Mental health first aid: where the boundaries lie

On World Suicide Prevention Day, which is marked each year on 10 September, inclusion and engagement consultant Lynn Pilkington discusses where the boundaries lie when helping someone through a mental health crisis, be it a friend, colleague or client.

We’ve been working towards this for years. Finally, we have environments (sometimes, if they’ve been doing the valuable work) where people can feel comfortable to open up at work about their mental health struggles or disability. We’ve run the campaigns, reduced the stigma and the conversations are now happening. 

Now, what? How do we navigate the landscape that we’ve worked so hard to create?

Last year I talked about this issue at the CIPD conference on a panel on ‘Is there a mental health emergency at work?’. My contribution was rather underwhelming, reiterating that ‘tis always been thus’. Having worked around the topics of mental health and inclusion for the last decade in various roles, I’m familiar with the common concerns that people have when they start talking about mental health problems or disability, in workplaces or other environments. What if I say the wrong thing? What should I do now? Have I got to go with them to the GP and check in on them?

The one-word answer to these questions is ‘boundaries’.

Defining boundaries

Boundaries are the mutual expectations between two people due to the nature of their relationship. Creating and maintaining boundaries is essential to any discussion about sensitive topics. This prevents an undue emotional burden and gives each party a clear role and responsibility. Without these, all parties suffer from confusion and muddy expectations.

Let’s take an example to show how an instance of mental health first aid, ie a first responder interaction with someone in crisis, would vary depending on the nature of the relationship.

Individual A is describing symptoms of severe anxiety, a relationship breakdown and says that ‘life is not worth living’. Regardless of the nature of my relationship with individual A, I would listen non-judgementally to their experiences, encourage them to get help and validate their emotions. Due to an indicator to ask about suicide, I would ask directly about whether Individual A had been thinking about taking their life.

What changes in these conversations is the duty of care between us.

The duty of care

If the conversation was part of a dialogue between friends, I may check in on this person and offer to support them to appointments with professionals. If Individual A was my direct report in a workplace setting I would consult HR and refer to policies and procedures, including safeguarding routes. The Law Society of Scotland has information about what a solicitor should do if their client says that they are at risk of self-harm and how that disclosure interplays with a solicitor's duty of confidentiality to their client (Rule B1.6).

Although Individual A would be opening up about the same sensitive information, my response varies in line with the nature of the relationship.  

Further, this relationship will dictate what needs to be done with the information shared.

If someone discloses that they are at risk of immediate harm, it may be essential to share that information in line with a safeguarding duty. That said, details would not usually be shared out of respect for that person. Indeed, if this is a workplace conversation, it would be reasonable to expect that details of the conversation would not be relayed to anyone else, unless specific permission was given by the individual. 

With regards to documenting the information shared, again, the nature of the conversation and the boundaries of the relationship will dictate what is appropriate.

Usually, one-off mental health first aid discussions between colleagues or strangers are not recorded. However, if taking place in a workplace, the HR department may be looking to track conversations taking place that indicate workplace trends. This may assist in identifying common issues and support implementing preventative interventions. In this instance, an anonymous log may be used, featuring brief information on the circumstances and advice given, without any identifying information. On the other hand, if a line manager was having a discussion with a direct report about their ongoing mental health issues and discussing reasonable adjustments, this conversation should be recorded in writing and saved securely.

Perhaps one of the few legacy benefits of the COVID-19 pandemic is the apparent increase in openness about mental health struggles and other conditions. These conversations are essential for everyone to flourish and receive essential support and care. Talking alone is not enough, however – it needs to be paired with its essential accomplice, ‘boundaries’.

Lynn Pilkington is an award-winning inclusion and engagement consultant with over 15 years' experience working across the public, private and third sectors in Scotland. Lynn specialises in disability inclusion, trauma-informed practice, and systemic change with a focus on turning policy into action. She regularly delivers talks and workshops on mental health, identity, accessibility and inclusive leadership. Lynn has engaged with the Law Society in many capacities over the years, from volunteering on committees to running training and follow-up sessions.