How Companies Teach Their Employees First Aid for Mental Health

At Delta Air Lines’ Atlanta headquarters in late January, 24 employees are arguing over which of them has the worst disease. Half of them had been given cards naming a physical or mental health diagnosis and were told to line up, from the least debilitating to the most.

The woman holding “gingivitis” quickly takes a place at the far left of the line. But everyone further down to the right—low back pain, moderate depression, paraplegia, severe PTSD—keeps switching spots.

“Severe vision loss,” someone says to the man holding the corresponding card, “are you a pilot?” He doesn’t know. There is no further information: not what the person does for a living, whether their condition is well managed, or if they have health care coverage.

“We’re in a pickle down here,” a woman pleads to the instructor, Rochele Burnette, who’s standing by, silent and smiling. Burnette waits until someone finally suggests the right answer: they should be in a vertical line, not a horizontal one. “How we look at a mental disorder and how we look at a physical condition should be the same,” Burnette says. “One could be just as debilitating as the other.”

This is the first lesson of Mental Health First Aid at Work, a training that the National Council for Behavioral Health provides, for a cost, to a growing number of corporations. Of the people taking today’s class, some were there because they had seen firsthand how much a mental health crisis can impact the workplace. A Delta employee killed himself several months ago, and counselors were brought in to help the many people who were affected. Others wanted to improve their mental-health vocabulary, and their confidence in handling related issues. “When someone says, ‘Hi, do you have a minute?’ we never really know what’s going to follow,” one HR employee says in the class. “Sometimes it’s very easy, and sometimes we quickly find ourselves in uncomfortable situations.”

Over the next four hours, the Delta employees learn how to spot symptoms and warning signs of possible mental health concerns in a colleague, reach out and offer initial help, then guide them to professional help and the resources the company offers, like short-term counseling through the free employee assistance program (EAP) and a confidential app that lets you chat immediately with behavioral health coaches. Getting the words right can be tricky; much of the class is devoted to figuring out what to say to a coworker in distress. On everybody’s desk is a handout of helpful and harmful phrases. “One of the things you’ll see on your card is How are you doing, really?” says Burnette. “That ‘really’ really pulls out something extra.” In the potentially harmful category: putting off the conversation until later in the week, suggesting they simply work it out with their manager, or telling them to “just hang in there.”

The office may seem an unlikely place for such a class, but Burnette reminds her students that the historical norm to keep your personal life at home is unrealistic. “What affects you in your life affects you in your work,” she tells the group.

There are no requirements that U.S. employers provide mental health training. But as mental illness diagnoses and suicide rates rise in the U.S., while the stigma of talking about them drops, companies are finding that their employees want a bigger focus on mental health at work. “A little over a year ago, we really started to hear more and more from employees about the need for these kinds of services,” says Rob Kight, senior vice president of human resources at Delta. “It caused us to take a deep look at what we were providing. And we decided, you know, it’s not enough.”

Prioritizing employees’ mental health has become not just a moral issue, but also a tool to recruit and retain young talent. A 2019 poll by the American Psychiatric Association found that millennials—who now comprise the largest generation in the U.S. workforce—tend to be more comfortable than their older peers discussing their mental health at work. Investing in this area may also make financial sense, since untreated mental illness and substance abuse issues can be costly for employers. Untreated depression alone costs the average 1,000-person U.S. company more than $1.4 million per year due to missed days and lost productivity, according to the Center for Workplace Mental Health at the American Psychiatric Association Foundation.

Corporate trainings have emerged as popular solutions, and Mental Health First Aid at Work is among the most widely used. Mental Health First Aid started in 2000 in Australia as a way to educate people about what to do when they encounter someone experiencing mental health problems, which are much more common than the emergencies traditional first aid courses teach. It later spread to 27 countries, each with their own licensing organizations. In the U.S., the National Council for Behavioral Health runs the program, and in 2013 it launched a version tailored for the workplace. More than 200 companies—including Bank of America, Gillette, Starbucks and Unilever—have offered one or both of its four- and eight-hour training programs to employees, says Betsy Schwartz, vice president for public education and strategic initiatives at the National Council for Behavioral Health.

“We’ve seen a significant increase in corporate interest,” Schwartz says. “In companies that train a larger number of employees, we get feedback about a whole culture shift.” Though there hasn’t been much research on the work-specific training, some studies have found that Mental Health First Aid improves knowledge about mental health, and confidence in responding to related issues, for the people who take it. The benefits to the person receiving help from a person who’s gone through the training, however, are not clear.

The number of organizations that run this type of training is growing. The Center for Workplace Mental Health at the American Psychiatric Association Foundation is developing a digital training for managers called “Notice. Talk. Act. at Work,” which teaches the early warning signs of mental health issues and how to have empathetic, compassionate conversations. “We cannot talk about mental health enough in the workplace,” says Darcy Gruttadaro, director of the Center for Workplace Mental Health. “We have a long way to go—the more we can reinforce it, the better.” Some companies have developed their own programs. The consulting firm Booz Allen Hamilton trained all employees in 2018 and 2019 to spot the five signs of emotional suffering—depression, in other words. The professional services firm EY (formerly Ernst & Young) offers digital training to help employees recognize the signs that a colleague is struggling and connect them to company resources.

Merely offering services and resources isn’t always enough. Employees have to know about and trust them. Most large companies have a free EAP, for example, which typically offers short-term counseling sessions and other wellbeing services for employees and their family members through outside providers. But even when people are aware that their company has an EAP, they often fear their HR department is monitoring who uses the programs, and that doing so could be a black mark on their employment record. As a result, many studies show that EAPs have historically been underused. “There shouldn’t be, but there is a stigma around this that exists in our country,” says Kight. “We have to help break that down and let people know that it’s okay to take advantage of these services.”

Soon, the two dozen Delta employees in today’s training will join the more than 600 who have completed Mental Health First Aid at Work since the airline started offering it in 2019. Though it’s not mandatory, the goal is for all 90,000 employees to take it, according to Delta’s HR team.

After Burnette gives the students a lesson in what to do if a coworker is having a panic attack, she ends on a hopeful note: proven ways a person can help themselves feel better. Exercise is one, and so are sleep, relaxation and 12-step programs. “But let me tell you something about this one right here,” she says, pointing to a slide on family, friends, faith and other social networks. “When you know you have people you can talk to that are nonjudgmental—I can go to you and have the conversation, and no matter what, you’ll listen—people have had better outcomes, because they have support.”

“I want to speak to that, because I’ve been thinking about how I can articulate this,” says a young man sitting in the front row. “Very early on in life, I found myself trying to remove stigma around mental health and talk about it, because I saw it in my family. It made me say to myself, I don’t want this to happen to me, so how can I make it normal? I started to talk to my friends and people that I’m close with. I say, hey guys, let’s get together and have drinks, and talk about what’s really going on.”

There’s no reason why conversations like these can’t happen in the workplace, too, the new thinking goes. “We’ve all grown up thinking certain conversations are professional and certain conversations are not professional,” Burnette says. “We bring our whole selves to work, so why can’t we talk about our whole self?”