If it was not already abundantly clear that we are hurtling directly towards the Age of the City, this conference made the point inescapable. City living permeates health through and through. Not only the root of psychosocial, cultural, economic, biological risk factors and protective health factors alike, The City fundamentally shapes the way we interact with health care too. Concurrent with universal mass migration into cities, global aging and super-aging offers substantial new challenges to health.
 
The global population is ageing exponentially
Opening the conference with a detailed review of the future demographic and geographic changes affecting our shared home was WHO director of the Department of Ageing and Lifecourse, Dr John Beard. Published in 2007 the WHOs “Global age-friendly cities: a guide” framework will be familiar to many readers. From this starting point Dr Beard highlighted the substantial demographic changes in age across developing areas of the world. He explained that while developed countries like the UK saw national life expectancy slowly grow from 40 to 60 years between 1800 and 1920, India saw the same age jump in just 35 years (1960 - 1995), and China in just 15 years (1950 - 1965).(1) Populations largely naive to supporting large numbers of elderly citizens are similarly those most faced by the challenges of rapid urbanisation. World Urbanisation Prospects, from the UN highlights that while currently around 54% of the world’s population live in cities, by 2050 it will have increased to 66%, with 90% of this change coming from Africa and Asia.(2)

The rise of dementia
Importantly, old age represents a rather different profile of mental health conditions compared to other age groups. Old-age psychiatry stands as a separate area of subspecialty within psychiatry for exactly this reason. While mental health problems affect people of all ages (for example, older people have similar rates of depression to other age groups (3), dementia stands almost uniquely as a mental health condition that predominantly affects the elderly. Dementia is set to increase rapidly around the world, especially amongst people who live in low and middle income countries as a consequence of longer life expectancies and changing risk factors for disease. Given a standardised age profile, dementia affects 5-7% of the population, a rate that is constant across all countries. Dementia causes more disability than any other condition in elderly people and with that comes the need for care, a need which puts a great strain on countries without the infrastructure for domiciliary care. Unfortunately this often results in huge economic losses for households that may need to provide sometimes quite intensive care for relatives with dementia. Carers of people with dementia may find it difficult to travel long distances for care, resulting lower rates of healthcare utilisation in this group of people for whom social and health care needs are high, and more often than not unmet.

Assessing the cognitive footprint in urban design
Dementia is only the tip of the iceberg; cognition and cognitive impairment lies underneath the surface, and to tackle that could reduce the rates of dementia. Many factors similarly contribute to cognitive impairment: exercise, pollution, loneliness, poverty. Professor Martin Prince pointed out that a reduction of risk factors by 10% could reduce the prevalence of dementia by 8%. There is a clear opportunity therefore to address some of the risk factors of city living which are also implicated in cognitive decline through thoughtful urban design. Professor Rossor suggests that concept of a ‘cognitive footprint’ should be considered when assessing the impact of policies: how will this affect cognition and brain health? 

There is good evidence that some factors associated with city living are good for mental health: higher employment, better healthcare access, varied recreational opportunities. However, many negatives co-occur: fewer spontaneous opportunities for exercise, less societal integration, fewer green spaces, safety fears, and noise and light pollution. (4) Physical limitations, cognitive decline, a different profile of mental and physical conditions and perhaps relative lack of social support among older people make the mental health implications of cities different to other groups. Yet, overall, only patchy evidence applies the bio-psycho-social variations in the elderly experience of city living to mental health outcomes. Despite the increase in funding for dementia, as a field of research it suffers from a lack of researchers. At the conference, Professor Rossor called for more interdisciplinary research in this field involving biomedical researchers, sociologists and of course urban planners.

Healthy cities in a global context
Over many years numerous associations between the urban environment and mental health have been established. Elderly residents are more likely to spend time in the area surrounding their homes than younger adults who commute away for work. Prof Anthea Tinker in her workshop “Age-friendly cities in a global context” outlined the effects of neighbourhood qualities on numerous health measures. The so-called “walkability” of a neighbourhood is directly related to the amount of exercise elderly populations take. Furthermore this relationship may have benefit to mental health too. Evidence suggests that environments which are distinctive, recognisable, familiar are often reported by people with dementia as more comforting. Changes in urban design which therefore make a space more accessible: safe, walkable, but remain familiar are therefore likely to promote its use and quite possibly more than just mental health benefit.

Green Space
A particularly important opportunity for urban design is green space. Professor Caroline Ward Thompson, Professor of Landscape Architecture at University of Edinburgh discussed how green space exposure impacts the mood of older people. It is clear from observational studies over many years that exposure to green spaces is good for mental health. But does it exert more or less impact for elderly people? How does physical decline affect this population’s ability to access green spaces? In her work Prof Ward-Thompson employed neuroimaging techniques, notably EEG (electroencephalography) to assess the experience of stress in green environments. In short, there seems to be evidence for the relaxing effect of walking in green space. To these writers’ relief, there was a strong feeling in the room that any practical applications of this knowledge should be reified through protecting and increasing the availability of green spaces and making them more accessible to the elderly. There is a danger that because of the difficulties of elderly populations accessing parks and especially so fields or forests, that artificially creating mock up green environments in elderly people's homes is an easy alternative. The “active ingredients” of green space exposure on mental health and mood are still largely unknown. Further studies to assess what exactly delivers the benefit - the exercise, the quiet or light, the greenery itself for example - are needed.

An emerging design challenge: facilitating older people's participation in the workforce
Recent work by speakers Dr Mauricio Avendano and Professor Karen Glaser examined the complex associations between mental health and retirement. They noted that some retirees giving up work receive a boost to their mental health, particularly when the retirement is planned but many others do not, particularly those who are forced to take retirement due to physical and/or mental health problems. (5) Given the health benefits of employment, alongside the economic unfeasibility of ever-longer periods of retirement, they proposed that retirement age should rise in line with aging populations.  In this light we may have to find ways to facilitate longer working lives, and better incorporate different physical and cognitive abilities in the workplace. For urban designers, this sociological shift could mean examining the concepts of elderly commuting, and creating different sorts of work environments.

War, displacement and the elderly
Anthropologist Dr Hannah Kienzler and clinical academic Prof Richard Sullivan discussed the implications of war upon elderly populations. We frequently hear on the news about conflict zones around the world, but little time is spent considering the burden on older adults. The elderly population tend to stay within regions of conflict, in part due to the high risk associated with fleeing with potential sensory disabilities and health conditions (and indeed refugee camps often have challenges providing long term care). Dr Kienzler identified the role of older people as carriers of knowledge with a key role to be harnessed in post-conflict community rebuilding and humanitarian planning.

Posters
A number of posters were presented on the day, including one by UD/MH associate Jacob King titled: “Urban environments and depression in older adults: Designing mental health promotion into our cities” Concerning similar themes to Prof Tinker’s workshop, in the poster he suggested that mental health promotion can be built into cities. We have already seen that there may be benefit in making use of green space more accessible, making a neighbourhood more walkable, and community facilities more accessible, and so on. In short by following public health concepts originally developed in the fight against HIV, an intervention, an urban design feature, should be available, accessible, and acceptable. (6) For example, walking around a neighbourhood may be acceptable if it is safe, perhaps with fewer cars or less busy pavements. A green space could be accessible if there were well maintained flat walks ways and situated within a reasonable distance to residences, or indeed incorporated into one’s routine environment. And most simply, health care services are only effective if they are available in an area.

Concluding remarks
Only a limited number of factors which constitute the vast number of associations of city living, older adults and mental health could possibly have been explored at The Global Aging Conference. Several key facets, access to local amenities and health care, and social care and loneliness were notably missing. But while nothing especially new or ground breaking in the field of urban design and mental health was established at the conference, we reasonably believe that such emphasis, as was placed by 3 workshops and a selection of poster presentations, marks a notable step for a high profile medical conference. Employment, green space, neighbourhood quality are indeed three highly important areas in the urban space mental health connection. While rigorous evidence for the association of these factors is still in its early stages, each offers an interesting reference point to begin thinking about how the specific needs the elderly population require of their urban environment for good mental health.

References
 

1. Roser M. (2017). Life expectancy. Our World In Data. Available online: https://ourworldindata.org/life-expectancy/ Last accessed 14.05.2017.
2. United Nations. (2014). World Urbanization Prospects: The 2014 Revision. Department of Economic and Social Affairs Population Division. 
3. Cutrona C, Wallace G, Wesner K. (2006). Neighborhood Characteristics and Depression. Current Directions in Psychological Science, 15(4):188-192.
4. Barua A, Ghosh M, Kar N, Basilio M. (2011) Prevalence of depressive disorders in the elderly. Annals of Saudi medicine 31(6): 620-4.
5. Latif E. (2013) The impact of retirement on mental health in Canada. J Ment Health Policy Econ. 16(1):35-46.
6. Blankenship KM, Bray SJ, Merson MH. Structural interventions in public health. AIDS. Jun 2000;14(Suppl 1):S11–S21.
   

At present, studies on health-promoting environments are dominated by research focusing on the difference between the urban and the natural environment and less is known about which qualities of the natural environment promote mental health.

Aim of the research
Therefore the research group Nature, Health & Design at the University of Copenhagen, initiated a qualitative research project in the Danish Health Forest Garden Octovia. The aim of the project was to gain knowledge of which qualities and features of the environment were perceived as restorative.

Methods
The design of the Health Forest Octovia, where the research took place, is based on Grahn & Stigsdotter's research on perceived sensory dimensions (PSD). The Health Forest is located within an existing Arboretum and consists of eight different spatial settings.  26 female students participated in the study. They were individually interviewed about their restorative experience while participating in a guided walk through the health forest. 

Key findings that are relevant for planners and designers

•  The experience of both openness and enclosure in a natural environment are important for psychological restoration: openness to provide an overview, and enclosure to provide a feeling of safety.
• A diverse range of sensory stimulation enhances the feeling of restoration in a natural environment.
• An optimal natural environment for psychological restoration should include the perceived sensory dimensions of serenity, richness in species, nature and refuge.
• The specific environment where users grew up should be taken into account when designing restorative natural environments for different user groups.
• One should pay attention to any possible unwanted associations when choosing design features since they may have negative connotations.  

Citation: Ulrika Karlsson Stigsdotter, Sus Sola Corazon, Ulrik Sidenius, Anne Dahl Refshauge, Patrik Grahn. Forest design for mental health promotion—Using perceived sensory dimensions to elicit restorative responses, Landscape and Urban Planning, Volume 160, April 2017, Pages 1-15

Winter is on the wing, and spring is filtering in with fresh air, fresh thought and sunshine... and Mental Health Awareness Month.

This annual opportunity to raise public awareness about mental health was established by the National Association for Mental Health (now Mental Health America) in 1949, around the same time as legislators were founding the Housing Act of 1949, which would instigate urban development and renewal in America, and thus start to reshape our cities. Although the Housing Act plans did not pan out as originally intended, what was begun was a serious start to looking at how cities and the built environment could be inclusive and supportive of all citizens.
 
Of interest is what happens when we combine Mental Health Awareness with the built environment. How are we as designers, planners and citizens integrating what the past 68 years have shown us to do, or as Jane Jacobs would say, what to not do?

Each year a theme is presented for Mental Health Awareness Month, which is explored through the rest of the year. This year’s theme is “Risky Business” and focuses on the diverse risk factors for developing mental illness. The upcoming Mental Health America Annual Conference is aptly titled Sex, Drugs, and Rock & Roll, and will examine some of these risk factors.

However, risks to mental health are not confined to individual factors. The built environment can help create and maintain risk factors for mental illness by increasing stimulation while stripping away protective factors for good mental health, for example:

• Reducing access to nature
• Reducing opportunities for physical activity
• Overloading the senses
• Eroding privacy and quiet time
  
• Interrupting sleep
• Reducing safety (from crime to traffic to wayfinding)
• Separating people from their social networks

Architects, urban planners and designers can make an impact. We, as designers of the world around us, can Mind the GAPS to help address these risks. We can open doors, create opportunities in our cities, societies, and communities to support awareness and address risks to improve mental health for all. We can dive into our own creative intelligence and promote green space, walkable cities, and infrastructure that allows us to move around and express happiness & health. We can look for where our efforts support or create opportunities for social interaction, community support, and personal freedom. We can advocate for creative space, for communal space, and for safe, meditative place. Through these efforts we can play a role in improving mental health across the board. Designing healthcare facilities, buildings, public spaces, and communities that take into consideration all the sensitive aspects of being unwell, creating humane opportunities for refuge (or outlet), and pro-actively advocating the development of physical places for healing and wellness. Being knowledgeable about what hurts, what helps, what heals. These are starters. We can:

• Recognize environment affects the mind, the body and perception.
• Boost cognitive health by creating visually and aesthetically pleasing buildings & cities.
• Advocate for buildings, spaces, cities and communities that have plenty of fresh air, good light and green spaces, while reducing noise and visual pollution through good design.
• Create buildings and places for refuge, escape and outlet.
• Design places that facilitate people talking to each other in positive, natural social interactions.
• Improve mental health by creating safe, walkable communities.

Although it can be challenging to think about mental, emotional, and behavioral health problems, ignoring them won’t make them go away.  When there is illness, it affects those nearby.  When many are ill (as in 1 in 4 estimated) it affects society at large.  It is necessary to take good inventory of the risk factors within the built environment, if we are to help rebuild, strengthen, repair and recover.

by Layla McCay, UD/MH Director

Colour therapy is a set of methods for using colours to help cure diseases. With a long history in the annals of complementary and alternative medicine, the 'colour cure' was a popular treatment for mental illness at the turn of the 20th century.

While there is little scientific evidence that the various colour-based therapies can cure any particular diseases, the psychology of colour has long been recognised as an important psychological factor in architecture and interior design: colours can evoke spontaneous emotional reactions that can affect mood and stress. This may in turn exert influence mental wellbeing, an effect that is particularly relevant to designers of the interior and exterior built environment.

The impact of colour on how we feel has been explored by architects and designers in all sorts of contexts, from increasing office productivity to improving wellbeing. The colour red is generally said to be associated with an increase in appetite, reduced depression and increased angry feelings, purple with boosting creativity and developing problem-solving skills, orange with optimism, blue with a sense of security and productivity, and green with a sense of harmony and effective decision-making. The potential effects extend beyond single colours: a monotonous colourscape may be associated with irritability and negative ruminations, while highly saturated, intense colour patterns may increase stress.

An interesting blog by Parkin Architects discusses the opportunities for colour to exert mental health impact in healthcare facility design, again pointing to certain colours that, in addition to helping eliminate the 'institutional look' of facilities, might exert specific impacts on mental health.

Rigorous scientific research on the specific impact of colours on mental health is in its infancy. TheFarthing boutique has developed a new infographic that reflects current ideas on the psychology behind the use of different colours to impact responses in various designed environments. Their sharing this infographic with us reminds us that harnessing the use of colour in urban design to promote good mental health is an interesting field that may have potential, warranting further scientific exploration.

This post was written by Layla McCay, Director of the Centre for Urban Design and Mental Health, in response to a new infographic developed and shared by Toby Dean and Jessica Morgan of TheFarthing.

World Health Day was on Friday April 7th, and since the World Health Organization designated this year's theme 'depression: let's talk', we had an impromptu urban design and mental health social media flashmob so that architects, planners, citymakers and others could talk about our role in preventing depression. Using the hashtags #udmhflashmob and #designagainstdepression, people and organizations from around the world came together and shared interesting, important and fun ideas and experiences around leveraging urban design to help prevent depression.

Using hashtag analytics, #udmhflashmob reached 1 million people during World Health Day, the majority of whom were in the US, Australia, the UK and Japan, while #designagainstdepression reached 593,000 people - and counting. Did you miss it? Join in the fun: here's some of our posts.

You can keep up the fun with the #DesignAgainstDepression hashtag anytime. And keep a look out for the next #udmhflashmob - a fun way to raise awareness and share great design, research, policy, and initiatives.

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.

Cherry blossom season is upon us in Japan. The national news is filled with cherry blossom reports: it feels like everybody is invested in the specific day that the flowers will bloom in their town. There is good reason for this interest, and not just the national appreciation of beauty, flowers and the ephemeral nature of life. Cherry blossom behavior is part of Japan’s national psyche. In a unique moment of nationwide celebration, the country’s usual work-focused culture presses pause, and a different priority is embraced: cherry blossoms viewing, known as hanami. People walk amongst cherry blossoms, admire them, photograph them… Admiring cherry blossoms is part of the pulse of Japan.
 
As the flowers fleetingly blossom, so too does another fleeting pleasure: leisurely outdoor social interaction. Everyone dashes to their nearest cherry blossom location to enjoy raucous, convivial, drunken hanami parties, crowded on blue tarpaulin sheets spread under the trees. Offices, universities, friends, and just about anyone else organises hanami parties, characterised by picnicking (with copious alcohol usually involved). Office workers are even sent to the park early in the morning to secure a good spot.

But as the blossoms start to fade, so too does this particular form of social interaction. At the end of cherry blossom season, Japanese people pack up their picnic blankets and store them til next spring. This seems a missed opportunity: many people live in very small homes, particularly those in large cities like Tokyo, which inhibits their inviting others to their homes for socialising. Picnics should be an ideal solution. And yet they are not. Part of the reason may be lack of venue. Tokyo has only 5.4 m2 of green space per person; this compares to 11.8m2 in Paris, 26.9m2 in London and 29.1 m2 in New York. While picnicking takes over many public spaces during hanami season, for the rest of the time this is not appropriate, and many parks are designed to be admired, not as appropriate social dining spots for adults. But finding the right venue is not the only hurdle. Picnics do not tend to be part of Japanese culture. According to many Japanese people, picnicking outside at any non-hanami time of the year is generally considered 'bizarre', 'childish', and even 'suspicious'.
 
Hiroshi Ota, an architect, and Kaori Ito, an urban designer, helped establish the Tokyo Picnic Club in 2002. Its mission: to tempt Tokyoites to picnic outside of hanami season, socialising in natural settings year-round. They claim: ‘to picnic is the urban culture to utilize the public spaces, to make up for the deficiencies of our city life.’ The appreciation of parks is a cultural norm, but the idea of picnics is unusual. Yet they offer many benefits, not least the opportunity to promote good mental health in the city. Picnicking offers exposure to natural green spaces, encourages physical activity (at least walking to the picnic spot), and facilitates pro-social interaction, which are all urban factors associated with good mental health.

The connections between picnics in the park and good mental health tends to be underappreciated. “Japanese people don’t feel the direct connection between spending time in nature and health,” Ota explains. “However, if parks are used for community activities, that can lead to improved mental health.”

The Tokyo Picnic Club helps people make that all-important but unappreciated connection between urban design and mental health by linking picnics to more commonly accepted health promotion ideas. “In Japan, people tend to think about food when it comes to health. Since the idea of the picnic is based on food, this helps with the idea that going to the park for a picnic can help enhance health.” Ito adds that in Japan, expressing creativity is another important facet of mental health, and this can be achieved by preparing elaborate picnics. “When Japanese people enjoy creativity, they tend to feel happy. Therefore, we believe that writing a poem, making food, and wearing creative costumes during the picnic may also make people feel happy.”
 
There are further benefits to socialising in the park, Ito proposes: “If you go to a shopping centre, you will notice the lack of diversity. However, parks are open for anyone. You can see all the generations, including rich, poor, elderly and young people.”

But their enthusiasm for picnics is not shared by everyone. The Tokyo Picnic Club described setting up picnics in various patches of green space around Tokyo – and measuring how long it took before their party caught the attention of the police and were reprimanded for their subversive attitude to picnicking outside the social boundaries of hanami season. It rarely takes long before they are questioned - and often asked to move on.
 
“We just want the places to have our picnic. We need neither benches nor waterworks. We simply want a spacious lawn. If Green Fields such as beautiful parks are open to us, the picnic becomes the art of encounter in our urban lifestyles. If Brown Fields such as ex-industrial sites or abandoned harbors are open to our picnic, we can develop meals, tools, manners and conversations to fit in the new atmosphere of the modern cityscape.”
 
The Tokyo Picnic Club hopes that by raising awareness, the value of year-round picnicking will be better understood and appreciated in Japan. Their efforts have included portable lawns, and Grass on Vacation, an art show where they remove aeroplane-shaped pieces of turf from locations where people do not sit on the grass, and take them on ‘vacation’ to other locations where the grass can 'enjoy' its intended use: people are encouraged to sit, lie, socialise, eat and generally enjoy the experience of nature in the city.

The Tokyo Picnic Club smilingly insist that the "Right to Picnic" should be a basic human right for urban dwellers. Given the normality of picnicking in other cities all over the world, in Tokyo, this is a surprisingly subversive demand.

In time, the Picnic Club hope for proper observation of one of the 15 rules of Tokyo Picnic Club: every day is a picnic day. By encouraging people’s access to green space and positive, natural social interaction, this is also an apt mantra for mental health promotion in the city.

April will be Happy Birthday to the World Happiness Report. Fresh off the press on March 20th (The International Day of Happiness), this year’s report marks the 5 year anniversary of the first edition. First published in April 2012 by the Sustainable Development Solutions Network in support of the UN High Level Meeting on Happiness, The 2017 World Happiness Report spans across 155 countries, and the data is used world-wide in informing policy makers in their decision processes. 
 
For the researcher, the scientist, the evidence based practitioner, and for any persons in society focused on wellness in the world, this 188 page report provides data-focused, tangible summaries to help gauge well-being of people where they live.

The key factors that the top ten 'happiest' countries have in common are:

• more healthy years of life expectancy
• social support
• trust (perceived absence of corruption in government & business)
• perceived freedom to make life decisions
• generosity

 
Of particular interest in this year’s World Happiness Report is that it reveals the important role of social factors in supporting happiness. The calculations show that elevating the social foundations from low levels up to the world average levels would have greater positive affect than that of living longer, and making more money, combined.

In Norway the oil prices fell, yet they moved into the number one position in the World Happiness Report.  The idea that the successful output of goods and services does not denote a country's wellbeing, is shown in the fact that China’s Gross National Product (GDP) multiplied 5 times over a hundred years, while its subjective wellbeing (SWB) spent 15 years in decline, before starting to improve. Stress and anxiety in the labor market are attributed to this decline of SWB from 1990-2005, whereas changes in unemployment and in the social safety net are ascribed to their substantial recovery. Meanwhile, the Report attributes lower levels of happiness in many African countries to the slowness of change, even as democracy improves. Meeting basic needs in infrastructure and youth development still have not been sufficiently achieved, though the report suggests that African people's exceptional optimism may be their saving grace.
 
In Western countries mental health seems to affect happiness more than income. "In rich countries the biggest single cause of misery is mental illness," said Professor Richard Layard, director of the Wellbeing Programme at the London School of Economics' Centre for Economic Performance on this year’s Day of Happiness. The United States, Australia, Britain and Indonesia hold economic variables, social factors and health as their key determinants of happiness, while the emergence of mental illness is reportedly more important to all three Western Societies than income, employment or physical illness. 
 
The 2017 World Happiness Report adds investigation of how work affects happiness, and shows that while income may not buy happiness, work matters. Across the world, those with jobs gauged their lives more satisfactorily than the unemployed, and demonstrate that rising unemployment rates affect everyone negatively. The report goes further into condition and types of work as also having an effect on predicting happiness levels.
 
The United States happiness rating has declined this year, now ranking at 14th, with a score of 6.99. While income and life-expectancy improved, the following four social variables declined:

1. Less social support
2. Less sense of personal freedom,
3. Lower donations (less generosity),
4. More perceived corruption of government and business

Based on the calculation system, these declines in social variables could explain the significant drop in overall ranking for the US, emphasising that meeting social needs is crucial to happiness scores.
 
The 2017 World Happiness Report serves as a tool for many purposes.  It helps to understand who is doing well, who isn’t, as well as why or why not in terms of national 'happiness'.  Furthermore this report provides a clarification for areas of need – such as the need for the increased social support that is present where we see a greater level of measured happiness.

What this all culminates in is a viable agenda for implementation. The 2017 World Happiness Report demonstrates how social factors affect wellbeing and happiness positively, or conversely where there is lack, negatively. These aspects can be addressed through our development of policies and solutions, as planners, architects, designers and citizens active in our communities. We can target our efforts to support or create opportunities for social interaction, community support, and personal freedom. Through these efforts we can play a role in improving happiness across the board.
 
For UD/MH practical measures for solutions see:

• How Urban Design Can Impact Mental Health
• Mind the GAPS Framework

We are often contacted by journalists, urban designers, planners and policymakers, asking the same simple question: can you give us some examples of urban design that promotes good mental health in cities around the world? We want to be able to give them a range of interesting examples from cities all over the world, but our eyes can't be everywhere.

The aim of our Instagram page is to present good (and bad!) examples of urban design for good mental health from all over the world. These could take any form, such as; parks, open spaces, public buildings, housing, etc - and any scale, city-wide or nuanced (as long as it fits into a photograph). The pictures should demonstrate the use of any of the urban design factors that affect mental health. These snapshots will weave together to create a patchwork of inspiration, and points of discussion – as well as feeding into the growing discourse of conscious urban design for the benefit of public health. The pictures may also be shared on our website or in publications to demonstrate challenges and possibilities.
 
It would be great to see this page grow and attract and connect new audiences around the world, alongside the other social media channels used by UD/MH. Moreover, it is a great way for all of us to show off our favourite cities, and our projects.
 
How can you get involved?

• If you are active users of Instagram, please visit the page @urbandesignmentalhealth – follow, check out, share and comment on current posts.
• Think of great images you have (or go out and take some photographs) that show urban design that promotes good mental health (or that does not).
• Ensure that the images are your own, or that we have permission to post them, potentially over multiple platforms such as our blog, etc. Include appropriate attributions that we should use.
• Include a short description about the location, context, and relevant features.
• Submit the images to us directly through Instagram or by email.
  
• Enjoy the images being shared on Instagram and on other platforms.
• If you submit a lot, we can discuss the possibility of you doing a photo essay for UD/MH.

We look forward to seeing and sharing your pictures.

To support the collective social wellbeing set out in the Marmot Review, Fair Society Healthy Lives (2010), we need to foster a culture that regards and manages places as essential infrastructure. We have entered a critical era where greater thought leadership in our place-making culture is essential.

Dubbed “Toxic Assets” by CABE, Britain’s poorly performing urban places and communities continue to absorb much of our GDP, where land, places and people are exploited and treated like commodities.
In his book Collapse: How Societies Choose to Fail or Survive, Jarred Diamond discusses the dangers of continued exploitation and the outcomes for societies that could not change their behaviour patterns: certain extinction.

With expenditure outstripping income, we have entered a long period of economic depression with high levels of ‘welfare’ costs signifying a nation under stress. Whilst the government’s economic austerity measures may rebalance the budget on paper, their short-term nature does not address the fundamental health and wellbeing issues that impact individuals, communities and the wider stability of the nation.
The Marmot Review emphasises the impact of urban quality on matters of equity, health and wellbeing giving urban designers an important role to play, but not through the technocratic fixes that they are typically trained to deliver. So, where do we start when thinking about the relationship between place-making, health and wellbeing?

THE URBAN PENALTY

Probably the most fundamental principle is embodied in the Government’s “No Health Without Mental Health” policy. Social scientists have consistently found urban areas to have higher prevalence’s of both diagnosed mental health conditions and a lowered level of wellbeing known as “languishing”. Public health research identifies this failure as the ‘urban penalty’, or the ‘urbanicity effect’, arguing that it results from poor social integration, social isolation, discrimination and deprivation – things we intuitively grasp as urban designers.

However, if we explore these issues through the lens of Life History Theory developed by evolutionary psychologists, we can begin to see things a little differently and to understand better the adaptive nature of human behaviour in context. Research has found that where resources are stable, reliable and predictable, people can plan their futures, enabling greater resilience and the capacity to adapt in response to inevitable life stresses, to change and to cooperate with similarly future oriented people they encounter in their communities. It should be no surprise that public spending is lowest in places where people are prosperous, well-educated and healthy.

When we study low resource environments through this same lens, we find that people live their lives and forage in a different adaptive way. This can be difficult for design professionals to understand and, furthermore, the outcomes of this way of being are typically disapproved of by society. The insecurity of resources promotes an adaptive strategy, termed ‘future-discounting’ in those who live in these harsh environments. In other words, in these environments immediate gratification of wellbeing needs is an ingrained, sensible strategy to pursue.

In general people who live in harsh environments will tend to thrill seek, shun long term educational goals, have children younger, act impulsively etc. However, together, harsh environments and the behaviours they prime have significantly negative impacts on sustainable individual and community wellbeing. Harsh environments also tend to get harsher as people make only defensive, short-term investments in them. This includes the managerial actions that public authorities imposed upon these places.

And when we talk about resources we mean more than money – we refer to the whole resource of our human habitat and relationships. A gated, well healed estate is just as capable of promoting low levels of wellbeing as public housing can.

WHAT IS WELL-DESIGNED?
In short, Life History Theory shows how the qualities of an environment directly determine our life strategies and our wellbeing. In so doing, it emphasises the utmost importance of urban design, but when government policies demand places are ‘well designed’, what do they expect from this nebulous phrase? In 2012, Dr Steven Marshall published a paper interrogating urban design theory and found it “based on assumption and consensus, open to wide and personal interpretation by all players in the built environment and pseudo-scientific at best” – assuming built environment practitioners apply any principles at all.

The time to address the weaknesses in our urban design practices and prejudices is overdue. We need to widen our knowledge base and work with social scientists to understand our intrinsic human ecology and the predictability of its ‘pattern language’. Whilst many secure professionals can successfully ‘forage’ in the ecological niche that is the ‘built environment’ or ‘regeneration’ industry, we embrace higher concerns that will advance thought leadership in place-making.

We need to design, manage and maintain ‘psychologically benign’ environments that reduce feelings of ‘threat’ to optimise opportunities for people to interact and cooperate. This is prosociality; co-operative social behaviour towards a common goal that benefits other people or society as a whole, such as helping, sharing, donating, and volunteering. Prosocial communities are central to sustained wellbeing and themselves encourage future focussed perspectives in the individuals who live in them.

AN EXEMPLAR

The BBC documentary series The Secret History of Our Streets provides a good illustration of the issues we face today. Silo thinking, unaccountable planning (eg highways), starchitecture (remote), all create harsh environments that are barriers to our intrinsic preference for cooperation and interaction.

In the episode on Duke Street in Glasgow (2 of series 2), we can watch an unfolding story of a place that developed from nothing during the Industrial Revolution, suffered social policy failures and then was dismantled bit-by-bit by planning and design policy failures. The scenes near the end of the programme show a townscape that has been ‘un-placed’. An uplifting aspect of the programme is the positive response from the community against this threat, demonstrating the powerful force of prosociality where it prevails.

A WELL-DESIGN PLACE

It is important to note the fore-sighting that tells us that at least 80% of the buildings that we will inhabit in 2050 have already been built. Moreover, many of the new buildings erected between now and then will be constructed within existing fabrics and infrastructures, and so be quickly assimilated to become ‘existing’ too and subject to the same management regimes. We therefore need to:

• Stop ‘UN-PLACING’ townscapes
• Remove barriers to ‘PROSOCIALITY’ caused by short-sighted renewal and management programmes.
• Embrace the social sciences to focus ‘CO-DESIGN’ leadership on urgently regenerating existing places within an ‘accountable people-focussed agenda’.
• Create ‘OUTCOME’ oriented policies to deliver objective, evidence-based place-making principles that embed community wellbeing.
• Together we might instigate a ‘WELL-DESIGN’ process for place making rather than an indefinable ‘well designed’ output.
• Instead of being distracted by Utopian (‘no–place’) dreams on green fields, we need to pursue the ‘Eutopian’ (well-place) dream that is achievable through inter-disciplinary thinking, knowledge mobilisation and sensitive management of our existing townscapes.

The original version of this blog was posted at What Works Wellbeing