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 wanted 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.

The OECD reaches the same conclusion in its 2026 report “Economic Case for Preventing Mental Ill Health”: clinical interventions cannot counteract the factors that give rise to mental ill health in the first place. More investment in services is needed, but on its own it treats the symptoms rather than the causes. What is needed is a shift from asking people to cope better to changing the conditions they live in.

What “Mental Health in All Policies” means

The idea is not new. The Ottawa Charter of 1986 described health as something “created and lived by people within the settings of their everyday life; where they learn, work, play and love.” It made “building healthy public policy” the first of its five action areas and asked decision-makers in every sector to consider the health consequences of their decisions.

In 2013, the Helsinki Statement turned this into Health in All Policies: an approach in which every sector considers how its decisions affect health, seeks gains that serve both health and its own goals, and avoids causing harm. Mental Health in All Policies applies the same approach to mental health and well-being.

In practice, it asks four questions of any policy:

• Determinants: How will this decision affect the conditions people need to stay mentally well, such as income, housing, work and social contact?
• Equity: Will it narrow or widen the gaps between groups, both in who becomes unwell and in who gets help?
• Opportunity: What can better mental health give back to this sector, such as better learning, higher productivity or safer communities?
• Accountability: Once the policy is in place, who is responsible for its effects on mental health?

This is not about the health sector asking other ministries for favours. It is about results every sector already cares about. Mentally healthy children learn better. Employees who are mentally well take fewer sick days.

Even a finance ministry should have a direct interest: poor mental health means lost working time, lower tax revenue and higher social costs. Because both the causes and the costs reach across so many ministries, no single ministry can deal with mental health alone. It needs a whole-of-government approach, led by the prime minister’s office, not just the health minister.

Why good intentions stall

Health in All Policies has been endorsed for decades but implemented unevenly. The reasons are familiar: separate budgets and lines of accountability, political cycles far shorter than the time it takes for results to show, evidence that is hard to link to any single decision, and commercial interests that push the other way.

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 from the top, ideally written into law
• framing around goals the other sector already has, so that cooperation feels like a shared gain rather than a demand from health.
• people whose job is to broker work across ministries, so it does not fade when a champion moves on
• shared data and indicators
• 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 turns what has been tested into policy advice s that national and regional decision-makers can use.

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

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Further reading

• Interreg BSR. New project platform boosts cooperation for better mental health
• World Mental Health Day 2026
• WHO (2025): Over a billion people living with mental health conditions
• OECD (2026), The Economic Case for Preventing Mental Ill Health, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/16668f16-en.