Urban Sanity. Understanding Urban Mental Health Impacts and How to Create Saner, Happier Cities

By Todd Litman

 

Does urban living threaten our mental health and happiness? Popular culture is rife with stories suggesting that city living causes emotional stress and unhappiness. Some scientific studies also suggest that mental illness and depression rates increase with urban density. Are these claims credible? What are their implications? How can communities and individuals maximize urban mental health and happiness?

These are important and timely questions. The human experience is increasingly urban; we are in the middle of the transition from 80% of the world’s population living in rural to 80% in urban areas. Decision-makers and individuals need practical guidance on how to maximize sanity and happiness when planning cities and choosing where to live. This article summarizes recent research on these issues.

Experiencing the urban environment

Researching mental health and happiness can be challenging because the two are difficult to measure, and much of the existing research is incomplete and biased, focusing on a particular impact or group, and failing to consider confounding factors that would differentiate between association (a particular condition is more common in cities) and causation (city living causes a condition).

This is also an emotional issue; many people assume that cities are either good or bad, and search for supporting evidence. This is understandable. Urban and rural areas tend to differ in many ways, including values and lifestyles; people often favour the geographic area that reflects their identity. Because city living (particularly apartments and public transit) is often stigmatized, many people work hard and commute long distances in order to afford a single-family house and a personal automobile; they may feel threatened by evidence that city living can be healthy and enjoyable, which would question the value of their sacrifices. In addition, many cities have unattractive and unpleasant features, including concentrated poverty and social problems, which provide empirical evidence that cities are physically, mentally and morally dangerous.

Another challenge is common confusion concerning what constitutes urban. The term conjures up images of skyscrapers, crowded sidewalks, subways, and concentrated poverty; although these conditions exist, they are not representative of the overall urban experience. Urban includes a variety of community types, ranging from city centres to suburban villages. Most urban residents live in moderate-density neighbourhoods that contain a mixture of single-family and low-rise apartments, and rely on a mixture of walking, cycling, bus and rail transit, as well as automobile transport, and most cities have a mixture of low-, middle- and high-income households. People who imply that all urban residents live in high-rise apartments and forego automobile travel, and most urban residents are poor, are using atypical examples.

When considering how environments affect human sanity and happiness it is important to keep in mind humanity’s tremendous diversity and adaptability. People live successfully in a wide range of environments, from frozen tundra to dry deserts, and from single-family houses in sprawled suburbs to high-rises in dense city centres. Many of us will live in and adapt to a variety of environments during our lifetime. We shouldn’t assume that any one environment is optimal for everybody, or that our housing needs and preferences cannot change.

Increased and reduced risks of city living

It is understandable that city living can seem stressful and depressing. Mental illness and associated social problems such as substance abuse, homelessness and crime, often concentrate in some urban neighbourhoods. Urban environments tend to be noisy and busy which can stimulate stress and fear, particularly for newcomers. In addition, many people work in cities, live in suburbs, and recreate in rural areas, and so associate cities with responsibilities and stress, suburbs with home and family, and rural areas with relaxation and enjoyment. However, these issues are complex.

My review of the research indicates that city living has a variety of impacts on our mental health and happiness. Credible research suggests that urban residency is associated with increased psychosis and mood disorder risks (e.g. schizophrenia, depression), addiction to some drugs (cocaine and heroin), and some people’s unhappiness, but but with lower rates of dementia and Alzheimer disease, some substance abuse (alcohol and methamphetamine), much lower suicide rates, and for many people, particularly those who are poor or alienated, urban living is associated with increased happiness. Urban living also tends to improve mental health by increasing economic and social opportunities, fitness and health, and access to mental health services.

Higher mental illness and unhappiness rates in cities may result largely from the concentration of people with elevated risk factors, such as poverty, disability and minority status, because urban areas offer more economic opportunities, services and tolerance. This can create a self-reinforcing cycle of increased poverty, mental illness and associated social problems in such areas, called social drift. As a result, the association between cities and mental illness does not necessarily indicate that cities cause these problems, or that a typical person will become less sane or happy by moving to an urban neighbourhood. In addition, higher rates of mental illness in cities may partly reflect better reporting by urban health professionals. In fact, many people are better off overall in cities than in smaller communities that offer less opportunity and support.

Households tend to be smaller and more mobile in cities than in rural areas, which can increase isolation and depression, but urban residents also tend to have larger social networks than in smaller communities, reflecting cities’ greater social opportunities. Urban conditions tend to increase some mental illness risk factors including noise, toxic pollution, crime and social over-stimulation, but these impacts are declining or can be reduced with appropriate planning. It is hyperbola to claim that cities cause “relentless” stress. Urban newcomers may be stressed by noisy and busy urban environments, and frequent interactions with culturally diverse neighbours, but over time most residents learn to accommodate these conditions. For visible minorities, cities’ increased cultural diversity can reduce stress and increase happiness. In most countries, surveys find higher self-reported happiness (also called life satisfaction) in cities than rural areas.

Rural areas tend to have much higher (about double) suicide rates than urban areas, which suggests that city living increases overall mental health and happiness. If urban living double residents’ lifetime psychosis risk, from about 1% to 2%, as some researchers suggest (others estimate much smaller effects) this approximately equals the higher rural suicide rates. Since psychosis is generally treatable and transitory, while suicides are permanent and devastating, cities’ increased psychosis risk is generally preferable to higher rural suicide risk.

How to create saner and happy cities

Better public policies and design strategies can increase urban mental health and happiness. These include:

  • Targeted social service. Recognize that cities tend to attract people with elevated mental illness risks, and provide appropriate mental health, housing and substance abuse treatment services.
  • Affordability. Improve affordable urban housing and transportation options (walking, cycling, public transit, taxi, etc.) to reduce residents’ financial stress.
  • Independent mobility. Provide independent mobility options for diverse community members, including those who are poor, have disabilities or impairments, adolescents or seniors.
  • Pro-social places. Create public spaces that promote community and encourage positive interactions among residents. Involve residents in creating public places and activities that meet their needs.
  • Community safety. Create communities that minimize urban dangers including traffic, crime and harassment, and pollution exposure. This can involve traffic safety programs, crime prevention though environmental design, appropriate lighting, passive surveillance by nearby residents and by-passers, and other community safety programs.
  • Design for physical activity. Integrate physical activity by providing good walking and cycling conditions, high quality public transit, compact and mixed neighbourhoods, local parks and recreational facilities, plus appropriate community sports and recreation programs.
  • Pollution reductions. Implement noise, air, light and toxic pollution reduction programs.
  • Greenspace. Design cities with appropriate greenspaces, including local and regional parks, green infrastructure, and out-of-city wilderness access programs.

Such policies are important in both developed countries that currently under-support cities compared with suburbs and rural areas, and in developing countries where new cities are developing rapidly.

This is not to suggest that everybody should live in dense cities; some people are unsuited due to their lifestyle or temperament, for example, because they own large pets, engage in noisy activities, or are uncomfortable with cultural diversity. However, because cities tend to improve economic and social opportunities, many people benefit from urban living overall, because their economic and social gains more than offset any additional mental stress, particularly over the long run as they become accustomed to urban environments. Since urban living reduces per capita land consumption and transport costs, it tends to provide additional, indirect benefits.

Many people should find these research reassuring: it suggests that most people can take advantage of urban living benefits without sacrificing their sanity or happiness.

Todd Litman

Todd Litman is founder and executive director of the Victoria Transport Policy Institute, an independent research organization dedicated to developing innovative solutions to transport problems. His work helps expand the range of impacts and options considered in transportation decision-making, improve evaluation methods, and make specialized technical concepts accessible to a larger audience. His research is used worldwide in transport planning and policy analysis.
Todd Litman
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