Avoiding the Ambulance – How Early Intervention can Minimize Workplace Mental Health Crises


In 2014, the NHS introduced its 111 service, for ‘urgent but not life-threatening’ medical issues. Until then, you could call a patchwork of local services under the NHS Direct banner, or 999 for an emergency.

111 was developed to fill the hole that a system of under-pressure GP surgeries and emergency services created.

Not led by clinicians, but by operators following a pathway, it’s a way for unwell people to access support without automatically calling out the sirens and flashing blue lights.

Early help for employers

111 has its critics, but in principle at least, the service acknowledges that not everything needs a trip to A&E, but equally, some things can’t wait until the GP is available.

It raises the question, is there an equivalent in workplace mental health provision?

Even as companies get better at offering support for employee mental illness, is there enough help for people early in the process, or does the help only kick in once a problem has become serious and, potentially, entrenched?

Mental Health First Aid

The idea of mental health first aiders (MHFAs) is designed to build a network of support within an organisation. It’s symptomatic of how mental health care is trying to reach parity with physical wellness – employees on hand to help their colleagues, as and when required.

And, broadly, the system works. A study into MHFAs by the University of Nottingham found that the course led to better understanding of mental health issues and to more conversations happening in the space.

But there was also evidence that MHFAs are only being called upon when problems are already critical and occasionally first aiders were being asked to cope with serious problems outside work hours.

They’re acting more like 999 than 111. This has huge ramifications – non-experts are being asked to help with serious medical crises, unprepared to offer appropriate support and ill-equipped to deal with the fallout for their own wellbeing.

Mental health first aid is relatively new, so there’s still lots to learn about its effectiveness, but one area that companies need to address urgently is boundaries – what are they expecting MHFAs to do?

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The Nottingham University study showed that MHFAs can only be one piece of a wider approach to employee mental health. Without broader and more integrated planning, it’s not going to succeed.


This isn’t down to a lack of willing on the part of companies, their HR and wellbeing teams. It may be that instinctively we shy away from getting help until things become so bad that there’s no choice.

Despite huge strides forward in recent years, there’s still a lingering stigma around mental health. The same is true of many physical health conditions – some people don’t want to be a burden, imagine they’ll just get better, or would rather not think about what’s wrong with them.

In mental health terms, this means that some first aiders are turning into A&E doctors – dealing with a crisis, rather than a niggle – a job they shouldn’t be asked to do, no matter how willing.

Early help

What can organisations do to avoid putting their first aiders in impossible positions, and to offer better early intervention so that employees feel able to get help before a trickle becomes flood?

A holistic approach to mental wellness would go a long way catching the cracks in our mental resilience early. For too many organisations, help is on hand when the dam breaks, but not before.

Encouraging regular engagement with our mental health – whether things are going okay, or we sense a struggle around the corner – is more effective than mopping up after a serious episode.

There’s also an overlooked obligation on organisations to make sure people feel anchored and safe when experiencing a challenge to their mental health.

Whatever strategies, tools and training are put in place, they need to be part of a stable environment for people going through difficulties – no matter how small.

An uneven or panicked response will only make the situation worse, however well-intentioned.

Cost of mental ill health

From a business perspective, it makes sense to address this. Over £34bn each year is lost to businesses through poor mental health of employees. Addressing this in a joined-up way will mean organisations lose less time to absenteeism, and reap the benefits of a more content, happier workforce.

999, 111, the GP, the pharmacist and self-care – there’s a sliding scale of interventions when it comes to physical health. It’s time to fill the gaps in the support of mental wellbeing, too.

Clear boundaries, holistic care and the right help at the right time will mean fewer emergencies. Paramedics may do incredible things in a physical health crisis, but better to avoid the emergency altogether if we can.

1.       https://www.personneltoday.com/hr/mental-health-first-aid-presents-safety-concerns-for-trained-staff/

2.       https://mhfaengland.org/organisations/workplace/

About the Author:

Dr. Lynne Green is chief clinical officer, XenZone. She is a Clinical Psychologist with 20 years’ NHS experience. Dr Green was previously Clinical Lead for the Child and Adolescent Mental Health Service in Lancashire Care Foundation Trust plus Lead Consultant Psychologist for eating disorders and inpatient services. Clinically, she has a particular interest in suicide prevention and eating disorders, and was a clinical therapist on a leading eating disorder research trial with a Centre of Excellence at Oxford University. In addition to her Clinical Psychology doctorate and BSc (hons) in psychology, both from Leicester University, Lynne has an MSc in Psychiatry from Manchester University.



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