• Tim

The Mental Health Continuum

Updated: Feb 25, 2021

It's very tempting to think that people are either experiencing poor mental health, or they're not. This view is oversimplistic, as we'll see in this post about the Mental Health Continuum.

There are many different models that can be used to help us think about mental health. However, some of these can be stigmatising, focusing on when a person has been diagnosed with a mental health condition.

The model we're going to look at in this post is my favourite as it helps us to think about someone's mental health in a more useful way.


The Continuum

At it's core, the Mental Health Continuum is a sliding scale with someone who is mentally healthy at one end and someone who is unwell at the other.

Clinically, as someone's mental health declines, we can recognise a couple of other points on the scale.

If someone is 'reacting' they may be experiencing common, self limiting distress. If someone is 'injured', they may be experiencing more severe functional impairment.

An easier way to think about this is to replace these clinical terms with lay terms...

We can probably already start to imagine a person who is 'coping' or 'struggling'.

It's worth noting that the continuum is dynamic, illustrating that someone's mental health can change over time. Some people have quite stable mental health, others less so.

For some, the changes happen over minutes, hours or days, but for others, these changes might be noticeable over longer timescales such as weeks, months or seasons.

The Reality

If we think about mental health in this way, it's worth considering what that means for the people around us.

In reality, at any given time, some people will be mentally healthy or coping, whilst others may be struggling or unwell.

Perhaps the reality of those around us is more like this...


Spotting a Problem

Sometimes it's hard to spot someone who's struggling or unwell. People often try to hide problems with thier mental health due to stigma. Look out for a future post about this.

It may be that you spot the specific symptoms of a particular condition, such as stress, depression or anxiety. However, we know that as someone's mental health changes, we see changes in various aspects of their lives.

Let's look at each of these in turn.


When people are mentally healthy, they're often calm and confident. It's normal for people to have fluctuations in their mood but if these fluctuations become amplified, it could be a sign of a problem.

Being overly irritable, impatient or anxious, or perhaps persistently sad or numb all point to a potential problem.

Thinking and Attitude

Most people have at least some sense of humour and can focus on tasks for a sustained period of time. However, as someone's mental health deteriorates, they may lose either or both of these.

Optimist, pessimist or realist? It doesn't matter really, but if we notice that someone's attitude is becoming more negative, there could be a problem.

Behaviour and Performance

When people are mentally healthy, they're usually able to perform well, within their ability. People are socially and physically active.

As someone's mental health deteriorates, we see an associated loss of performance, whether in a work, home or education setting.

People tend to withdraw from social contact and do less physical exercise. Both of these are protective of mental health, so potentially worsening the problem. Read this post about Resilience to find out more.

Historically, people have been disciplined (at school, at work or in law) for a lack of performance or poor behaviour.

Perhaps in these cases, we should instead ask ourselves about the underlying reason for the problem. Dealing with the cause, rather than the symptom, must be a kinder, more effective and more efficient way to effect change.

Physical Changes

We may become aware of changes in someone's physical characteristics. Perhaps they're having trouble sleeping or they're sleeping to much. Perhaps their appetite or body weight has changed. Perhaps their appearance or personal hygiene has deteriorated.

Substance Use

We live in a culture where alcohol and illicit drugs are rife amongst the poulation. This is not limited to particular socio-economic groups, so forget your stereotypes.

We may become aware that someone is using alcohol or drugs more than they used to. This is often a conscious or sub-conscious attempt to 'self-medicate'.

Alternatively, we may become aware of some of the results of increased substance use. This may be something obvious by seeing them under the influence or hung over. However, it may be more subtle clues such as poor timekeeping, performance, or appearance or even financial or relationship issues.


What to do?

If you suspect someone is coping, struggling or unwell, you can help. Talk to the person and tell them what you've noticed. Invite them to talk to you and suggest other places where they can get help.

You may have access to people who have more training than you, such as Mental Health First Aiders, School Councillors or an Employee Assistance Programme (EAP).

If necessary, you could call 999 for an ambulance or 111 for more advice. The person may wish to contact their GP or speak to a mental health charity.

They may also want to try self-help strategies. The NHS Mental Health website, Every Mind Matters is extremely useful.

Remember, problems with mental health are common. Listen to someone with kindness and compassion and encourage them to seek support and you won't go far wrong.


If you'd like to know more about our Mental Health Awareness of First Aider courses for groups or individuals, please get in touch.