By 2020, depression is predicted to become the leading disease burden in developing countries. Community-based studies of mental health in urban areas of developing countries have documented prevalence rates of between 12 and 51 per cent (Source: Cited in UN Habitat Report Cities in a Globalized World, Global Report on Human Settlement, 2001).

According to this report, prevalence of anxiety and depression is typically higher among women than men, and among lower-income communities, with variations reflecting differential exposure and vulnerability to diverse risk factors, including control over resources, marriage patterns, cultural ideology, long-term chronic stress, exposure to stressful life events, coping strategies and social support.

Urban environments, and low-income urban environments in particular, are characterized by harsh physical and social environments, poor quality of life characterized by poor-quality housing, lack of access to basic services like water and sanitation and low paying employment and income generation opportunities. Day-to-day life in these contexts can amount to chronic stress.

The strategies that low-income households employ to cope with such stresses are numerous, including working longer hours, engaging in informal work, taking up more than one job at a time, deploying children into income-generating activities, exploring new niches in the informal sector and maximizing the use of the meager resources available. While these strategies build some degree of resilience, the chronic stress of poverty and stressful life-events can have very negative direct and indirect effects on physical and mental health.

Urbanization has also been associated with a breakdown of extended families and increase in single parent households that has implications for the coping strategies themselves, and for physical and psychological well-being.

Under these circumstances the need for support- social, emotional and practical/ logistical- cannot be overstated. Social support refers to the degree to which a person’s basic social needs are fulfilled through interaction with others. Emotional support is the building block of relationship and comprise such feelings as love, empathy, companionship. In addition to these, there is a need for and practical support expressed as goods, services, information that people need in order to lead a meaningful life. These support systems act as key resources drawn upon to cope with or to ‘buffer’ the potential mental health effects of chronic or short-term stress.

However, this area is often neglected and there are considerable knowledge gaps concerning the interrelationships of mental illness with social support and cohesion. In this context, the understanding of social capital defined as the density and nature of the network of contacts or connections amongst individuals in a given community that can act as support, needs to be better understood and strengthen. Social capital is being increasingly recognized as an important ‘fall back mechanism’. Given this, it is important to emphasize its significance in policies to mainstream initiatives that can strengthen social capital. Can we do it?

What can be done to address the issues of mental health in urban scenarios?