Would you like to talk to our practice counsellor? I ask Danielle. She is a lone parent of 2 young children. She is a part-time healthcare assistant at the local hospital and a carer for her mother who has an autoimmune condition. Her council flat is damp, which has been aggravating her asthma. She has come to see me to get a new inhaler.

I sense that she is struggling and when I ask her how things are at home she bursts into tears, telling me that she’s been crying almost daily, is unable to sleep at night and has been losing her temper with her children. ‘I just don’t feel myself and I don’t have anyone to talk to. My mum thinks I need anti-depressants’ she says.

When I see Danielle 2 months later, she is smiling. She’s found the first 2 counselling sessions very helpful. The counsellor provides a compassionate, listening ear but has also referred her to the practice Link Worker who has put her in touch with the local women’s centre and is supporting her to sort out the damp in her flat. ‘I think I’ll just leave the anti-depressants for now, doctor’ says Danielle.

Without access to a practice counsellor, I may have tried to see Danielle again myself. I may have prescribed anti-depressants. Or, knowing that she would have to wait up to a year for outside counselling, I may simply have given her the inhaler prescription and sent her on her way.

Having worked as a GP in several different practices, I can honestly say that I would never again consider working somewhere that doesn’t have in-house counselling. It is such a key part of good primary health care. In fact, it is the bare minimum. That it doesn’t exist in all GP practices in this country, despite such widespread need, is, and should be, unacceptable. It’s why I am delighted to hear of the work of 123GP.

Although the availability of timely, high quality counselling for everyone who needs it is essential, I would also like to see us go beyond this bare minimum to consider the wider determinants of mental ill health.

Rather than seeing it as a chemical imbalance in the brain to be fixed by tablets and talking therapies, I prefer to reframe mental ill health as, to use the words of Dr Bruce Perry, ‘what do you expect?’  syndrome.

The science shows us that, for human beings to flourish and be mentally healthy, we need the following: nurturing relationships with calm, non- stressed, attuned care givers from birth onwards; loving, authentic relationships with other adults; a sense of purpose and meaning in our lives; autonomy and agency; time outdoors in nature; financial security; a hopeful and secure future; not to mention clean air, nutritious food and the time, space and opportunity to move our bodies.

In Northern Ireland today, where thousands of people live in poverty, with no secure, meaningful work, isolated from others and from the natural world, frightened about the future and living with the legacy of conflict, institutional abuse and childhood trauma, the high prevalence of mental ill health suddenly looks very normal. What do you expect?

This is something that manifests in the biology of individuals but it is a reflection of a much larger issue. We can start by asking ‘what has happened to you?’ rather than ‘what is wrong with you?’

As the UN said in 2017 ‘To understand the problem, we need to shift from talking about chemical imbalances to also talking about power imbalances in the way we live’.

The best counsellors in the world aren’t going to make us better if it’s our society that is making us sick. Will our government have the courage to follow the wisdom of the UN and address these issues in its upcoming Mental Health strategy? It seems unlikely.

Which is why I’m so grateful for the work of organisations like PPR, to advocate for mental well-being as a human right for us all.