Mental disorder is reported to account for almost a third of global disease burden as measured by years lived with disability (YLDs)¹. On the other hand, mental well-being results in broad positive impacts². Effective public mental health interventions exist to treat mental disorder, prevent associated impacts, prevent mental disorder from arising, and promote mental well-being and resilience^{2, 3}.

However, only a minority of those with mental disorder receive treatment, with far lower coverage in low- and middle-income countries (LMICs)⁴. There is even less coverage of interventions to prevent associated impacts of mental disorder, and negligible coverage of interventions to prevent mental disorder, or promote mental well-being and resilience. This implementation gap represents a breach of the right to health, and results in population-scale suffering and associated economic costs³. The gap has further widened during the COVID-19 pandemic^5-7.

The United Nations (UN) Sustainable Developmental Goals have set a target of universal coverage by 2030 which includes treatment and prevention of mental disorder and promotion of mental well-being. The most recent World Health Organization (WHO) Mental Health Atlas highlighted that “global targets can be reached in 2030 only if there is a collective global commitment over the next 10 years across Member States to make massive investments and expanded efforts at the country level relating to mental health policies, laws, programmes and services”⁴.

Public mental health involves a population approach to improve coverage, outcomes and coordination of interventions to treat mental disorder, prevent associated impacts, prevent mental disorder from arising, and promote mental well-being and resilience. This aims to support efficient, equitable and sustainable reduction in mental disorder, promotion of population mental well-being, and achievement of the UN Sustainable Developmental Goals target of universal coverage by 2030³.

The WPA Action Plan 2020-2023 promotes public mental health as a guiding principle^{8, 9}. A Working Group on Public Mental Health has been then established, including experts such as J. Allan, F.K. Baingana, J. Campion, Y. Huang, A. Javed, N. Lamb, S. Levin, C. Lund, M. Marmot, S. Saxena, T. Schulze, E. Sorel, H. Tu, P. Udomratn, and M. van Ommeren (observer).

The Working Group highlighted that pub­lic mental health is not well defined or understood, with some languages having no terms for it. This contributes to lack of action on relevant issues. The Group agreed upon the definition outlined above, which is reported on the Group webpage of the WPA website (www.wpanet.org/public-mental-health) and in a recent publication³.

The main objective of the Working Group is to improve implementation of public mental health interventions in four ways. The first is to raise awareness, value, acceptance and prioritization of this area in national health policies. The second is to promote national assessments of public mental health unmet need and required actions which can then inform policy development and implementation. The third is to promote public mental health training, including through digital platforms, which can support psychiatrists and other professionals to address the public mental health implementation gap, particularly in LMICs, through identification of required actions by different sectors as well as clarification of a core curriculum, training targets and milestones. Examples of public mental health training are highlighted on the above-mentioned Group webpage. The fourth way is to support development of integrated public mental health approaches to disease management and prevention including through engagement with primary and general health systems.

Further objectives include: a) work with interested countries in order to facilitate these approaches with identified funding; b) engagement with other organizations on the public mental health agenda – thus far, these have included the Organization for Economic Co-operation and Development (OECD), the UN International Children's Emergency Fund (UNICEF), and the WHO; c) disseminating work relevant to public mental health through publica­tions, presentations and training, also de­livered online; d) supporting a public mental health approach in other areas of the WPA Action Plan 2020-2023, including child, adolescent and youth mental health, the management of comorbidities, and partnership with other organizations.

Publications already produced by the Working Group include an editorial on the field as a whole¹⁰, articles dealing with the public mental health approach to the COVID-19 pandemic^11-13, and papers about required actions to address public mental health implementation failure^{3, 14}. Members of the Working Group have given and will give presentations at World Congresses of Psychiatry in 2021 and 2022, and will present in a public mental health symposium at the 2022 International Congress of the UK Royal College of Psychiatrists.

In order to achieve consensus on requi­red actions to address the public mental health implementation gap, the members of the Working Group were invited to contribute to a health policy article³, which recommends the following six actions: a) making the public mental health case through assessment of unmet need, estimation of impact and associated economic benefits from improved coverage, as well as collaborative advocacy and leadership; b) public mental health practice; c) public mental health train­ing and improving population knowledge; d) improving coverage of public mental health interventions through settings-based approaches, integrated approaches, digital technology, maximizing existing resources, and focus on high-return interventions; e) a rights approach, legislation and regulation; f) public mental health research, including that focused on implementation.

^{据报道，以残疾寿命 (YLD) 1}衡量，精神障碍占全球疾病负担的近三分之一。另一方面，心理健康会产生广泛的积极影响²。存在有效的公共心理健康干预措施来治疗精神障碍、预防相关影响、预防精神障碍的出现以及促进心理健康和恢复力^{2, 3}。

然而，只有少数精神障碍患者接受治疗，在低收入和中等收入国家 (LMIC) 的覆盖率要低得多⁴。预防精神障碍相关影响的干预措施的覆盖面甚至更少，预防精神障碍或促进心理健康和复原力的干预措施的覆盖面也可以忽略不计。这种实施差距代表了对健康权的侵犯，并导致人口规模的痛苦和相关的经济成本³。在 COVID-19 大流行^5-7期间，差距进一步扩大。

联合国 (UN) 可持续发展目标设定了到 2030 年实现全民覆盖的目标，其中包括治疗和预防精神障碍以及促进心理健康。最新的世界卫生组织 (WHO) 精神卫生地图集强调，“只有在未来 10 年内会员国做出全球集体承诺，在国家层面进行大规模投资和扩大努力，才能在 2030 年实现全球目标。精神卫生政策、法律、计划和服务” ⁴ .

公共心理健康涉及一种人口方法，以提高干预措施的覆盖率、结果和协调，以治疗精神障碍、预防相关影响、预防精神障碍的发生，并促进心理健康和复原力。这旨在支持有效、公平和可持续地减少精神障碍，促进人口心理健康，以及实现到 2030 年实现全民覆盖的联合国可持续发展目标³。

WPA 2020-2023 年行动计划将促进公众心理健康作为指导原则^{8, 9}。随后成立了一个公共心理健康工作组，成员包括 J. Allan、FK Baingana、J. Campion、Y. Huang、A. Javed、N. Lamb、S. Levin、C. Lund、M. Marmot 等专家、S. Saxena、T. Schulze、E. Sorel、H. Tu、P. Udomratn 和 M. van Ommeren（观察员）。

工作组强调，公共心理健康没有得到很好的定义或理解，有些语言没有术语。这导致在相关问题上缺乏行动。小组同意上述定义，该定义在 WPA 网站的小组网页 (www.wpanet.org/public-mental-health) 和最近的出版物³中进行了报告。

工作组的主要目标是从四个方面改进公共心理健康干预措施的实施。首先是在国家卫生政策中提高对该领域的认识、重视、接受和优先考虑。第二个是促进对公共心理健康未满足需求和所需行动的国家评估，从而为政策制定和实施提供信息。第三是促进公共心理健康培训，包括通过数字平台支持精神科医生和其他专业人员解决公共心理健康实施差距，特别是在中低收入国家，通过确定不同部门需要采取的行动以及明确核心课程、培训目标和里程碑。公共心理健康培训的例子在上述小组网页上突出显示。第四种方式是支持开发综合的公共心理健康方法来进行疾病管理和预防，包括通过与初级和一般卫生系统的接触。

进一步的目标包括： a) 与感兴趣的国家合作，以利用确定的资金促进这些方法；b) 与公共心理健康议程上的其他组织合作——迄今为止，这些组织包括经济合作与发展组织 (OECD)、联合国国际儿童紧急基金会 (UNICEF) 和世界卫生组织；c) 通过出版物、演讲和培训传播与公共心理健康相关的工作，也可以在线提供；d) 在 WPA 2020-2023 年行动计划的其他领域支持公共心理健康方法，包括儿童、青少年和青少年心理健康、合并症管理以及与其他组织的合作。

工作组已发表的出版物包括关于整个领域的社论¹⁰、处理 COVID-19 大流行的公共心理健康方法的文章^11-13以及关于解决公共心理健康实施失败所需行动的论文^{3， 14} . 工作组成员已经并将在 2021 年和 2022 年的世界精神病学大会上发表演讲，并将在 2022 年英国皇家精神病学学院国际大会上的公共心理健康研讨会上发表演讲。

为了就解决公共精神卫生实施差距所需采取的行动达成共识，请工作组成员为卫生政策第^{3条做出贡献}，它建议采取以下六项行动： a) 通过评估未满足的需求、估计影响和扩大覆盖范围带来的相关经济利益，以及协作宣传和领导，使公众精神健康成为案例；b) 公共心理健康实践；c) 公共心理健康培训和提高人口知识；d) 通过基于环境的方法、综合方法、数字技术、最大限度地利用现有资源和关注高回报干预措施，提高公共心理健康干预措施的覆盖率；e) 权利方法、立法和法规；f) 公共心理健康研究，包括以实施为重点的研究。