Key Stakeholder Message: Dr. Kedar Marahatta
Dr. Kedar Marahatta, Mental Health Specialist, WHO Nepal: I sincerely appreciate the Bangladesh Urban Health Network (BUHN), Eminence Bangladesh, and all collaborating partners for organizing this important dialogue on strengthening mental health in rapidly urbanizing settings. Bringing together policymakers, researchers, practitioners, and development partners to discuss urban mental health is both timely and necessary as cities across South Asia continue to expand at an unprecedented pace.
Urbanization undoubtedly creates opportunities for economic growth and improved access to services; however, it also introduces new and often overlooked mental health challenges. Across Nepal and many countries in the region, we observe that urban residents face increasing levels of psychological stress driven by social isolation, migration, insecure employment, housing instability, environmental pressures, poverty, and widening socioeconomic inequalities. Despite living in densely populated environments, many individuals experience loneliness, weakened community ties, and reduced social support as traditional family structures evolve and migration separates families and social networks. While specialized mental health services are more likely to be located in urban centres than in rural areas, physical proximity does not necessarily translate into equitable access. Financial barriers, uneven distribution of qualified professionals, long waiting times, stigma, and limited confidence in public health services continue to prevent many people from seeking timely care. Vulnerable populations, including low-income households, informal workers, migrants, people experiencing homelessness, women, adolescents, older persons, and persons living with disabilities, often remain the furthest from quality mental healthcare despite having the greatest need. Another important challenge is that urban health systems are frequently designed around institutional convenience rather than people's daily realities. Many mental health facilities operate only during regular office hours, making services difficult to access for working individuals, students, and those employed in the informal sector. As a result, many people delay treatment until their conditions become more severe or seek expensive private care that places additional financial strain on households.
Addressing these challenges requires a shift towards people-centred and equity-oriented urban mental health systems. Mental health services must become more affordable, geographically accessible, culturally responsive, and flexible enough to accommodate the diverse lifestyles of urban populations. Extended clinic hours, weekend services, community outreach, digital mental health platforms, workplace-based counselling, and the integration of mental health into primary healthcare can significantly improve access while reducing stigma. Equally important is rebuilding public confidence in health systems through quality improvement, respectful care, and continuity of services. Investments in community engagement, mental health literacy, and multisectoral collaboration are essential to ensuring that mental health is recognized not only as a healthcare issue but also as a critical component of urban planning, social protection, education, employment, housing, and disaster resilience. As cities continue to grow, promoting mental well-being must become an integral part of sustainable urban development. Healthy cities cannot be achieved without mentally healthy communities. This requires coordinated action across governments, civil society, academia, development partners, and local communities to ensure that no one is left behind.
