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Sara Tai on Inner City Mental Health

On the future of mental health

Eric Maisel
Source: Eric Maisel

The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.


Interview with Sara Tai

EM: You work extensively with inner city populations. What are some of the special emotional and mental health concerns or challenges of inner city populations?

ST: Positive mental health is determined by the extent to which we succeed in making our current experiences resemble the way we would like them to be – feeling we can control the things that are important to us. Inner city environments can offer increased opportunities for getting what you want, but on the other hand, can also act as a disturbance on the process of making your life the way you want it to be.

For example, we all have a certain sense of safety that we would like to experience and yet inner cities are generally more threatening environments. Most of us desire a certain level of connectedness and belonging to other people and yet cities can be transient places with less sense of community, leaving one isolated and disconnected. So if emotional and mental health concerns are understood in terms of distress resulting from being less able to control what’s important to you, inner city populations are at increased risk.

EM: You also work with folks from various and diverse cultures. Can you share your thoughts on how “culture” plays itself out when it comes to emotional and mental health challenges?

ST: Culture represents collectively shared personal preferences (we could call these values, needs, goals etc.). Again, it’s the things people strive to experience a degree of control over. For example, how much you want to tell strangers about yourself, or how much help you ask others for. If others share your preferences, then making life the way you want it to be is easier. Good mental health depends on our ability to accommodate a range of preferences.

If you want to live in accordance with your own cultural preferences but you also want to get along with people for whom your preferences are unacceptable, there’s a potential problem. Prioritizing one preference over another won’t necessarily resolve mental distress; true solutions allow both needs to be accommodated. So, deciding to be less bothered about what others think might only provide short-term resolution. Conflicts of this nature have emerged as maintaining mental distress in almost everyone I have worked with clinically. Cultural themes are good examples of this.

EM: You specialize in cognitive-behavioral therapy (which is the dominant therapy in the UK). Can you tell us a little bit about how CBT works and why you think it works?

ST: The basic premise of CBT is that the way we think about problems affects how we feel and behave. If you believe you weren’t promoted because your boss dislikes you, this could depress you more than concluding they couldn’t afford the pay raise! CBT aims to help people develop less distressing alternative perspectives.

There is a good evidence base that CBT is effective for many mental health problems but why is less clear. I’m increasingly trying to address this in my own research. Lots of therapies are sometimes effective and identifying the common active ingredient seems more sensible than generating more ‘methods’. I would summarize the essential element of any effective psychotherapy as that which helps a client sustain their awareness on a problem, through some form of external expression, long enough to enable emotions associated with the problem to be experienced, processed and evaluated. This is what facilitates broadening perspectives and solution generation coming from within the client.

EM: What are your thoughts on the current, dominant paradigm of “diagnosing and treating mental disorders”?

ST: I find it far more helpful to ask what bothers a person about their symptoms than focusing on the symptoms. Two or more people experiencing the same symptoms usually have vastly different underlying concerns. The problem with categorizing experiences is the assumptions that are then made, often with little evidence, as to what causes the problem and the appropriate treatment.

For example, one person’s depression might bother them because it stops them from having close relationships, whilst another person might be concerned by an inability to perform as well at work. Focusing on the distress rather than symptoms helps individuals become aware of the things that are important to them and their goals, so they can find ways of making their lives more in line with how they want them to be.

EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?

ST: I would encourage them to talk to someone they feel comfortable talking openly and honestly with. When you talk about a problem out loud, it becomes something different to that which goes around silently in your own head. Shifting attention to why something is bothering you, and not just attending to the experience of being bothered, involves directing your awareness to what it is you want that the problem is getting in the way of.

Becoming aware of how we want things to be is the first step in generating potential solutions, and reducing mental and emotional distress. A solution is when you can achieve what’s important to you without taking yourself further away from other simultaneously important goals. Getting advice or being taught what to do can often get in the way of finding the right solutions for yourself. This can be why seeing a trained professional is more advisable than just talking it over with friends or family.


Dr. Sara Tai is a Consultant Clinical Psychologist at the University of Manchester, UK with extensive clinical and research experience of working within multi-cultural inner city areas. She is an experienced researcher, practitioner, trainer and supervisor of transdiagnostic approaches (including Cognitive Behaviour Therapy (CBT) and the Method of Levels and is involved in international research, consultancy and training psychological interventions for psychosis. She has numerous publications in this area, including "Principles based counselling and psychotherapy"


Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at, visit him at, and learn more about the future of mental health movement at

To learn more about and/or to purchase The Future of Mental Health visit here

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