At the Ministerial Conference of the European Office of the WHO the Helsinki declaration was endorsed by all member states of the European Region. The Declaration offered a vision of a comprehensive and inclusive scope of mental health activities. Since then many countries have drafted or scrutinised strategies according to the declaration and activities have been developed in areas ranging from anti-stigma and suicide prevention strategies to the improvement of facilities, development of services and community activities.

There have been numerous successes, but we have also become aware of challenges which need addressing in a variety of ways. These include the absence of evidence in some crucial areas, the cost of service development, health systems not suited to the demands of mental health care, workforce challenges and the stigma and discrimination experienced by users, carers, services and staff.