How to do Mental Health First Aid

What exactly is Mental Health First Aid?

The way that I find most beneficial to think of mental health first aid is to compare MHFA to a physical health first aider.
A physical health first aider is not a doctor, a surgeon, a paramedic or an ambulance driver.
However, that does not undermine the importance of a physical health first aider.
A physical first aider can save a life – because they are the first person on the scene, and are therefore the very best person at the time and place to provide support.

It’s the same with mental health first aid.
A mental health first aider is not a psychologist, or a psychiatrist, or a doctor or a medical expert.
However, a mental health first aider can be the most important person in another person’s recovery from a mental health challenge,
because the psychologists/psychiatrists/doctors are not walking around with our friends, colleagues, and family members – but we are.
This simple fact of proximity makes the first aider the best-placed person to notice signs of distress and guide someone toward appropriate help.

To do that, a person needs specific knowledge and skills.
And that’s exactly what mental health first aid provides.
It equips everyday people — not professionals — with the skills to increase the chances of recognising possible signs of impaired well-being, and to respond in a supportive way: what to notice, what to say, and what to do.

It’s not about turning people into amateur psychologists — though, understandably, some who are unfamiliar with the concept might assume that.
It is about offering timely, compassionate, and informed support that could make all the difference.

How can I recognise signs of impaired well-being in others?

In MHFA workshops here in Switzerland, after dispelling many myths about mental health and mental illness, de-stigmatising and providing a strong foundation of facts on the topic, I then proceed to a key question:

How can we recognise the signs of potential mental health challenge in others?

Often people are reluctant to answer.
Many are unsure.
On occasions, I’ve had people retort: “We cannot recognise signs of mental illness because we are not trained in psychology.”

The way I address this is as follows:

“I agree that we are not trained – nor training – to be psychologists.
We are also not advocating to attempt to diagnose anyone with a mental illness. (I explain the complexities of the DSM 5 and the ICD-11 in the workshops, and strongly emphasise that we are in no position to label anyone with anything, that doing so is not what I am advocating, and share my view that “Labels are for clothes, not people.”)

So what are we doing?
Being intentionally very selective with my words, I explain that we are training to look for “Signs of impaired well-being”, and I explain that this is on a continuum, that we are all on this continuum and move around it throughout our lives, and provide a practical definition of well-being.

I then ask the question that cuts through the jargon, overcomes any blocks about needing to be a psychologist to notice changes in others’ behaviour, and provides the insight:

“Has anyone in this room, ever in the history of your life up until today, ever noticed possible signs of impaired well-being in yourself, or any other person on the planet?”

Everyone starts nodding…
I follow up: “What were those signs?”

The participants then start naming a multitude of signs and symptoms of impaired well-being, without any of them needing to be trained as psychologists!

For example:

• Looking more tired than usual
• Change in temperament – more irritable, sad, angry, etc
• Avoiding social interaction
• loss of interest in things they previously enjoyed
• Change in appearance – such as looking disheveled or neglecting hygiene
• Changes in sleeping patterns
• Experiencing racing negative thoughts
• Expressions of hopelessness or being overwhelmed
• and many others…

The beauty of this is that participants prove to themselves that they have this ability, without me needing to convince them.

In the session, we explore this topic in more detail.
Every participant receives a workbook that outlines common signs of impaired well-being to look out for for future reference, and to deepen their knowledge.
The key is knowing what signs to look out for, and being proactive in this regard.

However, I always share two very important caveats when introducing these signs:

1. Signs are not proof — they are clues.

Any single sign could have multiple explanations.
For example: someone looking more tired than usual might be dealing with a well-being challenge — or they might have stayed up late binge-watching the football finals.

This is why we look at:

• Multiple signs,
• In context,
• And at best, we form a hypothesis.

We then explore that hypothesis by gently engaging in a conversation with the person and asking questions — using specific communication skills to reduce the chance they feel judged or attacked (more on that below).

2. It’s not your fault if you don’t notice the signs.

This is not about guilt.
This is not about blame.
Mental health is not black and white — it’s full of nuance, complexity, and grey areas.

Why?
Because we are dealing with human beings, not human flowcharts.

People can and do:

• Mask how they’re feeling
• Hide their distress
• Downplay their struggles
• Stay silent due to fear, shame, or cultural norms

So if you don’t notice something, it does not mean you failed.
This is not about perfection. It’s about increasing the chances that we might notice something — and knowing what to do if we do.

When we care about someone, we want to show up in a way that helps.
That’s what this training is for — and that’s what I’ll explore next.

What can we do if we notice signs of possible impaired well-being in someone we care about?

Engage in a conversation with the person, for the following 3 reasons:

1. to “test” your hypothesis.Isthis person struggling at the moment, what is going on for them? The only way to find that out is to engage in a conversation with them.
2. to ensure they arenotsuffering in silence.
3. so that they know someone cares about themand how they are feeling – NOT just their output and performance.

Now, we engage in the conversation using some very practical communication skills.

I’ll outline some of these below. (Of course, in the full training, we go into this in a lot more detail, and practise the skills in teams, to experience the effect ourselves, which is much more powerful than the theory…but to give you a taste I offer the following key skills):

1. USE “I” STATEMENTS, ESPECIALLY IN OPENING REMARKS.  
   AVOID “YOU” STATEMENTS.
   The reason for this is because “YOU” statements are a judgement and can be experienced as an attack.
   When a person feels attached, they usually get defensive (or counter attack!) and this results in silence, or verbal violence!

   Example of “YOU” statement:
   “You’ve been really stressed and tired lately. Are you okay?”
   
   “Example of “I” statement:
   “I’ve had the impression that you’ve had a lot on your plate lately…What are your thoughts on what I’ve just said?”

2. OPEN QUESTIONS, NOT CLOSED QUESTIONS. 
   The reason is because closed questions (questions that can be answered with yes/no) don’t encourage dialogue…and we are wanting to provide a space to listen and understand, and to do that we want to provide conditions for the other person to speak!
3. SILENCE
   This is so important.
   We SLOW the conversation down.
   We ask one question at a time, and allow the person plenty of time to answer.
   These are questions the person may not have considered before – which is a good thing!
   If they are struggling with a challenge, it means their current thoughts and actions haven’t been able to overcome this challenge.
   Thinking different things is therefore often a good step!
   But we need to provide time for a person to reflect, and answer earnestly, and we do that with, among other thing, the use of silence.

    

4. SEEK TO UNDERSTAND THE PERSON, NOT TO SOLVE THEIR PROBLEM.
   We don’t rush in with advice.
   We listen.
   We unpack the other person’s story.
   We ask QUESTIONS.
   This is often a challenge as we (especially managers) want to race in and SOLVE.
   But this doesn’t work with something as contextual and subjective as a well-being challenge.
   It’s like offering someone who is having vision problem our prescription glasses, and expecting them to work perfectly for this person also.
   Often, the person’s vision is worse through our glasses!
   So instead, we ask questions so we canunderstand, and then reflect what resources we are aware of that may fit forthis person’s specific challenge.

    

5. USEFUL QUESTIONS:
   Some questions that can be extremely useful in getting to the actual issue, without needing to solve or become a psychologist are provided below.
   I have personally seen all of the following questions provide incredible benefits for many people struggling in different life and work situations…
   I provide a specific case study example from a well-known Swiss company here: 

• How are you feeling?
• How are you sleeping?
• How long have you been experiencing that/feeling this way?
• What have you tried so far to feel how you would like to feel?
• What would you change in the workplace if you could?
• Who else have you told about how you have been feeling?
• What are your thoughts on speaking with your manager about this?
• What are your thoughts on speaking with an expert about this?
• What do you know about the Employee Assistance Program?

Of course, context, relationship, tonality, body language, many factors other than the specific words are important regarding this.
We will never connect with a person and establish trust if we are trying to remember the “best” question to ask.
The way we ask “the best” question is to be totally focussed on the other person, and their needs, not in our own head.
This nuance its what we discuss, and practise, in the live trainings, which makes ALL the difference.
These skills are really learnt by doing, and we do that in the controlled setting in the workshops.
And almost every person I’ve trained (thousands) are amazed at how some simple strategies, some of which I’ve outlined above, make ALL the difference in how these conversations go!

Conclusion: How to do mental health first aid

I hope that has given anyone reading a better idea of what mental health first aid is, and how to do mental health first aid.