Introduction The World Health Organization (WHO) was established 60 years ago based on a constitution that in its first paragraph stressed that its principles are basic to the “happiness, harmonious relations and security to all people…”. The stress on mental health aspects was repeated in the definition of health to show that this was not an incidental choice of words [1]. Again 30 years ago when the declaration of Alma Ata was introduced to the world [2], the definition was reaffirmed and a new opening to scaling up mental health interventions through integration into primary health care was put forward. Yet, although considered formally an integral part of general health worldwide, and the WHO definition of health and its constitution implies that mental health is an integral part of health and as important as physical health [1], mental health is a somewhat paradoxical area of health. In reality, convincing data on the great burden of mental health [3,4] is juxtaposed with the low political will and insufficient resource allocation to deal with and avert the burden [5,6]. In fact, the low priority of mental health is not just a technical problem but an important moral one as well [7]. There is international documentation on the conspicuous shortage of mental health services in low- and middle-income countries [8] in the face of the increasing burden as a result of rapid economic and social change [9]. What are the reasons for this service gap and how can the problem be resolved? This paper tries to tackle these issues and propose possible future directions.