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Exciting changes have the potential to reshape the tools used to treat mental illness, promote mental health, and bring this country's too-long fragmented and specialist-centered mental health system closer to delivering on the goals of improving population health, expanding access, and engaging with structural and social determinants. Innovative practices such as task sharing, cross-sector integration, and participatory methods are ready to be mainstreamed into psychiatric professional identity and practice. Local governments have started to adopt these new strategies, perhaps the most prominent recent example being ThriveNYC, a comprehensive attempt to drive mental health improvement. By enabling and partnering with other practitioners in these ways, psychiatrists can reach more people in more places, giving psychiatry an opportunity to evolve and flourish. As psychiatrists, we and our leadership should seize that opportunity and help lead this progress.

Promoting population mental health and meeting the burdens of mental illness is a priority public health challenge of the 21st century. But too little attention has been placed on how to design and sustain the scope of strategies and commitments that credibly live up to the full breadth of that challenge. ThriveNYC is an effort by New York City to fill that gap, through a public health approach backed by investment in resources and leadership. ThriveNYC can by example help mobilize a larger community of investigators and policymakers to consider how to meet this challenge, to get to consensus on key elements for effective action and implementation, to reimagine who and what the mental health "system" includes, and, in doing so, to strengthen the social contract that underlies well-being.

Common mental disorders pose tremendous health and social burdens in the poorest countries. This Open Forum describes a planning framework to advance effective, sustainable design and implementation of mental health services in these settings. It builds on research in treatment dissemination and on the authors' experience in several initiatives-including the Millennium Villages Project in sub-Saharan Africa and the Partners In Health system in Haiti (Zanmi Lasante). The authors describe a "pyramid of care" approach that specifies five key skill packages to address common mental disorders in low-resource settings and five implementation rules: assess context first; identify priority care pathways and map them across skill packages; specify decision supports, supervision, and triage rules; use quality improvement practices; and plan for sustainability and capacity building. The framework addresses the need for a shared vocabulary and a set of tools to coordinate and compare efforts to scale-up mental health treatment across diverse settings.