No Plasters and Pills for Social Ills: New Approach to Mental Health Needed (Part One)

Why the 10-year Mental Health Strategy must be a turning point in how we respond to emotional distress and trauma. Sara Boyce  |  Wed Jan 13 2021
Campaigners have been met with institutional arrogance and indifference.
The starting point of any mental health strategy must be "what happened to you?" and the solution must be "how can we fix the systems and processes that caused you to experience distress?"

As we experience a second wave of the pandemic, we know that until a vaccine is rolled out and everybody vaccinated, no one is immune from contracting Covid-19 and becoming ill or dying from it. We also know that not everybody is at an equal risk.

Its disproportionate impacts on the physical health and well-being of some communities over others are well known. It closely replicates the patterns of deeply entrenched inequality in societies. To such an extent that some medical experts are calling the outbreak to be recognised as a ‘syndemic’ rather than pandemic, due its disproportionate impact on marginalised communities (Syndemics are where biological and social factors increase a person’s likelihood of harm or worse health outcomes).

Our own statistics bear this out. In the north's most deprived areas there have been 66 deaths per 100,000 population compared with 55.2 per 100,000 persons for the region as a whole, with the highest Covid-19 related deaths in urban areas (66.9 deaths per 100,000 population).

Significantly, Richard Horton, the editor-in-chief of the medical journal, The Lancet has pointed to the absolute need to tackle those underlying social and economic factors which increase vulnerability to Covid-19, and to the limitations of a purely biomedical solution ‘"Unless governments devise policies and programmes to reverse profound disparities, our societies will never be truly Covid-19 secure."

As with the virus’s unequal impacts on physical health, so too with its impacts on mental health. Without a doubt the pandemic is taking a toll on all of us, in terms of our psychological well-being as we grapple with continued restrictions and disruptions to daily life, anxiety about ourselves and our loved ones’ health and safety and fears for the future. An increase in levels of anxiety and distress are rational and expected responses in the face of the existential crisis we have been facing in 2020 and in no way should these be pathologized.

However, beyond this, the impact of the pandemic on key socio-economic determinants of good mental health, such as income, unemployment, poverty and discrimination, will be disproportionately felt in poor and marginalised communities. Before Covid-19 these structural factors were known to both cause and exacerbate mental distress and trauma. The virus has reminded us just to what extent this is the case.

And it seems like there’s a need for reminding. The impacts on mental health of the Executive’s policies and action/inaction pre-covid on social security, poverty, immigration, housing, women’s rights, institutional abuse, academic selection and many more, were routinely rendered invisible. Policies that are known to cause significant levels of distress and harm, like Universal Credit just to mention one, didn’t warrant a mention in approaches to mental health. Flying in the face, not only of what the evidence tells us, but also of a growing acceptance world-wide that, in the words of the UN Special Rapporteur on the Right to Health Professor Dainius Puras ‘the best ‘vaccine’ for the protection of good mental health is the use of human rights-based approaches in all policies’.

The Covid-19 crisis is causing very significant and widespread levels of emotional pain and suffering for people. For some, this is related to the illnesses and deaths resulting from Covid-19, but for many more it will come from the wider fall-out from the virus – unemployment, poverty and increased inequality.

The pandemic and our response to how it impacts on our psychological well-being must mark a decisive turning point in how as a society we deal with emotional distress and trauma. The Minister for Health has a unique opportunity to introduce the much-needed paradigm shift in mental health with the development of the 10-year mental health strategy. Away from the current individualised, medicalised and pathologized understanding of emotional distress and trauma, towards a conceptual approach that locates psychological pain and suffering within its structural and societal context. Making the connection between ‘public issues’ and ‘private troubles’ as the sociologist CJ Wright Mills put it.

The Ministerial Working Group on Mental Well-Being, Resilience and Suicide Prevention, set up in January 2020, represented a welcome recognition that mental health is not just a matter for the Department for Health. It will soon be a year since its establishment. It’s time for it to start playing a key role in telling a different story about mental health. In that regard, the Executive Office has been more than a little reticent in sharing information on the work of this group since its inception. A Freedom of Information request by PPR in October has been stalled, on the somewhat spurious grounds that the Executive Office would have to seek permission from all other government departments before it could release the information requested.

Part 2 of 'No Plasters and Pills for Social Ills: New Approach to Mental Health Needed' will be published Monday 18th January 2021.

Sara Boyce works as an organiser with the #123GP mental health rights campaign. She has worked with PPR since 2016, both as an organiser and also as a policy worker across a range of campaigns supported by PPR. Prior to joining PPR Sara worked on both sides of the Irish border with a range of community and human rights organisations, including with Traveller groups and children and young people’s organisations.

She also worked for over a decade from the mid 1980s to the late 1990s as a Speech and Language Therapist, before undertaking a Masters in Equality Studies in UCD in 2006. Sara is passionate about promoting the power of poetry and other forms of creativity in challenging oppression and inequality at all levels.


‘Poetry is the lifeblood of rebellion, revolution and raising consciousness.’ (Alice Walker)