The post-communist WHO European region, often called Central and Eastern Europe (CEE), includes 28 countries with over 770 million people. Mental health systems remain shaped by the communist legacy of centralized institutions, a narrow biomedical focus, and neglect of social and psychological dimensions. Chronic underfunding persists, further strained by shrinking civic space in some countries and the war in Ukraine. Substantial progress has been made in the past decade, with modernization and rights-based approaches gaining ground. Yet reforms face entrenched barriers: underinvestment disproportionate to the burden; pervasive stigma, weak advocacy, and limited involvement of people with lived experience; dominance of institutional care over prevention, promotion, and community services; reliance on donor-driven projects that falter once funding ends; and human resource problems. Governance is often unstable, with low prioritization, clientelism, and personal biases undermining reforms. Research and data remain scarce, leaving systems unevaluated and vulnerable to reversal. Poor decision-making compounds these barriers: systemic missteps, driven by limited expertise, weak evidence, and personal biases, prevent resources from achieving the best possible outcomes. To move forward, CEE must integrate health, social, and education systems, secure sustainable crisis services, strengthen professional skills, involve people with lived experience, expand public mental health expertise, and, above all, commit greater and more transparent investment, closer to western European levels, if resilient and effective systems are to be built.

Alma Mater Europaea Campus College Rezonanca Pristina Kosovo

Center for Early Development Clinical Centre of Montenegro Podgorica Montenegro

Centre for Global Mental Health Health Service and Population Research Department Institute of Psychiatry Psychology and Neuroscience King's College London London United Kingdom

Department of Medical Psychology Psychiatry and Psychotherapy Kyrgyz Russian Slavic University Bishkek Kyrgyz Republic

Department of Mental Health Heim Pal National Pediatric Institute Budapest Hungary

Department of Propedotherapy of Family Medicine International Higher School of Medicine Bishkek Kyrgyz Republic

Department of Psychiatry Psychosomatic Medicine and Psychotherapy University Hospital Goethe University Heinrich Hoffmann Straße 10 60528 Frankfurt am Main Germany

Department of Psychology Faculty of Arts Charles University Prague Czech Republic

Department of Social Work Faculty of Arts Charles University Na Příkopě 584 29 Prague Czechia

Department of Social Work Faculty of Health Care and Social Work Trnava University Trnava Slovakia

Faculty of Medicine University Ss Cyril and Methodius Skopje North Macedonia

Federation Global Initiative on Psychiatry Hilversum Netherlands

Global Initiative on Psychiatry Sofia Bulgaria

Global Public Health Department Karolinska Institutet Stockholm Sweden

Ilia State University Tbilisi Georgia

Institute of Behavioural Sciences Semmelweis University Budapest Hungary

Institute of Mental Health of Ukrainian Catholic University Lviv Ukraine

Institute of Public Administration Governance and Professional Development of Lviv Polytechnic National University Lviv Ukraine

Institute of Social Studies University of Lower Silesia Wroclaw Poland

Lisbon Institute of Global Mental Health Comprehensive Health Research Centre NOVA Medical School Universidade NOVA de Lisboa Lisbon Portugal

London Imperial College London United Kingdom

Mental Health Perspectives Vilnius Lithuania

Military Institute of Medicine National Research Institute in Warsaw Poland

National Centre of Mental Health Riga Latvia

National Directorate General for Hospitals Budapest Hungary

Nicolae Testemitanu State University of Medicine and Pharmacy Chişinău Moldova

St Marys University London United Kingdom

Tallinn University of Technology Tallinn Estonia

Tenenet o z Senec Slovakia

The National Mental Health Center of the Ministry of Health Baku Azerbaijan

UBT Higher Education Institution Pristina Kosovo

University of Medicine Pharmacy Science and Technology George Emil Palade Târgu Mureş Romania

University of Medicine Tirana Albania

University Psychiatric Hospital Vrapce Zagreb Croatia

University Psychiatry Clinic Skopje North Macedonia

Vytautas Magnus University Kaunas Lithuania

WHO Collaborating Centre for Public Mental Health Research and Service Development National Institute of Mental Health Topolová 748 Klecany 250 67 Czechia

World Health Organization Barcelona Office for Health Systems Financing Spain

Zagreb School of Medicine and Zagreb University Hospital Centre Zagreb Croatia

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