Suicide is a huge public health problem with 700,000 deaths per year. United Nations are aiming to reduce suicide rates with 33 percent before 2030. Some countries have experienced declining trends, especially in Asia, partly due to restrictions in access to highly lethal pesticides. USA are facing increasing trends and in many western European countries there has been declining tendencies, but most recently rates have been rather stable.

Suicide preventive strategies have focused on universal prevention, thus intervention targeting the who population, selective prevention aiming to reduce risk in different high risk groups, and indicated prevention targeting people who are already having suicidal behavior. In most cases, suicidal acts are carried out within a short period of time, and in many cases without a long period of warning signals. In a way, suicidal acts resemble heart attacks or epileptic episodes more than other complications that often develop slowly and gradually. This makes the task of creating awareness programmes even more difficult.

However, a thorough mapping of risk groups and risk situations will enable us to plan a more targeted intervention. Thus, epidemiology and clinical research can play together.

The most important task is to identify those of immediate risk of suicide and provide treatment and support. There are four distinct risk groups with a very high suicide rate. These are 1) people sent home from psychiatric emergency room visits, 2) people recently discharged from psychiatric hospitalization 3) people who were hospitalized due to attempted suicide 4) people who have called life-line or other NGO-driven helplines because of suicidal thoughts. It can be helpful to evaluate the population attributable risk associated with different risk factors. The population attributable risk is an estimate of the proportion of the problem that could be avoided if the increased risk in a specific risk group could be reduced to the level of the general population. All these four groups have a very high risk of suicide and together they accounted for 25 - 50 percent of all suicides in Denmark, and the help they are offered are in most countries fragmented and not well organized. Coherent and assertive interventions are needed in order to reduce suicide rates. Interventions will need to involve monitoring persons in high-risk groups for longer periods.

All mental disorders are associated with increased risk of suicide, especially the first years after first hospital contact.

Safety plans have proven to be an effective tool for suicide prevention, and this concept will be presented

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Disorders due to addictive behaviors have been included in the eleventh revision of the International Classification of Diseases (ICD-11). Such conditions include gambling disorder and gaming disorder, and each has online specifiers given the relevance of the internet to each of these conditions in modern societies. This presentation will consider problematic usage of the internet with respect to formally specified disorders (gambling, gaming) as well as other online behaviors (e.g., use of social media) for which problematic engagement may be considered as an “other specified disorder due to addictive behaviors” in the ICD-11. European and global initiatives (e.g., the Lancet Psychiatry Commission on Problematic Usage of the Internet and the development of screening and diagnostic instruments involving World Health Organization workgroups) will be discussed. Clinical, developmental and public health implications will be presented to provide an up-to-date understanding of rapid changes in this area.

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The transition from institutional to community-based mental health care has been a key policy goal for decades. Despite progress, challenges such as inadequate funding, political prioritization, and a lack of clear frameworks persist. The European Community Mental Health Services Provider (EUCOMS) Network created a shared vision.

EUCOMS aims to outline the principles and key elements for implementing effective community-based mental health care systems. The primary goal is to bridge the gap between evidence, policy, and practice while promoting recovery-oriented, inclusive, and effective care models.

The development process involved a collaborative, multi-phase approach. Starting with expert workshops and literature reviews, the framework was refined through input from 100 stakeholders, including mental health professionals, researchers, and peer experts across Europe. Structured feedback rounds and consultation workshops further shaped the consensus.

EUCOMS identifies six principles for high-quality community-based mental health care: Human Rights: Ensuring dignity, liberty, and equality for all individuals, with a focus on reducing stigma and discrimination. Public Health: Adopting a population-based approach to promote mental health and prevent illness. Recovery: Supporting personal, functional, and clinical recovery through individualized care. Effectiveness: Implementing evidence-based interventions and practices tailored to local contexts. Community Networks: Strengthening formal and informal support systems to enhance resilience. Peer Expertise: Integrating the lived experiences of service users into service design, delivery, and evaluation. In my presentation I will focus on how these principles are turned into practice in 3 countries in 3 different regions: The Netherlands, Portugal and Ukraine. The Netherlands: the nationwide implementation of the Flexible Assertive Community Treatment model, professionalization of peer expertise and the ecosystem approach on mental health. In Portugal, a nationwide guide for establishing and evaluating community mental health teams in Portugal, promoting integrated, accessible care. In Ukraine, the a nationwide All Ukraine mental Health program was launched during the war, implemented supported by all ministries supported by WHO.

The EUCOMS Network presents a comprehensive framework for regional implementation of community-based mental health services. These principles advocate for systems that are inclusive, recovery-oriented, evidence-based, and integrated within the community. The model requires adaptable implementation, considering cultural, economic, and systemic contexts. Future efforts should focus on stakeholder engagement, capacity building, and sustained advocacy to align policy and practice with these principles.

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The increasing incidence of mental disorders poses an urgent challenge for psychiatry—one that cannot be addressed by treatment alone. The only sustainable path forward is to prioritize mental health promotion and primary prevention at all levels: universal, selective, and indicated. While often seen as a long-term investment, primary prevention is cost-effective and essential for reducing the future burden of mental illness. This is not science fiction; it is a necessary shift that must happen now within our clinical services. In this lecture, I will show how primary prevention is already being implemented within the Institute of Psychiatry and Mental Health in Madrid, showcasing real-world programs that integrate prevention into everyday psychiatric practice. By embedding prevention into mental healthcare, we can move from a reactive to a proactive model—one that truly addresses the root causes of mental disorders and ensures a healthier future.

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With both the Russian invasion of Eastern Ukraine and Crimea in 2014, and the war that began in February 2022, Ukraine has faced extensive damage, numerous casualties, widespread displacement of people, and significant psychological trauma. These events have strained health care and, particularly, mental health care systems that were ill-equipped to handle such stresses.

The Commission was created in February 2023, coincident with the first anniversary of the Russian attacks. Prof. Irina Pinchuk was invited to lead The Lancet Psychiatry Commission on Mental Health in Ukraine, with Prof. Norbert Skokauskas and Prof. Bennett Leventhal as Co-chairs. The Commission brought together 40 experts in mental health, economics, law, and science from 12 countries, formed into five workgroups (Clinical Services, Clinical Training, Research, Forensics and Legal Advocacy, and Finance).

The Commission recommends a stepped-care model in which low-intensity services are provided by non-specialist personnel, with proper training, integrated in primary care, augmented by digital tools, all directed to moving individuals from institutional to community-based services; Developing a multidisciplinary mental health research infrastructure that is adequately funded and initially focused on relevant issues such as PTSD, the war’s impact on Ukrainians, and innovative service models for Ukraine; Policy and legislative changes; Increase in Ukraine’s mental health spending, to 4.5% of total healthcare expenditures.

The Lancet Commission supports Ukraine’s goals to end the war, provide evidence-based services for its citizens and to join the global community with improved resources clinical education, research, legal structures, funding, and care.

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