Mental health is under the local spotlight

According to Eurostat, EU cities are experiencing increased depression and anxiety disorders. It’s also alarming that suicide is among the leading causes of death among women and young people aged 15-25.

Numbers are frightening. The city of Ghent reports that 11% of its inhabitants use antidepressants, while in Madrid, 28% of the population aged 15- 64 was at risk of poor mental health in 2021. The municipality states that, since 2017, there has been a 9.3% increase in depression and 8.7% in anxiety cases.

Besides the COVID pandemic, several recent negative trends are impacting citizens’ psychological health, such as the war in Ukraine, the climate crisis, high inflation, and technological phenomena like social media and cyberbullying.

What can cities do?

There’s a lot that cities can do to detect and address psychological issues more efficiently. Although their competency in this area is shaped by the national legal and regulatory framework, and in spite of a lack of resources, municipalities can provide alternative treatments and complement unavailable national-level psychological services.

Cities invest in parks, gardens, and other green spaces to create relaxation, recreation, and social interaction, promoting physical activity and a healthy lifestyle. This way, local governments can help residents to reduce stress, improve their mood, and maintain good mental health.

Creating healthier cities also means addressing noise and air pollution, mostly from industrial facilities and transportation. That’s why by building infrastructures like cycling paths and pedestrian zones and by imposing car-free zones, municipalities promote walking, cycling and the use of public transport, designing a low-pollution environment.

In addition, individual and societal factors related to psychological wellbeing are strictly connected to social policies, employment, environment, and urban and community design, all under the competence of local governments. So, indeed, there’s a lot that cities can do to promote inhabitants’ mental wellbeing.

Mental health as a crosscutting element

Many cities boast mental health plans, while others integrate a psychological approach into their municipal strategies. Dusseldorf, Lisbon, Nantes, San Gillio (Turin), Toulouse, and Warsaw understand mental health as a crosscutting element, and have appointed coordinators, local councils, and advisory boards to mainstream psychological considerations into relevant local policies.

Likewise, Barcelona, Brno, Glasgow, Stockholm, and Turin have adopted multiple tools to ensure a cohesive approach, such as guidelines or integrated policy planning. This ensures that various city departments responsible for education, culture, employment, housing, transport, culture, or environment policies reflect the needs of mental health and wellbeing.

In Milan and Rotterdam, psychological initiatives are coordinated by a dedicated policy department, whereas Malmo employs and provides training to individuals who have lived through mental health illnesses to ensure that their perspectives are incorporated into city-wide initiatives.

Psychological wellbeing is a complex topic that requires tracking changes and trends. To monitor it, Madrid and Milan regularly collect data, generate statistics, identify trends and patterns, which allow them to develop targeted interventions. Madrid also focuses on loneliness prevention by investing over €3 million annually and involving different city departments in the task.

Who can help?

A lack of funding and human resources compels cities to partner with other organisations to plan and implement mental health and wellbeing programmes. Cluj-Napoca works with the NGO sector, including health and cultural organisations, to co-create psychological initiatives. Helsinki and Warsaw rely on interactive and participatory methods, involving residents, businesses and other groups in planning and designing public services.

Milan set up a similar scheme with the Milan Pact for mental health, which governs the engagement of  cultural associations, experts, cooperatives and users through a consultation, co-design, and co-management process. Nantes uses its local mental health council as a platform for talks and coordination with stakeholders.

Madrid applies an innovative health asset model that encourages communities to focus on people’s health and wellbeing. The work is implemented through municipal community health centres that use public areas, workplaces and festivals to promote community participation. Vienna ensures expert collaboration in psychiatric and psychosomatic care through steering groups and focus groups.

Antwerp focuses on offering accessible psychology services for citizens at affordable prices. in partnership with service organisations and hospitals. Ghent boasts diverse consultation structures such as the Ghent Care Council, which relies on a network of professionals, civil society and citizens.

What are the most vulnerable groups?

Raising public awareness and promoting positive attitudes toward mental health can encourage people, and vulnerable groups in particular, to seek help when needed.

In cities, the population groups most at risk of suffering from psychological issues are young people, women, migrants, refugees, people with disabilities, seniors, homeless people, and low-income individuals. Poverty can significantly impact mental health, and many inhabitants are struggling with poverty-related stress and hardship.

But cities are taking action to protect the most vulnerable. Stockholm facilitates the employment of individual with long-term psychological problems, offering a job coach to guide them through the process. Helsinki focuses on developing service chains and multi-level collaboration in mental health services, especially for children and youth, while Glasgow preserves children’s mental health in schools.

Lisbon organises participatory forums dedicated to vulnerable groups such as the homeless, LGBT+ or migrants with high psychosocial risks to promote participation, activism and decision-making. Vienna holds low-threshold campaigns to raise awareness and promote support services targeted to vulnerable groups. Malmo runs regular seminars for organisations and citizens, encouraging dialogue about psychological wellbeing and disability.

Toulouse implements an outreach strategy targeting young people to help them overcome isolation and stigma. The city also works with young homeless people with mental health and addiction through its housing-first approach.

On 22-24 March, Zaragoza hosted the ‘Mutual learning on homelessness and mental health’ event for Eurocities members. The Spanish city follows the First Chance Plan, that was launched in 2018 and whose actions have been adapted to align with the housing-first approach.

Cities seek help

Local governments show a political commitment to placing psychological health and wellbeing in a prominent position on the agenda. However, their capacities and resources often limit the scope and impact of local initiatives. EU and national support, including through funding, can play a crucial role in improving municipalities’ abilities to respond to the needs of people living in cities.

Among others recommendations, local governments advocate for investing and reinforcing urban prevention measures. This will enable EU countries and cities to reduce the social and economic costs associated with untreated psychological illness and support the overall wellbeing of urban communities.

Similarly, they seek support from experts to better understand the needs and challenges of mental health in urban areas. In addition, local governments are eager to work in tandem with healthcare providers and other stakeholders to develop and implement effective mental health policies and programmes. Cities’ inhabitants sorely need it.

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Marta Buces Eurocities Writer
Michaela Lednova Senior Policy Advisor
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