The Delusion of Mental Health

What if our greatest failure in mental health is not a lack of awareness, compassion or support, but our growing reluctance to tell people the truths they might need to hear?

We have never been more vocal about mental health. We have awareness days, corporate wellbeing programmes, social media campaigns, meditation apps, support groups, inspirational slogans and an ever-expanding industry devoted to helping people feel better.

We wear the ribbons. We share the posts. We ask, "Are you okay?" We applaud the organisations that publicly demonstrate their commitment to wellbeing.

And yet the numbers refuse to cooperate.

In 2017, a team led by Professor Anthony Jorm of the University of Melbourne reviewed twenty-five years of data from Australia, Canada, England and the United States. Between 1990 and 2015, all four countries substantially increased the provision of mental health treatment, particularly antidepressants. Yet the prevalence of mood and anxiety disorders and their symptoms did not fall.¹ More care was delivered. The burden did not shrink.

Today, more than two in five Australians aged 16 to 85 have experienced a mental disorder at some point in their lives, and one in five have experienced one in the past twelve months. Among young people aged 16 to 24, the twelve-month figure is 38.8 per cent, close to two in five.²

None of this means treatment does not work. Therapy and medication help a great many people, and researchers still debate why population figures have not improved: rising social and economic stressors, better reporting, gaps in the quality of care and chronic underinvestment in prevention have all been proposed.¹ Some have gone further. Oxford psychologists Lucy Foulkes and Jack Andrews have put forward what they call the prevalence inflation hypothesis: that awareness efforts, while helping many people recognise genuine problems, may also lead some to interpret ordinary distress as disorder, and that the label itself can shape behaviour in ways that deepen the very symptoms it names.³ They are careful to present this as a hypothesis that must be tested rather than an established fact. So should we.

But beneath all this activity, an uncomfortable question remains.

Are we genuinely helping people become healthier, more self-aware and better equipped to navigate the realities of life? Or have we become so preoccupied with demonstrating our compassion that we have forgotten what genuine help sometimes requires?

I believe we need a far more courageous conversation about mental health.

Not because awareness is worthless. Not because listening is unimportant. Not because people in psychological distress should simply toughen up and get on with life.

Quite the opposite.

We need this conversation because human suffering deserves far more than well-intentioned gestures. It deserves our honesty, our intelligence, our courage and our willingness to explore uncomfortable possibilities. Above all, it deserves an approach that recognises the whole human being, including the parts of ourselves we would rather not examine.

The Dangerous Comfort of Doing Something That Looks Good

There is something deeply reassuring about joining a movement that allows us to demonstrate our humanity without challenging our understanding of it.

We can organise an awareness event, publish a supportive message, introduce a workplace initiative and congratulate ourselves for contributing to a worthy cause. These activities can have value. They can encourage conversation, reduce isolation and help people recognise when professional help is needed.

But awareness is not transformation.

Consider the workplace, where wellbeing has become an industry of its own. In 2024, Dr William Fleming of the University of Oxford's Wellbeing Research Centre analysed survey data from 46,336 employees across 233 UK organisations. Workers who had taken part in individual-level wellbeing interventions, including mindfulness, resilience and stress management training, relaxation classes and wellbeing apps, appeared no better off across multiple measures of wellbeing than colleagues who had not. The one exception was volunteering and charity work.⁴ Fleming's conclusion was that organisations may achieve more by changing the conditions of work, such as scheduling, management practices, resourcing and job design, than by offering the worker another app. The study is cross-sectional and cannot prove cause and effect, but it should unsettle anyone who measures their commitment to wellbeing by the number of programmes on offer.

It is worth pausing on that single exception. The only intervention that helped was the one that turned people outward, towards others and towards something that mattered beyond themselves.

Talking about a problem is not the same as understanding it. Understanding a problem is not the same as changing the conditions that sustain it. And demonstrating compassion publicly is not proof that we know how to practise it when the situation becomes uncomfortable, complicated or personally demanding.

We must stop confusing the visibility of our intentions with the effectiveness of our actions.

The real measure of a mental health initiative is not how many people participated, how many photographs were published or how many organisations displayed their commitment. It is whether the initiative meaningfully improved people's ability to understand themselves, access appropriate care, navigate their difficulties and build more sustainable lives.

What changed?

What became possible that was not possible before?

Did someone receive the treatment they needed? Did they gain a better understanding of their emotional patterns? Did they find the courage to leave a destructive relationship, seek help for an addiction, rebuild a damaged connection or take a meaningful step towards a life they had been avoiding?

These are harder questions to answer than how many people wore a particular colour on a particular day. But they are the questions that matter.

We Don't Need Another Day of Asking. We Need What Comes After.

Let me be clear. Asking someone whether they are okay can be an extraordinarily important act. For someone who feels invisible, isolated or frightened, a sincere question may open a door they have been struggling to open themselves.

The problem is not the question. The problem is what happens after we ask it.

Australia offers an unusually clear test. R U OK? Day, founded in 2009, is the country's most visible mental health campaign. An earlier evaluation found that people exposed to it were up to six times more likely to reach out to someone who might be struggling.⁶ The asking is happening.

In 2026, economists from Monash University and the University of Melbourne used nine years of national survey and Medicare data, from 2011 to 2019, to measure what the day actually changes. The campaign produced a small but statistically reliable lift in self-reported mental wellbeing, strongest among men aged 25 to 49. That matters, and it deserves to be acknowledged. But the researchers found no detectable increase in GP mental health treatment plans or psychiatric prescriptions in the weeks that followed, and their estimates were precise enough to rule out moderate effects.⁵ People felt a little more connected. On the evidence, they did not take the next step.

The authors describe this as a gap between short-run psychological responses and outcomes that require behavioural follow-through. I would put it more simply. That gap is exactly where our culture is failing.

Do we genuinely want to understand the answer, including when it demands something of us? Are we prepared to remain present when the conversation becomes difficult? Can we tolerate the complexity of another person's suffering without reaching for a comforting slogan or an easy solution? And if someone tells us they are not okay, what happens next?

Too often, we have become comfortable with the ritual of asking but far less comfortable with the responsibility of responding.

We want to be the person who checks in, but we may not know how to help beyond listening. We want to be compassionate, but we fear saying something that could upset someone. We want to support recovery, but we are uncertain how to encourage change without appearing judgemental.

So we become cautious. We soften everything. We avoid difficult subjects. We reassure people that they are doing wonderfully when we may not understand what they are going through. We celebrate the courage it takes to speak while sometimes failing to help them discover what they might need to do next.

Then we congratulate ourselves for having the conversation. But a conversation is a beginning, not an achievement in itself.

If our concern ends when the conversation becomes uncomfortable, are we practising compassion, or simply protecting ourselves from the discomfort of caring?

Perhaps the real test of compassion begins after the question has been asked.

When Listening Becomes the Entire Intervention

Listening matters enormously. There are moments when people need to speak without interruption, explain their experiences without being dismissed and feel that someone is willing to remain beside them without immediately trying to fix everything. We should never underestimate the restorative power of being heard.

But listening, valuable as it is, is not always sufficient.

A person can be listened to for years without developing a clearer understanding of the patterns contributing to their difficulties. They can receive endless reassurance while continuing to repeat behaviours that undermine their relationships, health, confidence and sense of direction. They can become exceptionally articulate about their pain without becoming any more capable of responding to it.

Research on friendship offers a striking illustration. Developmental psychologist Amanda Rose coined the term co-rumination for the habit of discussing problems with a friend repeatedly and at length, speculating about their causes and dwelling on negative feelings.⁷ In a six-month study of 813 children and adolescents, girls who co-ruminated reported closer, more satisfying friendships, and at the same time developed more symptoms of depression and anxiety.⁸ The support felt good. It also kept them circling the problem.

The most effective therapies already understand this tension. When psychologist Marsha Linehan was developing what became Dialectical Behaviour Therapy, she found that an unrelenting focus on change felt invalidating to the people she was treating, while a focus on acceptance alone left them stuck. Her answer was to hold both at once: validation and change, acceptance and accountability, offered together.⁹ That synthesis is the heart of what I am arguing for.

At some point, we need to ask a difficult question. When does support help someone move forward, and when might it unintentionally help them remain where they are?

This is not an accusation against support groups, counsellors, psychologists or anyone who dedicates their life to helping others. Nor is it a suggestion that people should be pushed towards change before they have the stability, safety or capacity to pursue it. It is a challenge to the assumption that being supportive must always mean avoiding discomfort.

Sometimes a person needs to be heard. Sometimes they need protection. Sometimes they need professional treatment. And sometimes, when the circumstances are right, they need someone who respects them enough to ask a question they have been avoiding.

What are you noticing about your own behaviour?

What happens just before you begin to spiral?

What are you doing that might be making this harder to manage?

Is there a conversation you know you need to have?

Is there a habit you have repeatedly promised yourself you would change?

Is there something you keep attributing to circumstances that might also ask you to examine your own response?

These questions are not inherently cruel. Asked with sensitivity, good timing and genuine care, they are invitations to greater self-understanding. Their purpose is not to make someone responsible for every hardship they have experienced. It is to help them discover where they may have some influence, even when much of their situation lies beyond their control.

Compassion should make difficult truths easier to face, not make difficult truths permanently off-limits.

The Fear of Saying Something That Might Actually Help

One of the strangest contradictions in our current mental health culture is that we encourage people to speak openly about their struggles while making honest conversations increasingly difficult to navigate.

We are right to challenge cruelty, stigma and dismissive attitudes towards psychological suffering. But somewhere along the way, some of us have begun to confuse challenging a person's perspective with invalidating their experience.

Part of the explanation lies in language. University of Melbourne psychologist Nick Haslam has documented what he calls concept creep: over recent decades, psychology's concepts of harm, including abuse, bullying, trauma, mental disorder, addiction and prejudice, have steadily expanded, both outward to cover new kinds of experience and downward to cover milder ones.¹⁰ Haslam is clear that much of this expansion has been well motivated and has helped society recognise suffering that was once ignored. But he also warns that it risks pathologising everyday experience and encouraging a sense of victimhood that feels righteous yet leaves people powerless. When the boundary of harm keeps widening, the space for honest conversation narrows.

Consider one of the most familiar protective gestures of our time: the trigger warning. In 2023, researchers led by Dr Victoria Bridgland at Flinders University published the first meta-analysis of the experimental research on trigger warnings, content warnings and content notes. The warnings did not reduce distress when people encountered difficult material, did not lead people to avoid it and did not improve understanding. What they did reliably was increase anxiety in anticipation of the content.¹¹ Most participants studied were not people with diagnosed trauma, so the findings do not settle every case. But they show how easily the appearance of care can be mistaken for its substance.

I can acknowledge that your pain is real without agreeing with every interpretation you have formed around it.

I can respect your experience without assuming that every belief you hold about yourself is accurate.

I can care deeply about your wellbeing while questioning whether certain habits, decisions or relationships are contributing to your difficulties.

And I can recognise that you have suffered through circumstances you did not choose while still believing that your future may depend, in part, on decisions you can make now.

None of these positions requires a lack of compassion. They require discernment.

Yet many people are frightened to express them. They fear being labelled insensitive, judgemental, dismissive or psychologically uninformed. And so we walk on eggshells around the very conversations that might help us understand one another more deeply. We become so concerned with saying the wrong thing that we abandon the possibility of saying something meaningful.

Of course, there are situations in which direct questioning is inappropriate. Trauma, severe depression, suicidal distress and other serious conditions require responses tailored to the individual, the circumstances and the level of risk. Timing matters. Competence matters. Professional care matters. There is no virtue in delivering an uncomfortable truth carelessly.

But there is equally little virtue in withholding a potentially helpful observation simply because we are afraid of being misunderstood.

We need to recover the ability to speak honestly without humiliating, to challenge without condemning and to disagree without withdrawing our care.

A society that cannot distinguish cruelty from constructive honesty will struggle to help people develop the psychological resources they need to navigate a complicated world.

What If We Have Confused Comfort With Wellbeing?

We live in a world that increasingly treats discomfort as something to eliminate rather than something to understand.

When we feel anxious, we want the anxiety to disappear. When we feel sad, we want to feel happy. When we feel uncertain, we seek reassurance. When life becomes difficult, we search for ways to restore our previous emotional state as quickly as possible.

There is nothing wrong with wanting relief. Psychological suffering can be exhausting, debilitating and, at times, dangerous. People deserve effective treatment and every reasonable opportunity to recover.

But relief and recovery are not always identical.

Clinical science has a name for the habit of escaping uncomfortable thoughts, feelings and sensations: experiential avoidance. A 2022 meta-analysis pooled 441 studies involving more than 135,000 people and found experiential avoidance linked to depression, anxiety, obsessive-compulsive and related disorders and post-traumatic stress, across diagnoses and across cultures.¹² In anxiety research, the small protective habits people use to feel safe, such as checking, escaping, avoiding and repeatedly seeking reassurance, are consistently implicated in keeping fear alive, partly because they prevent a person from discovering that they can cope.¹³ The relief is real. So is the price.

Sometimes the immediate objective should be stabilisation and relief. At other times, lasting improvement also requires us to tolerate uncertainty, process difficult emotions, reconsider unhelpful beliefs and act constructively even when our feelings do not cooperate.

We need to distinguish between pain that signals danger, pain that signals a genuine unmet need and discomfort that accompanies learning, adaptation or necessary change. These experiences are not interchangeable.

An abusive relationship is not a growth opportunity that someone must learn to tolerate. A traumatic experience is not a lesson someone should be grateful to have received. A person living with a serious mental health condition does not simply need to think differently.

But neither is every unpleasant emotion evidence that something is fundamentally wrong. Grief can be an appropriate response to loss. Anxiety can arise because something matters deeply to us. Fear can appear when we approach an unfamiliar challenge. Frustration can emerge when our expectations collide with reality.

There is even evidence that a measure of difficulty can strengthen us. In a multi-year national study, psychologist Mark Seery and colleagues found that people who had faced some lifetime adversity reported better mental health and wellbeing than those who had faced a great deal of it, and also better than those who had faced none at all. They were also the least shaken by new hardships.¹⁴ The data cannot prove cause and effect, and no one should mistake this for an argument in favour of suffering. But it suggests that a life protected from all difficulty is not necessarily a stronger one.

How we interpret difficulty matters too. In research led by Alia Crum and colleagues at Yale, employees who were helped to see stress as potentially enhancing, rather than purely debilitating, reported improvements in both wellbeing and work performance.¹⁵

Our emotions deserve attention, but they do not always provide complete or accurate instructions about what we should do. The goal cannot be to eliminate every difficult feeling. It must involve learning to understand our emotions, recognise what they may be communicating and decide how best to respond.

A healthier mind is not one that experiences less discomfort. It is one that becomes better equipped to understand and navigate discomfort without being governed by it.

This distinction matters because a life organised entirely around avoiding distress can become a life increasingly restricted by it. We avoid difficult conversations until our relationships deteriorate. We avoid uncertainty until our opportunities disappear. We avoid failure until we stop attempting anything that matters.

In trying to protect ourselves from discomfort, we can gradually surrender the very experiences that make life meaningful.

The answer is not to glorify suffering. It is to stop assuming that every form of suffering can be resolved by removing the source of discomfort, without examining what the experience is asking of us.

The Missing Conversation About Self-Awareness

For all our conversations about mental health, I believe we devote far too little attention to a fundamental human capacity: self-awareness.

Not the superficial ability to name an emotion or identify a personality type. I mean the capacity to observe ourselves honestly, including our physiological responses, emotional patterns, assumptions, habits, relationships and behaviour.

Can we recognise when our thinking becomes distorted by fear? Can we distinguish between what happened and the story we have constructed about what happened? Can we notice when we are reacting to the present through the unresolved experiences of our past?

Can we recognise when we are using alcohol, food, excessive work, social media, isolation or other behaviours to avoid feelings we do not know how to process? Can we admit when our actions are inconsistent with the person we claim to want to become? And, perhaps most importantly, can we remain curious about what we discover without immediately defending ourselves against it?

This is where genuine self-enquiry begins. It requires us to become interested in our own minds rather than simply believing everything they tell us. It requires us to examine our emotional responses without treating them either as enemies or as unquestionable authorities.

Neuroscience suggests why this matters. In a well-known brain imaging study at UCLA, Matthew Lieberman and colleagues found that simply putting a feeling into words reduced activity in the amygdala, the brain's threat-detection centre, while increasing activity in a region of the prefrontal cortex associated with regulation.¹⁶ Naming what we feel does not make the feeling disappear. It changes our relationship to it.

Self-awareness also means paying honest attention to the body. We may discover that our anxiety intensifies when we neglect sleep, become physically inactive or repeatedly expose ourselves to stressful environments. The evidence here is no longer anecdotal. A 2021 meta-analysis of 65 randomised controlled trials involving more than 8,600 people found that improving sleep produced medium-sized improvements in depression, anxiety and rumination, and that the more sleep improved, the more mental health improved.¹⁷ An umbrella review published in 2023, drawing together 97 reviews covering 1,039 trials and more than 128,000 participants, found that physical activity produced medium-sized reductions in symptoms of depression, anxiety and psychological distress, with higher-intensity activity producing greater benefit.¹⁸

The same honesty applies to how we cope. Alcohol can feel like relief, yet in a ten-year study of adults with depression, those more inclined to drink to cope showed a stronger link between their depressive symptoms and both their drinking and their drinking problems over time.¹⁹

We may notice that our anger emerges when we feel powerless, rejected or unable to communicate a need. We may realise that our loneliness is complicated by our reluctance to initiate relationships, reveal vulnerability or take the emotional risk of connecting with others. We may discover that our low confidence is reinforced by years of avoiding the very challenges that could build it.

These are possibilities to investigate, not universal explanations for mental health conditions. Biology, trauma, social circumstances, discrimination, physical illness and many other factors shape psychological wellbeing. But the willingness to examine our own experience can reveal opportunities for change that remain invisible when we refuse to look.

Self-awareness creates the possibility of choice. Without it, we can spend years repeating familiar responses while wondering why our circumstances never seem to improve. With it, we can begin to recognise the moment an old pattern appears and ask whether we want to keep participating in it.

That moment may seem insignificant. It is not.

It is the space in which a different response becomes possible.

Personal Responsibility Is Not the Same as Blame

We need a far more intelligent conversation about personal responsibility.

The phrase has become so closely associated with judgement that we hesitate to use it, particularly when discussing people in psychological distress. But removing responsibility from the conversation does not necessarily protect people. In some circumstances, it quietly tells them that they are powerless passengers in their own lives.

We must make an essential distinction.

Blame asks, "What is wrong with you?"

Responsibility asks, "Given where you are, what can you do next?"

Blame looks backwards in search of a verdict. Responsibility looks forward in search of possibilities.

Blame reduces a person's identity to their mistakes, limitations or circumstances. Responsibility separates what has happened to someone from what may still be possible for them.

This is not merely philosophy. Across four experiments, Juliana Breines and Serena Chen at the University of California, Berkeley found that people who responded to their own mistakes and weaknesses with self-compassion, rather than self-criticism or efforts to boost their self-esteem, were more motivated to improve. They were more likely to believe they could change, more motivated to make amends and willing to study longer after failing a test.²⁰ Harshness does not produce accountability. Kindness, it turns out, is what makes accountability possible.

Not everyone begins with the same advantages. Not everyone has the same physical health, psychological resources, financial security, social support or access to treatment. Some people face extraordinary obstacles that cannot be overcome through determination alone. Acknowledging these realities is not an excuse. It is a necessary part of understanding human behaviour.

Equally, acknowledging that circumstances influence us does not mean they completely define what is possible. And the belief that nothing we do makes a difference carries its own risk: a meta-analysis spanning 18 cultural regions found that a more external locus of control, the sense that our lives are governed mainly by forces outside us, was associated with more symptoms of anxiety and depression.²¹

There may be parts of our lives we cannot immediately change. We may not be able to reverse a loss, erase a traumatic experience, cure a medical condition or control another person's behaviour.

But there may still be decisions available to us.

We may be able to seek professional assistance, establish a regular sleep routine, move our bodies, reduce our reliance on alcohol, reconnect with one person we have been avoiding or take one small step towards something that matters to us.

That last step matters more than it sounds. Behavioural activation, a therapy built on scheduling small, meaningful actions even before motivation returns, has been shown in a meta-analysis of 26 randomised controlled trials to be an effective treatment for depression.²² We do not always need to feel ready before we act. Often, acting is how readiness arrives.

None of these choices erases what happened. But each restores a measure of authorship. And authorship, the sense that we still have a hand in writing what comes next, may be one of the most protective things a human being can hold.

Towards a More Courageous Compassion

The opposite of compassion is not honesty. It is indifference. And indifference can wear a very kind face. It can look like a ribbon, a slogan, an app, a day on the calendar or a conversation that ends the moment it becomes difficult.

Jorm and his colleagues suggested that if we want fewer people to suffer, we may need to close not only a treatment gap but a quality gap and a prevention gap.¹ I would add one more: a courage gap. The distance between what we say we care about and what we are willing to do, and to say, when caring becomes demanding.

Closing it would look different from what we do now.

It would mean measuring mental health initiatives by what changed, not by who attended. It would mean changing the conditions that wear people down, not only offering individuals ways to tolerate them. It would mean following every sincere "Are you okay?" with a second question: "What would help you take the next step, and how can I help you take it?"

It would mean teaching self-awareness as seriously as we teach awareness, and treating sleep, movement, connection and purpose as foundations of mental health rather than afterthoughts. And it would mean training ourselves to hold two truths at once: that a person's pain is real, and that they may still have more power than they believe.

The truest compassion does not ask us to choose between kindness and truth. It asks us to offer both, in the right measure and at the right time, to the whole human being in front of us.

That is not the end of the mental health conversation.

It is where the real one begins.

A note on the evidence

Several studies cited here are correlational or cross-sectional and cannot by themselves establish cause and effect; where that is the case, the text says so. Superscript numbers refer to the sources listed below. This article is a work of commentary and is not a substitute for professional advice.

If this article raises concerns for you or someone you care about, please speak with your GP or a mental health professional, or contact Lifeline on 13 11 14 or Beyond Blue on 1300 22 4636. In an emergency, call 000.

References

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