Collective action for young people's mental health: the citiesRISE experience

Globally, most young people with mental health problems lack the support and access to the care they need1. The rapidly urbanizing, technology‐based societies of today present social, political, economic and culture changes that increase both risks to, and opportunities for, young people's mental health.

However, current approaches to supporting the mental health of young people typically lack an integrated understanding of the pressures and challenges they face, especially at critical life transitions. They do not address the rapidly increasing disparities experienced by young people, particularly by those who are marginalized2. Beyond scaling up a single model, we believe that the most promising path forward for mental health leverages place‐based solutions, taking services to young people through a range of access points and intervention methods.

citiesRISE is a multi‐stakeholder initiative. It was formed as a response to the concern that fragmented and small‐scale efforts are failing to address the rising tide of mental health problems among young people worldwide, despite the existence of effective approaches in several parts of the world3. citiesRISE is using proven methodologies of collective action and a network approach to introduce and scale up interventions backed by evidence and experience.

citiesRISE is working now in four countries: India, Kenya, the US and Colombia. Organizations at the local, national and global levels are working together to implement programs in the first five cities of Chennai, Nairobi, Seattle, Sacramento and Bogotá. In each of these cities we are convening young leaders, psychiatrists and other mental health professionals, government and civil society stakeholders, as well as cross‐sectoral partners, to learn about local initiatives, and connect to global ideas, insights and resources.

We are jointly designing interventions that will address supply (e.g., the scale of services and support available for early intervention) and demand (i.e., awareness, help‐seeking behavior) for services as well as relevant societal factors. The vision of this initiative and the approach has attracted a range of investors from philanthropy and industry.

citiesRISE is currently developing five key offerings:

• City platforms that are testing a collective action approach: identifying the needs of the city, connecting different sectors, and evaluating opportunities to scale up existing community interventions while also recommending new and promising approaches.

• Youth leadership: it is critical to tap into the insights and energy of young people in the design and delivery of mental health interventions. Our early work in Nairobi and Chennai has demonstrated that youth are engaged in improving local mental health locally, bringing en‐ergy and passion to the cause; just as young people everywhere are found at the center of movements for social change, in the process of growing into the leaders of tomorrow.

• The Learning Collaborative is a knowledge forum that will pool and provide access to information. Cities will use it to compare local information and experiences and learn about emerging best practices. The Collaborative will collect data from each city, contribute to city‐level processes, and provide opportunities to share ideas and knowledge.

• The Accelerator was launched with Grand Challenges Canada to support promising social businesses and young innovators. It has been working to identify innovative approaches to improving mental health as well as proven models that are ready for scaling up, such as the Friendship Bench, StrongMinds, Atmiyata, Drumbeat and others. In this initial phase it is being set up to provide financial and technical assistance to test and scale ideas rapidly. The vision is to offer cities and communities new tools for adoption into their core programs along with the scaling up of proven models.

• A global framework for monitoring and evaluating the work in each city is being finalized, with site‐specific and shared indicators.

Partnerships are vital to implement strategies on prevention and treatment of mental illness and the promotion of mental health through the citiesRISE platform. The WPA‐citiesRISE partnership, for example, gives the opportunity to dem‐onstrate the community orientation of psychiatry while contributing to the local and global efforts to improving the mental health of young women and men in adversity4, 5.

The citiesRISE concept differs from approaches that focus primarily on mental health care delivery by trained specialists alone. citiesRISE aims to mobilize all available resources, including young people, non‐specialists and sectors beyond health care. Psychiatrists and other mental health specialists are centrally involved in several roles such as advocates, advisors, clinical supervisors and trainers, as well as in direct clinical care.

Building on successful models sourced from cities around the globe, our process involves:

• Identifying local leaders, specifically among a city's youth population.

• Hosting a series of working sessions to identify community needs and capabil‐ities.

• Building consensus on shared goals and a framework for monitoring and eval‐uation.

• Providing funding and technical assistance to accelerate the work at the city level.

• Evaluating the work with the goal of building sustainable initiatives and strategies that can scale.

• Sharing and implementing successful initiatives in cities worldwide.

Achieving better mental health needs a broad strategy that engages many disciplines and sectors, such as neighborhood safety, commercial development, public spaces, and cultural life, including education, arts and sports1. Including and activating young people at every stage has provided energy and insight for this work. With the right kind of leadership from public and private sectors, we believe that affordable support for mental health can be developed by connecting formal and informal services across hous‐ing, transport, law enforcement, education and health systems.

Accessible psychosocial support services can mitigate the impacts of contemporary urban problems such as homelessness, poverty, and loss of education and job opportunities. Cities can therefore lead the way in accelerating the scaling up of solutions and catalyzing local collective action towards addressing mental illness and improving mental health.

In this way, we encourage a broad approach to include, for example, awareness‐raising and education programs, the use and design of public spaces, and the role of technology to support communities and complement the development of clinical services for those that use and need them.