The Maths Don’t Add Up: Why 1 in 50 Mental Health First Aiders Isn’t Enough

In October 2026, MHFA England published the first ever Workplace Mental Health First Aid Standards. Let me say this first, and clearly: this is a big step forward, and I welcome it. I’m an MHFA England Instructor Member, I’ve trained over 1,000 people, and I have huge admiration for the organisation and the work it does. Employers now have a framework for what good mental health first aid looks like, and that’s long overdue.

But there’s one part of the standards I want to open up for discussion: the numbers. Organisations with more than 50 employees are now required to have at least one Mental Health First Aider (MHFAider) for every 50 employees, with one in 25 as an aspirational benchmark. When I first read that, my honest reaction was: the maths don’t add up.

This isn’t a criticism. It’s a conversation I think we need to have, and I’d love you to be part of it.

Where does 1 in 50 come from?

The standards say the 1 in 50 ratio is “in line with physical first aid provision”. That’s the only reasoning given. There’s no data, no research and no explanation of how the number was reached, for either 1 in 50 or 1 in 25.

For physical first aid, the Health and Safety Executive suggests around one first aider for every 50 employees in higher-hazard workplaces, such as factories and warehouses. For low-hazard workplaces like offices, it’s one for every 100. In other words, the physical first aid ratio is based on how likely people are to get injured at work.

So my question, asked with genuine respect, is this: what evidence is the mental health first aid ratio based on? Because mental health doesn’t work like a cut finger.

Mental health first aid isn’t physical first aid

With physical first aid, something happens. Someone trips, cuts their hand or collapses. Everyone can see it, the first aider steps in, and in most cases it’s over in a matter of minutes.

Mental health doesn’t announce itself like that. People wear masks. They smile in meetings, hit their deadlines and say “I’m fine” when they’re anything but. A lot of mental ill health in the workplace is completely invisible until someone notices the signs or finally feels safe enough to reach out.

And when they do, it’s rarely a five-minute job. A supportive conversation can easily take an hour. It often needs a follow-up, sometimes several. It can be emotionally heavy, and it stays with the MHFAider long after the conversation ends. In 2020, I received a call from a 19-year-old in Pembrokeshire who was preparing to take his own life. Staying with him on the phone, keeping him safe and getting the police and ambulance to him wasn’t a quick fix. That is the reality of mental health first aid at its most intense, and it looks nothing like putting on a plaster.

Copying a ratio from physical first aid and applying it to mental health first aid assumes the two are alike. They’re not.

Let’s do the maths

Here’s what we know about mental health in the UK right now:

• Around 1 in 6 people experience a common mental health condition, such as anxiety or depression, in any given week (Mind).
• 8.89 million people in England were prescribed antidepressants in 2024/25, roughly 1 in 6 of the population (NHS Business Services Authority).
• 6,162 suicides were registered in England and Wales in 2025, with rates at their highest level in around 25 years (ONS).

Now take a team of 50. If 1 in 6 are experiencing a common mental health condition this week, that’s around eight people. Under the minimum standard, those eight people share one MHFAider.

The standards themselves say MHFAiders use their skills two to three times a week on average. So even if everything goes perfectly, one MHFAider can only reach a fraction of the people who might need them. Not everyone who is struggling will want support, of course, but the gap is still huge.

Now imagine being that one person. You spend half a day supporting a colleague, then try to catch up on your own work. The next day, someone else needs you. And the day after that. You’re the only MHFAider for 50 people, so there’s no one to hand over to and no one to talk to about how it’s affecting you. That’s not a sustainable role. That’s a recipe for burnout.

Mental health first aid needs a team

One of the most important things I teach on every course is self-care. Mental health first aid isn’t only about looking after other people. It’s about looking after yourself too. It’s the oxygen mask rule: you put yours on first, or you can’t help anyone else.

That’s why I believe mental health first aid, done properly, needs a team, even in the smallest organisation. At a minimum, that means:

• At least two MHFAiders, so they can support each other and there’s always cover.
• The freedom to step back when their workload gets too much, a big project lands or life gets in the way, knowing someone else is there.
• An MHFA Lead to hold it all together.

What a good MHFA Lead does

The standards rightly require a designated MHFA lead. In my experience, this role is the difference between mental health first aid that works and mental health first aid that’s just a list of names on the intranet. A good MHFA Lead:

• Sets the boundaries, so MHFAiders understand their role and its limits, and acts as the correct escalation point if there’s overreach or a breach. This protects the MHFAider, the person being supported and the organisation.
• Runs monthly MHFA meetings, where MHFAiders share themes (never personal details), support each other and spot gaps and risks.
• Keeps skills sharp by practising ALGEE through scenarios, especially for MHFAiders who haven’t had many conversations recently.
• Plans who is active each month and recognises when someone needs to step back, protecting people from burnout.
• Makes MHFA visible and accessible, including when MHFAiders wear lanyards to show they’re available and how people can book a conversation.
• Turns conversations into action, identifying emerging wellbeing needs across the organisation so it can respond with prevention, not just one-to-one support.

None of that works with one MHFAider for every 50 people. It needs a network. I’ve written a full guide to the role here: What does an MHFA Lead do?

So what number would I suggest?

My recommendation is one trained person for every five employees. At that level, everyone has someone they know and trust close by. MHFAiders can share the load, support each other and step back when they need to. And support is available across every team, site and shift.

I know that sounds like a lot. It doesn’t have to happen overnight. Start with the standards, build towards one in 25, then keep going. I’ve set out a practical phased plan in our guide: How many Mental Health First Aiders does a workplace need?

What I’m not saying

I’m not saying the standards are wrong to exist. They’re a huge step in the right direction, and every employer should be working towards them. I’m also not saying more MHFAiders replace professional help, a manager’s duty of care, occupational health or an Employee Assistance Programme. MHFAiders are a first point of contact, not therapists.

What I am saying is that if we want mental health first aid to be delivered safely, sustainably and well, the minimum needs to reflect the reality of mental health at work today, not the reality of a first aid kit.

Let’s talk

I’d genuinely love to hear your views on this, whether you agree with me or not.

• If you’re an MHFAider, how many people are you there for, and does it feel manageable?
• If you’re an employer, what ratio do you have, and how did you decide on it?
• And to MHFA England, an organisation I’m proud to be part of: I’d welcome the chance to understand the evidence behind 1 in 50 and 1 in 25.

Share your thoughts with me on LinkedIn, or get in touch. And if you’d like help building a mental health first aid team that works for your organisation, find out about private courses for employers.