With mental distress that model often does not work at all

What we see in practice is that people stay in treatment for years. Diagnoses, protocols and treatments come, and yet the distress often remains. Or it changes shape, slumbers in the background, returns in waves. The treatments stretch out, sometimes endlessly. As if just one piece of the puzzle is still missing, one last intervention that will make the difference.

Slowly but surely we are starting to realise that this medical model falls short in many cases. Not because specialists do not do their best, but because the nature of mental distress asks for something else.

Mental distress is work that has to be done

When you end up in mental distress, you often end up in a long, existential process. A process in which old certainties evaporate, in which fear, pain, loneliness and loss overwhelm you. It is not an illness that you ‘just’ cure. It is an inner crisis that asks for deepening, reorientation and, yes, work.

You have to learn to deal with the compelling and powerful forces in your mental space: your fears, your trauma, your gloom, your despair, your confusion. At the start that relationship is often completely lopsided. Those forces seem endlessly stronger than you. But along the way you can learn to relate to them differently. You learn to bear, to practise, to structure, to explore and above all to experiment.

And that is where it chafes: the experiments that are needed seldom go in the direction people want. You may have to adapt your lifestyle, revise your relationship with yourself, rearrange your social surroundings, find meaning again. And above all: learn to look your fears and trauma in the eye and stop avoiding them. That takes courage. That is the real work.

What do you need for that?

Not an endless number of specialists. What you need is someone who helps you for a while to get that work into focus. Someone who can clarify with you: what is going on here? What is the real work that is waiting for you?

And then, and not after another year of treatment with that one specialist, you are not put on hold or treated on and on. You are discharged from specialist care, with the trust that you can get to work.

But you are not left alone.

Social holding

You get access to something much more important than a treatment room: social holding. A place, a group, a community where you can keep coming. Where people hold each other, motivate each other, inspire each other. Where you may fail and come back. Groups in which the process of recovery, giving meaning and transformation is shared.

That can be within mental health care. But just as well at recovery colleges, in social services, in the neighbourhood, with peers, in complementary care. The key word is continuity of connection, not of treatment.

From fixing to supporting

The specialist remains important, but gets a different role. Not as the fixing specialist who solves your problem, but as an expert who thinks and feels along with you for a time. Who helps you map the landscape of your distress. And who then lets you go with gentle trust, towards a place where that work can really be done. In connection. In movement. In life itself.

In this way a different model arises. Mental health care in which the focus is no longer on endless treatment, but on supporting meaningful recovery. In which specialist input serves your process, and in which the real work happens in daily practice, together with others. Because in the end it is relationships that carry us, not guidelines.

Read more: What is recovery? and Recovery is personal.

Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare. 

Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.

Want to read more?

Blogs by Jim van Os can be read here

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