First Aid for Mental Health and Power Dynamics

Potential power dynamics are always going to play a part in life but how do they impact mental health first aid training and the way support each other in the workplace ?

First Aid for Mental Health and Power Dynamics

If you are a senior partner, business owner or even executive officer how would you feel if a much more junior member of staff approached you and asked if you were ok? Flip that round and now consider how a lower-ranking employee handles the complexities of asking the boss or line-manager if they’d like a chat or a coffee because the former has noticed the latter seems to be struggling a bit of late.


Power dynamics in work and life are always going to be complex and will be at play however fair and equitable we think we may have strived to make the territory. I do though think it’s important to consider how we can educate and empower those who may be more junior to feel comfortable with asking a senior colleague if they might need support. Also, to think how we can create a culture where those in power or authority might not feel threatened or inappropriately challenged when someone technically ‘subordinate’ offers a listening ear. I am very aware that much of this will be down to individual personality, strength of personal relationships, communication skills, personal choices about how much you wish to disclose and to whom, and how secure you may feel in your own role. 


As I write Matthew Syed's excellent Black Box Thinking comes to mind. The principle focus of the book is that we cannot grow unless we are prepared to learn from ‘failures’ and mistakes. In the opening chapters Syed describes a minor operation which goes horribly wrong when the doctors become so focused on achieving intubation via the mouth, which is becoming more and more problematic, that they fail to resort to the risky but last possible option of a tracheostomy, where the airway is accessed via a tube in the neck. A nurse correctly anticipates that this procedure is required, prepares a kit and  informs the doctors that it is ready for use but her sense that she is one of the most junior people in the room and that the three consultants present are the authority figures holds her back from saying anything. The nurse ultimately feels unable to speak up and tragically the patient dies. Syed also describes another situation, which has striking parallels, where a plane crashes because the pilot is directing all his attention to solving a possible issue with the landing gear and fails to notice that the fuel level is dropping critically low. Again, others present, the first officer and engineer, had noticed how perilous the situation was becoming but as Syed puts it they had ‘issued strong hints, had agonised about making their concerns more explicit, but had been intimidated by the sense of hierarchy. Social pressure, and the inhibiting effects of authority, had destroyed effective teamwork.’  Social hierarchies are a well-documented aspect of psychology and can hold us back from expressing a thought or opinion even, it seems, when it might be a life-saving one. In many situations it makes total sense to show deference to a boss but to quote Syed ‘it can be fatal when a 90 tonne aeroplane is running out of fuel.’          


One of the main ‘take homes’ from a Mental Health First Aid training, and one thing that makes it so valuable in my opinion, is a developed sense of confidence to be able to open up a non-judgmental conversation and offer support should you spot signs that someone might be having some difficulties with their mental health. What you might notice may be florid or subtle, ongoing or temporary, but the idea is that the course will have equipped you with the some skills and understanding in order to recognise when something might be ‘wrong’, provide the space for a fellow human say how they feel, should they wish to disclose this, and to receive some support and possibly signposting to professional help. How much more problematic is this to achieve though when there is a real or perceived imbalance of power? As someone who is in the business of delivering trainings, and a huge believer in their value, I definitely don’t want to deter anyone from attending a course or booking one for their organisation. However, I do think the issue of power dynamics, for want of a better expression, does need to be considered and discussed. I think, like the topic of mental health itself as a whole, or when someone is experiencing difficulties, this issue is likely to prove most problematic if ignored or not talked about at all.     


I have to admit, perhaps naively, it was something I had not really considered until it was raised by an extremely experienced and astute HR professional at a meeting at a global firm in the City. In that instance I’m hopeful that both a number of senior figures and more junior ones within the company will be able to be trained, at a variety of levels, to ensure as many people as possible will have someone they feel able to speak to, should the need arise. I realise that this is not always practical or affordable and that, perhaps, those in positions of authority may not feel that they can justify the ‘time out’ to attend a two (or even one) day training.  I also appreciate that just because someone has a similar status within a company it doesn’t automatically make them a person to whom you feel able to open up. I do though think that increasing the number of senior figures who either feel able disclose mental health difficulties or who very visibly attend mental health training would be hugely beneficial in a number of ways. A healthy well-being culture that is also one of openness can surely only grow successfully from the ‘top down.’ The 2017 Thriving At Work report looked into ‘how employers can better support the mental health of all people currently in employment including those with mental health problems or poor well-being to remain in and thrive through work.’ Amongst many, at times, stark findings Paul Farmer and Lord Dennis Stevenson concluded that ‘across all businesses, there are still few managers, directors and senior officials declaring a long term mental health condition. Employees tend to perceive that having a mental health condition could hamper their progression…’ I can’t help but wonder if the reported figure of 35% of employees who believe they would be less likely to get promoted if they had depression would decrease if more of those in positions of authority felt able to be transparent about their own struggles and willing to not only support but take part in mental health trainings.


I have certainly seen signs to indicate, that things are changing and that they will continue to do so. I have been fortunate enough to run a very successful and dynamic ’open’ course where an MD of a logistics/haulage company shared his experiences and knowledge very productively with sport coaching students, and vice versa. The interplay between those at different stages of their life and career, and who had grown up in vastly differing landscapes in terms of mental health awareness, was hugely rich and valuable. The HR director previously mentioned was also very open to thinking about the possibility of encouraging their senior staff to get involved in training. However, I wonder, for example, how many large companies would be willing to run in house courses where colleague from all levels of the organisation would be trained together.  


As the conversation around mental health continues to grow great strides forward are being made but new questions and dilemmas will undoubtedly be uncovered. Just because they may be tricky, uncomfortable or difficult to solve doesn’t mean they should be ignored. Legitimate, titular or expert  power are always going to exist in organisations and necessarily so. How tragic though if that one junior member of staff, despite attending mental health first aid training, did not feel they could support a senior colleague in need due to the power of hierarchical pressure.  





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