Mental health sits on a continuum, not a fixed state. Everyone moves between thriving, coping, struggling and being unwell depending on life events, biology and environment. Mental health first aid is NOT about diagnosing or treating - it's about recognising signs early, listening without judgement, and guiding someone to the right professional support.
Most courses teach a five-step approach, often remembered as ALGEE:
This order matters: safety and listening always come before advice-giving.
In the UK, roughly 1 in 4 people experience a mental health problem each year, and about 1 in 6 report symptoms of a common mental disorder (like anxiety or depression) in any given week. Around 1 in 8 adults show symptoms of both anxiety and depression together. Suicide is the leading cause of death in men under 50 in the UK. These figures come from consistent NHS and mental health charity surveillance data and are commonly tested.
Protective factors include strong social connections, secure housing, financial stability and a sense of purpose. Risk factors include isolation, bereavement, financial stress, trauma and physical illness. Recognising these helps a first aider understand context without making assumptions.
Using person-first, non-judgemental language (a person living with depression, not a depressive) reduces stigma and is considered best practice across all UK awarding bodies as of 2026.
Anxiety and depression are the two most common mental health conditions a Mental Health First Aider will meet. They can occur alone or together (mixed anxiety and depression is itself a recognised presentation). Both sit on a spectrum from normal, everyday stress or low mood through to a diagnosable clinical condition.
Anxiety becomes a disorder, not just normal worry, when it is excessive, hard to control, lasts most days for six months or more (the general threshold used for Generalised Anxiety Disorder), and interferes with work, relationships or daily life.
A depressive episode is generally considered clinically significant when low mood or loss of interest/pleasure (anhedonia) persists most of the day, nearly every day, for at least two weeks, alongside other symptoms.
Use a listen-support-signpost approach: give the person time and space, avoid minimising ('just relax'), encourage them to talk to their GP, and know your organisation's referral routes (e.g. Employee Assistance Programme, IAPT/NHS Talking Therapies, or crisis services if risk is present).
A mental health crisis is any situation where someone is at risk of harming themselves or others, or is too distressed to keep themselves safe. This includes suicidal thoughts or intent, self-harm, panic attacks, acute psychosis (losing touch with reality), severe intoxication with mental distress, and reactions after trauma.
Most courses teach a simple action plan, often shortened to ALGEE:
Always assess risk to life FIRST, before anything else. Safety beats comfort every time.
You must ask directly and plainly, for example 'Are you having thoughts of suicide?' or 'Are you thinking of ending your life?'. Asking does NOT plant the idea or increase risk — this is a myth. Avoid vague euphemisms like 'you're not thinking of doing anything silly?' as they can be misread and shut the conversation down.
A plan, a means, and a timeframe together mean high immediate risk — for example someone who has chosen a method, has access to it, and names a time. In this situation, do not leave the person alone. Call emergency services (999 in the UK, or the local equivalent) and stay with them until help arrives.
Lower but present risk (thoughts without a specific plan or means) still needs urgent professional follow-up, such as a same-day GP appointment, a crisis team referral, or a helpline like Samaritans (116 123, free, 24/7 in the UK).
Self-harm is usually a coping mechanism, not necessarily a suicide attempt, but it always needs a compassionate, non-judgemental response and a check for medical injury and suicide risk. Never express shock, disgust, or anger — this shuts people down and stops future disclosure.
Follow up, encourage ongoing professional support, and look after your own wellbeing too — supporting someone in crisis is draining and you are not expected to cope with it alone.
ALGEE is the five-step action plan taught on Mental Health First Aid (MHFA) courses. It gives a memorable structure for approaching someone who may be experiencing a mental health problem or crisis. It is not a diagnostic tool and it does not replace professional treatment - it is a framework for early, practical support.
ALGEE has exactly 5 steps, and the letter E appears twice, standing for two different types of encouragement (professional help, then other supports).
Mental Health First Aid (MHFA) is not therapy and not diagnosis. Your job as a first aider is to notice, listen, and link the person to proper support, then step back. Recovery is understood as a personal journey, not a fixed cure - many people live well with an ongoing mental health condition, similar to how someone manages diabetes or asthma.
Most MHFA-style courses teach a five-step action plan, usually remembered as ALGEE:
Use this order every time - reassurance before professional help, professional help before informal support. Skipping the risk-assessment step is the single most common exam trap.
First point of call in the UK is usually the GP. Signpost also to NHS 111 (option 2 for mental health), talking therapies (NHS Talking Therapies, self-referral, no GP needed), and in a crisis the person can go to A&E or call 999 if there is immediate danger to life. Never promise confidentiality if someone is at risk of serious harm - safety overrides secrecy.
First aiders must protect their own wellbeing too. Recognised self-care pillars: sleep, nutrition, physical activity, social connection, and setting boundaries around how much support you personally provide. Compassion fatigue and burnout are real risks for repeat supporters - the exam expects you to know that a first aider should debrief or seek supervision after a difficult episode, not carry it alone.
Stigma is the negative attitude or discrimination attached to mental ill health. It stops people asking for help early, makes symptoms worse, and can cost jobs and relationships. Mental Health First Aiders (MHFAiders) actively challenge stigma by using open, non-judgemental language and treating a mental health crisis with the same seriousness as a physical one.
MHFAiders keep disclosures confidential except where there is a risk to life - then safeguarding overrides confidentiality and information must be escalated appropriately.