Building unified, resilient mental health systems in a diverse Europe

The World Health Organization's (WHO) report World Mental Health Today underscores a sobering reality: more than one billion people worldwide are currently living with mental health conditions.¹ The human suffering and economic costs are immense—depression and anxiety alone account for an estimated US$1 trillion in annual productivity losses each year. While some progress has been made, including reductions in suicide rates, the prevalence of depression, anxiety, and related disorders continues to rise.

Mental health systems remain chronically under-resourced. Large gaps in services, governance, research, and financing persist, especially in low-income countries. Even within existing mental health budgets, community-based care—the backbone of sustainable systems—receives little support. These inequities are important challenges for the Fourth High-level Meeting of the UN General Assembly on the prevention and control of Noncommunicable Diseases (NCDs) and the promotion of mental health and wellbeing on Sept 25, 2025, in New York.

Against this context, The Lancet Regional Health—Europe's Mental Health in Europe Series is both timely and essential. The Series not only maps the current state of mental health in the region but also provides important and concrete recommendations for future action.

From a service perspective, Barbui and colleagues review coverage and gaps in European adult mental health care.² Their findings highlight two urgent priorities. First, the striking diversity in mental health service provision and organization across the European Region. Second, and most crucially, the lack of standardized and consistent monitoring systems. Without robust longitudinal data, it is impossible to track progress or meaningfully compare outcomes across countries. Developing a European consensus on core indicators and harmonized monitoring systems is therefore essential.³ While implementation remains the responsibility of individual nations, international collaborations—including scientific associations, patient and family organizations, WHO, and the EU—can drive alignment. Initiatives such as the WHO/Europe Pan-European Mental Health Coalition (2021–2025) and the EU-supported jA ImpleMENTAL project are promising platforms; continuation and expansion of these kinds of initiatives are vital.^4,5

Complementing this, Winkler and colleagues focus on Central and Eastern Europe.⁶ Here, challenges are often more severe, but progress is real. Countries have shown resilience even in extreme adversity, exemplified by the remarkable reform efforts in Ukraine despite ongoing war. As highlighted in The Lancet Psychiatry Commission, Ukraine demonstrates how determined leadership, and international collaboration can accelerate transformation in mental health services, training, and research—true “building back better.⁷

Yet sustainable transformation depends on people. Europe faces a growing health workforce crisis. Although health and social care employ more workers today than ever—over 10% of EU jobs in 2022—shortages remain acute. Based on universal health coverage benchmarks, EU countries collectively lack 1.2 million doctors, nurses, and midwives.⁸ Beyond shortages, psychological distress among health care workers (HCWs) threatens system resilience. Burnout, absenteeism, and staff turnover are rising, driven by factors such as workplace aggression and workload pressures. Almeida-Meza and colleagues' contribution provides an in-depth analysis of HCW mental health and actionable solutions.⁹ These insights will be critical to inform policy, including pending outputs from the WHO Pan-European Mental Health Coalition's workforce research.

Children and young people are another urgent priority. Since the COVID-19 pandemic, concerns about a youth mental health crisis have intensified. The OECD has identified best practices to address these challenges, but implementation lags.¹⁰ In this Series, Tarasenko and colleagues present a comprehensive assessment of youth mental health across the WHO European Region.¹¹ Their findings are unsettling—pointing to widespread needs and long-term risks—but also hopeful, offering concrete, evidence-based interventions that can be scaled.

The European Union's motto, “United in Diversity,” also describes its mental health systems: marked by diversity, but requiring unity in solutions. As this Series demonstrates, the region is rich in ideas and committed to progress. Yet reform cannot be achieved without adequate investment. Despite recent initiatives, including the European Commission's Communication on a comprehensive approach to mental health allocating €1.23 billion, national spending on mental health remains too low. On average, only 4.5% of health budgets in Europe go to mental health—far below the burden it represents. Prevention receives only a fraction of this.

This is one aspect the articles in this Series do not approach. Indeed, it would be extremely helpful to have a cost-economic analyses of the interventions proposed in the different contributions. A well-thought through health-economic plan and assessment is essential to help countries when making difficult decisions in resource allocation.

Scientific evidence, creative strategies, and strong collaborations will move the field forward, but structural underfunding remains the greatest barrier. In today's complex geopolitical environment, resource allocation is a societal decision as much as a technical one. The forthcoming UN High-Level Meeting must provide not only recognition but also guidance on how to prioritize mental health in national and global agendas.

This Series shows that solutions exist. What is needed now is the political will—and the funding—to implement them.

Contributors

All authors (GD, MD & IG) contributed equally to: reading of the articles of this series, the development of ideas, synthesising in view of the commentary, GD wrote first draft corrected and approved by other authors.

Declaration of interests

No conflict of interest.