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

Some experts claim that city living causes mental illness and unhappiness, but a new study indicates that urban environments provide many mental health benefits. Better planning can help make sane and happy cities.
Todd Litman | September 6, 2016, 5am PDT
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Better planning can help create saner, happier cities.
Lissandro Melo

Does urban living threaten our sanity and happiness? Popular culture is rife with stories which suggest that living in a city increases loneliness and unhappiness, and some scientific studies indicate that urbanization increases mental illness and depression. Are these claims credible? How can communities maintain mental health and happiness?

These are important and timely questions. The human experience is increasingly urban; transitioning from rural to more urban areas. Decision-makers and individuals need practical guidance on how to maximize sanity and happiness when planning cities and choosing where to live.

My newest report, "Urban Sanity: Understanding Urban Mental Health Impacts and How to Create Saner, Happier Cities" examines these question. It indicates that city living has mixed overall mental health impacts. Credible research suggests that urban residency can increase psychosis and mood disorder risks, addiction to some drugs, and some people's unhappiness, but tends to reduce dementia, some types of substance abuse and suicide rates, and increases happiness for many groups, particularly very poor and alienated people. Urban living also tends to increase mental health by increasing economic opportunities, fitness and health, and access to mental health and addiction treatment services. The table below summarizes these effects.

Urbanization Mental Health Impacts

Increased Risk

Reduced Risks

  • Psychosis (e.g. schizophrenia) and mood disorders (e.g., stress and depression)
  • Self-reported unhappiness (in affluent countries)
  • Cocaine and heroin addiction

  • Self-reported unhappiness (in poor countries)
  • Dementia and Alzheimer disease
  • Alcohol and methamphetamine abuse
  • Suicide rates

In most countries, surveys find higher self-reported happiness (also called life satisfaction) in cities than rural areas. In the United States, rural residents report slightly (up to three percentage points) higher average happiness ratings than in large cities, but this probably reflects confounding factors, so they do not really indicate that people who move from rural to urban areas necessarily become less happy.

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.

When considering how environments affect human sanity and happiness it is important to keep in mind people’s tremendous diversity and adaptability. Humans 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 centers. Many of us will live in and adapt to a variety of environments during our lifetime. We shouldn’t assume that our personal preferences are universal or unchangeable.

Overall, I found little credible evidence that urban living significantly increases overall insanity or unhappiness, and lots of evidence that most people are mentally better off overall living in compact, mixed, walkable neighborhoods. The scientific studies which indicate that urban living significantly increases mental illness and unhappiness tend to be incomplete and biased; they consider a limited population, and fail to account for confounding factors and so cannot differentiate between association and causation.  

There is plenty of empirical evidence that most people are happier living in cities, including huge worldwide rural-to-urban migrations, and high urban housing costs; these would not occur if billions of people did not consider themselves better off overall in urban conditions. Much of the evidence that consumers dislike cities, and that cities increase mental illness and unhappiness, are specific to North American conditions where public policies are strongly anti-urban and cities have severe social problems; as a result, such evidence does not apply to economically successful, well designed urban neighborhoods.

This study identified the following mechanisms through which urbanization can impact mental health:
  • Concentrated mental illness risks. Many cities experience social drift, a self-reinforcing cycle in which disadvantaged groups (people who are very poor, mentally and physically disabled, addicted and alienated) locate in central areas that are accessible without a car, tolerant of deviance, and develop a concentration of related social service. This occurs because such areas offer better economic and social opportunities, and better access to services, so disadvantaged groups rationally locate there. Although such areas may have higher than average mental illness rates, most of these people are probably better off than if they located in more isolated areas.
  • Substance abuse. Substance abuse is both a cause and symptom of mental illness. Abuse patterns differ by geography: cocaine and heroin addiction is more common in cities, while prescription drug, methamphetamine, and alcohol abuse rates tend to be more common in rural areas. Since alcohol and marijuana abuse is more common than heroin and cocaine addiction, total substance abuse rates tend to be higher in rural areas.
  • Social isolation and loneliness. Urban residents, particularly newcomers, sometimes experience social isolation, often described as lonely in a crowd, which may contribute to mental illness and unhappiness. Several factors may contribute to this, including higher rates of inter-regional mobility (moving to another community). One survey found that only a third of urban residents spend their entire lives in the same area, compared with half of rural residents, resulting in fewer local friends and family members. Urban residents are often described as less welcoming than in smaller communities, possibly to avoid social overstimulation. On the other hand, smaller communities are often described as exclusive and unfriendly to outsiders, particularly minority group members and non-conformists, while cities tend to accommodate more diversity. Minority group members often find more social opportunities than they would in smaller communities.
  • Noise and light pollution. Noise and light pollution exposure can increase stress and interrupt sleep. They tend to increase with density, and so can be considered as inherent to cities, but can often be managed and reduced with improved design.
  • Toxic pollution. Exposure to some toxins, such as heavy metals, may increase mental illness. They tend to increase with development density, roadway proximity and highway travel. However, exposure to many of these chemicals is declining due to emission controls. For example, childhood lead exposure peaked between 1940 and 1970, and declined after it was phased out of gasoline and paint.
  • Excessive stimulation and stress. Some people speculate that urban living causes "relentless" stimulation (also called cognitive overload) that imposes mental stress. This is understandable since urban environments tend to be busy and noisy, cities contain competitive industries and jobs, urban areas offer more economic and social opportunities than rural areas, and many people work in cities but live and recreate in suburban and rural areas, and so associate cities with responsibility and stress. However, these effects are largely associations rather than being unique to cities: a rural job can impose as much stress as an urban job, and except for ambient noise, there is no reason that urban residents cannot engage in relaxing activities, such as knitting and reading, as they could in rural areas.
  • Crime. Crime is both a cause and effect of mental illness. Fear of crime, whether real or perceived, tends to increase stress and distrust, which reduces mental health and happiness. Crime rates tend to increase with city size, but this effect is declining. For example, U.S. urban crime rates peaked in 1992, when they were nearly ten times higher than rural areas, but subsequently declined significantly. As a result of these trends, the contribution of crime to urban mental illness is likely to decline in the future.


  • Crowding. Crowding (excessive people in confined spaces) can cause mental stress, although it is difficult to isolate this effect from confounding factors such as poverty. People sometimes use evidence, such as rat colony studies, to argue that urban densities (people per acre or hectare) are harmful, but that conclusion is inappropriate since crowding is primarily associated with poverty, not density. There is no evidence that typical urban densities (20-60 residents per hectare or 8-25 per acre) cause social problems.
  • Economic stress. Economic stresses may contribute to mental illness and unhappiness. Rural and urban areas have different economic stresses. Rural areas tend to have higher poverty rates, and fewer education and employment opportunities (particularly for non-drivers), higher transportation costs, and less access to affordable goods and services, such as bulk retailers. Many cities have high living costs, high economic disparity rates (differences between high and low income households), and concentrated poverty, and urban residents tend to have less opportunity to build their houses and grow food than rural residents. Although urban areas tend to have less absolute poverty, they may have more relative poverty (expectations concerning what income level is sufficient) because residents are exposed to wealthier neighbors, but modern marketing is increasing exposure in rural areas.
  • Transport conditions. Local transport conditions affect mental health and happiness. Improved walking conditions and increased walking activity can increase community cohesion (positive interactions among neighbors), community security (more passive surveillance), public fitness, and health. Reduced vehicle travel also reduces per capita traffic casualty and crime risks, which can cause mental stress to victims and their families.
  • Inadequate access to nature. Some experts argue that people require regular interactions with nature, and that urban living leads to nature deficit syndrome. Cities generally offer less access to nature than suburban and rural areas, although most cities have greenspaces, including public parks and private gardens that can provide natural experiences. Because suburban and rural living significantly increases land consumption, pavement area and energy consumption, suburban and rural residents can be considered to consume nature, while urban living helps protect and therefore produce (i.e., protect) nature.

This research suggests that the following urban policies and design strategies can help create saner and happier cities:

  • Targeted social service. Recognize that cities tend to attract people with elevated mental illness risks (poverty, mental and physical disabilities, minority and immigrant status, alienated, etc.), and provide appropriate social services, including programs to treat mental illness, homelessness and substance abuse.
  • 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 (streets, parks, public buildings, etc.) that promote community and encourage positive interactions among residents, particularly vulnerable groups including poor, people with disabilities, visible minorities, migrants, youth and seniors. 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 (particularly for vulnerable groups including pedestrians, cyclists, people with disabilities, etc.), 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 (since transit travel complements walking and cycling), compact and mixed neighborhoods (so common destinations, such as schools and shops, are located within walking and cycling distance of most homes and worksites), 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 (15-25% of urban land should be devoted to public parks, and most homes should be within a five-minute walk of neighborhood parks or appropriate recreational facilities), green infrastructure (such as street landscaping and rooftop gardens), and out-of-city wilderness access programs.

This research also provides insights for increasing mental health and happiness in suburban and rural areas:

  • Since many suburban and rural areas have high poverty and substance abuse rates, they need social services that respond to those needs, including affordable housing and transport options.
  • Because residents are isolated, residents are vulnerable to loneliness and depression, and so require suitable places to socialize, and options for accessing those places.
  • Because some smaller communities can be exclusive and oppressive, they may require targeted programs to include minorities and non-conformists.
  • Because transport systems more automobile-dependent, it is particularly important to improve walking and cycling conditions.

This is a challenging and 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 favor 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 centers to suburban villages. Most urban residents live in moderate-density neighborhoods 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.

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 this research reassuring: it suggests that most people can take advantage of urban living benefits without sacrificing their sanity or happiness, and good planning can help create saner and happier cities.
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