40 out of 42 cities reported that at least one mental health service specific for people who use drugs is available, indicating needs recognition. However, across six service types- psychological counselling, psychiatric services, support groups, crisis intervention, mental health education and family therapy/support- provision remains uneven with gaps and variations between cities. Only 18 of the 40 cities reported that all 6 types services existed. 22 cities reported five or fewer, and 10 reported operating with three or fewer. Psychological counselling was the service type most reported as available, while family therapy/ support was reported as the least available. Geographically, Western European cities tend to offer the broadest range of mental health services.