By Nicholas Singh, Founder of MindFit®. Reviewed by MindFit® Clinical Advisors.
TL;DR
- We spend enormous sums on mental health and the numbers keep getting worse, largely because the system is built to respond after someone is already in crisis.
- Prevention is not wishful thinking. Randomized trials show psychological prevention programs cut the incidence of new depressive disorders by around 20%, which beats statins for heart disease on the same measure. It works through a phone, too.
- The gap is that almost nobody gets those tools before they need them. Making mental fitness training as ordinary as physical training is how that changes.
On this page: Why is it getting worse? · Does prevention work? · Does it work through a screen? · Where the evidence stops · What proactive looks like · What this does not mean · FAQ
We have spent billions on mental health, and the numbers have not moved in the right direction. The World Health Organization estimates that about one in eight people worldwide live with a mental disorder, and most of them are not receiving care.
The usual explanation is that we need more treatment. We do need more treatment. But there is a structural problem underneath it that more treatment alone will not solve: almost everything we have built activates only after someone is already in trouble.
Why is the mental health crisis getting worse?
Because the model is reactive by design. You get help once there is a problem to name. Before that point, there is essentially nothing on offer, which leaves the entire stretch of life where a problem is forming completely unserved.
The American Psychological Association’s 2023 survey shows what that gap feels like from the inside. Two-thirds of adults said that in the past year they could have used more emotional support than they received. Around a third said they do not know where to start when it comes to managing their stress, and a third said they feel completely stressed out no matter what they try. Meanwhile 61% said the people around them just expect them to get over it (APA, 2023).
None of those people are in crisis. All of them are struggling, and none of them are being reached, because struggling is not a diagnosis and the system waits for a diagnosis.
Does prevention actually work?
This is the question that matters, and it has an answer that is better than most people assume.
Meta-analyses of randomized controlled trials have found that psychological prevention programs reduce the incidence of new depressive disorders by roughly 20% compared with control groups (Cuijpers et al., 2021). An earlier review put the figure at 21%, with a number needed to treat of 20, meaning roughly one new case of depression prevented for every twenty people who go through a program (van Zoonen et al., 2014). These are people who did not have a disorder at the start and were less likely to develop one after learning skills in advance.
One in twenty may not sound like much until you see what it is competing with. In primary prevention of heart disease, statins have a five-year number needed to treat of 40 to 70. Blood pressure medication runs 80 to 160. Aspirin is over 300 (Ridker et al., 2009). Those are among the most widely prescribed preventive interventions in medicine. Preventing a case of depression for every twenty people trained is, by that standard, a strong result rather than a weak one. The comparison is not perfectly like for like, since the cardiac figures cover five years and the depression figures usually one or two, but the gap is wide enough that the direction is not in doubt.
So the principle holds. Teaching people psychological skills before they are unwell measurably reduces how many of them become unwell.
Does it work through a screen?
The obvious objection is that trials like these involve clinicians and structured programs, not software. That objection is weaker than it used to be.
A randomized trial published in JAMA tested web-based guided self-help in adults with subthreshold depression and found it significantly reduced the incidence of major depression at twelve-month follow-up (Buntrock et al., 2016). More recently, the RESiLIENT trial recruited nearly four thousand adults with subthreshold depression, delivered five core cognitive behavioral skills through a smartphone app, and followed them for fifty weeks. Smartphone-delivered CBT was associated with roughly a 40% lower risk of developing major depression (Akechi et al., 2026).
Delivery through a phone is not the limiting factor. What people are given to practice is.
Where the evidence stops
Three caveats, because this is where arguments like this usually get overstated.
The strongest evidence is for selective and indicated prevention, meaning programs aimed at people already at elevated risk or already showing symptoms below the diagnostic threshold. Universal prevention, offered to everyone regardless of risk, has barely been tested for its effect on incidence.
These were structured clinical programs, most of them guided, built around specific therapeutic protocols. They are not general wellness apps, and a meaningful share of participants still developed depression.
And none of this is evidence about MindFit®. We have not run trials of this kind and we do not claim to prevent any condition. What the research establishes is that the underlying principle is sound: teaching psychological skills in advance changes outcomes, and it can be done at scale. That is a reason to build in this direction, not a result we get to borrow.
Curious where you stand right now? The free Mental Fitness Test scores you across nine attributes in about five minutes.
What a proactive approach looks like
Physical health worked this out decades ago. We do not wait for a heart attack to recommend exercise. Cardiology still exists, and so do gyms, and nobody finds that arrangement confusing. Mental health has the clinic and almost nothing else.
Closing that gap takes four things.
Training as routine. Skills like regulating stress, reframing a situation, and holding attention under pressure work the way physical training works. They respond to regular practice, not to a single intense effort at the worst possible moment.
Tools people will actually use. Preventive skills only help if they reach people, which means short, accessible, and available before anything has gone wrong. This is the part the current system is worst at, and it is the gap MindFit® exists to fill.
Education. Most people do not know that mental capacities are trainable at all. That belief is the entry point for everything else, and it is why the language of fitness matters more than it might seem.
Community. People are far more likely to keep a practice when it is shared and normal. Nobody feels self-conscious mentioning a workout. Mental training should be equally unremarkable to bring up.
What this does not mean
A few things this argument is not.
It is not a case against therapy. Treatment is essential and often the only appropriate answer. The case for prevention sits alongside clinical care rather than competing with it, and the prevention research itself comes out of clinical psychology.
It is not a claim that training prevents mental illness. MindFit® is not treatment and has not been shown to prevent any condition. The evidence above is about structured prevention programs in trials, and I would rather say that plainly than borrow credibility that is not ours yet.
And it is not advice to handle serious struggle alone. If you are dealing with depression, anxiety, or anything affecting your daily life, reach out to a professional. Building capacity is something you do alongside that, not instead of it.
The shift worth making
Reversing a crisis this large will take more than any one product or campaign. But the direction is clear enough to act on. We know that teaching people psychological skills before they are unwell reduces how many become unwell. We know almost nobody currently gets those skills. And we know what happened the last time a country decided that training the body proactively was everyone’s business rather than a medical afterthought.
We do not wait for our bodies to break down before we exercise. There is no good reason to keep waiting for our minds to.
You can start now. Try a live exercise and see what training under pressure actually feels like.
Frequently asked questions
Can the mental health crisis actually be prevented?
Not entirely, but the evidence says a meaningful share can. Randomized trials show psychological prevention programs reduce the incidence of new depressive disorders by roughly 20% relative to control groups (Cuijpers et al., 2021; van Zoonen et al., 2014). Prevention works best alongside treatment, not instead of it.
Can prevention work through an app?
The evidence says the delivery method is not the barrier. A randomized trial in JAMA found web-based guided self-help reduced the incidence of major depression at twelve months (Buntrock et al., 2016), and the RESiLIENT trial found smartphone-delivered CBT was associated with roughly 40% lower risk of developing major depression over fifty weeks (Akechi et al., 2026). Both tested structured clinical programs in people with subthreshold symptoms, which is not the same as a general wellness app.
Why doesn’t the current system prevent problems?
Because it is built to respond to diagnoses. Before someone meets criteria for a condition, there is very little on offer, which leaves the period when a problem is forming largely unserved.
Is mental fitness training a form of prevention?
It shares the same logic: build psychological skills before you need them. But mental fitness training is not a clinical prevention program and has not been shown to prevent any diagnosed condition. It is training, in the same way that going to the gym is training rather than medicine.
What is the difference between mental health and mental fitness?
Mental health, in common use, refers to the presence or absence of illness. Mental fitness is the trainable capacity to adapt and perform under pressure. They are related but distinct, and you can work on one while managing the other.
Where should I start?
If you are struggling significantly, start with a professional. If you are functioning but want to build capacity, start with a short daily practice and a baseline measure of where you currently stand.
Sources
Cuijpers, P., Pineda, B.S., Quero, S., Karyotaki, E., Struijs, S.Y., Figueroa, C.A., Llamas, J.A., Furukawa, T.A., & Muñoz, R.F. (2021). Psychological interventions to prevent the onset of depressive disorders: a meta-analysis of randomized controlled trials. Clinical Psychology Review, 83, 101955. https://doi.org/10.1016/j.cpr.2021.101955
van Zoonen, K., Buntrock, C., Ebert, D.D., Smit, F., Reynolds, C.F., Beekman, A.T., & Cuijpers, P. (2014). Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. International Journal of Epidemiology, 43(2), 318–329. https://doi.org/10.1093/ije/dyt175
Buntrock, C., Ebert, D.D., Lehr, D., Smit, F., Riper, H., Berking, M., & Cuijpers, P. (2016). Effect of a web-based guided self-help intervention for prevention of major depression in adults with subthreshold depression: a randomized clinical trial. JAMA, 315(17), 1854–1863. https://doi.org/10.1001/jama.2016.4326
Akechi, T., Noma, H., Tajika, A., Toyomoto, R., Sakata, M., Luo, Y., Horikoshi, M., Kawakami, N., Nakayama, T., Kondo, N., Fukuma, S., & Furukawa, T.A. (2026). Cognitive and behavioural skills to prevent major depression among adults with subthreshold depression: 50-week follow-up analysis of smartphone CBT randomised trials (RESiLIENT trial). British Journal of Psychiatry. https://doi.org/10.1192/bjp.2026.10630
Ridker, P.M., et al. (2009). Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low LDL cholesterol and elevated high-sensitivity C-reactive protein (JUPITER). Circulation: Cardiovascular Quality and Outcomes, 2(6), 616–623. https://doi.org/10.1161/CIRCOUTCOMES.109.848473
American Psychological Association (2023). Stress in America 2023: a nation recovering from collective trauma. https://www.apa.org/news/press/releases/stress/2023/collective-trauma-recovery
World Health Organization. Mental disorders fact sheet. https://www.who.int/news-room/fact-sheets/detail/mental-disorders