Imagine a scenario where we are all 'invisibilised’ for a day. As human beings, we yearn to be seen, acknowledged, heard, represented, and be part of a group. When we fail to be seen, heard, or recognised, and in contexts this is not achieved, our core sense of identity is shaken. Externally, despite everything seeming to be progressing and functioning even in the urban chaos, the absence of productivity, communication and interaction would be palpable. This is often the harsh reality for new migrants in cities, often marginalised to the peripheries of burgeoning megalopolises.

The term ‘invisible’ is apt here – as mental health issues often go unnoticed due to the absence of ‘visible’ symptoms. A lack of awareness and understanding about mental health contributes to apathy and creates an environment where addressing mental health concerns without judgement becomes challenging. The stigma and discrimination associated with mental health further widens the gap in accessing support and care for mental health. This marginalisation extends not only to individuals but also to the mental health conditions that remain unseen and unaddressed, stifling open discourse.

This year, as we observe World Mental Health Day (WMHD) on October 10, the theme “mental health as a universal human right” takes centre stage. It underscores the need for equitable planning and quality healthcare delivery to ensure access to mental health care and services for all communities. This year’s theme builds upon the 2022 World Mental Health Report, which recognised that “mental health is an integral part of our general health and well-being and a basic human right”. The report emphasised the intrinsic and instrumental value of mental health, enabling us to connect, function, cope and thrive.

As we discuss importance of mental health well-being for all, the faces of so many our research participants from different communities and urban geographies come to the fore – the lactating mothers in Ahmedabad, migrant families in the urban slums of Delhi and Bangalore, sanitation workers in Tamil Nadu, vegetable vendors in Bhopal, and the gig workers delivering groceries and food. The acute lack of awareness and availability of mental health services in urban primary care settings is glaring. Services are often confined to specialist care in tertiary institutions. Transition to urban reality thus is complex for migrants who are disenfranchised and inundated with social, economic, cultural adjustments. The recent WHO South-East Asia Regional Paro Ministerial Declaration on mental health challenges acknowledged low investment in mental health (below $1 per capita in several countries), a shortage of trained health workers, significant treatment gap, lack of services in primary care, stigma and data paucity as gap areas in the region. The declaration called for a shift from a disease-centric approach to a focus of well-being, acknowledging broader mental health determinants, and placing communities at the centre of our responses.

Change can begin within our institutions and those we work with. Creating an environment that fosters positive mental health, whether for lactating mothers, children in need of exclusive breastfeeding, the families of sanitation workers, or migrant workers in the informal economy is the need of the hour. Dignity in life, aspirations for the future, and health as a basic common good are core values that should drive our commitment to inclusivity, liberalism, and support for the evolving dynamics of human lives in urban settlements.

Collectively, we all need to take mental health from a realm of being ‘invisible’, ‘not noticed’, ‘not understood’, ‘not discussed’, ‘not seen’, ‘uncomfortable’ to being ‘visible’, normalised, discussed and mainstreamed. In a year when we have become the most populous nation in the world, this day should be a reminder for us to ensure that mental health and well-being must be at the core of our health planning, including the urban settings.

This article is authored by Aruna Bhattacharya, medical anthropologist, School of Human Development at Indian Institute for Human Settlements, Bengaluru and Anant Bhan, global health researcher, Sangath.