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Looking back at the work

Between 2022 and 2026, I delivered 30 Mental Health First Aid cohorts within an NHS Foundation Trust.
Recently, I stepped back and reviewed the evaluation data from those cohorts. I looked at both the measurable shifts in confidence and knowledge, and the written reflections learners shared about their experience.

I wanted to understand what consistently seems to help staff feel more confident having mental health conversations in demanding healthcare environments.

Across all cohorts, the data was clear:
• Confidence increased from 4.68 to 8.54
• Knowledge increased from 4.76 to 8.74
• Instructor rating averaged 9.89 / 10
• Recommendation likelihood averaged 9.78 / 10

The knowledge scores moved, as you would expect. What really stood out was the confidence shift, and how learners described that change in their own words.

And certain themes recurred.

1. Psychological safety comes first

The most consistent qualitative finding was not about content, but about how the learning space felt.
Learners frequently described feeling encouraged without pressure:

“Everyone was encouraged to share personal experiences if they felt comfortable, but were not pushed to do so.” (Learner Cohort 8)

“Created a psychologically safe place which really helped me engage.” (Learner Cohort 21)

When staff feel psychologically safe, participation shifts. Conversations deepen and learners begin connecting material to real colleagues and real workplace situations.

Without safety, frameworks remain theoretical.

With safety, learning becomes usable.

2. From hesitation to confidence

A second recurring theme was hesitation. Many learners described arriving concerned about saying the wrong thing, overstepping boundaries, or making a situation worse.

By the end of the course, that language shifted. Learners spoke about feeling able to begin conversations rather than avoid them.

“I now feel confident and comfortable to be able to help support someone.” (Learner Cohort 5)

“I feel much more confident and competent in assisting with mental health first aid.” (Learner Cohort 8)

Confidence in this context does not mean certainty. It appears to mean reduced hesitation. When fear of getting it wrong softens, conversations become more likely.

3. Knowing where to start

A third recurring theme was the value of having a clear starting point. In complex healthcare environments, uncertainty often stops conversations before they begin. The ALGEE framework gives staff somewhere to start.

“I have found myself using the ALGEE approach already in my life.” (Learner Cohort 10)

“Role play of putting ALGEE into use… really enjoyed.” (Learner Cohort 6)

This framework doesn’t seem to stay in the training room. Learners describe using it in real conversations with colleagues.

4. Confidence includes boundaries

An unexpected but consistent theme across cohorts is increased awareness of limits.
Participants frequently reflect on understanding their role differently:

“I understand that my role is to support, not diagnose.” (Learner cohort 7)

In NHS contexts, where caring roles carry significant emotional responsibility, clearer boundaries appear to protect both staff wellbeing and patient care.

Confidence here is not about doing more, but about knowing how to respond appropriately.

A mixed-methods perspective

This reflection draws on both quantitative evaluation measures and qualitative learner comments gathered through MHFA England’s standardised feedback process.

The numbers demonstrate that change occurs. Learner voice helps explain how and why.

Together, they suggest that effective mental health learning depends less on information delivery and more on creating conditions where confidence can emerge.

Reflections

Looking across four years of NHS delivery, I’ve come to see my role less as leading learning and more as guiding confidence.

NHS staff rarely need convincing that mental health matters. What they often need is structured time, a psychologically safe space, and practical tools that make conversations feel possible.

When confidence shifts, conversations begin. And when conversations begin, support becomes more visible within teams.

Invitation

I am currently exploring partnerships with NHS Trusts seeking to strengthen mental health confidence across staff teams. If these reflections resonate with challenges within your organisation, I welcome a conversation about how this approach might translate into your context.