Mental health is an essential component of health, yet it is often not given the attention that ir deserves as a global health and development issue. In this paper, we examine the global health context, including the substantial burden of disease, resources available for mental health, treatment gap, human rights issues, links between mental health and development, and economic impact of mental disorders. Then we consider recent actions taken at the global level to advance mental health as a global health issue. Finally, we look at South Africa as an example of a country that is ripe for change in its approach to mental health. This is a country with a high prevalence of mental disorders and a large treatment gap, yet it has a number of strengths on which to build a response to improving population mental health. We make suggestions as to how South Africa can move ahead on its mental health agenda, whilst also being a model for other countries in the region and across the globe.