The social, economic, human rights and political challenges to global mental health addressed in this paper explore the inextricable relationship between mental health, poverty and debt. They include the need for more health economics research on cost-effective interventions; limited funding available to improve access to mental health services; the need for a move away from a concentration of limited resources available on specialist services in major cities alone in favour of better integration of mental health into country-wide primary care-led services; the need for careful strategic dialogue and action around public policy and its implementation; the role of health professionals and national mechanisms in scaling up access to services; the need for an improved global architecture for mental health; the need to strengthen links between mental and social development; and  consideration of the importance of a human rights approach as an additional lever to argue for improvements in mental health policy and implementation.