On #WorldHealthDay join the #udmhflashmob and #DesignAgainstDepression

Friday 7th April is World Health Day, and this year the World Health Organization has announced the theme, which is depression: let's talk. Depression is the leading cause of ill health and disability worldwide. More than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. People who live in cities have up to 39% increased risk of depression. This is important for architects, city planners, and other urban designers. So, in line with the World Health Day theme, #letstalk about #designagainstdepression.

What is depression?

Depression is an illness characterized by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks. In addition, people with depression normally have several of the following symptoms: a loss of energy; a change in appetite; sleeping more or less; anxiety; reduced concentration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide.
- World Health Organization

What does urban living have to do with depression?

The physical and social environments of urban life can contribute both positively and negatively to mental health and wellbeing. There are three main reasons that city life is associated with increased depression:

1. Pre-existing risk factors: Some of the reasons for people moving to the city also happen to be risk factors for depression: for example, poverty, unemployment, homelessness, existing physical and mental health problems, previous trauma, personal crises, family break up, addiction, and immigration. This  leads to a population who are particularly vulnerable to depression.
2. Social factors: People with many of these pre-existing risk factors often encounter negative disparities in the city, such as physical and psychological segregation into neighborhoods characterized by poverty and social challenges, engendering feelings of injustice and hopelessness, and experiences of prejudice and discrimination that may affect mental health.
3. Environmental factors: The urban setting can affect people in two key ways: increasing stimuli, and stripping away of protective factors.

• Overload: People who live in the city experience an increased stimulus level: density, crowding, noise, smells, sights, disarray, pollution and intensity of other inputs. Every part of the urban environment is deliberately designed to assert meanings and messages. These stimuli trigger action and thought on a latent level of awareness, and become more potent as an inability to ‘cope’ sets in. This can have the effect of overload: increasing the body's baseline levels of arousal, stress, and preparedness, but also driving people to seek relief: quiet, private spaces; over time this urge may evolve into social isolation associated with depression and anxiety, and also forms the basis of the ecological hypothesis of schizophrenia.
• Erosion of protective factors: People who live in the city may find that they have less access to the factors that are protective for good mental health compared to those in rural areas. For example, they may have diminished access to nature, fewer opportunities to integrate exercise as part of their daily routines, and reduced leisure time as increased time is spent at work and commuting around the city. People may find themselves feeling unsafe, having less privacy, and even less sleep, due to factors like crowding, light, noise and stress. Rural to urban migration often sees people leaving behind their strong social networks of friends and family, and it takes time to develop similarly supportive social capital in the city. This may particularly be the case as urban dwellers may be reluctant to engage in social interactions, to avoid overstimulation, due to safety concerns, or because of the reduced likelihood of future relationships with each individual they encounter.  As these protective factors erode, people become more vulnerable to developing mental health problems.

So how can urban design help reduce the risk of depression for people living in cities?

• Design green space into the city: There are important relationships between accessible green spaces and mental health and wellbeing. Access to natural settings in neighbourhoods and in the course of people’s daily routines is likely to improve and maintain mood, and help prevent depression.
• Design active space into the city: Regular exercise is as effective as anti-depressants for treating mild-moderate depression, and a key opportunity for promoting good mental health. Action opportunities can be embedded into people's routines as they move around the city, from improving walkability and bikability infrastructure to traffic calming, reliable public transport, and access to exercise facilities in the city for all.
• Design pro-social space into the city: One of the most important opportunities for preventing depression is natural, positive social interactions, from close, confiding relationships to feeling part of a community. Urban places should facilitate social interaction (while also ensuring opportunities for privacy to avoid overload), eg. compact, walkable neighbourhoods with street benches on which to rest, mixed-land use with welcoming shopfronts and amenities, fine-grain street fronts (long, monotonous blocks of featureless walls can make people prone to ruminations), and multi-use public open spaces where people can get together for cooperative community events with opportunities for participation and volunteering.
• Design to improve sleep: Sleep is one of the most important protective factors against depression. And yet cities can erode sleep patterns with increased ambient noise, light pollution, and crowding. Sirens, alarms, vehicle traffic noise, noises from adjacent homes, and construction work may all be more likely in the city, and urban residents are more likely to sleep at times that do not match with their biological clock. Good building insulation, street trees, walls, and other noise barriers can help prevent urban noise from disrupting sleep, as can traffic restrictions. Street lighting can be oriented downwards to reduce residential light pollution.
• Design for safety: A sense of safety and security is integral to people’s mental health and wellbeing. People are deterred from taking advantage of green, active and pro-social opportunities in the city if they fear for their safety. Whether fear of crime, traffic, or getting lost (for example for people with dementia), improving safety can increase people's access to these opportunities.

Learn more detail about these opportunities on our website.

ACTION: What can I do today?

Let's fill the internet with great design to reduce depression. For World Health Day, the Centre for Urban Design and Mental Health is kicking off a #udmhflashmob - all day on April 7th:

1. Take pictures of places in your city or share your firm's work encapsulating some of the design elements that help #designagainstdepression (click here for more info). Upload  to Twitter (tag @urbandesignmh) and/or Instagram (tag @urbandesignmentalhealth). State the city, the design features of interest, and use the hashtags: #worldhealthday  #udmhflashmob and even #designagainstdepression Bonus: you'll get some air, exercise, and walk around green spaces while you take the pictures, improving your own mental health while you do this.
2. If you don't have pictures, just tag us on Twitter and write about your suggestions and links to how architects, urban planners, designers, geographers, engineers and more can contribute to #designagainstdepression on #worldhealthday
3. Follow the hashtags, look at everyone's photos, comment, learn and be inspired about how you can integrate mental health promotion into your projects.

While the whole world is talking about depression for World Health Day, let's make sure they think about the important and innovative roles that designers and other citymakers can play in preventing depression and promoting better mental health and wellbeing for the population.

#udmhflashmob This is Granary Square, Kings Cross in central London, UK. This public open space invites people to sit and relax with a book, eat their lunch, or meet and chat with friends. It incorporates natural and artificial elements, and is accessible by a biking and walking path along the canal, and by many forms of public transport. #greenspace #openspace #socialspace #activespace #worldhealthday