The world is experiencing a mental health crisis, one which disproportionately affects those who are already on the margins of society, from low-income groups and LGBTQ+ persons to those traumatised by war and intimate partner violence. Our young people, arguably the greatest human resource asset of any society, are especially threatened. This crisis is reflected in many ways, but the key metrics used by many are that of the prevalence of mental illness, substance use problems and self-harm. Based on these metrics, the situation was worsening in most countries, even before the pandemic which has added fuel to the fire. There might be many causes of this crisis, not least the increase in risk factors alongside the disappearance of protective factors compounded by the failure to care for people with mental illness; indeed, at the heart of the mental health crisis is the crisis of care, impervious it seems to the efforts taken by different countries: a signal that the current paradigms are fundamentally inadequate. This lecture will build on syntheses of innovative science from diverse contexts published in two Lancet Commissions and the Disease Control Priorities Project co-led by the presenter, to argue that this crisis must require us to interrogate the core assumptions underlying our understanding of the nature of mental health problems and the architecture of the mental health care delivery system and proposes a series of a paradigm shifts which are needed to shift the needle on the global burden of suffering attributed to mental health problems.