Lessons from the world's cities on protecting our mental health

All over the world people are migrating to cities, spurred by a range of economic, political, and social circumstances. Today, 54% of the world’s population lives in cities, and that is expected to rise to 66% by 2050. While this influx of new residents will put stress on urban infrastructure, it also presents an enormous opportunity to address persistent social problems, with mental illness being one of the most significant.

Mental illness, which affects over 450 million people, is one of the world’s most devastating and underfunded problems. It affects lives across the globe in schools, workplaces, prisons and homes, from the privileged to the marginalised. Young people are the most profoundly affected - and for them, mental ill health can set the stage for lifelong difficulties.

Every 40 seconds someone in the world takes their own life - that’s 800,000 suicides a year. By 2030 depression alone will become our most burdensome illness, more than cancer, diabetes, and chronic respiratory diseases combined. Today, depression is responsible for an estimated $2.5-$8.5 trillion loss in annual global output.

Demographic trends suggest that the largest group in our swelling urban populations will be young people. Around 60% of all city dwellers will be under the age of 18 by 2030. This offers an opportunity to harness the enthusiasm and ingenuity of the young, who are not only uniquely affected by mental illness, but who also have the capacity to develop imaginative and forward-thinking solutions.

We have spent the past two years searching for the best ways to spark systems-level change in order to improve the mental health of young people. We traveled around the world to meet with entrepreneurs, city governments, community and youth leaders to better understand the problem and to look into potential solutions more deeply. We were inspired by the amazing work happening at the local level across cities and communities in 11 countries, from Chennai, India to Nairobi, Kenya, and from Seattle, United States to Bogotá, Colombia.

The discussions from our global listening tour taught us that tackling this problem requires big, bold action and a keen understanding of five key principles:

Mental health must be normalised and brought into the open: While gaps in the available data stymie efforts to raise global attention, lack of information, shame, and judgment are all barriers to early action being taken in our communities. Our governments and civil societies have to learn to value mental health as a basic need, and to then reduce stigma and improve help-seeking and recovery. Smart use of data can not only target efforts more efficiently, it can also enable people to see mental illness as something we face every day, with one in every four of us experiencing it during our lifetimes.

Mental health solutions must take into account areas of public life beyond healthcare: Housing, transportation, criminal justice, education, public safety and other sectors have a crucial role to play. As a result, it will be essential for city governments and community leaders to work together to implement policies and programmes that address a range of urban issues, with the broader goal of improving mental health outcomes for young people.

Mental health must be addressed by transformational rather than transactional approaches: Access to mental health services is often considered the only solution, while the need for long-term systemic changes that promote mental health as well as those that support the prevention and treatment of illnesses and recovery from associated psychosocial disabilities is largely overlooked. Similarly, predictive and pre-emptive approaches are seldom seen in policy and practice, leading to a treatment framework that addresses illness only when it is chronic and disabling.

The insights and energy of young people must be harnessed to shape change and accountability mechanisms: Mental illnesses are chronic diseases of the young, with over 75% of mental health issues manifesting in those under 24 years old. Methods and models for supporting young people are often outdated and lack an integrated understanding of the pressures young people face today, while overlooking the stigma that people experience in using conventional doctor-patient services. We need to simultaneously tap into the ubiquitous use of technology by young people to accelerate their access to information and mental health support, while developing standards that take young people’s mental wellness into consideration in order to create more supportive technology.

Coordinated action at the local level and sharing knowledge across cities are key to accelerating the uptake of proven solutions: Models and methods for integrating and measuring mental health are sorely lacking. The most promising path forward for mental health is comprehensive, place-based solutions and networks operating at scale to support local implementation of solutions. A network can accelerate the aggregation of interventions in the ecosystems of individual cities while finding opportunities to capitalise on best practices and lessons learned from other, similar cities.

Mental health and behavioural problems are the primary source of adjustment problems in our youth. They create barriers to social and economic integration for over a billion young people worldwide - but early action can ensure that support is available to vulnerable people earlier in their lives. Urban planning, workplaces and refugee crises are all good examples of where integrating mental health considerations early in the design process will yield extensive benefits.

Cities have long demonstrated a willingness to pursue innovative public policies that would be unrealistic on a national scale. With the right kind of leadership from public and private sectors, affordable support for mental health can be developed by connecting formal and informal services across housing, transportation, law enforcement, education and health systems. Accessible psychosocial support services can buffer against contemporary urban problems such as homelessness, poverty, loss of education and job opportunities. Cities can therefore lead the way in accelerating the scaling of solutions and catalysing local collective action towards addressing mental illness and improving mental health.