By almost every conventional metric, we are “doing more” mental health care than ever before. We spend more money on mental health intervention than at any point in history. Stigma around seeking care has declined dramatically. Therapy, medication, crisis lines, hospital-based services, and digital platforms are more common than ever. The scope of intervention has expanded, with mental health care increasingly embedded across other health care settings and within institutions like schools and workplaces. If mental health outcomes tracked neatly with spending, awareness, and clinical capacity, we would expect them to improve dramatically.

They have not.

A common good–focused mental health care system begins by reckoning honestly with that mismatch and questioning the assumption that more inputs automatically produce better outcomes. In our current fragmented system, expert mental health care remains difficult to access for many people with the greatest needs. Meanwhile, upstream strategies focused on promoting well-being, preventing crises, and supporting recovery are underfunded and unevenly distributed.

This new approach does not mean rejecting treatments delivered by clinical experts or turning away from promising technological innovations. Instead, it means rejecting the idea that mental health care is best understood and addressed solely through diagnosis and individualized treatment in clinical settings. We must expand the aperture of mental health care to advance the common good.

Beyond Either/Or: The Spirit of Both/And

At the heart of a common good approach to mental health care is a posture of both/and, not either/or.

Mental illnesses are common, disabling, and treatable. Evidence-based treatments including medication and therapy, delivered with fidelity and quality, are absolutely vital. These treatments should be accessible and affordable to everyone. People in crisis should receive care without stigma or delay. Severe mental illness deserves rigorous and sustained treatment. Many recent treatment innovations are very promising and build upon a strong foundation established over decades. A common good-focused mental health care system does not discard the crucial treatment approaches that improve millions of peoples’ lives.

Human beings are not self-contained psychological units. We are formed in families, shaped by relationships, embedded in communities, and oriented toward meaning.

And also: human connection, belonging, purpose, action, and service are not peripheral to mental health care. They are among its primary inputs. When these inputs are excluded from the mental health care system, the system underperforms and results lag. This is what we are seeing today.

Human beings are not self-contained psychological units. We are formed in families, shaped by relationships, embedded in communities, and oriented toward meaning. We continually develop across our lifespans, with evolving biological, psychological, and social strengths and vulnerabilities and robust capacities to adapt to the contexts of our lives. A system that treats mental distress solely as an individual pathology occurring at a moment in time—managed primarily through diagnosis and treatment—misses something essential.

If we take a both/and posture seriously, the next question is not what we believe about mental health care, but how our systems behave by default.

Shifting Default Strategies Toward Meaning and Connection

Rather than focusing solely on expanding choices, a common good mental health system would emphasize shifting defaults so that the most accessible paths to care are also the most supportive.

Instead of defaulting to long-term, individualized treatment as the primary response to an individual’s distress, care systems could default to:

• Early, brief, and relationship-based supports
• Family- and caregiver-based interventions
• Peer- and community-based programs
• Low-barrier entry points that do not require diagnostic labeling
• Payment for prevention and early intervention services.

A common good system would first provide earlier, lighter-touch support that is effective and humane, reserving long-term and intensive interventions for those with more severe illnesses.  Defaults, however, are shaped not just by values but by the rules that determine who gets access to care, when, and on what terms.  

Moving Beyond Diagnosis as Gatekeeper

Another foundational change involves how we organize access to care.

In mental health care, diagnoses are often clusters of symptoms rather than discrete biological conditions with clearly differentiated treatments. Yet our systems of care and payment require people to be labeled before support can begin. This creates perverse incentives: mild or situational distress is pathologized, preventive care is delayed, and people must first become “sick enough” to deserve help.

We have created a system in which it is relatively easier to access expensive, reactive crisis care and harder to access effective, brief interventions that prevent crises from occurring in the first place.

A common good mental health care system would loosen the grip of diagnosis as gatekeeper. It would allow people to access support based on need, distress, or life circumstance, emphasizing early intervention, brief support, and practical help long before symptoms escalate.

Loosening diagnosis as the primary gatekeeper would also create space to rethink who mental health care is designed for in the first place.

Family Mental Health Care as an Explicit Approach

A common good–focused mental health system would also move decisively away from radical individualism by adopting family mental health care as an explicit strategy.

When mental health care is framed primarily as an individual struggle to be overcome through personal resilience or compliance with treatment, the role of families and caregivers is easily overlooked.

For decades, mental health care has been organized around the individual: one patient, one diagnosis, one treatment plan. But distress rarely arises in isolation, and healing rarely occurs there either. When mental health care is framed primarily as an individual struggle to be overcome through personal resilience or compliance with treatment, the role of families and caregivers is easily overlooked.

Family mental health care starts from a different premise: supporting families is often the most effective way to support individuals.

This approach recognizes that:

• Children’s mental health is deeply shaped by the well-being of caregivers and vice versa; when children struggle, their caregivers are deeply affected.
• Caregiving stress is a legitimate mental health concern, not a private failing.
• Strengthening family relationships through communication, empathy, and problem-solving can bolster traditional treatment strategies focused on individual symptoms and struggles.
• Families are primary sites of shared agency, responsibility, adaptation, growth, and meaning. This is true across the lifespan.
• Families have many forms and configurations—biological, adoptive, blended, ‘chosen,’ and otherwise. For almost everyone, family support in some form is crucial to flourishing.

A common good framework would treat families as central actors in mental health care, worthy of support, investment, and respect.

Treating families as central actors would naturally expand our understanding of who counts as an expert in mental health care.

Peer-Delivered Support

A common good mental health care system would efficiently deploy expert support where it is most useful and would recognize multiple forms of expertise. That expertise can come from advanced clinical training as well as the lived experience of community health workers, peer support specialists, recovery coaches, informal networks of care, and others.

Within a revitalized system, clinical services by trained and licensed professionals would focus on individuals and families facing complex and impairing mental health conditions. Meanwhile, peer-delivered support would be widely available with minimal barriers to access and oriented toward promoting positive mental health, addressing minor challenges and crises, and strengthening informal networks of care around individuals and families who are struggling.

This approach would counter the tendency to treat people experiencing mental health challenges as passive recipients of care rather than as contributors to their own recovery and to the well-being of others.

Recognizing multiple forms of expertise would also raise a broader question about where mental health belongs within everyday institutions.

Mental Health Care in More Places Implicitly, Fewer Places Explicitly

A common good mental health care system would help more of our shared institutions support positive mental health without turning every setting into an extension of clinical settings.

The goal is not to turn teachers, coaches, managers, or neighbors into quasi-clinicians, but to make our culture more fluent in the practices that support good mental health: connection, predictability, contribution, and belonging. When we frame young people or those in distress primarily as fragile or vulnerable, we risk denying agency and excluding them from shared responsibility.

A common good approach instead treats mental health as something we cultivate together, across ordinary roles and relationships and, crucially, not something that belongs only to professionals or clinical spaces.

A system oriented toward everyday support must also grapple with what happens after moments of acute crisis.

Recovery and Rehabilitation

We devote disproportionate resources to addressing acute mental health crises through emergency psychiatric care and inpatient hospitalization. These necessary short-term interventions address immediate safety but have limited impact on long-term outcomes. A primary focus on crisis can unintentionally reinforce the belief that decline is inevitable and that stabilization is the best we can hope for.

A common good mental health care system would dedicate significant resources to recovery and rehabilitation following acute episodes of illness. This would include expanding intensive outpatient and partial hospitalization programs and assertive community treatment (ACT) teams, but also extend to structured supports in education, employment, and family life that facilitate reintegration and reduce recurrence.

The common good benefits when people are supported not just to survive crises, but to reenter community life with stability, dignity, and purpose.

Recovery-oriented systems, in turn, would require a careful balance between acknowledging harm and preserving hope.

Addiction, Connection, and the Conditions for Recovery

The opposite of addiction is not sobriety, but connection.

We cannot talk about mental health without also talking about addiction, and a common good approach starts with acknowledging something that recovery communities have long understood: the opposite of addiction is not sobriety, but connection.

Social scientists often group suicides and overdoses together as “deaths of despair,” rooted in a sense of disconnection from people, place, and purpose. We can debate policy responses, but rebuilding connection and community must be at the core of any approach.

Addiction rarely begins in a vacuum. Experiences of trauma—especially in childhood—are among the strongest predictors of later substance use. Adverse Childhood Experiences (ACEs), including abuse, neglect, household instability, and poverty, significantly increase the likelihood of addiction, with risk rising as exposure accumulates. These risks can be mitigated by Protective and Compensatory Experiences (PACES), such as stable relationships, safety, and opportunities for belonging and growth.

Addiction is not  a failure of individual behavior, but rather is a reflection of the conditions in which people are formed and live, including both biological and social factors. Addressing it requires attention to connection, family, and the environments that shape resilience and vulnerability over time.

Trauma-Informed, Without Trauma Fatalism

A common good mental health care system would be trauma-informed, acknowledging the real and lasting effects of adversity. But it would resist trauma fatalism: the idea that past harm defines the limits of future possibility.

Healing often occurs not only through insight or treatment, but also through belonging, contribution, and purpose.

People are shaped by their experiences, but they are not reducible to them. Healing often occurs not only through insight or treatment, but also through belonging, contribution, and purpose. A common good framework holds compassion and agency together and is consistent with the perspective of post-traumatic growth that is so relevant to human flourishing.

How we understand trauma shapes not only care, but the stories we tell about who people are and who they can become.

Rejecting Mental Illness as Identity

Mental health challenges are real. They can be painful, debilitating, and life altering. But they are not who a person is.

A common good framework would reject the idea that diagnoses or symptoms should become primary markers of identity—not by dismissing suffering, but by respecting human dignity. It would resist narratives that reward fragility, fatalism, or permanence and instead orient care toward participation, contribution, and belonging.

Reframing Mental Health Care for the Common Good

Taken together, these shifts point toward a different approach. They also expose why changing the current approach is so difficult.

The systems shaping mental health care are fragmented and siloed: health care, education, child welfare, housing, employment, and the justice system. Each of these systems has its own funding streams, regulatory structures, and political dynamics. As a result, the possibilities for action are just as fragmented.

Progress will require working across systems that were not designed to work together and navigating trade-offs rather than pretending they do not exist.

This makes reform in mental health care genuinely complicated. There is no single policy lever to pull and no universal program to scale. Progress will require working across systems that were not designed to work together and navigating trade-offs rather than pretending they do not exist.

But complexity does not mean paralysis. When systems are fragmented, a powerful way to begin is by considering how we frame problems. Shared framing can travel across silos even when funding streams cannot. In that sense, reframing mental health care for the common good is not a distraction from “real” reform but a prerequisite for it.

If a common good–focused mental health care system is to take root, it will require more than new programs or more funding. It will first require a shift in how we collectively think about mental health: who it belongs to, what leads to good mental health, and what kinds of solutions are possible when mental health problems arise.

Research from the FrameWorks Institute shows that public debates about mental health are shaped less by evidence than by a small number of deeply embedded cultural mindsets: individualism, fatalism, and otherism. Common good mental health pushes back against all three: 

• Individualism frames mental health as primarily a matter of personal responsibility, willpower, and individual choice. 
  • In contrast, a common good approach recognizes that mental health is produced relationally in families, schools, workplaces, and communities. 

• Fatalism treats rising distress as an unsolvable crisis—too large or complex to meaningfully address beyond emergency response. 
  • In contrast, a common good approach shifts attention from perpetual crisis management toward prevention, recovery, and rehabilitation. 
• Otherism casts people struggling with mental health challenges, especially young people, as a separate and fragile “them” rather than as members of a shared “us” with agency and capacity. 
  • In contrast, a common good approach treats people experiencing mental health challenges not as passive recipients of care but as participants in their own healing and contributors to the well-being of others.

This reframing does not deny suffering, minimize illness, or romanticize community. It holds clinical care and social context together.

A common good–focused mental health care system is more than simply a different set of policies. It is a different moral posture that understands mental health not as a private struggle to be managed or a permanent crisis to be endured, but as a shared responsibility and a public good worth cultivating together.

Jay Chaudhary is a Senior Fellow for Mental Health & Community Wellbeing at the Sagamore Institute, and a Visiting Fellow at Capita.

Matthew Biel is the Director of the Thrive Center for Children, Families and Communities at Georgetown University, and Division Chief of Child and Adolescent Psychiatry at MedStar Georgetown University Hospital.