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Mental disorders, such as depression, anxiety, and substance use disorders, impose an enormous global disease burden1 that leads to premature mortality and aff ects functioning and quality of life. If left untreated, mental disorders can result in worse treatment adherence and outcomes for commonly co-occurring diseases, such as tuberculosis, diabetes, cardiovascular disease, and cancer.2 Yet parity between mental and physical health conditions remains a distant ideal. Poor mental health also impacts on economic development through lost production and consumption opportunities at both the individual and societal level.3,4 Unfolding tragedies, such as the confl ict in Syria, displaced populations in Colombia, the burgeoning refugee crisis in the Middle East and Europe, and reconstruction eff orts after natural disasters in Japan and Nepal or disease outbreaks such as Ebola virus in west Africa, compound mental health needs of aff ected populations. But the mental health aspect of these crises is often overlooked.

To highlight the scale of these issues, and the gains from addressing them, the World Bank Group and WHO co-hosted the Out of the Shadows: Making Mental Health a Global Priority meeting in April, 2016. This event aimed to put the mental health agenda at the centre of global health and development priorities by spurring eff orts to: increase awareness about mental health as a development challenge and the associated economic and social costs of inaction; debate the economic and social benefi ts of investing in mental health; and identify ways for stakeholders to act across sectors.

Jim Yong Kim, President of the World Bank Group, and Margaret Chan, Director-General of WHO, along with other leaders,5 called for a collaborative response to tackle mental health as a development challenge by pursuing multidisciplinary approaches that encompass integrated health services at the community level, in schools and in workplace programmes, and initiatives to address the mental health and psychosocial needs of displaced populations. Funding is needed to build upon social protection and employment schemes that facilitate the reintegration of aff ected persons back into their communities.

New pledges were made and existing commitments to mental health were reaffi rmed. The World Bank stated its intention to incorporate mental health

into its programmes and activities across sectors, including health, education, social protection, fragility, emergencies and reconstruction, and confl ict and violence. This support included a commitment to champion mental health parity in the provision of health services, as part of its programmes to support the realisation of universal health coverage.6

Complementing these commitments, WHO announced its continued commitment to support and monitor implementation of the Mental Health Gap Action Plan (mhGAP),7 which aims to scale up mental health services in low-income and middle-income countries. WHO also announced that the next WHO-led World Health Day in April, 2017, will be devoted to depression and suicide.

The business sector committed to working towards a more supportive work environment. A promising initiative is the seven-step guide to workplace mental health, developed by the World Economic Forum’s Global Agenda Council on Mental Health.8 Another focus was the contribution of business to mental health in the development of new technologies, such as mHealth, that can help improve access to care and reach vulnerable populations.6

Researchers committed to generating evidence and pioneering new approaches to address the challenges of mental health prevention, detection, and treatment. The Innovation Fair, co-organised by the Mental Health Innovation Network and funded by the Wellcome Trust with contributions from Grand Challenges Canada and the US National Institute of Mental Health, off ered many innovative approaches in mental health that can be used at scale and implemented in low-resource settings, even in the context of fragility and confl ict. As a key next step in generating new evidence and advancing research, the Global Alliance for Chronic Diseases announced the launching of a US$50 million call on research into mental health (including dementia).9

The intergovernmental forum Asia Pacifi c Economic Cooperation (APEC) also committed to prioritise mental health through full implementation of the APEC Roadmap to Promote Mental Wellness in a Healthy Asia Pacifi c10 and the launch and growth of the APEC Digital Hub for Best and Innovative Practices in Mental Health Partnerships.

Non-governmental organisations presented new collaborative initiatives for mental health advocacy

Time for mental health to come out of the shadows

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and support. Two new platforms were launched to bring organisations together under the banner of mental health: mhNOW and an NGO call for action #NGOs4mentalhealth. Both call on development partners to support their eff orts by integrating mental health into existing programmes and building capacity for mental health, in collaboration with people living with mental health problems and their carers.

The cross-cutting nature of mental health issues, and the need to integrate mental health services into general health systems as part of the progressive realisation of universal health coverage, were consistent themes advocated by policy makers and politicians throughout the event. Alongside the inclusion and scale-up of essential mental health services as part of national health insurance benefi t packages, a number of other key entry points for integrating mental health into related programmes were recommended, including maternal and child health programmes, workplace health and wellness programmes, and as part of rescue and reconstruction work in confl ict and humanitarian settings.

The economic impact of mental health on individuals and society is a major global challenge for development. The global economy loses about $1 trillion every year in productivity due to depression and anxiety.11 However, the return on investment for mental health innovations, and specifi cally the fi nding that every $1 invested in treatment for depression and anxiety can lead to a $4 return in better health, was a key take-home message of the meeting.11 Ministers of Finance reacted to this situation by calling for global action. Canada’s Finance Minister William Francis Morneau made a commitment to support mental health across health, corporate, housing, education, and justice sectors, and set an inspiring example for others to follow. Ethiopia’s Minister of Health, Kesetebirhan Admasu, promoted the idea of a national mental health trust fund. Alternative sustainable funding models were also put forward, such as Canada’s RISE Asset Development, which lends at low interest rates to people with a history of mental health and addiction challenges. There is still a long way to go to promote investment, resources, and accountability in the mental health sector.12,13 Next steps include enhanced international cooperation;14 the creation of private–public partnerships, specifi cally with technology companies; integration of mental health into other health and development sectors; and exploration of alternate models of mental health

fi nancing, such as the dedicated use of revenue from higher taxes on tobacco and alcohol.15 Each sector must keep the momentum going, and it is only by increasing collaboration and resources to make mental health a global development priority that progress will be made.

Arthur Kleinman, *Georgia Lockwood Estrin, Shamaila Usmani, Dan Chisholm, Patricio V Marquez, Tim G Evans, Shekhar Saxena Harvard University Asia Centre, Harvard University, Cambridge, MA, USA (AK); Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK (GLE, SU); Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland (DC, SS); and Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA (PVM, TGE) georgia.lockwood-estrin@lshtm.ac.uk

We declare no competing interests.

© 2016. World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved.

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10 APEC Life Sciences Innovation Forum, APEC Health Working Group. APEC roadmap to promote mental wellness in a healthy Asia Pacifi c (2014–2020). Beijing: 26th APEC Ministerial Meeting Beijing, 2014. http://mddb.apec.org/ Documents/2014/MM/AMM/14_amm_014.pdf (accessed May 25, 2016).

11 Chisholm D, Sweeny K, Sheehan P, et al. Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry 2016; 3: 415–24.

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13 WHO. Mental health atlas 2014. Geneva: World Health Organisation 2015. 14 Collins PY, Saxena S. Action on mental health needs global cooperation.

Nature 2016; 532: 25–27. 15 Marquez PV. Economic slowdown and fi nancial shocks: can tobacco tax

increases help? The World Bank Blogs, Feb 8, 2016. http://blogs.worldbank. org/voices/economic-slowdown-and-fi nancial-shocks-can-tobacco-tax- increases-help. (accessed May 18, 2016).