The previous panoramic view provides sufficient evidence that cultural understanding of urban realities and expressions of their impact on mental health are necessary for a successful approach to mental health in cities. The issues go beyond understanding how urban realties and cultural issues differ in New York from Jakarta; every city has a variety of unwritten cultural norms that permeate every aspect of its mental health. Unless these norms are understood within the dynamic structure of city living, any attempt to intervene on mental health programs will be doomed to failure. Understanding the cultural blueprint of a city, however, is only the first step, as we need to shed our cultural assumptions while we consider contextual socioeconomic and political factors for each city. Finally we need to adapt our western view of cultural values and how citizens function or do not function within the urban environments. Because each city in is its own culturally specific entity, the three steps outlined previously can help create an accurate portrait of what is needed to implement culturally sensitive changes. A paradigm shift, laid on a bicurcated foundation, on the one hand a locally attuned awareness of urban cultural dimensions and on the other educational programs based on extensive knowledge of worldwide problems such as stigma, gender-specific issues, disability, and the plight of vulnerable populations can potentially have far reaching implications on mental health policy changes addressing the cultural needs of cities. Urban mental health is poised to be one of the central issues for the next few decades, because of the size of the world urban population and because of the protean nature of its problems. Cultural factors interplay with urban dynamics in a unique, at times creative, other times destructive, fashion. Under conditions of socioeconomic disadvantage vulnerable individuals who lack adaptive mechanisms may become mentally ill or experience an exacerbation of their mental illness. Understanding how cultural dynamics articulate with adaptation to urban life may greatly enhance our ability to properly assess and treat mental disorders in cities. In the assessment and treatment of patients living in urban areas contextual cultural factors rather than being merely complementary assume a preeminent if not crucial role.