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Rivers and jigsaws: prevention and workplace mental health

Prevention is the golden thread in any good workplace wellbeing strategy. As a component part, mental health first aid is sometimes said to fall short in this area.


But does it really? Well, yes and no. It depends on what you understand by ‘prevention’.

The ‘river story’ is a helpful parable here.


It tells of a man and a woman fishing downstream early one morning when someone struggling to stay afloat suddenly appears in the water. The pair jump in and quickly and pull them out. Another person soon follows, then another and another.


Most are rescued. But at times there are so many that some drift further downstream and the coastguard need to be called into action. This continues until early afternoon, by which time the man and the woman are exhausted.


They decide to go upstream to find out why so many people are falling the river. When they arrive, they discover that people are being drawn to the water’s edge to look in, but that the unstable river bank is causing many to fall in.


They go to the town’s local leaders to warn them of what is happening. The leaders respond in turn by building a protective barrier to allow people to stand safely on the river bank. Some still fall but there are now far fewer people to be rescued.


In this story, Mental Health First Aiders are the fisherfolk, helping to prevent people drifting further downstream.


Working upstream as the town leaders did, is about dealing with risk and protective factors which, if managed effectively, enable people to thrive.


Both have their place in preventing mental illness.


Self-care and managing stress are important parts of the work upstream. And it’s why we deal with both on Mental Health First Aid England courses and in our supporting resources.  


In the workplace, the real task is to empower employers to understand the full scope of

prevention, and where mental health first aid fits in. This starts with helping them to break down the jargon of primary, secondary and tertiary prevention – each stage of our river.  

Primary prevention in the workplace equates to creating the conditions for people to thrive, from healthy job design to fair and equal pay, and everything in between.


Secondary prevention, also known as early intervention, is about nipping an issue in the bud. This means empowering people to understand signs of mental ill health, and to offer and seek support early.


And with tertiary prevention we put supports and adjustments in place for those who may have a long-term or chronic health issue.


These concepts are hardwired into how we think about physical health at work. For example, employers might subside gym memberships to encourage exercise, conduct workplace desk assessments to guard against musculoskeletal injury and offer jabs to prevent flu.


We have physical first aiders who can step in to provide CPR or treat wounds and prevent infection. And we make adjustments to support those with physical disabilities at work.

Mental health first aid is just one part of this preventative framework. And more broadly, one lever of an effective public health approach to promoting and protecting mental health.


But bringing early intervention for mental ill health into every workplace can be transformative.

Supporting people to get on a road to recover or manage symptoms sooner can make a huge difference, preventing people falling into crisis and falling out of work. Something we know happens to 300,000 people every year.


In all, mental health first aid is one piece of the jigsaw. The challenge now is to help employers to understand the whole picture, and give them more tools to address prevention at every bend in the river.


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