Mental health is an intrinsic part of health. Its prevailing position as secondary to physical health and its consequent neglect are based on inaccurate assumptions about mental health. Nowhere in the world, in either the developed or the developing countries, has mental health work been given priority as part of social policy, health policy or public policy. Yet all countries readily admit the major impact of mental health disturbances on the national economy and public health. The mentally sick are at the bottom of the list in service systems the world over, and the common attitude towards them tends to be highly negative. Meanwhile there is convincing evidence of the global and growing need for mental health services. The international debate on mental health policy has its origins in two arenas: in human rights issues and in service reform issues. The debate on human rights concerns legislation on mental health, compulsory treatment and coercive measures. As to the service reform process, the universal focus has been on the financing of health care, on cuts and downsizing, where no priority has been given to the quality of care. The social consequences of mental illnesses may be far more seriously marginalising for the patient than is the illness itself. They are caused by the inexperience and the exclusion mechanisms of the social community. They are evident also in non-institutional services, causing isolation and rejection. The state of mental health patients will not improve without the strong involvement of health policy planners, quality assurance developers and the medical and scientific community. We need far more studies and research in the field. We need also the empowerment of the patients themselves and their relatives.