'Frontline' staff who are not clinicians need better support

Before a patient ever meets a clinician in a mental health setting, they will usually meet someone else first, a receptionist, porter, cleaner, or security officer. Those early interactions matter. They shape how safe, welcome, and understood someone feels from the moment they arrive.

Having worked across NHS services for many years, I have seen first-hand how critical these non-clinical roles are to the safe running of mental health services. I have also seen how exposed and unsupported many of these colleagues can be.

The NHS’s overlooked first point of care

Receptionists, porters, domestic staff, and security teams are not clinicians. They are not trained mental health professionals. Yet they are routinely the first point of contact for people who may be distressed, frightened, confused, or angry. They manage high volumes of unplanned interactions every day, often without knowing what state of mind someone will arrive in.

Despite this, these roles frequently receive only basic training and limited ongoing support. They sit in the lowest pay bands, yet deal with some of the most challenging situations within our services. Without them, clinics would not function, but too often, they are overlooked in discussions about care, despite being central to how services function.

Clinical staff rightly benefit from structured training, supervision, and professional frameworks. They work to planned clinics and defined caseloads. By contrast, non-clinical frontline staff absorb everything that comes through the door. They carry the emotional weight of repeated difficult encounters while being expected to remain calm, professional, and compassionate at all times.

When support is lacking, the impact is real. Staff burn out. Confidence drops. People become unsure when to intervene and when to step back. Mixed messages can escalate situations rather than calm them. Across the NHS, many support staff describe feeling forgotten when policies are written, an invisibility that adds to emotional strain.

Leaving people to “just cope” is neither fair nor safe.

I recall watching a receptionist calmly guide an agitated patient to a quieter waiting area while discreetly alerting the nurse in charge. There was no formal training behind that response, just instinct, empathy, and courage. These are qualities we depend on every day, yet rarely acknowledge or develop.

We often talk about “one team”, but in practice, there remains an invisible divide between clinical and non-clinical roles. That divide matters. A clean, safe, well-managed environment is not separate from patient care; it is part of it.

I have seen porters stay with confused patients who had wandered into the wrong area, offering reassurance until help arrived. Patients remember these moments. They remember kindness, calm voices, and being treated with dignity. These interactions happen daily, yet rarely feature in reports or discussions at board level.

Ignoring support staff puts patients at risk

If we are serious about safety and quality, we need to be clearer about what we expect and what we will not tolerate. There must be firm boundaries around abuse and threats, while also recognising that behaviours such as shouting or pacing may be signs of distress rather than malice. Staff need practical guidance to judge when to de-escalate and when to step back.

Training must reflect reality. Generic sessions are not enough. Support staff need learning that matches the situations they face: listening skills, simple de-escalation techniques, knowing how to keep themselves safe without being asked to act beyond their role, and practising scenarios drawn from their own workplaces. Short, regular sessions work far better than one-off courses.

Small, everyday measures also make a difference. Clinicians flagging patients who may need quieter entry routes. Clear and fair sign-in processes. Staff knowing exactly who to call, and in what order, when something feels unsafe. Simple adjustments can prevent distress before it escalates.

Emotional support matters too. After difficult incidents, a brief debrief should be routine, not just paperwork. People need space to talk, not to be told to toughen up and move on. Peer support and Mental Health First Aiders should be visible and accessible, not token gestures.

Cost pressures cannot be ignored, but they must be handled with care. Estates and facilities teams are often the first to feel the impact of cuts to cleaning, security, or reception services. Reductions rarely reduce demand; they simply shift pressure onto fewer people. Operational risk rises, and so does emotional strain.

Any decision to reduce support services must consider not just financial savings, but the effect on safety, resilience, and staff wellbeing.

Receptionists, domestic staff, porters, and security teams are the hidden foundation of our mental health services. They are often the first to face frustration, and the last to be recognised.

Supporting them properly is not an optional extra. It is a patient safety issue, a workforce issue, and a leadership issue. If we value safe, compassionate care, we must also value the people who hold the doors open to it.