Mental health management in the context of TB care in the WHO European Region: a consensus statement

Background Integrated care for TB and mental health is critical, as mental disorders worsen TB outcomes. WHO guidelines recommend routine screening for mental health conditions and integrated care for TB patients, yet implementation remains uncertain. Methods We conducted a survey with the participation of 34 experts from 26 countries from the WHO European Region within TBnet and the ADVANCE-TB COST Action, followed by a Delphi process to assess the uptake of WHO recommendations and build consensus on strategies for integrated TB-mental health care. Results The survey showed substantial gaps: only 21% of experts, representing six countries, reported local or national guidelines integrating mental health into TB care, and systematic screening was rare, including for drug-resistant TB. Building on these findings, the Delphi process reached consensus on the need for validated screening tools at key treatment stages, structured referral pathways, and tighter alignment between TB and mental health services. Eighteen consensus recommendations were developed, addressing training, routine data collection, technology-supported care, and sustainable financing. Conclusion Mental health remains insufficiently integrated into TB care across the WHO European Region. Routine screening coordinated referral systems and implementation of the proposed recommendations are essential to deliver people-centred, equitable, and effective TB care.