There is no law requiring you to have mental health first aiders. The Health and Safety Executive looked at whether mental health should be brought into the First-Aid Regulations and decided against it. The Health and Safety (First-Aid) Regulations 1981 still cover physical first aid only.
That surprises a lot of employers, because the marketing around mental health first aid often implies otherwise. What the law does require is different, broader, and harder to discharge with a two-day course.
What the law actually requires
Section 2 of the Health and Safety at Work etc. Act 1974 requires employers to ensure, so far as is reasonably practicable, the health, safety and welfare of employees. “Health” here has never meant only physical health.
Alongside that, the Management of Health and Safety at Work Regulations 1999 require a suitable and sufficient risk assessment — and work-related stress is a foreseeable risk that must be assessed like any other. See how risk assessment works.
HSE’s position is specific and worth quoting in substance: mental health at work should be managed through proper risk assessment and the HSE Management Standards for work-related stress — not through mental health first aid as a regulatory matter.
The six Management Standards cover demands, control, support, relationships, role and change. They target the causes. Mental health first aid targets the symptoms once they appear. Both have value; only one of them is what HSE actually points employers toward.
The uncomfortable implication
An organisation that trains twenty mental health first aiders and changes nothing about workload, autonomy, management quality or job security has bought a response mechanism for a problem it is still manufacturing.
That is not an argument against mental health first aid. It is an argument against treating it as the whole answer — which is the most common way it gets used, because it is visible, finite and easy to put in a board report.
MHFA England, and what the trademark means
This is where terminology matters, and where buyers get confused.
MHFA England® is a registered trademark and the body that licenses the two-day Mental Health First Aid course in England, whose graduates are certified as MHFAider® for three years. If you want that specific certification, it must come through MHFA England or one of their licensed instructors. Nobody else can award it.
Separately, a wide range of providers — including us — offer CPD-accredited mental health awareness and mental health first aid awareness training. This is legitimate, useful, and much cheaper. It is not the MHFA England licensed qualification and does not make anyone an MHFAider®.
How to decide: if your organisation has specified MHFA England certification — or you want the recognised two-day standard with the trademarked designation — book through MHFA England. If you want to build understanding across a workforce, brief managers, or prepare people before committing to the full course, CPD awareness training does that job at a fraction of the cost.
What matters is not buying the cheaper thing believing it is the more expensive thing.
What a mental health first aider actually does
The role is far narrower than the title suggests. A mental health first aider is trained to:
- Notice that someone may be struggling — changes in behaviour, performance, attendance, mood or engagement
- Start a conversation without making it worse
- Listen non-judgementally, which is harder and more valuable than it sounds
- Signpost to appropriate support — GP, occupational health, employee assistance programme, crisis services
- Recognise a crisis and know how to respond, including where there is risk of suicide or self-harm
What the role explicitly is not:
- Not a therapist, counsellor or clinician
- Not qualified to diagnose anything
- Not responsible for anyone’s recovery
- Not a substitute for occupational health or professional treatment
- Not an HR function, and not a route for performance management
The physical analogy holds. A first aider keeps someone stable until proper help arrives. They do not perform surgery.
Five ways organisations get this wrong
- Treating the training as the strategy. First aiders without a stress risk assessment, workable workloads and competent line management are a plaster over a structural problem.
- No support for the first aiders themselves. People who absorb colleagues’ distress need supervision, a route to escalate, and permission to step back. Without it they burn out — and they are volunteers.
- Blurring the boundary with HR. If a first aider’s notes could end up in a capability process, nobody will confide in them. Confidentiality limits must be explicit and honest up front.
- No referral pathway. Signposting only works if there is somewhere to signpost to. Know your EAP, occupational health route and local crisis services before training anyone.
- Nobody knows who they are. A list on an intranet page nobody visits is not provision.
What good provision looks like
- A completed stress risk assessment using the HSE Management Standards, acted upon
- Line managers trained to spot and respond — they see people daily, first aiders do not
- A clear, published referral pathway
- Mental health first aiders, if you choose to have them, with defined boundaries and their own support
- Sickness absence and turnover data actually reviewed for patterns
- Reasonable adjustments handled properly — mental health conditions can be disabilities under the Equality Act 2010, which brings a duty to make reasonable adjustments
That last point carries more legal weight than anything about first aiders, and gets far less attention.
How many should you have, and how often is refresher training?
There is no ratio in law, because there is no legal requirement at all. Organisations commonly work to something in the region of one per 50–100 staff, adjusted for risk, dispersal and shift patterns — but that is convention, not regulation.
On refreshers: MHFA England certifies MHFAiders® for three years. For CPD awareness training there is no expiry, though annual refreshment is sensible given how quickly confidence fades on skills that are used rarely.
Further reading
- HSE — Work-related stress and the Management Standards
- HSE — First aid at work
- MHFA England
- Equality Act 2010
Mental health training
Our Mental Health First Aider course covers recognising when someone is struggling, starting the conversation, listening without judgement, signposting, and responding in a crisis. For managers specifically, Mental Health Awareness for Managers. Also: Mental Health Awareness · Youth Mental Health First Aid
Related: Risk assessment: what UK law requires · What first aid training do you actually need?
£9 per course. CPD accredited, 100 % online, verifiable e-certificate on completion. Pay for 2, get 3 — any 3 courses for £18.
Important: this is CPD-accredited awareness training and general information — not medical advice, not therapy, and not a clinical qualification. It is not affiliated with, endorsed by, or licensed by MHFA England®, and it does not confer MHFAider® status or any MHFA England certification; that designation is available only through MHFA England and its licensed instructors. Awareness training does not qualify anyone to diagnose or treat mental illness. If someone is at immediate risk, call 999. Samaritans can be reached free on 116 123, at any hour.