Context

• The experiences of people who grew up without care, endured homelessness after childhood abuse, or faced dehumanising psychiatric treatment reveal forms of suffering that cannot be captured through numerical indicators alone.
• These accounts show how distress emerges and manifests differently across lives shaped by deprivation, stigma, and systemic neglect.
• When mental health discourse focuses narrowly on symptoms and integration into predefined norms, barriers, social attitudes, and structural inequities remain overlooked.

Beyond the Deficit Lens

• Dominant approaches continue to view psychosocial disability through a deficit-oriented framework, emphasising integration into communities that reinforce narrow ideas of productivity and normality.
• This persists despite global gaps in mental health-care access of 70%–90% and despite advances in medication and therapy.
• These improvements have not addressed fundamental questions about the social conditions that produce suffering or the need for care grounded in dignity, agency, and equity.

Understanding Distress in Context

• A reimagined mental health system must centre dignity and disability justice, acknowledging that suffering arises from interactions between personal histories and broader societal forces.
• Material and relational deprivation often both precipitate and result from mental ill-health.
• Data linking suicides to family conflicts and relational ruptures point to deeper layers of shame, alienation, and abandonment, which are rarely spoken about or addressed.
• Explanations for distress, biological, psychological, social, cultural, political, and historical—are interlocking rather than competing frameworks.
• These influences intersect with caste, class, gender, and queer identities, shaping both experiences of distress and access to care.
• Effective mental health support requires attention to this overlapping complexity rather than reducing suffering to a single cause.

Care as Meaning-Making and Relational Justice

• People experiencing crises need space to explore uncertainty, identity, vulnerability, and purpose, yet mainstream models often prioritise biological or social determinants at the expense of these meaning-making processes.
• While tangible supports such as housing, medication, and financial assistance are essential, they cannot resolve feelings of disconnection or existential incoherence.
• Care must integrate material support with relational work, acknowledging that meaning and recovery unfold within a person’s social and ecological context.
• This orientation aligns with disability justice, which seeks liberation, wholeness, and autonomy, not mere integration into unequal systems.

The Way Forward

• Justice-Centred Model
  • A justice-centred model reframes treatment from ‘What is wrong with this person?’ to What does this person need to live the life they want?
  • This may include medication, community connection, spiritual grounding, or economic stability. This shift also strengthens trust and continuity of care, addressing common experiences of disillusionment and disengagement.
  • Building trust requires collaboration, dialogue, and acceptance of non-linear progress.
  • Justice, understood as recognising mutual obligations and repairing harms, demands that mental health care acknowledge the social contexts that create suffering.
  • Care cannot be ethical if it ignores the injustices that shaped a person’s distress.
• Transforming Care, Education, and Research
  • Transforming the system requires changes across training, practice, and research.
  • Mental health education should prepare practitioners to sit with uncertainty, navigate complex social realities, and value small wins.
  • Research must prioritise context-sensitive, granular insights over purely large-scale generalisations, employing transdisciplinary methods that link theory and practice to understand what works, for whom, and why.

Conclusion

• Those with lived experience and community members often labelled as non-specialists must be recognised as essential practitioners.
• Their experiential knowledge and contextual understanding provide forms of expertise that formal training cannot replace.
• They must receive fair compensation, training, and systemic support comparable to formally credentialed professionals.