In 1974, the secretary of state for employment Michael Foot stood up in the House of Commons to speak in support of the Health and Safety at Work Act. For 45 years this landmark legislation has protected people and helped to reduce workplace deaths and injuries. Foot started his speech by pointing out that 1,000 workers were killed each year, half a million were injured at work, and 23 million working days were lost because of injury or an accident. Foot had hardly got into his stride before Christopher Mayhew, then a Labour MP, intervened to point out that 38 million days were lost in industry, not because of injury or accident, but because of people suffering from mental illness. Why, he asked, were these conditions excluded from the bill?
It was a good question in 1974, and it remains a good question now. Our modern understanding of mental health has transformed since the 1970s. We enjoy a growing awareness and literacy around the symptoms of and remedies for mental illness. Thanks to brave public figures and persistent campaigners, much of the ignorance and stigma has been reduced. And yet, we are only just starting to put mental health at the centre of our public policy and our national conversation, which is where it should be.
One important provision of the 1974 Health and Safety Act was that workplaces should have a trained first aider, ready to provide the very first response to an injured colleague. Since 1974, millions of people have completed first aid training and volunteered as workplace first aiders, and there must be many people alive today who owe their lives to their speedy response.
It is obvious that the requirement for first aiders in the workplace should specifically include mental health first aid, making employers responsible for this aspect of their employees’ wellbeing too. This could be achieved with a straightforward and simple change to the existing law. Indeed at the last general election, one of the party manifestos included the promise to “amend health and safety regulations so that employers provide appropriate first aid training and needs assessment for mental health, as they currently do for risks to physical health”. That was the Conservative Party manifesto, but we are still waiting, two years on, for ministers to fulfil their pledge.
There is certainly the demand. NHS Digital suggests one in six adults experience some form of mental illness at any given time (other statistics suggest the proportion of us affected could be even greater). There are 28 million people in the UK workforce, so we can estimate there are at least five million people at work who are experiencing mental ill health.
The Where’s Your Head At? campaign – of which I am a member – set up a petition calling on the responsible minister for health and safety at work to change the law to expand employers’ responsibility to ensure someone in every workplace is trained in physical first aid to include mental health first aid too. It has over 200,000 signatures.
The campaign also co-ordinated a letter to the Prime Minister calling for statutory mental health first aiders that was signed by over 50 businesses and organisations. These included trade unions such as Community, retailers such as WHSmith, financial bodies such as Standard Chartered, and utility services such as Thames Water. Organisations such as St John Ambulance and Mental Health First Aid England provide mental health first aid training, and over quarter of a million people have already completed it.
The main objections to this change seem to be that mental health is complex, the symptoms are hard to spot and the remedies require expertise and medical qualifications. You can’t treat depression like it’s a sprained ankle, detractors say. But this is to miss the point. Mental health first aiders are not designed to replace mental health professionals, or to provide services on the cheap, any more than current first aiders replace paramedics or heart surgeons.
The point of a mental health first aider is to be a champion for good mental health in the workplace, to provide a safe port-of-call for anyone wanting to talk about their mental health, and to offer signposting to available expert advice and professional services. I have observed and taken part in some mental health first aid training, and I have met many mental health first aiders, and I am convinced that even a few hours’ training can make a real difference.
When we succeed in our campaign and make mental health first aiders statutory, there will be new issues to tackle. As the economy transforms, with more workers not having a traditional “workplace”, but instead working from home, from hubs, or at a table in a coffee shop, then we must ensure this growing group of workers is not left out.
One thing I have been very keen to discuss with trade unions such as Community is how we work with people in the gig economy, or with people working as freelancers and consultants, who are as prone to mental ill health as anyone else. Indeed, aspects of this new economy, especially with the uncertainty and precariousness it brings, may prove to be the triggers for some forms of mental illness.
But traditional sectors are affected too. One agricultural worker takes their own life every week, according to the Office for National Statistics. Construction workers are three times more likely to take their own lives than the average male worker. Risk of suicide is elevated in the performing arts – 69 per cent higher for women than the average, and 20 per cent higher for men. Those working in the music industry, for example, are three times more likely to experience depression.
Hundreds of thousands of people are already stepping up and volunteering to be mental health first aiders. Enlightened employers, large and small, are getting involved, from Barclays to South Liverpool Housing Association. As is too often the case, public opinion and public behaviour are advancing faster than our framework of laws and regulations. Parliament is lagging behind the people. So ministers need to deliver on their promise, make time available to change the regulations, and create a statutory scheme for mental health first aiders. When we look back in 40 years, we will wonder why it took so long.