by Layla McCay, Director, Centre for Urban Design and Mental Health

This week UK healthcare think tank The Kings Fund published a report on gardens and health, commissioned by the National Gardens Scheme. The report reviews the evidence for the impact of public and private gardens and gardening on health. This UD/MH summary focuses on the aspects identified in the report as being most relevant to mental health. Read the full report here.

Theories of how gardens impact on mental health
Gardens were a feature of the earliest psychiatric institutions. The main theories around the links between gardens and mental health are summarised by Clatworthy et al, 2013:

• Attention restoration: gardens can provide 'fascination', non-goal orientated and effortless attention, providing restorative effects to mental state.
• Stress reduction: exposure to natural settings has been associated with reductions in the body's physical manifestations of stress.
• Social connections and exercise: gardens promote social interactions and physical exercise.

The report author, David Buck, notes that high quality research in this field is currently rather limited.

Main impacts of gardens on mental health
The evidence for benefits of gardens on mental health is closely related to the body of research on green space. The proportion of green and open space in a neighbourhood has been linked to better childhood cognition and adult mental welbeing, (Barton and Pretty 2010) for all ages and socio-economic groups, and  exercising in green spaces has been linked to better mental wellbeing. (Alcock et al 2014; White et al 2013). The effects seem to be related to  improving companionship, a sense of identity and belonging (Pinder et al 2009) and happiness (White et al 2013).

Young people and gardens
Young people have reported feeling a sense of personal achievement, pride and empowerment through growing food and being involved with gardening, and experiencing positive social interactions. Children with learning of behavioural difficulties particularly valued gardening, commenting that gardens were peaceful and relaxing places. (Ohly et al 2016)

Older people and gardens
The report identifies gardening as helping to support social connections, alleviating loneliness (Pettigrew and Roberts 2008), having psychological importance for some older people in creating responsibility for something, going so far as to represent 'a meaningful reason for existence.' (Wright and Wadsworth 2014). The report proposes that since up to 13% of Alzheimer's dementia may  be attributed to a sedentary lifestyle (Raji et al 2016), by encouraging physical activity, gardens further play a role in dementia prevention. Gardens may also be helpful in supporting good mental health for people with dementia. Carers report that people with dementia who have access to a garden show less agitation and aggression. (Whear et al, 2014). Garden access also had positive impacts on the social interactions between people with dementia and their carers, friends and family. Mechanisms by which these benefits were achieved were not studied, but staff members suggested the gardens keep people with dementia's 'senses alive', offer a connection with life, reignite childhood memories, and give a sense of purpose and ownership and freedom from the confines of an institutional setting. However, staff also expressed concerns about the risk of falls in gardens.

The business case for gardens and mental health
The report concludes that while access to green space seems to be able to reduce admissions to hospital for mental health problems (Wheater et al 2007),  the diversity of needs and approaches means no simple general case can prove the business case for gardening. However it does identify some attempts to value gardens in mental health.  The New Economics Foundation (2014) estimated a programme offering gardening for people with mental health problems in England to be around £7,000 per person through reduced healthcare costs, welfare benefit reductions and increased tax contributions. Prescribing woodland activity programmes for people with mental health problems in Scotland was valued at  £8,600 per quality-adjusted life-year (QALY)– a highly cost-effective intervention. ( Willis et al 2016) In terms of benefits to businesses, retailers report an increase of trade of 40-80% where places are more walkable, including through small urban parks and greener walkways.  (Ross and Chang 2014)

Equity of access to green space
People who live in the most deprived communities in the UK were found to be 10 times less likely to live in the greenest areas compared to people who live in the most affluent communities (Balfour and Allen 2014). Minority ethnic groups, urban deprived populations, more disadvantaged social groups, those aged over 65 and disabled people were reportedly less likely to visit green spaces than the national average. Reasons suggested that contribute to this effect include poor maintenance, inadequate facilities, and safety concerns. (Natural England 2015)

Key policy implications proposed by the report

• Ministries of Health, Environment, Local Communities, and Directors of Public Health should integrate gardens as a tool to help deliver their policy objectives. They should collaborate to ensure population access to well-designed gardens, recognising this particularly as a public health activity, and an intervention to support people with dementia.
  
• Key organisations working on gardens should collaborate to develop and align a joint strategy that supports practical policy recommendations at national and local levels.
  
• Collaborations, partnerships and other innovative funding mechanisms should be considered to secure public access to well-designed gardens.
  
• More research is needed: particularly, what specifically works, and for whom? More economic evaluation data would also be helpful.
  

by Katarzyna Klijer, BSc psychology student at Goldsmiths University, London and UD/MH Associate.

According to The Office for National Statistics, around 74% of the UK population is currently employed. Furthermore, the statistics show that working people spend around 54% of their waking hours at a workplace. Considering most of us spend more than a half of our day at a place of work, it is not surprising that stress-related illnesses are rapidly increasing in the working population. The World Health Organization predicts that by the year 2020 mental health illnesses and cardiovascular diseases will be the prime types of disorders affecting working people. Many studies have suggested that buildings can have potentially significant impacts not just on organizational effectiveness, but also on human wellbeing. Therefore, the important question that should be addressed is: how can we improve our employees' mental health through the design of workplaces. Perhaps it is time to start thinking of building design as an explicit employees’ benefit, contributing meaningfully to their health and well-being.
 
Many studies on urban design and mental health have shown that even small changes can decrease stress, improve wellbeing, and help prevent people from developing a range of mental disorders - as well as improving productivity. Organizations should consider the applications of this research in workplace design.

An important design opportunity when considering mental health in any workplace is  access to a natural environment. People working in an environment that incorporates natural elements such as daylight have reported a 15 percent higher level of well-being (reduced stress levels) compared to those who lack access to daylight or other elements of the natural environment in their place of work.

Light has a strong impact on peoples’ circadian rhythm and hormonal activity which fundamentally influences quality of sleep, mood, energy, productivity, and our overall wellbeing. Thus, maximising daylight in the workplace should be a priority for employee wellbeing.

Access to outdoor areas encourages people to spend their breaks outside; it has been suggested that workplaces should provide access to outdoor areas to help boost employees' mental health.

Indoor biophilia touches in interior design may have important impact on employees' mental health.  Biophila touches, for example placing more plants in office areas to reduce stress levels, or incorporating sounds from nature, for instance rippling water, may help individuals recover faster from stressful experiences compared to building noises (for example, air conditioning equipment).

'Green buildings' have been  positively correlated with peoples’ well-being and their job satisfaction (Heerwagen, 2000), and the concept has started to be used in many workplaces. Common green building features include: (1) Advanced ventilating and mechanical systems to increase air flow, (2) Selection of building materials and furnishings that have low toxicity, (3) Increased contact with the natural environment, and (4) greater attention to construction, maintenance and operation of buildings to reduce build up of microbial agents.

A second essential consideration for wellbeing in workplaces is social interaction. While privacy and quiet spaces are important, loneliness and isolation can be associated with stress and depression. Given that more than half of people's waking hours are spent at work, it is important for employees to feel they are part of a community. Research by Clark and Watson (1988) found positive moods to be associated with daily events, especially social interaction among workers. Therefore, spaces that encourage community and engagement, for instance, cafeterias with a coffeehouse vibe or group fitness spaces are important.

Finally, a number of studies have shown clear links between physical activity and mental health. Working long hours in a sitting position does not promote the active lifestyle that is important for both physical and mental health, so workplaces can learn from urban design interventions that aim to promote activity. Designing workplaces with good bike store facilities and safe pedestrian access will help encourage active transport to and from work. Once at work, rather than presenting the elevator as the convenient and attractive default option, workplaces can design attractive internal stairwells that encourage walking between floors. A variety of work areas, light and spacious corridors, and even specific walking routes within and around the building can all promote inter-office mobility . Usage of distance markers or energy consumption information can further encourage people to be active in the workplace, enabling them to recognise and track their accomplishments in different ways.

In conclusion, we know that more than half of the adult population spends around 8 hours per day every day, 5 days per week at their workplace, with significant positive or negative impact on their mental health. It is important for companies to recognise and act on this information when they are designing the workplace, both to increase employee wellbeing, and as an added bonus, to boost productivity.