OBJECTIVE To describe mental health care needs and challenges across the WHO European region of 51 nations. METHOD Based on morbidity and mortality data from HFA Statistical Database and Health2l, the policy framework of WHO Europe, major trends in mental health care needs, psychiatric reform and mental health promotion are discussed. RESULTS There is a mortality crisis related to mental ill health in Eastern European populations of transition. Destigmatization is required to improve early intervention and humanization of services, and national mental health audits are needed to create the basis for national mental health planning, implementation and monitoring. There are both problems and advances in service restructuring, and comprehensive mental health promotion programmes, preventive and monitoring strategies are required. CONCLUSION Partnerships between national and international organizations, especially WHO and the European Union, have to be strengthened to make progress on the way to integrated community mental health services.