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A tale of two cities: urban mental health in Vancouver and New York City

Urbanization and mental health are inter-linked. With the expansion of cities, pressures on services are increasing. The constraints for providing healthcare services are tremendous and financial resources can be demanding. In this chapter, service provision in Vancouver and New York are compared. It is well recognized that in most countries, there exist three levels of government: the national or federal, state or provincial assemblies, and city or municipal councils. In theory, each order is relatively independent. Local or municipal governments typically derive their powers from state or provincial law. This is notable because it places statutory limitations on what cities are responsible for, and restrictions on how, and where, the municipality may raise and spend monies. Health care policies may be developed at federal or national levels and, paradoxically, their delivery is expected at local levels, raising specific issues and pressures on local authorities.