From Stigma to Strategy: OECD Pushes for Equity in Global Mental Health Systems

The OECD Health Working Paper No. 180, Understanding and Addressing Inequalities in Mental Health, offers a powerful examination of the entrenched disparities in mental health across 37 OECD countries. Authored by Francisca Vargas Lopes and Ana Llena-Nozal, and supported by expert input from Health Canada, the Public Health Agency of Canada, Statistics Canada, and the OECD Health Division, this extensive study draws from data collected via national health surveys, the Institute for Health Metrics and Evaluation (IHME), and country questionnaires. It maps out how inequalities in mental health outcomes, access to care, and treatment experiences persist and often worsen for certain groups, especially women, minorities, and those with low incomes. It also investigates the policy responses (or lack thereof) by OECD countries and proposes interventions to narrow these gaps.

Mental Health Disparities Are Deep and Persistent

Across all dimensions, gender, ethnicity, socio-economic status, and identity, inequalities in mental health are striking. Women experience anxiety and depression at significantly higher rates than men, with a 20% higher prevalence across the OECD. Yet men die by suicide at rates 2.7 times higher, reflecting a tragic gender paradox. Substance use disorders are also more common among men, offsetting some of the gender gap when included in overall mental health prevalence. Meanwhile, LGBTIQ+ individuals face dramatically higher rates of distress: in the U.S., over 60% of transgender people report symptoms of anxiety or depression. Indigenous populations, such as First Nations Australians or Māori in New Zealand, have disproportionately high suicide rates and psychological distress, often rooted in intergenerational trauma, colonial history, and ongoing exclusion.

These disparities are even more severe for people with low income or education. On average, individuals in the lowest income quintile are 3.5 times more likely to report moderate to severe depressive symptoms than those in the highest. Those without a high school diploma are 2.4 times more likely to suffer similar conditions. Such groups are more exposed to stressors like housing insecurity, financial instability, or job loss, many of which both result from and contribute to poor mental health. The relationship is cyclical: poor mental health affects employability and income, and low income increases vulnerability to mental disorders.

A Disjointed Path to Mental Healthcare

While women and economically disadvantaged groups report more frequent mental health consultations, this does not translate to equitable care. Women are 54% more likely than men to see a psychologist or psychiatrist, but also 88% more likely to report unmet needs due to cost. The same pattern holds for low-income individuals: they are more likely to seek help, yet face more affordability barriers and often receive lower-quality care. For ethnic minorities, LGBTIQ+ communities, and immigrants, the experience of seeking mental healthcare can be alienating. Discrimination, stigma, cultural insensitivity, and language barriers all impede access. Many patients from these groups report misdiagnoses or inadequate treatment, with some ending up in the criminal justice system rather than being connected to preventive mental health services.

Even in countries with universal healthcare or large-scale initiatives like the UK's NHS Talking Therapies and Norway's Prompt Mental Healthcare, disparities in access and outcomes remain. These systems often fail to meet the complex needs of vulnerable populations, especially when services lack cultural competence or rely on a one-size-fits-all clinical approach. Treatment outcomes are generally worse for those in lower socio-economic brackets, and mental health systems rarely coordinate with social support services like housing, education, or employment aid.

Promising Policies, but Patchy and Under-Evaluated

Three-quarters of OECD countries report having mental health strategies that mention inequalities, but only a minority of them have dedicated, stand-alone plans focused on addressing disparities. The UK’s Advancing Mental Health Equalities strategy and Canada’s culturally focused programmes for Black and Indigenous communities are among the few robust models. Most other countries embed inequality responses within broader mental health frameworks, often with limited scope or follow-through. While gender and socio-economic disparities receive the most attention, groups like LGBTIQ+ individuals, refugees, and Indigenous populations are less frequently included in national strategies. Alarmingly, only a third of countries have conducted any evaluation of these policies, making it difficult to measure their real-world impact or improve their design.

Still, there are bright spots. Twenty countries have adopted training programmes for health professionals in cultural competence, and 23 support peer-led initiatives that promote early intervention and more trusting care environments. These approaches not only expand access but also provide lower-threshold entry points to care for people who distrust or avoid traditional health services.

Building a More Inclusive Future for Mental Health

The report concludes with a clear call for systemic change. Closing mental health gaps will require more than expanding access, it demands rethinking how care is designed and delivered, and addressing the root social determinants of mental health, such as poverty, discrimination, job insecurity, and housing instability. Countries must invest in data systems that allow disaggregated monitoring of mental health by gender, income, ethnicity, and more. They should also scale up community-based, culturally grounded services and embed mental health into broader strategies for employment, education, and social inclusion.

Ultimately, mental health equity is a reflection of societal justice. Reducing mental health disparities is not only about improving treatment but about enabling dignity, agency, and opportunity for all individuals, especially those society has long overlooked. With this report, the OECD and its partners have drawn a line in the sand, reminding policymakers that the time to act is now.