Mental health and NCDs: A shared but differentiated agenda for the 2025 UN High-level meeting

More so than previous UN General Assembly high-level meetings on noncommunicable diseases (NCDs), mental health has featured prominently in the discussions and preparations for the fourth high-level meeting, to be held in September 2025. In this opening commentary, the links between mental health, mental health conditions and other diseases – including but not limited to the major NCDs – are set out, revealing the rationale and need for an integrated public health approach to addressing them. Subsequent commentaries will focus on selected issues outside this shared agenda that nonetheless represent key concerns also deserving of attention and consideration by heads of state in the run-up to the high-level meeting.  

Mental health conditions and their links to NCDs and other chronic diseases

Mental health conditions include disorders such as psychosis and depression, and other mental states associated with significant distress, impairment in functioning, or risk of self-harm. Due to their shared determinants and common co-occurrence, mental health, neurological and substance use (MNS) conditions collectively describe a constellation of health conditions and disorders that compromise mental or brain health and functioning and may lead to cognitive, intellectual, psychosocial or physical impairment. But key determinants and consequences of these conditions are also those underlying NCDs (e.g. cancer and diabetes) and communicable diseases (e.g. HIV and TB). The inter-connectedness of these conditions and their determinants can be exemplified as follows.

• Tobacco and alcohol use, unhealthy diet and physical inactivity are not only key modifiable risk factors for major NCDs such as cardiovascular disease (CVD), cancer and diabetes, but also dementia, meaning that reduced exposure to these risk factors leads to improvements in cognitive as well as physical health.
• Among people living with diabetes or those with CVD, there is a notably elevated incidence of depression, and vice-versa.
• Harmful use of alcohol often co-occurs alongside anxiety, depression and other mental health conditions, is a significant cause of cancer, and negatively influences health outcomes for people living with HIV and TB.

These inter-relationships point to the need for an integrated person-centred approach to the identification, treatment and follow-up of people living with these conditions, as well to addressing shared social and other determinants. 

Prevention and management of NCDs and MNS conditions: a shared agenda

The global mental health and NCD communities share an agenda that will lessen the burden of both MNS conditions and NCDs. This agenda includes promotive and preventive efforts to focus on risk factors and health education: lifestyle interventions to encourage physical activity, healthy diets and the avoidance of tobacco and alcohol, and early screening programmes at the community level. Integrated services at the community and general health-care levels can increase access to care and improve adherence to treatment, health outcomes, and quality of life.  Sustainably financing the response to NCDs and MNS conditions will allow for essential NCD and mental health packages including intervention packages and training to be successfully implemented, critical for achieving universal health coverage. 

Coordinating advocacy, programmatic, policy-based and legislative actions to improve those living with MNS conditions and NCDs must include expert input from people with lived experience (PWLE) of these conditions. Engaging PWLE meaningfully should be seen not just as a tool but as a rights-based approach to addressing health inequities and achieving health for all.

Public mental health issues for prioritized consideration

The upcoming UN High-Level Meeting on NCDs and Mental Health provides an opportunity to celebrate progress and highlight areas of need moving forward. Among the many issues to be considered, there are several specific mental health topics already highlighted in the Secretary General’s Progress Report, which are outlined below and will be explored in more depth in subsequent communications.  

• Stigma and discrimination: Though progress has been made in societal attitudes and behaviours toward people with mental ill-health, barriers on individual and structural levels remain. Self stigma, public stigma and institutional stigma can be addressed through more opportunities for leadership for PWLE, inclusive collaborations, and social contact – the idea that contact between a stigmatized group and those displaying stigmatizing attitudes and behaviours will reduce stigma and discrimination. Additionally, responsible reporting by the media and creating safe online spaces can be prioritized to eliminate stigma and discrimination against those with mental ill-health.
• Child and youth mental health: One in seven 10–19-year-olds experience mental health conditions, though these remain largely unrecognized and untreated. Several key drivers account for poor mental health of young people, including poverty, domestic and community violence, bullying, family dysfunction, substance use and some aspects of technology and social media. Mental ill-health in young people limits their future contribution to society. Despite the interest, investment in youth mental health remains very low.
• Community-based mental health services that protect human rights. In most countries, mental health care is heavily weighted toward provision in institutions; between 1–2% of health budgets go toward mental health, and about two-thirds of this limited amount goes on average toward institutions. Better supports at the community, primary and secondary care levels will result in more people having access to prevention and treatment. 
• Suicide prevention and decriminalization: Suicide is the third-leading cause of death among 15–29-year-olds, and more than 720 000 people lose their lives to suicide each year. Nearly three quarters of those deaths occur in low- and middle-income countries. Suicide and suicide attempts are criminalized in more than 20 countries; this deters people from seeking the help they need, and results in an underreporting of the issue to governments who need to understand the scale of the problem.

Key messages:

1. Mental health and related conditions share several concerns and priorities with NCDs but also have many distinct issues and concerns. The shared agenda includes addressing social, commercial and environmental determinants for health and promoting healthy lifestyles, as well as a person-centred approach to treatment and care. 
2. People with lived experience of mental ill-health should be involved in policies and programmes that affect them.
3. Priority areas in mental health for advocacy, policy change and legislation enactment include child and youth mental health, suicide prevention and decriminalization, deinstitutionalization and rights- and community-based services.