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 Action Plan (Mental Health First Aid)
- Approach, assess for risk of suicide or harm
- Listen non-judgementally
- Give reassurance and information
- Encourage appropriate professional help
- Encourage self-help and other support 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 them to breathe slowly and deeply, and remind them that the attack will pass
- Do not crowd them
- Wait with them until the attack passes (most panic attacks last between 5 and 20 minutes)
- Follow up the next day
Disclosure of Suicidal Thoughts
- Take it seriously — always
- Ask directly: "Are you thinking about suicide?" (a 2014 review of the evidence by Dazzi et al. found no significant increase in suicidal ideation from asking about suicidal thoughts)
- Listen without judgement
- Do not leave them alone if they are in immediate danger
- Call emergency services (999 in the UK, or your local emergency number) if there is an immediate risk
- Connect them to crisis support: Samaritans (116 123, UK and Ireland), 988 Suicide & Crisis Lifeline (call or text 988, 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 the next couple of days
Return-to-Work Planning
Phased Return
After a mental health-related absence, a phased return is often helpful. An example plan (adapt it to the person and Occupational Health advice):
- Week 1: Reduced hours and workload, daily check-in
- Weeks 2–3: Gradually increased hours and reintroduction of responsibilities
- Week 4 onwards: 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
- Acas – Supporting mental health at work: acas.org.uk
- Mental Health First Aid England: mhfaengland.org
- CIPD (HR guidance on wellbeing and mental health): cipd.org
- Samaritans: 116 123 (UK/IE), samaritans.org
- 988 Suicide & Crisis Lifeline (US): call or text 988, 988lifeline.org
- Lifeline (Australia): 13 11 14, lifeline.org.au
- HSE Stress Management Standards (UK): hse.gov.uk