Why More Treatment Doesn’t Always Mean Less Suffering

Understanding the Treatment-Prevalence Paradox and Why Upstream Prevention Matters

Treatment-Prevalence Paradox is a serious matter.

More people are seeking help for their mental health than ever before. Yet, the prevalence of mental health conditions remains high — and in some groups, suicide rates are even rising. Why?

This phenomenon is known as the Treatment-Prevalence Paradox. Even as access to treatment improves, population-level mental health outcomes don’t necessarily improve in tandem. This isn't a failure of treatment — but a reminder that treatment alone is not the whole story.

• Why is this the case? And what can we learn from it?

  Prevalence Increases as Treatments Improve: An Evolutionary Perspective on the Treatment–Prevalence Paradox in Depression

  Depression is an eminently treatable disorder that responds to psychotherapy or medications; the efficacy of each has been established in hundreds of controlled trials. Nonetheless, the prevalence of depression has increased in recent years despite the existence of efficacious treatments—a phenomenon known as the treatment–prevalence paradox.
  
  Ezawa, I. D., Robinson, N., & Hollon, S. D. (2024). Prevalence increases as Treatments improve: An Evolutionary Perspective on the Treatment–Prevalence Paradox in Depression. Annual Review of Clinical Psychology, 20(1), 201–228. https://doi.org/10.1146/annurev-clinpsy-080822-040442

• Recovery Isn’t Linear — Recovery Takes Time and Patience
  

  The Hidden Variables in Mental Health Recovery — And Why Customised Care Matters More Than Ever

  

  When most people think of mental health treatment, they imagine talk therapy, perhaps some medication, maybe a support group. It’s a tidy picture — and it’s incomplete.
  

  Here’s the reality: mental health recovery isn’t linear, and it’s rarely about one thing. Trauma, neurochemistry, stress, nutrition, environment, genetics, unresolved grief — these factors rarely exist in isolation. That’s why a “textbook” approach to treatment so often fails the people it’s supposed to help.
  
  New Perspective Studio (PTY) Ltd. (2025, June 4). The hidden variables in mental health recovery — and why customised care matters more than ever. Medium. https://medium.com/@fifthessencestudio/the-hidden-variables-in-mental-health-recovery-and-why-customised-care-matters-more-than-ever-b48581e1a1f6

  
  Mental health conditions are deeply personal, often chronic, and rarely resolved by a single intervention.
  

  Many individuals spend years trying to find the right mix of treatment — therapy, medication, lifestyle changes, and supportive relationships before they see meaningful progress. It can involve:
  

  • Trying multiple therapists or counsellors before finding one who fits

  • Navigating side effects or non-responsiveness to medication

  • Dealing with the social stigma or isolation that treatment does not automatically remove
    

  Accessing treatment is only the first step in a long journey, and that journey looks different for each person.
  
  

• Healing Requires More Than Clinical Help
  
  We cannot place the full weight of recovery on mental health services alone. Many of the factors that impact mental health lie outside the clinic:
  

  • A young person may be in treatment but still stuck in a toxic school or family environment.

  • An adult may take medication but remain overwhelmed by financial insecurity or chronic loneliness.

  • A senior may attend therapy but continue to feel invisible or disconnected from community life.
    

  Treatment helps address symptoms, but healing happens in context — through relationships, meaning, hope, and support. This is where community and upstream efforts come in.
  
  I still recall the time when one of my members needed support from:
  

  • A psychiatrist for medication for symptom management

  • A psychologist for cognitive therapy

  • A credit counsellor to assist in debt management

  • A strong community to journey with her.
    

    

• Prevention Is Just as Urgent as Intervention
  
  If we only focus on intervention and treatment, we are always playing catch-up.

  Upstream suicide prevention means creating environments where:
  

  • People learn the skills to regulate emotions and cope with distress early

  • Peers, families, and colleagues are equipped to notice signs and provide support

  • Social structures (like schools, workplaces, neighbourhoods) are built for connection, not just productivity
    

  These upstream efforts don’t replace treatment — they complement and strengthen it. They help reduce the number of people reaching crisis in the first place, and improve the recovery environment for those already struggling.
  

  I believe prevention is not a secondary concern. It is a vital and often overlooked piece of the puzzle.
  
  

The Treatment-Prevalence Paradox reminds us that while treatment is vital, it is not sufficient on its own. True change comes when families, workplaces, schools, and communities work upstream — not only to respond to distress but to reduce the risk of distress altogether.

Let us not only ask, “How do we treat those who are unwell?” — but also, “How do we build a world where fewer people fall through the cracks in the first place?”