Gender and sexual minorities

A person’s living environment can have substantial impact on his/her mental health due to a range of factors related to the environment. It has often been argued that urban settings are a hotpot of sociocultural evolutions that attract individuals from the gender and sexual minority (GSM) groups. This has led to migration from rural to urban areas and also from one urban area to another urban area. Various push and pull factors in both the rural and urban areas help GSM individuals decide in which direction to move. While rural areas present with challenges such as social isolation within a homophobic/transphobic environment, urban areas also have their own unique set of challenges for the GSM population. In this chapter, we focus on various factors in both rural and urban settings that impact on the mental health of GSM population.

Sex in the city

Sexual acts form the basis of human life. In urban areas, both male and female sex workers and their mental health have been studied. The risks of resulting sexually transmitted diseases are higher and, consequently, physical and psychiatric comorbidity may be higher. The theory of sex markets focuses on sexual partnering and emphasizes that it is fundamentally a local process, meaning that the two people must live within reasonable geographical proximity to initiate and develop a sexual relationship that is physical. Of course, often people do indulge in cybersex, for which adequate electronic and WiFi facilities have to be available. Economic needs and perspectives may play a major role in transient sexual partnering.

Common mental disorders in cities

Common mental disorder (CMDs) are the most common psychiatric disorders in the general population, as well as at primary care. They include a triad of three illnesses—depression, anxiety disorders, and somatoform disorders. Global data suggest that the urban population exceeded the rural population in 2007. Cities provide an opportunity for economic growth and comparatively better healthcare facilities. However, what is worrisome is the increased vulnerability for many illnesses, especially CMDs. This chapter reviews the noteworthy literature about CMDs in cities across the world and discusses some of best practices in treating CMDs in various cities.

Cross-cultural contact: psychosis and the city in modern life

In the modern globalized world with rapid industrialization and urbanization the city has once again become the focus of modern social, economic and political life. Urban spaces and places have been the focus of research by many disciplines, including epidemiology, sociology, anthropology, and urban studies. In this chapter, the authors outline the importance and the role of culture in urban mental health employing various historical, sociological, and epidemiological contexts. The authors point out that modern multicultural approaches in viewing the metropolis can be conceptualized as a global hub of migration. This therefore becomes a place where individuals encounter the other and various boundaries between spaces and residence, and between wellness and illness, intersect. Acculturation to the urban places may take some time and the authors propose that the psychological process of acculturation is a useful beginning in terms of unpicking and understanding the phenomenology of identity formation and cross-cultural contact. The chapter traces the historical development of the city in parallel to the literature on psychosis and the city in developed and developing contexts, before critically examining the role of culture in informing our explanatory and interpretive frameworks of psychosis epidemiology.

Urban design and mental health

Associations between the urban living environment and mental health are becoming increasingly apparent. People who live in the city often have increased pre-existing risk factors for mental illness. However, intrinsic features of the city’s built environment can further exacerbate people’s risk of mental ill health. Cities can increase people’s exposure to socio-economic disparities and discrimination, deliver sensory input overload, and erode many of the protective factors that are associated with maintaining good mental health. Cities have not yet fully explored and leveraged the role of urban planners and designers in promoting and supporting public mental health. However, opportunities abound. Urban mental health may be improved by designing cities to provide residents with regular access to green space, integrating physical activity opportunities, facilitating positive, natural social interactions, and fostering feelings of safety. Integrating pro-mental-health design features into urban guidelines and recommendations can contribute to public mental health promotion and strengthen cities.

Research challenges

This chapter examines how urban living affects residents’ mental health and happiness, and ways to use this information to create saner and happier cities. Some often-cited studies suggest that urban living increases mental illness and unhappiness, but a critical review indicates that much of this research is incomplete and biased, and the issues are complex, often involving trade-offs between risk factors. City living may increase some forms of psychosis and mood disorders, drug addiction, and some people’s unhappiness, but tends to reduce dementia, alcohol abuse, and suicide rates, and many people are happier in cities than they would be in smaller communities. This chapter examines specific mechanisms by which urban living can affect mental health and happiness, and identities practical strategies that communities and individuals can use to increase urban mental health and happiness. This analysis suggests that it is possible to create sane and happy cities.

Urbanization and marginalization

From research among vulnerable urban individuals it is known that mental illness and substance use disorders are risk factors for social marginalization, homelessness, and poverty. The majority of homeless individuals have experienced early-childhood trauma, maltreatment, foster care, and family dysfunction. Limited access to physical and mental health care continuity further marginalizes the already vulnerable and creates social exclusion. The general migration of people towards big metropolitan areas also increases the pressure on limited infrastructure and health care in urban centres. This constitutes a significant public health threat and heralds the need to reposition the healthcare system and, in particular, mental health services to manage the situation. To provide equal access and a minimal quality of care the priorities of the healthcare systems need to be newly defined from the principles of harm reduction.

Why urban environments matter for refugee mental health

Refugees are at increased risk of mental disorders. This is increasingly attributed to the post-migration context in which they live, typically socio-economically deprived urban areas. In general, neighbourhood factors are relevant to mental health outcomes. There is now research showing that neighbourhood ethnic density is related to the incidence of psychosis and other mental disorders for ethnic minorities. One consequence of dispersal policies is that refugees are often placed in urban areas far from others from their country of origin, which is likely to affect their mental health. Refugees are more likely to be exposed to other neighbourhood factors shown to have adverse mental health consequences, e.g. high levels of social deprivation and low levels of social cohesion. The extent to which these factors might explain the elevated risk of mental disorders among refugees is still unknown and further research is needed.

Globalization and urbanization

More than 50% of world’s population lives in the cities that are bustling with possibilities. Growth in these cities is mainly associated with the change in their demographic and geographical situations. Globalization has contributed further to movement of people and resources creating tensions and overpopulation in some parts and reduction in others. It is inevitable that overpopulation and urbanization leading to overcrowding have been shown to have negative consequences on people’s physical and mental health. Numerous efforts have been made through governmental policies and non-governmental organization (NGO) involvement in order to promote healthy cities between policymakers, healthcare professionals, and community members.

Sociology and the study of cities

Cities, as well as urban places, are a fascinating focus of study. Sociology comes into its own when studying not only physical urban spaces, but also processes that happen in urban spaces. Various schools of study of sociology have highlighted various aspects. For several decades the Chicago School of Sociology shaped urban sociology as a whole. For example, urban sociologists, whether at Chicago or elsewhere, see the city as a place consisting of different concentric zones—a zone of manufacturing, for example, as well as a red light district, and particular ethnic settlements. Each of these zones carries with it various issues related to mental health, well-being, and mental illness. Some of the earliest studies in urban mental health originated from Chicago. The concept of public space and its functioning creates a number of issues that need exploration. There appears to be a genuine intellectual division and tension between those who insist that public space permits people to gather and express themselves freely and those who insist that the reality of the world today has eliminated the notion of public space. This chapter explores these issues within the broader context of globalization.