This is the inaugural Method + Measure post – a publication for reflective practitioners who care about results.
I want to start it with something that should already be the centre of every mental health conversation happening right now, and isn’t.
A paper was published in Nature Reviews Psychology in January 2026 – Lucy Foulkes and her team at Oxford – and it says, in proper academic language, what I’ve been ranting about for years. That mental health awareness campaigns are not just falling short of fixing the crisis. In several measurable ways, they are making the crisis worse.
That paper has been sitting there for four months. The profession has barely talked about it. Awareness campaigns continue to roll out, more loudly each year. May has rolled around again – Mental Health Awareness Month – and the same playbook is being run, with the same energy, by the same people, under research conditions that have just been shown to be considerably less rosy than everyone had hoped.
This is the gap Method + Measure is launching to close.
What the paper actually says
The Foulkes paper – The psychological consequences of mental health awareness efforts – pulls together the evidence from a load of studies on what mental health awareness campaigns actually do to people. Not what they’re supposed to do. What they actually do.
Three things, basically.
First – the bar for “disorder” keeps dropping.
Normal human stuff that used to be called “having a hard week” is now being labelled as a condition. The threshold has crept lower and lower until ordinary distress qualifies as something that needs treating.
Second – telling people they might have a condition can actually give them the condition. Or make it worse. The paper calls this the nocebo effect. You read the symptoms, you start noticing them in yourself, your brain helpfully provides them. The label produces the thing.
Third – and this is the loop that’s killing us – awareness campaigns drive self-diagnosis, which drives demand, which drives more diagnosis, which drives more campaigns. The system grows by feeding on the conditions it claims it’s trying to fix.
And then the paper drops the line that should actually stop the profession in its tracks. It says that several proper, high-quality trials of mainstream interventions – universal mindfulness programmes, CBT, DBT – have shown those interventions making people worse. Not failing to help. Actively making things worse.
Yes you read that right. MAKING THINGS WORSE.
The most respected, most widely deployed, most-funded models in the field have been shown – in good studies – to harm the people they’re meant to be helping when delivered universally.
And this isn’t some critic on Substack saying it. This is Nature Reviews Psychology. One of the most institutionally serious journals in the field.
What I want practitioners to do with this
If you’re a therapist or a counsellor – and you’ve been quietly noticing for years that what you see in the room doesn’t match the official story your profession keeps telling itself – you now have proper academic cover to say so out loud.
I am very tired of being in what feels like a minority going on about this. The good news is I no longer have to feel that way.
Here’s what the paper means in practice:
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More awareness on its own isn’t the answer. Sometimes it’s making things worse.
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Universal interventions that ignore the individual in front of you can do harm.
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Volume of conversation about mental health is not the same thing as quality of work.
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If you’ve been operating on the assumption that “more awareness = better” – that assumption has been seriously challenged at the highest level, and most of the profession is still pretending it hasn’t.
Take this paper into your supervision. Take it into your team meetings. Take it into the conversations that get awkward when someone raises these questions.
You no longer have to be the awkward one. Nature is the awkward one now.
Why I’m launching with this
I’ve been waiting for the right moment to make Method + Measure properly live.
This is it. Not because the paper is new – it’s been out four months. Because the gap between what we now know and what we’re still doing is now too wide to ignore, and Awareness Month is upon us again whether we like it or not.
The Foulkes paper is the receipt. For everything I’ve been arguing about the field for years. For why I’ve been quietly building measurement tools, methodology that gets results in weeks not decades, profile assessments practitioners can use in the room with clients. For why I started Ladder of Growth.
It’s not contrarian to say the model has problems. It’s not anti-therapy. It’s not part of any culture-war thing. It’s just looking at the evidence and saying – okay, so the evidence says this isn’t working as well as we’ve been telling everyone. What are we going to do about it?
That’s what this publication is for. That’s the conversation I want to have with you, week after week.
Awareness was meant to be a starting line. We’ve been treating it as the finish. The Foulkes paper makes it impossible to keep doing that with a straight face.
If you’re already here – forward this to one colleague who needs to read the paper. Send it into your supervision group.
Awareness was the loudest decade. The next decade has to be action.
I’m in.
📄 Foulkes, L., Winterburn, I., Sandra, D., Inzlicht, M., Andrews, J. L., & Guzman Holst, C. (2026). The psychological consequences of mental health awareness efforts. Nature Reviews Psychology, 5, 173–184. Read it here →