Mental Health Strategy is Asking and Answering the Wrong Questions

Why the 10-year Mental Health Strategy must develop a different narrative in relation to emotional distress and truama. Sara Boyce  |  Thu Apr 22 2021
Changing the Context - Understanding Mental Health

Well done to ASCERT for organising an incredible talk with the world-renowned physician and public speaker, Dr. Gabor Mate.

Listening to Dr. Mate speak so compassionately and knowledgeably about addiction and trauma, reinforced an understanding already shared by mental health activists in the #123GP campaign.

It’s to do with how mainstream mental health services respond to emotional distress and trauma and it is this: they are asking the wrong questions.

Dr. Mate shared his mantra with us, which is, ‘The question is not why the addiction, but why the pain?’

In the past year #123GP activists have also had the pleasure and benefit of connecting with Jo Watson and her colleagues in Drop the Disorder, a UK-based group open to anyone who is interested in challenging traditional approaches to emotional distress. (Jo Watson will be speaking on 18 May at an event organised by Féile na gClóigíní Gorma )

Jo spoke at a #123GP webinar in July 2020. She shared much wisdom with us that day but one thing she told us sticks out.

In a similar vein to Dr. Mate, Jo Watson said that services need to stop asking people, ‘What is wrong with you?’ and start asking, ‘What happened to you?’

In one way this seems like a small enough shift, but what lies behind it is profound. The question you ask will determine your response.

Rather than responding with, ‘How can we fix you?’ the response will be one of, 'How can we fix the systems and processes that caused you to experience distress?'

Crucially it’s about recognising that the source of pain and trauma is always and invariably to be found in a person’s lived experience, beginning with childhood.

Poverty, unemployment, homelessness, violence and discrimination - all of these are massive stressors and causes of distress and trauma. These conditions do not fall from the sky however. They are the result of conscious political decisions and policy choices by governments everywhere, including our own.

Which brings us to the Department for Health’s draft ten-year Mental Health Strategy.

The opportunity presented by the development of a ten-year Strategy has not translated into a transformative approach to how mental health is understood or addressed.

A major flaw in this Strategy is the failure to ‘surface’ the implicit understanding of the underlying causes of emotional distress and trauma.

There is little evidence of any shift away from the dominant narrative around ‘mental health’, one that is predicated on an individualised, pathologised model.

Instead, this Strategy appears to be one drafted by Department of Health officials, with the main goals being the re-configuration and improvement of existing mental health services within both primary and secondary mental health services, as well as developing new ways of working.

Given how badly existing services are failing, nobody is saying that this work isn’t needed. But if the Department presses ahead with a Strategy that fails to recognise the underlying causes of emotional distress and trauma then all we can expect is more of the same.

Covid has shone a huge light on the pre-existing, deep, structural inequalities that exist in our society, inequalities that are causing significant harm and that are being greatly exacerbated as a result of the pandemic.

There is a huge onus on the Department of Health and all Executive departments to ensure that we have a Mental Health Strategy that starts with the question, ‘What happened to you?' and follows with, 'How can we fix the systems that caused you harm?'

Read PPR’s response to the consultation on the Mental Health Strategy here.

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)