A new WHO roadmap for mental health policy reform

Mental health systems across the world remain in urgent need of reform. Despite decades of advocacy and a growing body of evidence highlighting the harmful effects of institutionalization, this persists – not only in large psychiatric hospitals but also in smaller community services that retain an institutional character ¹ . High‐quality community‐based services are scarce, waiting lists are unacceptably long, and rights‐based, person‐centered, recovery‐oriented interventions – though evidence‐based – have yet to be meaningfully integrated into policy or practice ² . Mental health services too often remain focused on diagnosis and medication ² , ³ . Coercive practices – including seclusion, restraint, and involuntary admission and treatment – continue to harm people, discourage help‐seeking, and violate basic human rights ⁴ , ⁵ . Meanwhile, poverty, discrimination, conflicts, the climate crisis, and social exclusion deeply shape mental health, and tackling these root causes must be central to both policy and service delivery ⁶ .

Nonetheless, resources remain inadequate. Public spending on mental health is critically low, with a global median of just 2% of government health budgets – much of it still directed toward large institutions associated with human rights violations ⁷ . However, increased funding alone will not be enough. It is equally important to change the paradigm of care towards a holistic, rights‐based approach that treats each person as an individual with unique needs, aspirations and strengths. Only by pairing substantial new resources with policy reforms that emphasize dignity, autonomy, and social inclusion can we realize the full potential of mental health services that truly serve people and communities.

Reforming mental health systems cannot be the responsibility of the health sector alone. A comprehensive, cross‐sectoral response is essential, one that integrates across housing, education, employment, justice, social protection and beyond. However, many countries still lack robust national policies and strategic action plans reflecting this interconnected reality. Although governments have pledged progress through United Nations (UN) resolutions, international conventions, and global and regional World Health Organization (WHO) action plans, national frameworks remain fragmented and insufficient ⁷ .

Against this backdrop, the WHO has released a Guidance on Mental Health Policy and Strategic Action Plans ⁸ . Aligned with the UN Convention on the Rights of Persons with Disabilities ⁹ , the Guidance provides a comprehensive, modular framework to support the development or revision of national mental health policies in line with the latest evidence and international human rights standards.

The release of this Guidance is both timely and essential. Countries across the globe are facing a dramatic rise in mental health needs, fueled by economic instability, the climate crisis, armed conflicts, global health threats such as the COVID‐19 pandemic, and other emergencies. These converging challenges are exacerbating poverty, food insecurity, and inequality – particularly in low‐ and middle‐income countries – and placing additional strain on the mental health of populations already at risk.

The WHO Guidance is organized into five modules, each addressing a critical component of modern mental health policy. The first module introduces the Guidance by outlining the urgent policy challenges that must be addressed, including chronic underinvestment, overreliance on institutional care, limited stakeholder engagement, widespread human rights violations, and failure to address the social and structural determinants of mental health.

The second module identifies five key policy areas requiring urgent reform: leadership, governance, and enabling conditions; service organization and development; workforce and human resource development; person‐centered, recovery‐oriented, rights‐based interventions; and the mental health sector's role in addressing the social and structural determinants of mental health and broader societal issues. For each area, the Guidance offers a flexible menu of directives, strategies and actions, that can be tailored to suit national priorities, resource levels, and system structures.

The third module outlines a process‐oriented roadmap for selecting and implementing policy actions, detailing nine adaptable steps to support the development, implementation and evaluation of mental health policies and strategic action plans. This module also emphasizes the importance of participatory processes that meaningfully involve all key stakeholders – especially people with lived experience. It includes two checklists to help countries both develop and evaluate the content and the process of their policies and strategic action plans.

The fourth module presents three illustrative country case scenarios, demonstrating how countries with varying income levels and systems capacities can tailor the Guidance to their unique contexts and available resources.

Finally, the fifth module compiles a consolidated directory of all recommended policy options and strategies, designed as a practical reference tool to support policy dialogue and decision‐making.

This Guidance is vital for a broad spectrum of stakeholders: policy makers and planners, health and mental health professionals, researchers, civil society organizations, community leaders and, notably, people with lived experience of mental health conditions. Different groups can apply the Guidance in multiple ways: policy makers and planners can use it to systematically review policies, identify gaps, align strategies with evidence and rights obligations, and tailor policy reforms to local contexts; service providers can draw on its person‐centered, recovery‐oriented directives to design and continuously improve quality of care; researchers can lead the development of new evidence and evaluation frameworks, using the Guidance to inform research priorities and shape methodologies; civil society and advocacy groups can employ its tools to foster collaborative dialogue and drive policy change; and people with lived experience can leverage it to build knowledge, support advocacy efforts, and ensure their meaningful participation in decision‐making processes.

In light of many entrenched shortcomings in mental health systems and practice worldwide, this WHO Guidance bridges the gap between recognizing systemic failures and implementing context‐sensitive policy reforms that redirect resources from coercive, institutional models toward holistic, community‐driven care. It supports safe and strategic deinstitutionalization, the development of high‐quality community‐based services, and the elimination of coercion, abuse and neglect through rights‐based approaches that uphold dignity and autonomy. It promotes care models that integrate responses to social and structural determinants (such as housing, education and employment), champion recognition of legal capacity and decision‐making rights for service users, and empower people with lived experience to co‐create policies and lead anti‐stigma efforts. By broadening access to physical health, lifestyle, psychological, social and economic supports, the document moves policy beyond an overemphasis on biomedical treatment. Far from a one‐size‐fits‐all blueprint, it encourages countries to select and adapt strategies aligned with their unique priorities and constraints, while progressively working toward more ambitious policy reforms.

We urge governments, mental health providers and their professional bodies, academia, civil society organizations and donor agencies to embed this Guidance in forthcoming mental health strategies, shift funding from institutional beds to community supports, legislate for full legal capacity, and ensure meaningful participation of people with lived experience at every stage of reform. Business as usual is no longer acceptable; with these tools now available, the path toward equitable, rights‐based, and effective mental‐health systems is clearer than ever.