Towards mental health friendly cities: Global progress, achievements and challenges — a narrative review

More than one billion people now live with a mental health condition, and by 2050 nearly 68% of humanity will live in cities, making the urban environment one of the most consequential—yet most neglected—determinants of population mental health. This narrative review synthesizes the emerging international agenda of the "mental health friendly city": an urban settlement that deliberately organizes its policies, built environments, services, and institutions to protect and promote mental well-being across the life course. Drawing on peer-reviewed literature, global frameworks, and documented city initiatives, the review examines global progress and achievements, and critically appraises four domains of action: public awareness and stigma reduction; urban infrastructure and the built environment; public health systems; and education. Substantial conceptual progress is evident—from the WHO Comprehensive Mental Health Action Plan to the citiesRISE Mental Health Friendly Cities framework and city programs such as Thrive LDN and headspace—alongside persistent challenges: a vast treatment gap, chronic underfinancing (a median of roughly 2% of government health budgets), inequitable exposure to urban stressors, fragmented governance, and weak measurement. The review concludes that mental health must be repositioned as core urban infrastructure, and identifies priorities for research and practice, with particular attention to rapidly urbanizing low- and middle-income contexts such as India.