Mental health is crucial for a fulfilling life, yet mental ill-health significantly affects a large part of the population in OECD countries. Major depression and anxiety disorders are the most prevalent conditions, with a considerable burden of their subclinical forms: approximately one‑fifth of people in OECD and EU27 countries experience mild-to-moderate depressive symptoms. This chapter examines the prevalence and uneven distribution of mental health conditions and discusses their societal and economic impacts. Additionally, it explores both systemic and personal barriers to mental health care contributing to the high unmet care need and large treatment gap. Finally, it provides a state of play of the mental health policies in OECD countries and introduces country examples of 11 candidate best practices aimed at mitigating the substantial burden of mental ill-health.
Mental Health Promotion and Prevention
Abstract
Mental ill-health imposes high burden – including mild and moderate forms – and is unequally distributed in the population and over the life course
Around 2% of the population in OECD and EU27 countries has moderately-severe and severe depressive symptoms, while approximatively 19% report mild-to-moderate symptoms. While severe symptoms are associated with significant impairment in social and occupational functioning, individuals with mild-to-moderate symptoms of depression and anxiety may also experience lower quality of life and functioning. Yet, more than two‑third of these remain undiagnosed. If left untreated, mild symptoms of depression and anxiety can deteriorate into mental illnesses: addressing these symptoms early offers substantial potential for prevention and improved mental health outcomes.
High levels of mental distress persist, particularly post-COVID‑19, possibly leading to increased burden of mental ill-health. This burden is unequally distributed, with women experiencing 62% higher rates of moderate to severe depressive symptoms than men. In contrast, men have higher suicide rates, which are up to seven times greater than those experienced by women. Suicidal thoughts have increased among young people, with up to a quarter of young people reporting such thoughts during the pandemic, despite no significant change in suicide deaths across OECD countries.
Mental ill-health often begins early in life, with 75% of adult mental disorders starting before adulthood. Vulnerability increases during life transitions, such as adolescence, pregnancy and postpartum, or migration, and is heightened by negative events such as unemployment or death of a relative or friend. The uneven distribution of mental health conditions has a particularly detrimental impact on people in low income and/or with low education. Socio-economic disadvantages such as unemployment and income loss, exacerbate mental health issues.
Mental ill-health has a heavy toll on both health, social and economic outcomes
Mental ill-health has substantial economic costs to the society, including considerable costs from reduced employment and productivity. Existing estimates of mental ill-health costs exceeded 4% of the GDP for 28 EU countries in 2015. Costs go beyond mental health services and include costs of treating comorbidities and suicide attempts, as well as social considerable spending primarily through disability benefits. The mental ill-health employment gap is stark, with people experiencing severe mental distress having employment rates over 25 percentage points (p.p.) lower than those without mental distress. Education and employment outcomes are closely linked, with mental health conditions leading to lower educational attainment which hampers labour market participation. Other reasons for the employment gap include stigma and discrimination.
Health system and personal barriers in access mental health care drive high unmet need and a large treatment gap
Support for people with mental health issues remains limited across OECD countries. While different measures exist, they tend to conclude that around two‑thirds of people in OECD countries do not receive the support they would need, or they seek. Those with severe symptoms are 2.4 times more likely to receive treatment than those with mild symptoms and only one fifth of those with major depressive disorder in high-income countries received adequate care.
Several barriers to accessing mental health care are related to structural challenges of health systems. These include financial constraints – such as limited coverage and out-of-pocket payments – which deter individuals from seeking care, organisational issues – such as long waiting times-, and geographical challenges – such as long travel distances- that particularly affect rural areas. Underlying these systemic barriers is the limited capacity of mental health professionals.
In addition, barriers to care are often also personal. Examples include low perceived need, limited mental health literacy, and various forms of stigma that significantly hinder access to mental health care. Low perceived need is the most common reason for not seeking treatment, particularly among those with mild-to-moderate symptoms. Stigma – whether perceived, external, or self-imposed – deters many from seeking help. Additionally, two in five individuals in OECD countries struggle to find mental health information.
OECD and EU27 countries have been implementing policies to address barriers in access to quality care, reduce stigma and discrimination and promote good mental health and prevent mental ill-health
Following the increase in attention to mental health globally, especially post-COVID‑19, many countries have implemented comprehensive policies addressing multiple domains: stigma reduction, promotion of good mental health and prevention of mental ill-health and improving access to quality mental health care. For instance, in 2023, 83% of OECD and EU27 countries with available responses reported having introduced initiatives to combat stigma and discrimination, and 88% focussed on improving mental health awareness and literacy. In terms of care, 96% reported allowing access to some form of mental health services without a referral (although this might be by phone or online or include out-of-pocket payments), and 78% have integrated mental health promotion and treatment into primary care. Further, 73% reported the use of talking therapy, an evidence‑based treatment that is effective particularly for mild-to-moderate symptoms of depression and anxiety.
Mental health is pivotal for living a meaningful life and encompasses more than just the absence of mental illnesses or of mental ill-health, including multiple aspects of psychosocial functioning (OECD, 2023[1]) (Box 2.1). Theoretical frameworks conceiving mental health have been evolving over the past decades and currently agree on the existence of a continuum of functioning and symptoms that can appear and disappear and evolve over time (OECD, 2023[1]). Mental ill-health can result from diagnosable mental health conditions (defined according to psychiatric classification systems), but also from subclinical manifestations of these conditions or from non-disorder-specific psychological distress (Box 2.2). Without prejudice of several other categories of mental health conditions – such as bipolar and psychotic disorders – this chapter focusses on major depression, anxiety disorders and related symptoms which are of very high prevalence in the population and are targeted by most best practices studied in this report.
This report addresses both subclinical symptoms and diagnosed mental health conditions. Terminology related to mental health varies across countries and contexts, with different preferences shaping the language used. For consistency, this report applies the following terms:
Mental health issues/problems/challenges, mental distress, and subclinical symptoms – used to describe experiences that do not meet diagnostic thresholds.
Mental health conditions, mental disorders, and mental illnesses – used to refer to diagnosed conditions.
Mental ill-health – used as an umbrella term encompassing both subclinical experiences (e.g. distress, subclinical symptoms) and diagnosed conditions (e.g. major depression, anxiety disorders).
Box 2.2. Diagnostic and screening tools for mental ill-health
Different instruments are used to measure mental ill-health. This box provides an overview of the two most common alternatives: structured interviews, that allow the diagnosis of mental disorders as per internationally recognised psychiatric classification systems; and screening tools, designed to identify individuals at risk of conditions which should then be clinically assessed. In line with the remaining of the report, examples focus on depression and anxiety related mental ill-health, responsible for a large burden worldwide.
Structured interviews for clinical diagnosis of major depression
The Diagnostic and Statistical Manual (DSM) is used by medical doctors to establish diagnostic criteria for mental disorders, such as major depression. DSM‑5 is the latest version of the manual, published in 2015 by the American Psychiatric Association. According to these criteria, applied through structured interviews, patients are diagnosed with major depression if they report five or more depressive symptoms, including at least one of the symptoms “depressed mood” and/or “loss of interest or pleasure”. The list of symptoms include:
Depressed mood most of the day
Loss of interest or pleasure in activities most of the day
Significant weight loss or weight gain, or decrease or increase in appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings worthless or excessive or inappropriate guilt
Diminished ability to think or concentrate, or indecisiveness
Recurrent thoughts of suicide.
Comparable diagnostic criteria are also defined for generalised anxiety disorder.
Patients reporting less than five symptoms do not fulfil the diagnosis of major depression but may be considered in the “subclinical depression” category. While there is significant heterogeneity in the conceptualisation of subclinical depression, a systematic review found that most studies define subclinical depression as having two to four symptoms including depressed mood or loss of interest (Rodríguez et al., 2012[2]).
Screening tools for depressive and anxious symptoms
Screening tools are designed to capture a continuum of mental ill-health and to identify symptoms of different severity. Among the most used tools:
The Patient Health Questionnaires (PHQ) are scales validated by research to assess the severity of depressive symptoms (OECD, 2023[1]; Kroenke et al., 2009[3]). The PHQ‑9 is composed of nine questions referring to the previous two weeks. In each question, the frequency of the symptom is associated with a number of points: not at all (0 point), several days (1), more than half the days (2), nearly every day (3). The total score ranges from 0 to 27, with higher score indicating greater severity of symptoms. The score cut-offs used to define the severity of symptoms are shown in Table 2.1. A shorter version of the questionnaire, the PHQ‑8, removes the final question of PHQ‑9, which focusses on suicidal ideation, and scores 0‑24 points. A positive screening result is considered when scoring 10 or more, in both PHQ‑8/9.
The Generalised Anxiety Disorder scale (GAD‑7) is a tool to assess anxiety symptom severity (Spitzer et al., 2006[4]). The GAD‑7 is composed of seven items capturing the presence of anxiety symptomatology, each with four categories of response (similarly to the PHQ). The sum of the seven items ranges between 0 and 21 points and allows for the identification of one of the four categories of symptom severity (Table 2.1). A positive screening result is considered when scoring 10 or more in GAD‑7.
Source: Kroenke et al. (2001[5]), “The PHQ‑9: Validity of a brief depression severity measure”, https://doi.org/10.1046/j.1525-1497.2001.016009606.x; Spitzer et al. (2006[4]), “A brief measure for assessing generalized anxiety disorder: the GAD‑7”. https://doi.org/10.1001/ARCHINTE.166.10.1092.
Symptom screening tools have been increasingly incorporated into national health surveys to measure population mental health. PHQ‑8 is applied in more than 60% of OECD countries (OECD, 2023[1]), for example through the European Health Interview Survey (EHIS), the Korea Community Health Survey, and the United States National Health Interview Survey. Estimates of mental disorders prevalence in the population are likely to differ depending on the type of instrument used to measure them. Compared with diagnostic interviews, screening tools are likely to overestimate population level prevalence, as these tools were designed to identify individuals at risk – some of whom may not meet the criteria for a confirmed diagnosis.
Major depression and generalised anxiety disorder are the most diagnosed mental health conditions in OECD countries. On average across OECD countries, estimates suggest that around 3.4% of the population lived with major depression and 5.8% with generalised anxiety disorder in 2022 (IHME, 2024[6]). Individuals suffering from major depression experience depressed mood or a loss of pleasure or interest in activities for most of the day, while individuals with anxiety disorders experience excessive fear and worry. The symptoms of both conditions result in significant distress or significant impairment in social and occupational functioning. The severity and the duration of symptoms are key factors of the clinical diagnosis of mental disorders.
On average, around 19% of people in OECD and EU27 countries experience mild-to-moderate depressive symptoms. OECD analysis of survey data from OECD and EU27 countries found that nearly one in five people aged 15 and above reported having mild-to-moderate symptoms of depression in 2019, based on the screening tool PHQ‑8 (Box 2.2). Specifically, 15% of respondents reported having mild symptoms of depression, 4% had moderate symptoms, while 2% had moderately-severe and severe symptoms (Figure 2.1). More than 25% of the population aged 15 and above report mild-to-moderate symptoms in Luxembourg, the Netherlands, Iceland and Estonia, compared to less than 15% in Poland, Korea, Italy, Ireland, Czechia, the Slovak Republic, Bulgaria, and Greece. In all the studied countries, the mild and moderate symptoms represent the bulk of mental ill-health: 90% of individuals with mental health symptoms had reported mild-to-moderate symptoms. Individuals with mild-to-moderate symptoms, not fulfilling the diagnostic of major depression, have lower quality of life, poor health perception, higher level of disability and impairment in physical functioning (Rodríguez et al., 2012[2]).
Note: Age 15+. In the United States, the moderately-severe and severe are grouped.
Source: OECD analysis based on EHIS, 2019, and national survey data for Korea (Korea Community Health Survey 2019), the United Kingdom (European health interview survey 2019) and the United States (National Health Interview Survey 2019).
People with mild and, often, moderate depressive symptoms are less likely to be identified because they do not meet existing clinical criteria. OECD analysis based on survey data from 22 OECD countries confirms that the likelihood of reporting a diagnosis of depression increases with the severity of symptoms (Figure 2.2). Specifically, about 8% of the surveyed population reported to have been diagnosed with depression in the last 12 months. This proportion increases with the severity of symptoms: the share of those with a diagnosis is 20% in those with mild symptoms, 47% in those with moderate symptoms, 67% in those with moderately-severe symptoms, and 77% in those with severe symptoms. As more than half of individuals with mild and moderate symptoms are undiagnosed, they represent a large potential for prevention and early intervention that might prevent the deterioration of their mental health.
Note: Age 15+.
Source: OECD analysis based on EHIS, 2019.
If left untreated, mild symptoms can turn into mental illnesses. People with mild and moderate symptoms are significantly less likely to receive a mental health therapy or treatment compared to those with severe symptoms (Evans-Lacko et al., 2018[7]). However, if milder symptoms are left untreated, they can deteriorate to mental disorders. Evidence shows there is a 10% to 20% risk that subclinical depression deteriorates to major depression. In addition, subclinical depression poses a 33% to 50% risk of patients developing moderate functional impairments (Teepe et al., 2023[8]), in domains such as physical or social functioning.
The burden of mental ill-health is possibly increasing, although more data are needed to confirm this trend. Previous OECD analysis showed that population mental health fluctuated during the COVID‑19 pandemic, typically worsening during periods of infection and movement restriction and lock-down (OECD, 2023[9]). As the pandemic receded, population mental health has improved, although level of mental ill-health has remained elevated. In about half of the OECD countries with available data, the proportion of people reporting depressive symptoms decreased in 2022 compared to 2020 levels, but this proportion remains at least 20% higher than pre‑pandemic levels. Several factors can explain the persistent high level of mental distress, such as the cost-of-living crisis, climate crisis, conflicts, as well as increased awareness and changing language around mental health, that reduce stigma and make it easier to speak and seek support.
The prevalence of different mental disorders is distributed differently by gender. Studies consistently show higher prevalence of internalising disorders amongst women (e.g. depression, anxiety and eating disorders) while men have higher prevalence of externalising conditions (e.g. conduct disorders, attention deficit/hyperactivity disorders, among others) and substance use disorders (Farhane-Medina et al., 2022[10]; Needham and Hill, 2010[11]; Herrmann et al., 2023[12]; Otten et al., 2021[13]; Mental Health Foundation United Kingdom, 2017[14]). Figure 2.3 shows the shares of men and women with depressive symptoms of moderate or higher severity (i.e. PHQ‑8≥10), by country. It also presents the relative differences (in percentage) calculated as the difference in shares between women and men divided by the share in men. Where the proportions of women reporting symptoms is more than twice that of men the relative difference exceeds 100%. Across all 28 countries studied, the prevalence of depressive symptoms of moderate or higher severity is higher in women by 62% (average relative difference). The relative difference varies from 23% in Germany to 100% and above in Norway and Italy, where women are more than twice likely to screen positive for depression. Evidence from some countries also suggests that the trends for the past decades might differ by gender. For example, in England from 2000 to 2014, rates of depression and anxiety steadily increased in women and remained largely stable in men (McManus et al., 2016[15]).
Respondents with moderate or severe depressive symptoms (PHQ‑8≥10)
Note: Results were estimated using survey weights and are not age‑standardised. Individuals are classified as having moderate or severe symptoms based on a PHQ‑8 score equal or higher than 10, which is also the cut-off for a positive screening on being at risk of a (clinical) diagnosis of depression. Countries are ranked by increasing prevalence for women. The grey bars represent the level of relative difference (on the secondary Y-axis). The OECD25 average excludes Bulgaria, Croatia and Romania.
Source: OECD estimates based on the 3rd wave of the Eurostat European Health Interview Survey, National Health Interview Survey (NHIS) 2019 for the United States and the Korea Community Health Survey 2019 for Korea.
In line with the potential increase in the burden of mental ill-health, rates of suicide thoughts, have also increased, especially among young people. In the OECD and EU27 countries for which data was available, up to a quarter of young people reported having had suicidal ideation during the COVID‑19 crisis, which was five times higher than pre‑pandemic levels (OECD/EU, 2022[16]). However, in most countries, this trend did not translate into an increase in deaths by suicide (Box 2.3). In 2021 and 2020, death by suicide represented 11.2 deaths in 100 000 people, compared to 11.1 in 2019 and 11.3 in 2018, on average across OECD countries. Over the last two decades, historical data show declining trends in suicide rates, with an average reduction across OECD countries of 34% for males and 24% for females, between 2001 and 2021.
Suicide is defined as the act of deliberately killing oneself (WHO EMRO, 2024[17]) or when people harm themselves with the goal of ending their life, and die as a result (National Institute of Mental Health, 2023[18]). Suicidal behaviours – often referred to as suicidality – includes suicidal thoughts, suicide attempts, plans, and preparatory acts for suicide (Nock et al., 2008[19]).
Self-harm episodes may occur with or without suicide intention. Determining if an episode of self-harm constitutes or not suicidal behavioural poses methodological challenges, because of existing stigma around suicide and difficulties for ascertaining the intentions of the person. Moreover, some suicide attempts might not require medical care and thus might go unregistered, leading to an underestimation of the prevalence of suicidal behaviours in the population.
Men have higher suicide rates than women. This pattern could be seen in all OECD and EU27 countries studied, both in 2001 and 2021, with rates of death by suicide in men being two to seven‑fold higher than in women (Figure 2.4). Between 2001 and 2021, deaths by suicide decreased by one‑third in men in 30 countries and in women in 24 countries. In the countries where suicide rates have increased, the relative percentage change was higher in women than in men, except for the Netherlands.
Notes: Annual deaths per 100 000 inhabitants, cause of death intentional self-harm. Latest available data for Norway and New Zealand is from 2016.
Source: OECD Health Statistics 2024.
While cross-country comparisons in suicide attempts should take in consideration different practices in reporting and consequent data limitations, studies seem to consistently report a reverse gender pattern in suicide behaviour, in what has been named as the suicide behaviour gender paradox. While men have higher rates of death by suicide, women are more likely to report suicide intention and, in some countries, suicide attempts too. Differences in the lethality of suicide attempts (e.g. means of suicide) seem to explain at least part of the higher suicide fatality among men (Schrijvers, Bollen and Sabbe, 2012[20]; Freeman et al., 2017[21]). For instance, French data from 2012 to 2023 show consistently higher rates of hospital stays due to self-harm and suicide attempts in women than in men. In addition, the same data also suggests that while self-harm hospitalisations have decreased in adults aged 25 to 65 years old, a sharp and worrying increase is observed since 2020 for girls and young women aged 10 to 24 years old (Drees, 2024[22]).
Over their life course, people face several periods of increased vulnerability to mental ill-health. Life stages at increased vulnerability can include specific periods, such as childhood and adolescence, but also transition periods (e.g. transitioning into adulthood or parenthood). Higher vulnerability to the onset of mental health conditions can also be a consequence of negative events and unexpected shocks in someone’s life. For instance, becoming unemployed, the death of someone close, being forced to migrate are all negative events that can lead to a deterioration of mental health. Last, there are population groups that are consistently more vulnerable and at higher risk of mental ill-health, such as people in low socio-economic status or groups minoritised due to their ethnicity, indigeneity, gender or sexual orientation. Importantly, this disadvantage tends to persist over the life course and for some groups, such as people living in precarious situations, extend intergenerationally (Vargas Lopes and Llena-Nozal, 2025[23]).
Mental disorders with an early onset in childhood and adolescence tend to persist throughout the life course. Approximately 75% of adult mental disorders have their onset during adolescence, and this early onset increases the risk of recurrence and disabling physical conditions in adulthood (Erskine et al., 2015[24]; Kessler et al., 2005[25]). In high-income countries, mental disorders are the main cause of disability among adolescents and young adults (Gore et al., 2011[26]; Erskine et al., 2015[24]). Figure 2.5 shows the sharp increase in prevalence of anxiety disorders and major depressive disorder from early ages, peaking at 15 to 19 years old (anxiety disorders) and 20 to 24 (major depression) and persisting into adulthood. The prevalence of anxiety disorders tends to decrease over lifetime and particularly for old people, while the prevalence of major depressive disorder is sustained and increases again from 80 years onwards.
Source: IHME (2024[6]), GBD Results, http://ghdx.healthdata.org/gbd-results-tool/result/fe3810d88cf54f085e5b2883ff865925.
Life course transition periods and turning points, such as pregnancy and postpartum, make women vulnerable to mental ill-health. Women face higher risk of onset and recurrence of mental ill-health conditions during pregnancy and in the postpartum period (Howard and Khalifeh, 2020[27]). Large registry-based cohort studies identified the first five months postpartum as a time of vulnerability for all mental disorders, including major depression, bipolar disorders, schizophrenia and adjustment disorders. Women with previous history of these conditions are at higher risk. Depression is the most prevalent mental health condition during the perinatal period. The likelihood of depressive episodes postpartum can be twice higher than during other periods of woman’s life course, with detrimental effects that often go beyond the individual and impact both the infants and the family (Leight et al., 2010[28]). Historically, the prevalence of major depression in high-income countries has been reported to around 10% and 15% during the first year postpartum. These estimates are likely to vary more across countries and often increase in the context of low and lower-middle income countries (Faisal-Cury et al., 2013[29]). Based on a recent meta‑analysis, the prevalence of postpartum depression was estimated as 17.0% for Northern America, 16.6% for Central-Eastern Europe, 16.3% for Southern Europe and 13.8% for Northern Europe. The same analysis reports twice the prevalence of postpartum depression among women with financial problems compared to those without. Likewise, women without family or partner support are twice as likely to have postpartum depression as those with support, and non-married women are 71% more likely to have postpartum depression than married or cohabiting women (Wang et al., 2021[30]).
Mental disorders are consistently more prevalent among individuals with low socio-economic status. The association between low socio-economic status and mental ill-health is well-documented, particularly for depressive and anxiety disorders, and regardless of what defines the socio-economic status: low income, low educational status or unemployment at the individual level (Muntaner, 2004[31]; Blas and Kurup, 2010[32]; Yu and Williams, 1999[33]; Sareen et al., 2011[34]) or, at the area-level, living in a neighbourhood with low socio-economic conditions or low social capital, among other indicators (Silva, Loureiro and Cardoso, 2016[35]; Rehkopf and Buka, 2005[36]). For example, in the United States, the risk of developing major depression was 44% higher for individuals with lower income, and 13% higher for those with second-lower income, compared to those with higher income (Sareen et al., 2011[34]).
The effects of socio-economic status on mental health becomes evident when people experience events that abruptly change their income or their employment towards a disadvantaged situation. Becoming unemployed or having a substantial reduction in household income increases the risk of mental disorders, especially depression and other mood disorders (Barbaglia et al., 2015[37]). In the United States, decreasing income category in a three‑year period was associated with an increased risk of developing depressive/bipolar, anxiety or substance use disorders (adjusted odds ratio, 1.30; 99% confidence interval, 1.06‑1.60), compared to no income change (Sareen et al., 2011[34]). The experience of unemployment is associated with higher risk of mental ill-health, including suicide, through mechanisms such as stress, lower life satisfaction and lower self-esteem (Amin, Korhonen and Huikari, 2023[38]; Escudero-Castillo, Mato Diaz and Rodriguez-Alvarez, 2022[39]; Milner et al., 2013[40]). Longer time in unemployment is associated with higher burden of mental ill-health, and unemployment can have lasting detrimental mental health effects, which may outlast the duration of the unemployment spell (OECD, 2021[41]). Greater exposure to unemployment is associated with higher risk of suicide (Milner, Page and Lamontagne, 2014[42]). Other adverse life shocks, such as personal injury, jail or separation from a spouse also result in greater risk of mental disorders for socio-economic groups already in disadvantage, but to a lesser extent than those related to income losses, deprivation or poverty. For example, Australian longitudinal data suggests that between 22% to 35% of mental health inequalities in favour of higher-income groups are explained by life events related to financial hardship and 2% to 5% by negative life shocks such as personal injury, separation from a spouse, death of a relative or friend, or being detained in jail (Hashmi, Alam and Gow, 2020[43]).
Evidence about differences in mental health based on migration status is mixed. Some studies suggest that foreign-born people experience a slightly higher rate of mental health conditions compared to those who were born in the country, while other studies point to no significant differences or even reversed pattern of better mental health among migrants (Vargas Lopes and Llena-Nozal, 2025[23]). Several factors, which are challenging to account for in empirical analysis, might explain these mixed results: the reason(s) behind the decision to migrate (e.g. avoid conflict and violence vs. seek better educational opportunities or financial situation), the socio-economic status of the migrants, or the countries of origin and destination (WHO, 2023[44]; Füller, Vieth and Otto, 2023[45]). OECD analysis of 25 countries showed that eight countries registered a higher prevalence of symptoms of depression of moderate or higher severity among native‑born individuals (Czechia, Hungary, Ireland, Italy, Luxembourg, Portugal, the United Kingdom, the United States) while the remaining 17 countries had a higher prevalence among foreign-born (Vargas Lopes and Llena-Nozal, 2025[23]). Where there is heightened risk of mental illness amongst immigrant communities, these may be driven by various social and structural factors such as acculturative stress, poor social support, deprived socio-economic conditions, multiple negative life events, experiences of discrimination and traumatic pre‑migration experiences (Abebe, Lien and Hjelde, 2014[46]; Salami et al., 2017[47]).
For refugees, both pre and post-migration stressors drive poor mental health, and post-migration factors may moderate the ability to recover from pre‑migration trauma (Hynie, 2018[48]). The experience of displacement and refugee typically includes loss of material property such as homes and possessions, as well as disruption of family, personal and professional projects and plans. Further traumatic situations might be related with war and violence, injury and witnessing death (Barbui et al., 2022[49]). Post-migration stressors include complexity in the asylum and resettlement processes, discrimination, poor social integration or loneliness, worrying about family and friends overseas, and economic stressors (Chen et al., 2017[50]; Goodkind et al., 2021[51]). A meta‑analysis focussing on studies of Syrian refugees resettled in high-income western countries found a prevalence of 40% for anxiety, 31% for depression and 31% for post-traumatic stress disorder and a pooled prevalence of having any of the three disorders of 33%, all significantly higher than in the general population.
Besides high population burden, mental ill-health translates into substantial economic consequences. The high costs result from the healthcare needed to treat mental disorders, social security support required by people with lived experience of mental health conditions but also the adverse labour market consequences faced by these people (OECD/European Union, 2018[52]; OECD, 2021[41]).
Overall costs related to mental ill-health are estimated to have exceeded 4% of GDP across 28 EU countries in 2015, representing EUR 600 billion. This total cost is broken down into approximately 1.3% of GDP (or 190 billion euros) in spending on healthcare systems, 1.2% of GDP (170 billion euros) on social security programmes, and a further 1.6% of GDP (240 billion euros) in other costs related to lower employment and lower productivity. Other estimates of the economic value associated with mental disorders suggest losses of USD 4.7 trillion globally in 2019 (EUR 4.1 trillion), reaching the equivalent of 6.5% of GDP in Western Europe and 8% of GDP in high-income North America (Arias, Saxena and Verguet, 2022[53]). Estimates for the United States in the same year attribute USD 334 billion (EUR 295 billion) to the societal cost of major depression disorder (MDD), of which 38% was related healthcare costs, 34% to reduced employment and productivity (e.g. absenteeism and presenteeism), and 24% to household-related cost (annual income loss by an adult without MDD living with an adult with MDD) (Greenberg et al., 2023[54]). In Germany, the proportion of direct medical and social care costs amounted to 30% of the economic burden of mental disorders, with the rest being attributed to sick leave, unemployment and early retirement (König et al., 2023[55]).
Previous OECD work suggests that mental health care accounted for about 13% of health spending across EU countries in 2015, being similar to spending on cancer care in several countries (OECD/European Union, 2018[52]). Health expenditure data from 2018 covering additional countries suggests that there was considerable variation in the proportion of total health spending allocated to mental health care: from 4% in Estonia, Greece and Poland to 10% or above in England, Canada, Germany, Norway and France. On average, OECD countries with available data spent 6.7% of their health budget on mental health (OECD, 2021[56]). Spending on mental health services increased during the pandemic in countries such as the United Kingdom, Australia and the United States, including public funding and private health insurance, but also out-of-pocket costs (Cantor et al., 2023[57]; Welfare, 2024[58]; Helen Giulburt, 2024[59]).
Health and social care costs resulting from mental ill-health go beyond the expenditure on mental health services only. Healthcare costs also result from treating comorbidities and suicide attempts. For example, a Canadian study shows that comorbidities, intentional self-harm, suicide and all-cause mortality were higher in patients with depression, who had healthcare utilisation costs 3.5 times higher and social services costs three times higher than those of peers without depression (Tanner et al., 2020[60]). In addition, the costs of mental health conditions increase with severity. Compared with average healthcare costs of the German population, the excess direct medical and social care costs of treating severe mental health conditions in Germany is up to 20 times higher than the cost of mild disease severity (EUR 10 485 vs. EUR 511 excess cost1 by person for a 6‑month period), and five times higher than treating moderate disease severity (EUR 2 417). The main cost driver, and explanation to the large differences in costs by severity, are hospital stays (König et al., 2023[55]).
Due to limitations to their labour participation, people with lived experience of mental disorders often require welfare support in the form of sick leave benefits, disability benefits, unemployment insurance or early retirement. OECD estimates from EU countries suggest that the bulk (66%) of mental-health-related social spending is attributable to disability benefits (EUR 112 billion out of EUR 170 billion spent on social security programmes on average, in 2015) (OECD/European Union, 2018[52]). This proportion may vary on a country basis, depending on the generosity and organisation of welfare programmes (e.g. if disability assessment does not appropriately recognise mental-health-related disability, unemployment benefits might be more often used). Other social spending attributable to mental ill-health includes social assistance benefits or lone‑parent benefits (OECD/European Union, 2018[52]).
The direct costs with social programmes are not the only economic consequence of mental health-related disability. Costs due to productivity losses are large, potentially the biggest contributor to the economic burden of mental disorders (OECD/European Union, 2018[52]). There is variation in the literature regarding the phenomena captured in estimating productivity losses, whether not only absenteeism but also presenteeism of those employed is captured, as well as exiting from the labour market through several pathways – unemployment, disability or early retirement, or due to premature death. Furthermore, productivity losses increase with disorder severity. Based on German data, productivity losses range from around EUR 5 612 per 6 months per person for mild disease severity to EUR 21 399 for severe disease severity (König et al., 2023[55]).
In line with high-cost estimates of negative labour market impacts, previous work has described the mental ill-health employment gap observed in OECD countries based on data from mid‑2010s. On average in 31 OECD countries, the employment rate for people with moderate mental distress was 10 p.p. lower than for those without distress (Figure 2.6). For those with severe distress, the difference was even larger (26 p.p. difference compared to those without distress). In 22 out of the 31 countries studied, employment rates for people with severe mental distress were less than 50%. Employment gaps were of similar magnitude in countries with overall high employment rates (such as Switzerland) or in countries with low employment rates (such as Italy).
Note: The figure presents data between 2012 and 2016. Individuals with mental distress have provided survey responses to a series of mental health questions that place them in the bottom quintile of respondents. Ireland data are excluded due to data quality concerns.
Source: OECD (2021[41]), Fitter Minds, Fitter Jobs: From Awareness to Change in Integrated Mental Health, Skills and Work Policies, https://doi.org/10.1787/22257985.
Work-based discrimination against people with mental health conditions remains high. Many people reporting a mental health condition would like to work but cannot find a suitable job (OECD, 2021[41]). Despite increased awareness around mental health in the recent years, discrimination remains widespread. In a survey from 2019, a quarter of respondents in OECD countries agreed that anyone with a history of mental health condition should be excluded from public office (Figure 2.7). This proportion reached more than 40% of respondents in countries such as Colombia, Korea and Mexico (OECD, 2021[41]).
Note: Data from 2019.
Source: OECD (2021[41]), Fitter Minds, Fitter Jobs: From Awareness to Change in Integrated Mental Health, Skills and Work Policies, https://doi.org/10.1787/22257985. Adapted from Ipsos MORI / King’s College London (2019), World Mental Health Day 2019, https://www.ipsos.com/sites/default/files/ct/news/documents/2019-10/world-mental-health-day-2019_0.pdf.
The impacts of mental ill-health on educational outcomes and transitions from school to the labour market are key determinants for labour participation in adulthood. Mental health condition onset is associated with decreased school performance (Owens et al., 2012[61]; Fröjd et al., 2008[62]). OECD data show that students reporting mental distress are 35% more likely to have repeated a grade, on average in OECD countries. In adulthood, the education-related disparities persist. Among OECD countries, the share of working-age people who have completed high-level education is consistently lower for people with mental distress compared to those without (28% vs. 35% on average across OECD countries) (OECD, 2021[41]).
Two-thirds of people with mental ill-health do not access to the care needed
About two‑thirds of individuals in OECD and EU27 countries who need mental health care are estimated to lack access to treatment. Without a standardised and uniformly adopted definition, this report approximates the treatment gap using two complementary sources (see Box 2.4). According to estimated data from the OECD, an average of 33% of people in OECD countries and 32% in EU27 countries who require mental health care receive it, leaving around two‑thirds without adequate access to treatment. Proportions of treatment coverage range from 22% in Colombia to 45% in Switzerland (Figure 2.8).
Note: Any type of treatment ranges from specialty mental health services, general medicine, human services (e.g. social worker) or complementary alternative medicine (such as chiropractors or self-help groups).
Source: OECD analysis based on data from Evans-Lacko et al. (2018[7]), “Socio‑economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys”, https://doi.org/10.1017/S0033291717003336 and OECD (2021[56]), A New Benchmark for Mental Health Systems: Tackling the Social and Economic Costs of Mental Ill-Health, https://doi.org/10.1787/4ed890f6-en.
Understanding the extent of unmet mental health needs is challenging due to inconsistent data definitions. Without a standardised and uniformly adopted definition, this report approximates the treatment gap using two complementary sources:
Data from previous OECD work (OECD, 2021[56]) investigating the unmet needs for mental ill-health due to financial reasons, wait times or transport. Based on this analysis, access to mental health services was identified as the complementary figure to the proportion of individuals with unmet needs.
The treatment coverage identified by the WHO World Mental Health Survey (Evans-Lacko et al., 2018[7]), which asked respondents if they had sought professional help for emotional, mental health, nerve, or substance use disorders, and if they received treatment within the past 12 months.
Although the two surveys examine slightly different issues and cover marginally different mental health conditions, comparing data from both sources for countries included in both analyses suggests very similar conclusions, as showed in the figure (Figure 2.8). At the net of a few countries with outlying results (e.g. Slovak Republic and Lithuania) in one of the two datasets, the analysis supports a broad comparability of data. Extrapolation for countries lacking data was performed using an ensemble model based on a lasso regressor, incorporating the following country-specific indicators: suicide rates, depression rates, World Happiness Index, number of mental health professionals, universal healthcare service coverage index and gross domestic product (GDP). Extrapolated data should only be considered as a high-level indicator of the possible coverage of services for mental ill-health.
Access to mental health treatment varies by disorder severity and by socio-economic status. Individuals with severe symptoms are 2.4 times more likely to receive mental health treatment than those with mild and moderate symptoms (Evans-Lacko et al., 2018[7]). Furthermore, the mental health treatment gap is more pronounced among population groups with lower socio-economic status. Individuals with lower educational attainment are 20% less likely to access mental health treatment than those with higher education. This discrepancy is more pronounced when it comes to specialty services, human services, and complementary alternative medicine, while there is no statistically significant difference in access to general medicine. The effect of income level on treatment access is somewhat inconsistent. Individuals with lower income are as likely to access any type of mental treatment as those with higher income, while they are 20% less likely to access specialty services, but are 50% more likely to utilise human services. Only a small proportion of those treated receive minimum adequate mental health care.
Minimally adequate treatment refer to the minimum combination of treatments proven by research to be effective for treating depression (Moitra et al., 2022[63]; Thornicroft et al., 2017[64]). Among 14 OECD and EU27 countries studied, only one fifth of individuals with major depressive disorder received minimally adequate treatment. This proportion was higher than 30% in countries such as Germany and the Netherlands, but was below 10% in Bulgaria, Colombia, Mexico and Romania (Thornicroft et al., 2017[64]). The treatment gap is exacerbated by the low recognition of depression, with only about half of individuals with major depressive disorder recognising their need for care, particularly in low-income settings. It is likely that treatment rates for less severe symptoms are even lower, as individuals may not perceive their symptoms as serious enough to seek care.
Health system and personal barriers hinder access to treatment for mental ill-health
Health system barriers to access treatment
When seeking mental health care, individuals can face challenges within the healthcare system that can hinder access to treatment. Health system characteristics, such as the availability of healthcare services and the breadth and depth of the health benefit basket, are key determinants of healthcare access (Paris et al., 2016[65]). This section describes three main systemic barriers to mental care: financial, organisational and geographical barriers.
Financial barriers are particularly problematic in countries where mental health services are not fully covered by public health insurance, requiring individuals to pay out-of-pocket for treatment (OECD, 2021[56]). This financial burden can deter people from seeking the help they need. A Dutch study examining over 1.4 million mental health treatment records from 2010 to 2012 found that increasing cost-sharing in 2012 led to a 13.4% reduction in regular mental health care usage among adults, with the greatest decline in low-income groups (Ravesteijn et al., 2017[66]). This reduction was accompanied by a substantial rise in involuntary commitments and acute care needs. In the United States, in 2020, 30% of adults with any mental illness and a perceived unmet need for services reported not receiving care because their health insurance did not cover any mental health services or because insurance reimbursement was inadequate. This figure was similar for those with serious mental illnesses (Modi, Orgera and Grover, 2023[67]).
Organisational barriers, such as long waiting times, are another significant obstacle. Longer waiting times for mental health care are associated with poorer treatment outcomes and higher treatment costs (van Dijk et al., 2023[68]; Adu et al., 2024[69]; Catarino et al., 2023[70]). The perceived uncertainty and lack of support due to longer waiting times can lead to increased emotional distress, reduced functioning and worsening of existing symptoms (Punton, Dodd and McNeill, 2022[71]). A study of patients with major depressive disorders found that longer waiting times were associated with poorer treatment outcomes once treatment was started, even after adjusting for potential confounders such as severity and suicidality (van Dijk et al., 2023[68]). Similarly, research on early intervention in psychosis services in England showed that longer waiting times were associated with worse patient outcomes one year after treatment acceptance, particularly for waits longer than three months, with the largest impact on symptomatic and social functioning (Reichert and Jacobs, 2018[72]).
Geographical barriers further complicate access to mental health treatment, particularly in rural and underserved areas where mental health providers are scarce. The long distances that some individuals must travel to access care can be prohibitive, especially for those without reliable transportation. A US study found that adults in rural areas were less likely to receive mental health care and more likely to receive treatment from providers with less specialised training, compared to those living in urban areas. Contributing factors included a shortage of mental health providers, limited availability of specialised care, gaps in provider training and underutilisation of existing services in rural areas (Morales, Barksdale and Beckel-Mitchener, 2020[73]).
A fundamental constraint underpinning health system barriers is the limited capacity of mental health professionals. Shortages in mental health workforce have been identified as an issue in many OECD countries (OECD, 2021[56]). On average across OECD and EU27 countries with available data, there are 0.53 psychologists and 0.52 mental health nurses per 1 000 population. Countries such as Iceland, Norway and Denmark, have higher rates of psychologists, exceeding 1.3 per 1 000 population, while Korea and Hungary are below 0.03. For mental health nurses, countries such as Australia, France, Belgium and Türkiye have rates above 0.9 per 1 000, while Spain and the United States report less than 0.05 (OECD, 2021[56]).
Personal barriers to access treatment
Personal barriers play an important role in deterring people from seeking and remaining in treatment. Personal barriers are reported most frequently than health system barriers, especially for individuals with mild-to-moderate symptoms (Andrade et al., 2014[74]). Understanding and addressing personal barriers is essential for ensuring that individuals receive the appropriate support. The rest of this section further describes the personal barriers to mental health care including low perceived need for treatment, limited mental health literacy, and various forms of stigma.
Low perceived need for mental health treatment is the most common reason for not beginning treatment, particularly among those with mild-to-moderate symptoms. Data from the WHO World Mental Health surveys collected between 2001 and 2009 in 24 high- and low-income countries show that around 60% of respondents who qualified for a clinical diagnosis but reported no service use, had low perceived need for professional treatment (Andrade et al., 2014[74]). The proportion of respondents with low perceived need is significantly higher among those with mild-to-moderate symptoms versus those with severe symptoms in nine countries, and the difference is not statistically significant in the remaining countries. For individuals who perceived a need for mental treatment but did not seek care, several reasons were provided. Nearly two in three respondents (63%) reported that they wanted to handle the problem on their own. This was the most frequently cited reason, regardless of the level of symptom severity. About 16% reported low perceived efficacy of treatment, 24% reported that the problem was not severe, 16% were convinced that the problem would resolve itself with time, and 8% reported concerns related to stigma (Andrade et al., 2014[74])
Decision not to seek care is influenced by the information available (or lack of information) to the individuals and their ability to use and act on this information to make decisions. Finding information on how to deal with mental health problems was reported to be difficult or very difficult by 39% of respondents in 16 OECD countries in 2019-2021 (Figure 2.9). This proportion varied from 19% in Slovenia to 50% or more in Bulgaria and Germany. It is uncertain whether these difficulties were due to a lack of mental health literacy or if the relevant information is either unavailable or not easily accessible. Besides, the levels of mental health literacy are low among the general population (Tay, Tay and Klainin-Yobas, 2018[75]), as well as among adolescents and young adults (Nobre et al., 2021[76]). Low levels of mental health literacy likely result in people not having sufficient resources to deal with mental health problems and not seeking care.
Stigma around mental health also presents a significant obstacle to accessing mental health care. Fear of judgement and discrimination prevent people from disclosing their mental struggles, then resulting in under-reporting of mental ill-health (Bharadwaj, Pai and Suziedelyte, 2017[77]). This also prevents people from seeking the mental health treatment they need (Schnyder et al., 2017[78]). Many individuals avoid seeking mental health treatment due to the fear of being judged or treated differently by others, a phenomenon known as perceived stigma. For example, a US study found that one in five college students with unmet mental health needs avoided seeking care due to fear of judgment (Eisenberg, Golberstein and Gollust, 2007[79]). Similarly, one in seven adults avoided treatment due to concern about being judged by their neighbours (Mason et al., 2013[80]). Beyond the fear of external judgement, self-stigma plays a critical role in deterring individuals from seeking mental health treatment. When people internalise negative societal beliefs about mental illness, it can lead to feelings of shame and lower self-esteem, making them less likely to seek the treatment they need (Thornicroft et al., 2022[81]). Because of this internalisation, individuals tend to overestimate how negatively they will be perceived by others if they seek mental health care. There is a clear discrepancy between how individuals who seek mental treatment think they are perceived and how they are actually viewed by others (Pedersen and Paves, 2014[82]).
Note: Due to the wide variety of sampling and data collection procedures across countries, country differences should be interpreted with caution.
Source: The HLS19 Consortium of the WHO Action Network M-POHL (2021[19]), International Report on the Methodology, Results, and Recommendations of the European Health Literacy Population Survey 2019-2021 (HLS19) of M-POHL, https://m-pohl.net/sites/mpohl.net/files/inline-files/HLS19%20International%20Report.pdf.
Addressing stigma is essential, as it can exacerbate mental ill-health and, in some cases, cause more harm than the condition itself. Effective strategies to combat stigma include promoting social contact between those with and without mental ill-health, which has been shown to be the most effective way to change negative perceptions (Thornicroft et al., 2022[81]). Moreover, the media plays an important role in shaping public attitudes and it is essential to involve people with lived experience in developing anti-stigma initiatives.
The increased global attention to mental health, particularly heightened by the COVID‑19 pandemic, has resulted in a growing body of research, evidence‑based interventions and programmes, guidelines, and tools becoming available for implementation (WHO, 2022[83]). In response to emerging mental health challenges, many countries and organisations have prioritised and strengthened their mental health policies, aiming to boost promotion and prevention of mental ill-health and improve access to and quality of mental health services. The OECD Mental Health Performance Framework aims to guide the development of effective and responsive mental health systems (Box 2.5).
The OECD Framework for Mental Health Performance recommends six key principles to guide the development of effective and responsive mental health systems. Among these, the focus on prevention of mental illness and promotion of well-being emphasises proactive measures to reduce mental health issues before they escalate and to promote overall well-being
Key sub-principles for promotion and prevention policies include:
Strengthening suicide prevention: Implement strategies and programmes aimed at reducing suicide through early intervention and support.
Improving mental health awareness and literacy: Increase public understanding of mental health issues to reduce stigma and encourage help-seeking behaviour.
Making schools mental health friendly environments that build resilience: Ensure that educational environments support mental health by building resilience among students and providing access to mental health resources.
Ensuring that workplaces promote good mental health: Develop policies and practices that foster a supportive work environment, reduce stress and enhance well-being.
Enabling front line actors to recognise and respond to mental distress: Train teachers, police officers, and others to recognise and respond effectively to signs of mental distress, ensuring that individuals receive timely and appropriate support.
Improving access to care by making it easy for individuals to seek help: Make it easier for individuals to seek help by reducing barriers to access, such as stigma, cost and geographical challenges.
Source: OECD (2021[56]), A New Benchmark for Mental Health Systems: Tackling the Social and Economic Costs of Mental Ill-Health, doi: 10.1787/4ed890f6‑en; OECD (2019[84]), “OECD Mental Health Performance Framework”, https://www.oecd.org/content/dam/oecd/en/topics/policy-sub-issues/mental-health/oecd-mental-health-performance-framework-2019.pdf.
In 2023, a majority of OECD and EU27 countries reported having implemented or being currently implementing a national mental health policy. The OECD and the WHO Regional Office for Europe, with support from the European Commission Directorate General for Health and Food Safety, jointly carried out a questionnaire on mental health system capacity across European Union countries and Iceland and Norway, in 2023. The OECD has extended the survey to all OECD Member countries. Results of this survey show that around 90% of countries had a national action plan to address mental ill-health in 2023 (Table 2.2) (OECD/WHO Regional Office for Europe, 2023[85]).
The scope of the national mental health strategies generally extends beyond the provision of mental health services. They also encompass suicide prevention, early interventions, building socio‑emotional resilience, reducing stigma, collaboration with other sectors such as education or social sector, among others. For example, Australia’s National Mental Health and Suicide Prevention Plan emphasises prevention, early intervention, suicide prevention, and improving children’s well-being across education and health systems (Commonwealth of Australia, 2021[86]). In France, the Mental Health and Psychiatry Roadmap focusses on promoting mental well-being, ensuring co‑ordinated care, and improving the social inclusion of people with mental health disorders. The plan has a strong focus on combating stigma, early intervention and tailoring care to vulnerable groups, such as children and adolescents (Ministère du Travail, de la Santé et des Solidarités, 2024[87]). In England, the national long-term plan serves as a comprehensive healthcare strategy that places a strong emphasis on improving mental health services. It aims to enhance access to mental health care, promote early intervention, and provide integrated support for both physical and mental health needs, while prioritising crisis care and tailored services for vulnerable populations, particularly children and adolescents (NHS England, 2019[88]).
A vast majority of countries have implemented suicide prevention policies. Out of the 43 countries studied, 12 countries have fully implemented suicide prevention strategies through national programmes, while 26 countries are in process of implementing these strategies at national, regional or subnational levels. Only three countries have either addressed suicide prevention in their policies without implementing any activities, or do not have clear policies in place, while two countries have no data available (Table 2.2). Most prevention programmes also address after-care for individuals who have attempted suicide.
Most OECD and EU27 countries prioritise early interventions aiming to ease access to mental health care and support, particularly for individuals with mild-to-moderate symptoms. A total of 78% of the OECD and EU27 countries with available responses (33 out of 42) have policies to enable mental health promotion, prevention, and treatment of mental health conditions to be delivered in primary care settings (Table 2.2). In addition, 96% of countries with available responses (25 out of 26) provide direct access to mental health care without referral. Yet, efforts to improve access to mental health care are often limited by shortages in mental health workforce capacity (see section on Health system barriers to access treatment), along with insufficient health infrastructure and limited engagement of people with lived experience of mental ill-health or carers (WHO, 2024[89]).
To facilitate access to treatment for individuals with mild-to-moderate symptoms, some countries are expanding the availability of talking therapies. These evidence‑based interventions involve guided discussions with a trained professional to help individuals understand and manage their emotional and psychological issues. They can include counselling, psychological therapies, group therapy and general advice, delivered by mental health professionals, general practitioners or through online platforms. Talking therapies can be effective for a range of mental health conditions, particularly for mild-to-moderate symptoms of depression and anxiety. Talking therapies can be delivered in a variety of settings, including primary care, schools and workplaces. Seventy-three per cent of countries with available responses reported the use of talking therapies, despite variation in the level of implementation. Around 19% reported that a few general practitioners provided talking therapies, 46% reported some, while only 8% indicated that all the general practitioners provided talking therapies (OECD, 2021[56]).
Most countries also put a high priority on promoting good mental health and building resilience over the life course. A vast majority (90%) of countries have implemented policies and programmes to support and promote the mental health of children and adolescents. Similarly, 90% of countries have introduced policies and programmes to support mental health in educational settings. Furthermore, 83% of countries have implemented policies and programmes to reduce stigma and discrimination, while 88% have policies and programmes to improve mental health awareness and literacy (Table 2.2).
Note: n/a: Not available. “Yes” indicates that policies or programmes are either fully implemented or that implementation is underway either at the national or regional level, while “No” indicates that the policy has been addressed but not yet under implementation, or that there is no policy in place.
Source: OECD/WHO Regional Office for Europe (2023[85]), Mental Health Systems Capacity Questionnaire 2023 – Strategy or action plan that guide implementation of the mental health policy; OECD/WHO Regional Office for Europe (2023[90]), Mental Health Systems Capacity Questionnaire 2023 – Policies and programmes that support suicide prevention; OECD/WHO Regional Office for Europe (2023[91]), Mental Health Systems Capacity Questionnaire 2023 – Policies and programmes to enable mental health promotion, prevention and treatment of mental health conditions in primary health care; OECD/WHO Regional Office for Europe (2023[92]), Mental Health Systems Capacity Questionnaire 2023 – Policies and programmes to improve mental health awareness and literacy; OECD/WHO Regional Office for Europe (2023[93]), Mental Health Systems Capacity Questionnaire 2023 – Policies and programmes to address stigma and discrimination; OECD/WHO Regional Office for Europe (2023[94]), Mental Health Systems Capacity Questionnaire 2023 – Policies and programmes to support mental health in educational settings; OECD/WHO Regional Office for Europe (2023[95]), Mental Health Systems Capacity Questionnaire 2023 – Policies and programmes to support and promote mental health of children and adolescents; OECD (2021[56]), A New Benchmark for Mental Health Systems: Tackling the Social and Economic Costs of Mental Ill-Health, https://doi.org/10.1787/4ed890f6-en.
Subsequent chapters to this report analyse 11 candidate promising and best practices aimed at preventing mental ill-health and promoting good mental health. All the interventions and programmes identified were consistent with the policy areas included in the OECD Framework for Mental Health Performance (Box 2.5). Six of the selected interventions aimed to improve help-seeking behaviour, particularly for people with mild-to-moderate symptoms and improve access to low-threshold and specialised care services. Three of the case studies were education-based programmes that aimed to develop children’s skills to manage mental health problems, for example by strengthening their social and emotional coping skills. Two of the case studies focussed on suicide prevention, while three focussed on front-line workers, such as providing training for midwives and teachers to help people in mental distress or a crisis (Table 2.3). Some intervention covers multiple policy areas at the same time. The target population of the selected interventions is diverse, including children, adolescents, adults, perinatal women, and people with mild-to-moderate mental health symptoms, as well as those with mental illnesses and suicidal ideation. The selected interventions cover more than 11 countries as some of them are implemented in multiple countries. The interventions are delivered in various ways, such as in healthcare settings, by web-based tools, peer-based programmes and school settings.
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← 1. For mild disease severity group: no statistically significant difference between costs in the cohort with mental conditions and those in the control without mental disorders.