By Madhavi Prashant Patil, Architect, Urban Designer and Assistant Professor, India

In any city , the city centre is the entity of social life. But the city may not function effectively as a well knit unit if it is too densely filled with people. Cities, by their very nature, tend to have high population density and heterogeneity of people driven there through economic growth and sociocultural trends, amongst other reasons. But these are  demographic facts - they cannot define the experience of living in this environment.

The term OVERLOAD provides a helpful link between  demographic facts and the individual's experience in the city. Overload, or stimulus overload, can be defined as a psychological state wherein scenarios and encounters are so mentally, perceptually, and emotionally arousing that they drain or even go beyond the person.  It is a term coined by American social scientist Stanley Milgram in the 70s in his writing on the Experience of Living in Cities. Overload is caused by the cumulative effect of a range of environmental stressors that tend to be particularly prevalent in cities: crowding and invasion of personal space; insufficient working and living space, noise, dirty or untidy conditions, pollution, and a disorganized environment, to name but a few.

Faced with overload, people tend to adapt by starting to withdraw from scenarios that deliver high levels of stimulation. However, prolonged adaptation to mitigate the effects of overload can also diminish the physically social aspect from people's lives that is so important for mental health and wellbeing. The effects of this withdrawal can include reductions in people's social, moral and environmental interactions within the city, increased desire for anonymity (to help remove oneself from unwanted events), a search for physical and emotional privacy, and a reduced willingness to trust and assist strangers.

In addition to describing his cognitive overload model, Stanley Milgram characterized the various generators of the stimuli that contribute to overload as 'inputs'; inputs include people, vehicles, activities, and even environmental factors like temperature, noise and pollution. He proposed six specific adaptations to cope with overload:
 
1. Allocation of less time to each input.
2. Disregarding of low priority inputs.
3. Redrawing boundaries to social transactions, shift the burden to others.
4. Blocking of receptor prior to entrance.
5. Employing filtering devices to diminish intensity of inputs.
6. Creation of special institutions to absorb inputs/shield the individual.

In terms of the individual, this can mean:

Prioritizing: Organizing and approaching tasks based on importance.
Refusing: Identifying tasks that don’t need to be done.
Limiting: Avoiding the mindset that more is better.
Queuing: Getting tasks ready to be done later.
Delegating: Identifying tasks to be given to others.
Shifting:  Perceiving situations more positively by accepting them as a part of your job.

And in terms of the city itself, and opportunities for urban design, this can mean:

Improving the task performance of individuals: Optimum usage of available infrastructure to facilitate better task delivery.
Implementation of principles of selectivity: Devise strategies to put forth important and critical points to avoid confusion and in turn save time and energy.
Increasing social interaction to reduce overload: Create opportunities to promote positive social interaction and inculcate the sense of responsibility.
To control the intensity: Control the generator of activities to reduce the intensity.
To provide a place to pause: Linking all available open pockets to the main street. Create a place from a space.

With the increase in density and intensity in cities, more and more people are at risk of overload, but even small interventions in urban design can help people cope with their inputs more effectively.

In my opinion, urban design affects our mental health in two ways. Directly, because good environments make us feel good while monotonous, badly proportioned environments can make us feel bad, creating sensory deprivation and symptoms of mental ill health. And indirectly, because urban spaces set the stage for social interaction, thus counteracting the alienation human beings have struggled with since modernity. Man is essentially a social animal, a flock animal.

Urban design can influence our mental state through the distance between buildings, their proportions, the number of sensory impulses, and other physical factors: all this has been the subject of many thorough studies. And there is no lack of sociological writings about the alienation caused by modern city life, its solitude and isolation. But there seems to be a missing link between the two. More than fifty years after she wrote her Death and Life of Great American Cities, Jane Jacobs still remains unrivaled in the way she links community life and urban planning. But she provides few, although invaluable, indications as to urban design.

The gap between designing spaces and furthering community life can be bridged by resorting to the tritest of metaphors, that of the stage. The urban environment can be broken down into the same elements we find on a stage, and if we make these elements interact and reinforce one another when we design urban spaces, then we can literally set the stage for the play of urban life. There is nothing new to this: back in the 16th century architects tested out their designs in the theatre. If something worked on stage, they considered it would work in the street.

But the life that goes on in squares and streets is also closely connected to the aesthetic dimension of play. One of the greatest philosophers of the 20th century, Hans Georg Gadamer, wrote about the aesthetic experience he defined as "play, game or festival", and the shared experience of parades and festivities. Any street market in any Mediterranean city is a kind of festival and just as with the stage of elaborate plays,  we find all the elements of a theatre production. Consider the performance of a salesman at a market stand in Italy, or in a Turkish bazaar: both parties in the negotiations know the scene is not to be taken seriously, but to be valued and enjoyed for what it is, namely a well-performed play. And it is often the quality of the performance, rather than the arguments, which will seal the deal.

The metaphor of the theatre can therefore be used both for the urban space as stage, and for the interaction and community life that takes place on that stage. And if an urban designer uses the tools of the theatre trade or the elements present on stage - players, costumes, lighting, props, and an audience which is however never wholly passive – and finds ways to make the players and the audience interact, then he or she can create spaces which can affect the mental health of those who use them both directly and indirectly: directly because of their physical characteristics, and indirectly because they further community life.

In practice this means designing streets and squares that are not only compact enough to bring people close, with good acoustics and atmosphere-creating lighting. It also means designing or choosing all the props – signs, plants, café furniture, benches and street lamps – and ensuring the result is so elegant that people feel like dressing up a bit. But above all it means giving people excuses to gather and interact. This does not mean they have to form friendships. But sometimes being part of a crowd, chatting with a shopkeeper, complaining about a queue to those alongside can make all the difference for someone going through depression or simply feeling alone. Many such opportunities to exchange a few words have disappeared today. We hardly ever go to post offices, shop at street markets or buy tickets from real people. Machines have taken over where there used to be people. It has become more important than ever to set the stage for urban life. And this cannot be done just by designing good spaces. There must be people and they must be allowed to interact.

To create urban spaces that contribute to better mental health, we must design stages with pretty backdrops, good lighting, suitable props, and we must not only make them attractive, but actually give people reasons to visit them, spend time in them, and interact in the play that is urban life.

The following authors have been influential to my work and are recommended for further reading on the subject of the urban theatre:

Bauman, Z. (1995). Life in fragments. Oxford, UK: Blackwell Publishers Ltd.
Bauman, Z. (2000). Liquid Modernity. Cambridge, UK: Polity Press.
Bauman, Z. (2003a). City of fears, city of hopes: Goldsmith's College.
Cattaneo, C. (1950). La società umana. Milan: Arnoldo Mondadori Editore.
Epstein Nord, D. (1988). The City as Theater: From Georgian to Early Victorian London. Victorian
studies: 159-188.
Gadamer, H.-G. (1986). The relevance of the beautiful and other essays. Cambridge, UK: Cambridge
University Press.
Gadamer, H.-G. (2012). Sannhet og metode. Oslo: Pax Forlag.
Gehl, J. (2010). Byer for mennesker. København: Bogværket.
Jacobs, J. (1961). The Death and Life of Great American Cities. 1992 (Vintage) utg. New York:
Random House.
Lozano, E. E. (1974). Visual needs in the urban environment. Town Planning Review, 45 (4): 351.
Sennett, R. (1990). The Conscience of the Eye - The Design and Social Life of Cities. London: Faber and Faber.
Whyte, W. (1980). The Social Life of Small Urban Spaces. Washington, D.C.: The Conservation
Foundation.

Since the 1970s, environmental design and behavior researchers have looked into the relationship between the design of places and their impact on people’s health. This emphasis on “evidence-based design”, or the use of social science research to understand the person-place relationship, is perhaps most commonly seen in the creation of health care facilities that links the design of hospitals to decreasing patient recovery times and increasing the efficiency of nursing staff (McCullough 2010). Similar evidence exists that links health and urban places as well, which is often centered around the role of nature (e.g., gardens) in urban places (Souter-Brown 2015), but also on a wide variety of other variables, such as transit/walkability, social factors, and epidemiological characteristics (Moughtin, Signoretta & Moughtin 2009). Many urban design theorists also carefully examine historic towns and cities across the globe and how they developed over time. What’s survived to the present has been through a kind of Darwinian evolution, where only the most useful urban design principles are repeated through millennia, while others are discarded because they didn’t work. This is essentially the empirical platform upon which the “new urbanism” movement rests—“old” urbanism.

The fact that urban environments are often associated with “historic” places should be of no surprise. Whether officially recognized by law as historic places or accepted by people as such, most people associate downtowns, or urban cores, with the location of the oldest buildings and places in their community. To date, there has been little interest in disentangling the physical age of a place from its design, if only to provide empirical evidence to support the conservation of the historic environment. As a result, there is very little research that addresses how the historic environment—differentiated from other types of urban environments—is perceived, valued, and utilized by people. There is even less literature that looks at the relationship between the historic environment, health, and wellbeing. The studies that do exist offer a tantalizing glimpse at the possibility that historic places have additional, bona fide, positive effects on health, centering on overall mental health, such as creativity/imagination and wellbeing, and physical health.

My own research (Wells 2009; Wells and Baldwin 2012), for instance, has established a link between the appearance of patina (or decay) in an urban environment, the experience of “spontaneous fantasies”, and an increased level of emotional attachment to a place. Even when there are two urban residential neighborhoods with essentially the same urban design, people who live in the authentically old place (i.e., with the patina) have higher levels of place attachment, which seem to be related to the ability of this patina to spontaneously create vignettes of the past in people’s heads. These fantasies are often not connected with any real, concrete facts, and are not at all like daydreaming. People do not seem to have any direct control over their appearance—they either happen or do not, based on direct environmental stimulation. This association with increased levels of place attachment is important, because there is an association with increased mental health and wellbeing for people who are more strongly attached to the places in which they live (Brown & Perkins 1992).

Clearly, the experience of spontaneous fantasy is a creative and imaginative act, which other researchers have also found to be true, such as when handling museum heritage objects, as Ander et. al (2013) investigated as part of the “Heritage in Hospitals” program in the United Kingdom. When hospital patients handled ancient archaeological artifacts, they experienced a similar kind of spontaneous fantasy that linked them emotionally with the past. This experience also was associated with a higher degree of wellbeing and even reduced pain levels in patients.

Jane Grenville (2007) argues that built heritage provides a kind of “ontological security” for people. In other words, the familiar, known, and stable qualities of heritage environments provide understandable psychological cues that lead to improved mental health. This concept is closely related to how the historic environment provides people with a sense of identity, a phenomenon that the humanistic geographer Yi-Fu Tuan (1977) arguably first explored in the 1970s, but which has become a much more common theme of built heritage conservation, such as Ned Kaufman’s (2009) work on conceptualizing the historic environment as a series of evolving “storyscapes”. In archaeology, there is evidence that a community’s participation in archaeology—conceptualized as people working as peers with archaeologists—leads to significant social benefits and improved overall wellbeing (Neal 2015; Thomas 2014).

And, of course, we know that pre-World War II, pedestrian-oriented environments are synonymous with built heritage. These urban areas were created for the benefit of people, rather than automobiles (which didn’t exist or were marginal factors at the time), so it is natural that they contain the mixed-use and density characteristics that encourage physical activity—especially walking. One issue with this perspective, however, is that the heritage of Modernism, in which anti-pedestrian orientation and single uses are character-defining features, offers a challenge for heritage conservation in terms of health. Do we conserve/preserve places that clearly may not be so good for the health of people? Are there ways to ameliorate these issues without negatively impacting the authenticity of Modernist buildings and landscapes? These are all questions that will need to be answered in the twenty-first century.

Barring the issues with the heritage of the recent past, there is a growing body of evidence that links built heritage and heritage landscapes to mental and physical health. These benefits need to be made more widely known in arguments for urban design and conservation, which also happen to fit very well within another concept linked to health: sustainability. The reuse of existing buildings reduces energy use, pollution (e.g., landfill waste), and is even linked to more vigorous local economies. If we add the health benefits of heritage into this mix, an argument for the conservation of built heritage and cultural landscapes becomes even stronger.

DO YOU HAVE ANY IDEAS, EXPERIENCE OR QUESTIONS ABOUT THIS? PLEASE COMMENT BELOW.

Works cited:

Ander, E., L. Thomson, G. Noble, A. Lanceley, U. Menon, & H. Chatterjee. (2013). Heritage, health and well-being: Assessing the impact of a heritage focused intervention on health and well-being. International Journal of Heritage Studies, 19(3), 229-242.

Brown, B. B., & Perkins, D. (1992). Disruptions in place attachment. In I. Altman & S. Low (Eds.), Place attachment, pp. 279-304. New York: Plenum Press.

Grenville, J. (2007). Conservation as psychology: Ontological security and the built environment. International Journal of Heritage Studies, 13:6, 447-461.

Kaufman, N. (2009). Place, race, and story: Essays on the past and future of historic preservation. New York: Routledge.

McCullough, C. S. (2010). Evidence-based design for healthcare facilities. Indianapolis, IN: Sigma Theta Tau International.

Moughtin, C., P. Signoretta, & K. McMahon Moughtin. (2009). Urban design: Health and the therapeutic environment. Boston: Elsevier/Architectural Press.

Neal, C. (2015). Know your place? Evaluating the therapeutic benefits of engagement with historic landscapes. Cultural Trends, 24(2), 133-142.

Souter-Brown, G. (2015). Landscape and urban design for health and well-being: Using healing, sensory, therapeutic gardens. Abingdon, Oxon : Routledge.

Thomas, S. (2014). Making archaeological heritage accessible in Great Britain: Enter community archaeology. In Public participation in archaeology, S. Thomas & J. Lea (eds.), pp. 23-33. Woodbridge: The Boydell Press.

Tuan, Y. F. (1977). Space and place: The perspectives of experience. Minneapolis: University of Minnesota Press.

Wells, J. C. (2009). Attachment to the physical age of urban residential neighborhoods: A comparative case study of historic Charleston and I'On. Ph.D. dissertation, Clemson University.

Wells, J. C., & Baldwin, E. D. (2012). Historic preservation, significance, and age value: A comparative phenomenology of historic Charleston and the nearby new-urbanist community of I’On. Journal of Environmental Psychology, 32(4), 384-400.

Sophie Gleizes an Urban Geographer and policy practitioner now working at the European Commission's Directorate-General for Health and Food Safety, launches a new UD/MH series on traumascapes, urban design and mental health. 

Take a moment and think about your personal mental map of a city you are familiar with, one you may have known for a while. Are there places you avoid more than others because of some negative association? Do any places in your neighbourhood cause distress for you? Have you ever felt vulnerable in your urban environment?
 
We project emotions, memories or ideas onto particular places which influence our decisions to visit them or not, and how we feel when we get there. This means the imagined and symbolic attributes of a place are an important key to understanding people’s psychological responses to their setting. Geographical frameworks offer valuable insights on how place and space affect the wellbeing of city residents, helping us understand ‘emotional and psychological responses to places and their significance for well-being,’ according to health geographer Sarah Curtis.
 
One feature of a healthy urban community looks at whether its members experience a sense of belonging and ease where they live. That said, what ought to be done when people undergo a troubled relationship with a place, potentially jeopardizing their happiness or mental health?
 
Some places seem to be keepers of memories that trigger distress, shame, fear or sadness, particularly those that have formed the stage for a traumatic event such as urban violence, natural disasters, military conflicts or terrorist attacks.

According to the editors of Post-Traumatic Urbanism, an urban trauma describes ‘a condition where conflict or catastrophe has disrupted and damaged not only the physical environment and infrastructure of a city, but also the social and cultural networks’. Maria Turmakin coined the term ‘traumascapes’ to denote spaces that still bear wounds from a traumatic incident, both in their physical state and in their inhabitants’ minds. A traumatic incident dislocates the continuity of the “lived and imagined landscape” of the city.  It disturbs places at the core of our ‘emotional ecosystems’: they are no longer, and never will be, the same again. Displacement and damage spread confusion in people’s mental maps of a city, as victims lose literal or mental sight of landmarks. A physically hurt environment has real emotional impacts on remaining inhabitants, with related consequences for community resilience. We cannot but think, for instance, of the physical blow of the fall of the Twin Towers in New York City on 9/11/2001, which not only has left a vacuum in the urban fabric, but also generated deep feelings including insecurity, distress, horror, and vulnerability among city residents, blurring the perceived boundaries between "safe" and "threatening" places. These feelings have been brutally reactivated during the Paris attacks on 13th November 2015. Even though the physical damage in Paris was lower than in New York, profound wounds have been left in our imagined landscape of the city.
 
Reconstructing place – restoring its familiarity – is therefore crucial in the process of healing from trauma. Urban geographers, for instance, are interested in how city dwellers, visitors and designers process this disruption and adjust (or not) to the new situation. Urban designers and city-makers alone may have inadequate competencies and insights for handling such complex, locally sensitive issues This seems to be a responsibility best shared by different actors (residents, academics, artists, etc.).
 
To help understand the issues and urban design opportunities in the complex field of traumascapes, my upcoming series of op-eds will particularly focus on several places in Sarajevo, Bosnia, a post-traumatic city besieged for four years during the war of Yugoslavia in the 1990s. During the siege, the physical urban space where people were dwelling was subject to a brutality conceptualised as “urbicide” – the murder of a city. In 2014, I conducted research in Sarajevo that to identify how different groups of people process traumatic memories, and understand what that showed about their collective and individual identities relating to a place.

Traumas are not only contained in a place and an event, but also in the ways they are lived and represented across time. Places are endlessly reinterpreted in power struggles and through (in)formal negotiations over their meaning and representation. Deliberately or not, planning decisions can impede communities’ ability to process extremely stressful events in their history by maintaining a sense of trauma associated to a place. This is all too often visible in Sarajevo’s urban built environment, parts of which remain derelict or in ruins.  In this vein, places can serve as powerful tools for furthering the political vision of certain groups or institutions. Urban design challenges are thus particularly acute in a country where inter-ethnic issues remain sensitive. There is a widely held interest in how to achieve healing without forgetting traumatic episodes: similarly, we must ask how urban planners and policy makers can engage with traumatic places while taking into account a plurality of publics and generations.
 
This is the first in a series of op-eds intended to inform designers, planners, policy makers and anyone interested in questions of trauma, resilience and place-making from a social scientific and geographic perspective. Taking a qualitative approach, these insights highlight the complexity of ‘senses of places’ and practices relating to ‘traumatized’ built environments. This leads us to observe the difficulty of designing projects that effectively respond to the various needs of different individuals and communities.
 
This series claims no straightforward guideline for practice. The site of trauma is a particularly challenging object, insofar as there exists no simple, universal solution. There may be larger issues at stake, such as post-conflict peacebuilding that includes institution-building, civil society regeneration, etc. As we will see, responses to these spaces vary in terms of perceptions, cognition, personal histories and resilience, as well as the embodied experience of the place in the moment.
 
Lastly, at a time when our everyday mental maps seem increasingly vulnerable to the eruption of shock and violence, it is crucial to develop knowledge of the effect of trauma on cities and their various realities in order to develop appropriate and effective solutions.
 
As this traumascapes series proceeds, I will be discussing:

• What are different groups of people’s perceptions and experiences of Sarajevo’s places imbued with trauma? How do they interact with these places and what can we more generally learn from these meanings and practices?
• How to avoid univocal appropriation of the space and denial of its other meanings and purposes? What are the various urban design practices at hand to deal with such spaces?
• How to repair the city after physical trauma in a way that also profoundly heals its inhabitants? How to reconcile people with their environment when they are perceived as hostile? How can urban design help elicit a new awareness of our urban environment, and even have a certain therapeutic impact?
• How can urban design help younger generations and foreigners inhabit the distance between their own experiences and these traumatic events?

Biophila, our innate love of nature, is an obvious way to enhance our cities into environments promoting mental health. The word was first coined by the social psychologist Eric Fromm to describe the positive feelings we obtain from interaction with natural systems and species. This describes everything from the joy we experience in seeing a family of ducklings swimming in a pond, to the beauty of an old growth forest, and the harmonious sound of crickets on a summer night.

Biophila was originally explored as a niche area of psychology and neuroscience research.  Books such as The Biophila Hypothesis, The Last Child in the Woods, and Healing Spaces have done much to spread the concept of biophilia to other fields, and it is now beginning to gain traction in design circles, influencing architecture, interior design and urbanism.

When one thinks of nature and cities, the first thought that comes to mind is likely a tree-lined street with a beautiful canopy. Trees are one of the best ways to start with enhancing the natural environment in a city because of their myriad of benefits, from creating summer shade havens to ecosystems for birds that calm us with their song.  Much work is already being done to green our cities; planting more trees is a top priority for stormwater management, reducing the heat island effect, and the health benefits they bring for urban dwellers.  Organizations such as the Sustainable Urban Forests Coalition and Million Trees NYC are non-profits that have grown recently, dedicated to planting and maintaining our urban forests. Washington DC, for instance, has proudly made tree planting and protection a priority by having an Urban Forestry Administration as part of the District's Department of Transportation. 

But beyond greening our urban landscape, biophilia has a wider focus: to bring more of the natural world in contact with our day to day lives. The Biophilic Cities Project and Partnership for Sustainable Communities are two non-profits working to bring biophila to urban environments. Terrapin Bright Green, a sustainable research & development consultant based in New York, has published several recent white papers on the topic of special interest to the built environment. The 14 Patterns of Biophilic Design and the Economics of Biophilia make the case for incorporating natural systems into our built environment for both financial reasons and to support our wellbeing. Design strategies such as incorporating natural patterns and analogues, creating a visual connection with nature, stochastic sensory stimuli, dynamic lighting, complexity, and the concepts of spatial prospect and refuge explain that creating a biophilic environment is the next step beyond planting trees.  

Research on the physiological effects of natural environments has revealed tangible benefits in stress reduction, concentration, memory, creativity, comfort, healing, and emotion and mood regulation. A few empirical results specific to mental health include:

• Spatial forms evoking mystery and risk result in a strong dopamine or pleasure response
• Prospect, or long range views, result in improved comfort, perceived safety and reduced boredom and fatigue
• Presence of water results in improved concentration, memory, enhanced perception and psychological responsiveness
  

This is the first in a series of posts where I will explore specific examples of biophilia in urban environments and its relation to mental health, which can be seen as a reflection of our strength and fragility as a species. As humans, we are highly sensitive to our environment. Surrounding ourselves with nature reaffirms that we live in a connected world.

Have you ever heard of green building? According to the US Green Building Council, green building is defined as ‘a holistic concept that starts with the understanding that the built environment can have profound effects, both positive and negative, on the natural environment, as well as the people who inhabit buildings every day’ and ‘an effort to amplify the positive and mitigate the negative of these effects throughout the entire life cycle of a building’ (Kriss, J., 2014). Green building, which is also called ‘sustainable building,’ is ‘the practice of creating and using healthier and more resource-efficient models of construction, renovation, operation, maintenance and demolition’ (US EPA: Green Building, 2014). Its aims are to reduce the adverse effects of the built environment which impacts on both human and the nature by maximizing the efficiency of energy, water and other resources, minimizing waste and environmental pollution, and improving health and productivity (US EPA: Green Building, 2014). 

The USGBC created Leadership in Energy and Environmental Design (LEED) certification, a rating system to assess how the built environment meets the requirements of green building (Concrete Thinking, 2015). Nationals Park in Washington, D.C. is the first Major League Baseball stadium with LEED certification (USGBC, 2014). It uses energy-efficient field lighting, which anticipates savings of $440,000 over 25 years (USGBC, 2014). The ballpark does not only encourage visitors to use public transportation but also provides parking areas and valet services for bicycles, promoting environmentally friendly transportation without using fossil fuel (USGBC, 2014). The USGB reported that the stadium could save over 4 million gallons of water a year thanks to low-flow faucets and dual-flush toilets as well as air-cooled chillers instead of water-cooled chillers (USGBC, 2014). 

But how about the impact on human health? A literature review article identified that green buildings can benefit both physical and mental health (Allen et al., 2015). For instance, green buildings designed to improve indoor air quality can reduce the incidence of workers’ asthma and allergies, which in turn, can enhance their productivity (Allen et al., 2015). Compared to a conventional hospital, a LEED-certified green hospital indicated a reduced mortality rate of patients, higher satisfaction of employees, and improved quality of care indicating a lower rate of blood stream infections (Allen et al., 2015). According to the Indian Green Building Council, green hospitals designed to maximize daylight and optimize the artificial light can reduce seasonal affective disorder, sometimes referred to as 'winter depression' (Indian Green Building Council, 2015). They found that green hospitals with more gardens and landscape are associated with positive feelings such as pleasantness and calmness for both patients and employees (Indian Green Building Council, 2015). In particular, environmental noise can lead to cognitive dysfunction as well as psychological distress for both adults and children (Stansfeld & Matheson, 2003; Weitzman et al., 2013). Green space can provide buffer to block or reduce environmental noise. 

Living in an environment that incorporates green space is certainly better for our mental health. However, it can be a challenge to create large open spaces or green spaces in highly populated and small land areas such as New York City in the US, Tokyo in Japan, or Seoul in South Korea. Using innovative solutions like green roofs or rooftop gardens are one way not only to reduce environmental noises but also to make it easier to access the natural environment. The initial cost of installing a green roof may be more costly than a conventional roof, but tangible and intangible benefits of a green roof can soon offset the expenses (US EPA: Green Roofs, 2013). These roofs can reduce energy use of cooling and heating; reduce air pollution and greenhouse gas emission; slow storm-water runoff; and improve the quality of life and human health (US EPA: Green Roofs, 2013). 
​Green building is a fascinating and rapidly emerging concept, but its relationship with mental health, especially for specific mental illnesses, is not well documented yet. Interdisciplinary studies to find out the impacts of green buildings on mental health and multi-sectoral interventions to make our environment greener and healthier are needed for the better future.

• What are the most effective ways of achieving exposure to the natural environment in different settings?
• What is the minimum 'dose' of natural environment exposure needed to achieve mental health benefits? 
• Do particular countries/cultures build nature into their urban environment in ways that offer lessons for others?

If you have research or ideas about these questions or any others pertaining to the question of green building and mental health, please send us an op-ed to be considered for publication in Sanity and Urbanity. 

References 

1. Allen, J.G., MacNaughton, P., Laurent, J.G.C., Flanigan, S.S., Eitland, E.S. & Spengler, J.D. (2015). Green buildings and health. Current Environmental Health Reports, 2(3), 250-258. 

2. Concrete Thinking. (2015). Benefits > LEED. Retrieved from http://www.concretethinker.com/solutions/LEED-Certification.aspx 

3. Indian Green Building Council. Green Hospitals. (2014). Technical Bulletin. Retrieved from https://igbc.in/igbc/html_pdfs/technical/Green%20Hospitals.pdf 

4. Kriss, J. (2014). What is green building? The US Green Building Council (USGBC). Retrieved from http://www.usgbc.org/articles/what-green-building 

5. Stansfeld, S.A. & Matheson, M.P. (2003). Noise pollution: non-auditory effects on health. British Medical Bulletin, 68, 243-257. 

6. The US Green Building Council (USGBC). (2014). Nationals Stadium. Retrieved from http://www.usgbc.org/projects/nationals-stadium 

7. US Environmental Protection Agency (EPA). (2013). Green Roofs. Retrieved from http://www.epa.gov/heatisld/mitigation/greenroofs.htm 

8. US Environmental Protection Agency (EPA). (2014). Green Building. Retrieved from http://archive.epa.gov/greenbuilding/web/html/ 

9. Weitzman, M., Baten, A., Rosenthal, D.G., Hoshino, R., Tohn, E. & Jacobs, D.E. (2013). Housing and child health. Current Problems in Pediatric and Adolescent Health Care, 43(8), 187-224.

Mental health can be seen as a sliding scale with disease on one end, optimal condition on the other. Most of us sit somewhere in between, hopefully closer to the optimal side. Things happen in life that tip that scale towards one end or the other, many of those things being in our environment. An urban environment has the possibility of pushing us in either direction. The stigma commonly associated with mental illness may stem from the idea that it is an internal problem that the person can change themselves. Yet the impact that the natural and built environment has on our mental health is palpable and often out of our control. Everyone has symptoms of poor mental health at times. Here are some examples of ways that cities can cause common mental health symptoms:

• Have you felt sad or down after spending an entire day indoors or underground?

• Have you worried for your safety, or the security of your belongings?
• Have you felt a lack of autonomy, like a bee in a hive, working and living in high rises?
• Have you felt that days or weeks go by without spending time outside, causing you to lose track of time?
• Have you gone home, to hole up in your apartment, sheltered away from noise, pollution, visual and social stimulation?
• Have you felt tension, aggression or anxiety in crowded trains or streets?
• Have you had problems sleeping due to sirens, light pollution, or exhaustion from a non-stop lifestyle?
• Have you felt helpless, anonymous or lonely because it seems that none of the other millions of people around you care about anything but themselves?
• Do you dream of your next weekend escape to the country?
  

These are all symptoms of an unhealthy mental state which can be caused or exacerbated by urban conditions. Yet this is no reason to truck out to the burbs. Cities offer extensive benefits for our wellbeing, which we can experience all the time:

• Have you felt refreshed by spending leisure time in a park?
• Have you felt energized by special events with thousands of people?
• Do you smile when walking past a child or pet a dog that goes by on the sidewalk?
• Are you inspired by interactions with new cultures and ideas?
• Are you more active because you commute via public transportation, taking escalators, stairs, walking or biking?
• Are you more productive and intellectually stimulated because of educational and career opportunities available to you in the city?
• Have you felt exhilarated after seeing a skyline or crossing a major bridge?

Improving the urban environment by integrating nature, social connection and stress-relieving elements can both relieve the negative symptoms and increase the positive interactions we have in the urban environment. Both the negative symptoms and positive benefits of urbanism are things every one of us can experience. Those of us who have the means to get away or change our environment can usually prevent the negative symptoms from going from a few bad days into a disorder, by putting ourselves in more frequent contact with the positive experiences. But many urban residents don’t have the ability to change their environment. By advocating for urban designers, planners and architects to collaborate with health professionals to design urban environments that promote our mental wellbeing, we can improve the effect the urban environment has on everyone.