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Breaking the Silence: World Mental Health Day and the Global Call for Universal Mental Health Rights

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dr. Karunia Valeriani Japar

Table of Contents
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Introduction

World Mental Health Day, observed every October 10, stands as a global opportunity to spotlight mental health as an essential component of human well-being, social participation and public health. With nearly one in eight individuals experiencing a mental health disorder worldwide, the burden of psychological condition conditions continues to rise, particularly following global stressors such as the Coronavirus disease 2019 (COVID-19) pandemic. Despite increasing recognition from health organizations and research institutes, significant gaps remain in awareness, access to care, and social understanding, especially in low and middle income countries [1,2].

This year’s World Mental Health Day affirms that “mental health is a universal human right,” inviting multidisciplinary collaboration and advocacy to ensure that mental health services reach all, regardless of cultural, social, or economic background. The continuing stigma makes it challenging for many to seek help, with misconceptions persisting that those affected by mental illness are somehow “ less capable” or ” different” from others. Evidence shows that mental illness is not a sign of personal weakness or instability, but rather a health issue shaped by complex biopsychosocial interactions demanding equal attention as physical health conditions [1,3,4,5].

In advancing public health strategies and social justice, World Mental Health Day advocates for prevention, compassionate care, and ongoing support, encourage communities to break the silence, recognize the legitimacy of mental health challenges, and celebrate achievements in psychosocial recovery. This article explores modern approaches to prevention, management, and relapse prevention, while challenging and promoting help seeking as cornerstone of resilience and recovery [1,3,5].

Epidemiology and Determinants of Mental Health

Mental health disorders constitute a major contributor to the global burden of disease, with recent estimates indicating that over one billion people are living with mental health conditions worldwide. The prevalence and incidence of mental disorders including depression, anxiety, schizophrenia, bipolar disorder, and other have risen significantly over the past three decades. For example, from 1990 to 2021, the global age standardized incidence rate (ASIR) for mental disorder increased by 15.23%, while disability, adjusted life years (DALYs) which measure years of healthy life lost due to illness, surged by 73.52%. major depressive disorder and anxiety disorders represent the largest portion of mental health related disability, affecting life quality and socio economic function across all demographics [6,7,8].

The burden of mental disorders varies by gender, region, and socio demographic index (SDI). Females consistently show a high age standardized burden of disease compared to males, while high income and urban regions report greater incidence and disability, partly due to better diagnostic capacity and resource availability. Conversely, low and middle SDI regions carry higher rates of undiagnosed and untreated mental health issues due to stigma and limited access to care [8].

Social and Environmental Determinants

Social determinants play a central role in shaping mental health outcomes. Factors such as poverty, unemployment, poor housing conditions, food insecurity, and limited education are strongly associated with increased psychological distress and higher rates of mental illness. Marginalized and disadvantaged groups (migrants, ethnic minorities, sexual minorities) experience compounded risk due to discrimination, chronic stress, and exclusion from services. Family relationships, community safety and neighborhood environments also critically affect well-being, with violence, instability and lack of support serving as triggers for symptoms of depression, anxiety and trauma [9,10,11].

Ecological factors such as air pollution, urban crowding, exposure to community violence, and climate change have increasingly been linked to mental health deterioration, particularly among vulnerable youth. In developed settings, work strain and social isolation further contribute to the rising mental health burden post COVID-19 pandemic [8,11,12].

Biological and Individual Determinants

While social factors dominate risk, genetic predisposition, early life adversity, physical health comorbidities, and neurobiological changes also affect susceptibility to mental disorders. Women report higher rates of depression and anxiety while age, chronic medical illness, and personal history of trauma further mediate risk. Psychiatric epidemiology embraces a biopsychosocial frame work, acknowledging the dynamic interplay of biological, psychological, and environmental influences in the onset and course of mental illness [8,11,13].

Implications

The growing global burden of mental health conditions underscores the need for population level preventive interventions, equitable access to services and integrative health policies targeting upstream determinants. Effective mental health improvement demands action not only in clinical practice, but also across social, policy, and environmental domains [8,11].

Preventive Strategies for Mental Health Disorders

General Strategies for Mental Health Disorders

Preventing mental health disorders requires a shift from reactive care toward proactive health strategies that address the determinants of well being at individual, community and policy levels. Evidence supports that early intervention, health promotion, and multisectoral collaboration are essential to decreasing the incidence and burden of mental illness across the lifespan [14,15].

Universal and Integrated Approaches

Universal prevention strategies prioritize interventions that benefit the entire population, regardless of risk profile, and include mental health literacy campaigns, anti-stigma initiatives, and public health campaigns targeting risk behaviors. Effective school based programs combine Social Emotional Learning (SEL) and Positive Behavior Interventions and Supports (PBIS) to teach adaptive skills and coping mechanisms, significantly reducing the risk of both internalizing and externalizing symptoms in children and adolescents [16,17].

A holistic, integrated framework merges lifestyle medicine pillars adequate physical activity, sleep, nutrition, and social connection with targeted psychosocial interventions such as stress management, mindfulness, and resilience training, traditional practices like mindfulness, yoga and meditation have been validated for their role in promoting emotional regulation and reducing the risk of depressive and anxiety symptoms [14].

Targeted and Selective Prevention

Selective strategies focus on those at elevated risk due to social, genetic, or environmental factors. Community approaches include screening for trauma and adversity, family support programs, and tailored interventions for marginalized populations, which address social determinants such as poverty, discrimination, and housing insecurity. Early life interventions such as parental training or reflective parenting, school based emotional learning, and attachment security programs develop adaptability and emotional stability, buffering against chronic stressors [15,18].

Technology driven innovations are increasingly critical, providing scalable digital platforms for psychoeducation and early detection, while reducing stigma via anonymous support and promoting self-care. Evidence shows that integrating mental health into primary care and public health systems enables better access and equity, especially in resource limited settings [15,16,18].

Clinical and Community Level Initiatives

Multisectoral partnerships among governments, medical institutions, workplaces and civil society are vital. Policies should address upstream determinants, food security, stable housing, employment, and social justice. While fostering community environment that support participation and connectedness. Healthcare providers must promote mental health literacy and empower proactive engagement in healthy behaviors: regular exercise, nutritious diet, substance abuse prevention, mindfulness and routine professional check-ups [14,15,18].

Cultivating personal agency and self-care responsibility, guided by ongoing support and professional advice, strengthens long-term resilience and buffers against relapse. The future of prevention rest upon the operationalization of adaptable capacity, using cross-disciplinary research and practical interventions that reflect cultural, developmental and personal difference [15,17,18].

Clinical Management of Mental Health Conditions

The clinical management of mental health conditions involves a systematic, multimodal approach integrating medical, psychological, and social interventions tailored to individual patient needs. Evidence-based protocols emphasize that management should be both person centered and multidisciplinary, involving collaboration between psychiatrist, psychologist, primary care providers, and where necessary social and occupational therapist [19,20,21,22].

Assessment and Diagnosis

Routine screening and comprehensive assessment are the cornerstones of effective mental health management. Standardized tool such as the PHQ-9 (for depression), GAD-7 (for anxiety), and Structured Clinical Interviews help in accurate diagnosis, tracking severity, and guiding treatment planning. Clinical history, mental status examinations, and collateral information are essential to understanding the context, course and comorbidity of symptoms [21,22].

Multimodal Treatment Strategies

Clinical guidelines advocate a “stepped-care” model, wherein intervention intensity is matched to illness severity and individual preferences [19,23]:

  • Psychotherapy: Psychotherapeutic modalities (e.g., cognitive behavioral therapy, interpersonal therapy, psychodynamic therapy) are foundational, particularly for mild to moderate cases and show robust efficacy in symptom improvement, emotional regulation, and long-term functional recovery [20,23].
  • Pharmacotherapy: For moderate to severe disorders, or when psychotherapy is contraindicated or ineffective, evidence-based pharmacological treatments are recommended primarily selective serotonin reuptake inhibitors (SSRIs) for depression/ anxiety and antipsychotics for psychotic disorders. Combination therapy often yields better outcomes than medication alone, especially for chronic or complex cases [23].
  • Lifestyle and Psychoeducation: lifestyle modifications including physical activity, nutrition, sleep hygiene, and substance use reduction are integrated into management plans for all individuals, with psychoeducational interventions enhancing treatment adherence and relapse prevention [19,22].
  • Caregiver Support and Social Interventions: Family or caregiver involvement is vital, with resources directed toward education, emotional support, and engagement in rehabilitation programs where appropriate [19,22].

Integrated and Person-Centered Care

Recent consensus and WHO guidance call for integrated care models combining mental and physical health interventions implemented via multidisciplinary teams (“Psycho-Cardio” teams in CVD patients, for example). Stepped care promotes early screening, prompt referral for severe symptoms, and tailored treatment pathways that adjust to context and resources. Avoiding benzodiazepine overuse, regular follow-up, and holistic recovery support are highlighted in current guidelines [19,22,24].

Outcome Monitoring and Guideline Use

Adherence to clinical guidelines improves symptom remission and functional recovery, shortens time to improvement, and reduces the risk of chronic disability. Ongoing monitoring using validated symptom scales, regular case review, and outcome audits ensure intervention efficacy and patient safety [25,26].

Post-treatment Recovery and Relapse Prevention

Post-treatment recovery for mental health conditions is multidimensional and ongoing process that extends far beyond the acute phase of care. Recovery involves the pursuit of a fulfilling, hopeful, and meaningful life, even amid limitations caused by mental distress. While relapse prevention ensures the maintenance of well-being and reduces the risk of recurrent episodes [27,28].

Person-Centered Recovery Planning

A successful recovery plan is individualized, collaborative, and builds on the strengths, aspirations, and lived experiences of each person. It focuses not just on symptom management, but also on reintegration into community life, meaningful social engagement, and developing a sense of autonomy and empowerment. Best practices incorporate [27,29]:

  • Structured goal setting using the SMART framework (Specific, Measurable, Achievable, Relevant, Time-bound) to ensure realistic, trackable progress [29].
  • Engagement with supportive networks such as families, peer groups, or lived experience practitioners to foster resilience and reduce isolation [29,30].
  • Incorporation of daily self-care routines, mindfulness practices, and healthy lifestyle behaviors that reinforce stability and reduce vulnerability to relapse [29].

Aftercare and Continuity of Support

Evidence indicates that aftercare interventions including regular follow up appointments, telephone check-ins, home visits, and psychoeducation for patients and families substantially reduce psychiatric readmission rates and enhance long-term functioning. Multidisciplinary community mental health teams and case managers facilitate continuity, especially during critical transition periods such as post-discharge [28,31,32].

Aftercare may involve structured step-down services, vocational or occupational therapy, and support with housing, employment, and social re-integration. Involving the family is particularly important where formal community services are not accessible, helping sustain recovery and identify early warning signs [28].

Relapse Prevention Strategies

Relapse prevention in mental health is a proactive, skill-based process that teaches individuals to recognize triggers, monitor early warning signs, and implement adaptive coping response before crisis occurs. Core elements include [32,33]:

  • Education to normalize the possibility of lapses and reduce feelings of shame or guilt if setbacks occur [33].
  • Development of personalized action plans for high-risk situations, such as emotional distress, major life events, social pressures, or substance exposure [33,34].
  • Enhancement of commitment to change by reviewing progress, reinforcing motivation, and adapting strategies as life circumstances evolve [29,33].
  • Ongoing therapeutic interventions (e.g., cognitive behavioral therapy, mindfulness training), self help and support group participation to reinforce skills and provide community [27,33,35].

Relapse prevention is most effective when social, economic, and policy support address broader determinants of health, such as safe housing, financial security, and discrimination.

Mental Health Stigma: Addressing Myths and Misconceptions

Despite growing awareness and advances in mental health care, stigma remains one of the foremost barriers preventing individuals from seeking timely help, adhering to treatment, achieving, encompassing public stigma (societal prejudice and discrimination), self-stigma (internalized negative beliefs), and institutional stigma (structural inequalities within health and social systems) [36,37,38,39].

Origins and Prevalence of Stigma

Stigma toward people with mental illness is rooted in cultural stereotypes, lack of mental health literacy, and misinformation about the causes and nature of psychiatric conditions. Prevalence studies reveal high rates of perceived stigma globally, across diverse societies and even among healthcare professionals. Individuals with mental illness are often perceived as dangerous, unpredictable, or personally responsible for their conditions, beliefs contradicted by scientific evidence [40,41,42,43].

Myths and Misconceptions

Common myths fueling stigma include:

  • “People with mental illness are ‘crazy’ or violent.” In reality, the vast majority are not violent and are often more vulnerable to victimization that others [36,39].
  • “Mental illness is a sign of weakness of poor character.” Mental disorders have well-established biological, psychological, and social determinants, comparable to physical conditions like diabetes [39].
  • “Mental health problems are rare.” In fact, mental disorders are highly prevalent, with estimates exceeding 50% lifetime prevalence in some populations [38].
  • “Treatment is ineffective and people can’t recover.” Many individuals experience complete or partial recovery with timely, evidence-based care [36].

Impact and Consequences

Stigma leads to social isolation, delayed treatment, reduced opportunities for employment or education, and poorer health outcomes. Self-stigma lowers self-esteem, inhibits help-seeking, and worsens clinical outcomes, while institutional stigma can present as underfunded services or unequal resource allocation [36,37].

Strategies for Addressing Stigma

  • Educational Interventions: Public health campaigns can dispel myths, improve mental health literacy, and present accurate information on causes, course, and treatment of mental disorders [39].
  • Contact-based Strategies: Facilitating positive, non-stereotyped interactions between the general public and people with lived experience of mental illness reduces prejudice and foster empathy [37,39].
  • Empowerment and Advocacy: Supporting individuals and families to become advocates and to share their recovery stories can challenge negative narratives and encourage others to seek assistance [37].
  • Policy Change: Enacting laws that protect against discrimination in health care, education, and employment, and mandating adequate service provision, is crucial for reducing structural stigma [36,37].

Conclusions

Destigmatizing mental health is essential to improving early identification, access to care, and treatment engagement, ultimately advancing public health outcomes. Myths and misconceptions must be actively challenged through education, social contact and advocacy, reinforcing the truth that mental illness is common, treatable, and never a cause for shame [36,37,39].

Role of Social Support and Help Seeking Behavior

Social support and proactive help seeking behavior are recognized as critical factors in the recovery, maintenance, and overall wellbeing of individuals facing mental health challenges. The presence of stable, empathetic, and structured support networks is repeatedly linked with improved psychological outcomes, reduced relapse rates, and greater resilience [44,45,46].

Social Support and Recovery

Social support encompasses emotional, informational, and instrumental assistance, provided by trusted individuals such as family, friends, peers or support groups. The size and quality of social networks contribute directly to better clinical outcomes. Empirical studies have shown that high perceived social support is associated with a significant reduction in depression and anxiety symptoms, lower post-traumatic stress scores, and improved self-worth and social connectedness. On the contrary, isolation and poor social support predict greater relapse risk in conditions such as schizophrenia and major depressive disorder [44,47,48,49,50].

Participation in meaningful activities and regular social interaction foster a sense of autonomy and life satisfaction, amplifying recovery even in the context of severe mental illness. The efficacy of social support is mediated through enhancing self-efficacy [47,49].

Help Seeking Behavior

Help seeking behavior refers to the willingness and proactive efforts of individuals to reach out for assistance, whether formally from healthcare professionals or informally from peers and family. Positive attitudes toward help seeking, shaped by mental health literacy and reduced stigma, are associated with earlier clinical engagement and better symptom outcomes. Importantly, help seeking behavior is moderated by cultural perceptions, individuals beliefs, and the perceived accessibility of mental health services [50,51,52,53,54,55].

Research demonstrates that educational programs aimed at raising awareness of mental health symptoms and treatment options can effectively increase the rates of help seeking and promote earlier intervention. Adolescents and younger adults often turn first to informal supports such as teachers and friends, emphasizing the importance of community based and peer led resources [50,53,54].

Preventing Relapse and Sustaining Well-Being

Ongoing social support systems- family involvement, peer support interventions, community groups play a vital role in preventing relapse, maintaining adherence to treatment, and detecting early warning signs of recurrence. Strengthening these networks is now central in relapse prevention guidelines, with interventions targeting self-efficacy, resilience, and adaptive coping. Supportive environments buffer against stress and mitigate the impact of financial, occupational, or personal life challenges that could precipitate relapse [48,50,56].

Effective strategies to foster social support and promote help seeking behavior such as mental health literacy campaigns, integrated care models, and stigma reduction programs are key to improving mental health outcome globally. The ongoing transformation of mental health services must prioritize these determinants to support sustained recovery, prevent relapse, and cultivate resilient communities [24,45,46].

Implications for Practice and Policy

Recent advances in mental health research and public health have underscored the essential need for systemic transformation in mental health practice and policy. The current environment calls for evidence based, person centered, and rights-oriented care models that address both clinical needs and the broader social determinants of mental health [24,57,58].

Practice Implications

For clinical and community practitioners, adopting integrated, multidisciplinary approaches is critical. Evidence shows that seamless collaboration among mental health professionals, primary care, and social services yields improved access, continuity of care, and better treatment outcomes [57,59].

  • Routine implementation of standardized screening tools, early intervention programs, and stepped care models should be prioritized to facilitate prevention, timely identification, and individualized treatment [57,59].
  • Recovery oriented and co production models where service users, families and communities are actively involved in service design, enhance engagement, satisfaction, and long-term recovery [57,60].
  • Expansion of digital intervention and telehealth has broadened service reach, especially for underserved populations, but must be coupled with clear standards for data privacy and equity [57,61].
  • Mental health promotion efforts such as psychoeducation, peer-led support, and social prescribing should be embedded in routine practice to reduce stigma and promote well-being [57,59].

Policy Implications

At the policy level, the WHO calls for urgent transformation to address persistent gaps in funding, access, and quality of care. Policy priorities include: [57,62]

  • Enacting legislation that ensures parity between mental and physical health coverage and prohibits discrimination against individuals with mental health conditions [57,63].
  • Scaling up investments in community-based services, integrated models of care, and prevention, including resources for social determinants such as employment, education, and housing [57,63].
  • Implementing governance frameworks that support program accountability, clarity of roles, and meaningful service user involvement at all stages of system development [57].
  • Expanding workforce capacity through targeted recruitment, training in holistic, recovery-oriented care and support for clinical leadership in mental health [57,63].
  • Ensuring person centered, right based approaches, especially community inclusion, protection of autonomy, and adaptation of services for marginalized and vulnerable groups [44,62].

Global and Local Impact

Failure to prioritize and reform mental health infrastructure result in delayed care, increased economic burden, and persistent health inequities. Policy innovation must align with international best practices, adapt to national contexts, and responding to emerging challenges such as population aging, migration, and digital transformation [57,58,63].

Conclusion

Mental health is an integral component of individual and public well-being, with a rising global burden underscored by increased prevalence, social and environmental determinants, and persistent stigma. Addressing mental health requires shifting from reactive to proactive and comprehensive strategies, emphasizing prevention, early intervention, and holistic, person-centered clinical management. Effective recovery and relapse prevention are grounded in individualized care, self-agency, multi-sectoral support systems, and inclusive aftercare services. Destigmatizing mental illness through public education, empowerment, and policy change is paramount to improving access, outcomes, and quality of life. Transforming mental health practice and policy demands integrated care models, robust investment in community resources, and a rights-oriented paradigm, ensuring mental health care is accessible, equitable, and embedded within broader health and social policies. Ultimately, fostering social support and promoting help seeking behaviors are vital to cultivating resilient, thriving communities and achieving sustained recovery for all.

References

  1. World Health Organization. World Mental Health Day [Internet]. www.who.int. 2023. Available from: https://www.who.int/campaigns/world-mental-health-day
  2. Shen N, Jilka S, Sawchuk K. Editorial: World mental health day 2022: key drivers of risk to mental health services and innovative solutions. Frontiers in Health Services. 2024 Jul 19;4.
  3. The Impact of Culture and Diversity O C T O B E R 1 0 2 0 0 7 [Internet]. [cited 2025 Sep 27]. Available from: https://www.encontrarse.pt/wp-content/uploads/2016/12/docs_wfmh2007.pdf
  4. Rosen A. World Mental Health Day | Johns Hopkins | Bloomberg School of Public Health [Internet]. publichealth.jhu.edu. 2023. Available from: https://publichealth.jhu.edu/2023/world-mental-health-day
  5. Shen N, Jilka S, Sawchuk K. Editorial: World mental health day 2022: key drivers of risk to mental health services and innovative solutions. Frontiers in Health Services. 2024 Jul 19;4.
  6. SingleCare Team. Mental health statistics 2020 [Internet]. The Checkup. 2020. Available from: https://www.singlecare.com/blog/news/mental-health-statistics/
  7. World Health Organization. Over a billion people living with mental health conditions – services require urgent scale-up [Internet]. Who.int. World Health Organization: WHO; 2025. Available from: https://www.who.int/news/item/02-09-2025-over-a-billion-people-living-with-mental-health-conditions-services-require-urgent-scale-up
  8. Mao QS, Guo YX, Tian XL, Zhao HL, Kong YZ. Global burden of mental disorders in 204 countries and territories results from the Global Burden of Disease Study 2021. World Journal of Psychiatry. 2025 Aug 19;15(8).
  9. Jeste DV, Smith J, Lewis-Fernández R, Saks ER, Na PJ, Pietrzak RH, et al. Addressing social determinants of health in individuals with mental disorders in clinical practice: review and recommendations. Translational Psychiatry [Internet]. 2025 Apr 3;15(1). Available from: https://www.nature.com/articles/s41398-025-03332-4
  10. Kirkbride JB, Anglin DM, Colman I, Dykxhoorn J, Jones PB, Patalay P, et al. The social determinants of mental health and disorder: Evidence, prevention and recommendations. World Psychiatry : Official Journal of the World Psychiatric Association (WPA) [Internet]. 2024;23(1):58–90. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10786006/
  11. Alegría M, NeMoyer A, Falgàs Bagué I, Wang Y, Alvarez K. Social Determinants of Mental Health: Where We Are and Where We Need to Go. Current Psychiatry Reports [Internet]. 2018 Sep 17;20(11). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181118/
  12. Wang J, Guan X, Tao N. GBD: incidence rates and prevalence of anxiety disorders, depression and schizophrenia in countries with different SDI levels, 1990–2021. Frontiers in Public Health. 2025 May 16;13.
  13. Karam EG, Keyes KM. Reflections on the current status of psychiatric epidemiology and public mental health. World Psychiatry [Internet]. 2025 May 15 [cited 2025 Sep 27];24(2):286–7. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12079490/
  14. Patterson EH, Miller C, Hannapel M. Public psychology and holistic approaches to prevention and treatment of depression. Frontiers in Psychiatry. 2025 Jun 3;16.
  15. Jiang F, Tang Y. Promoting Mental Health and Preventing Mental Disorders: Adopting a Proactive Health Approach. Alpha Psychiatry. 2025 Apr 3;26(2).
  16. Centers for Disease Control and Prevention. Protecting the Nation’s Mental Health [Internet]. Mental Health. CDC; 2025. Available from: https://www.cdc.gov/mental-health/about/what-cdc-is-doing.html
  17. Cook CR, Frye M, Slemrod T, Lyon AR, Renshaw TL, Zhang Y. An integrated approach to universal prevention: Independent and combined effects of PBIS and SEL on youths’ mental health. School Psychology Quarterly. 2015 Jun;30(2):166–83.
  18. Rudenstine S, Feliz S, Brown O, Schulder T. Defying risk: moving from resilience to the capacity to adapt, a contribution to mental health prevention. Frontiers in Psychology. 2025 Jul 2;16.
  19. Grover S, Avasthi A, Majid A. Clinical Practice Guidelines for mental health and well-being in patients with chronic medical illnesses. Indian Journal of Psychiatry [Internet]. 2024 Jan 1;66(Suppl 2):S338. Available from: https://journals.lww.com/indianjpsychiatry/fulltext/2024/66002/clinical_practice_guidelines_for_mental_health_and.15.aspx
  20. Pei T, Ding Y, Tang J, Liao Y. Evaluating the Effectiveness of a Multimodal Psychotherapy Training Program for Medical Students in China: Protocol for a Randomized Controlled Trial. JMIR Research Protocols. 2025 Jan 3;14:e58037.
  21. American Psychiatric Association. Clinical Practice Guidelines | psychiatry.org [Internet]. Psychiatry.org. 2020. Available from: https://www.psychiatry.org/psychiatrists/practice/clinical-practice-guidelines
  22. 2025 ESC Clinical Consensus Statement on mental health and cardiovascular disease [Internet]. Escardio.org. 2025. Available from: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Mental-Health-and-CVD
  23. Reeves G, Anthony B. Multimodal Treatments versus Pharmacotherapy Alone in Children with Psychiatric Disorders. Pediatric Drugs. 2009 May;11(3):165–9.
  24. World Health Organization. New WHO Guidance Calls for Urgent Transformation of Mental Health Policies [Internet]. Who.int. World Health Organization: WHO; 2025. Available from: https://www.who.int/news/item/25-03-2025-new-who-guidance-calls-for-urgent-transformation-of-mental-health-policies
  25. Moreno EM, Moriana JA. Clinical guideline implementation strategies for common mental health disorders. Revista de Psiquiatría y Salud Mental (English Edition). 2016 Jan;9(1):51–62.
  26. Setkowski K, Boogert K, Hoogendoorn AW, Gilissen R, Balkom AJLM. Guidelines improve patient outcomes in specialised mental health care: A systematic review and meta‐analysis. Acta Psychiatrica Scandinavica. 2021 Jul 5;144(3):246–58.
  27. Jaiswal A, Carmichael K, Gupta S, Siemens T, Crowley P, Carlsson A, et al. Essential Elements That Contribute to the Recovery of Persons With Severe Mental Illness: A Systematic Scoping Study. Frontiers in Psychiatry [Internet]. 2020 Nov 19;11(586230). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710894/
  28. Majid Barekatain, Maracy MR, Rajabi F, Hajar Baratian. Aftercare services for patients with severe mental disorder: A randomized controlled trial. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences [Internet]. 2014 Mar;19(3):240. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4061646/
  29. How to Build Long-Term Mental Health Goals After Completing Treatment [Internet]. Thehighpointresidence.com. 2025 [cited 2025 Sep 27]. Available from: https://www.thehighpointresidence.com/blog/how-to-build-long-term-mental-health-goals-after-completing-treatment
  30. DSpace [Internet]. Who.int. 2025 [cited 2025 Sep 24]. Available from: https://iris.who.int/bitstream/handle/10665/381760/WHO-EURO-2025-12307-52079-79927-eng.pdf?sequence=1
  31. Health Direct. Recovery and mental Health [Internet]. Health Direct. 2024. Available from: https://www.healthdirect.gov.au/mental-health-recovery
  32. Mpanza DM, Govender P, Voce A. Perspectives of service providers on aftercare service provision for persons with substance use disorders at a Rural District in South Africa. Substance Abuse Treatment, Prevention, and Policy. 2022 Aug 12;17(1).
  33. Overview of relapse prevention [Internet]. comorbidityguidelines.org.au. Available from: https://comorbidityguidelines.org.au/psychological-approaches/psychological-approaches/relapse-prevention
  34. Guenzel N, McChargue D. Addiction Relapse Prevention [Internet]. Nih.gov. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551500/
  35. Insight – Toolkits – Relapse prevention [Internet]. Qld.edu.au. 2025. Available from: https://insight.qld.edu.au/toolkits/relapse-prevention/detail
  36. Singhal N. Stigma, Prejudice and Discrimination Against People with Mental Illness [Internet]. American Psychiatric Association. 2024. Available from: https://www.psychiatry.org/patients-families/stigma-and-discrimination
  37. Girma E, Ayele B, Gronholm PC, Wahid SS, Hailemariam A, Thornicroft G, et al. Understanding mental health stigma and discrimination in Ethiopia: A qualitative study. Cambridge Prisms: Global Mental Health [Internet]. 2024;11. Available from: https://www.cambridge.org/core/services/aop-cambridge-core/content/view/927FF97F07919F311D176EFED49F82F9/S2054425124000554a.pdf/understanding-mental-health-stigma-and-discrimination-in-ethiopia-a-qualitative-study.pdf
  38. Evans L, Chang A, Dehon J, Streb M, Bruce M, Clark E, et al. The relationships between perceived mental illness prevalence, mental illness stigma, and attitudes toward help-seeking. Current Psychology. 2023 Mar 1;43(2).
  39. Ahad A, Gonzalez M, Junquera P. Understanding and Addressing Mental Health Stigma Across Cultures for Improving Psychiatric Care: A Narrative Review. Cureus [Internet]. 2023 May 26;15(5). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10220277/
  40. Torres IN, Pereira HP, Beatriz M, Marina S, Ricou M. Prevalence of stigma towards mental illness among Portuguese healthcare professionals: a descriptive and comparative study. Frontiers in Psychiatry. 2024 Aug 1;15.
  41. Hartini N, Fardana NA, Ariana AD, Wardana ND. Stigma toward people with mental health problems in Indonesia. Psychology Research and Behavior Management [Internet]. 2018 Oct;Volume 11(11):535–41. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6217178/
  42. Girma E, Ayele B, Gronholm PC, Wahid SS, Hailemariam A, Thornicroft G, et al. Understanding mental health stigma and discrimination in Ethiopia: A qualitative study. Cambridge Prisms: Global Mental Health [Internet]. 2024;11. Available from: https://www.cambridge.org/core/services/aop-cambridge-core/content/view/927FF97F07919F311D176EFED49F82F9/S2054425124000554a.pdf/understanding-mental-health-stigma-and-discrimination-in-ethiopia-a-qualitative-study.pdf
  43. Stanley N, Ogbodo Ada B, Nelson Chidinma O, Augusta Nkechi U. A Systematic Review on Prevalence and Perceived Impacts of Associative stigma on Mental Health Professionals. International Journal of Africa Nursing Sciences [Internet]. 2023 Jan 23;18(100533):100533. Available from: https://www.sciencedirect.com/science/article/pii/S2214139123000082
  44. Bjørlykhaug KI, Karlsson B, Hesook SK, Kleppe LC. Social support and recovery from mental health problems: a scoping review. Nordic Social Work Research [Internet]. 2021 Jan 4;12(5):666–97. Available from: https://www.tandfonline.com/doi/full/10.1080/2156857X.2020.1868553
  45. Hendryx M, Green CA, Perrin NA. Social Support, Activities, and Recovery from Serious Mental Illness: STARS Study Findings. The Journal of Behavioral Health Services & Research [Internet]. 2008 Nov 15;36(3):320–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682629/
  46. Acoba EF. Social Support and Mental health: The Mediating Role of Perceived Stress. Frontiers in Psychology. 2024;15(15):1–12.
  47. Dominguez MG, Brown LD. Exploring pathways to recovery and psychological well-being: examining the role of empathic and social self-efficacy, social support and social isolation. Frontiers in Psychology. 2025 Mar 17;16.
  48. Samuel T, Nigussie K, Mirkena Y, Azale T. Relationship between social support and schizophrenia relapse among patients with schizophrenia on follow-up at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: A case-control study. Frontiers in Psychiatry. 2022 Nov 24;13.
  49. Hendryx M, Green CA, Perrin NA. Social Support, Activities, and Recovery from Serious Mental Illness: STARS Study Findings. The Journal of Behavioral Health Services & Research [Internet]. 2008 Nov 15;36(3):320–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682629/
  50. Atadokht A, Hajloo N, Karimi M, Narimani M. The Role of Family Expressed Emotion and Perceived Social Support in Predicting Addiction Relapse. International Journal of High Risk Behaviors & Addiction [Internet]. 2015 Mar 20;4(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393558/
  51. Journal of Social Research [Internet]. ijsr.internationaljournallabs.com. Available from: http://ijsr.internationaljournallabs.com/index.php/ijsr
  52. Wodong GMA, Utami MS. The Role of Mental Health Knowledge and Perceived Public Stigma in Predicting Attitudes towards Seeking Formal Psychological Help. Jurnal Psikologi. 2023 Apr 28;50(1):1.
  53. Hardi N, Natalia N, Theresia F. Understanding Help-Seeking Behavior from Mental Health Literacy and Mental Health Belief Perspectives. Cermin Dunia Kedokteran. 2024 Dec 5;51(12):707–13.
  54. Help-Seeking Behavior and Related Mental Health Promotion Programs in Southeast Asian Youth: A Systematic Literature Review. Kesmas: Jurnal Kesehatan Masyarakat Nasional. 2025 Feb 28;20(1).
  55. Nandy Agustin Syakarofath, Dian Caesaria Widyasari. The Attitude of Help-Seeking Behavior Preventing from Mental Health Problems among Adolescents Living in District of Bondowoso. Jurnal Psikologi Integratif. 2023 Apr 27;11(1):25–5.
  56. Yanuarti T, Daud MNBM, Mohamed NHB, Atil AB, Triaswati R. The Relationship between Self-efficacy, Resilience and Social Support with Relapse Tendency in Substance Use Disorder in Indonesia. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal) [Internet]. 2025 Apr 30;11(2):234–43. Available from: https://journal.stikep-ppnijabar.ac.id/jkk/article/view/851
  57. Sharing the Vision Implementation Plan [Internet]. 2025. Available from: https://www.hse.ie/eng/about/who/mentalhealth/sharing-the-vision/sharing-the-vision-a-mental-health-policy-for-everyone-implementation-plan-2025-to-2027.pdf
  58. McGINTY B. The Future of Public Mental Health: Challenges and Opportunities. The Milbank Quarterly [Internet]. 2023 Apr 1;101(S1):532–51. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10126977/
  59. Mangalamchery V, Vaseel M, Uvais NA. MODELS OF PUBLIC MENTAL HEALTH IN PRACTICE: A SCOPING REVIEW. Journal of Community Mental Health and Public Policy. 2025 Apr 8;7(2):94–107.
  60. Piat M, Sabetti J, Bloom D. The Transformation of Mental Health Services To a Recovery-Orientated System of Care: Canadian Decision Maker Perspectives. International Journal of Social Psychiatry. 2010 Mar;56(2):168–77
  61. Bond RR, Mulvenna MD, Potts C, O’Neill S, Ennis E, Torous J. Digital transformation of mental health services. npj Mental Health Research [Internet]. 2023 Aug 22;2(1):1–9. Available from: https://www.nature.com/articles/s44184-023-00033-y#citeas
  62. WHO launches new guidance on mental health policy and strategic action plans [Internet]. Easpd.eu. 2025. Available from: https://easpd.eu/news-detail/who-launches-new-guidance-on-mental-health-policy-and-strategic-action-plans
  63. American Psychological Association. New policies affecting access to mental health care [Internet]. Apaservices.org. 2025. Available from: https://updates.apaservices.org/new-policies-affecting-access-to-mental-health-care

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