Ask most people where mental health is looked after, and they will point to a clinic, a counsellor or a helpline. Those matter. But most of what decides whether a person stays well happens far from any of them: in the rent they pay, the job they hold or lose, the school their child attends, the street they walk home on, the screen they look at before sleep.

This World Mental Health Day, 10 October, we want to make a simple point. Mental health is made, or worn down, by decisions taken in every ministry and every town hall. If we want more of it, we can’t leave health to the health sector alone.

This year’s theme from the World Federation for Mental Health, Lived Experiences Heard: Real Voices, Real Change, fits that argument well. People who live with mental health conditions know better than anyone how housing, debt, work and stigma shape their recovery. Their voices belong in those policy rooms too.

More than a billion people, and most of the causes sit outside health

In September 2025, the World Health Organization reported that over a billion people worldwide live with a mental health condition and called for services to be scaled up urgently. They should be. But no health system can treat its way out of a problem on that scale.

Look at what drives mental ill-health: income and debt, insecure work, poor housing, pressure at school, discrimination, violence, loneliness, climate anxiety, and digital environments built to hold our attention. Almost none of these are run by health ministries. They belong to finance, labour, education, housing, justice, environment and digital policy.

Public health learned this lesson long ago. The Ottawa Charter of 1986 already named “building healthy public policy” as the first of its five action areas. Tobacco is the classic case: leaflets and quit lines helped, but taxes, smoke-free laws and advertising bans did far more, and they reached everyone rather than mainly the better-off. Mental health now needs the same shift, from asking individuals to cope better to changing the conditions they live in.

What “mental health in all policies” means

The idea builds on Health in All Policies, which the 2013 Helsinki Statement defined as taking the health effects of decisions into account systematically, across sectors, looking for shared gains and avoiding harm. Mental Health in All Policies applies the same thinking to mental health and well-being.

In practice it asks four things of any policy:

• Determinants: how does this decision affect the conditions people need to stay mentally well?
• Equity: does it narrow or widen the gaps in who gets ill and who gets help?
• Opportunity: what does good mental health give back to this sector, in learning, productivity or safer communities?
• Accountability: who answers for the mental health effects once the policy is in place?

The third question is the one that makes the approach work. It is not about the health sector asking other ministries for favours. Children who are well learn better. Workers who are well take fewer sick days. A finance ministry does not have to care about mental health for its own sake to see the return.

Why good intentions stall

Health in All Policies has been endorsed for decades and implemented unevenly. The reasons are familiar: separate budgets and lines of accountability, political cycles far shorter than the time it takes for outcomes to show, thin evidence that is hard to attribute to any one decision, and commercial interests that push the other way. Other sectors are also wary of what they see as health trying to run their agenda.

Mental health adds hurdles of its own. Stigma is still real. Population data on mental well-being is weaker than for physical health. And there is a stubborn reflex that mental health simply means psychiatric services.

What helps is also well known. A clear political mandate, ideally written into law, as in Norway’s Public Health Act or Wales’s Well-being of Future Generations Act. People whose job it is to broker work across ministries, so it does not fade when a champion moves on. Shared data and indicators. Framing around goals the other sector already has. And a few early joint wins to build trust.

To that list we would add one more: involve people with lived experience from the start. They spot the side effects of a policy long before an evaluation does.

From projects to policy in the Baltic Sea Region

In the Baltic Sea Region, we are working to make this practical. The Baltic Sea Mental Health Platform, funded by the Interreg Baltic Sea Region Programme and led by the NDPHS Secretariat, brings together results from more than a dozen Interreg and EU-funded projects, from arts on prescription to school and workplace programmes.

With Odense Municipality, Poznań University of Life Sciences, the International Sport and Culture Association and the Estonian Coalition for Mental Health and Well-being, the platform turns what has been tested in schools, workplaces and communities into recommendations that national and regional decision-makers can use. It runs until June 2028.

For regional cooperation, this means that good practice no longer has to end when a project does: what works in one city or country can be adapted in another, and governments can learn from each other’s policy choices. As coordinator of Policy Area Health in the EU Strategy for the Baltic Sea Region, the NDPHS links these results to the wider Strategy and to ministries in partner countries, so tested approaches reach the people who make policy.

One question for every decision

On World Mental Health Day it is tempting to talk only about awareness and services. Both matter. But the most useful thing a government can do is quieter: make it routine, in every ministry, to ask what a decision will do to people’s mental health, and to ask the people most affected before it is made.

A housing plan, a school reform, a change to benefits or bus routes. Each one is also a mental health policy, whether anyone calls it that or not. The question is only whether we notice in time.

Ülla-Karin Nurm, 

Director of the NDPHS Secretariat, Policy Area Health Coordinator, EUSBSR

———————-

Further reading

• Interreg Baltic Sea Region. New project platform boosts cooperation for better mental health
• World Federation for Mental Health: World Mental Health Day 2026
• WHO (2025): Over a billion people living with mental health conditions