Medicine Has Lost Its Way With Mental Health (Feat. Dr. Smith, MD)
Medicine Has Lost Its Way With Mental Health (Feat. Dr. Smith, MD)

Bold Beautiful Borderline

Primary care doctor Dr. Robert Smith talks with Sara about how modern medicine sidelines mental health, leaving most people untreated or poorly supported. The conversation outlines the training gaps, human cost, and the large-scale changes he believes are needed to protect patients with conditions like BPD and beyond.

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49:54•17 Jun 2026

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Has Medicine Lost Its Mind on Mental Health? Dr. Robert Smith Speaks Out

Episode Overview

Primary care doctors receive extremely limited formal training in mental health yet provide most of the mental health care, leaving many conditions unrecognised and untreated.
Only a minority of people with mental health disorders receive any care, which Dr. Smith links to preventable deaths, including suicide and opioid-related fatalities.
Lifestyle issues such as smoking, drinking, overeating, and inactivity are major drivers of chronic disease, but are rarely addressed with proper psychosocial support.
Profit-driven priorities in the broader healthcare system can overshadow quality patient care, particularly for mental health and psychosocial needs.
Dr. Smith argues that meaningful change requires much more mental health education for clinicians, closer collaboration with counsellors and psychologists, and organised public pressure on political leaders.

“"They spend only 2% of training time in mental health, even though mental health is the most common health condition doctors face in practice."”

How do people find hope in the darkest times? Bold Beautiful Borderline takes that question straight into the heart of modern medicine with primary care doctor and author Dr. Robert Smith, who argues that "medicine has lost its mind" on mental health. Sara talks with Dr. Smith about how his early training focused almost entirely on physical illnesses like cancer and diabetes, leaving him completely unprepared for the huge number of patients whose main struggles were emotional, social, or psychiatric.

He explains that across medical school and residency, only about 2% of training time is spent on mental health, even though it is the most common health issue doctors see. Meanwhile, psychiatrists see a small minority of cases, leaving primary care doctors responsible for most mental health care without the training to match. You’ll hear Dr.

Smith lay out stark numbers: only about a quarter of people with mental health conditions receive any care, most of it from professionals who were barely trained in that area. He links this gap to preventable deaths from suicide and the opioid crisis, and to longer-term fallout like divorce, job loss, homelessness, and incarceration. The conversation doesn’t just sit in the problem. Dr.

Smith talks about lifestyle factors like smoking, drinking, overeating, and lack of exercise, arguing that proper psychosocial and motivational support could prevent the majority of chronic illnesses. He also criticises the "medical industrial complex" for being driven by profit, and calls for a radical shift: much more mental health training for doctors, meaningful integration of counsellors and psychologists into healthcare, and public pressure on politicians to force change.

For anyone with BPD, other serious mental health diagnoses, or loved ones trying to understand why getting proper care feels so hard, this conversation offers clarity, validation, and a clear message: your struggles are real, and the system needs to change for you, not the other way round. What part of this broken system have you felt most directly in your own life?

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