This chapter examines the current state of mental health policy across 44 OECD and EU countries, with a focus on interventions designed to improve mental well-being. Particular attention is given to policies supported by a strong evidence base, including those implemented in primary healthcare, workplace and school settings. The analysis is summarised in a matrix of policy options outlining intervention mechanisms, delivery settings, objectives and modes of implementation. These interventions form the foundation for the cost-effectiveness analysis presented in Chapter 5.
The Economic Case for Preventing Mental Ill Health
Abstract
International recognition of the growing burden of mental ill health has led to stronger policy action, with 42 out of 44 OECD and EU countries surveyed reporting that they have national strategies or action plans in place. A key reform trend is shifting management from hospitals to community-based interventions – initially in primary care, and increasingly in schools and workplaces – reflecting evidence that early, preventive approaches outside hospital settings can be effective and less expensive.
National mental health strategies include a wide range of evidence‑based policies, delivered through diverse mechanisms, settings and formats. To analyse this complexity, the chapter introduces a matrix of mental health policies, summarising how intervention options can be combined into comprehensive policies. The matrix focusses on interventions with a strong evidence base and frequent variation across countries, including mechanisms (e.g. psychological, pharmacological), delivery settings (e.g. PHC, workplace), intended outcomes (e.g. prevention, treatment) and modes of delivery (e.g. in-person, web-based).
A range of evidence‑based mechanisms are effective in preventing and treating mental ill health. Interventions can be grouped into five categories: i) mental health literacy and stigma reduction; ii) mindfulness and exercise‑based interventions; iii) psychological interventions (excluding CBT); iv) CBT; and v) pharmacological therapies. While variations in delivery sector or mode can influence effectiveness, all five categories have a strong evidence base supporting their use for prevention and treatment.
Countries are increasingly shifting the prevention and management of mental ill health towards community settings, including PHC, workplace and school settings. For nearly four out of five responding countries, policies to improve mental well-being are in development or have been implemented across these settings. This trend reflects a growing emphasis on early promotion and protection of mental health to prevent future ill health and reduce associated costs for individuals, health systems and economies. Intervention mechanisms, objectives and delivery modes vary by setting, with some approaches better suited to specific sectors.
Over the last decade, there has been increasing international recognition of the significant and growing burden that mental ill health imposes on society and the global economy, resulting in a range of international strategies and action plans to support the implementation of policies to improve mental well-being. In 2015, the OECD released the Council’s Recommendation on Integrated Mental Health, Skills and Work Policy (OECD, 2015[1]), which provides a series of guidelines to address the impact of mental ill health on health, education, employment and social outcomes. Following the publication of the Recommendation, in 2021 the OECD assessed progress achieved in relevant policy areas including health, youth, workplace and welfare policies (OECD, 2021[2]). In the same year, the OECD Mental Health System Performance Benchmark was developed, providing a framework to support governments to better understand and improve mental health systems (OECD, 2021[3]).
Over the same period, the WHO released the Mental Health Action Plan 2013-2020, which highlights four primary objectives to guide international health systems and leaders to address mental ill health through policy (WHO, 2021[4]). In 2019, the Action Plan was extended to 2030, and updates to its implementation options and indicators were endorsed by the World Health Assembly in 2021. Under each primary objective are global targets that provide specific and quantifiable goals, with associated indicators for measuring progress towards these targets (Box 4.1).
The WHO’s Mental Health Action Plan 2013-2030 sets out ambitious objectives to strengthen mental health systems worldwide. Table 4.1 outlines the global targets agreed in the Action Plan for each objective, along with the associated indicators against which progress is to be measured. Objectives 2 and 3 align particularly closely with objectives of the current publication, which seeks to provide governments with additional evidence on the interventions that are most cost-effective for promotion and protection of mental well-being – particularly in community settings such as school, workplace and PHC settings.
Source: WHO (2021[4]), Comprehensive Mental Health Action Plan 2013-2030, https://iris.who.int/handle/10665/345301.
The international commitment to stronger mental health policy was further strengthened in 2015 through the adoption of the Sustainable Development Goals (SDGs), which include targets specifically focussing on mental health (United Nations Department of Economic and Social Affairs, 2023[5]). These include SDG target 3.4 on “promoting mental health and well-being” through prevention and treatment policies and activities and SDG target 3.5 on “strengthening the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol”.
In response to the growing international emphasis on preventing and treating mental ill health, governments across OECD and EU countries have increasingly strengthened their policy focus in this area. This has been reflected by the substantial number of countries that have developed and implemented national strategies and action plans and implemented a strategic approach to addressing mental ill health. In 2023, the OECD and the WHO Regional Office for Europe, with support from the European Commission’s Directorate‑General for Health and Food Safety, carried out a survey on mental health system capacity across EU countries, Iceland and Norway (WHO Regional Office for Europe, 2024[6]). The OECD thereafter extended the survey to all OECD Member countries (referred to in this report as the WHO/OECD Mental Health Survey). According to the survey, 42 out of 44 (95%) national governments reported that they had a national mental health policy and/or a strategy or action plan in place to guide the implementation of a national mental health policy (Figure 4.1).
Note: OECD countries are dark blue; EU Member States that are not OECD countries are light blue.
Source: WHO/OECD Mental Health Survey.
In recent decades, mental health reforms across OECD countries have increasingly focussed on delivering care outside hospital settings. Aligned with the overall focus of this publication, this chapter places particular emphasis on three key areas of non-hospital interventions: PHC-based, school-based and workplace‑based initiatives. Together, these approaches aim to make mental health support more accessible within communities, better integrated into daily life and tailored to groups with specific needs. This focus reflects growing evidence that interventions delivered outside traditional clinical settings are both effective and cost-saving, as they help to prevent and detect mental ill health before it escalates into more serious conditions requiring treatment. Consequently, most interventions discussed in this chapter, and later modelled in Chapter 5, tend to be preventive, since treatment-oriented approaches are generally more appropriate for traditional clinical environments. Nonetheless, for certain interventions, the distinction between prevention and treatment can be less clear-cut, as some approaches may serve both purposes, depending on how and when they are applied.
Belgium is often mentioned among the countries that have implemented ambitious measures to reduce dependence on institutional care and to promote community-based, patient-centred approaches. Specifically, the Belgian reform is organised around local mental health networks that deliver five core functions, primarily in community-based settings (Box 4.2). These functions encompass services such as primary care and social support, ensuring that care is accessible beyond traditional hospital environments. This national experience, together with interventions implemented by other countries, represents an emerging best practice that offers valuable lessons for shaping future health system reforms across OECD countries (OECD, 2025[7]).
Box 4.2. The reform of the national mental health system in Belgium: Focus on strengthening primary healthcare service delivery
Since 2010, Belgium has implemented a nationwide reform of its mental health networks, aimed at expanding patient-centred, community-based mental health services and reducing reliance on psychiatric institutionalisation. This multisectoral approach introduced a broad range of services, including outreach and prevention, inpatient and outpatient care, primary care, day programmes, and vocational, housing and social support (Borgermans et al., 2018[8]). These reforms align with the WHO Mental Health Action Plan 2013-2030, which calls for a shift from institutional care toward PHC and other community-based settings. The Belgian model is built on decentralised leadership and delivers both acute and chronic mental healthcare through collaborative networks. Each network operates within a defined geographical area, develops its own governance mechanisms and provides five core functions through multisectoral partnerships (Figure 4.2).
Source: Adapted from Borgermans et al. (2018[8]), Multisectoral mental health networks in Belgium: An example of successful mental health reform through service delivery redesign: good practice brief, https://iris.who.int/handle/10665/345626.
To support this new model, funding was reallocated from institutional care to create mobile treatment teams (Function 2). Composed of hospital-based staff working in the community, these teams were cost-neutral for hospitals in the short term and free for patients. Evidence from over 13 000 patients followed in 2016 shows that these teams helped to prevent long-term hospitalisation. By 2017, their implementation had reduced the number of long-term psychiatric beds by 1 230. However, this represents only a modest change: Belgium had 152 psychiatric beds per 100 000 inhabitants in 2008, and this dropped by just over 1% to 150 beds per 100 000 by 2015 (European Commission, 2018[9]; WHO Regional Office for Europe, 2005[10]). More recent reviews suggest that the impact on outcomes for severely mentally ill patients has been limited, with reforms linked to slight improvements in continuity of care but not to broader clinical outcomes (Lorant et al., 2019[11]).
Another key aspect of the reform is its emphasis on strengthening primary mental healthcare (Function 1). The reform created co‑ordinated regional and local networks of mental health professionals and introduced reimbursement for both low-threshold and specialised psychological care. Over 30 multidisciplinary professional networks have been established nationwide, providing prompt and free‑of-charge access to psychologists for both children and adults. The new scheme covers up to eight low-threshold sessions and 20 specialised sessions per patient per year. OECD analyses have documented the reform’s positive impact on mental health outcomes (OECD, 2025[7]): among individuals who accessed psychological care through the networks, prevalence of mental disorders decreased by an average of 10% within six months of enrolment. The reform has also reduced financial barriers to care: nearly 40% of users reported that they had previously forgone psychological support when it was not reimbursed, suggesting that these individuals would probably have gone without treatment in the absence of the new scheme.
OECD and EU countries have introduced a diverse set of mental health interventions, which vary widely in both design and implementation. The remainder of this chapter highlights best practices and policies featured in these national strategies, with a focus on interventions delivered in primary and frontline healthcare, schools and workplaces. The analysis prioritises policies that are evidence‑based, are widely adopted across countries, and stand out for their innovation and/or cost-effectiveness.
The design and implementation of mental health interventions vary across multiple dimensions. This chapter examines selected interventions by grouping them according to four key characteristics:
Intervention mechanism refers to how the intervention influences mental health, such as through psychosocial support, pharmacological treatment, or education and awareness strategies.
Place of delivery is the setting in which the intervention is provided. As noted earlier, this chapter focusses on delivery in primary or frontline healthcare, school and workplace settings.
Objective relates to whether the intervention primarily aims to prevent mental ill health or to treat it. While many interventions have traditionally been used for treatment, they are increasingly adapted for early-stage prevention.
Delivery mode is the way the intervention reaches recipients – whether face‑to-face with a provider, via web-based platforms, over the telephone or through other channels.
These factors are not mutually exclusive and can be combined in numerous ways. For example, a psychosocial intervention might be delivered across multiple settings such as PHC, school or workplace settings using different modes (in-person, online or by phone) and targeting various objectives, from promotion and prevention to treatment.
Table 4.3 illustrates how these characteristics can be combined to form individual mental health interventions or policies. The matrix summarises common combinations of policy elements, many of which are frequently applied in research and practice. In Chapter 5 of this publication, a selection of these widely implemented and well-studied combinations is modelled using the OECD SPHeP-NCDs framework. Although other interventions exist – including parenting programmes and suicide prevention programmes, some of which are examined in the publication on best practices in public health for mental health promotion and prevention (OECD, 2025[7]) – the interventions presented in Table 4.3 reflect the most prevalent approaches identified in the literature and policy documents.
Note: * Prescription of pharmacological therapies depends on the regulatory guidelines of different jurisdictions.
Interventions influence mental health through several mechanisms
Mental health interventions rely on diverse mechanisms to promote well-being and improve outcomes, reflecting the complexity of mental health needs and the variety of approaches available to address them. Interventions to improve mental well-being can employ a variety of mechanisms – psychological, biological, social or interpersonal – each differing in terms of goals, effectiveness, cost and suitable settings. The following section does not aim to be exhaustive; rather, it highlights the main types of interventions widely used in national health strategies and supported by strong evidence, including systematic reviews.
Mental health literacy and stigma-reduction interventions
Mental health literacy initiatives and stigma-reduction programmes are effective in both promoting well-being and encouraging help-seeking for mental ill health (Moreira, 2018[12]). With relatively low implementation costs, these interventions offer significant potential as cost-effective strategies for mental health promotion and prevention (Yeo et al., 2024[13]).
Health literacy plays a critical role in enabling individuals to make informed decisions about their health. It refers to the social and cognitive skills that determine a person’s motivation and ability to access, understand and apply information to maintain good health (Nutbeam and Kickbusch, 1998[14]). Interventions to improve health literacy typically target three levels: seeking healthcare, preventing disease and promoting overall well-being. By strengthening these skills, such interventions directly influence an individual’s capacity and willingness to act on health information, ultimately improving health outcomes. This link between health literacy and better health outcomes also applies to mental health. People with mental ill health often have lower health literacy than the general population, with some studies reporting inadequate health literacy rates of nearly 50% (Degan et al., 2021[15]). Evidence also shows that these individuals are less likely to seek timely treatment for conditions such as depression or anxiety (Wells et al., 1994[16]).
As with low mental health literacy, stigma surrounding mental health and its treatments remains a major barrier to help-seeking (Schomerus et al., 2018[17]). Stigma-reduction interventions aim to eliminate feelings of embarrassment or shame associated with mental ill health, thereby promoting well-being and encouraging help-seeking behaviours (Bonabi et al., 2016[18]). Additionally, improving mental health literacy among key groups, such as police officers and emergency department staff, not only helps to reduce stigma but also equips them with the knowledge to understand and respond appropriately to individuals in need of support.
These interventions are generally implemented as awareness-raising activities, structured training sessions or media campaigns. Such approaches aim to inform individuals about mental health, challenge misconceptions and normalise help-seeking behaviours. Awareness campaigns can reach large audiences to reduce stigma, while targeted training equips specific groups such as educators, employers and first responders with practical knowledge and skills to identify and respond to mental health needs. These activities are particularly effective because they are scalable, adaptable to different contexts and relatively inexpensive compared to clinical interventions.
Mental health literacy and stigma-reduction interventions are widely recognised for increasing awareness, and evidence suggests that they also promote help-seeking behaviours (Kutcher, Wei and Coniglio, 2016[19]; Cook et al., 2014[20]; Xu et al., 2018[21]). A recent meta‑analysis found that health literacy interventions were associated with a significant reduction in depression and anxiety scores (Magallón-Botaya et al., 2023[22]), although their long‑term effectiveness remains uncertain – particularly regarding their impact on stigma and social distance (Freţian et al., 2021[23]). These positive effects hold across variations in delivery setting, objective and mode of implementation. For instance, both mental health literacy and stigma-reduction interventions have proved effective in PHC, school and workplace settings (Sampaio, Goncalves and Sequeira, 2022[24]; Bonabi et al., 2016[18]; Lam et al., 2022[25]). Norway, for example, successfully piloted a school-based mental health literacy programme (Box 4.3). Evidence also supports diverse delivery modes, including traditional media and online platforms (Brijnath et al., 2016[26]). Importantly, the way these interventions are designed and implemented can significantly influence their effectiveness, underscoring the need to align strategies with emerging evidence on what works best (Brijnath et al., 2016[26]; McCullock and Scrivano, 2023[27]).
In Trondheim, Norway, school health services implemented “MEST” – short for the Norwegian word for coping – as a mental health literacy intervention in upper secondary schools, supported by the Norwegian Directorate of Health (Bjornsen et al., 2017[28]). The programme offers voluntary participation in open school seminars, classroom sessions and small group discussions focussed on improving students’ mental health literacy and providing practical resources for well-being. Topics include sleep hygiene, stress management, relaxation techniques, body image, self-esteem and emotional regulation.
The effectiveness of MEST was evaluated through a randomised controlled trial of 357 students in 2017. Results showed that students who participated in MEST improved their mental health literacy by 2.1% compared to non-participants, as measured by the 10‑item Mental Health Promoting Knowledge scale (Bjornsen et al., 2017[28]). Girls who participated in the programme reported higher mental well-being scores on the Short Warwick-Edinburgh Mental Well-being Scale, but no statistically significant effect was observed among boys. These findings suggest that mental health literacy programmes like MEST can effectively increase knowledge and, in some cases, improve well-being, although impacts may vary across demographic groups.
Similar school-based interventions in Germany, Australia and Wales have reported comparable benefits, including improved mental health literacy and, in some cases, greater intention to seek help for mental ill health (Kirchhoff et al., 2023[29]; Simkiss et al., 2023[30]; Hart et al., 2018[31]).
Mindfulness-based interventions
Mindfulness-based interventions have grown significantly in prevalence over the past decade, supported by a growing evidence base demonstrating their role in both preventing and treating mental ill health (Galante et al., 2023[32]). Originating from Buddhist traditions, mindfulness is commonly defined as “the awareness that emerges through paying attention on purpose, in the present moment and non-judgementally to the unfolding of experience moment by moment” (Baer et al., 2019[33]; Kabat-Zinn, 2013[34]). These practices encourage individuals to observe thoughts, feelings, physical sensations and behavioural urges, emphasising that how people respond to distress – rather than the distress itself – often determines the extent to which it can be relieved or transformed (Crane et al., 2016[35]).
Mindfulness-based interventions typically include three core components:
Mindfulness meditation training builds familiarity with the mind and body, teaching that attention can be regulated and optimised through practice.
Mindful activities typically involve formal practices such as body scans, mindful movement and sitting meditation. These aim to support “decentring” or “re‑perceiving”, helping individuals recognise that thoughts are not always accurate reflections of reality.
Collective and individual inquiry using participatory learning encourages recognition of direct experiences – thoughts, emotions and sensations – and patterns of reactivity, creating opportunities to develop new, healthier response patterns.
Mindfulness-based interventions have surged in popularity over recent decades, becoming one of the most widely used approaches for mental health promotion (Burke et al., 2017[36]). An estimated 20% of Australians, 15% of British adults and 5% of adults in the United States have practised mindfulness at some point in their lives (Samele, 2016[37]; Simonsson, Fisher and Martin, 2021[38]; Dib et al., 2021[39]).
The rise in popularity of mindfulness-based interventions has been accompanied by a growing body of evidence demonstrating their effectiveness in preventing and treating mental ill health across diverse settings. A systematic review and meta‑analysis found that psychological distress, including anxiety and depression, was reduced by a small to moderate degree (5.4%) within one to six months following a mindfulness-based intervention (Galante et al., 2023[32]). Workplace‑based mindfulness programmes have shown effect sizes ranging from small to large for outcomes such as mental distress, although evidence on long-term impacts remains inconclusive (Vonderlin et al., 2020[40]). Similarly, a meta‑analysis of school-based interventions reported reductions in anxiety, while highlighting the need for more robust research to guide policy (Phan et al., 2022[41]). Overall, targeted mindfulness interventions appear more effective in preventing depression and anxiety than universal approaches (Galante et al., 2023[32]).
Mindfulness-based interventions have also demonstrated strong effectiveness as treatments for mental health conditions, including depression, anxiety and substance use disorders (Galante et al., 2021[42]; Korecki et al., 2020[43]). In fact, some studies show that these interventions perform comparably to CBT and other standard evidence‑based treatments for conditions such as major depressive, generalised anxiety, alcohol use and substance use disorders (Hofmann and Gomez, 2017[44]; Korecki et al., 2020[43]). These benefits extend to web-based mindfulness programmes, which have been found effective in reducing symptoms of depression and anxiety (Sevilla-Llewellyn-Jones et al., 2018[45]). Overall, evidence supports the efficacy of mindfulness-based interventions for both prevention and treatment of mental ill health. Given that they achieve similar outcomes to care‑as-usual treatments while requiring fewer resources, they hold promise for cost-effectiveness and even cost savings compared to interventions such as CBT (Zhang et al., 2022[46]). Box 4.4 illustrates an example where mindfulness training delivered in group sessions achieved comparable results to treatment as usual, while significantly reducing resource requirements by enabling participants to continue practising skills individually.
In Skåne County, Sweden, a group-based mindfulness programme delivered in PHC settings proved effective for managing depression and anxiety, offering a lower-cost and less resource‑intensive alternative to traditional treatment options (Sundquist et al., 2018[47]).
The eight‑week mindfulness group therapy programme was introduced for PHC patients seeking treatment for depression, anxiety, stress or adjustment disorders. The initiative aimed to address the challenge that conventional treatments for these conditions are often resource‑intensive, costly and difficult to access. Patients were recruited from 16 PHC centres, where two instructors at each site were trained to deliver mindfulness group therapy adapted from mindfulness-based stress reduction and mindfulness-based cognitive therapy techniques. The programme consisted of weekly two‑hour in-person group sessions with an average of eight participants. Sessions included structured and guided mindfulness exercises, complemented by take‑home resources such as a CD, training manual and diary to support an additional 20 minutes of daily mindfulness practice at home.
The intervention was evaluated through a randomised controlled trial of 215 participants, assessing its impact on mental health symptoms both eight weeks after completion and at a one‑year follow-up. Results showed statistically significant improvements in depression, anxiety and adjustment disorders at both time points. Specifically, symptoms of depression and anxiety decreased from a baseline score of 2.34 to 2.15 – an approximate 8% reduction – on the Hopkins Symptoms Checklist. These effects were comparable to treatment as usual. Overall, the findings suggest that mindfulness-based group therapy can deliver long-term improvements in depression and anxiety while offering a lower-cost, less resource‑intensive alternative to traditional treatments in PHC settings.
Psychological interventions (excluding cognitive behavioural therapy)
While definitions of psychological interventions vary, they are generally understood as treatments grounded in psychological theory, designed to improve functioning and delivered within a structured therapeutic relationship (Prothero et al., 2018[48]). In line with the WHO’s Psychological Interventions Implementation Manual, this publication uses the term to refer specifically to evidence‑based interventions that follow standardised, manualised protocols (WHO, 2024[49]). Psychological or psychosocial approaches that are not evidence‑based or that lack a structured manual are not included within this definition.
Psychological interventions cover a wide spectrum of evidence‑based approaches, including behavioural, cognitive, humanistic, systemic, motivational, disease‑focussed, social and environmental methods (National Collaborating Centre for Mental Health (UK), 2011[50]). Each approach is shaped by its underlying theoretical model and applies distinct techniques to improve mental health outcomes. Prominent examples include CBT, psychodynamic therapy, and eye movement desensitisation and reprocessing, among many others (Lovelock et al., 2018[51]).
CBT is considered separately from other psychosocial interventions due to the substantial body of evidence specific to CBT – particularly studies indicating that it may be more effective in treating a wide range of mental health conditions compared to other psychological interventions (Cuijpers et al., 2023[52]). This distinction enables a focussed discussion and comparative analysis of evidence and policies that use CBT-based interventions relative to other psychosocial approaches.
Psychosocial interventions have traditionally been delivered in frontline settings by mental health professionals (WHO, 2024[49]). However, strong evidence demonstrates their successful implementation across diverse community settings, using various delivery modes and targeting different outcomes. These interventions have proved effective in preventing and treating mental ill health in PHC settings, as well as in workplaces and schools (Linde et al., 2015[53]; Llistosella et al., 2023[54]; Carolan, Harris and Cavanagh, 2017[55]). Moreover, they have been adapted to address the needs of high-risk populations, such as refugees (Box 4.5).
In 2020, Türkiye was the world’s leading refugee‑hosting country, sheltering over 3.6 million Syrian refugees alone (United Nations High Commissioner for Refugees, 2020[56]). Refugee populations face heightened risks of mental ill health due to exposure to traumatic experiences, as well as increased vulnerability to discrimination, economic hardship and social isolation (Hou et al., 2020[57]; Acarturk et al., 2021[58]). To address these risks, a preventive psychological intervention known as “Self-Help Plus” was implemented and evaluated among Syrian refugees in Türkiye (Acarturk et al., 2022[59]).
The intervention, developed by the WHO and based on acceptance and commitment therapy principles, consists of a prerecorded audio course delivered in group settings by trained facilitators, complemented by an illustrated self-help book adapted to the target cultural context. The programme is structured into five sessions of two hours each, covering information and practical exercises for stress management. In Türkiye, the intervention was implemented among Syrian refugees experiencing psychological distress. Local non-governmental organisations working with refugee communities identified and recruited participants.
The programme was evaluated through a two‑arm, assessor-masked randomised controlled trial. In the treatment group, 322 participants received the Self-Help Plus Programme combined with enhanced care as usual, while the control group of 620 received enhanced care as usual only. Six months after completion, participants in the Self-Help Plus group were significantly less likely to meet diagnostic criteria for a mental disorder, including major depressive and anxiety disorders. Specifically, 40.7% of the control group met these criteria compared to 21.7% of Self-Help Plus participants. Although prevalence remained high, these findings indicate that preventive psychological interventions requiring relatively few resources can effectively reduce mental health risks among refugees. Self-Help Plus can therefore be considered a promising approach to preventing mental ill health in refugee populations.
Digital delivery models are increasingly recognised as a viable alternative to traditional in-person approaches for psychological interventions. Evidence indicates that psychological interventions delivered via telephone or web-based platforms can be as effective as those provided face to face (Castro et al., 2020[60]; Cowpertwait and Clarke, 2013[61]). These delivery modes became particularly widespread during the COVID‑19 pandemic, offering flexibility by removing the need for geographical proximity and reducing the costs and resources typically associated with psychosocial interventions, which are often time‑ and resource‑intensive (Witteveen et al., 2022[62]).
Leveraging frontline actors, such as teachers and social workers, to deliver psychosocial interventions has also proved effective and appropriate across diverse contexts (Arnold et al., 2022[63]). Psychological interventions are beneficial for both prevention and treatment of mental ill health, with emerging evidence suggesting that preventive approaches may be more cost-effective than care as usual (Moreno-Perel et al., 2017[64]; Conejo-Ceron et al., 2021[65]). Over the past two decades, research on psychological interventions has expanded substantially, creating new opportunities to implement approaches that are more cost-effective and accessible.
Cognitive behavioural therapy
CBT is a psychological intervention widely recognised for its effectiveness in preventing and treating a range of mental health conditions, including depression, generalised anxiety disorder, panic disorder and post-traumatic stress disorder (Butler et al., 2006[66]). CBT has a strong evidence base and is often considered the current “gold standard” in psychological treatment (David, Critsea and Hofmann, 2018[67]; Fordham et al., 2021[68]). It is the most extensively researched psychological therapy for depression and is recommended as a first-line intervention in most treatment guidelines (Cuijpers et al., 2023[52]). CBT encompasses a set of targeted strategies designed to modify thinking and behavioural patterns that contribute to negative emotions and maladaptive behaviours (David, Critsea and Hofmann, 2018[67]; Gaudiano, 2008[69]). Examples include:
Problem-solving therapy is a cognitive behavioural approach based on the premise that symptoms often stem from ineffective coping strategies. It helps individuals understand the role of emotions and develop more adaptive strategies (Nezu, Nezu and D’Zurilla, 2012[70]).
Dialectic behaviour therapy was originally developed for individuals at high risk of suicide. This talking therapy aims to help patients “build a life worth living” by developing new skills and coping strategies to replace maladaptive behaviours (Chapman, 2006[71]).
Meta-cognitive therapy is based on the principle that psychological disorders can result from perseverative thinking patterns, known as cognitive attentional dysfunction, including worry, rumination and threat monitoring. Treatment focusses on identifying and modifying these patterns through dialogue and behavioural experiments (Normann and Morina, 2018[72]).
Evidence suggests that CBT may be slightly more effective than other psychological therapies, although some argue that this difference is small or reflects the substantially larger evidence base for CBT compared to alternative approaches (Leichsenring and Steinert, 2017[73]; Cuijpers et al., 2023[52]). CBT also appears to have a similar short-term effect size to pharmacotherapy but demonstrates greater effectiveness at six‑ to twelve‑month follow-ups (Cuijpers et al., 2023[52]). Like other psychological therapies, CBT is effective across a wide range of settings and delivery modes, including PHC, school and workplace settings (Linde et al., 2015[74])). Its efficacy is maintained whether delivered face to face, by telephone or online, and whether aimed at prevention or treatment of mental ill health (Box 4.6).
CBT has long been a cornerstone of mental health treatment in PHC settings in the United Kingdom, supported by substantial investment from the National Health Service in recent years (NHS England, 2019[75]). Major reforms have expanded access to talking therapies under the Five Year Forward View for Mental Health (NHS England, 2016[76]) and the NHS Mental Health Implementation Plan (NHS England, 2019[75]). Since 2016, the number of adults accessing talking therapies on the National Health Service has increased by 11% (NHS England, 2024[77]).
In line with efforts to improve accessibility, the National Institute for Health and Care Research has funded the INTERACT Programme through its Programme Grants for Applied Research (Tallon et al., 2023[78]). This eight‑year initiative is testing a new CBT delivery model that integrates online CBT materials with high-intensity, therapist-led sessions delivered remotely and in real time. The approach aims to reduce costs and improve access for individuals with depression, including those facing barriers related to geography, work or caregiving responsibilities. Patients are recruited from PHC settings across the United Kingdom. The intervention begins with an in-person session, followed by real-time CBT delivered via instant messaging at scheduled appointments (Wiles, 2023[79]). Participants also receive supplementary materials and access to online tools and devices. The INTERACT Programme is ongoing and is being evaluated for both clinical efficacy and cost-effectiveness.
Pharmaceutical interventions
Pharmacological interventions remain a long-standing and essential component of mental health treatment. These include antidepressants for depressive disorders, diazepam for generalised anxiety disorder and methadone or buprenorphine for substance use disorders (WHO, 2009[80]). By design, pharmacological treatments are primarily suited to managing mental ill health rather than promoting mental well-being or preventing disorders. Their delivery is most appropriate in PHC or other clinical settings, given the need for prescription by a qualified health professional (Lam et al., 2022[81]). In recent years, prescribing practices have also increasingly incorporated telehealth and web-based channels, a trend accelerated by the COVID‑19 pandemic. While these modalities have improved access and proved effective, they may also exacerbate inequalities across demographic groups (Link et al., 2023[82]; McBain et al., 2023[83]).
Despite growing research and utilisation of non-pharmaceutical treatments over the past decade, pharmacological interventions remain among the most widely used approaches for mental ill health (Chen, Lee and Wang, 2023[84]). Antidepressants are the most frequently prescribed treatment for major depressive disorder (OECD, 2023[85]). Consumption of this category of medicines increased by over 40% in OECD countries between 2013 and 2023, and more than doubled in Chile, Estonia, Korea and Latvia (Figure 4.4). However, available data do not clarify whether this increase reflects changes in prescribing practices (such as longer treatment courses or higher dosages), a higher rate of individual prescriptions or both (Cipriana et al., 2018[86]; Chen et al., 2022[87]).
Note: DDD is defined daily dose.
Source: OECD (2023[85]), Health at a Glance 2023: OECD Indicators, https://doi.org/10.1787/7a7afb35-en.
Identifying the most appropriate treatment for each patient is critical to achieving optimal outcomes, including for pharmacological approaches (Ray et al., 2018[88]). Pharmacological treatments are effective for a wide range of mental health conditions and, in some contexts, represent the most suitable and effective option. For example, in the treatment of substance use disorders, pharmacological treatment plays a critical role in managing acute withdrawal, reducing cravings and urges to use illicit substances, and preventing relapse. In many cases, these treatments are recommended as first-line therapy (Maqbool et al., 2019[89]). Conversely, evidence suggests that for certain conditions, such as mild to moderate major depressive disorders, psychological interventions can be equally or more effective than pharmacological treatment (Chen et al., 2019[90]; Gartlehner et al., 2017[91]; Borwin et al., 2015[92]). Finally, in some cases, treatments combining pharmacotherapy and psychotherapy such as CBT offer the greatest benefits (Cuijpers, 2017[93]).
The effectiveness of mental health interventions varies according to multiple factors, including the condition being treated, severity, type of intervention, population characteristics and treatment duration, among others (Cheng et al., 2020[94]). This is especially important for pharmaceutical treatments, which may be associated with a range of side effects (Bousman et al., 2017[95]). Evidence shows that individuals who receive their preferred treatment, whether pharmacotherapy or psychotherapy, are twice as likely to complete therapy compared to those who do not, making treatment preference an important moderator of intervention effectiveness (Swift et al., 2021[96]).
Place of delivery is a vital factor in mental health interventions
The place of delivery is a critical element of any mental health intervention or policy. The setting influences not only the efficacy of an intervention but also its accessibility, uptake, coverage and adherence. National mental health strategies and action plans across OECD and EU countries emphasise the importance of implementing mental health promotion and protection measures beyond traditional health system settings – particularly in workplaces and schools, as highlighted in previous OECD work (OECD, 2021[2]).
As discussed in the remainder of this section, the WHO/OECD Mental Health Survey found that nearly four in five OECD and EU countries have been making progress on policies improving mental well-being across PHC, workplace and school settings. These efforts are essential to improving mental health early in the life course, and to ensuring timely identification and treatment of mental ill health. However, effective mental health strategies require a comprehensive, cross-sectoral approach that extends beyond schools and workplaces to include social services, long-term care, frontline actors such as paramedics and fire services, and employment and unemployment services (Box 4.7) (OECD, 2021[3]; OECD, 2022[97]; OECD, 2023[98]).
Beyond implementation in PHC, school and workplace settings, mental health policy plays a critical role in social services, including social protection systems and employment services. For example, between one‑third and one‑half of all unemployment benefit recipients experience mental health conditions, with risks increasing during prolonged periods of social assistance (OECD, 2021[2]). This underscores the strong link between joblessness and mental health, a relationship well documented over the past decade (Paul and Moser, 2009[99]). Yet mild to moderate mental health issues among benefit recipients remain insufficiently acknowledged and rarely integrated into policy in most OECD countries (OECD, 2021[2]). Similarly, social protection systems, such as cash transfer programmes, offer valuable opportunities to deliver mental health promotion and protection interventions (Bauer et al., 2021[100]). However, implementation of such programmes remains limited across OECD countries, highlighting an important opportunity to test and evaluate policies within social services, such as employment and social protection, to strengthen the evidence base on effective approaches for preventing, identifying and treating mental ill health in these settings.
Primary healthcare settings
PHC is the front line of health services and a key entry point for mental healthcare. Strengthening mental health provision in PHC is essential to improving access, reducing treatment-related stigma and preventing the chronicity of mental illness (Wakida et al., 2018[101]). In 2004, WHO formally adopted the Alma-Ata model of PHC, designed to deliver comprehensive, universal, equitable and affordable health services (WHO, 2019[102]). Under this model, countries are encouraged to adapt mental health services to promote self-care, build informal community care, develop community-based mental health services and integrate mental healthcare into general hospitals (WHO, 2009[103]). These recommendations, along with guidance from WHO, OECD and other organisations, have driven significant progress in integrating mental health interventions into national PHC systems (OECD, 2021[3]).
The vast majority of OECD and EU countries surveyed by the WHO/OECD Mental Health Survey have been making progress on implementing mental ill health interventions in PHC settings (Figure 4.5). However, progress remains uneven: only 8 of the 42 countries have fully implemented a policy and another 27 countries are still in the implementation process. This reflects both the complexity of adapting mental health services within PHC and the need for sustained investment and capacity-building. Encouragingly, there is emerging global evidence and a growing consensus on the specific operational principles required to scale these services successfully, shifting the focus from whether integration is possible to how it can be achieved systematically (Box 4.8). A robust and expanding evidence base also demonstrates the cost-effectiveness of mental health policies and interventions delivered through PHC (Gilbody, Bower and Whitty, 2007[104]).
Notes: OECD countries are dark blue; EU Member States that are not OECD countries are light blue.
Source: WHO/OECD Mental Health Survey.
Despite PHC’s potential to deliver accessible, person‑centred mental health support, many systems continue to underutilise it for several reasons – including, for example, insufficient political commitment, fragmented services and inadequate financing.
A recent report by the WHO Regional Office for Europe identifies four mutually reinforcing strategies for scaled-up integration: enhancing mental health competencies of primary care workers through education and training; integrating dedicated mental health professionals into primary care teams; strengthening linkages between primary care and specialist mental health services; and fostering multisectoral collaboration to address social determinants of mental health (WHO Regional Office for Europe, 2025[105]). To realise these gains, policy levers must transition from isolated clinical adjustments to comprehensive structural reforms. This necessitates a formal commitment at the highest levels of government to ensure that mental health is prioritised within national health plans and legislative frameworks, underpinned by redistribution of human resources and sustainable financing mechanisms.
Successful implementation further requires a “matched” or “stepped” care model that aligns service intensity with patient needs, supported by a robust enabling environment. This environment must include continuous supervision, digital and physical infrastructure upgrades, and improved data collection to ensure policy coherence. By addressing these systemic foundations, health systems can reduce stigma and close the treatment gap through a holistic, people‑centred approach. Based on the main messages of the report, some strategic dimensions for action and operational priorities for achieving this transition can be identified (Table 4.2).
Source: WHO Regional Office for Europe (2025[105]), Scaling Up Mental Health Services Within the PHC Approach: Lessons from the WHO European Region, https://iris.who.int/handle/10665/381029.
PHC is the main setting for treating most mental disorders, rather than specialist services (Jetty et al., 2021[106]). Patients also tend to prefer receiving care in PHC settings (Dunn et al., 2021[107]). This preference reflects a combination of factors, including system dynamics, resource availability and patient characteristics, but evidence points to several key drivers: the flexibility and familiarity of PHC, lower costs, reduced stigma, greater comfort and faster access to care. For these reasons, PHC is widely regarded as a critical setting to reduce the burden of mental disorders by promoting awareness, enabling early detection and ensuring rapid access to appropriate treatment. This approach has become increasingly important as health systems face growing demand for mental health services (Fleury et al., 2012[108]; Cummings et al., 2023[109]).
Within PHC settings, CBT and other psychosocial interventions are effective in reducing symptoms of depression, anxiety and alcohol use disorder (Butler et al., 2006[66]). Research also indicates that many patients prefer psychosocial treatments over pharmacological options, which, while effective, can be associated with side effects not present in psychosocial approaches (McHugh et al., 2013[110]; WHO, 2009[103]). However, implementation of CBT and similar interventions in PHC remains limited due to resource constraints, lack of training and time pressures among frontline workers, as these interventions are often resource‑intensive (Weisberg et al., 2013[111]). Digital delivery models offer a promising solution: when provided online or via telehealth platforms, these interventions demonstrate comparable effectiveness to face‑to-face methods and can significantly reduce costs (Catarino et al., 2023[112]; Hoifodt et al., 2011[113]).
In addition to treatment-focussed interventions, several mental health promotion and prevention strategies have proved effective in PHC settings. Mental health literacy programmes, for example, have been shown to improve outcomes, including reducing symptoms of depression and anxiety (Magallón-Botaya et al., 2023[22]). Similarly, mindfulness-based and exercise‑based interventions have demonstrated positive impacts when delivered in PHC contexts (Zemberi, Ismail and Abdullah, 2020[114]; Tomlinson-Perez et al., 2022[115]; Demarzo et al., 2015[116]). Some experts advocate for greater use of exercise prescriptions, both as a preventive measure and as part of treatment for individuals living with mental illness (Reinhart, Keller and James, 2017[117]; Ashdown-Franks et al., 2020[118]). These approaches not only improve health outcomes for individuals but also help to reduce pressure on overstretched mental health services. Canada is among the countries that have tested models using single‑session interventions to improve timely access to mental healthcare within PHC settings (Box 4.9).
In Canada, demand for mental healthcare significantly exceeds the availability of services, a challenge further intensified by the COVID‑19 pandemic, which drove a sharp increase in service needs (Statistics Canada, 2018[119]; Marshall, Miller and Moritz, 2023[120]). Even before the pandemic, access was constrained: a 2020 study reported that, between 2014 and 2016, the median waiting time from physician referral to a first specialist appointment was 88 days, with one‑quarter of patients waiting more than 233 days (Liddy et al., 2020[121]). These delays are likely to have worsened in recent years, as 76% of PHC clinicians report seeing more patients with medical and emotional needs (Wong, 2020[122]). Extended waiting times are associated with poorer treatment outcomes and higher costs of care (Adu et al., 2024[123]; van Dijk et al., 2023[124]; Catarino et al., 2023[112]).
To address long waiting times for mental health services, a study in Quebec, Canada, examined the impact of a single‑session intervention delivered in a university family medicine group setting (Perreault, Breton and Berbiche, 2023[125]). The approach aimed to improve timely access to psychological care by offering a single 60‑minute session with a psychologist in a PHC context. A single‑session intervention was offered to patients deemed appropriate by a healthcare professional, excluding those in crisis (for example, experiencing suicidal or homicidal ideation). Unlike traditional models that automatically schedule 8‑12 sessions, a single‑session intervention treats the initial session as a complete intervention, with no planned follow-up. The goal is for patients to leave with a clear problem-solving plan and confidence in their ability to manage challenges, while knowing that they can return if needed. This model seeks to address psychosocial issues promptly, recognising that delays in care often lead to further deterioration in mental health. Evidence suggests that single‑session interventions can achieve outcomes only slightly less effective than multi-session interventions, while requiring substantially fewer resources and less time (Weisz et al., 2017[126]).
The introduction of the single‑session intervention produced notable results. Of the participants, 69 (91%) received an appointment within seven working days and the number of patients accessing psychological consultations was approximately seven times higher than under the traditional multi-session model (Perreault, Breton and Berbiche, 2023[125]). Measures of patient-perceived problem intensity and psychological distress showed statistically significant reductions immediately after the session. On a scale of 1 to 10, perceived problem intensity fell from an average of 7.8 before the session to 6.8 after. Psychological distress scores, measured using the Kessler Psychological Distress Scale, decreased from 13.6 to 8.8, with scores above 16 indicating severe mental disorder. These improvements were maintained at six‑ to eight‑week follow-up, although the study used a pre‑post design without a control group. Overall satisfaction was high (92.9%) and 51% of participants reported that one session was sufficient to address their concerns. These findings suggest that single‑session interventions can provide timely access to psychological support, help to prevent deterioration in mental health and offer a cost-effective option for integration into PHC models without adding pressure to already overstretched health systems.
School settings
Childhood and adolescence are pivotal stages for shaping life‑long mental health. Evidence shows that mental health during these periods strongly predicts outcomes later in life (Mulraney et al., 2021[127]; Schlack et al., 2021[128]). Even small increases in symptoms during adolescence are associated with a higher risk of mental health conditions in adulthood (Solmi et al., 2022[129]). For example, a longitudinal study in New Zealand found that individuals with subthreshold depressive symptoms or major depression at age 17‑18 were 2.4 times more likely to experience mental health problems at age 25 compared to those who were asymptomatic (Fergusson et al., 2005[130]). These findings underline the importance of early intervention: effective mental health strategies targeting children and adolescents can deliver long-term benefits that persist throughout the life course (McDaid, Hewlett and Park, 2017[131]).
Schools provide an important opportunity to deliver mental health interventions in a familiar environment for students. As adolescents spend a significant proportion of their time in school, this setting is particularly well suited for interventions aimed at preventing and treating mental ill health (Eccles and Roeser, 2011[132]). School-based programmes can also help to overcome common barriers to accessing care, such as cost, location and time constraints (Werner-Seidler et al., 2017[133]).
A growing body of systematic reviews and meta‑analyses confirms that school-based mental health interventions can improve mental well-being and support prevention and treatment of mental ill health. However, while effects are statistically significant, they are often modest in size. For example, a recent meta‑analysis of more than 45 000 participants found that school-based interventions led to average improvements of 1.23% for depression and 1.05% for anxiety, across both universal and targeted trials (Werner-Seidler et al., 2017[133]). Despite these relatively small effect sizes, such interventions could represent a valuable public health opportunity. Even minor improvements in mental health during childhood and adolescence can translate into substantial reductions in health and economic costs over the life course.
Most OECD and EU countries are moving towards wider adoption of school-based mental health interventions. In 2023, 30 out of 36 countries reported that they were in the process of implementing such programmes, while an additional five had already achieved full implementation (Figure 4.6). This trend reflects growing recognition of schools as a key setting for promoting mental health and improving access to early support.
Notes: OECD countries are dark blue; EU Member States that are not OECD countries are light blue.
Source: WHO/OECD Mental Health Survey.
Evidence shows that a variety of interventions can be effective in school and educational settings, including psychosocial education and skill-building programmes, mindfulness practices, exercise‑based activities, mental health literacy initiatives, and stigma-reduction strategies (Werner-Seidler et al., 2017[133]; Das et al., 2016[134]; Strøm et al., 2014[135]). Among these, CBT-based interventions demonstrate the strongest evidence for preventing depression and anxiety in young people (Hetrick, Cox and Merry, 2015[136]).
Both preventive and treatment-focussed interventions can be delivered in school settings, and there are indications that universal prevention programmes may be more commonly implemented than targeted or selective approaches (Horowitz et al., 2007[137]). Universal interventions are generally easier to implement, require fewer resources and carry less risk of stigmatising students compared to targeted programmes (Offord et al., 1998[138]). However, evidence suggests that targeted interventions tend to achieve larger effect sizes (Calear and Christensen, 2010[139]). Delivery mode also matters: interventions can be provided face to face, online or through blended approaches, with implications not only for effectiveness but also for implementation costs and cost-effectiveness (Clarke, Kuosmanen and Barry, 2015[140]). While delivery modes are found to affect intervention efficacy, they also have substantial implications for implementation costs and therefore for relative cost-effectiveness. Similarly, the choice of provider influences outcomes. Programmes delivered by medical professionals typically show greater impact than those implemented by teachers or school staff, although they are more resource‑intensive (Werner-Seidler et al., 2017[133]; Stallard et al., 2014[141]). Box 4.10 illustrates a successful example from Australia, where an intervention combined online materials with classroom learning to improve mental health literacy and teach strategies for identifying and managing symptoms of mental ill health.
Australia has implemented a universal, school-based intervention that provides evidence of a scalable prevention strategy targeting youth depression, anxiety and substance use (Birrell et al., 2018[142]). Known as the Climate Schools Combined Programme, the intervention applies cognitive behavioural principles to help students identify and manage problematic mental health symptoms. It is built on a social influence approach, presenting information in an engaging and age‑appropriate format for adolescents aged 13‑14. Delivery combines online learning with classroom activities to reinforce key messages. The Programme consists of 12 lessons of 40 minutes each, including a 20‑minute online cartoon component followed by a 20‑minute teacher-led activity. Teachers are supported by a hard-copy manual that provides implementation guidelines, links to the education syllabus and lesson summaries.
The Climate Schools Combined intervention was rolled out in 88 schools across Australia starting in 2014, reaching more than 6 300 students aged 13‑14 (grades 8 and 9). A randomised controlled trial found that, compared to the control group, students who participated in the Programme demonstrated greater knowledge of alcohol, cannabis and mental health (Teeson et al., 2020[143]). The Programme also reduced the growth in the odds of any drinking and heavy episodic drinking, and lowered symptoms of anxiety over a 30‑month period. After 30 months, the likelihood of being diagnosed with generalised anxiety disorder was 11.4% among students in the intervention group, compared to 15.4% in the control group. Similarly, the odds of developing depression were 15.2% for those receiving the intervention versus 19.6% for controls. These findings are promising and support the case for scaling up school-based interventions that combine evidence‑based techniques with engaging, age‑appropriate content.
Workplace settings
With nearly 60% of the global population engaged in work and around 15% of working-age adults living with a mental disorder at any given time, the workplace represents a critical setting for promoting mental health and providing support for mental ill health (WHO and ILO, 2022[144]; OECD, 2021[3]). As with schools, workplaces are environments where individuals spend a substantial portion of their time, making them well suited for interventions that protect mental health and help to identify those at risk (Rugulies et al., 2023[145]).
The economic impact of mental ill health is particularly pronounced among working populations, driven by costs associated with absenteeism, presenteeism and lost productivity (OECD, 2022[97]). Consequently, effective workplace mental health interventions have the potential to be not only cost-effective but also cost-saving, given the substantial economic returns that can result from improving mental health among the working-age population (de Oliveira et al., 2020[146]). Investments in health and well-being initiatives that boost productivity and reduce absenteeism can generate significant benefits for both employers and governments (OECD, 2022[97]). Reflecting this potential, intergovernmental organisations have published guidelines to support wider uptake and implementation of workplace‑based mental health interventions (WHO, 2022[147]; WHO and ILO, 2022[144]; OECD, 2021[3]).
While the majority of OECD countries (27 out of 38) have introduced some form of workplace mental health intervention (Figure 4.7), these measures remain relatively underutilised overall, despite evidence pointing to their potential effectiveness and cost-efficiency (OECD, 2021[2]). It is important to note, however, that these figures probably underestimate the full scope of activity, as many initiatives implemented by private companies and employers may not be captured by government reporting, and therefore remain unrecorded.
Notes: In contrast to the rest of questions collected by the WHO/OECD Mental Health Survey from 2023, only OECD countries were included in this question. As such, non-OECD EU countries are not captured in the analysis for workplace‑based interventions.
Source: WHO/OECD Mental Health Survey.
Recommendations from the OECD, WHO, International Labour Organization and others highlight a wide range of evidence‑based options for implementing workplace mental health interventions. While this breadth offers flexibility, it also makes it difficult to isolate the impact of individual intervention components, given the diversity of elements and outcomes assessed in the literature (Hesketh et al., 2020[148]). Nonetheless, several approaches have demonstrated clear benefits for health and economic outcomes, particularly when implemented at scale (Rugulies et al., 2023[145]). Specifically:
Physical activity and exercise‑based programmes, such as supervised training sessions or aerobic classes delivered once or more per week, are effective in reducing symptoms of depression and anxiety (Chu et al., 2014[149]; Christensen et al., 2016[150]).
Mindfulness and meditation interventions can improve mental health, although their impact on depression remains inconclusive (Lomas et al., 2018[151]).
Psychosocial interventions, including CBT, have proved effective in reducing symptoms of depression and anxiety, with no significant differences between delivery modes such as web-based, telephone or face‑to-face formats (de Oliveira et al., 2020[146]; Carolan, Harris and Cavanagh, 2017[55]).
Stigma-reduction interventions show more limited evidence: while they appear to improve mental health knowledge in the workplace, it remains unclear whether these improvements lead to greater help-seeking or better mental health outcomes (Hanisch et al., 2016[152]).
Box 4.11 provides an example of a successful mental health literacy and stigma-reduction intervention trialled in the workplace.
As part of the Horizon 2020 Project funded by the European Commission, an online workplace mental health literacy and stigma-reduction intervention was piloted across nine economies: Albania, Australia, Finland, Germany, Hungary, Ireland, Kosovo, the Netherlands and Spain.
The initiative, known as the Mental Health Promotion and Intervention in Occupational Settings Programme, aims to improve mental well-being and reduce depression, anxiety and suicidal behaviour. Delivered through a hub online platform, the Programme provides psychoeducational materials, videos, audio clips and interactive exercises. It targets small (10‑50 employees) and medium-sized (50‑250 employees) enterprises and offers multilevel interventions: at the individual level (e.g. coping strategies), group level (e.g. peer support and de‑stigmatisation), supervisor level (to encourage help-seeking and address psychosocial risks) and organisational level (to promote positive work environments) (Arensman et al., 2022[153]).
A pilot study involving 25 organisations included 346 participants at baseline and 96 at six‑month follow-up (Tsantila et al., 2023[154]). Results showed significant improvements in mental well-being, reductions in anxiety symptoms, and decreases in personal stigmatising attitudes toward depression and anxiety among participants receiving the intervention.
In addition to interventions targeting individual workers, workplaces offer an important opportunity to implement organisation-level measures that address risk factors with the potential to have a negative effect on employees’ mental health (Cohen, 2017[155]). Such interventions can reduce psychosocial risks, including unsafe working environments, excessive working hours and insufficient financial or social protections (Rugulies, 2019[156]). These risks may have intensified in recent years as labour markets undergo rapid transformation – driven by technological change such as teleworking, automation and artificial intelligence – which was further accelerated by the COVID‑19 pandemic (ILO, 2020[157]). While individual-level interventions have been studied more extensively, there is evidence that organisation-level approaches, such as increasing flexibility or promoting employee participation, can have positive mental health effects (Harvey et al., 2014[158]). Some countries have also introduced formal protections for workers’ mental well-being. For example, France (2016), Spain (2017) and Ontario, Canada (2022) have enacted legislation granting employees the “right to disconnect” from work-related communications outside working hours and during holidays (Lerouge and Pons, 2022[159]; Fricke, 2023[160]).
The intervention delivery mode plays a key role
Over the past decade, the growing availability and adoption of internet-enabled technologies has created significant opportunities to improve healthcare accessibility, responsiveness and efficiency, while reducing costs and environmental impact. Widespread use of personal computers, tablets, smartphones and other connected devices has driven rapid growth in the delivery of health services through phone‑based and web-based platforms, including mental healthcare. This trend accelerated sharply during the COVID‑19 pandemic, as digital solutions facilitated continuity of care while minimising physical contact and reducing transmission risks (Jayawardana and Gannon, 2020[161]). Alongside this expansion, research has shown that telehealth approaches can be as effective as traditional face‑to-face delivery models.
In 2023, more than half (58%) of OECD and EU countries reported having fully or partially implemented policies and programmes to support the integration of digital technologies into mental healthcare delivery (Figure 4.8).
Notes: OECD countries are dark blue; EU Member States that are not OECD countries are light blue.
Source: WHO/OECD Mental Health Survey.
Digital technologies and telehealth have the potential to reduce the costs associated with traditional models of care significantly. Interventions well suited to online or telephone delivery, such as psychotherapy and mindfulness-based programmes, can be provided at lower cost through web-based platforms, given their reduced time and resource requirements (Kählke et al., 2022[162]). These technologies have also enabled new approaches to mental health promotion and treatment, including self-guided mobile applications, which have grown increasingly popular in recent years (Chandrashekar, 2018[163]). With strong evidence and considerable potential for cost-effectiveness, these delivery models offer an important opportunity to expand mental health prevention and care across diverse settings, supporting early intervention and ongoing management throughout the life course.
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