The moral economy of worth: Why rights-based mental health must engage cultural logics of contribution.

Global mental health advances its commitment to rights-based care grounded in dignity, autonomy and freedom from coercion, assuming worth is inherent and support is a right. This Perspective aims to strengthen that agenda by adding a cultural-implementation lens: in many settings, everyday moral reasoning links worth to contribution (e.g., labour, perseverance and fulfilment of social obligations), creating a moral economy of worth in which legitimacy is earned, relational and conditional. Drawing on cross-cultural psychology, the article argues that contribution-based moralities are especially salient where three cultural dimensions co-occur: restraint, collectivism and long-term orientation. In such contexts, support can be morally misread as unearned reward, rest as indulgence and reduced functioning as moral failure, producing ethical dissonance that shapes help-seeking, clinical practice and policy uptake without implying rejection of human rights. Using Japan as an illustrative case, the article shows how norms of perseverance (ganbaru) and regulated dependence (amae) can intensify contingent self-worth, self-stigma, rapid-return expectations and family hesitation to seek support. To improve legitimacy and sustainability, five strategies are proposed: broaden what counts as contribution; frame recovery as stewardship for future participation; avoid morally triggering eligibility language; use culturally credible lived-experience narratives; and engage institutions across levels that shape moral judgement.