As I approach qualification as a clinical psychologist, I find myself confronting an uncomfortable truth: the mental health field often individualises problems that are fundamentally systemic. While therapeutic interventions certainly have their place, we must acknowledge that no amount of talking therapy can fully address the profound impact that social inequality has on psychological wellbeing.

The Medicalisation of Social Suffering

The contemporary mental health system operates within a paradigm that frequently pathologises normal responses to abnormal circumstances (Moncrieff et al., 2022). A person experiencing anxiety while facing eviction isn’t suffering from an anxiety disorder—they’re having a rational response to housing insecurity. Similarly, the depression experienced by someone working multiple precarious jobs to make ends meet isn’t primarily a chemical imbalance but rather a reasonable reaction to chronic stress and exploitation.

Psychologists are increasingly recognising this dynamic. As Psychologists for Social Change (2018) note, “Psychological research shows that many mental health problems are linked to social determinants such as poverty, precarious employment, discrimination, and social isolation” (p. 3). Yet our interventions remain largely focused on helping individuals adapt to unjust circumstances rather than challenging those circumstances themselves.

The Evidence on Inequality and Mental Health

The connection between inequality and mental health outcomes is robustly established in research:

The Marmot Review (Marmot et al., 2020) demonstrated that health inequalities, including mental health disparities, have continued to widen across the UK. Areas with higher deprivation consistently show significantly higher rates of psychological distress.

Research by Wilkinson and Pickett (2018) conclusively showed that more unequal societies have higher rates of mental illness. Their analysis found that mental health problems are three times more common in societies with larger income differences.

A systematic review by Silva et al. (2023) found that neighbourhood deprivation was significantly associated with increased rates of depression and anxiety, with effects persisting even after controlling for individual factors.

The COVID-19 pandemic has only exacerbated these trends. Studies show that the mental health impacts of lockdowns and economic disruption fell disproportionately on those already experiencing disadvantage (Office for National Statistics, 2021).

The Limitations of Individual Therapy

While cognitive behavioural therapy, mindfulness practices, and other psychological interventions can provide valuable coping strategies, they have inherent limitations when applied to problems that are social in origin:

1. Accessibility barriers: Those most affected by inequality often face the greatest barriers to accessing mental health support. Long waiting lists, geographical disparities in service provision, and the inability to take time off work all prevent people from receiving care (NHS England, 2024).
2. Practical obstacles: Even when therapy is accessible, practical obstacles often undermine its effectiveness. How can someone practice mindfulness when they’re working 60-hour weeks across multiple jobs? How can someone engage with therapy homework when they’re preoccupied with feeding their family?
3. Victim-blaming implications: Focusing exclusively on changing thoughts and behaviours can implicitly suggest that the problem lies within the individual rather than within unjust systems. This risks reinforcing self-blame and stigma.
4. Limited scope: Even the most effective therapy cannot provide stable housing, adequate income, or relief from discrimination—yet these factors are often more determinative of mental wellbeing than any psychological intervention.

Towards a More Holistic Approach

As mental health professionals, we need to expand our conception of practice to include advocacy for systemic change. This might include:

• Acknowledging limitations: Being honest with clients about the extent to which therapy can address problems that are social or political in nature.
• Advocacy as practice: Recognising that advocating for policy change is a legitimate part of promoting mental health, not an optional “extra” to clinical work.
• Community psychology approaches: Shifting focus from individual pathology to building community resilience and addressing structural determinants of wellbeing.
• Interdisciplinary collaboration: Working with social workers, community organisers, and policymakers to develop holistic interventions.
• Critically examining our own practices: Questioning whether our interventions may inadvertently reinforce harmful narratives about individual responsibility for structural problems.

Conclusion

None of this is to suggest that psychological interventions have no value. They clearly do. Rather, it is to argue that we cannot therapise people out of poverty, discrimination, or precarity. As psychologists, we have an ethical obligation to acknowledge the limits of our practice and to advocate for the social and economic changes that would do more for mental health than any number of therapy sessions ever could.

The evidence is clear: if we truly care about mental health, we must care equally about social justice. These are not separate concerns but deeply interconnected aspects of human wellbeing.

References

Marmot, M., Allen, J., Boyce, T., Goldblatt, P., & Morrison, J. (2020). Health equity in England: The Marmot review 10 years on. Institute of Health Equity.

Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., & Horowitz, M. A. (2022). The serotonin theory of depression: A systematic umbrella review of the evidence. Molecular Psychiatry, 27, 4396–4408. https://doi.org/10.1038/s41380-022-01661-0

NHS England. (2024). NHS Mental Health Implementation Plan 2023-2028. NHS England.

Office for National Statistics. (2021). Coronavirus and depression in adults, Great Britain: January to March 2021. UK Government.

Psychologists for Social Change. (2018). Universal credit: Psychological impact of poverty and austerity. Psychologists for Social Change.

Silva, M., Loureiro, A., & Cardoso, G. (2023). Social determinants of mental health: A review of the evidence. The Lancet Psychiatry, 10(2), 162-172.

Wilkinson, R., & Pickett, K. (2018). The inner level: How more equal societies reduce stress, restore sanity and improve everyone’s wellbeing. Penguin.