Shifting the Focus: A Case for a Positive Mental Health Framework in Europe

open letter

Jaisalmer de Frutos-Lucas*, PhD, European Public Health Alliance; School of Social Sciences and Communications, Universidad Europea; https://orcid.org/0000-0003-2970-4338

Alessandro L. Gallina, PhD, European Public Health Alliance; https://orcid.org/0000-0002-0127-8309

Brigid Transon, MSc, European Public Health Alliance; https://orcid.org/0009-0000-9644-5095

* Corresponding Author

Abstract: This open letter advocates for a paradigm shift in European mental health policy by proposing the adoption of a European Positive Mental Health Framework. It argues that current approaches remain overly focused on severe mental health problems and institutional care, while overlooking the broader continuum of mental health. This includes mental well-being aspects such as emotional resilience, life satisfaction, and social connectedness. The authors highlight the need for robust, strength-based surveillance systems that track the core components and the enabling conditions of mental wellbeing. Drawing from international models such as Canada's Positive Mental Health Surveillance Indicator Framework and the OECD’s Well-being Framework, the letter underscores the feasibility and importance of coordinated, cross-country monitoring. Despite challenges in standardising definitions and metrics, the letter emphasises that harmonised data collection is essential for designing responsive and preventative mental health systems. It calls on the EU to build on existing scientific and policy initiatives, including the European Public Health Alliance’s indicator development, to create a framework that enables both comprehensive measurement and actionable change. By shifting focus toward positive mental health, the EU can not only better prevent illness but also enhance societal wellbeing resilience in the face of future crises.

Keywords: Positive Mental Health, Mental Health Indicators, Surveillance

Introduction

In June 2023, the European Commission launched its Communication on a comprehensive approach to mental health (European Commission, 2023), a timely and necessary step toward advancing mental health across the European Union (EU). While we welcomed this renewed political momentum, we highlighted some room for improvement (Gallina, 2023). Two years on, we critically examine how at least three of the five pillars outlined for future action (namely, promotion, early detection, and quality of life) could be significantly strengthened by adopting a European Positive Mental Health Framework. This call aligns with growing international momentum, including the forthcoming United Nations Political Declaration on the prevention and control of noncommunicable diseases (NCDs) and the promotion of mental health and wellbeing. The declaration´s zero draft underscores the urgent need to create health-promoting environments, expand community-based mental health services, and reorient health and social care systems to meet the mental health needs of populations across the life course (World Health Organization, 2025). Crucially, it also highlights the critical role of improved surveillance and systematic data collection to support evidence-based action, committing to embedding mental health reporting into national SDG review processes. Within this context, the European Union has a unique opportunity to lead by example. Towards this aim, we propose three key questions: What is mental wellbeing? How can it be effectively monitored and promoted across Europe? And which international initiatives can Europe build upon to move from vision to action?

Main Argument

Public health approaches to mental health have been traditionally centred around outcomes associated with severe mental health issues, including the prevalence of psychiatric disorders, hospitalisation rates, and suicide mortality rates (European Commission, n.d.). However, over recent years, health policy agendas have increasingly prioritised positive mental health and wellbeing. This paradigm shift aligns with public sentiment, as evidenced by a recent Flash Eurobarometer on Mental Health, which found that 89% of EU citizens consider the promotion of mental health as important as physical health (European Commission, 2023). Mental health spans a broad continuum, and according to the World Health Organization (WHO), it is “a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community” (World Health Organization, 2022). This wider and inclusive definition encompasses positive dimensions of mental health, such as emotional resilience, social connectedness, life satisfaction, and a sense of purpose, which are core components of mental wellbeing. Fostering these dimensions not only promotes individuals’ mental health but enhances societal resilience in the face of systemic crises (e.g., pandemics, environmental disasters, and armed conflict) (Akbari et al., 2024).

To operationalise such a shift, we must strengthen surveillance systems to go beyond tracking harm. Although traditional indicators are important, they only offer partial insights and often occur too late for effective prevention. Positive mental health surveillance must therefore adopt a strength-based approach, focusing on protective factors and enabling conditions for mental wellbeing. Nevertheless, developing more comprehensive and meaningful indicators of mental health and wellbeing remains inherently challenging.

Cultural and methodological variations in how mental health is defined, quantified, and perceived hamper standardisation across communities and countries. Despite these challenges, promising models exist: the Public Health Agency of Canada’s Positive Mental Health Surveillance Indicator Framework provides disaggregated and regularly updated data across multiple positive mental health outcomes (Orpana et al., 2016; Government of Canada, 2024). At the international level, the OECD’s Well-being Framework further exemplifies progress, offering harmonised measurement guidelines for subjective wellbeing. From a positive mental health approach, the main limitation of this framework is that it is mostly centred around contributing factors such as housing, education, health, job quality and civic engagement.  However, its broad adoption across 38 countries underscores the viability of coordinated cross-country data collection (Organisation for Economic Co-operation and Development [OECD], n.d.). Together, these efforts illustrate how standardised and harmonised monitoring of mental health and mental wellbeing is not only achievable but essential for evidence-based policy.

Call to Action

In the EU, while there is a notable absence of coordination across Member States, recent progress is being made. Drawing on scientific evidence, existing monitoring frameworks, and expert consultation, the European Public Health Alliance has recently published a report on Building Better Indicators for Mental Health and Wellbeing (European Public Health Alliance, 2025). The proposed indicators incorporate multiple facets of mental health, from foundational factors such as mental health awareness and literacy, to proxy indicators like self-care behaviours and support networks, and more direct measures of mental health outcomes, including emotional resilience and life satisfaction. The primary objective of these indicators is to generate timely, high-quality data to inform the design, implementation, and evaluation of effective strategies and interventions

Considering all the above, the proposed European Positive Mental Health Framework should have a dual purpose: first, to enable systematic, comparative surveillance of mental health and mental wellbeing across the EU; and second, to act on the data collected to build systems that support mental health across the life course.  Improved surveillance mechanisms that generate high-quality, disaggregated data are a critical first step, but true progress lies in translating this data into concrete, sustained action, which fosters meaningful, lasting change, leading to the integration of mental wellbeing into all policies. Advancing this approach will not only support more equitable mental health outcomes within Europe but also respond directly to the United Nations’ call to prioritise mental health promotion, strengthen data and surveillance infrastructure, and integrate mental wellbeing into national and global development agendas.

References

Akbari, K., Zareiyan, A., Yari, A., Najafi, M., Azizi, M., & Ostadtaghizadeh, A. (2024). Mental health preparedness and response to epidemics focusing on COVID-19 pandemic: A qualitative study in Iran. BMC Public Health, 24(1), 1980. https://doi.org/10.1186/s12889-024-19526-2

European Commission. (n.d.). EU-Compass for Action on Mental Health and Well-being. Public Health. Retrieved May 6, 2025, from https://health.ec.europa.eu/non-communicable-diseases/mental-health/eu-compass-action-mental-health-and-well-being_en

European Commission. (2023a). Communication on a comprehensive approach to mental health. Public Health. https://health.ec.europa.eu/publications/comprehensive-approach-mental-health_en

European Commission. (2023b). Flash Eurobarometer 530: Mental health. Mental Health. https://europa.eu/eurobarometer/surveys/detail/3032

European Public Health Alliance. (2025). Building better indicators for mental health and wellbeing. https://epha.org/building-better-indicators-for-mental-health-and-wellbeing

Gallina, A. (2023, December). Mental health in Europe: It is time for a strategy. The Parliament Magazine. https://www.theparliamentmagazine.eu/news/article/mental-health-in-europe-it-is-time-for-a-strategy

Government of Canada. (2024). Positive Mental Health Surveillance Indicator Framework. https://health-infobase.canada.ca/positive-mental-health/Stat

Organisation for Economic Co-operation and Development. (n.d.). Measuring well-being and progress. Retrieved May 6, 2025, from https://www.oecd.org/en/topics/measuring-well-being-and-progress.html

Orpana, H., Vachon, J., Dykxhoorn, J., McRae, L., & Jayaraman, G. (2016). Monitoring positive mental health and its determinants in Canada: The development of the Positive Mental Health Surveillance Indicator Framework. Health Promotion and Chronic Disease Prevention in Canada, 35(1). https://doi.org/10.24095/hpcdp.36.1.01

World Health Organization. (2022). Mental health: Strengthening our response. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

World Health Organization. (2025). Zero draft: Political declaration of the fourth high-level meeting of the General Assembly on the prevention and control of noncommunicable diseases and the promotion of mental health and well-being. https://www.who.int/publications/m/item/zero-draft--political-declaration-of-the-fourth-high-level-meeting-of-the-general-assembly-on-the-prevention-and-control-of-noncommunicable-diseases-and-the-promotion-of-mental-health-and-well-being