Executive summary
Mental health plays a central role in people’s lives and is intrinsically tied to many other aspects of people’s wider well-being. The COVID-19 pandemic brought renewed attention to its importance, as direct health impacts and lost lives combined with social isolation, loss of work and financial insecurity all contributed to a significant worsening of people’s mental health. In the meantime, new threats to mental health, such as the cost-of-living crisis and climate change, have emerged or become more salient. Already well before 2020, it was estimated that half of the population will experience a mental health condition at least once in their lifetime and the economic costs of mental ill-health amounted to more than 4% of GDP annually. On the other hand, positive mental health, or having high levels of emotional and psychological well-being, is increasingly being recognised as a policy target in its own right by governments across the OECD.
Successful and people-centred strategies to promote good population mental health need to acknowledge that the ability to thrive depends on the broader living conditions experienced by individuals, families and communities. The recognition that these strategies hence need to involve a range of sectors across all of government is nothing new. Indeed, calls for comprehensive “health in all policies” approaches, which systematically integrate (mental) health considerations into policies across sectors, have been renewed at both national and international levels in recent years. Yet in practice, coalition-building with other sectors remains limited and often not implemented at scale. Some of the most commonly cited difficulties include the fact that inter-departmental task forces dealing with mental health are often time limited and lack decision-making power; furthermore, aspects such as accountability or plans for monitoring and evaluation of partnerships are often absent from high-level strategy documents, and resource constraints remain a challenge.
The OECD Well-being Framework has, for more than a decade, pioneered a multidimensional approach to measuring the outcomes that matter for people, the planet and future generations. Drawing on this conceptual framework and longstanding work of the organisation on integrated approaches to mental health, this report uses a “well-being lens” to underscore the reciprocal relationships between mental health and the outcomes typically under the responsibility of non-health government departments. Ultimately, recognising which policies under their mandate can or are already contributing to improving mental health as well as their own objectives can benefit the government’s broader policy goals, thus facilitating a move towards a “mental health for all policies” mindset.
Mental health shapes and is shaped by many aspects of life
Mapping the relationship between mental health and people’s economic, social, relational, civic and environmental experiences reveals that those with worse mental health outcomes also fare far worse in most other aspects of their well-being. For instance, compared to the general population, those at risk of mental distress are nearly twice as likely to be at the bottom of the income distribution, to be unemployed, or to be dissatisfied with the safety and availability of green spaces in their neighbourhoods. They are also more than twice as likely be unhappy with how they spend their time and to report low trust in other people, and their risk for feeling lonely is more than four times higher. Conversely, protective factors – such as being financially secure, being in good physical health, living in a safe and clean living environment, and having healthy social relationships – can provide resilience against poor mental health outcomes and support good emotional and psychological well-being.
Policies can deliver mental health and well-being co-benefits
There are several options for “win-win” policies that can jointly improve both mental health and other policy goals. Based on the evidence of the strong interlinkages between mental health and other well-being outcomes, and existing policy practices underway in OECD countries, this report identifies a range of illustrative examples of such co-benefits. More known practices cover aspects such as increased access to social assistance programmes, integrating mental health service provision into unemployment services, encouraging employers to prioritise mental health at work, or school-based interventions and the incorporation of social and emotional learning in curricula. More recent innovations for mental health promotion include the expansion of social prescribing programmes, the recognition of the value of unpaid work, interventions to tackle racism and discrimination, prioritising social connectedness as an explicit policy target, and accounting for the mental health costs of climate change (and the benefits of climate action).
Collaboration across stakeholders requires new ways of working
Successful implementation of such “win-win” policies across sectors requires adequate resources, incentives and working arrangements that enable all relevant stakeholders to contribute. This report also reviews selected mental health initiatives across OECD countries to demonstrate how policy makers have in practice been aligning action across government agencies; redesigning policy formulation to address the joint factors influencing mental health through impact evaluation; refocusing efforts towards the promotion of positive mental health; and connecting with societal stakeholders, including those with lived experience, youth, civil society and researchers.
Lessons learned first show the importance of clearly defining mental health goals (i.e. what it is that should be improved, and who can contribute), for instance through using multidimensional frameworks to point out interlinkages and establish coordination with other sectors; formulating concrete implementation plans; or explicitly monitoring positive mental health. Second, intersectoral collaboration and partnership building – be it between different government agencies, levels of government or when supporting community actors – take resources, including time, to do well, and can be supported by a move away from short-term project cycles. Third, strategic grantmaking seems to be a promising approach for allocating funds to mental health promoting activities, including at the local level, that do not traditionally fall under the remit of the health sector. Lastly, provisions for impact evaluations should be integrated into programme design from the outset to improve learning and build the evidence base on successful interventions.
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