With mental health firmly on the agenda at the UN General Assembly High-Level Meetings in New York this September, mental health is receiving the global attention it deserves. But awareness alone is not going to be enough -we need large-scale action.

In too many countries and communities, mental health care is unavailable, unaffordable, and overly reliant on institutional models that isolate rather than integrate and include. To reduce suffering, uphold human rights, improve access and quality, and move towards universal health coverage, we must reimagine mental health systems from the ground up.  This means building comprehensive, community-based networks of mental health services and supports for people of all ages.

Community-based mental health care brings services closer to where people live, work, study and connect. It reduces isolation and supports recovery in everyday environments. But it is more than a compassionate alternative to institution-based care – it is the evidence-based model for expanding access to care, advancing rights and improving health and social outcomes.

As highlighted in WHO’s  World Mental Health Report: Transforming Mental Health for All, good community-based systems combine a range of services to meet diverse needs and ensure continuity of care. These include:

mental health services integrated into general health care, such as primary care clinics and general hospitals;

dedicated community mental health services, including mobile teams, day centres and peer support networks;

mental health services in non-health settings, such as schools, workplaces and social services.

Together with informal support from families and communities, these services are well positioned to ensure people of all ages, including children and older adults, receive the right support at the right time.

From institution to inclusion

For many countries, a key step towards community-based care is deinstitutionalization  – shifting resources from psychiatric hospitals towards community-based services. This is not simply about closing institutions; it is about replacing outdated, often harmful, models with person-centred, recovery-oriented care.

Long-stay psychiatric hospitals often fail to meet basic standards of care. Many adopt a narrow biomedical approach, have poor living conditions, and are linked to human rights violations. Yet millions are in these facilities each year, with many staying for extended periods -sometimes for life.

Deinstitutionalization does not mean discharging everyone at once. It is a gradual, complex process that includes improving hospital care, shortening stays, preventing new admissions and addressing livelihoods, housing and care of former residents. It requires the development of robust community-based alternatives to support discharged individuals and prevent rehospitalization.

This transition demands financial and strategic investment, careful planning, a committed health work force, and the meaningful involvement of long-stay residents, their families and communities.

While deinstitutionalization and building secondary care mental health services is especially vital for people with severe mental health conditions, we must also address the huge treatment gaps for the most common mental health conditions, depression and anxiety. These conditions affect hundreds of millions globally, yet often go untreated due to limited resources, stigma, lack of access and poor recognition.

Scaling up and diversifying routine mental health care means embedding it across all sectors – health, education, social care, and digital platforms. One of the most promising strategies is task-sharing, which involves training non-specialist providers, such as general physicians, nurses, community workers, and peer supporters, to deliver the highly effective evidence-based mental health interventions that are available for these conditions.

Task-sharing addresses workforce shortages, expands access and frees up specialists to focus on complex cases. Research shows that it improves health and social outcomes and is cost-effective, also in low- and middle-income countries.

Yet task-sharing alone will not be enough for depression and anxiety. Reimagining care means also considering other strategies for scaling up include using digital technologies for self-help as well as peer-led initiatives.

At every stage, the voices of people with lived experience must be front and centre. Their insights into what works, what doesn’t, and what truly matters are essential for building systems that are responsive and respectful, and effective in implementing evidence-based interventions.

Community-based networks of mental health services empower people to thrive, not just survive. They reduce stigma, enhance access, and better support recovery and inclusion across levels of need.

The shift from institutional to community-based care is a complex but essential transition. It involves improving hospital care, shortening stays, preventing new admissions and ensuring strong community-based alternatives.

Scaling up care for depression and anxiety requires innovation. Proven strategies such as task-sharing, self-help, digital technologies, and peer support can expand access to care, high, middle and low-income countries.