When asking whether mental health treatment works, it’s essential to begin by defining what “work” actually means. For many, it’s about finding relief from overwhelming symptoms. For others, it’s about regaining a sense of purpose, building meaningful relationships, or simply feeling like themselves again. But how do we measure these outcomes? Mental health professionals often use terms like “response,” “remission,” and “recovery” to describe progress, yet these terms reflect very different things.
Response
Response refers to a noticeable reduction in symptom severity. In clinical trials, this often means a 50% improvement on a standardized symptom scale. For example, a patient with major depressive disorder might feel less sadness, experience improved sleep, or regain some energy. Response is an important goal of treatment—a sign that the intervention is having an effect. However, response doesn’t mean the symptoms are gone. People in this stage may still feel far from “normal” and continue to face significant challenges in their daily lives.
Remission
Remission takes improvement a step further. Here, symptoms are minimal or absent, typically falling below a clinical threshold for a defined period. For instance, someone with anxiety might no longer experience panic attacks or excessive worry. Remission is often the benchmark for success in research studies and is a more ambitious target than response. However, remission doesn’t necessarily mean the person has fully recovered. They may still struggle with underlying vulnerabilities, such as cognitive difficulties, residual fatigue, or the fear of relapse. Just because they no longer meet criteria for a specific disorder doesn’t mean they have optimized their health and their lives.
Recovery: The Ultimate Goal
Recovery transcends symptom relief. It’s about regaining control of one’s life and achieving personal milestones. Recovery often involves reconnecting with loved ones, returning to work or school, and finding joy in daily activities. Importantly, recovery is subjective—it’s defined by the individual’s own goals and aspirations. For example, a person with bipolar disorder may consider themselves recovered if they can manage mood fluctuations while maintaining meaningful relationships and a fulfilling career. Recovery often requires a comprehensive treatment approach that might include medications, metabolic therapies, psychotherapy, lifestyle changes, vocational rehabilitation, and perhaps most importantly, community, relationships, and support systems.
Measuring Success in Mental Health Treatment
Mental health treatment outcomes are typically evaluated using standardized tools like the Hamilton Depression Rating Scale (HAM-D) or the Positive and Negative Syndrome Scale (PANSS) for schizophrenia. While these tools provide valuable data for research and clinical care, they don’t always capture what matters most to patients—their quality of life. For someone living with schizophrenia, a “successful” treatment might not just mean fewer hallucinations, but also the ability to maintain a job or reconnect with family.
The gap between clinical definitions of success and patient-defined recovery highlights a critical issue in mental health care. Many treatments aim for response or remission, but these benchmarks may fall short of addressing the holistic needs of individuals. Recovery, on the other hand, requires a more comprehensive approach that integrates mental, physical, and metabolic health.
Barriers to Recovery
Achieving recovery is not without its challenges. Many treatments fail to help patients achieve remission, so people are left with significant symptoms that prevent them from recovering. Others have side effects to medications, such as cognitive impairment or lack of motivation, that significantly impact quality of life. Additionally, stigma, fragmented care systems, and limited access to personalized treatment options can impede progress. Misaligned expectations also play a role. When patients expect full recovery quickly but only achieve response or remission, they may feel disheartened and disengage from care. Recovery takes time. It’s a journey.
Expanding the Definition of “Works”
To truly answer the question, “Does mental health treatment work?” we must broaden our definition of success. Effective treatment should not only reduce symptoms but also help individuals achieve their unique goals and aspirations. This requires a shift toward personalized care—treatments tailored to the individual’s biology, environment, and personal preferences.
Emerging therapies offer new hope. Metabolic and mitochondrial interventions, for example, aim to address the root causes of mental illness rather than just managing symptoms. Holistic approaches that incorporate therapy, lifestyle changes, and social support can also enhance recovery. By focusing on the whole person, rather than just their diagnosis, we can move closer to treatments that “work” in the truest sense of the word.
Mental health treatment can and does “work,” but the definition of “work” matters. Response, remission, and recovery represent different stages of improvement, each with its own significance. While response and remission are important, recovery should be the ultimate goal. By expanding our approach to mental health care and redefining success to include both clinical and personal outcomes, we can better meet the needs of those seeking treatment and help them live fuller, more meaningful lives.
Dr. Christopher Palmer is a Harvard psychiatrist and researcher working at the interface of metabolism and mental health. He is the Founder and Director of the Metabolic and Mental Health Program and the Director of the Department of Postgraduate and Continuing Education at McLean Hospital and an Assistant Professor of Psychiatry at Harvard Medical School. For almost 30 years, he has held administrative, educational, research, and clinical roles in psychiatry at McLean and Harvard. He has been pioneering the use of the medical ketogenic diet in the treatment of psychiatric disorders—conducting research in this area, treating patients, writing, and speaking around the world on this topic. Most recently, he has proposed that mental disorders can be understood as metabolic disorders affecting the brain, which has received widespread recognition in both national and international media outlets.
