Dr Lade Smith and the Prague Agreement: A legacy of global mental health advocacy

In October 2025, the World Psychiatric Association met for its annual Congress, and amid the papers and proceedings something of quieter consequence occurred. A document was opened for signature, the Prague Agreement, modest in its wording and considerable in its reach. It asks the world to fund mental health as it ought to be funded, and it makes that case not on compassion alone, but on economics.

The scale is not in doubt. Mental ill-health costs the world in the region of $5 trillion. Wealthy nations carry it and poorer ones carry it, a burden indifferent to border or income.

What distinguishes mental illness is its timing. Most physical disease arrives later in life, after a person has been educated, has worked, and has contributed. Mental illness reverses that order. It tends to begin young, with the majority of conditions emerging before the age of 24 years. It arrives, in other words, precisely as a life is being formed, narrowing what a person might otherwise have become.

The greater cost, then, lies not in treatment but in lost capacity. In the young life that never quite finds its footing, and in diminished contribution across the decades that follow. The cumulative global loss is projected at some $16 trillion across two decades, and because younger populations tend also to be poorer ones, the weight falls hardest where means are least.

Yet the response has been thin. Only a small fraction of health spending worldwide is directed to mental health, against a financing gap running to hundreds of billions each year. This is less a failure of resources than of priority. The means often exist. The intention does not.

Clinical care matters, but it is not the whole of recovery. Much of what determines a person's health is shaped not in the consulting room but in the conditions of a life, in housing, employment, education, and the quiet fact of belonging. A person may be treated in a clinic, but they recover in a community.

And the investment repays itself. Spent early, on prevention and on care close to home, it returns more than it costs, often within a decade. Prevention is not merely humane. It is efficient.

There is a shrewdness to the remedy proposed. Governments have been asked before, and asked again, with modest result. So the appeal is directed instead to those who finance them. The major international lenders would make their support contingent on a country holding a genuine, cross-government mental health strategy. There is precedent for such leverage, and it has moved nations before.

No one should be reduced to their economic value, and by rights the case for mental health should stand on human dignity alone. But that argument, faithfully made for many years, has not moved the world far enough. So the Agreement makes the second case alongside the first, that the promotion of good mental health is no longer only a human rights imperative. It also makes economic sense.

That is the quiet turn worth remembering. Not the abandonment of the moral case, but its reinforcement. Where conscience has not sufficed to compel action, the ledger is enlisted to complete the argument.

The Agreement is, moreover, a coalition rather than a solitary appeal, and among the bodies that stand behind it is the Association of Psychiatrists in Nigeria. NPUK is thus drawn close to this work on more than one thread, through partnership abroad and through leadership at home.

For it is the work of Dr Lade Smith CBE, a psychiatrist of Nigerian heritage whose tenure as President of the Royal College of Psychiatrists has just drawn to a close.

It is no incidental endorsement. The Agreement is the product of both vision and persistence, authored and led by her, and carried with characteristic resolve from an idea to an instrument now open to the world.

We mark her contribution not as a farewell, but as a testament to what our profession exists to serve, and to what a discerning mind, sustained over time, can set in motion.

This piece draws on;

1. The Global Economic Case for Mental Health (October 2025), the document underpinning the Prague Agreement, and on reporting by The Nordic Psychiatrist. https://www.europsy.net/app/uploads/2025/11/Global-Economic-Case-for-Mental-Health-October-2025-6.10.25.pdf

2. https://www.thenordicpsychiatrist.com/post/wpa-congress-and-the-prague-agreement

For more information, please see npuk.org.uk