Physical and Mental Health: The journey to integration
We are co-leading a special issue for the Journal of Public Mental Health on integrating physical and mental health. This is how we are approaching it.
An inspirational (and frustrating) meeting in New York
A diverse, global group of clinical, academic and public health experts, policy and implementation specialists, donors, and advocates with lived experience gathered in a small room in New York in April 2025 to discuss how to make Integrated Prevention and Care in Mental Health and Non-Communicable Diseases (NCDs) a reality around the world.
This roundtable (held in the margins of the United Nations Multi-Stakeholder Hearing on NCDs and Mental Health) was led by the Global Mental Health Action Network and the World Federation of Public Health Associations (and indeed included the co-editors of this special issue). However, instead of hopeful and optimistic (as was our intention), we left the meeting frustrated.
Our source of frustration was clear: all around the world (in Low-, Middle-, and High- Income Countries), many practitioners and researchers are delivering impactful work integrating prevention and care for people at risk or living with mental and physical health problems, but scaling, awareness, funding, and commitment to such programmes remains limited.
In other words, effective interventions exist to support, prevent suffering, and address widening inequalities in people living with NCDs and mental health conditions. However, implementation of such interventions is negligible even in HICs. This implementation failure breaches the right to health and results in population scale preventable suffering, broad negative impacts, and associated economic costs.
There is evidence that integration works
Following our discussion, but also through our partnership work around the world, we are aware of many models of prevention and care that are effective in integrating physical and mental health.
In our meeting, we learned from each other about:
A task-shifting intervention in Vietnam that has demonstrated up to 80% reduction in depression in community settings. In these contexts, community-led planning increased intervention uptake, screening rates and system-level engagement.
The introduction of a new screening tool in Mozambique, in the context of community-driven research, paired with policy and academic engagement, that yielded scalable models that eliminate waiting lists and improve outcomes on both mental health and NCDs.
A task-sharing model in West Africa for people living with Sickle Cell Disease, that improves wellbeing, overall health outcomes, and reduces healthcare costs.
Many others have similar experiences: in Liberia a Universal Health Coverage pilot is reimagining cross-sectoral engagement and sustainable change; in Indonesia annual free health screenings are now integrating mental health assessments alongside diabetes and cardiovascular disease checks; South Africa’s most recent strategic plan integrated NCDs and mental health with common goals; in Nepal a training and supervision network has been changing how integrated primary care is being delivered.
Our rationale for a special issue
This begs the question, if so many settings, communities, and researchers have the evidence and the experience of what works, what is it that is holding us back?
We are aware of several challenges, for example: physical and mental health are often addressed (in both policy and care) in silos; there is limited awareness in how addressing the shared social and commercial determinants of health makes an impact on both physical and mental health; there are workforce shortages and referral limitations in many settings; formal recognition and remuneration of community health workers remains limited; budgets are restricted and often shrinking. And lastly, the experiences of people with lived experience are often tokenised and not taken into account for their grounding value in shaping real-world responses.
Therefore, with this special issue, we are not looking to reinvent the wheel; we are seeking to create a blueprint for pragmatic, resource-sensitive integration of policies and services. At this point in time, we are not seeking to be convinced about integration. We know that collaborative care models, where NCD care and mental health care are integrated and provided in the primary and community care setting, are effective for patients, strengthen health care service systems, and reduce costs.
What we would like to surface is how do we make it happen – the emphasis on the “how” rather than on the “what”. How do innovative research and programmes show success and returns on investment? How can evidence-based public health principles create the arguments for more effective prevention? How can the implementation of collaborative and integrated care models be enhanced by tapping local knowledge of social, political, cultural, and health system nuances? How can people with lived experience and advocates play a formal and effective role in driving change forward? These are just some of the questions that we would like this special issue to address.
We will welcome contributions across the spectrum of promotion, prevention, care and recovery, as well as from authors of any formal or informal expert background.
Getting serious about integration
By bringing together mental health and NCDs, this year's United Nations High-Level Meeting (HLM) is a unique opportunity to showcase best practices and make new commitments to invest in primary and community care and prevention services. This builds on a historic year for mental health advocacy, that also saw the clearest and biggest representation ever from experts by experience at a UN HLM Multi-Stakeholder Hearing.
National governments have a significant opportunity to commit to systematically shifting the locus of care from institutions and over-medicalisation towards human rights-based care and prevention models, prioritising early interventions and a network of community-based mental health services (which go hand-in-hand with community-based NCD services). This would result in better health outcomes, fewer deaths, more efficient health systems, and substantial returns on investment.
The Journal of Public Mental Health will publish the special issue in a year aiming to highlight programmes and research that have successfully integrated physical and mental health services (with a particular emphasis on public mental health, i.e. promotion, prevention, early intervention and community care). It will also outline progress in policies, spending, and strategies in public mental health across the world and provide meaningful lived experience perspectives on the interconnections between mental and physical health, especially in the context of NCDs.
The time is ripe (and indeed urgent) not just for the conversation on integration, but also for getting serious about making it happen.
The Co-Editors of the Special Issue of the Journal of Public Mental Health on “Physical and Mental Health: The journey to integration (promotion, prevention, care and recovery)”:
Dr Antonis Kousoulis, Global Mental Health Action Network, United for Global Mental Health
Dr John Pateña, HealthRight International, New York University, World Federation of Public Health Associations
Stephanie Whiteman, University of the West Indies, Cave Hill
Tabitha Ellis, Global Mental Health Action Network, Global Health Advocate and Person with Lived Experience
