Mental health services and the city: a neighbourhood-level epidemiological study

Introduction: Neighbourhood composition is considered a social determinant of mental health that can be addressed by policymakers to improve outcomes. Deprived neighbourhoods typically lack resources such as leisure and park facilities but also daycare centres. However, the study of specific needs and resource distribution tailored to the clinical-demographic features of mental health service users is still in its infancy. Aim: In this study, we aimed to identify discrepancies between neighbourhood resources and epidemiological composition of a representative sample of mental health service users in the large metropolitan area of Milan in Italy. Methods: In a cross-sectional study design, we described neighbourhood-specific density of community services and the socio-demographic and clinical features of residents who accessed local mental health services in the same geographical areas. Data were retrieved from municipal and mental health registries and analysed at a neighbourhood level and at a higher level of neighbourhood clustering based on territory coverage of three mental health departments. Results: At the neighbourhood level, no significant difference could be observed between resources of the three identified urban areas. However, a strong heterogeneity of resource localization was observed for public housing properties, social services, juvenile community homes, social aggregation spaces and day centres for disabled individuals after controlling for population density across the three areas. This heterogeneity did not match the distribution of service users or specific diagnosis–related needs across different urban districts. Non-affective psychoses were found to be more frequently diagnosed in deprived neighbourhoods, whereas anxiety disorders were most frequent in an area which incorporates relatively more affluent neighbourhoods. Further studies including a neighbourhood-level socio-economic index are needed to confirm the likelihood of these associations. Conclusion: Our preliminary findings suggest a heterogeneous distribution of diagnoses across city areas, which might reflect uneven neighbourhood resources. Overall, this study highlights the need to adequately tailor neighbourhood resources to the specific mental health needs of vulnerable individuals.