Reacción a "Reactions: how to make cities that care for young people's mental health"

The study provides a multidisciplinary view that identifies priorities for a city that promotes and protects the mental health of young people and adolescents. The 518 participants, from 53 countries, different professional profiles and age groups, proposed an initial list of 134 characteristics of a youth-friendly city. The 40 preferred characteristics have been classified into six levels, following a conceptual model that combines social and environmental exposures in an urban setting and their interaction with adolescent development: personal, interpersonal, community, organisational (employment, health services), political and environmental relationships. 

The authors conclude by identifying a set of priorities for cities that require intervention at multiple levels and in all urban sectors: providing young people with resources for personal and emotional development; developing and maintaining safe, healthy and strong intergenerational relationships; promoting integration and participation in all areas of community life; facilitating fulfilling and safe employment; inclusive and violence-free education; access to affordable housing; maintaining safe and free public spaces for socialisation, learning and connection; providing safe and reliable infrastructure for basic services and transport; city design for safety and protection for vulnerable groups, built for mental health promotion; access to green and blue space; access to recreation and the arts. 

Finally, the authors propose as a next step the need to involve different stakeholders to build consensus, prioritise and plan the co-design of the implementation of the most salient features of a mental health friendly city for young people in specific cities. 

The methodology and design of the study are sound. However, the study has some limitations such as the under-representation of the youth-adolescent group in the participant panel which has revealed differences in the priorities identified compared to older panellists. This discrepancy could have implications for policy design by decision-makers 'on behalf of young women and adolescent girls' and not listening to their voice, so that the interventions designed may not match what is most needed for them. Therefore, the participation of young people in policy development is even more crucial. Asking them more about what supports their mental health based on their personal experiences could simplify and improve interventions for this group. On the other hand, the participants do not reflect the full social and economic diversity of urban populations (academics, educators, leaders and well-connected youth), and the number of more vulnerable participants is minimised. Finally, the biased geographical representation to some geographical regions (e.g. North America and Nepal), may have generated biased responses dependent on cultural context. Complementing the findings of this work with qualitative studies, including co-creation processes with groups of adolescents and young people, in other geographic regions and in a local context, would contribute to identifying and understanding key nuances for the development of an urban environment that protects and promotes their mental health.