Titled 'No One Left Behind - Mental Health Care for All', Lucy's essay was one of only two winning entries selected from submissions across 38 countries. As part of her award, the WPA awarded her a bursary covering flights, accommodation and registration to attend the congress and collect her prize in person.
Lucy's essay examines how mental health inequalities affect five key population groups: people experiencing homelessness, LGBTQ+ individuals, those living in socioeconomic deprivation, neurodivergent people, and racial minorities. With the early stages guided by her own experiences on placement in psychiatry, Lucy then carried out a detailed review of the evidence and found that each of these groups faces a significantly higher risk of developing mental health conditions and often has a poorer experience of healthcare services. She proposes practical, tailored solutions, such as the 'Housing First' model for people who are homeless, which as been successful in other countries by prioritising stable accommodation before treating issues such as addiction. She was also determined to include neurodivergent people in her analysis, "a group that isn't always thought of when people talk about health inequality".
Describing what it was like to win the prize, Lucy said, "I was so shocked - I had zero expectations. I just thought that, even if I wasn't successful, there would always be something to learn." She added that attending the conference was a highlight of her medical training so far. "As a student it's not always financially possible to go to these types of events, so having the bursary was a huge help. It was amazing to meet people who were all interested in psychiatry - from students like me to renowned academics and clinicians in different fields."
Looking ahead, Lucy hopes to use this achievement as a stepping stone towards a career in academic psychiatry. "Psychiatry was never really on my radar, but during a two-month placement in liaison psychiatry, I really took to it. It's so interesting trying to understand what's going on in someone's mind - almost like being a detective." Since then, she has continued to gain experience in the field, including completing a King's Undergraduate Research Fellowship (KURF). "I want to blend both clinical work and research in the future. There is so much opportunity in psychiatry, and I hope this experience will open doors to a clinical academic path."
No One Left Behind - Mental Health Care For All
By Lucy Stiles
Introduction
Mental health is the great equaliser, affecting individuals regardless of age, race, income and more. Yet in practice, mental health care often remains deeply unequal. During my recent placement in psychiatry, I witnessed firsthand how systemic disparities, rooted in homelessness, age, race, intellectual disability, and socioeconomic status, quietly shape and often limit access to care. For those who live on society’s margins, mental health challenges are not isolated medical phenomena but deeply intertwined with experiences of exclusion, discrimination, and systemic neglect.
The United Nations’ Sustainable Development Goal #10: Reducing Inequalities highlights the urgent need to address disparities within and between countries. This essay argues that to achieve genuine mental health equity, the global community must recognise and address the compounded inequalities of five key groups: the homeless, ethnic and racial minorities, individuals of low socioeconomic status, LGBTQ+ individuals, and neurodivergent people. Each of these populations faces unique challenges that increase the risk of developing mental health disorders while simultaneously decreasing their access to care. These groups often encounter stigma, structural racism, diagnostic overshadowing, and fragmented services. This essay proposes a multi-faceted approach that combines healthcare reform, policy innovation, and grassroots activism, all underpinned by the principles of inclusion outlined in UN Sustainable Development Goal #10.
Focus Area One: Homelessness
Homelessness represents one of the clearest examples of how social inequality shapes mental health. People experiencing homelessness are disproportionately affected by severe mental illnesses, including schizophrenia, bipolar disorder, depression, and substance use disorders. A systematic review found that the prevalence of psychotic illnesses among homeless populations was nearly ten times higher than in the general population, with similar results for anxiety and depression (1). Mental illness can be both a cause and a consequence of homelessness, creating a vicious cycle that is difficult to escape.
Structural barriers worsen the vulnerability of homeless individuals to poor mental health. For example, lack of stable housing complicates prescription availability and therefore medication adherence as well as sleep hygiene, sense of belonging, safety and more, all of which form the foundations of mental well-being. Furthermore, societal stigma often frames homeless individuals as 'difficult' or 'non-compliant,' rather than recognising the huge systemic barriers they face. Studies have shown that healthcare professionals, despite good intentions, may unconsciously hold biases that lead to poorer engagement and quality of care for homeless patients (2).
Addressing homelessness as a social determinant of mental health is crucial to fulfilling UN Sustainable Development Goal #10. Firstly, governments should prioritise the national and international expansion of the Housing First model (3), which offers immediate access to permanent housing alongside mental health support that is unconditional. Unlike traditional models that often mandate sobriety or treatment
adherence before housing is granted, the Housing First model acknowledges that stable shelter is a prerequisite for recovery, not a reward for it.
Secondly, healthcare systems must increase funding for mobile outreach mental health teams. Homeless individuals may be unable to travel to services, so we should travel to them. By reaching individuals directly in shelters, streets, and temporary accommodations, we can facilitate better engagement with mental health care. Furthermore, mental health services should be integrated into housing support, employment assistance, and social care within unified service hubs to reduce fragmentation and systemic navigation barriers.
Beyond policy changes, huge cultural shifts within the healthcare system itself are required. Anti-stigma training and structural competency education for all professionals working with homeless populations could help individuals be more aware of any unconscious bias they may hold and promote trauma-informed care practices. Finally, housing security must be embedded into all psychiatric care pathways. Clinicians should be reminded to formally assess and address housing status as an essential component of treatment planning.
Put together, these interventions can dismantle barriers, restore dignity, and ensure that access to mental health care does not remain a privilege of the housed. Committing to these reforms would mean a step in the right direction to achieving the vision of Sustainable Development Goal #10: a world in which no one is left behind.
Focus Area Two: Ethnic and Racial Minorities
Those belonging to ethnic and racial minorities face profound disparities in mental health outcomes, shaped by systemic racism, historical trauma, cultural exclusion, and discriminatory practices within healthcare systems. Research has shown that minority populations are at greater risk of mental health disorders, often exacerbated by barriers to accessing appropriate and culturally-minded care. Experiencing racism has been independently associated with poor mental health outcomes, including higher rates of depression, anxiety, and psychological distress (4).
To dismantle these inequities, we must embed culturally competent care at every level. Training for healthcare providers on cultural humility, anti-racism, and unconscious bias should be made mandatory, and, unlike traditional cultural competence models, which often focus superficially on "knowing" other cultures, these courses should be shaped on principles of cultural humility, which emphasises a lifelong process of self-reflection, institutional accountability, and patient-centeredness. It is also essential to ensure access to interpreters and cultural liaison workers within mental health services to bridge communication gaps and foster trust, ultimately improving care outcomes.
Research shows that ethnic minority patients often experience better outcomes when they engage with providers who share or are attuned to their cultural backgrounds (5). Supporting the recruitment of a more diverse mental health workforce through widening participation type schemes could help foster a sense of belonging for those in minority groups and help them to feel more seen.
Policies must also mandate the systematic collection and public reporting of ethnicity data in mental health outcomes, ensuring transparency and driving targeted improvements.
Involving minority communities in the design, delivery, and evaluation of mental health programs can ensure interventions are responsive, respectful, and effective, providing a pathway toward equity.
Addressing racial and ethnic inequalities in mental health care is a fundamental requirement for justice and public health. Implementing structural reforms that prioritise cultural inclusion and dismantle systemic barriers can help in achieving Sustainable Development Goal #10: reducing inequalities within and between societies.
Focus Area Three: Socioeconomic Deprivation
Socioeconomic status is a powerful determinant of mental health, influencing exposure to stressors, access to resources, and the ability to access effective treatment. Individuals living in poverty face higher rates of depression, anxiety, and other common mental disorders compared to their wealthier counterparts. A strong association has been shown to exist between low socioeconomic status risk of mental illness across high, middle, and low-income countries, with poverty operating both as a risk factor and a consequence of poor mental health (6).
Financial instability can be a source of daily psychological stress as it restricts access to stable housing, nutritious food, healthcare, as well as reduced opportunities for social participation, all of which are key components to psychological wellbeing. The experience of financial hardship can itself generate chronic stress and feelings of hopelessness, increasing vulnerability to depression and anxiety. Those living in poverty are also less likely to access timely mental health care, often facing long waiting lists, geographic barriers, and prohibitive costs.
Governments must invest in robust social protection systems to buffer individuals against the mental health consequences of poverty. Universal access to affordable, high-quality healthcare — including mental health services — must be established as a basic right, not a privilege determined by income or employment status. Expanding the availability of free or low-cost psychological therapies, particularly through community-based services, is essential to ensure early and equitable intervention.
Addressing these inequalities requires reform extending beyond the healthcare system. Economic policy also plays a crucial role in promoting mental health equity. Raising minimum wages to living wage standards, strengthening employment protections, and enacting progressive taxation can help reduce financial strain at the population level. Finally, meaningful reform requires centring the voices of people with lived experience of poverty and mental illness in policy design. Empowering affected communities to help produce solutions ensures that interventions are both effective and mindful of the lived experience. Reducing socioeconomic inequalities to improve mental health is essential for achieving Sustainable Development Goal #10.
Focus Area Four: LGBTQ+ Community
LGBTQ+ individuals experience disproportionately high rates of mental health difficulties, including depression, anxiety, substance use disorders, and suicidal ideation. These disparities are not intrinsic to LGBTQ+ identities but are driven by societal stigma, discrimination, and exclusion. The Minority Stress Theory (7) explains how chronic exposure to social stressors such as rejection and victimisation leads to worsened psychological distress within LGBTQ+ populations. Global evidence confirms that
LGBTQ+ youth and adults have a higher risk of adverse mental health outcomes compared to their heterosexual and cisgender peers (8).
To address these inequalities, healthcare systems must ensure that mental health services are explicitly inclusive and affirming of diverse sexual orientations and gender identities. This includes providing targeted training for all healthcare providers on LGBTQ+ health needs, cultural competence, and trauma-informed care. Affirmative therapeutic approaches, which validate rather than pathologise LGBTQ+ identities, should become standard practice within all mental health services.
On a policy level, enforcing anti-discrimination laws in healthcare, employment, education, and housing can create safer environments that protect the mental health of LGBTQ+ individuals. This should begin early; for example, schools should implement inclusive curricula and anti-bullying programs that address homophobic and transphobic harassment, reducing the early-life stressors that contribute to the long-term psychological harm often seen in this group. Funding should be allocated to expand access to gender-affirming healthcare, including mental health support for transgender and non-binary individuals.
Furthermore, community-based initiatives can play a key role in fostering a sense of community in this group and promoting mental well-being. Peer-led support groups, LGBTQ+ community centres, and advocacy organisations could provide culturally sensitive, accessible mental health resources that can reduce feelings of isolation. Funding and supporting these grassroots movements ensure that interventions are not only top-down but embedded within the lived realities of LGBTQ+ communities.
By implementing these reforms, we can begin to dismantle the systemic inequalities that the psychological wellbeing of the LGBTQ+ community at risk. Promoting inclusion, protecting rights, and celebrating diversity are not only moral imperatives but necessary actions to achieve the aims of Sustainable Development Goal #10: reducing inequalities and ensuring that no one’s mental wellbeing is left behind.
Focus Area Five: Neurodivergent Individuals
Neurodivergent individuals, such as those with autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), dyslexia, and other cognitive variations, experience disproportionately high rates of mental health difficulties. Research has consistently shown elevated risks of anxiety, depression, and suicidal ideation among neurodivergent populations compared to neurotypical peers (9). These disparities are not always directly attributable to neurodivergence itself but are often shaped by systemic exclusion, social misunderstanding, and lack of tailored support.
Despite growing awareness, many neurodivergent individuals still experience significant barriers to mental health care. Diagnostic overshadowing, where clinicians attribute psychological distress solely to a neurodevelopmental diagnosis, rather than recognising concurrent mental health issues, remains a key issue. Furthermore, standard mental health services are often ill-equipped to meet the needs of neurodivergent individuals, relying on communication styles, therapeutic models, and sensory environments that can be inaccessible or even harmful to individuals with neurodivergence.
To address these inequalities, structural and cultural reforms within mental health care systems are required. All clinicians should be trained in neurodiversity-affirming practices
to highlight different cognitive styles and communication needs. Mental health assessments and interventions should be adapted to accommodate sensory sensitivities, for example, by allocating specific quiet areas or quiet times. Providing flexible appointment formats, such as offering longer sessions or written communication options, can make services more accessible and effective.
Policy reforms should mandate the inclusion of neurodivergent perspectives in mental health service design and evaluation. Neurodivergent individuals are equal partners in creating and governing services to ensure that new interventions are genuinely helpful. Moreover, expanding access to early diagnostic services, particularly for marginalised groups such as women and ethnic minorities who are often underdiagnosed, can prevent years of unmet need and cumulative psychological harm.
Education and employment systems must also evolve to support neurodivergent mental health. We should aim to improve schooling practices and workplace accommodations to reduce the chronic stress and exclusion that contribute to poorer mental health outcomes in this population. Lastly, public awareness campaigns celebrating neurodiversity can help tackle stigma and promote societal acceptance.
Reducing inequalities for neurodivergent individuals is essential for achieving UN Sustainable Development Goal #10. Building systems that affirm neurodivergent identities and support their psychological well-being represents a critical step toward a more equitable, inclusive world.
Solutions overview
Achieving genuine mental health equity requires an intensive and multi-faceted approach that addresses both healthcare systems and the wider structural determinants of mental health. The examples explored in this essay, homelessness, ethnic and racial minority status, socioeconomic disadvantage, LGBTQ+ identity, and neurodivergence, highlight patterns of exclusion and systemic bias in society.
Firstly, mental health services must be restructured to promote accessibility, inclusivity, and cultural safety. Expanding mobile outreach models for underserved populations, mandating cultural humility and anti-discrimination training in professional education, and adapting services to accommodate neurodiverse needs are key steps. Universal health coverage, inclusive of comprehensive mental health care such as psychological therapies, must be seen as a basic entitlement rather than a privilege based on an individual’s income, geography, or identity.
Beyond reform within the healthcare system itself, addressing social determinants of mental health is essential. Governments should prioritise investments in affordable housing, equitable education, secure employment, and robust social protection systems in order to mitigate the economic and social stressors that can drive mental ill-health.
Finally, communities must be placed at the centre of any reform. Co-producing services with people who have lived experience of poverty, discrimination, or neurodivergence ensures that interventions are grounded in reality rather than taking a paternalistic approach. More funding should be provided for community-led initiatives, peer support networks, and advocacy organisations to promote change from within.
Taken together, these actions reflect the true spirit of UN Sustainable Development Goal #10: reducing inequalities not only between but within nations, and ensuring that no one’s mental health is left to chance or circumstance.
Conclusion
Mental health care has long been framed as a universal need, yet in reality, it remains deeply conditioned by inequality. Homelessness, racism, poverty, LGBTQ+ discrimination, and the marginalisation of neurodivergent individuals are key issues in who receives care, how they are treated, and what outcomes they have. The consequences are alarming, with higher rates of psychological distress and the systematic exclusion of millions from the promise of mental wellbeing.
Sustainable Development Goal #10 envisions a world where these disparities are no longer inevitable. Meeting this challenge requires more than minor adjustments. It demands a reimagining of mental health systems as instruments of equity, empowerment, and inclusion. By addressing social determinants, embedding cultural and neurodiversity competence, and elevating the voices of those most affected, we can build a future where mental health care is accessible, acceptable, and effective for all.
No one should be left behind when it comes to mental health. By committing to reforms that promote inclusion, dignity, and justice, we can bring the principles of UN Sustainable Development Goal #10 closer to reality.
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