Mental health in the city

In a recent survey, more than half of U.S. mayors named mental health as the one of their main post-pandemic challenges. They’re not wrong. While city leaders have always grappled with the seemingly negative association between city-living and health outcomes, the pandemic exacerbated many existing mental health crises.

In the workplace, one-in-three local government workers reported being burnt out. At home, domestic violence and trauma rose significantly. And at schools, rates of sadness and hopelessness ballooned amongst high school students in U.S., with particularly worrisome rates among teen girls and LGBTQ+ youth.

While Covid-19 precautions have now dropped from the top of most city leaders’ agendas, addressing the mental health crisis – that the pandemic exacerbated – should not.

So what can cities do?

Below, we offer three suggestions for city leaders – both in their capacities as policy makers and as leaders of some of their region’s largest workforces – to improve mental health outcomes among their residents.

Fostering social connection

Social connectedness is one of the most effective antidotes to poor mental health. Examples abound of how cities can make purposeful policy choices that facilitate interpersonal connection.

City leaders can start by looking to promote social connection amongst their own employees. In a recent field experiment conducted by The People Lab, we found that encouraging 911 dispatchers to exchange anonymous advice with colleagues meaningfully reduced burnout. City leaders can promote connection in their workplaces by creating spaces for sustained and open dialogue, particularly among frontline workers.

The standard city leaders set in their own workplaces is important not only because the health of a public sector workforce affects how a city delivers its services, but also because standards established in the public sector can set the norms for the rest of the labor market.

Cities can also harness urban design to promote connection. Research indicates that the walkability of one’s neighborhood is associated with individuals’ sense of community. In an effort to make their cities more pedestrian-friendly, urban designers have experimented with converting parking spaces and driving lanes to wider sidewalks and designing “bumping places” to promote frequent interactions with neighbors.

Cities that replaced parking spots with expanded outdoor dining during the pandemic saw increased foot traffic and found that small businesses – an important element of thriving cities – benefited financially from the increased outdoor space. Cities that want to take the open-streets model one step further can follow Barcelona’s approach: the Catalonian city’s 3-by-3-block “superblocks” restrict vehicular traffic over a multi-block area and provide large spaces for residents to mingle unimpeded by cars.

Improving access to public services

Cities can also improve access to critical public services and the social safety net. Poverty is stressful and can have far-reaching consequences on individual and household health. Research has shown that being poor is correlated with increased cortisol levels – a critical stress marker – in children and above average rates of depression, anxiety and psychosis in adults. Conversely, food assistance programmes – such as the Supplemental Nutrition Assistance Program in the US – have been associated with improved psychological well-being.

Here, too city leaders have an active role to play. In one large-scale experiment, residents of public housing projects were offered housing vouchers to move to other neighborhoods. When they re-surveyed study participants an average of five years later, researchers found that those who received housing vouchers experienced improvement across a range of mental health measures. These range from decreased rates of depression to improved quality of sleep.

Similarly, early signs indicate that universal-basic-income programmes have positive effects on mental health – though more research is needed to draw any definitive conclusions. Other research from England suggests that providing free bus passes was associated with lower levels of depression and loneliness amongst older adults.The evidence is clear: in actively working to improve access and delivery of public services to their low-income residents, city leaders are also contributing to better mental-health outcomes.

Employing “restorative” design approaches

Restorative design approaches can also promote well-being. In their book “Restorative Cities: Urban Design for Mental Health and Wellbeing,” researchers Jenny Roe and Layla McCay encourage city leaders to incorporate green, blue, sensory and play spaces into neighborhoods.

Proximity to parks and water has been found to be associated with decreased stress among older adults, although more research could help determine the causal link. And Roe and McCay argue that positive sensory experiences, such as light displays and reflective sculptures, like Chicago’s famed “Bean”, as well as places for play, such as athletic fields and skate parks, can benefit mental health, too.

Our cities are often noisy, polluted, expensive, competitive places that can be full of daily frustrations – from the congested commute to the interminable search for an apartment. But at the end of the day, cities are also where we connect with others; where we seek financial security; and where we benefit from investments in public spaces and public goods. City leaders have a role to play in ensuring that their residents can benefit from the latter while mitigating the costs of the former.

Read more on the OECD work on cities.

Associate Professor at the Harvard Kennedy School, Faculty Director of The People Lab at Harvard Kennedy School | + posts

Dr. Elizabeth Linos is the Emma Bloomberg Associate Professor for Public Policy and Management, and Faculty Director of The People Lab at the Harvard Kennedy School of Government. The majority of her research focuses on how to improve government by focusing on its people and the services they deliver. Specifically, she uses insights from behavioral science and evidence from public management to consider how to recruit, retain, and support the government workforce, how to reduce administrative burdens that low-income households face when they interact with their government, and how to better integrate evidence-based policymaking into government.

Her research has been published in various academic journals including The Journal for Public Administration Research and TheoryPublic Administration ReviewEconometrica, American Economic Journal: Economic PolicyBehavioural Public Policy, and others. Her work has also been highlighted in media outlets including The New York TimesThe EconomistBBCNPRSlate, and the Harvard Business Review. As the former VP and Head of Research and Evaluation at the Behavioral Insights Team in North America, she worked with government agencies in the US and the UK to improve programs using behavioral science and to build capacity around rigorous evaluation. Prior to this role, Dr. Linos worked directly in government as a policy advisor to the Greek Prime Minister, George Papandreou, focusing on social innovation and public sector reform.

Lab Manager at The People Lab at the Harvard Kennedy School | + posts

Jeremy Margolis is the Lab Manager of The People Lab at the Harvard Kennedy School. He works with the Lab’s Faculty and Executive Directors to manage the daily operations of the Lab and serves as a member of research teams across the Lab’s portfolio of projects. His research interests lie in workplaces and management, the criminal legal system, and processes of diversification and cultural change in institutions. Prior to joining the The People Lab, he worked as a legal assistant at a civil rights law firm in New York. Jeremy holds a B.A. in Sociology from Amherst College.