Why We're Treating More People Than Ever, Yet Mental Health Keeps Getting Worse

The Problem Nobody Wants to Name

Since 2008, the NHS has rolled out the largest mental health treatment programme in history. Over a million people now receive therapy each year through IAPT (Improving Access to Psychological Therapies). It's been called a "world-beating standard."

During this same period, mental health in the UK has steadily worsened. Common mental health disorders increased from 17.6% in 2007 to 22.6% in 2023/4. One in five young people now has a probable mental health condition.

We're treating more people than ever. They're getting sicker than ever.

Something's not working.

The CBT Revolution That Wasn't

CBT dominates NHS mental health provision because it promises something irresistible: quick, measurable results that can be standardised and delivered at scale. Six to twelve sessions. Structured protocols. Questionnaire scores that show "recovery."

The economic case was explicit from the start. Richard Layard, the economist who championed IAPT, argued it would pay for itself through reduced welfare costs. Get people off benefits, back to work. £650 for therapy versus £650 per month in disability payments. Simple maths.

But here's what actually happens: 60% of people referred don't complete treatment. Of those who do, about half "recover" - meaning their questionnaire scores drop below a clinical threshold. Not thriving. Not understanding themselves better. Just scoring differently on standardised measures.

What CBT Actually Does (And Doesn't Do)

CBT treats your mind like faulty software that needs debugging. Negative thought? Challenge it. Catastrophising? Here's a worksheet. Anxiety? Let's restructure those cognitions.

It's compelling because it offers control. You can master techniques, complete homework, track your progress. For certain specific problems - phobias, some forms of OCD - this can be genuinely helpful.

But most human suffering isn't a technical problem. It's not about thinking errors that need correcting. It's about patterns laid down before you could speak, relationships that taught you who you had to be to survive, the gap between who you are and who you learned to perform.

CBT doesn't touch any of that. It teaches you to manage symptoms while the underlying patterns continue untouched.

The Questions We're Not Asking

Here's something curious: CBT therapists rarely choose CBT for their own therapy. They know all the techniques, can spot every cognitive distortion, understand the protocols inside out. Yet when their own lives fall apart, they tend to seek something deeper.

Because when you're lying awake at 3am, you don't need someone to challenge your thinking errors. You need to understand why you keep ending up in the same painful place.

When your third relationship implodes in exactly the same way, you don't need a thought record. You need to understand what you're unconsciously recreating and why it feels so familiar.

What Psychodynamic Therapy Offers Instead

Psychodynamic therapy starts from a different premise: your symptoms make sense. They're not errors to be corrected but communications to be understood.

Depression might be protecting you from rage you're not allowed to feel. Anxiety might be the only way your body knows how to say no. That pattern of choosing unavailable partners? It might be the only kind of love that feels familiar.

This work takes time because we're not fixing surface problems - we're understanding the machinery that creates them. It's not efficient. It can't be standardised. You can't measure it in questionnaire scores.

But it changes things at the root rather than managing symptoms at the surface.

The Uncomfortable Truth

The mental health crisis isn't a treatment failure - it's a conceptual one. We've mistaken emotional suffering for a technical problem. We've confused symptom management with healing. We've prioritised getting people functional over helping them understand what's actually wrong.

CBT works brilliantly for what it was designed to do: reduce symptoms quickly and cheaply enough to get people back to work. The system is working exactly as intended.

But human suffering isn't a productivity issue. Trauma isn't a thinking error. And the patterns that keep us stuck weren't created by faulty cognitions - they were survival strategies that made perfect sense at the time.

Where This Leaves Us

I'm not saying CBT is useless. For some people, in some situations, it's exactly what's needed. Learning to manage panic attacks or challenge specific phobias can be life-changing.

But we need to be honest about what we're doing. Teaching people to cope isn't the same as helping them heal. Managing symptoms isn't the same as understanding causes. And getting people functional enough to work isn't the same as helping them build lives worth living.

The question isn't whether CBT or psychodynamic therapy is "better." The question is: what are we actually trying to achieve?

If we want to manage symptoms and hit targets, CBT does that efficiently.

If we want to understand why people keep ending up in the same patterns, why the same problems keep recurring despite everyone's best efforts - that requires something different.

That requires being willing to sit with not knowing. To tolerate messiness. To value understanding over efficiency.

Most importantly, it requires admitting that the current system - despite treating more people than ever - isn't actually working.