The Pressing Challenge of WASH and Mental Health in Urban Slums
Inadequate access to safe water, sanitation, and hygiene (WASH) services is a critical issue affecting the health and wellbeing of urban poor communities across the developing world. In Hyderabad, India’s fourth-largest city, nearly one-third of the population resides in informal settlements or slums that lack basic infrastructure and public services.
This intersection of poor WASH access and urban poverty creates significant physical and mental health risks for slum residents. Contaminated water, limited sanitation facilities, and poor hygiene conditions contribute to the spread of waterborne illnesses, undernutrition, and communicable diseases. Beyond the immediate health impacts, the chronic stress of living in such conditions can profoundly affect mental wellness, leading to higher rates of depression, anxiety, and other psychological distress.
“The constant worry about where our next meal will come from, how we will get water, and whether our children will fall sick again takes a huge toll. I feel hopeless and exhausted much of the time.” – Meena, resident of Basti Nizampur slum, Hyderabad
However, despite the clear links between WASH access, physical health, and mental wellbeing, these issues are often addressed in isolation. Public health initiatives tend to focus narrowly on improving infrastructure or changing hygiene behaviors, while mental health programs overlook the critical role that environmental conditions play. Integrating WASH, physical health, and psychosocial support is essential for truly addressing the multidimensional needs of urban slum dwellers.
Amplifying Marginalization: The Mental Health Impacts of Poor WASH
The residents of Hyderabad’s informal settlements face a range of interrelated challenges that heighten their vulnerability to poor mental health outcomes. Lack of secure water and sanitation services is a major source of chronic stress, as families must devote significant time and energy to meeting these basic needs.
Women and girls bear a disproportionate burden, often responsible for collecting water from distant and unreliable sources. The physical and opportunity costs of this labor, combined with safety concerns around open defecation and using shared sanitation facilities, contribute to high levels of anxiety and depression.
“Every morning, I have to wake up at 4 am to wait in line for the community tap. I never know if the water will be flowing or how long I’ll have to stand there. It’s humiliating, and I’m constantly worried about my children’s health.” – Rekha, resident of Basti Nizampur slum, Hyderabad
Poor children in slum communities are also deeply impacted. Exposure to contaminated water and inadequate sanitation increases their risk of diarrheal diseases, malnutrition, and developmental delays – all of which can negatively affect cognitive function, social-emotional skills, and mental wellbeing. The lack of safe play spaces and high incidence of violence in informal settlements further compound these challenges.
Moreover, the stigma and shame associated with living in a slum can contribute to social isolation, low self-esteem, and feelings of hopelessness. Residents may avoid seeking mental health support due to the double burden of poverty and the societal discrimination they face.
“The other kids make fun of us because we live in the slum. I don’t have any friends at school, and my parents are always fighting about money. I just want to stay in my room and be alone.” – Ananya, 13-year-old resident of Basti Nizampur slum, Hyderabad
Addressing the intersection of WASH and mental health in urban informal settlements requires a holistic, community-driven approach that empowers residents, tackles stigma, and integrates services to meet their multifaceted needs.
Uplifting the Community: Integrated WASH and Mental Health Interventions
Recognizing the critical linkages between WASH access, physical health, and psychological wellbeing, a coalition of local NGOs, community organizations, and public health authorities in Hyderabad have pioneered an innovative approach to address these challenges in the city’s informal settlements.
Improving WASH Infrastructure and Services
The first step has been to enhance water and sanitation infrastructure and services within the slums. This has involved:
- Constructing community-managed water kiosks and sanitation blocks with safe, reliable access
- Training local youth as WASH technicians to operate and maintain the facilities
- Implementing behavior change communication campaigns to promote hygiene practices
These efforts have not only improved health outcomes, but also reduced the time and labor burden for women and girls, freeing them to pursue educational, economic, and recreational opportunities.
Integrating Mental Health Support
Recognizing that improved WASH alone is insufficient, the coalition has also integrated mental health services and psychosocial support programming:
- Embedding counselors and social workers within the community WASH centers
- Training community health workers to identify signs of distress and provide basic mental health first aid
- Establishing peer support groups and recreational activities to foster social connections and resilience
By co-locating these services, the program ensures that residents can seamlessly access holistic care for their physical and mental wellbeing. Importantly, the community-based model also helps to destigmatize mental health issues and encourage help-seeking behavior.
Empowering the Community
Underpinning this integrated approach is a strong commitment to community engagement and leadership. Residents, especially women and youth, have been actively involved in all stages – from needs assessments and program design to ongoing management and evaluation.
This emphasis on participation and ownership has been crucial for building trust, tailoring interventions to local contexts, and ensuring long-term sustainability. Community members serve as WASH technicians, mental health peer supporters, and advocacy champions, amplifying the voices of the urban poor and catalyzing broader systems change.
“Before, we felt powerless and resigned to our situation. But now, we have a say in how our community is run and access to the support we need. It’s transformative.” – Pooja, resident of Basti Nizampur slum and community WASH committee member, Hyderabad
Scaling Impact through Partnerships and Policy Change
The successes of this integrated WASH-mental health model in Hyderabad’s informal settlements have attracted widespread attention, leading to new partnerships and policy developments that aim to scale the approach.
At the city level, the municipal government has committed to replicating the community-based WASH and mental health centers across all slum areas, allocating dedicated funding and resources. This has involved close collaboration with the NGO coalition to adapt the model to different neighborhood contexts and train broader networks of community health workers and volunteers.
Meanwhile, at the state level, the Telangana government has integrated the WASH-mental health integration framework into its flagship urban development and slum upgrading programs. This has enabled the mobilization of additional technical and financial support, as well as the adoption of the approach within the state’s universal health coverage initiatives.
Internationally, the Hyderabad model has also sparked interest from development organizations, research institutions, and policymakers seeking holistic solutions to the challenges facing urban informal settlements. The coalition has shared its learnings through global forums, forged partnerships with peer organizations in other countries, and influenced the agenda of major initiatives like the Sustainable Development Goals.
“What makes this model so powerful is its ability to transcend traditional sectoral boundaries. By bringing together WASH, health, and social support, we’re able to tackle the root causes of urban poverty and marginalization in a truly transformative way.” – Dr. Aisha Rahman, director of the Hyderabad Urban Health and Environment Initiative
As the world continues to urbanize, with slum populations projected to grow exponentially, the need for integrated, community-driven approaches to improve WASH access, physical health, and mental wellbeing has never been more urgent. The experience of Hyderabad’s informal settlements offers a powerful blueprint for cities across the Global South to follow.
https://unhabitat.org/sites/default/files/2020/10/wcr_2020_report.pdf
https://www.habitat.org/sites/default/files/documents/Housing-and-Sustainable-Development-Goals.pdf
https://www.frontiersin.org/articles/10.3389/fpubh.2022.1043602/full
