Mental health challenges among India’s urban poor remain largely overlooked. Rapid urbanisation, poverty, and social vulnerabilities intensify distress, demanding urgent equity-driven public health interventions
Amid the hustle, bustle of India’s big cities, beneath the skyline of rapid development, lies an often unseen reality. The reality where mental distress, mental health issues trouble India’s urban poor. These class of people generally have no opportunity to seek professional help. For many living in informal settlements, everyday struggles over housing, safety, income, and dignity quietly shape their emotional well-being. They may not have diagnosable mental illnesses, yet the weight of instability, insecurity, and exclusion takes a deep psychological toll. As India’s cities expand, bringing nearly 40 percent of the population into urban spaces by 2036, it becomes vital to recognise that mental health is not just a medical issue but a social one — deeply tied to the lived experiences of poverty, inequality, and neglect in our urban landscapes.
Asianet News English talked to Mukta Gundi, Faculty at Azim Premji University, Bengaluru. This is what she has to say:
‘I lost my identity card of the sanghatana. So many days have been wasted in tension as I must apply for it again to receive my benefits.’
‘I am scared to talk to my father about my problems. He is into making illegal alcohol… I don’t feel safe. Better to be silent.’
Both these people, a ragpicker and an adolescent girl, from an urban informal settlement, may not necessarily be diagnosed with any mental illness, yet their expressions vividly remind us how everyday precarities create distress among the urban poor. Such forms of distress among the urban poor in India do not get enough attention in India’s public health system.
Rapid urbanisation is projected to see nearly 40 percent of the country’s population (600 million people) living in urban areas by 2036. According to the 2011 Census, approximately 17.4 percent of the urban population resided in slums, and around 13.7 percent of them lived below the Poverty Line. Data from 2019-21 indicates that the incidence of multidimensional poverty in urban areas is roughly 5.27 percent.
The category of urban poor includes diverse communities, such as those living in recognised and unrecognised slums, who are often systematically excluded from the category of mainstream urban lives — daily wage workers, migrant workers, and those working in the informal sector. Rapid and unplanned urbanisation exacerbates various kinds of vulnerabilities faced by the urban poor in India. Overcrowded and unsafe neighbourhoods, poor quality of housing, lack of access to sanitation facilities, quality education and healthcare, and precarious occupations compound the vulnerabilities of the urban poor.
Available evidence indicates a worrying health status among the urban poor. Do the urban poor face harsher social vulnerabilities than their rural counterparts? How does this experience affect their physical and mental health?
Recent Surveys
Recent surveys and studies indicate a large burden of mental health concerns among the urban poor. For example, the National Mental Health Survey (2016) shows that urban metro cities have a higher prevalence of major depressive disorders, especially among the poor. A multisite survey among 12 states in India showed that residents of cities with a population of over one million had three times higher chances of having depressive disorders as compared to the rural population. Lower levels of education and poverty are important contributing factors. Another study conducted in informal urban settlements in Mumbai indicated that about 12 percent of adolescents are at risk of mental health issues. However, even in comparison to the limited data on physical health conditions among the urban poor in India, there is a bigger gap and neglect in addressing mental health concerns. Further research is needed to understand how these risks get shaped by occupations, caste and gender, especially among the more vulnerable populations within the category of urban poor, such as pregnant women, the elderly, and more at-risk populations, such as sex-workers and homeless beggars.
Urban spaces are often dynamic, involving a constant interplay of various sociocultural, environmental, neighbourhood-related, political, and economic adversities that can shape mental well-being among the urban poor. Mental well-being is intricately linked to the embodiment of the dynamic interplay of such adversities. A lack of stability, limited material resources, broken social network, risky external conditions, exposure to conflict, unequal social dynamics and power relations shape expressions of trauma among the urban poor. These expressions of suffering, or perhaps even their struggles to express their everyday stressors, need deeper understanding and acknowledgement in research and practice.
Overall, there is an urgent need to focus on the mental health challenges among the urban poor as several questions remain unanswered. For instance, how do we better understand the expressions of their social suffering and psychosocial distress beyond diagnostic labels? How do the lived experiences of different populations living in poverty in urban areas shape their mental health? How should public health practitioners prioritise their needs by building granular, layered and substantive evidence on mental health? How can the urban health system be made sensitive and robust to address urgent mental health care access-related (and preventive) needs among urban vulnerable populations?
Neglecting the social vulnerabilities and related mental health needs among the urban poor will lead to many long-term consequences, burdening India’s fragmented urban public health systems. Timely interventions, grounded in sound public health approaches to mental health, are essential to address these concerns. Promoting mental wellbeing among different urban poor populations, addressing stigma through participatory approaches, creating a well-trained cadre of frontline health workers who can identify and refer people with mental illnesses to the health system, strengthening the implementation of state-run District Mental Health Programme through innovative models, such as collaborative telepsychiatry, integrating mental health into general health care, helping these populations build social ties, and providing psychosocial rehabilitation for those on the path of recovery are some important strategies that can be implemented. Promoting better mental health among the urban poor requires a lens of equity to safeguard the dignity and rights of the most vulnerable.
The author would like to thank Adithya Pradyumna and Arima Mishra for their inputs.
The views and opinions expressed in this article are those of the author and do not necessarily reflect the views or the positions of the organisation they represent.