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Getting Under the Skin: What is the Role of Cities in Mental Health and Illness?

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By Jewel Bailey - CAMH 

Here’s a compelling fact: half of the workforce in the Greater Toronto and Hamilton area is suffering from a mental health issue – that’s more than 1.5 million people! This begs the question: how does the place where we live, play, and work impact our mental health?

It’s well established by researchers that people who live in cities have higher levels of mental illness than their rural counterparts. The United Nations predicts that by 2050, 70 percent of the world’s population will live in cities. Currently 85 percent of Ontarians live in cities. As more people move to urban areas, the need for experts from different fields to focus on how city living impacts mental well-being will become increasingly important.

One of the international experts who has studied mental health and the metropolis is Professor Nikolas Rose from King’s College, London. He examined years of research on how mental health is shaped by city living. Rose says scientists have made the connection between mental illness and factors such as social exclusion, racism, and poverty, but what they have not determined is the process through which the “city gets under the skin”. He believes that as scientists from various disciplines work together they might be able to explain the process through which urban living affects the brain.

Other findings from Rose’s work include the following:

  • Cities should be viewed from an ecological perspective, with humans co-existing in a complex, ever-evolving environment. There is constant social stress produced by “noise, sprawling transport networks, the cacophony of diggers and concrete mixers, scaffolds and cranes”. Humans are not passive in these environments, but are always negotiating these spaces.

  • Researchers identified stress as one of the reasons for elevated levels of mental illness among urban dwellers. One group of researchers found that people who are born in cities, and continue to live in urban environments, process stress differently, which might be linked to why there are higher levels of stress in urban areas.

  • Stress is a subjective experience based on people’s perception of what is occurring around them. How a person interprets an element in their environment (e.g. crowding) determines whether it’s stressful or not; what one person considers stressful might not be stressful for another.

What is one of Rose’s more interesting points? He states that in the aftermath of a traumatic event, most people do well just speaking with family and friends. Only a few will require ongoing intervention by a mental health provider. This highlights the resiliency of humans.

While researchers such as Rose continue their work, policymakers are asking the question: what can cities do to improve the mental health residents? New York provides a good example of what can be done. The city has created a comprehensive mental health plan called Thrive NYC which is built on 6 principles. Dr. Gary Belkin, Executive Deputy Commissioner of Mental Hygiene in the New York City Department of Health and Mental Hygiene, and one of the leaders of the plan, notes that NYC had to rethink and restructure how mental health services were delivered, and also engage citizens in the process. One of the six principles is partnering with communities to improve mental health.

Thrive NYC’s work began by assessing where people go and how they access services. According to Belkin residents may not always access services in traditional mental health facilities so the system must reach people in their natural settings. For example, in this video, Thrive NYC worked with a Black faith-based organization to reach members of that community. The plan recognizes community stakeholders as “innovators in their own health” and builds the capacity of community-based organizations to increase access to programs and services. The success of Thrive NYC has sparked other international cities, such as London, to launch similar strategies.

Both Rose and Belkin were in Toronto recently, delivering talks on mental health and city, as part of a series hosted by the Provincial System Support Program at CAMH and the Wellesley Institute. You can find links to their presentations below.

As we turn the spotlight on the reality of mental illness during mental illness awareness week, let’s consider how we can build healthy, vibrant communities in rural and urban areas. Because more people are migrating to cities, where there are higher rates of mental illness, cities require unique attention. Cities touch the lives of residents in multiple and intimate ways. The urban environment can be a source of stress and happiness, but working to create supportive environments, and strengthening communities for action, as Thrive NYC has done, can impact the mental well-being of all residents.

Here are links to some resources:

  1. For more information on Thrive NYC and the principles click here

  2. To watch Rose’s presentation click here

  3. To watch Belkin’s presentation click here

  4. About mental health and mental illness

  5. Mental health first aid

  6. The friendship bench

Share your views - what do you think cities in Ontario can do to promote the mental health of residents and support those living with a mental illness?

Measuring Partnership Effectiveness
How can we work “with” people in poverty?

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