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.

Mental health issues can be debilitating for those who have to live with them but also have significant social and economic implications for society. Individuals experiencing mental distress are less likely to complete education or to find employment and have a good job. They are also more likely to struggle with work performance and to earn less, and at increased risk of job loss and labour market exit, all of which can have consequences on income and well-being. The COVID-19 crisis further deepened the challenges facing individuals with mental health conditions, while the changes in how we learn and work prompted by the pandemic could have potential long-term implications for mental health policy.

In 2016, Ministers of Health and of Employment from all OECD countries welcomed the Recommendation of the Council on Integrated Mental Health, Skills and Work Policy. This was a milestone. It marked the recognition by OECD countries that the obstacles to ensuring good mental health for all individuals cannot be overcome within the health system alone, and that it requires a “mental-health-in-all-policies” approach that addresses the interactions between mental health conditions and social and labour market outcomes, especially in youth, workplace and welfare policies. Such an approach also requires a three-way change in how policies are delivered, characterised by: (1) intervention and support by the right persons, especially front-line actors; (2) early intervention, following a timely identification of mental health issues; and (3) the provision of integrated services and interventions from different providers and authorities.

This publication summarises steps taken by OECD countries in the past five years towards implementing timely and integrated provision of services in health, youth, workplace and welfare policies. It builds on the Report on the Implementation of the Recommendation on Integrated Mental Health, Skills and Work Policy five years after its adoption. This 2021 Report was approved by the Employment, Labour and Social Affairs Committee and the Health Committee of the OECD in April 2021, and welcomed by OECD Ministers at the Ministerial Council Meeting in October 2021. This publication therefore draws on information provided by member countries, including through:

  • A Policy Questionnaire on Recent Country Experience in the four areas covered in the Recommendation (health, youth, workplace, and welfare) in the period 2015-20;

  • A Follow-Up Questionnaire on Dissemination and Usefulness of the Recommendation, which also included questions on countries’ early mental health responses to the pandemic;

  • Evidence collected as part of the Mental Health Benchmarking Project and published in mid-2021 in the OECD publication A New Benchmark for Mental Health Systems;

  • A supplementary Questionnaire for Non-Government Stakeholders in mental health policy;

  • A set of survey-based comparative indicators on the labour market, skills and health outcomes of individuals experiencing mental health conditions.

This publication was prepared by the Directorate for Employment, Labour and Social Affairs, led by Stefano Scarpetta. Shunta Takino was the main author of the publication. Christopher Prinz managed the project and the team working on the publication. Duncan MacDonald prepared the section on mental health indicators and Daniel Camacho Hernandez contributed to the data work in Chapter 2. Dana Blumin provided statistical support throughout the publication. Lucy Hulett and Liv Gudmundson prepared the document for publication. Francesca Colombo, Emily Hewlett, Mark Keese, Helen Lockett, Mark Pearson and Stefano Scarpetta provided comments and suggestions at various stages of the project. Claire Marguerettaz and Céline Folsché provided essential assistance on the legal process of assessing the implementation of the Recommendation.

Chapter 1 of this publication provides the rationale of a whole-of-government approach to mental health policy as set out in the OECD Recommendation on Integrated Mental Health, Skills and Work Policy.

Chapter 2 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. These indicators are based on data from national and international population surveys. Most data are available online or provided to the OECD by the European Union. The authors would like to extend particular thanks to the Ministry of Health in Israel; the Ministry of Health, Labour and Welfare in Japan; the Robert Koch Institute in Germany; Sciensano in Belgium; Statistics Netherlands; the National Statistical Institute in Spain; the Federal Statistical Office in Switzerland; and the National Center for Health Statistics in the United States for providing national data.

Chapter 3 presents the key findings of the 2021 Report on the Implementation of the OECD Recommendation on Integrated Mental Health, Skills, and Work Policy. The authors would like to extend their thank the delegates of the OECD Employment, Labour and Social Affairs Committee and the OECD Health Committee for their valuable comments on the 2021 Report, and especially for their responses to the Policy Questionnaire on Recent Country Experience, which is the main source of information for policy developments discussed in this chapter.

Chapter 4 presents the significant impact of the COVID-19 crisis on population mental health and policy responses to mitigate these impacts. The authors are grateful for OECD countries’ responses to the Follow-Up Questionnaire on Dissemination and Usefulness of the Recommendation and to the Youth and COVID-19 Questionnaire, which inform the discussion of immediate policy responses to COVID-19 in this chapter.

The analysis and data presented in Chapter 4 also benefitted heavily from the expertise and insights of Emily Hewlett, Yuka Nishina and José Bijlholt, including through their work on the OECD Mental Health Benchmarking Project. The analysis also draws on discussions with and comments from Lara Fleischer and Jessica Mahoney of the OECD Centre on Well-being, Inclusion, Sustainability and Equal Opportunity. Tracey Burns and Francesca Gottschalk of the Directorate for Education and Skills also provided in-depth comments on the impact of COVID-19 and school disruptions on young people’s mental health. It also identifies emerging priorities in mental health policy and discusses how these priorities could affect integrated mental health, skills, and work policies going forward.

Metadata, Legal and Rights

This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area. Extracts from publications may be subject to additional disclaimers, which are set out in the complete version of the publication, available at the link provided.

© OECD 2021

The use of this work, whether digital or print, is governed by the Terms and Conditions to be found at