It is a critical time for the mental health sector. It feels as if we are close to a transformational tipping point. Awareness and understanding of the importance of mental health for everyone, everywhere has grown substantially, to the point where political will across the world is in place for the type of change that has never been seen before; however, there is still at least a US$200 billion annual gap in public finance for mental health. Political will is hard to quantify; ultimately it is finance that counts.

We have seen many positive outcomes from political gatherings over the past few years — UN General Assembly, World Health Assembly, Human Rights Council, and UN Security Council resolutions on mental health; the 2025 High-Level Meeting on NCDs and Mental Health; and the 2026 African Union Common Position on Non-Communicable Diseases (NCDs), Injuries, and Mental Health, to name just some. We now have the Third Internal Financing Dialogue on NCDs and Mental Health (IFD3) to focus minds on how we finance this political progress. Hosted by the Government of the Philippines, in collaboration with the World Health Organization and the Asian Development Bank, it brings together governments, international financial institutions, development partners, and civil society to identify practical solutions for financing NCDs and mental health at a time of mounting fiscal pressure.

New, increased, and improved investment in mental health

This one feels different. There are three tangible outcomes that could lead to new, increased, and improved investment in mental health: a regional compact on access to health products and services, a financing toolkit, and the Manila Declaration, which presents opportunities to action commitments. United for Global Mental Health, the Global Mental Health Action Network, and the wider mental health and NCDs communities will be working hard to ensure this happens.

The initial conversations are more about expenditure than they are about revenue raising. The health economists in the room argue that revenue raising should be for entire health systems and not specific condition types or siloed programming. With this in mind, for me, there are three areas of focus for mental health at the IFD3:

1. Commitment of governments to deinstitutionalise mental health systems using finance as the policy tool. Public resources for mental health are scarce at the best of times. What is more, the vast majority of finance is allocated to tertiary facilities, such as large psychiatric hospitals rather than community-based services. This is more than 80% of public mental health budgets in many low- and middle-income countries. For this transition to happen safely, mental health systems founded on primary and community-level care need to be built up. This will, in some cases, require external investment — exactly the type of structural investments that all internal development finance should be focused on.
2. The redesign of national coverage policies to ensure that quality-assured and cost-effective mental health (and NCDs) interventions are fully integrated into universal health coverage benefit packages. This is a key investment for structural change that can enable moving away from tertiary mental health facilities. Plus, it is the best way to invest in prevention — mental health promotion, early intervention, and community-based programmes, especially prevention strategies for children, adolescents, and young adults.
3. The imperative of a whole-of-government approach: sustainable financing for mental health (and NCDs) requires alignment across health, finance, education and other social sectors, trade, and planning ministries. It is only through joined-up fiscal policies and cross-sectoral investment strategies, such as national development plans and medium-term budgetary mechanisms, that the transformation to effective mental health systems can be reached.

There are other things at play. The financial earthquake that was the end of USAID and the shrinking of official development assistance budgets across the world has forced a much-needed conversation about the future of the global health architecture. If ever there was an opportunity for mental health to be understood as a cross-cutting opportunity to improve all health and social outcomes, this is it. Those with power in this conversation but who are not well-versed in NCDs and mental health must, at the very least, understand that mental health and NCDs make up 75% of the global disease burden, and yet finance is nowhere near enough to match the need. We are at a tipping point for mental health, we must make smart financial decisions to make sure things tip the right way.