The outstanding debt: structural gaps and lack of sustainable mental health policies in emerging countries

Purpose This study, a commentary, aims to critically examine the structural gaps and lack of sustainable mental health policies in emerging countries, with a focus on their impact on people with psychosocial and intellectual disabilities. It emphasizes the urgent need for systemic, rights-based and inclusive reform. Design/methodology/approach Drawing on a reflective and analytical perspective, this paper synthesizes regional experiences and existing evidence to identify key barriers in public mental health systems, including underfunding, territorial inequality, institutional fragmentation, stigma and the invisibility of vulnerable populations. Findings Current mental health policies are often reactive, short-term and detached from social determinants. Critical deficits include limited intersectoral collaboration, weak community-based services and scarce user participation. Data scarcity and the gap between progressive laws and practical implementation further hinder sustainable progress. However, case examples from Chile, Brazil, Colombia and South Africa demonstrate that inclusive, community-oriented approaches are feasible when supported by political will and social participation. Originality/value This paper reframes mental health as a human rights and social justice issue, advocating for inclusive, participatory and territorially grounded strategies. It underscores the need for community-based primary care, intersectoral collaboration and active involvement of people with lived experience in policy design, monitoring and evaluation to achieve truly sustainable and transformative mental health systems in emerging countries.