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To provide an update on urban mental health and highlight the challenges that require urgent attention.The majority of the world's population live in towns and urbanization is expected to increase in all areas of the world. Challenges to mental health in urban areas include loneliness, violence, high crime rates, homelessness, noise and other pollutants, traffic accidents, drug abuse, and insufficiency of mental health services.Urbanization is a global and growing phenomenon that pose significant challenges to mental health and mental health services. Fast and unstructured urbanization, such as that seen in many developing countries, further exacerbates these challenges. There are promising initiatives emerging including initiatives to end homelessness, to improve access to green areas in urban environments, to provide emergency psychiatric services, and to develop new forms of mental health services adjusted to urban settings. Regrettably there are no universally accepted guidelines that would help governments in structuring health services for people with mental illness in towns and help to prevent mental health problems related to rapid urbanization.