October 10th is International Mental Health Day and this year's theme is mental health in the workplace. Unemployment is a major risk factor for mental health problems, and being employed usually protects our mental health. But since we spend a large portion of our days working, our work environment can have a wide range of effects on our wellbeing. This can affect how we feel, our relationships with friends and family, and importantly, our mental health. A challenging workplace can contribute to and exacerbate problems like stress, anxiety, depression, and drug and alcohol use, while a supportive environment can help staff thrive.
The World Health Organization says: "A negative working environment may lead to physical and mental health problems, harmful use of substances or alcohol, absenteeism and lost productivity. Workplaces that promote mental health and support people with mental disorders are more likely to reduce absenteeism, increase productivity and benefit from associated economic gains. "
Workplace design for better mental health
Many of mental health challenges at work stem from relations with colleagues, degree of support, and working hours - but design also plays a role. In developing a workplace that supports mental health, let's look at some of the opportunities for workplace design. Then at the end, watch architect, Shigeki Irie, discussing how he implemented these ideas in his design of the new Coca-Cola Japan HQ LEED Platinum building in Tokyo.
Nature: Natural settings are good for our mood and stress; they can also increase stamina and concentration, which may affect productivity. Nature can be integrated into the workplace in various ways, including views, plants and water features within the office, and nature analogues such as materials and patterns (e.g. use of wood) and other decor (e.g. artwork) that evoke nature.
Physical activity: Workplaces should be set up in ways that encourage regular physical activity in the course of people's ordinary workday, such as designing buildings that favor the use of stairways, and providing other exercise opportunities.
Social interaction: Workplaces should encourage appropriate social interaction, both formally and informally. This may involve routing decisions around the workplace, design of rest areas and meal areas, and also connect to community linkage. Being in an office building all day can create feelings of disconnection and isolation: how can designers counteract this and maintain a sense of place and connection to the local community?
Circadian lighting: Many workplaces are indoors and a lack of natural light can affect people's sleep. Since sleep is an important protective factor for mental health, and poor sleep can exacerbate mental disorders. Leigh Stringer, author of The Healthy Workplace, says: "Circadian lighting in workplaces takes into account natural and artificial light, a certain intensity of light at the desktop height level, and the presence of high light levels for a certain amount of time during the day. Even if your workspace is lit at 500 lux, which is more than enough light for reading and most work tasks, it will not necessarily reset sleep schedule."
Choice and control: Feeling in control of your workplace environment reduces your risk of workplace stress. This includes being able to set up or select different styles of work spaces depending on individual preferences, for example providing multiple settings, or flexible use of individual work stations. It also includes being able to control noise - sometimes background noise can help people concentrate; other times it provides a stressful distraction.
CASE STUDY: Coca-Cola HQ, Tokyo
At our UD/MH Tokyo dialogue, Shigeki Irie, the architect in charge of the LEED Platinum Coca-Cola Japan HQ design, explained how he integratated principles of good mental health into the design of the building. To deliver nature exposure, physical activity, social interaction, circadian lighting, and community connection, he used a 'handshake design' to deliver a staircase running up the side of the building whose glass walls provide views of greenery and local streets. This staircase constitutes a venue in itself, with 'communication steps' to hold meetings, to relax and to have lunch. Also for lunch, he brought the office's cafeteria, previously underground, to an area overlooking a park, so that the room is now bright and surrounded by nature. He further enhanced connection and communication through opening up the office to enable people to see each other, and by enacting the Japanese concept of engawa, creating a welcoming area where the outside and inside interact (a concept rather like the American porch). And increased physical activity opportunities by creating bike parking and showers - unusual for a Tokyo office building.
Watch Shigeki Irie's talk here:
Designing for good mental health is the responsible choice - and it makes good business sense. Read more about mental health in the workplace.
Today, October 1st, is International Day of Older Persons. This year the theme is enabling and expanding the contributions of older people in their families, communities and societies at large. The World Health Organization recognizes that a key component of achieving this is through the creation of age-friendly environments:
Age-friendly environments foster health and well-being and the participation of people as they age. They are accessible, equitable , inclusive, safe and secure, and supportive. They promote health and prevent or delay the onset of disease and functional decline. They provide people-centered services and support to enable recovery or to compensate for the loss of function so that people can continue to do the things that are important to them - WHO
Urban design for ageing populations?
From the perspective of architects, planners and other city designers, age-friendly environments contribute to good mental wellbeing by enabling older people to access nature, meet friends, get exercise, conduct useful tasks, and participate and contribute to their communities. By enabling these actions, good design can enable participation in the community for people of different abilities, improving quality of life, and reducing the risk of mental health problems like loneliness and depression, including for people with dementia.
Mind the GAPS
Urban designers and planners can particularly contribute by designing high quality spaces by 'Minding the GAPS':
Read more: Download the World Health Organization Global Age-Friendly Cities Guide (2007) and check out Wisconsin's example of a Dementia-Friendly Communities toolkit.
Join: Is your city an age-friendly city? Join the World Health Organization's network.
First Washington DC, then London, and now Tokyo. On 1 August 2017, the Centre for Urban Design and Mental Health delivered our Tokyo dialogue in partnership with Japanese think tank Health and Global Policy Institute. The event brought together architects, urban planners, health professionals, policymakers, academics and others from the Tokyo area to learn and share knowledge and experience at the nexus of urban design and mental health. The talks were filmed and once subtitled, they will be shared online, along with better photos. But for now, a quick summary.
The event kicked off with a brief talk by UD/MH Director Layla McCay about the links between urban design and mental health, with some examples from her Tokyo research. If you can't wait for the video, here's a similar talk she did last week at Pecha Kucha Tokyo. If you'd like to read her full Tokyo urban design/mental health case study, it's here.
Next up were eight 5-minute talks from a range of exciting Japan-based speakers, all of whom have worked in various capacities in urban design for mental health. Themes that emerged included:
Here is a brief summary of the talks. These will be available on video in due course:
YOSHIHARU KIM 金 吉晴 氏 is president of Japan's National Center of Disaster Mental Health and the Director of the Department of Adult Mental Health, National Center of Neurology and Psychiatry (NCNP), Japan, affiliated to the Ministry of Health, Labor and Welfare. He set the scene with a look at the historical context of how mental health has been addressed in jails and asylums, and the evolution to care in the community - which means designing for good quality, appropriate homes and diverse, inclusive communities that are 'supportive but stimulating'.
NAOMI SAKURAI 桜井 なおみ 氏, in addition to being a social worker, professional engineer, and industrial counselor, is President of Cancer Solutions Co., Ltd and Patient Representative at Japan's National Cancer Control Promotion Council. She discussed her realisation in the UK that urban planning was intrinsic to health promotion. After being diagnosed with cancer, her patient and professional perspectives enabled her to bring these ideas to Japan, including community engagement in urban planning for wellbeing.
MASAHARU SAKOH 酒向 正春 氏 is Director of Nerima Ken-ikukai Hospital and a stroke rehabilitation specialist. He is interested in community design to support patients once they have been discharged from hospital. He discussed the importance of community integration for better quality of life and mental health in order to support rehabilitation after any illness. His work includes the design of Hatsudai Healthy Road (interesting article in English) in central Tokyo, which delivers a wide, well-lit, accessible pavement lined by health and social facilities.
FUMIKO MEGA 妻鹿 ふみ子 氏 is a Professor of Social Work at the School of Health Sciences at Tokai University and manages the Japan Volunteer Coordinators Association. Her talk focused on leveraging urban design to create a sense of belonging in the community, with a particular focus on the opportunities of so-called 'third spaces' in Tokyo.
TARO YOKOYAMA 横山 太郎 氏 is a medical oncologist and palliative care doctor at Yokohama Municipal Citizens’ Hospital. He works on the “CO-MINKAN” project, a privatized community center for healthy urban development. He also supports the development of a VR dementia simulation to increase insight for both carers and urban designers. He proposed that dementia is not a personal problem; it is a city problem: cities should be designed to better meet the needs of the super-ageing population by implementing dementia-friendly design.
Picture: Tadamichi SHIMOGAWARA 下河原 忠道 氏 gives UD/MH Director Layla McCay a demonstration of a VR dementia experience
YOSHIYUKI KAWANO 河野 禎之 氏 is a clinical psychologist and Assistant Professor in the Center for Diversity and Accessibility, University of Tsukuba. He is also a member of the Dementia Friendly Japan Initiative (DFJI) and World Young Leaders in Dementia (WYLD). He attested: "there is no reason for dementia patients to lose things they enjoy just because of challenges of navigating the city". He proposed the role of urban design in enabling people with dementia to remain in their houses and navigate their neighbourhoods, including safely using transportation.
KANA HISHIDA 菱田 佳奈 氏 works at Tokyu Land Corporation on the development of a dementia-friendly care residence, Setagaya-nakamachi. This project has been delivered in partnership with the Dementia Services Development Centre (DSDC) at Stirling University in the UK. She specifically highlighted the opportunities of integrating dementia-friendly design in terms of colour, engagement with nature, and creating a sense of security and community.
SHIGEKI IRIE 入江 茂樹 氏 from Jun Mitsui & Associates Inc. Architects and Pelli Clarke Pelli Architects Japan, Inc. is the architect of the new Coca-Cola Japan headquarters building in Shibuya, Tokyo, the first HQ building in Japan to achieve LEED Platinum status and the venue of this event. Continuing our tradition of holding our events in architecturally exciting buildings, we were delighted that Coca-Cola Japan agreed to host us - and the opportunity to tour the building was a particular highlight for many architects - and many other locals who have watched it going up.
A focus of this building was connection to nature, to colleagues, and to the community. This meant creating a place of interaction. Irie discussed the specific design features intended to improve staff happiness and mental wellbeing; particularly relevant in Tokyo where people work long hours, and good mental health at work is an emerging priority for companies - and thus for architects and designers. These included:
Finally, Edition 3 of the Journal of Urban Design and Mental Health was launched. This edition has a Tokyo theme, and features cover art by the President of HGPI, Ryoji Noritake.
Thank you to our partners and supporters in Japan who helped make this event possible:
Health and Global Policy Institute (HGPI), British Embassy Tokyo, Coca-Cola Japan, National Graduate Institute for Policy Studies, and the NGO Promotion Committee for Healthy Cities.
Ryoji Noritake (HGPI President) and Layla McCay (UD/MH Director) after the event
By Tom Mayes, vice president and senior counsel for the National Trust, USA
What scientific evidence supports historic preservation? We study the economics of historic preservation and know that it supports a vibrant and sustainable economy. We research the environmental and energy impacts of historic preservation and know that the greenest building is the one that is already built. We research what people like and know that they prefer old places. But what about the so-called “softer” benefits of historic preservation? What studies support those notions of belonging, continuity, memory, and identity that we all feel?
Memorial Union Terrace in Madison, Wisconsin. How do everyday people perceive and value historic places? | Credit: Tom Mayes
Although there is abundant anecdotal evidence indicating that older and historic places provide a sense of belonging and identity that is beneficial for people’s emotional and mental health, the health benefits of retaining and reusing such places have not been studied extensively. In four decades of research about the impacts of place attachment and place identity, very little has focused specifically on the factor of age of place or the distinction that age provides. Although I don’t doubt the deeply held attachments people feel for old places, I do think we will be more influential with policymakers if we have solid scientific studies to back up the perceived softer benefits of preservation. Or, as one of the other fellows at the American Academy in Rome said to me, “Show me the studies!”
It helps to go to the source. At the invitation of Jeremy Wells, professor of historic preservation at the University of Maryland and incoming chair of the Environmental Design Research Association (EDRA), David Brown, chief preservation officer at the National Trust, and I spoke at a plenary session of EDRA’s annual conference in Madison, Wisconsin, in June. EDRA’s purpose is to advance and disseminate research, teaching, and practice toward improving an understanding of the relationships among people, their built environments, and natural ecosystems. The theme of the conference, “Voices of Place: Empower, Engage, Energize,” sounds exactly like a preservation conference theme. And, in addition to a historic preservation track, the conference also featured tracks about cities and globalization; health and place; cultural aspects of design; and sustainable planning, design, and behavior—among others. Jeremy has long been an advocate for conducting more scientific research about people’s relationships with old places. He invited us to speak expressly for the purpose of spurring EDRA members to conduct more research that could help us shape preservation practice to better meet people’s needs.
Period Garden Park in Madison, Wisconsin. People appreciate the layering of historic communities and the associated sense of discovery and mystery. | Credit: Tom Mayes
The timing of the EDRA conference couldn’t have been better. This spring the National Trust released Preservation for People: A Vision for the Future, which, as David Brown said, “signals a philosophical shift toward using preservation to serve people and help them flourish.” Preservation for People recommends that the preservation field “support and publicize research on the health, economic, community, and sustainability benefits of preservation,” including through partnerships with entities performing environmental health research to study the impact of older and historic places on human health. And in November, when we gather in Chicago for PastForward 2017, an entire track of sessions dedicated to health and historic preservation will include a panel on environmental psychology and historic preservation.
At the EDRA conference, David and I shared information about what preservationists say and believe about historic preservation, beginning with the ideas of continuity, memory, and identity from the “Why Do Old Places Matter?” essays and highlighting key themes from Preservation for People—especially the idea that historic preservation should be about helping people flourish. Jeremy discussed which aspects of historic preservation have been studied from a social science point of view and which haven’t. He focused on the following ideas:
Jeremy Wells, incoming chair, welcomes attendees to the Environmental Design Research Association conference (EDRA 48) at Momona Terrace, the Frank Lloyd Wright–designed convention center in Madison, Wisconsin. | Credit: Tom Mayes
Jeremy also raised a number of questions about historic preservation, hoping to spur additional research:
We must be open to the possibility of reshaping preservation practice in response to what we hear. For example:
Carillon Tower at the University of Wisconsin in Madison. | Credit: Tom Mayes
In addition to the plenary session on historic preservation, the conference included a meeting of the Historic Environment Network and a full historic preservation track. Here are some key, relevant ideas I heard while attending some of those sessions:
This post originally appeared on the Preservation Leadership Forum blog. Preservation Leadership Forum is a network of preservation professionals brought together by the National Trust for Historic Preservation. Forum provides and curates cutting edge content, offers online and in person networking opportunities, and brings new, diverse perspectives to the business of saving places.
Health specialists: do you know anything about health impact assessments? Is this something you have ever used, or not? Our friends at the Barcelona Institute for Global Health (ISGlobal) seek health researchers and practitioners to participate in their short survey to obtain an international perspective surrounding the understanding, training and use around the health impact assessment (HIA) in the urban design context.
Please click here to complete the short survey.
by Claire Malaika Tunnacliffe, UD/MH Fellow and PhD student at the Bartlett School of Architecture, UK
Summer has arrived in London. A time of year where everyone seems just a little happier, a little friendlier, and a little more open to each other. It was under this sunshine that on Tuesday 13th June, I headed off to a seminar at University College London, funded by the UCL Grand Challenges & British Council Newton Fund on “The Built Environment, Social Networks & Mental Wellbeing: Cross-disciplinary & International perspectives”. The seminar brought together a wide variety of academics and practitioners working in the interdisciplinary fields of urban planning, architecture and public health, providing a rich platform for introduction, reflection and discussion.
Using fiction to imagine and experience urban space
Across the afternoon, several speakers introduced their work and approach to the themes. Opening the session was Amy Butt, an architect, lecturer, design tutor, and researcher. Her work explores how fiction can draw out the human, emotional complexities of everyday urban life, exploring the relationships between people and place. “Strangeness is a vital point of reflection”, she notes, “and science fiction novels are an opportunity to imagine and empathically experience urban space”. Exploring the emotional sense of vertigo experienced in high rises through the 1975 Robert Silverberg novel “The World Inside”, Butt describes the feeling as an unbearable attack on one’s sense of self, a sense of coming apart, a dislocation of the soul:
“how can you create a sense of place when their grounding is mystifying?”
A good urban space is a used space
COHESION, presented by Dr Linda Ng Fat and Dr Leandro Garcia, is a UK-Brazil project funded by UCL Grand Challenge and the British-Council Newton Fund. Set up in 2016, it explores the effects of high-rise, high density housing in various countries. In its first year, COHESION undertook a comprehensive literature review (to be published), and will continue to further review the influence of living in high-rise buildings on social cohesion and mental health and wellbeing. Professor Laura Vaughan from the Bartlett School of Architecture gave a comprehensive and quick fire introduction to the history of housing planning and social aspects. Vaughan introduced the work of Space Syntax, which seeks to understand the relationship between spatial design, the use of space and long term social outcomes. The use of mapping to reveal connectivity and patterns helped understand the role of spatial layout in community dynamics and network creation. The layout of a housing project for example, makes the difference between neighbourliness versus isolation, and a community where frequent casual meetings are encouraged is more likely to thrive.
“Spatial accessibility shapes movement, and movement leads to copresence” Vaughan notes in closing, “A good urban space is a used space, the spatial nature of human society.” Furthermore, and a recurring theme throughout the afternoon, is that more research is needed, as there is a gap in the ethnographic social studies of architecture.
Copresence: a precursor to interaction
Dr Paula Barros from the Universidade Federal de Minas Gerais, explored the influence of physical design on social interaction within 3 squares in her native Brazil. Through behavioural mapping, her research explores the various contentions between spaces of conflict versus spaces of encounter in public spaces, and how copresence is a necessary precursor to interaction. Identifying ‘delight’, ‘comfort’ and ‘protection’ as factors into favoured spaces (such as on props or edges to sit or rest), she notes that there is a lack of cross-cultural perspectives in the field. By understanding the response to user needs will only lead to higher quality public spaces. Additionally, Barros points to a need to further understand how landmarks support social sustainability.
Schizophrenia: does where you live matter?
Dr James Kirkbride, Reader from the Division of Psychiatry at UCL, opened his talk “Mind Over Matter: Does the Built Environment Affect Mental Health” by first making a distinction between common mental disorders and psychotic disorders. Common mental disorders, such as anxiety and depression, are, he pointed out, very different experiences from psychotic disorders, such as schizophrenia, though they are often confusingly bulked under the same heading. Furthermore, there is an important distinction to be made between mental wellbeing, mental health and mental disorders, and that each have very different experiences and consequences for people.
Kirkbride’s primary expertise is the study in incidence of schizophrenia in East London, and the potential link to inequality in social environments. He found that the strength of evidence varied. The extent to which there are social or environmental causes of schizophrenia remains unknown, though urban births are associated with a higher risk of developing the disorder. As a result, Kirkbride set up Psymaptic, “a free online prediction tool for healthcare planners, commissioners and other key stakeholders who require accurate and reliable data on the expected incidence of psychotic disorder in England & Wales. The tool gives instant access to the expected incidence of psychotic disorder in different regions of England & Wales, based on their sociodemographic and socioeconomic profile”.
Injustices in access to the 'right to the city'
From Reading University, Dr Richard Nunes followed this with a more personal presentation on the journey of his research on mental health and the city, particularly in his work exploring the connection between environmental change and mental health research. Nunes noted the limits of what urban design can achieve if enduring injustices of access to the 'right to the city' persists, that there was still so much to do in terms of re-connecting design/planning with mental health, as well as the difficulties of working with people across various disciplines. The links between environmental change and mental health research remain patchy and under-explained. A strong linear-causal relationship continues to be pursued, with a gap emerging between subjective and objective dimensions of environmental change and mental health research. Moreover, Nunes states, “people are not randomly distributed into space! Remove that [idea] and we can start to try and understand the causality of mental health”. This was complemented by Dr Pedro Morais, Adjunct Professor at Uni-BH, Brazil, who gave a presentation on the height & historical meanings and contexts of high rises across three continents, Europe, USA and South America. His presentation addressed the issue of cultural associations or social preconceptions of high rises and the discontinuous city.
What if people left work feeling better than when they arrived?
Ankita Dwivedi Senior Associate from Gensler posed a closing question “What if people left work feeling better than when they arrived?” She discussed workplace design, stress and psychological well being, identifying that stress, anxiety and depression need to be tackled within the workspace as a case for action, as the potential rewards for businesses are huge. She asserted that the workplace is a microcosm of society and provides an opportunity for intervention, with the appropriate design and implementation in workplaces connecting to many further health pathways.
Research gaps and next steps
The day's discussions revealed an exciting and wide variety of work and entry points into the interdisciplinary connections of the built environment, social networks and mental health. However, what quickly became clear is that there is so much more research needed and encouraged. I walked away from the seminar wanting to do and understand more. As Nunes and Vaughan note, there is a gap in the ethnographic social studies of architecture, as well as efforts to reconnect design and planning with mental health. This, as Morias’s presentation elaborated on, needs more transnational comparisons, to understand the differences, similarities and learning curves from different contexts. Amy Butt’s creative approach to understanding high rises and their emotional experience though science fiction is an inspiring take on often invisible issues. It begs the question: what other ways of seeing and understanding the urban environment could reveal our emotional experiences of it? The afternoon was an excellent opportunity to network and hear from a wide variety of academics, practitioners, policy makers as well as the general public, and points to an ever growing interest and drive for more research.
About the author
By Leigh Stringer, workplace strategy expert and author of The Healthy Workplace
The built environment has a profound effect on our mental health and the building industry is uniquely positioned to lead the way. To quote Dr. Richard Jackson, University of California Los Angeles School of Public Health (previously director of the U.S. Center for Disease Control's National Center for Environmental Health), "We now know that developers and architects can be more effective in achieving public health goals than doctors in white coats."
As a workplace consultant, I always have been aware of the importance of the built environment on health. But it wasn’t until I started research for my book The Healthy Workplace a few years ago, and met with a long list of physiologists, neurologists, anthropologists, physicians, ergonomists, nutritionists and sleep exerts, that I realized the full impact of design not only on our health, but also on our well-being and performance. The truth is, I’ve always thought about worker health as one item on a long list of project goals – along with saving money, being environmentally responsible and meeting my client’s business needs. But after digging deeply into the research on health, I have started to believe that human health should be the foundation of workplace design and of business too. Why? Because companies thrive on the innovation and abilities of their people, and if employees are sick, overweight, stressed, sleep-deprived or disengaged, they prevent the company they work for from thriving and maintaining a competitive advantage in the marketplace.
So how can the built environment play a more meaningful role, particularly as it pertains to mental health? Here are five strategies I have found to be particularly compelling:
1. Provide workers choice on how, when and where they work
Epidemiological studies from Karasek and Theorell show that regardless of their job function, workers who feel more in “control” of their work and work environment are less likely to suffer from heart disease and stress. Find ways to build flexibility and choice into the work environment for your clients, including where, when and how they work. This might mean helping set up a work-at-home or flexible schedule policy, reconfiguring the work area to better suit individual preferences (like installing a treadmill desk or second computer monitor) or providing multiple settings for employees to work.
EYP’s Boston office has “sit to stand” desks to support individual workstyle preferences.
Photo Credit: Richard Mandelkorn Photography
2. Nurture “biophilia”
We have a strong desire to be in and among nature. It’s only natural – for most of human history we spent all of our time outdoors. This preference, referred to biophilia and popularized by E.O. Wilson, suggests that there is an instinctive bond between human beings and other living systems. There is mounting evidence that biophilic environments can improve stress recovery rates, lower blood pressure, improve cognitive functions, enhance mental stamina and focus, decrease violence and criminal activity, elevate moods, and increase learning rates. Interestingly, biophilia-based design can be manifested in many ways:
The “stair gym” at Children’s Hospital in Atlanta, designed by EYP Health, uses biophilic environmental graphics to create a more interesting and restorative experience.
Photo Credit: Jim Roof Creative
3. Reduce acoustical and visual distractions
Noise is an issue in almost every workplace environment. Workers need acoustic (and visual) privacy, when desired, for personal regeneration. Interestingly, noise can enable or disable productivity, depending on individual preferences and the type of work being done. The key is our ability to control what we hear. Psychologically, studies show that when people have a degree of control over the noise in their environment, they are less distracted by it. Contrary to popular belief, noise interruptions during simple, mundane tasks can be just the stimulation needed to be more productive. Interruptions caused by noise during complex work, however, require a longer period of time to re-orient, and continued interruptions are likely to have negative effects on mood that reduce the motivation to resume work.
4. Install “circadian” lighting
Our internal circadian rhythm or biological clock regulates the timing of periods of sleepiness and wakefulness throughout the day. This rhythm is controlled by a part of the brain at the back of the eye, which is triggered by changes in natural daylight. Unfortunately, most of the workforce spends 90% of the day indoors, which plays havoc with the human sleep cycle. To combat this, consider installing a circadian lighting system designed to trigger wakefulness into your next workplace design. Circadian lighting in workplaces takes into account natural and artificial light, a certain intensity of light at the desktop height level, and the presence of high light levels for a certain amount of time during the day. Even if your workspace is lit at 500 lux, which is more than enough light for reading and most work tasks, it will not necessarily reset sleep schedule. Note that the light that is important to our circadian rhythm is different from the light that is important to our visual system because of the spectral difference in the light sensitivity of our photoreceptors. Special LED lights are required if we want to use them to increase our wakefulness or help us sleep.
5. Locate workspace by a park
Proximity of the office to parks and other recreational facilities is consistently associated with higher levels of physical activity, healthier weight status and improved mental health. Not all design projects involve moving your clients to a new location, but if they do, consider including building selection criteria that include access and views to nature.
We will address the opportunities of pro-social interaction in the workplace in a future article.
About the Author
UD/MH Director Layla McCay made the intrepid trip from Tokyo to Okutama Forest to experience shinrin yoku, also known as forest bathing, a Japanese practice to improve mental and physical health. She wondered about lessons for urban design. Her experience could only be captured in the form of a comic interlude...
Around a quarter of people in urban Tokyo are said to regularly participate in shinrin yoku, or ‘forest bathing’. This Japanese practice was made official by the Ministry of Agriculture, Forestry and Fisheries in 1982. It means spending leisurely time experiencing the forest with all five senses. The point is to walk slowly and mindfully, appreciating the sounds, sights, smells, feel and taste of the forest, far from the screens and chaos of city life. Substantial research has found associations between spending this time in the forest and improvements in physiological and psychological indicators of stress, mood hostility, fatigue, confusion and vitality, including reductions in heart rate and blood pressure.
I love hiking and I usually find it serene. So how does shinrin yoku differ from the ordinary hiking experience? First, only a limited number of specific forests in Japan have been designated as official shinrin yoku sites. Designation requires a wide variety of criteria to be met, from ensuring visitors can experience the forest with all five senses, to having specifically tall trees, to scientifically recording health impact, to ensuring trained forest assistants are on hand.
None of these assistants were in sight when I got off the train at the only official shinrin yoku site within Tokyo’s borders: Okutama Forest. But the woman in the visitors’ office kindly provided me with a hand drawn photocopy of the routes and marked one for me in pink highlighter pen. Then, with her vague point in the right direction, I was sent on my way.
The other hikers who had been on my train inexplicably vanished and soon I was alone in the forest, ready to find out how shinrin yoku differs in practice from ordinary hiking in a forest. Without a proper guide, and being a little too much of an urbanite, I don’t know if I really found out. But since you didn’t get to join me, I will bring you inside the experience by welcoming you into my thought process over an hour and a half, one sunny Tuesday morning.
Walking down these steps, I see so many trees and greenery. I smell the forest. I hear the burbling river. It’s so serene. So quiet.
I hope it’s safe that I came here alone.
Oh my goodness, what’s that noise?
Oh, it’s my paper map crinkling in my hand. So 1990s. How lovely to have escaped technology. Better look at the map. Hmmm the route is very unclear. Cross this bridge? Maybe not. Oops, I think this is the wrong direction. Reverse. Google Maps has destroyed my orienteering skills!
Oh, but I do have my phone. Okay, let’s check Google Maps.
Google Maps doesn’t have this route. Hmmm this is not very relaxing so far. Oh, but here’s a sign, and it's in English. I apparently just walked the Okutama Fureai Shinrin yoku course, Hikawa Ravine without even realizing.
That wasn’t a very dramatic ravine. Or shinrin yoku experience. Onwards.
Oh, a paved road. That’s partly disappointing and partly reassuring. Also, a vending machine. Mmm cold lemonade. Delicious. Not sure that’s the taste of the forest the shinrin yoku experts had in mind.
Hmmm the directions to the next route are written in Kanji. I’ll ask Google Translate.
Urgh, Google Translate is bad at reading kanji carved into wooden direction posts. But I do recognize that one kanji means mountain. Think I’ll go the other way.
That was the wrong way. Reverse. Ouch, these ferns are jagging into my leg.
Aaargh a wasp! Or could it be one of these deadly Japanese hornets?
Pep talk time. Come on, enjoy the nature.
Oh okay, maybe this is the next forest bathing entrance. Japanese people clearly like to keep their signs subtle…
No, that was someone’s garden.
Oh okay, THIS is the entrance. Yes! Forest therapy. The Toke Trail. Now we’re talking! This is cool. The other therapy trail felt like just an ordinary hiking trail. This one is fancy. It has gravitas. It starts with a well kept, modern little hut. Oh, it’s locked. Hmmm maybe Tuesday morning is a sub-optimal time for forest bathing. Is the whole trail closed? No. Onwards!
How lovely that they have a special little train track and carriage for people in wheelchairs or who have other mobility challenges. Also, the walking trail is nicely kept, covered in chipped wood. The mountain views are beautiful. The trees are so tall. The sun is so bright.
Hmmm, better stop and put on some sun lotion.
Come on, be more mindful!
Oh this is nice. Charmingly designed. Lots of little chairs and tables of different types, tastefully blend into the scenery, encouraging you to linger and appreciate the scenery. Little viewing stations where you can curl up in a nook and look directly out into the forest. Maybe I’ll do that later. Wonder what the long, sloped table is for. Probably should have come on a weekend – they probably have activities. It’s so secluded today. I’m the only person here. So lovely.
Oh gosh, it’s a snake. Okay, freeze. Assess.
Yup, it’s a snake. It’s quite long. About a metre long. And it’s turned to look at me.
Why is there nobody else on this path?
Is it a poisonous snake? How would I know?
Google: Okutama forest snakes dangerous?
Google result: 'The world’s deadliest snakes', '25 of the world’s most venomous snakes', '10 most poisonous and most dangerous snakes in the world'.
I may have to stand here frozen forever.
Facebook: 'Alone in the forest and too scared to walk past a snake. I knew hiking alone was a harebrained scheme. He’s looking at me. Help!' (photo attached)
Facebook result: One like, three open-mouth emoji faces from urban friends.
Twitter: 'Snake etiquette please? March past him and hope for the best? Turn around and abandon walk?' (photo attached)
Twitter result: 'Doesn’t seem to be a viper which is good, so I’d walk past slowly, trying not to disturb him/her.'
Duly chastened for making gender assumptions about snake. Close eyes and dash past, in direct contravention of the slow walk instruction. Snake does not pursue. Though I am convinced he/she does for about 100 metres.
Heart pounding. Remember the research about the heart rate-reducing properties of the therapy walk. Alas.
Walk more rapidly than appropriate for a therapy walk. See a twig. Scream preemptively in case it’s a snake. Why is there nobody else on this path?
Pass hut number two. Locked again. Has yoga things inside. It would be nice to do yoga while looking out at the forest. But it’s not for me, apparently. Onwards.
Aaargh a… twig. Okay. Stop this. Enjoy the nature.
What’s that noise?! Oh, my map crinkling again.
Aaaargh something’s on my face. Oh, a spider web.
Not relaxed. Text friends to tell them I’m still alive. They are at work and unmoved.
Tell Twitter I’m still alive. Twitter asks if I have a bear bell. I do not, but suddenly recall the jangling of bells from fellow hikers on the train. And the picture of a bear outside the station accompanied by Japanese writing I failed to read.
Apparently I now have to sing to protect myself from bears. Relaxation is further diminishing (along with that of any person within earshot – of which there still appears to be none).
Thank goodness, a paved road.
Oh, I mean Awwww, what a shame the therapy walk is over.
Oh, a ten minute walk down the road and I can pick up the Fureai Shinrin Yoku path again.
Aaaargh, what was that?
I see three helicopters overhead. I wonder if Twitter has sent someone to rescue me.
Another signpost, another Google Translate fail. But aha, do I see the character for station? I believe I do.
I’d brought a picnic but am too paranoid to eat it til I’m back in town and there are no more scenic picnic tables.
Well that was a bit embarrassing. I think I did shinrin yoku wrong…
On the train back to the city. All the hikers’ bear bells are jingling as they serenely look at me, and they seem to be thinking: 'well, if you brought your laptop on shinrin yoku, you were already doing it wrong'.
About the author
Jacob King of the London School of Hygiene and Tropical medicine and UD/MH Associate reports from the Architecture and Mental Health Conference jointly run by Architects for Health and the Royal College of Psychiatrists on 19th May 2017.
Components of design for mental health
Physical characteristics of an environment that promotes good mental health
The day was focused around the presentation of cases of innovative, evidence based designs stretching from corridors and bedrooms, to bridges, gardens and entire psychiatric hospitals within the community. From each of these designs evolved a few recurring themes. Notably, that certain physical characteristics of environment are favoured for mental health promotion: open spaces, bountiful light, quietness, greenery, and cleanliness. Social spaces were considered essential, and multiple speakers highlighted the importance of spaces which function communally, designed to increase conversation and group activity. Yet the opposite was also deemed important: there should also exist spaces which are personal, isolating and foster feelings of security, ownership, and separateness. Finally, the need for spaces which are able to facilitate fruitful occupation was repeatedly identified. As such, designers seek to achieve an appropriate and accessible mix of social and asocial environments between which people can choose according to will .
The environment required of a psychiatric hospital is vastly different to that required of other settings. In particular, security must take top priority, there must be detailed environmental assessment for ligature points, and an understanding of which spaces are conducive for relaxation as much as being propagatory of violence and distress becomes key. While these priorities may pose a challenge to architects aiming to design a sense of freedom into their building, arguably this challenge should be tackled in much the same way as “designing mental health” into non-institutional settings.
Bringing good design from the psychiatric hospital to the wider community
Designing for mental health is often focused on the psychiatric hospital, and while this is important it is right that more emphasis is now being placed on non-institutional settings: the workplace, home and community milieu. Perhaps there is public health benefit to be realised from assessing the few core architectural features which promote mental health and studying how we can incorporate these, not only into psychiatric hospitals but into all architectural design projects. Simple design features like changing the colour of flooring or walls, the height of the space, and setting ‘boundary markers’, can establish psychological zones: demarcating personal quiet spaces from communal social spaces. Innovative ‘greening’ methods may introduce nature inside, or better yet, creative use of lighting, windows and exploiting pretty surrounding views can metaphorically do the same job. Access to gardens or an orchard (as in Bethlem Royal Hospital) and the ability to wander and observe the changes in the seasons may have some effect in breaking one from the monotony of a sterile interior, providing another route towards emotional and psychological comfort.
Leveraging architecture for behaviour change for mental wellbeing
In acknowledging that architecture can fulfill the functional needs expected of it (a psychiatric hospital being secure, a place of business being productive, a residential space being cosy etc.), we accept that certain behaviours can be architecturally promoted or deterred. At this conference several projects were presented showcasing attempts to change individual behaviour for public mental health benefit. The first among these took on the task of structural environmental intervention for suicide prevention.
Preventing suicides at the Derry Foyle bridge.
The prevention of jumping from buildings and bridges has been a focus of discussion across the globe. Infamously one Chinese factory insensitively installed netting around the outside of its building to catch its workers who would jump. In Northern Ireland, the Foyle bridge in Derry/Londonderry is known widely as a local 'suicide hotspot'. A folk narrative has developed around the bridge, drawing people from across the surrounding areas to this spot, as Beachy Head does in England, to kill oneself in a ‘traditional’ way.
The Our Future Foyle programme, funded by the Royal College of Art among other partners, aims to break this narrative and prevent suicides from the Foyle bridge. With multiple facets, the first step of this programme will revitalise the area surrounding the bridge with community events and business opportunities. Individuals attempting suicide often prefer to do so alone and out of sight of others. Therefore, by increasing footfall in the area through commercialising and pedestrianising the river bank and improving transport links, it is hoped that people will be dissuaded from jumping from the bridge.
The Foyle bridge: the view from the Derry city side. Photo credit: Wikimedia Commons.
The next step concerned the role of suicide barriers on bridges. Often these barriers themselves are devoid of artistic thought and become an extension of the suicidal narrative of a building or bridge: “Those barriers are there to stop people jumping off”. This project aims to install functional art, a series of connected five metre tall metal reeds, to echo the reeds on the river bank below. While acting functionally as a suicide barrier, the reeds will also feature multi-coloured lights at their peaks, which can be changed by those promenading past, creating new narratives associated with this place.
This idea of urban design is striking, especially if it is eventually proven effective in preventing suicides. By changing the narrative of a space, its social typology, and incorporating functional architecture - both social and physical barriers to suicide attempts - we wait to see if there is an effect on the prevention of suicide, a major mental health outcome.
New models of asylum
Asylum in the heart of London
The location of psychiatric hospitals is an important facet of urban design, making bold statements about society’s relationship with psychiatric patients. Historically this has been a point of contention. In London for example, as the city expanded outwards, asylums which had previously been on the outskirts of the city were pushed further and further back into the surrounding countryside. While the ethos of 19th century moral therapy also often included natural retreat, the “Not In My Back Yard” stance of many of London’s population unquestionably contributed to the construction of newer asylums in the surrounding countryside.
Yet this trend is now evolving, and an example is the imminent revitalisation of the Springfield University hospital, an old asylum built within large grounds in South West London. The grounds will be turned into new community homes, with a new psychiatric hospital at its heart. Wards will be built above shops. According to the architects' drawings, there will be a view from inside these rooms of happy attractive people bustling around a communal square, shopping, and enjoying the sun. What may at first appear to be an attempt to commercialise prime real estate in London may turn out to play a key part in destigmatising psychiatry and rehabilitating patients to community living much more readily than an isolated and unintegrated asylum of old.
MadLove: a designer asylum
Following their success as an exhibit at The Wellcome Gallery earlier this year, MadLove: a designer asylum is a service user-led art movement aiming to collectively design the “most crazy, bonkers, mental asylum we dare dream of”. A space which is both safe and nurturing of madness the lead artists, both service users themselves, suggest that psychiatric hospitals can often be more punishment than love. After multiple rounds of consultation a collaborative plan was developed and showcased.
MadLove: a designer asylum. Photocredit: MadLove, The WellcomeTrust, November 2016.
The MadLove design features tree-house style accommodation on a grassy hill, and a central hub with shops and occupational space. Someone is always available here to talk or relax with. The sounds of birds and the sea breeze (which carries in the smell of baking bread) can be heard around the asylum. There are no fences and residents come and go as and when they please. The results of their extensive service user consultations are freely available online.
Conclusion: evidence based design + participatory design = mental health
Architecture is just one tool of the urban planner, but it is essential in propagating mental health benefit to a city’s residents. In closing the conference, one architect made a plea to the audience - seconded by service users and psychiatrists alike - that design should be first, evidenced based, and more importantly built in collaboration with those who will live and work in their buildings and environments. The need for both evidenced based design and participatory design strikes at the heart of how architecture can foster effective mental health-promoting features of design, and reduce the often emotional and physical imposition of a building's primary function: security, sanctuary, or productivity alike.
About the author
Comment: explosive remnants of war may maintain traumascapes and preclude community healing after conflict
by Layla McCay, UD/MH Director
UD/MH is often asked about how mental health principles can be applied in different conflict and post-conflict situations. This week in the medical journal The Lancet, a review was published on the public health impact of 'explosive remnants of war'. The researchers highlight that beyond the physical injuries landmines and exploded or unexploded ordinance can cause to displaced people returning home after conflict, they also seem to exert significant impact on people's mental health. This can include anxiety, depression, and post-traumatic stress disorder (though a direct causative link could not be made). These mental health effects can occur even where the explosives are present but have not caused injury.
The paper does not speculate at length upon the reasons that these explosives may be linked to mental health problems. I wonder if an important contribution is how they can affect the meaning of a place.
The concept of ‘home’ is important for people’s sense of belonging, and as such, affects their mental health and wellbeing. Place is the canvas onto which people project their personal and shared memories and expectations. A place feels like ‘home’ because it brims with personal landmarks (the café at which we spent hours laughing with friends, the first apartment we lived in, the park bench from which our child leapt, playing astronaut). For many, home is, by definition, a safe place (or at least there are places where we know we can go to feel safe). Yet when people return home after conflict, they sometimes find that conflict has changed the meaning of the place that was once home. It is difficult to recognise. Personal landmarks become superimposed with physical and memory landmarks of fear and pain and sorrow and unease and trauma. When people lose the ability to reliably differentiate between safe and threatening, their perception of home evolves into a traumascape of disconnection and distrust.
Urban design has an important role to play in helping the feeling of a place revert to 'home' after conflict. This means healing without forgetting: reducing the physical scars of conflict, and designing a place that engenders confidence and pride, that supports mental health and wellbeing, such as reliable infrastructure, green spaces, social spaces, places to walk and exercise, and places to feel safe. Engaging residents in designing the right approach to rebuilding can have benefits in also rebuilding the community: strengthening social capital and trust, while empowering people to take control of a place and help bring back the meaning of the place as a home they recognise.
Explosive remnants of war, such as landmines, can confound these efforts, because a place can never feel entirely safe. War is still just beyond the doorstep. In avoiding and fearing the open spaces where people might otherwise have exercised, socialised, relaxed, and enjoyed nature, the prospect of finding home may be held in a state of suspended animation. People cannot trust their home not to harm them, and so they wait, walled in and tense.
The Lancet paper reports that international support for mine action is declining. And yet it is an essential part of rebuilding - not just physical rebuilding, but a rebuilding a community's trust that they are home.
For more on this topic, read UD/MH Fellow Sophie Gleizes on traumascapes.
Sanity and Urbanity: