A coalition of more than 150 global psychiatric associations and mental health charities is calling on international financial institutions to improve mental healthcare across the world by placing conditions on the funding they lend countries.
The Prague Agreement, a Royal College of Psychiatrists-led initiative published in World Psychiatry today, outlines the devastating impact mental illness has on the economic growth of countries and makes the case for urgent global investment to address this.
It has been signed by the World Psychiatric Association, European Psychiatric Association, American Psychiatric Association and dozens of other international mental health organisations.
Mental ill-health is estimated to cost the global economy US$ 5 trillion per year, primarily through loss of workforce and reduced productivity. These illnesses disproportionately affect young people, with 63% occurring by the age of 24, and can significantly harm their ability to engage with education and work when they could be at their most productive.
Despite this, mental health accounts for only 2.1% of government health budgets and on average there are only 0.3 psychiatrists per 100,000 people.
There are cost-effective ways of addressing these challenges, as many mental health disorders are preventable and treatable. In Australia, school-based interventions aimed at preventing depression in young people saved US$ 24.5 million over a ten-year period from 2012.
The earlier people receive support the less likely they are to become adults with chronic or relapsing mental illnesses. A balanced approach is therefore needed in which the majority of care is provided by community mental health services, and inpatient services are available for those who need them.
The United Nations Development Programme (UNDP) estimates that a US$ 2.8 billion investment in public mental health in the Philippines would generate US$ 4.27 billion over ten years. Investment in mental healthcare doesn't just save lives; it makes economic sense.
The signatories of the Prague Agreement are calling on the World Bank, International Monetary Fund and other global financiers to make their investments contingent on the development of a national cross-government mental health strategies with accompanying implementation plans when allocating development finance.
Dr Lade Smith CBE, former President of the Royal College of Psychiatrists, said:
“The rising impact of poor mental health on nearly 1.2 billion people across the globe is not only a moral injustice but a fundamental threat to the foundation of every national economy, its workforce.
“People living with mental illness are unable to find work and losing their jobs because they can't access the basic care and treatment they need to get better. This is a tragic situation for any individual to be in but also represents wasted potential on a scale rarely seen in human history.
“Financial institutions are uniquely placed to hold countries to account by requiring that they have a national mental health strategy in place in order to secure funding. We need these institutions to help drive change at a societal level, just as they do with climate change and gender equity.
“As individual nations, and a global community, we can no longer afford to wait. Countries must act decisively to support their citizen's mental health if they intend to be more financially stable, productive and prosperous both now and in the future.”
Professor Subodh Dave, President of the Royal College of Psychiatrists said:
“There is now worldwide recognition that a country's mental health and economic health are intrinsically linked yet this is rarely reflected in national spending plans. Too often mental health services are seen as an afterthought rather than an essential organ of any effective health system.
“The encouraging news is that many mental health conditions are preventable and treatable, and we already know what works. Early intervention, community-based services and a well-supported mental health workforce can improve outcomes for individuals while delivering wider societal and economic benefits.
“Governments do not need to start from scratch. The Prague Agreement provides a framework for embedding mental health into national policy, supported by clear implementation plans and measurable commitments. We hope it will encourage policymakers to work closely with mental health organisations to build modern, sustainable services that meet the needs of their citizens.”
Dr Anusha Lachman, Immediate Past President of the South African Society of Psychiatrists said:
“Africa’s child population is projected to increase to one billion by 2030, with no clear plan for prioritizing mental health intervention for all children, including those with disabilities. With under 5% of public health budgets allocated to mental health, innovative solutions are needed to promote universal access to mental healthcare matched by adequate personnel.
“Focussing on the first 1,000 days to reduce early life adversity and strengthening resilience impacts on the long-term health outcomes in high adversity settings. Investment in early life health requires early recognition and screening of children and their caregiving contexts. This demands integrated systems, upskilling and mental health workforce training, investment in intersectoral capacity building and task sharing to increase the quality, relevance, and reach of mental health services, reducing health inequities for young children.”
Dr Savita Malhotra, Immediate Past President of the Indian Psychiatric Society said:
“Mental ill-health is the world's largest untreated productivity liability. Over a billion people are affected; depression and anxiety alone cost roughly US$1 trillion a year, with the Lancet Commission putting cumulative losses at US$16 trillion to 2030. Onset peaks at 14.5 years, destroying human capital before a working life begins. Yet median government spending sits at 2% of health budgets, and only about 0.3% goes to mental health. WHO modelling shows US$4 returned for every US$1 invested. The allocation gap is extreme — 0.3% of aid against the second largest source of global disability, and it is the only major disease category where the world knowingly under-allocates capital by a factor of ten relative to its own measured burden. The argument for international investment does not rest on compassion, it rests on sound fiscal imperative.”
Dr Ramune Mazaliauskiene, President of the Lithuanian Psychiatric Association said:
“Although many mental disorders can be effectively treated – and some even prevented – insufficient funding for mental health services leads to poor mental health for many people; this, in turn, impacts us all as a society in a measurable way: through the economy. Conversely, adequate funding for mental health services and the timely, effective treatment of mental disorders foster economic well-being. It is important to note that this relationship is reciprocal: the aetiology of mental disorders often involves social and economic factors, meaning that effectively addressing these issues leads to better mental health and prosperity of the societies.”
Dr Theresa Miskimen, Immediate Past President of the American Psychiatric Association said:
“The Prague Agreement marks an important shift in the global conversation: mental health care must be understood not simply as a cost, but as an investment in people, communities, and economies.
“Mental illnesses often begin early in life, just as young people are learning, forming relationships, entering the workforce, and imagining their futures. When timely, effective care is out of reach, the loss is measured not only in economic terms, but in human potential.
“This agreement gives me hope because organizations around the world are speaking with a common purpose and a shared voice. Together, we can make mental health central to how countries plan for their future – because when people have the opportunity to be well, they can participate, contribute, and thrive.”
Dr Thelma Sanchez, from the Mexican Psychiatric Association said:
“Celebrating the Prague Agreement at the WPA Congress renews our hope for a future in which mental health receives the attention and resources it deserves. Turning this shared commitment into meaningful improvements in people’s lives requires sustained funding, international solidarity, and collaboration across borders. Professional associations such as the WPA and RCPsych play an essential role in connecting colleagues, sharing knowledge, and championing compassionate, person-centred care. Together, we can turn hope into more accessible services, better support for mental health professionals, and communities where no one has to face mental health challenges alone.”
Professor Danuta Wasserman, President of the World Psychiatric Association said:
“Importantly, the Prague Agreement highlights the urgent need for greater investment in mental health, with a strong focus on both prevention and treatment.”
Signatories of the Prague Agreement include the Royal College of Psychiatrists, World Psychiatric Association, European Psychiatric Association, American Psychiatric Association, South African Society of Psychiatry, the Association of Psychiatrists in Nigeria, the Indian Psychiatric Society, the Royal Australian and New Zealand College of Psychiatry, the Canadian Psychiatric Association, and several global mental health charities.
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