How mental health affects the city
'Mental Health is a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community' - World Health Organization
The World Health Organization definition of mental health above could just as easily be a definition of the elements necessary for the thriving, resilient, sustainable city. This is the aspiration of the United Nations Sustainable Development Goal 11. In order to achieve Goal 11, cities need to focus on promoting good mental health, preventing mental disorders, and supporting those who have mental health problems to live a healthy, happy, productive life.
Good mental health means a thriving population, but mental health problems can impede people's abilities to realize their potential, cope with stresses, work productively and fruitfully, and make contributions to their communities:
Mental health problems affect a large proportion of the urban population
Costs to the city
Direct costs to the city
Indirect costs to the city
Personal costs
Employment
Informal carers
Homelessness
And more.
Good mental health means a thriving population, but mental health problems can impede people's abilities to realize their potential, cope with stresses, work productively and fruitfully, and make contributions to their communities:
Mental health problems affect a large proportion of the urban population
- 1 in 4 people will have a mental health disorder in their lifetime, and this can occur at any age.
- Cities are about to see even more mental health problems: The global burden of disease attributable to mental and substance use disorders increased by more than a third between 1990 and 2010, mostly due to population growth and ageing. By 2050, more than two thirds of the world's population will live in cities.
- Many mental health problems are more common in cities: Depression (39% more), Anxiety (21% more), Schizophrenia (double). Details.
Costs to the city
- The OECD states that the direct and indirect costs of mental illness amount to over 4% of GDP.
Direct costs to the city
- Care: Direct costs for mental health disorders include health care, social care, and long term care costs.
- Disability costs: Mental health problems cause disability: mental disorders cause 7.8% of the world's burden of disease (5 of the 10 main causes of disability) Read the research.
- Physical health problems: Mental health problems also increase physical health problems: people with mental health problems are more likely to develop heart disease and cancers. The cost of treating disorders rises; for instance, the cost of treating diabetes is increased if the person also has depression, and they have poorer health outcomes for physical health problems.
- Mortality: People with mental health problems have increased mortality; people with severe mental illnesses (schizophrenia, severe depression, bipolar disorder) die on average 20 years earlier than the general population, typically of physical conditions such as cardiovascular disease.
- Undertreatment: People with mental health problems often do not receive the treatment they need; city spending rarely matches need, and access to care can be challenging. The OECD considers that undertreatment contributes to the high social and economic costs of mental disorders.
Indirect costs to the city
Personal costs
- People with mental health problems are more likely to experience distress, discrimination, marginalization, and problems with their employment, their finances, their relationships with family and friends, their physical health, and their ability to live a productive and satisfying life, engaged and participating fully in the multiple facets of the thriving urban community.
Employment
- Mental illness reduces employment prospects, productivity and wages.Around 5% of people of working age have a severe mental health disorder; a further 15% have a less severe disorder at any given time. The OECD estimates than 1 in 2 people of working age will have their work affected by mental health problems at some point.
- The employment rate of people with mental health disorders is 10-15% lower than those with good mental health. People with severe mental health problems are 6-7 times more likely to be unemployed, and with mild-to-moderate problems 2-3 times more likely to be unemployed compared to the general population. This has implications for working age benefit costs.
- Employed people with mental health problems also have more absences from work, and have 'presenteeism' at work. Three quarters of people with mental health disorders report that it affects their productivity at work.
- Note: adequate treatment improves employment outcomes.
Informal carers
- Family members are likely to provide substantial informal caring, which impacts their own employment potential, leisure time, mental and physical health, and relationships.
Homelessness
- Mental health problems can be associated with homelessness, including in association with unemployment, poverty, substance use, and challenges with forming and maintaining stable relationships.
- Studies show that 30-35% of homeless people have a mental illness; nearly a quarter have more than one illness, and up to three quarters of homeless women have a mental illness.
And more.