
    Results
    Limits
    One organisation, 21 of 34 invited officers responded, and the answers were self-reported.
    Checked

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  23. C23Supported

    In the same survey, two of the 21 officers had done refresher training.

    Source
    Summerfield et al. (2025). An evaluation of Mental Health First Aid Officer utilisation across an international, interdisciplinary oncology group. Journal of Medical Radiation Sciences. Open source (full text read)
    Passage
    Respondents reported their formal MHFA training took place predominantly between 2020 and 2023, and two MHFAO had completed refresher training (Table 1).
    Where
    Results
    Limits
    As C22. Most had trained recently, so few were due a refresher.
    Checked

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  24. C24Supported

    MHFA England's recommended price for its adult Mental Health First Aid course is £325 per person.

    Source
    MHFA England. Mental Health First Aid course page. Open source (full text read)
    Passage
    £325.00* /per person * This is our recommended price
    Limits
    A list price from the programme owner on the day it was read. Licensed instructors and in-house deliveries may charge differently. The cost of staff time is not included.
    Checked

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  25. C25Supported

    MHFA England's website says its training is proven to make a lasting difference.

    Source
    MHFA England. About us. Open source (full text read)
    Passage
    Our training is proven to make a lasting difference, building knowledge and confidence in mental health support.
    Limits
    Records what the programme owner says. Whether the evidence supports it is discussed in the body of this review.
    Checked

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  26. C26Supported

    MHFA England's workplace page cites Deloitte for a return of £4.70 for every £1 spent on staff wellbeing.

    Source
    MHFA England. Mental health courses for workplaces. Open source (full text read)
    Passage
    According to research from Deloitte, employers see a return of £4.70 on average for every £1 spent on staff wellbeing.
    Limits
    The figure is attributed accurately to Deloitte. See C27 for what it measures.
    Checked

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  27. C27Supported

    Deloitte's £4.70 figure is an average across employer investment in mental health and wellbeing generally, and the report does not mention mental health first aid.

    Source
    Deloitte (2024). Mental health and employers: the case for employers to invest in supporting working parents and a mentally healthy workplace. Open source (full text read)
    Passage
    Our analysis suggests that employers can achieve an average return of £4.7 for £1 invested in employees' mental health and wellbeing, and early intervention and prevention produces the highest benefits.
    Limits
    A full-text search of the report found no use of "first aid" or "MHFA". The report also says its authors did not review the methods of the studies behind the figure.
    Checked

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  28. C28Supported

    MHFA England's workplace standards page reports that 89 per cent of its first aiders believe they save lives.

    Source
    MHFA England. Workplace Mental Health First Aid Standards pledge page. Open source (full text read)
    Passage
    89% believe MHFAiders save lives
    Limits
    A survey of first aiders' beliefs. No trial has measured deaths or suicides after the training.
    Checked

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  29. C29Supported

    HSE says employers have a legal duty to protect workers from stress at work by doing a risk assessment and acting on it.

    Source
    Health and Safety Executive. Work-related stress: stress risk assessment. Open source (full text read)
    Passage
    Employers have a legal duty to protect workers from stress at work by doing a risk assessment and acting on it.
    Limits
    Guidance from the regulator summarising the duty, not the legislation itself.
    Checked

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  30. C30Supported

    HSE first aid guidance presents mental health trained first aiders as something an employer might decide to have after its needs assessment, not as a requirement.

    Source
    Health and Safety Executive. First aid at work: what employers need to do. Open source (full text read)
    Passage
    Following your employers' first aid needs assessment; you might decide that it will be beneficial to have personnel trained to identify and understand symptoms and able to support someone who might be experiencing a mental health issue.
    Where
    Mental ill health and first aid
    Limits
    The same section lists other options, including information or training for managers and employees, occupational health professionals and employee support programmes.
    Checked

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  31. C31Supported

    In a 2018 UK survey of organisations using the training, the most common main reason given for it was recognition of existing or potential mental health problems in the organisation.

    Source
    Narayanasamy M, Geraghty J, Coole C, Nouri F, Thomson L, Callaghan P, Drummond A (2018). MENtal health first aid in The wORkplace (MENTOR): a feasibility study. IOSH research report, University of Nottingham. Open source (full text read)
    Passage
    The majority of respondents (n=45) indicated that they felt training had been organised in recognition of existing or potential mental health problems among members of their organisation (Table 9).
    Where
    Section 3.2.2.10, Motivations for MHFA training
    Limits
    45 of 139 responses, so a plurality rather than a majority of all respondents. Respondents were mostly people involved in the training, reporting what they believed their organisation's reasons were. MHFA England helped recruit them.
    Checked

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  32. C32Supported

    The same study's authors concluded that, although many organisations wanted to improve staff wellbeing, the underlying drive was a productive workforce.

    Source
    Narayanasamy M, Geraghty J, Coole C, Nouri F, Thomson L, Callaghan P, Drummond A (2018). MENtal health first aid in The wORkplace (MENTOR): a feasibility study. IOSH research report, University of Nottingham. Open source (full text read)
    Passage
    Although many organisations were motivated to take steps to increase the wellbeing of their staff, the underlying major drive was to have a productive workforce.
    Where
    Section 4.4.1, Motivations for training
    Limits
    The researchers' interpretation of survey and interview data from six organisations.
    Checked

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  33. C33Supported

    An interviewee in that study observed that the people on the course had generally volunteered for it.

    Source
    Narayanasamy M, Geraghty J, Coole C, Nouri F, Thomson L, Callaghan P, Drummond A (2018). MENtal health first aid in The wORkplace (MENTOR): a feasibility study. IOSH research report, University of Nottingham. Open source (full text read)
    Passage
    But I suppose the people that were on that course were people that have generally volunteered to be on that course, rather than people that have been asked to go on that course, or told to go on that course
    Where
    Section 3, Who should attend MHFA training? (interviewee M183)
    Limits
    One interviewee's observation. Another interviewee in the same study described a waiting list because staff volunteered. Neither measures the attitudes of volunteers against colleagues who did not sign up.
    Checked

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  34. C34Supported

    Some organisations in that study capped the number of places on the course.

    Source
    Narayanasamy M, Geraghty J, Coole C, Nouri F, Thomson L, Callaghan P, Drummond A (2018). MENtal health first aid in The wORkplace (MENTOR): a feasibility study. IOSH research report, University of Nottingham. Open source (full text read)
    Passage
    Organisations might restrict the number of places available.
    Where
    Section 2, Why people do and do not attend MHFA training
    Limits
    Describes some of six organisations. No count of trained staff as a share of the workforce is given here.
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  35. C35Supported

    In the first workplace trial, participants' reasons for doing the course were mostly interest, workplace reasons and duty as a citizen.

    Source
    Kitchener BA, Jorm AF (2004). Mental health first aid training in a workplace setting: a randomized controlled trial. BMC Psychiatry, 4, 23. Open source (full text read)
    Passage
    When asked their reason for doing the course, 27.2% cited reasons relating to their workplace, 11.7% reasons relating to family or close friends, 4.9% reasons relating to their own mental health status, 20.5% cited duty as a citizen, 29% said they were just interested, and 6.7% wanted more accurate or updated information on mental health.
    Where
    Results
    Limits
    Australian government employees who volunteered for a trial in 2004. It records reasons, not attitudes before the course, and there is no comparison with staff who did not volunteer.
    Checked

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  36. C36Supported

    In the UK schools trial, the course was given to 8 per cent of staff, who then ran a peer support service.

    Source
    Kidger J, Turner N, Hollingworth W, et al. (2021). An intervention to improve teacher well-being support and training to support students in UK high schools (the WISE study): a cluster randomised controlled trial. PLoS Medicine, 18(11), e1003847. Open source (full text read)
    Passage
    Each intervention school received the following: (i) MHFA training for 8% staff who then provided a confidential peer support service for colleagues; (ii) MHFA for Schools and Colleges training for a further 8% teachers; and (iii) a 1-hour mental health awareness session for staff.
    Where
    Abstract, Methods and findings
    Limits
    Schools, and a package rather than the course alone.
    Checked

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  37. C37Supported

    In that trial, there was no evidence of a difference in teachers' mental wellbeing between intervention and control schools.

    Source
    Kidger J, Turner N, Hollingworth W, et al. (2021). An intervention to improve teacher well-being support and training to support students in UK high schools (the WISE study): a cluster randomised controlled trial. PLoS Medicine, 18(11), e1003847. Open source (full text read)
    Passage
    There was no evidence of a difference between arms in mean teacher mental well-being over the course of follow-up: unadjusted difference in means −0.48, 95% CI −1.63, 0.67, p -value 0.412 and adjusted difference in means −0.90, 95% CI −2.07, 0.27, p -value 0.130.
    Where
    Results
    Limits
    As C36. Wellbeing was measured across all teachers, which is the workforce-level question, but the intervention was more than the course.
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  38. C38Supported

    MHFA England describes the course as one of the most powerful tools an organisation can put in place for people and business.

    Source
    MHFA England. Workplace Mental Health First Aid Standards pledge page. Open source (full text read)
    Passage
    MHFA is one of the most powerful tools an organisation can put in place benefiting people and business
    Limits
    Records the programme owner's pitch. No source is given for it on the page.
    Checked

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  39. C39Supported

    MHFA England's campaign page calls for the course to be mandated in every organisation, like physical first aid.

    Source
    MHFA England. Set the standard. Mandate the change. Campaign page. Open source (full text read)
    Passage
    We are calling for MHFA to be mandated in every organisation, just like physical first aid.
    Limits
    The page is undated and still live. See C40 for the chief executive's position in October 2026.
    Checked

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  40. C40Supported

    In October 2026, MHFA England's chief executive wrote that its position is to build the evidence before asking government to legislate.

    Source
    McIntosh S (9 October 2026). Should mental health first aid be required by law? MHFA England blog. Open source (full text read)
    Passage
    This is why MHFA England’s position is to build the evidence before we ask government to legislate, not instead of it.
    Limits
    A statement of position. It sits alongside the still-live campaign page in C39.
    Checked

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  41. C41Supported

    In the first workplace trial, participants' own mental health before training was about half a standard deviation below Australian population norms.

    Source
    Kitchener BA, Jorm AF (2004). Mental health first aid training in a workplace setting: a randomized controlled trial. BMC Psychiatry, 4, 23. Open source (full text read)
    Passage
    Nevertheless, the participants' mean score on the mental health scale was around half a standard deviation below Australian population norms [9], showing that some were having on-going problems.
    Where
    Discussion
    Limits
    One Australian sample of volunteers in 2004. It describes trainees' own mental health, not their attitudes.
    Checked

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  42. C42Supported

    In the UK feasibility study, the most common way trainees were selected was that all employees had been invited.

    Source
    Narayanasamy M, Geraghty J, Coole C, Nouri F, Thomson L, Callaghan P, Drummond A (2018). MENtal health first aid in The wORkplace (MENTOR): a feasibility study. IOSH research report, University of Nottingham. Open source (full text read)
    Passage
    The most common was that all employees had been invited to undertake training, with 36.7 per cent of respondents indicating that this was the case and an additional 15.4 per cent stating that this method was used in conjunction with another selection criterion.
    Where
    Section 3.2.2.5, Selection processes for training
    Limits
    Other routes included employee request and selection by management. Respondents were reporting their organisation's process.
    Checked

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  43. C43Supported

    Authors of a French survey comparing trained and untrained civil servants said self-selection into the training could not be ruled out.

    Source
    Lebrat M, Carrouel F, du Sartz de Vigneulles B, et al. (2026). Assessment of knowledge, attitudes, and behaviors toward others' mental disorders to improve mental health first aid: cross-sectional study in a French workplace. JMIR Public Health and Surveillance, 12, e93207. Open source (full text read)
    Passage
    Because participation in MHFA training was voluntary, self-selection cannot be excluded, and trained participants may have differed from untrained participants in baseline mental health literacy, motivation, or interest in mental health.
    Where
    Limitations
    Limits
    The comparison was made after training, so it cannot separate selection from the effect of the course.
    Checked

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  44. C44Supported

    In the same survey, most trained civil servants gave professional or academic reasons for attending, and over half wanted to support family or friends.

    Source
    Lebrat M, Carrouel F, du Sartz de Vigneulles B, et al. (2026). Assessment of knowledge, attitudes, and behaviors toward others' mental disorders to improve mental health first aid: cross-sectional study in a French workplace. JMIR Public Health and Surveillance, 12, e93207. Open source (full text read)
    Passage
    Most cited professional or academic reasons for attending MHFA (384/545, 70.46%), followed by the desire to support relatives or friends (290/545, 53.21%).
    Where
    Results
    Limits
    Reasons recalled after training, in a survey that participants chose to answer. More than one reason could be given.
    Checked

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  45. C45Supported

    In the UK schools trial, the colleagues trained as peer supporters were chosen by colleague nomination rather than self-selection.

    Source
    Fisher H, Harding S, Bell S, et al. (2020). Delivery of a Mental Health First Aid training package and staff peer support service in secondary schools: a process evaluation of uptake and fidelity of the WISE intervention. Trials, 21, 745. Open source (full text read)
    Passage
    Selection of peer supporters was based on nominations by colleagues at the end of the baseline questionnaire; teachers were invited to suggest colleagues that would be well suited to the role of peer supporter.
    Where
    Methods, the WISE intervention
    Limits
    Schools only. Nomination picks people colleagues think suit the role, which is close to, but not the same as, the people they already go to.
    Checked

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  46. C46Supported

    In that trial, 8.6 per cent of staff completed the two-day course.

    Source
    Fisher H, Harding S, Bell S, et al. (2020). Delivery of a Mental Health First Aid training package and staff peer support service in secondary schools: a process evaluation of uptake and fidelity of the WISE intervention. Trials, 21, 745. Open source (full text read)
    Passage
    In the 12 schools assigned to the intervention arm, 113 (8.6%) staff completed the 2-day standard MHFA training course, and a further 146 (11.1%) staff completed the 1-day MHFA for schools and colleges training.
    Where
    Abstract, Results
    Limits
    The trial set a minimum of 8 per cent, so this reflects the design as well as uptake.
    Checked

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  47. C47Supported

    Twelve months on, 6.1 per cent of teachers said they had used the peer support service in the previous year.

    Source
    Fisher H, Harding S, Bell S, et al. (2020). Delivery of a Mental Health First Aid training package and staff peer support service in secondary schools: a process evaluation of uptake and fidelity of the WISE intervention. Trials, 21, 745. Open source (full text read)
    Passage
    At the 12-month teacher questionnaire follow-up, 34 (6.1%) of 557 teachers indicated they had accessed the peer support service in the previous 12 months.
    Where
    Results, research objective 6
    Limits
    Self-reported use of a formal service. Informal conversations with trained colleagues may not have been counted.
    Checked

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  48. C48Supported

    Peer supporters in that trial reported supporting a mean of 1.7 colleagues a fortnight, about half of whom they would not have supported before training.

    Source
    Fisher H, Harding S, Bell S, et al. (2020). Delivery of a Mental Health First Aid training package and staff peer support service in secondary schools: a process evaluation of uptake and fidelity of the WISE intervention. Trials, 21, 745. Open source (full text read)
    Passage
    Across all time-points combined, peer supporters reported that they had supported a mean of 1.7 (SD 1.8) colleagues in the previous 2 weeks, of which approximately half (mean 0.7, SD 0.8) were additional colleagues who they would not have supported prior to being trained.
    Where
    Results
    Limits
    Reported by the peer supporters themselves.
    Checked

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  49. C49Supported

    In the oncology organisation's survey, every first aid officer said most or all of their interactions were with staff already known to them.

    Source
    Summerfield et al. (2025). An evaluation of Mental Health First Aid Officer utilisation across an international, interdisciplinary oncology group. Journal of Medical Radiation Sciences. Open source (full text read)
    Passage
    All respondents (100%) reported that either, ‘most’ or ‘all’ MHFA interactions were with staff already known to them.
    Where
    Results
    Limits
    21 officers in one organisation, self-reported.
    Checked

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Back to the noteMental health first aid is sold to the workforce and taken by volunteers