This article explores the relationship between coaching and mental health issues. Coaching functions in a world that is dominated by the medical model of mental health, where problems are viewed as illnesses to be diagnosed and treated. The coaching industry also functions alongside many other helping by talking activities, such as counselling and psychotherapy. The relative mental health of individuals is often quoted as a difference between coaching and other “helping by talking” activities but this is, at best, a marketing tool and does not stand up to scrutiny in view of the diverse range of activities and viewpoints of psychological therapies. It is suggested here that a different approach to the mental health/mental ill health boundary is necessary and that by focussing on answering the question “what to do?” rather than the question “what is wrong?” the differences between coaching and other helping by talking activities can be acknowledged. The approach suggested allows for the professional and ethical management of boundary issues without the need for in-depth training in psychological dysfunction and diagnosis.