Where Mental Health First Aid Came From

Walk into almost any workplace today and you’ll find at least a handful of people trained in Mental Health First Aid. For some organizations it’s become the default answer to a very real problem, but the default isn’t always the most effective.

Mental Health First Aid has been around for more than two decades. It started in Australia in the early 2000s with a simple idea: if we train people in physical first aid and CPR, why wouldn’t we do the same for mental health? The parallel made sense. It made the concept approachable. It helped break down stigma. And because it sounded so logical, it spread quickly across industries and across Canada.

Today, it’s widely offered. Many workplaces have invested in it, often with the best intentions: to better support employees, reduce stigma, and give people the tools to step in when someone is struggling. At first glance, it feels like an obvious win.

But when we look at the evidence, the picture becomes more complicated.

What Mental Health First Aid Actually Does

What Mental Health First Aid does very clearly is improve people’s knowledge. It helps them understand mental health challenges better, shifts attitudes in a positive direction, and increases theoretical confidence — meaning if you ask someone, “If you noticed a colleague struggling, would you feel comfortable reaching out?”, they’re more likely to say yes after the training.

All of that is good. Truly. Increasing knowledge and reducing stigma are meaningful accomplishments.

But the challenge is that none of that necessarily translates into actual behaviour change.

The Missing Evidence 

The reality is, we don’t have evidence that people who take Mental Health First Aid actually reach out more often, intervene more effectively, or engage differently when a colleague is struggling. And there’s no research that shows training a large number of people in a workplace leads to better mental health outcomes for that workplace overall. No reduction in crisis incidents, no clear improvements in wellbeing, and no measurable shift in workforce-wide outcomes.

There’s also very little known about potential harms. This isn’t to suggest people are likely to cause harm intentionally, but anytime you give people the idea that they can help somebody experiencing an acute mental health issue, there’s a risk of overconfidence or misapplication. We simply don’t have data on how often that happens or what the unintended consequences might be.

So when organizations rely on Mental Health First Aid as a core component of their mental health strategy, we need to be honest about what it can do and what it can’t.

Diagnostic Labels Aren’t Useful at Work

One of the reasons it falls short, particularly in workplaces, is that it focuses heavily on diagnostic categories: anxiety disorders, mood disorders, psychotic disorders, substance-use disorders. That structure makes sense for a classroom. But it doesn’t make much sense for a workplace.

In most cases, you will never know a colleague’s diagnosis. You don’t need to. And in truth, the diagnosis rarely tells you what you actually need to know to support someone at work. An anxiety disorder looks different from person to person. A depressive episode affects people in different ways. What matters isn’t the label, it’s the functional impact.

Can someone focus? Is their memory affected? Is their organizational capacity compromised? Are there tasks that are suddenly harder? These are the questions that matter. They’re also the questions that help you respond supportively without wandering into territory you’re not trained to navigate.

The Bigger Challenge With Training

This is part of a bigger pattern I see with most training-based approaches to workplace mental health. Workshops, lunch and learns, half-day sessions… They're accessible, they feel productive, and participants generally enjoy them. But when it comes to determining whether they actually change behaviour at work, we’re left with very limited evidence. It’s simply hard to measure how training shifts real-world actions in complex, dynamic environments.

So why do organizations invest in Mental Health First Aid? Usually because it feels logical. Because it’s affordable. Because people walk away feeling good. Because it checks the box of “doing something.” And to be clear, that comes from a place of care, not avoidance. I’ve never seen an employer use Mental Health First Aid as a deliberate distraction from deeper organizational issues. Most simply don’t know what else to invest in, or what will actually move the needle.

This is why clarity is so important. Before choosing any mental health intervention, ask: What are we trying to achieve? And how will we know if it’s working?

Mental Health First Aid can absolutely be a useful starting point for sparking conversation and reducing stigma. But if the goal is to meaningfully improve mental health outcomes at work, we need to look elsewhere.

What To Do Instead

The World Health Organization released guidelines in the last couple of years that included a full review of the evidence. And their findings were striking. Out of all the interventions available, only one had enough evidence to be recommended with confidence: training for managers and supervisors.

It wasn’t diagnostic training or clinical training. It was practical skill building around noticing behavioural changes, recognizing when someone may be struggling, engaging in supportive conversations, and connecting employees to appropriate resources. These are functional, observable, workplace-anchored skills — things managers can use the moment they walk back into their work environment.

The other area with strong support isn’t training at all; it’s environmental change. Job design, workload, role clarity, psychological demands, and culture. This is the “hard hats and bricks” approach (take a read here for more), addressing the structure of the work itself, not just the worker. That’s where employers have influence and where sustainable mental health strategies live.

If You’re Using Mental Health First Aid, Don’t Throw It Out — Build on It

If you’re an employer currently using Mental Health First Aid, my take isn’t “stop” or “you’re doing it wrong.” Far from it. If you’ve invested in it, it likely means you care deeply about your people, and that’s the foundation of any meaningful mental health strategy. Knowledge and stigma reduction are valuable, and Mental Health First Aid can support both.

But I would encourage you to treat it as a starting point rather than the entire plan. Pair it with manager capability building. Pair it with environmental change. Pair it with measurable goals. Make sure you’re clear on what you want the training to achieve, and whether it’s achieving it.

And remember this: the people you’ve trained are often the ones who care the most. Use that to your advantage. Build a network of champions, create an employee advisory group or staff-led mental health resource community. Give those employees a structured way to share insights, raise concerns, and help shape the next steps of your strategy. You’ve already identified people who are engaged and invested, mobilizing them can create meaningful momentum.

If you’ve already taken the step of opening the conversation, now is the perfect time to take the step that actually changes the workplace.

That’s where the real impact begins.