How The City Affects Mental Health
There can be no health without mental health. Good mental health is essential not just for our personal wellbeing, but also to achieve resilient, sustainable cities. Globally, 1 in 4 people will experience mental health problems: mental health disorders account for 7.4% of the burden of disease, and are now the leading cause of long-term disability worldwide.
Good mental health can improve people's enjoyment, coping skills, and relationships, educational achievement, employment, housing and economic potential, help reduce physical health problems, ease healthcare and social care costs, build social capital, and decrease suicides.
The physical and social environments of urban life can contribute both positively and negatively to mental health and wellbeing. Cities are associated with higher rates of most mental health problems compared to rural areas: an almost 40% higher risk of depression, over 20% more anxiety, and double the risk of schizophrenia, in addition to more loneliness, isolation and stress. (click here for more detail).
Three reasons why people in cities may have increased mental health problems
- Pre-existing risk factors: Many people move to the city in search of better services, economic and social opportunities, and distance from past negative experiences. Some of the reasons that some people may seek these things happen to be risk factors for mental health problems: for example, poverty, unemployment, homelessness, physical and mental health problems, previous trauma, personal crises, family break up, addiction, and immigration. This social drift engenders a population who are particularly predisposed to mental disorders.
- Social factors: People with pre-existing risk factors, particularly poverty, minority status, or existing mental health problems often encounter negative disparities in the city. For example, this can involve physical and psychological segregation into neighbourhoods that may be characterised by poverty and social challenges, engendering feelings of injustice and hopelessness, and experiences of prejudice and discrimination that may affect mental health.
- Environmental factors: The urban setting can affect people in two key ways: increasing stimuli, and stripping away of protective factors.
- Overload: People who live in the city experience an increased stimulus level: density, crowding, noise, smells, sights, disarray, pollution and intensity of other inputs. Every part of the urban environment is deliberately designed to assert meanings and messages. These stimuli trigger action and thought on a latent level of awareness, and become more potent as an inability to ‘cope’ sets in. This can have the effect of overload: increasing the body's baseline levels of arousal, stress, and preparedness, but also driving people to seek relief: quiet, private spaces; over time this urge may evolve into social isolation associated with depression and anxiety, and also forms the basis of the ecological hypothesis of schizophrenia.
- Erosion of protective factors: People who live in the city may find that they have less access to the factors that are protective for good mental health than those in rural areas. For example, they may have diminished access to nature, fewer opportunities to integrate exercise as part of their daily routines, and reduced leisure time as increased time is spent at work and commuting around the city. People may find themselves feeling unsafe, having less privacy, and even less sleep, due to factors like crowding, light, noise and stress. Rural to urban migration often sees people leaving behind their strong social networks of friends and family, and it takes time to develop similarly supportive social capital in the city. This may particularly be the case as urban dwellers may be reluctant to engage in social interactions, to avoid overstimulation, due to safety concerns, or because of the reduced likelihood of future relationships with each individual they encounter. As these protective factors erode, people become more vulnerable to developing mental health problems.