COVID‑19 brought an unprecedented health crisis which quickly turned into a broader economic, labour market and social crisis. These uncertain circumstances led to a surge in the prevalence of mental distress, anxiety, and depression across OECD countries, and especially for young people and for adults facing job and income losses. The sizeable impact of the crisis on population mental health has placed a spotlight on a long neglected issue, and triggered a belated yet much-needed discussion both among the public and policy makers on how to protect and promote mental health.

The OECD publication Fit Mind, Fit Job, published in 2015, concluded that an integrated whole‑of-government approach was needed to tackle the poor social, education and employment outcomes of individuals with mental health conditions. Living with such conditions makes it harder to stay and do well in school, to transition to higher education or work, to work effectively and productively, and to stay employed. Changing this is not a task for the health system alone but one that must involve all policy fields. Particularly large improvements can come from measures in four policy areas, namely youth, workplace, welfare and health policy. The importance of policy interventions in these four policy areas was already recognised across OECD countries, all of whom have adhered to the OECD Recommendation on Integrated Mental Health, Skills and Work Policy. This Recommendation sets out principles on how countries can strengthen mental health policies through coherent action across three dimensions, including: i) the involvement of front-line stakeholders not normally seen as mental-health actors (the “who” of a good policy approach), ii) a focus on early identification and early intervention in all policy areas (the “when”), and iii) the provision of integrated health, education and employment services (the “what”).

This chapter provides the rationale of a whole‑of-government approach, set out in the OECD Recommendation on Integrated Mental Health, Skills and Work Policy, and explains the importance of an integrated, cross-sectoral approach to mental health policy. It introduces the “who, when and what” (or the three Ws) of effective integrated mental health policy as outlined in the implementation report on the Recommendation, which argues that countries need to take into account “who” is carrying out an intervention, “when” intervention is taking place, and “what” such interventions look like.

This chapter presents a series of indicators across 32 of 38 OECD countries on the mental health, skills and work outcomes for individuals experiencing mental health issues. The indicators are based on a large number of national and European population surveys, necessitating an approach that facilitates cross-country and cross-survey comparisons. The indicators show a considerable and systematic disadvantage of persons with mental health issues across many domains of life and limited progress, if any, over the past five years. Differences between countries can be large but the disadvantage is universal. The findings suggest there is a long way to go to eliminate the stigma underlying this deep-rooted disadvantage.

This chapter presents the key findings on the implementation of the OECD Recommendation on Integrated Mental Health, Skills, and Work Policy five years after its adoption. While countries are increasingly focusing on integrated policies at the strategy level and awareness-raising efforts are continuing, this is often yet to translate into integrated and well-connected practices at the working level. Progress has also been uneven across the thematic areas, with innovative and integrated practices increasingly seen in youth policies, whereas integrated practices remain rare especially in employment services and the welfare system.

This chapter summarises the latest findings on the impact of the COVID‑19 crisis on mental health and the corresponding implications for an integrated policy approach. It considers how the mental health impact has varied over time and across groups of the population, with a focus on young people who are among those most affected by the pandemic. The chapter also looks at policy responses that countries have put into place to address disruptions to education and disruptions to work (through widespread teleworking and use of short-time work schemes). Finally, it identifies emerging priorities such as improving data collection, assessing levels of stigma, addressing the impact of the digital transformation, and understanding the challenges of rising loneliness, and discusses how these priorities could affect the implementation of integrated mental health, skills, and work policies.