Why employers need to centre the “missing middle”
Vicki Cockman, MHFA England® Director of Training and Consultancy, shares her thoughts on the "missing middle", and why employers need to support this growing group of employees.
New data from 10,000 Mental Health First Aider conversations shows a growing group of employees risk falling between the gaps of existing workplace mental health support. The “missing middle” are people experiencing poor mental health, but who aren't in crisis and don't meet the threshold for clinical referral. Focusing resources on this group is one of the smartest things businesses can do. And it’s fast becoming essential.
As part of our response to the Government’s mental health strategy call for evidence, we analysed data from interactions logged in the MHFAider Support App. The app connects trained MHFAiders with round-the-clock guidance for supporting colleagues. Of the 10,000 anonymised conversations, a third related to a worsening mental health condition, forty percent related to life events and social pressures, and 25% to workplace stress and burnout.
This shows a need for three distinct support pathways. Without defined pathways, people in the second two groups risk more severe mental health difficulties if they go unsupported, creating pressure on NHS services downstream. Employers with wellness benefits and EAPs in place might believe they already have this covered. But the “missing middle” are lost between two extremes of workplace mental health support – wellness and crisis.
As the Government shapes the future of mental health services, the “missing middle” is firmly on the agenda. Its call for evidence specifically asked about this group, and how they can be supported at work. The Keep Britain Working initiative outlined a “fundamental shift” of responsibility for workplace mental health, with employers as active partners in preventing poor mental health and tackling economic inactivity.
I know from our work with over 20,000 organisations that employers often rely on managers to support colleagues’ mental health. Managers have a key role to play, but only 58% of employees feel confident their manager could have a supportive mental health conversation. Despite good intentions, many managers lack the confidence and skills to act. Alongside manager training, peer-to-peer conversations, with trained MHFAiders, can reach people early and bridge that gap.
An employee going through divorce wouldn’t meet the criteria for NHS support, and their manager or colleagues might not notice they’re struggling. But emotional and financial stress have an impact on both work and mental health. Feeling isolated, and left unsupported, they could reach crisis point. Our data shows that employees in situations like this are increasingly turning to MHFAiders.
Employers might see preventative support for this group of employees as a budget pressure they could do without. But in my experience, the cost of doing nothing is far greater. Without intervention, life and work pressures negatively affect productivity and engagement and can ultimately result in long-term absence. Preventative support is money well spent. According to Deloitte, employers see a £4.70 return for every £1 invested in staff wellbeing.
Our app data shows that MHFAiders are already doing meaningful work here. Of the conversations logged, 22% were signposted to a manager or HR function, and a significant proportion to community organisations and self-help resources. Peer-to-peer support empowers colleagues to self-refer to EAPs, or talk to their manager about their mental health, which they might not otherwise feel safe to do.
Starting workplace mental health conversations takes knowledge and skill. MHFAiders told us their training raised their confidence from 5.8 to 8.7 out of 10. But the course is just the beginning of their journey. The Association of Mental Health First Aiders offers MHFAiders community, support, resources, and opportunities for ongoing learning to keep their confidence levels high. It’s free to join and it’s open to anyone who’s done the training.
We know that embedded peer-to-peer support is effective in meeting the “missing middle” where they are. But it’s only one piece of the puzzle. Employers getting this right also focus on wider culture, particularly policy and the role that managers and leaders play in destigmatising mental health in their workplaces. When employees feel psychologically safe, they’re more likely to ask for support – early, when it matters most.
Employers who only focus resources at the extreme ends of the mental health spectrum risk leaving the “missing middle” unsupported. An early conversation with an MHFAider could transform an employee’s experience when feeling the impact a life event. They’d connect to practical help sooner, continue performing well, and see their workplace as true source of support. That’s exactly the preventative approach the Government is asking for – and it’s an investment that benefits employers most of all.