Mental Health Promotion and Prevention

Executive summary

Depression and anxiety pose a large burden on population health, well-being, and the economy

Mild-to-moderate depression and anxiety are the most common mental health conditions, affecting an estimated one in five adults across OECD and EU27 countries. These conditions often go undiagnosed – for example, about half of the individuals with moderate depressive symptoms do not receive a diagnosis. If left untreated, milder symptoms may progress into moderate functional impairments and even major depression. Mental health issues often emerge early in life and are exacerbated by vulnerabilities and socio-economic disadvantage, particularly among the unemployed, low-income and less-educated populations, resulting in substantive societal costs, including increased demand for health and social services, and reduced workforce productivity.

Eleven candidate best practices were assessed to be effective in promoting mental well-being, preventing symptom deterioration, and improving educational and occupational outcomes

The 2021 OECD Benchmark for mental health performance, set out six guiding principles, including promoting mental well-being and preventing mental illness. It identified key priorities such as school and workplace programmes, mental health literacy, early detection and support, facilitating help-seeking, and suicide prevention.

Aligned with these priorities, this report has identified 11 interventions with the help of OECD Member countries or through the European Union (EU) Best Practices portal. These interventions were assessed against validated best practice criteria – effectiveness, efficiency, equity, evidence quality, coverage, and transferability – outlined in the OECD Guidebook on Best Practices in Public Health. The interventions focus on:

• creating school environments that foster mental health well-being and resilience (e.g. Icehearts from Finland, This is Me from Slovenia, and Zippy’s Friends implemented in multiple countries);

• enhancing mental health literacy and equipping front-line professionals to identify and help an individual with mental distress (e.g. Mental Health First Aid implemented in multiple countries);

• preventing suicide (e.g. Suicide Prevention Austria, and VigilanS from France);

• improving access to mental health care by providing prompt and free consultations with mental health professionals (e.g. Belgian Mental Health Reform, and Norway’s Prompt Mental Health Care), youth walk-in centres (e.g. @Ease from the Netherlands), post-partum depression screening (e.g. Poland’s Next Stop: Mum), and online tools (e.g. iFightDepression® (iFD) Tool from Germany).

Evidence shows that interventions that provide prompt access to mental health care and support reduce symptom severity and duration by up to 87%. Programmes such as Mental Health First Aid and Zippy’s Friends, strengthen protective factors for mental well-being and mental resilience. Interventions, such as @Ease, Icehearts and the Belgian mental health reform, also demonstrated tangible improvements in school attendance and reduced work absenteeism, with reported gains ranging from 50% to 61%.

Scaling-up best practice interventions across OECD and EU27 would yield measurable health and labour market savings while remaining within reach for many health systems

OECD simulations show that implementing four interventions – Prompt Mental Health Care, iFD Tool, Next Stop: Mum, and VigilanS – across OECD countries could prevent 26.2 million cases of mental disorders over 2025‑2050, which represents about 1.4% of the new cases of depression and anxiety across OECD countries per year.

These interventions also have the potential to deliver health benefits at costs within reach for many health systems, making them a cost-effective approach. For example, scaling up interventions like Norway’s Prompt Mental Health Care could generate 35 Disability-Adjusted Life Years (DALYs) gained per 100 000 population per year on average across countries, compared with 56 DALYs lost per 100 000 population due to bullying-related depression in Canada. Estimated per capita annual savings could reach EUR 4.7 (USD 5.1) in health expenditure, and EUR 3.8 (USD 4.1) in labour market costs, with healthcare savings exceeding intervention costs in nearly one‑fifth of countries studied.

The potential for transferring the studied interventions from the origin countries to other OECD and EU27 countries depends on organisational arrangements, political support, and economic conditions. An OECD analysis indicates that around half of OECD and EU27 countries report enabling conditions readily in place to implement the candidate best practices.

Three priorities for scaling up mental health initiatives

Despite differences in scale, target populations, and delivery models, common success factors and challenges emerge from the studied interventions. First, common characteristics have proven effective in improving access to mental health care and support among the interventions, suggesting that to improve access, policymakers can:

• Expand low-threshold and specialised mental health services, including multidisciplinary networks (e.g. the Belgian mental health reform), teleconsultations and online tools (e.g. Prompt Mental Health Care and iFD Tool).

• Reimburse psychotherapy (fully or partially) to reduce financial barriers, as done in the Belgian reform and Prompt Mental Health Care.

• Destigmatise mental ill-health and raise mental health literacy in the population, as illustrated by Mental Health First Aid.

• Roll out peer-based programmes to train students and front-line workers, such as teachers, to help individuals with mental distress (e.g. @Ease and Mental Health First Aid). While mental ill-health treatment relies on healthcare professionals, these programmes can reduce stigma, encourage people to talk and seek help, and prevent early symptoms from worsening.

  Second, the limited evidence base for mental health interventions – due to gaps in data collection and inconsistent evaluation methodologies – act as a barrier to scaling up good practices. To address this, policymakers can:

• Encourage experts to adopt standard frameworks, such as the OECD Benchmark for mental health performance, to collect data and assess impact, including on subclinical conditions.

• Incentivise programme assessors to consistently apply these standards and ensure long-term monitoring to demonstrate effectiveness and sustainability, such as Icehearts in Finland.

  Third, scaling up mental health interventions across different settings presents several challenges including contextual variability, cross-sector co‑ordination, and limited workforce capacity. To facilitate transfer and implementation, policymakers can:

• Encourage implementers to share knowledge and apply established implementation strategies to support transfer across countries, as illustrated by the transfer of two practices (the Belgian reform and Suicide Prevention Austria) to other EU countries through the EU-Joint Action ImpleMENTAL.

• Foster cross-governmental co‑ordination for coherent and sustained action.

• Invest in workforce planning and development, including by creating roles for existing professions, such as midwife‑led post-partum depression diagnosis in Next Stop: Mum, or new professions, such as orthopaedagogues in the Belgian reform.