Why we need to address the social inequalities that drive mental distress
Having worked in mental health and social care for more than 20 years, I’ve seen a long line of ‘transformations’. You know you've been around a while when new ideas sound strangely familiar, often echoing what used to be standard practice. I often joke about my rose‑tinted glasses: “Wasn’t it better back then?” or “Remember when we were actually in communities? We knew people, their families, their neighbourhoods.”
Talk of neighbourhood models and community assets is resurfacing now, but these concepts have always been the foundation of good mental health care. Evidence consistently shows that social, economic and physical environments shape mental health across the life course and are closely tied to inequality.
Despite this, the medical model continues to dominate service design. This isn’t to deny the value of medication – clinical treatment can be essential – but its impact is often intertwined with social interventions that remain invisible in data. The broader research base reinforces this: social factors such as housing, economic stability, relationships and community conditions significantly influence both the onset and course of mental illness.
I think back to someone I worked alongside years ago: medication offered initial stability, but the real change came through addressing her housing, debt, relationships and occupation. These outcomes, important to her, were largely unseen but the impact significant. She consistently said these social interventions were what truly helped her.
Listening to lived experience
We talk a lot about co‑production, but how often is it meaningfully embedded into service design? Research stresses that social determinants – like poverty, trauma, discrimination and instability – are major contributors to mental ill‑health. Yet mental health services remain overwhelmingly structured around clinical responses.
I was recently moved by someone who described the fear they felt on an inpatient ward, worrying about being rapidly tranquillised when distressed. Their experience highlights how coercive practices can undermine safety rather than building it. How much harm do we intentionally inflict while believing we’re helping?
So why are more people than ever in crisis? Why are A&E departments filled with mental health presentations? We analyse endless streams of data but rarely pause to ask why things look like this or whether our system design is fundamentally flawed.
It’s not just funding – it’s what we fund
Of course, funding matters. But so does where that funding goes. The World Health Organisation emphasises that action on the social determinants of mental health – across early childhood, education, work, and community life – offers the greatest opportunity to improve population mental health and reduce inequalities. Yet mental health budgets and strategies continue to prioritise clinical services over social investment.
Are we investing in strong communities? Are we addressing the social inequalities that drive mental distress? Or are we simply repeating the same patterns, expecting different results?
The quiet, powerful work of social care
The social model has always been present, but rarely respected or seen as a viable alternative. Does mental health automatically sit within “health” just because of the name? Do we rely on clinical treatments because we hope they can fix what is, at its core, often the result of inequality, trauma, isolation, and unmet social need?
As an approved mental health practitioner and mental health social worker, I’ve consistently found that the greatest impact comes from:
- building trusting, safe relationships
- addressing social inequalities
- empowering people with choice and control
- supporting people to make sense of their experiences
- having really good, human conversations
These interventions are rarely reflected in the data dashboards decision‑makers rely on, yet evidence consistently shows social factors have profound and lasting impact on mental health outcomes.
The social model has always been present – it’s simply never been given equal weight. Maybe it’s time we stop asking whether a social approach complements clinical care, and start asking whether it should, in fact, be leading it.
Kirsten Bingham is strategic lead for mental health in Manchester, co-chair of the AMHP Leads Network and has worked as a mental health social worker for nearly two decades