This blog is a collaboration between the Trimbos Institute in the Netherlands and Centre for Mental Health in the UK. It was first published in the Netherlands and is reproduced here for UK readers.
Mental health doesn’t begin or end in the health system. How we live, work, study and interact with our environment shapes how we feel and function. Income, housing, education, climate and employment policies all directly and indirectly influence mental health. Yet it often remains an afterthought outside the realm of health. That needs to change.
From symptom management to prevention
In previous blogs, the Trimbos Institute advocated for a shift in mindset which addresses mental health at its roots, and builds stronger foundations for mental health. That means taking action not only when mental health problems arise, but proactively supporting the conditions that foster mentally healthy lives. Increasingly, countries are recognising this approach, captured in the principle of ‘Mental Health in All Policies’.
But turning this principle into practice remains challenging. What if every policy proposal, whether about housing, education or transport, was routinely assessed for its impact on mental health? Just as we assess financial, environmental or legal implications, could we also be asking: does this policy reduce or increase stress, social exclusion or uncertainty? Does it promote good mental health, social connection, or autonomy? Centre for Mental Health explored this in a briefing paper published in 2024.
Examples of mental health policy tests across Europe
Though not a new concept or approach, momentum is growing internationally. In June 2025, European countries gathered in Paris at a high-level conference on mental health in all policies, hosted by the French Ministry of Health and the World Health Organization (WHO). The resulting Paris Declaration set out guiding principles for how all sectors, not just health, can contribute to better mental health.
Some countries are setting the pace:
- Finland has legally mandated mental wellbeing and social impact assessments. Local governments align budgets and strategies across departments and are required to report annually on wellbeing and health indicators to local councils and national authorities.
- Scotland regularly evaluates how policies influence mental health. Stress and social cohesion are considered in urban renewal efforts, contributing to the inclusion of green spaces and social meeting points, which have shown to reduce loneliness and psychological distress.
- In England, cities like Liverpool have used Health Impact Assessments (HIAs) to examine how housing renewal affects mental health. One assessment revealed that large-scale demolitions increased stress and a sense of loss. In response, residences were given more of a voice, support services were strengthened, and communication improved. In London, Transport for London considered mental health impacts when redesigning major traffic junctions, such as whether wider sidewalks, safer crossings, and green elements could reduce pedestrians’ feelings of stress and anxiety. These insights led to design changes and measurable improvements in resident wellbeing. But we are yet to see this approach adopted nationally or systematically.
- In Flanders, an open-access screening tool was developed to assess how spatial planning affects (mental) health.
Although the Netherlands had a Health Impact Screening approach, it lacked focus on mental health. Other local efforts exist, but national uptake is limited. There is currently no widely used, practical tool to systematically assess the mental health impacts of policies.
In both the Netherlands and the UK, most initiatives remain local rather than national. Ideally, a mental health policy test would be applied consistently at both levels. International examples show that it’s entirely possible to embed mental health into decision-making processes.
The benefits of mental health policy assessment
Mental health impact assessments aren’t just about avoiding harm, but highlighting opportunities to promote and improve mental health. For instance:
- Housing and environmental policy: Decisions around housing, green space, or infrastructure can either reduce or increase stress. Access to green areas and social gathering spaces in neighbourhoods are associated with a lower risk of depression and anxiety.
- Work and income policy: Economic policies that reduce job insecurity or financial insecurity protect mental health.
- Climate policy: Heatwaves and natural disasters affect both physical and mental health, and in particular are linked to anxiety. Policies that give clarity and focus on preparedness and building back stronger together can reduce fear and uncertainty.
- Poverty policy: Living in poverty is a well-established risk factor for mental health difficulties. Design of social policies is particularly important – including that of complex social security benefits processes, which may worsen mental health, especially among people already facing economic and social deprivation.
What could a mental health policy test look like in practice?
Rather than reinventing the wheel, mental health considerations can be integrated into existing assessment frameworks through targeted questions, such as:
- Who is affected by this policy? Are they at increased risk of mental health problems?
- Does the policy strengthen protective factors like social connection and autonomy?
- How does this policy affect people living with mental illness? (It’s worth noting that this concerns a significant portion of the population.)
- Does the policy increase stressors like uncertainty, social exclusion, or financial strain?
- Is the social safety net designed in a way that is accessible and compassionate?
- Will impacts on mental health be monitored and evaluated?
Crucially, this shouldn’t become a mere checklist. It should be a call to dialogue, a prompt for more meaningful conversations between policymakers, people with lived experience, communities and researchers.
A first for the Netherlands – what about the UK?
Together with national and international partners, including Centre for Mental Health, Trimbos is currently developing a mental health policy test tool in the Netherlands. Their goal is a usable tool that supports policymakers in systematically integrating mental health into their decisions across policy levels.
We would like to do something similar in the UK, and encourage all national, regional and local governments to do likewise.
Mental health is not just a health issue, it’s a social and economic issue. With a mental health policy test tool, we can build and improve policies that put people’s mental health at the heart of decision-making.
Laura Shields-Zeeman is Head of Mental Health and Prevention at the Trimbos Institute
