The Mental Health and Performance Continuum

This post describes my view of mental health as a continuous spectrum.

Mental health and mental performance exist on a continuum, not as binary states. Like most natural processes in the world, if we plotted the population’s mental functioning (as a rough concept), we’d see a normal distribution from those struggling significantly on one end, through the average majority in the middle, to high performers on the other. The people at the left side of the spectrum suffer tremendously and are typically incapable of functioning in society, whereas the people on the right side are thriving. Commonly used mental health questionnaires such as the PHQ-9 assign individuals to a category of “severity”, such as “mild” or “severe”.

Many nations implement some sort of classification system for individuals, which determines the level and type of care they can receive. For example, Singapore uses a Tiered Care Model for mental health. Tier 1 focuses on Mental Wellbeing Promotion. It focuses on foundational support, mental health promotion, and self-help resources. This includes digital platforms, peer support groups, and community-based programs. Tier 2 focuses on Low-intensity services. It provides low-intensity interventions for individuals with less severe symptoms. This level may include general counseling or behavioral health coaching. Tier 3 focuses on Moderate-intensity services. It offers more intensive support for moderate symptoms, such as psychotherapy and other medical treatments. Tier 4 focuses on High-intensity services. This includes high-intensity, specialized care for individuals with severe symptoms who require psychiatric assessment and long-term psychological interventions from trained professionals in hospitals and specialist clinics.

Much of our approach to mental health care is focused on drawing a line somewhere on this axis (policy making), deciding where everyone falls on this axis (diagnosis), and then trying to move the individuals on the left side to the right across the line (treatment).

There are two limitations of this approach. First, it is hard to determine where we should draw this clinical line, and is often somewhat arbitrary. Who should be considered as healthy enough to not require support? Is it enough to be functional, to have a job? Secondly, this approach misses the opportunity to move those above the line further to the right. Someone who is able to have a job and pay the rent might still be suffering greatly. Someone who is doing okay may have the potential to truly flourish with the right support. Most of us have a lot of space to grow, yet this is not covered by the mental health ecosystem (and perhaps it should not). This is the territory of wellness, health promotion, and preventative initiatives.

I believe it’s important to provide access to tools and strategies to help individuals in this territory too. AI and scalable interventions may play an outsized role here, as clinical resources will always be limited and should be reserved for those in genuine crisis. If technology can democratize access to evidence-based practices for the vast middle of the distribution, we could see a population with improved resilience, clearer thinking, and better emotional regulation.