Urbanization and marginalization

From research among vulnerable urban individuals it is known that mental illness and substance use disorders are risk factors for social marginalization, homelessness, and poverty. The majority of homeless individuals have experienced early-childhood trauma, maltreatment, foster care, and family dysfunction. Limited access to physical and mental health care continuity further marginalizes the already vulnerable and creates social exclusion. The general migration of people towards big metropolitan areas also increases the pressure on limited infrastructure and health care in urban centres. This constitutes a significant public health threat and heralds the need to reposition the healthcare system and, in particular, mental health services to manage the situation. To provide equal access and a minimal quality of care the priorities of the healthcare systems need to be newly defined from the principles of harm reduction.