Scaling up mental health services through the primary health care approach: implementation strategies from across the WHO European region

1️⃣ ANALYTICAL SUMMARY

A massive need, an still unequal response. About one in six people live with a mental disorder in the WHO European Region (over 150 million), and more than 120,000 deaths by suicide occur each year (p.1). Needs are increasing due to economic crises, conflicts, climate, digitisation, and ageing (p.1). Yet services remain underfunded — about 2% of health budgets — and concentrated in psychiatric hospitals, to the detriment of community and primary care (p.1). As a result: nearly one in three affected individuals does not receive the treatment they need (p.2). The document advocates for a shift towards community-based, person-centred models, rooted in primary care (p.1–2).

Four strategies and one organising principle. The text describes four strategies: strengthening the skills of primary care professionals; integrating dedicated mental health professionals into teams; consolidating links with specialists; opening partnerships towards education, social services, housing, employment (p.2–3). The common principle is stepped care (stepped/matched care) : the intensity of support adjusts to need, referral to the specialist only occurs if necessary (p.2). Implementation relies on five levers — training, human resources, material resources, funding, governance — supported by the fight against stigma and the monitoring of indicators (p.3–5).

2️⃣ KEY POINTS OF THE DOCUMENT

1️⃣ The principle of stepped care structures the four strategies. Low-intensity support is provided in a generalist setting whenever relevant, with escalation to the specialist only occurring when needed; this broadens rapid access while reducing avoidable recourse to specialist services or hospitalisation (p.2).

2️⃣ Four deployment strategies, illustrated by country examples. Strengthening the skills of primary care providers (Sweden: psychiatric training in residency, about one in five patients referred to the specialist); integrating dedicated professionals (Netherlands: mental health nurses almost systematically in general practice, via ‘attached’ or ‘co-located’ models); strengthening the interface with specialists (Bosnia-Herzegovina, Türkiye); opening to other sectors (Belgium, England) — p.2–3.

3️⃣ The interoperable shared medical record is a decisive factor for continuity. When the electronic record — ideally equipped with a mental health module — is routine, transitions between primary care, specialist, and community services are facilitated; otherwise, the burden of continuity falls on patients and caregivers, and structured models of referral/counter-referral with a named coordinator serve as a transitional solution (p.3).

4️⃣ Social prescription (social prescribing) bridges to non-clinical resources. In England, integrated ‘link workers’ in primary care connect people to housing, financial and social support; British studies, mostly uncontrolled, show consistent improvements in well-being, loneliness, and quality of life, but the level of controlled evidence remains limited (p.3).

5️⃣ A safety rule: do not screen faster than you can follow up. In accordance with the classic principles of screening (Wilson & Jungner, 1968), the document warns: expanding detection without the capacity for rapid and effective follow-up poses a risk; AI is framed with caution (evidence still rare, most mature uses limited to decision support, triage, and planning) — p.5–6.

3️⃣ ACTION POINTS FOR LOCAL ACTORS

1️⃣ Map community resources in the area (support groups, associations, sports and cultural activities, parenting schemes) and organise active referral to them, with social prescribing serving as a concrete linking mechanism (p.3).

2️⃣ Structure the primary care / specialist interface through regular joint meetings, shared care plans including somatic comorbidities, and joint training — based on the model described for Bosnia and Türkiye (p.3).

3️⃣ Establish, in the absence of an interoperable shared record, structured models of addressing and counter-addressing. with the appointment of a named pathway coordinator, to avoid placing the continuity burden on patients and their relatives (p.3).

4️⃣ Provide protected time and sustainable working conditions before expanding primary care missions: a team already saturated cannot absorb new functions; investing in supervision, peer support, and a safer working environment is part of the deployment, not an aside (p.3–4).

5️⃣ Base any expansion of detection on verified follow-up capacity : map in advance the access times to specialists and escalation pathways, to avoid opening screening beyond what the system can follow (p.5–6).

6️⃣ Integrate mental health into non-health policies (WHO-UNESCO health-promoting schools, housing, employment) through local networks or intersectoral bodies, based on the model of Belgian regional networks and Finnish task forces (p.3, p.5). Unmet need reported by the document: digital integration and support for informal caregivers are among the weakest implementation areas in the EU, Iceland, and Norway (p.4).

4️⃣ ADDITIONAL REFERENCES

🔍➕ For more information, see the articles referenced by "Health Practices" on the theme of mental and psychological health ➡️🔗https://pratiquesensante.odoo.com/en/4-2-sante-mentale-et-psychique

1. HAS — Multiannual programme "mental health and psychiatry" 2025-2030 (November 2024). National framework of HAS work (pathways, coordination between general practitioners / psychiatry, early detection, indicators). Verified URL : https://www.has-sante.fr/upload/docs/application/pdf/2025-02/programme_pluriannuel__sante_mentale_et_psychiatrie__2025-2030.pdf
2. DREES / National Suicide Observatory — "The deployment of first aid in mental health in France" (sheet 5, February 2025). Operational tool for citizen spotting (PSSM), linking with suicide prevention. Verified URL : https://drees.solidarites-sante.gouv.fr/sites/default/files/2025-02/Fiche%205%20-%20Le%20d%C3%A9ploiement%20du%20secourisme%20en%20sant%C3%A9%20mentale%20en%20France.pdf
3. Government — "Mental health, a major national cause" (2025, extended in 2026). National strategic framework: destigmatisation, prevention and early detection, gradation of pathways. Verified URL : https://www.sante.fr/actualites/la-sante-mentale-grande-cause-nationale

5️⃣ FREQUENTLY ASKED QUESTIONS (FAQ)

1️⃣ What are the four chosen strategies? Strengthening the mental health skills of primary care providers; integrating dedicated professionals into teams; strengthening links with specialists; opening partnerships with other sectors (p.2–3).

2️⃣ What is stepped care (stepped/matched care) ? A model where the intensity of help adjusts to need: low-intensity support in a generalist setting, escalating to a specialist only if necessary (p.2).

3️⃣ What role for the dedicated professional integrated into the team? Psychologists, psychiatrists, mental health nurses, social workers, peer supporters; two models — "attached" (part-time) or "co-located" (full-time). In the Netherlands, mental health nurses are almost systematically integrated into general practice (p.2–3).

4️⃣ How to improve the link with specialists without a shared electronic record? Through structured addressing and counter-addressing models and a named pathway coordinator, in a transitional solution; joint meetings and shared care plans consolidate the interface (p.3).

5️⃣ What does social prescribing bring? It connects people to non-clinical resources (housing, social and financial aids). British data shows consistent improvements in well-being and loneliness, but remains largely uncontrolled (p.3).

6️⃣ What levers are there to support deployment? Training (pre- and post-graduate, WHO mhGAP programme), human resources (protected time, sustainable workloads), material resources (electronic records, telemedicine, dedicated spaces), funding (incentives, reduction of out-of-pocket expenses), governance (intersectoral alignment) — p.3–5.

7️⃣ What is the position on artificial intelligence? Caution: evidence base still rare, especially for complex relational interventions. The most promising uses are limited to targeted tasks (decision support, triage, planning), subject to transparent evaluation and data governance (p.6).

6️⃣ REWRITING IN EASY TO READ LANGUAGE

What is this document about?

Many people have mental health problems. In Europe, it is about 1 in 6 people. Often, these people do not receive the care they need.

This document explains how to help them better. The idea is simple: to provide care close to where people live. This is the role of primary care, like the general practitioner.

The 4 ways to do this:

• Train local caregivers in mental health.
• Add a person specialised in mental health to the team.
• Work better with specialised services (for example, psychiatrists).
• Also work with schools, housing, and employment.

An important rule:

One should not seek more problems than can be followed up.

If many people are identified, they must be able to be helped afterwards.

Otherwise, people wait too long.

What helps to succeed:

• Give time to caregivers.
• Do not overload the teams.
• Share information among caregivers.
• Fight against misconceptions about mental health.

7️⃣ CROSS-ANALYSIS — VALUES OF PRACTICES IN HEALTH

• Literacy: the document includes a plain language rewrite — no; it targets decision-makers and professionals, without an adaptation tool for the general public's levels of understanding, but promotes mental health literacy and stigma reduction (p.5).
• Empowerment: the co-production of training with people with lived experience and peer support are explicitly valued (p.3–4).
• Participation: co-construction mechanisms are described (care plans developed with patient, family, and doctor in Türkiye; co-production of anti-stigma campaigns) — p.3, p.5.
• Community health: the collective dimension is central (community resources, mutual aid, social prescribing as a platform for prevention and promotion) — p.3.
• Ethics : the text alerts to rights violations related to unnecessary institutionalisation and the risk of screening without the ability to follow up (p.1, p.6).
• Human rights : the approach advocates for equity, social inclusion, and care close to the place of living, in response to the premature mortality of the affected individuals (p.1–2).
• Intersectorality : recommended partnerships with education, social services, housing, employment, justice (p.3, p.5).
• Partnership : formalised models are cited (Belgian regional networks, Finnish intersectoral task forces, WHO-UNESCO school-health framework) — p.3, p.5.
• Combating discrimination : stigma, including among health professionals, is identified as a major barrier, with dedicated levers (WHO Mosaic toolkit, social contact approaches) — p.5.

8️⃣ EVALUATION OF THE RELIABILITY OF THE RESOURCE

Scientific relevance : high-level institutional source (WHO Europe, published in The Lancet Primary Care), authors employed or consultants of WHO — declared institutional conflict of interest (p.6). ⚠️ Nature to note : this is a Viewpoint, not a systematic review; it primarily relies on a policy paper from WHO Europe and a mini-conference, complemented by a non-systematic review of the literature (methodological framework, p.6). The level of evidence from the country examples is illustrative; the document itself qualifies several pieces of evidence as "emerging" or "mostly uncontrolled" (social prescription, p.3).

Inconsistencies / points to verify : the pagination of the booklet is in pre-proof (volume and numbers indicated by symbols " ▪ "), a sign of an online version before final layout. A reference (no.18) has a truncated DOI/identifier ("978240112360"), to be verified before citation. These elements are reported without alteration.

Operational relevance : high for the structuring of coordinated care pathways. The strategies and illustrative indicators (table, p.5) are directly usable as an organisational diagnostic grid, subject to adaptation to the French national context.

9️⃣ STRATEGIC HASHTAGS

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