Supporting Employees Through Mental Health Crises: A Manager's Practical Guide
Introduction
At some point, most managers will support an employee through a mental health crisis — a panic attack at work, disclosure of suicidal thoughts, sudden deterioration in behaviour or performance, or a colleague not returning after a breakdown. This guide provides practical, evidence-based guidance for these situations.
Recognising Warning Signs
Behavioural Changes
- Increased absence or lateness
- Withdrawal from colleagues and team activities
- Uncharacteristic errors or missed deadlines
- Difficulty concentrating or making decisions
- Emotional outbursts or visible distress
- Changes in appearance or self-care
- Increased alcohol or substance use (observable signs)
The Key Principle
You are not diagnosing. You are noticing change. The question is not "what is wrong with this person?" but "this person seems different from their normal — how can I check in?"
Having the Conversation
The ALGEE Framework (Mental Health First Aid)
- Approach, assess, and assist with any crisis
- Listen non-judgementally
- Give support and information
- Encourage appropriate professional help
- Encourage other supports (social connections, self-help strategies)
Practical Tips
- Choose a private, quiet space
- Use open questions: "How are you doing? I've noticed you seem a bit different lately."
- Listen more than you talk — silence is okay
- Do not try to diagnose, counsel, or fix
- Validate: "That sounds really difficult"
- Ask about practical support: "What would help you right now?"
- Signpost to professional support: EAP, GP, crisis lines
- Follow up — do not have one conversation and forget
What NOT to Do
- Do not say "everyone feels like that sometimes" or "just think positive"
- Do not share what the employee tells you without their consent (except in safeguarding situations)
- Do not assume you know what they need
- Do not avoid the conversation because it feels uncomfortable
Crisis Situations
Panic Attacks
- Stay calm and speak slowly
- Help the person to a quiet space
- Encourage slow breathing (in for 4, hold for 4, out for 4)
- Do not crowd them
- Wait with them until the attack passes (typically 5–20 minutes)
- Follow up the next day
Disclosure of Suicidal Thoughts
- Take it seriously — always
- Ask directly: "Are you thinking about suicide?" (asking does NOT increase risk — evidence from Dazzi et al., 2014)
- Listen without judgement
- Do not leave them alone if they are in immediate danger
- Call emergency services (999/911) if there is an immediate risk
- Connect them to crisis support: Samaritans (116 123 UK), 988 Suicide & Crisis Lifeline (US), Lifeline (13 11 14 Australia)
- Follow your organisation's safeguarding protocol
Sudden Deterioration at Work
- Prioritise the person's safety and dignity
- Offer to arrange transport home if they cannot work
- Contact their emergency contact if they consent
- Document what happened (factually, without judgement)
- Arrange a follow-up meeting within 48 hours
Return-to-Work Planning
Phased Return
After a mental health-related absence, a phased return is best practice:
- Week 1: 50% hours, reduced workload, daily check-in
- Week 2–3: 75% hours, gradual reintroduction of responsibilities
- Week 4+: Full hours with continued check-ins
Key Principles
- The employee decides what colleagues are told
- Adjustments should be agreed collaboratively, not imposed
- Occupational Health can advise on specific recommendations
- Review the return-to-work plan regularly (it may need extending)
- Do not assume the person is "fixed" — recovery is non-linear
Manager Self-Care
Supporting someone through a mental health crisis is emotionally demanding. Managers should:
- Use their own EAP or counselling resources
- Debrief with HR (without breaking confidentiality)
- Set boundaries — you are a manager, not a therapist
- Recognise that you cannot control the outcome
Resources
- Mind Manager Guide: [mind.org.uk/work](https://www.mind.org.uk/workplace/)
- Mental Health First Aid: [mhfaengland.org](https://mhfaengland.org)
- CIPD Managing Mental Health Guide: [cipd.org](https://www.cipd.org)
- Samaritans: 116 123 (UK/IE), [samaritans.org](https://www.samaritans.org)
- 988 Suicide & Crisis Lifeline (US): 988
- HSE Stress Management Standards (UK): [hse.gov.uk](https://www.hse.gov.uk)