citiesRISE: Transforming Youth Mental Health Worldwide

Rapidly urbanizing, technology-based societies of today present socio-economic and culture changes that increase risks to young people's mental health. The magnitude of this problem cannot be successfully addressed by existing top down, facility based, incremental scale up traditional models 

CitiesRISE is the first global action platform focused on the nexus of mental health, youth, and their cities with the aim of turning the tide on depression, addiction and suicide through evidence-based interventions. 

CitiesRISE network of cities and partnerships: 

1. Provides a platform for create innovative, cross-sectoral public private partnerships that leverage the full spectrum of technological and evidence to support solutions.

2. Creates hyper-local-global networks of cities and organizations that provide place-based, contextualized solutions with the support and collaboration of global evidenced-based models and partnerships. 

3. Provides an opportunity for rapid Iterations of solutions that increase access to prevention, care, support and treatment, while utilizing young people as peer counsellors. 

Mental illness is the leading cause of disability worldwide, setting the stage for challenges across social, cultural, emotional, educational, and economic dimensions. Unlike other illnesses, mental illnesses are “chronic diseases of the young,” with over 75% manifesting by age 24. Demographic trends suggest that 60% of all city dwellers will be under the age of 18 by 2030. Three persistent problems impact the mental health crises amongst urban youth:

• Mental health is addressed by transactional rather than transformative approaches. The need for long term systemic changes that promote mental health and those that support the prevention and treatment of illnesses and recovery from associated psychosocial disabilities is largely overlooked;
• Models and methods for integrating and measuring mental health are sorely lacking. Although proven models exist, effective replication is almost nonexistent and good practice examples invariably remain isolated; and
• Mental health problems are subject to short-term approaches confined to specific population groups, rather than being considered challenges for society as a whole. This means that the wider implications of a pattern of suicides, for example, or high levels of depression fail to lead to broader policy development that promotes mental health and reduces mental illness.

citiesRISE sees youth as a period of major transition from childhood to adulthood. Youth is understood as a fluid term rather than a fixed number, in which, we further define age groups by children (0 to 12 years), adolescence (period of 10-24 years as defined by the Lancet) and young adulthood (period of 15-35 years defined by African Youth Charter).  Young urban populations are exposed to a multitude of mental health risk factors. Many live in densely populated, exclusively urban areas, and face socio-economic problems across many aspects of their lives including family, friends, education, and careers. The stigma of mental health often prevents young people from seeking care in the formal health system, and so they have few touchpoints with individuals who have been trained and tasked with spotting the signs of mental illness and guiding the way to support. Young people therefore need mental health care to be delivered in new ways – ways that penetrate their daily lives by delivering prevention, diagnosis, and support through diverse access points. These can include families, community gathering points, the education system, the justice system, and others.

Over the past two years, citiesRISE has worked with city leaders, global experts, and young people to consolidate high-priority interventions and promising approaches that make services and supports for mental health more accessible for young people. High-priority interventions supporting the mental health of young people include integrated care sites that provide quick access to mental health care and referral to experts, parenting interventions that strengthen family systems, peer support and gate-keeper programs, and life-skills training that empowers young people with the tools to self-help.  There is robust evidence that exists for these aforementioned approaches among others and innovative ways these are being implemented across the world.

Nevertheless, methods and models for supporting young people are often outdated, and lack an integrated understanding of the pressures and adjustment challenges young people face today, while overlooking the massive disparities that young people in marginalized populations face. Beyond scaling a single model, we believe that the most promising path forward for mental health is to leverage place-based solutions, taking services where young people are through a range of access points and intervention methodologies. Based on outcomes and findings from the city landscape mapping, cities identify prevalence characteristics, gaps in current provision and proposed interventions.

Together, citiesRISE and the local partners co-create a package of priority interventions that target access points that young people frequently attend, from schools to community centers. citiesRISE helps develop an intervention package by a) evaluating existing local/global models and b) understanding the needs and capacities of a selected city. 

A central activity within and between the cities is to design an approach that is not just about interventions that are known to work, but address a real need to integrate a component that works with peer-counselors and ways to engage with young people in their communities who are particularly disadvantaged and which can be scaled beyond cities (such as telemedicine, hot-spot services, self-help groups). 

The dramatic shift necessary to adequately address the scale of mental health challenges globally requires systems-level change that can only be achieved by the large-scale alignment and coordination of collective action. No other platform brings together international and national leaders in mental health to offer a unique advantage in its networks, experience and expertise, at the scale of citiesRISE. Two key areas distinguish the innovation of citiesRISE:

1) The local-global network being created through citiesRISE for youth is a unique opportunity for fragmented efforts to be aligned in structured, cohesive strategy that can be rapidly adapted to multiple local contexts and create pathways for scaling through regional and other pathways, including public-private partnerships, to impact young people at scale.

2) In order to source and identify innovative work and accelerate the uptake of best models in communities, the citiesRISE architecture allows us to rapidly support and analyze relevance at the all levels. At the same time, building a global network across sectors brings the ability to cross pollinate ideas and share learnings, as well as create non-traditional partnerships. The local-global linkage brings infrastructure and evidence, a concept that is frequently used in the private sector to scale at the global level. 

In each city, an on-the-ground rapid assessment process is used to determine the key gaps and needs along with the determination of high-impact interventions that are ready for rapid design and implementation. As part of this process, core data sets are being established for each participating city in order to inform priority setting for interventions and for monitoring and evaluation. Chennai and Nairobi, two of our five operational cities lead the way in contextualizing an approach most relevant for the city, providing key learnings for research underway in our other cities. We are also making use of technology to improve access to care and mainstream initiatives around capacity-building and training new players in the mental health workforce 

Partnerships that enable effective use of technology are key to the citiesRISE platform. Across the range of opportunities for technology application citiesRISE has identified the following 4 areas as priority opportunities:

1. Using technology to create a shared learning platform or collaborative

2. Developing a digital accelerator platform for mental health

3. Using technology to mainstream initiatives around capacity-building and training new types of workforces in mental health

4. Improving access to care

Over the past two years, citiesRISE has worked with city leaders, global experts, and young people to consolidate high-priority interventions and promising approaches that make services and supports for mental health more accessible for young people. High-priority interventions supporting the mental health of young people include integrated care sites that provide quick access to mental health care and referral to experts, parenting interventions that strengthen family systems, peer support and gate-keeper programs, and life-skills training that empowers young people with the tools to self-help.  There is robust evidence that exists for these aforementioned approaches among others and innovative ways these are being implemented across the world.

In order to source and identify innovative work and accelerate the uptake of these models, a local-global architecture allows us to support and analyze relevance at the all levels. At the same time, building a global network across sectors brings the ability to cross pollinate ideas and share learnings, as well as create non-traditional partnerships. 

The below framework outlines how local and global efforts align toward achieving mental health friendly cities for youth.

The citiesRISE global platform for local action was designed to drive systems levels changes to support the mental health of young people. Thus, the work is motivated and operationalized with partners in participating cities. Currently, citiesRISE is designing its first set of solutions to be delivered in launch cities, focusing on the entry-points of schools, colleges, and informal settlements. The solutions and interventions designed will be built and prepared for long-term sustainability and scale. The expected reach for these efforts is currently being estimated.

Importantly, the work of citiesRISE has a strong network effect through the shared learning infrastructure and the network of global actors working on young peoples mental health. Over time, we anticipate many more cities to adopt solutions designed in the initial phase of work, leading to outsized impact.

Ultimately, our goal is to reach 1 billion young people by 2030 to turn the tide on depression, addiction and suicide through evidence-based interventions and community experience. 

We have two core development goals for the next five years:

1) Establishing a global backbone with proof-points of success in five global cities: After launching in 2017, citiesRISE currently focuses on developing the operational and backbone infrastructure to run a global action platform and on delivering proof-points of success in its first set of participating cities. This work involves launching and implementing interventions that show progress toward target results, operationalizing a shared learning network across low-, middle-, and high-income countries, and elevating the issue through policy engagement and advocacy locally and globally. 

2) Development of an accelerator fund, digital enterprise, and innovative local-global operating model: 

• Accelerator fund: Aim to support and enable expansion of city-level interventions as well as advancing the transformation of mental health practices globally. The pathways for acceleration can range from providing implementation service support (light-touch engagements: including technical and financial support), to deeper engagements that include building the core value propositions. 
• Digital Enterprise: The role of technology in increasing better identification systems and increasing access to care for young people is unprecedented. citiesRISE aims to be a global thought leader in this area, building tactical partnerships with technology solutions and platforms, enabling real-time data and stronger linkages between digital and physical support. 
• Innovative local-global operating model: As the effort grows, an effective backbone infrastructure and operating model is critical. We aim to keep learning from other global efforts and iterating to build a structure that meets changing needs in the field and young people. 

Three key barriers or challenges are key focus points for citiesRISE:

1. Formulating a structure for fund distribution that meaningfully supports local communities and the operational infrastructure for pooled funding.
2. Building out a digital enterprise in the rapidly changing technology and data landscape. 
3. Designing a global backbone equipped to meet identified goals and local needs. 

The ways that citiesRISE is addressing the aforementioned barriers include:

1. Mobilizing leading philanthropists to work together to support the global platform for local action. We plan to continue convening and coordinating actors in the donor community to see how we build out greater resources and pool funding to diversify investments and come-behind proven responses.  
2. Exploring a number of exciting partnerships to accelerate the design of the digital enterprise work stream. Technology platforms such as 7cups have joined forces with citiesRISE to expand impact and better engage in systems change while the University of Oregon's Center for Digital Mental Health is coming behind citiesRISE to build out new forms of data-collection and monitoring systems for young people. 
3. Establishing partners and stakeholders at local - global levels to co-develop the platform and its functions. citiesRISE worked extensively over the last 2-3 years with social entrepreneurs, NGOs, private sector, research experts and most importantly national institutions to co-create the offerings and functions of the initiative. 

citiesRISE is currently incubated at the Global Development Incubator (GDI), which is a 501c3 and has a strong record of building successful multi-stakeholder initiatives. One of the key activities for 2019 is working toward independent status as a 501c3.

Operating under the direction of its full time CEO, citiesRISE is comprised of dedicated senior and support staff and core institutional partners on the ground in Colombia, United States, Kenya and India. citiesRISE currently employs 7 full-time employees and 12 contract consultants.

Alongside the core team, citiesRISE works through an expanding network of global experts who play a key role on the solution team. These include leading practitioners from health and development, social innovation, systems leadership, and data and technology. 

citiesRISE was founded by Moitreyee Sinha and Chris Underhill. Moitreyee Sinha, CEO and Co-Founder, brings extensive experience in scaling up cross-sectoral global initiatives in health and other fields. Moitreyee is a leading expert in designing and implementing large-scale systems change and building public-private partnerships, highlighted by her success in building national programs for health, water and education across 22 countries. Chris Underhill MBE has been recognized around the world for his impact on the field of mental health, and is the President of Basic Needs, the world’s leading mental health NGO working in developing countries.

Add line that team and network of partners comprise of the worlds leading experts at local and global levels. Advisors come from fields such as x,y,s.z.. 

CitiesRISE has operationalized its non-profit model through incubation at the Global Development Incubator. Two core components of our business model include raising grant funds and operationalizing an Accelerator Fund, both of which aim increase the global capacity of organisations who work to promote good mental health as well as those who support or provide treatment to those with a mental health condition. The Accelerator Fund will include:

1. Incubation of grass-roots organizations and innovators to make their ideas into reality;

2. Accelerator support to early stage organisations to help them map out and achieve a plan for long-term, sustainable growth;

3. Later stage accelerator (Accelerator+) support to established organisations seeking to develop the quality, reach or range of their work;

4. Organisations working in related fields (e.g. HIV, maternal health, NCDs, Physical Disability) who are seeking to incorporate mental health into their work, i.e. Mainstreaming mental health.

CitiesRISE business model continues learn and adapt as work is being piloted in our first five partner cities.  

citiesRISE is actively seeking funding, primarily from grant making institutions. We also anticipate attracting and securing a diversified funder portfolio, including direct and inkind investment of funds and other resources from private and public foundations, corporations, government (local - federal), multilateral donors, collective donor groups, donor-advised funds, and individuals. 

There are a multitude of reasons why Solve can help accelerate the global transformation citiesRISE is leading:

First, collaborating with the Solve on a range of youth issue areas creates a path for accelerating integration of interventions that improve mental health. Both incremental and systemic integration of mental health is required to address youth mental health challenges and sustain a thriving youth population. Incrementally, we know that embedding mental health components into existing youth serving efforts, such as pairing workforce development and peer/community health advocates with psychosocial support, leads to better outcomes. Whereas at the systems level, mental health plays out in schools, workplaces, prisons, and homes, from the privileged to the marginalized, and thus must be systematically embedded into every facet of a young person's life.

Second, since the youth mental health sector is still nascent, collaborating with Solve provides an opportunity to leverage lessons learned and structures built by the spectra of global innovations. These partnerships and networks create entry points for new actors to engage with mental health, ensuring our efforts are complementary to the entire youth development field.

Cross-sector collaboration is a key part of the citiesRISE model. To date, we have been working with youth serving partners at local and global levels that focus on a range of issue areas, from arts for social change to innovative finance to LGBTQ rights. The culture of collaboration and partnership that we have built locally and globally compliments the Solve network of innovators, funders, and experts. 

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The success of the citiesRISE platform and programs will rely on the establishment of purposeful partnerships with private and public organizations that are prepared to formally invest time and resources in achieving the global goals.

Key partnerships are being developed across core thematic areas: Research and Evaluation, Practice Transformation, Youth Leadership and Capacity Building, Media Communications and Campaigns, City Networks, and Data and Technology. We cultivate four types of partnership:

• Facilitating partners support the work of others in each location through building capacity, providing facilities or other contributions that add value to the programs being implemented.
• Resource partners bring knowledge and expertise to the work, especially in specialized areas such as stigma reduction, suicide prevention, community engagement, public information or public policy development. Our resource partners include a growing network of leading mental health experts who provide strategic support across programs and address specific needs of each city and initiative.
• Implementation partners are the organizations which will work in cities in collaboration with each other in alliances, coalitions or other arrangements to implement the agreed activities.
• Investment partners provide financial support through grants or impact investments.

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CitiesRISE directly aligns with the Healthy Cities Prize because we: 

• leverage novel models of health delivery through the application of new technology and untapped community capacity to close gaps in access and increase health equity in cities;
• take a multi-disciplinary, holistic approach that puts the users of services and care, young people, at the center of the strategy; and,
• provide local and global stakeholders with a coordinating mechanism to drive impact at scale, accelerating the pace of shared learning and innovation transfer. 

Cities are strategic centers, nodes for growth and places where people living over wide areas gain access to employment, services, and resources. Cities can also have an influence far beyond their own inhabitants both nationally and globally. To conceptualize a city as a unit of change is an efficient way to scale up proven approaches. In this way, a network of cities will bring about broader systemic change in mental health and well-being globally. This is why we see citiesRISE as a new and higher trajectory. With the right kind of leadership from public and private sectors, affordable support for mental health can be developed by connecting formal and informal services across housing, transportation, law, education and health systems.

Most components of urban life including, for example, neighborhood safety, commercial development and housing, influence mental health and well-being. In return, those sectors are hampered in reaching their full potential by poor integration of mental health among the populations they serve, especially in urban settings. 

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Optimal mental health across the life course, especially for girls and women, continues to be a huge global challenge. Women are two times more likely than men to develop mental illness. Further, according to the WHO, between 20% and 33% of women in developing countries and 10% of women in developed countries have a significant mental health problem during pregnancy and after childbirth. 15.6% of pregnant women and 19.8% of postnatal women in LMICs will experience some kind of mental disorder, most commonly depression. Some of the social determinants that have been identified for this are poor socioeconomic status, less valued social roles and status, unintended pregnancy and gender-based violence.

In low-resource settings in our participating cities, compounding risk factors and limited pathways to support increase health disparities, particularly amongst young women. After landscaping activities in Nairobi and Chennai, young women living in adversity were identified as a key target population for local responses.

Through the Innovation for Women Prize, citiesRISE can amplify the global call for specific emphasis on the mental health of girls and women, as well as expand learning networks focused on the topic. Particularly through the Solve innovator network, citiesRISE is keen to learn from and collaborate with partners focused on the helping women rise globally and share insights into improving a range of conditions impacting women's health and wellbeing. 

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