La Mariscal has about 20,000 residents and a daytime population of over 180,000. People flock daily to work, to school, or to grab a bite and a beer. The neighbourhood has enormous potential of becoming a centre of educational urbanism. Good practices within La Mariscal would raise awareness and recruit almost two hundred thousand neighbourhood ambassadors who would go back home every evening to the farthest reaches of Quito's metropolitan region thinking about lessons learnt and, with the right kind of encouragement, about how to share them.
 
The potential is there, and it does not require billion dollar investments in infrastructure and services. What we need is to turn every resident and visitor to La Mariscal into a potential citymaker. And, as it turns out, this will be less of a feat than one would otherwise think.
 
Quito is sitting on a gold mine, urbanistically speaking. The bland cityscape of underserved neighbourhoods (or wealthy ones with security concerns) that boast endless perimeter walls and deserted sidewalks miraculously disappear when you enter La Mariscal. Close proximity between people is pervasive on mostly open facades built with non-residential uses on the ground floors. The human scale of stores, food stalls and shopfronts adds to the ease of walking and keeps the trail interesting. The experience is part of an adequately designed, properly scaled, outside 'living room' where public space is open, inclusive and ready to be shared by all.
 
Only it currently doesn’t work quite that way. Violent crime is not unheard of and petty thefts occur daily in the area. Old diesel engines battered by the low oxygen in this city at an altitude of 2800 metres above sea level spew black smoke on every street, and noise is well beyond acceptable limits. Storefronts are not inviting and people rarely say hello, let alone chat about the weather with strangers. We can safely affirm that La Mariscal has the bones, but still has a long way to go before it is able to set an example and recruit its floating population as unconscious citymakers and ambassadors of good urban practice.

An inviting city has specific characteristics of its built environment which make us feel good.  Its most salient characteristic is its (literally built-in) invitation to stop, observe, mingle, interact, and strengthen our social bonds. The great project of a city is, after all, to bring strangers together. Solitude is necessary for contemplation, reflection, and grounding, but it is the connections which cities make possible – everyday prosaic, romantic, and/or professional - that often generate better versions of ourselves and who we can be as a society.
 
The way we lay out our cities from the micro to the macro determines the nature of the invitation. Do we want to invite more cars? Then build more roads and they’ll surely come. But, isn’t it more lively streets and public spaces that makes us feel alive? Then the city's invitation to us is contingent on one imperative: it must nourish our senses and obey our human scale, not the scale of the automobile. It must give us fine-grained detail, not Brutalist-style monoliths, nor vast swathes of ashphalt for cars and their parking spaces.

​Tokyo is, for the most part, very inviting. That's why I choose to live here. Contrary to the “Lost in Translation” stereotype, the city is not alienating. Tokyo combines density and detail in walkable human-scaled streets and public spaces. Its detail includes, for example, engaging multiple small-scale signage and displays of blossoms at shop entrances, noren (a printed fabric hanging in restaurant entrances, much like a curtain but with a vertical split to allow patrons to enter) and even ceramic bowls of carp in front of a hairdresser.  

There are scattered parking lots, but their propinquity to the rich detail elsewhere renders their sensory impact even more jarring. They are spaces of nothingness and desolation. They don't uplift. They diminish us. ​

​Tokyo’s detail can only be perceived because it falls within our ‘social field of vision’ in numerous walkable human-scale streets. That is, within a range of up to 100 metres, our our senses are activated enough to engage meaningfully with our surroundings: to recognize the local okonomiyaki (Japanese seafood pancake) restaurant owner taking a break in his shopfront so as to stop and chat; to smell flowers; to notice the hanging noren printed with vegetables signaling a tempura restaurant inside. Tokyo’s predominant ‘architectural speed’ matches this social field of vision. That is, the architecture and the details amassed around it (the intricate woodwork and bamboo arrangement of the shop entrance and the flowers, signs, menus amassed in front) are at a walking (5km per hour) and cycling speed (average 15-20km per hour), not the speed of the automobile (average 60km per hour). This human mobility speed, and even the cycling speed, is visually stimulating and mentally nourishing because we can sense and engage with its details up close as we walk or cycle. Jan Gehl notes with ringing lucidity: “at its core, walking is a special form of communion between people who share public space as a platform and framework”. 

Medieval cities configured around central town squares and based on human mobility (architecture at walking speed were designed so people could walk in their daily commercial routines.  Who hasn’t beamed at the pleasure of walking in a town square in Italy? Tokyo does this superbly in many of its neighbourhoods. It offers abundant ‘experience space’ in small-scale streets, pocket parks, and informal and formal squares, while its major thoroughfares provide the ‘movement space’ for private automobiles, buses, and trucks. And it has vast ‘movement space’ underground in its ubiquitous labyrinthe subway system, which carries workers, students, and the upper middle class.

This is not the case in many cities where modernism has ignored the ‘life in between buildings’, as Jan Gehl refers to it, and focused on discreet stand-alone buildings intersected by vast networks of roads to accommodate (and ‘invite’) the car invasion of the 20th century. Until that time, as Jane Jacobs opined, city space was primarily ‘experience space’, designed to facilitate social interaction. The automobile upended this paradigm, to the detriment of our social capital and well-being by streamlining city space for the utilitarian purpose of allowing cars fast passage. The automobile radically disrupted human scale because cars take up more space than people, both when driving and parked (a parking lot for 20 to 30 cars and their owners denies a whole metropolitan citizenry a nice-sized town square). In a city of cars, all spatial dimensions increase to accommodate the car’s speed, and we are left with the impoverished experience of the 60 km per hour architecture (‘fast architecture’) of a busy road. Its monochrome blandness ignores human scale precisely because it is not built for humans and their mobility speed. That's the regrettable legacy of the 20th century: we built cities for cars, not for humans. 

People love to watch other people. They will stop, observe, mingle, sometimes make a new friend, and even occasionally fall in love if there is an appropriate ‘invitation’.  The invitation works if it obeys human scale, is designed at a walking or cycling speed, is rich in visual detail such as in Tokyo’s small streets, and pushes cars onto main roads. Tokyo is not perfect but it is a very good  touchstone of an ‘inviting’ human-scale city. Monocle magazine ranked Tokyo No. 1 in this years’ annual livability survey. Not undeserving.

The World Health Organization states: “There is no health without mental health,” which means that in terms of achieving healthy cities, mental health and other supplementary support elements are key. There are many factors for city planners, architects and others to contemplate regarding what a “mentally healthy” environment can look like and how to deliver it, and social-cultural, physical-built, and economic environments all come into play. These factors become particularly important in the context of supporting the mental health of refugees in the city.

Mental illnesses are on the rise, and we know that at least one in four people will experience some mental illness in their lives. These numbers are only magnified in communities experiencing distress across the board, such as refugees coming out of Syria. Although it is too soon to discuss impacts of these  recent refugee crises, it is very likely that with the highest number of migrants in our modern history, we will see further increases in mental illness in these populations.

Due to the stigma and misconceptions around mental illness, people often do not receive adequate medical care. In low and middle-income countries, approximately 80% of people living with mental illness receive no mental health treatment at all, or they use traditional healers that may not deliver effective care. This means they have fewer opportunity to achieve good health, reducing their chances to become involved in projects that may be able to help them out of poverty, or at least be able to afford the health care they require, creating a further vicious circle of poverty and mental illness. Thus, we cannot ignore mental health as a key determinant of health in urban contexts. We have to include mental health as part of the discussions about how we can encourage “healthy cities” for the sake of children and adults alike. Taking into consideration what types of positive support systems are needed for refugee populations, and others living in poverty, is key to “city” planning.

Children's mental health can be particularly impacted by growing up in slums and refugee camps.
First, we know that poverty is inextricably linked with mental illness, and can create and maintain a vicious cycle. People who live in urban poverty are at particular risk of mental illness, and those who are mentally ill are at a greater risk of social discrimination and exclusion; without healthy support systems, these people are more likely to experience extreme poverty.

Living in cities increases the risk of developing certain mental illnesses, and for refugees living in urban poverty, these risks are often exacerbated because their living environments are often inherently stressful. For example, we know that children may have increased exposure to domestic and sexual violence, they may be more likely to worry about economic hardships, including child labor and child marriage, and children in these settings may experience greater levels of neglect or lack of parental engagement, since parents often have to spend time away from the home to earn money. We also see greater social isolation in urban slums, including refugee camps - both informal tented settlements or otherwise, and as such, increased risks for children to become involved in  substance abuse, violence, sexual exploitation, and other risky behaviors and experiences.  Furthermore, these children's adult caregivers are also at increased risk of developing mental illnesses - and this is a further risk factor for children's mental health. We know that suicide is amongst the top three causes of death for those of child-bearing age (15-44 year olds). The old “village” life that refugee children may be used to - and the care associated with it - may not be as prominent in their new lives.

Stress is, of course, a normal brain response to threat - but when it occurs constantly, stress can cause the structure of the brain to change. Research has shown that the amygdala (an area of the brain that regulates emotions like anxiety and fear) shows higher activation levels in healthy individuals living in large cities than in healthy counterparts living in rural regions. Our brains start developing before we are born and continue up through the age of 23 or 24, so consistent stress associated with living in urban areas may literally alter young people's brain structure, which may lead to increased stress levels, anxiety, life-long hyperactivity, and greater vulnerability to various adult mental illnesses. Children with higher stress or childhood disorders are also less likely to do well at school, which affects their education and work opportunities. This challenge is magnified for refugee children, at least half of whom are out of school (at least 3.4 million refugee children), which causes further challenges, particularly when they are required to work instead, or get married at a young age.

 Strategies for designing living environments that promote good mental health for refugees

Creating safer public spaces through rebuilding community social networks, strategically improving the built environment, and securing economic opportunities can help change the narrative and help develop resiliency and rebuild the dignity of refugees' communities.

The social/community environment
When planning the design of living environments for refugees, there needs to be consideration around building capacity (human resources and otherwise) within the communities to capture the needs of individuals with distress. Utilizing experts and leadership from the community to develop strategies that are culturally relevant, appropriate, and effective, needs to be considered. Taking cultural contexts into consideration to ensure appropriate spaces is key. Organizing and promoting regular positive community activities, while providing a voice of power to the community, can help rebuild community social networks, and help redefine the narratives associated with the community. Communities also need to be able to restore a connection to their home countries, and help rebuild a sense of cultural identity, which has been shown to have a positive impact on mental health outcomes.

Some of the most successful youth development, violence prevention, and health promotion programs build on existing community assets, and are dependent on community members and organizations that connect individuals to a supportive community. In communities where organizational infrastructure and capacity is lacking or absent, violence and trauma have a more profound impact on individuals and communities. Thus, more effort needs to be made to create social cohesion between the host communities and refugee communities, assuming the host communities have that missing capacity.
 
Churches and spiritual leaders can fulfill some of these roles in many communities, but a healthy community has multiple entry points, including businesses, civic organizations, social organizations, schools, and youth-driven organizations that can contribute to the social and cultural environment that promotes positive relationships, social norms, behaviors, and activities within a community.
 
The physical/built environment
Reducing deterioration, and creating space for positive interaction are the most important physical/built environment priorities to support mental health. This may include reclaiming public space to be appealing to residents, reflect their community culture, and become a source of pride that can contribute to a sense of community worth and be supportive of healing.

The systematic disinvestment and neglect of poor inner city communities has been a part of the structural violence that has produced community trauma over the last half century in the US, and other western societies. This is only exacerbated in communities that are hosting refugees. Thus, there is a need to focus on improving and maintaining roads, buildings, parks, transportation, and other public services so that they are transformed from sources of toxic stress, into an environment that encourages positive social interaction and relationships. A great example of such an attempt is in Colombia with the various social development projects set up in Medellin.
 
Additionally, parks, playgrounds, and other recreational facilities provide critical opportunities for engaging in physical activity and gathering with neighbors, and especially in order to relieve stress. Their absence undermines community health, mental health and quality of life. Thus, these facilities not only normalizes daily life in the communities, but can serve as safe spaces for youth to gather and socialize, while engaging in physical activity.
 
The economic environment
Lastly, strategies to improve economic opportunities for youth and adults in these neighborhoods are critical to the success of healing from community trauma, improving community health and wellness, and resisting the pressures of additional dislocation. Actual workforce development strategies that improve employment skills, capacity, and readiness of community members, while linking them to job opportunities with a living wage is critical. This also helps avoid idle youth in refugee camps being recruited for armed forces, early marriage, or child labor activities. These strategies must be multi-sectoral, focusing on different segments of communities, including strategies to increase the proportion of young people and adults who attend primary, secondary and tertiary (including vocational) education, and undertake job training and placement. Planners must ensure that the infrastructure for people to access these opportunities is available. It would be helpful to institute restorative justice programs that shift the norms around conflict resolution and healing circles to, amongst other outcomes, support people to stay on paths to pursue educational and economic opportunities

What would help
Mental health is not always talked about and fully documented in refugee populations; we need more documentation of the extent of the challenge, and more research on the most effective interventions. But for urban planners and designers, there is a need for increased capacity to recognize the needs of these populations:  planning consultations with the communities are important - and should include people with mental health problems, and  mental health and wellbeing promotion (including opportunities for play) should be actively built into future developments.

An important new report on urban design and mental health, Urban Sanity: Understanding Urban Mental Health Impacts and How to Create Saner, Happier Cities, has just been published by the Victoria Transport Institute in Canada. The report evaluates the evidence that links urban design and mental health, and uses these specific links to propose policy recommendations. 

The report author, Todd Litman,  asserts that cities generally provide good opportunities for people to thrive - yet research tells us that people who live in cities have an increased risk of  psychosis, mood disorders, cocaine and heroin addiction and unhappiness (though a lower risk of dementia, alcohol abuse and suicide) compared to rural dwellers. Why? And what can we do about it?

The premise of the report is that urban living in itself does not cause mental disorders or even make people unhappy - rather, city life seems to be associated with increased mental health problems for two principal reasons:

1. People who happen to be at increased risk for developing mental illnesses tend to gravitate to cities, often attracted by  economic and social opportunities and services, creating a concentrated, self-reinforcing cycle of mental illness risk (this is also known as 'social drift'). 
   
2. Various specific factors that are particularly associated with city living seem to exacerbate people's risk of developing some mental illnesses.
   

The report identifies  factors that are particularly associated with the increased risk of mental illness in the city:

• Pre-existing risk factors for mental illness including: poverty, disability, minority status, drug addiction, unmarried
  
• Social isolation and loneliness (particularly as city dwellers have often migrated from afar)
• Excessive stimulation and stress
• Crime
• Economic stress
• Transport conditions
• Inadequate interaction with nature
• Noise and light pollution
• Toxin pollution (eg  via vehicle emissions)

Design and Policy recommendations from the report
The report makes specific design and policy recommendations to address the urban risk factors for mental illness identified in the report, replicated here:

Targeted social service: Recognize that cities tend to attract people with elevated mental illness risks, and provide appropriate mental health, housing and substance abuse treatment services.

Affordability: Improve affordable urban housing and transportation options (walking, cycling, public transit, taxi, etc.) to reduce residents’ financial stress.

Independent mobility: Provide independent mobility options for diverse community members,
including those who are poor, have disabilities or impairments, adolescents or seniors.

Pro-social places: Create public spaces that promote community and encourage positive interactions among residents. Involve residents in creating public places and activities that meet their needs.

Community safety: Create communities that minimize urban dangers including traffic, crime and
harassment, and pollution exposure. This can involve traffic safety programs, crime prevention
though environmental design, appropriate lighting, passive surveillance by nearby residents and bypassers, and other community safety programs.

Design for physical activity: Integrate physical activity by providing good walking and cycling
conditions, high quality public transit, compact and mixed neighborhoods, local parks and
recreational facilities, plus appropriate community sports and recreation programs.

Pollution reductions: Implement noise, air, light and toxic pollution reduction programs.

Greenspace: Design cities with appropriate greenspaces, including local and regional parks, green
infrastructure, and out-of-city wilderness access programs.

What this report makes clear is that improving mental health through urban design is not a nebulous aspiration: practical architecture and urban planning approaches that target specific risk factors are likely to yield results. Better population mental health is an essential contributor to a thriving, sustainable city, and this report contributes an important analysis that will be helpful to citymakers.

Access to parks and urban green space facilitates exposure to nature, exercise and social opportunities that have positive impacts on both physical and mental health.  In the last decade, rates of migration have risen dramatically across the globe: by 2038, it’s expected that half of London’s residents will be of a black and minority ethnic origin (BME). Our cities, towns and communities are becoming increasingly multicultural and, yet there are inequalities. A recent report by the Equalities and Human Rights Commission showed that in the UK, ethnic minorities are experiencing worse health outcomes. This is particularly the case for mental health: in 2012, the proportion of adults in England who were at risk of poor mental health was found to be higher among Pakistani/Bangladeshi and African/Caribbean/Black respondents than White respondents, and there were inequalities in accessing healthcare.

Hence, it is increasingly important that research reflects the diverse make-up of these populations. A new study has sought to better understand the differences in use and perception of urban green space amongst BME groups in the UK, and illustrated the need for park facilitators to accommodate the needs, attitudes and interests of our multicultural population.

Several reviews have recently synthesised evidence showing the health benefits of contact with green space across a variety of international contexts but evidence of benefits by race/ethnicity is a notable gap. Given that BME groups in the UK generally suffer from poorer health and a wide range of environmental inequalities – perceiving their local open space to be poor in quality and reporting lower levels of use – the possible benefits of research into the relationships between green space, health and ethnicity is huge. While past studies have begun to identify different patterns of use and preference by ethnic minorities in urban green space, compared with white British populations, there is a need to better identify the underlying – and intrinsic – motivations behind these diverse behaviours. The study, conducted by Jenny Roe, Peter Aspinall and Catharine Ward Thompson, addresses this gap by exploring the role of urban green space in promoting general health within deprived urban communities in England.  The study took an usual approach by exploring how aspects of social wellbeing – feelings of loneliness, perceptions of trust in the local neighbourhood, and place belonging – relate to general health, alongside the physical neighbourhood characteristics of deprived BME and white British communities, including perceptions and use of local green space.
 
Using a self-rated general measure of health, the study explored individual, social and environmental predictors of general health in six ethnic groups living in three of England’s most ethnically mixed conurbations (i.e. London, Manchester and the Wolverhampton and Coventry area). The results of a household questionnaire, given to 523 people, identified three distinct health groups according to ethnicity: (1) people of Indian origin, who recorded the best health, (2) white British and (3) a segment labeled ‘Mixed BME’ combining people of African-Caribbean, Bangladeshi, and Pakistani origin, and ‘Other BME’ (e.g. people of Chinese origin and other white background), who reported the worst health.
 
A key finding was that aspects of social wellbeing predicted general health in all three health groups.  Trust was a high ranking predictor of general health, particularly amongst people of Indian origin, compared to our ‘Mixed BME’ group, where place belonging ranked more highly.  All of our measures of social wellbeing were found to be highly correlated to perceptions and use of community green.
 
Significantly, general health in the worst health group (i.e. those ethnicities within the ‘Mixed BME’ group) was far more likely to be predicted by variables in urban green space usage and perception than in any other health group. Those of African-Caribbean, Bangladeshi, and Pakistani origin, and Other BME, perceived the quality of local green space to be poorer (i.e. less safe, less attractive) and their visiting patterns varied significantly between winter and summer. In particular, low level of visits in winter was a significant determinant of poor general health. By comparison, the best health group (i.e. people of Indian origin) rated their neighbourhood more positively and felt greater levels of place-belonging than the other two health groups. For people of Indian origin, walking to a local urban green space was a predictor of good health, and they were much more likely to be accompanied by someone during visits (90%). The study identifies a clear correlation between self-reported general health and levels of use and perception of urban green space amongst BME communities and, consequently, points to a need for health policy to better understand how to foster positive use of urban green space amongst ethnic minorities throughout the year.
 
By exploring the differences in use and perceptions of urban green space by ethnic group, the study identified the need for urban planners to take into account the diverse usage patterns of minority groups. For instance, we know that young women of Asian-British origin will be more likely to visit local green space if they can find a space to be among women of their own ethnicity.  Park planners and recreational facilitators must therefore make a pronounced effort to understand these patterns of behaviour in order to better, and more appropriately, provide for BME groups. The study made clear the need for a culture of health specific to locality, race and ethnicity and the need for an intersectional approach to research – which is able to understand differences according to ethnicity, gender and poverty – to become the norm.

This op-ed is based on a new study by Jenny Roe and colleagues:

Roe J, Aspinall PA, Thompson CW. Understanding Relationships between Health, Ethnicity, Place and the Role of Urban Green Space in Deprived Urban Communities. Int. J. Environ. Res. Public Health 2016, 13(7), 681. doi:10.3390/ijerph13070681

It’s a sad fact, I’m afraid. Our cities don’t seem to be very good for us.

The isolation and mistrust in this anonymous note will be familiar to many who experience periods of low mood, anxiety or feelings of paranoia from time to time.

To understand the psychology that underpins a phenomenon known as the urbanicity effect – the higher prevalence of diagnosable mental distress and low wellbeing in cities, we, the Prosocial Place research team, have run a series of group walks through a 2-mile route of the South of our great city, Liverpool, collecting ‘data’ along the way.
 
At 16 stops along this reversible route from station to station, we asked our 48 participants to record their gut reactions to place, resulting in a rich resource of residential city sentiment. What’s interesting about this urban walk is that it transits some stark living contrasts and includes neighbourhoods, only metres apart, that are amongst the most different in terms of overt deprivation (confirmed by official Index of Multiple Deprivation statistics).  
 
In typical psychological science mode, this information must be rigorously analysed using complex statistical procedures so that we can be sure that we report only the findings that emerge as having a 95% likelihood of being ‘true’ or ‘real’. However, much of the richness of the walkers’ responses exist in what they say about the things they notice when they stop to consider how they feel.

Using a text mining software package called Sentiment Analysis, we were able to show how the way our walkers described ‘salient features’ – those things that catch our eye and grab our attention as we walk through places, correlate with the inferences we make about the characters of the people who live in those places. This tells us how poor place management speaks unjustified volumes about matters such as the trustworthiness and the amount of control that the residents of places have over their own lives.  This is psychology in action – where sensory information entering our central nervous systems provides the basis for ‘higher level’ decision-making and reasoning. In effect, what we are seeing is the operation of an automatic, evolutionary-selected process that tells us where we should go and where we should avoid if we want to survive.

Of course, the inferences we make about people on the basis of sensory information is based upon ‘quick and dirty’ heuristic reasoning which, in Nobel prize winning research, Daniel Kahneman tells us is often incorrect.

So, when we see cues to threat in the residential places of our cities, we make biologically and psychologically inevitable, but nevertheless likely incorrect, inferences about the people who live there. We were able to show this inaccuracy using a classic research technique of social psychology called the dropped letter method.

Our dropped letter experiment
During the months of November and December using careful methods to control for timing, weather and distance from post box, the undergraduate members of our research team ‘dropped’ Christmas cards in the two shopping lanes through which our walks passed, a relatively deprived and a relatively non-deprived area. The envelopes were addressed to consenting friends and families of the research team who reported how many of these cards they received in the post along with the details inside about where and when the cards were dropped. This gave us an objective snapshot of the ‘prosociality’ of the folk who live in these areas and use the two shopping lanes that differed starkly in terms of official deprivation statistics and contrasted greatly in terms of the sentiments they elicited in our walkers.

The results
In compelling contrast to the heuristically-driven decisions we make about the people who live in areas characterised by neglected fabric acting as cues to threat, exactly the same number of Christmas cards were returned from both lanes, demonstrating just how wrong our ‘quick and dirty’ reasoning can be when making judgment about the nature of a neighbourhood.

Unless we are those "lucky fucks and angels” that Pete Townsend sings of, who spend their time and money amidst the abundance of wealth and resource that marks our city centres these day, we live locally: we forage in our high streets and walk routes of our neighbourhood streets and parks with our kids, our friends and our dogs. But in resource- torn Britain we have made some curious choices about how we manage our urban ecologies – the places where we work, rest, and play. The residential, not retail or commerce, city has for the most part, been devastated from lack of management to the extent that we intuitively react to the lack of assets, signalling a lack of thrival and so a threat to survival. It looks like ‘the fittest’ have adapted by going to forage elsewhere.  It is they who live the thriving life of plenty and who wax lyrical about the culture and the opportunity that their city affords them. A Tale of Two Cities -  still. Dickens’s opening lines are spooky:
 
"It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way - in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only.”
 
That we have residential places in our 21st century cities that our biological system tells us we should avoid for our own good is surely a human rights issue and an international scandal (because Britain is not alone in this). By walking to understand and by placing the living environment at the centre of psychological study, we can begin to understand how and why we are so dramatically affected by the cities where so many of us now live. If,  by coming out of our research labs and onto the streets, psychologists and other researchers can influence equitable place-making policy for the common good, we will achieve something very powerful .

Rhiannon Corcoran, Professor of Psychology and Academic Director of the Heseltine Institute for Public Policy and Practice, University of Liverpool and UD/MH Fellow.

Graham Marshall, Landscape Architect, Urban Designer and Honorary Senior Research Fellow at the University of Liverpool and UD/MH Fellow.

Rosie Mansfield, Demonstrator in School of Psychology and postgraduate student, University of Liverpool.

Christophe de Bezenac, postgraduate student, University of Liverpool.

Katherine Overbury, undergraduate psychology student, University of Liverpool.

Ellen Anderson, undergraduate psychology student, University of Liverpool

The World Health Organisation has recognised that increasing urbanisation is reshaping urban population health problems, with depression expected to be the second leading cause of loss disability-adjusted life years by 2030. It is widely accepted that the natural environment has a positive effect on health and wellbeing and plays a role in disease prevention.
 
Nature in an urban environment can foster a sense of community which is key for improved health and wellbeing as connection with local community can reduce the risk of long-term health conditions such as depression, heart disease and increase life expectancy.
 
Since the 1950s, psychologists have recognised the importance of community for individual and group wellbeing by understanding human behaviour from both a social and physical environmental perspective. More recently, epidemiologists have shown how mental health outcomes are influenced by community connections, belonging, networks, social cohesion and social capital, therefore a sense of community is considered a preventative method to mitigate against psychological and physical illnesses.
 
Therefore, urban design should not just consider access to nature and green space but also the interactions that this can facilitate to encourage connection with place both with nature and community which is vital for health and wellbeing.

How can nature foster a sense of community?
 
In the field of community psychology, a sense of community has been defined by membership, influence, integration and fulfilment of needs as well as a shared emotional connection. Arguably these factors, particularly emotional connection, can be facilitated in green environments.
 
An experiment conducted by psychologists at the University of Rochester with virtual images, showed the more nature the study group were exposed to, the more likely they were to value emotional connections with other people and have increased generosity than those exposed to city views. Those that were not exposed to nature images were more focused on external goals such as increasing personal income. The research suggests that nature is significant in cultivating values that influence wellbeing and building a sense of community.
 
Why do humans need to connect to nature and community?
 
There are some theories that exist which aim to understand why interaction with nature has a positive impact on health and wellbeing. The biophilia hypothesis is a theory commonly referred to, particularly as increasing research through design practice shows the positive impact of biophilic design. However, the topophilia hypothesis provides a further suggestion to why interaction with nature is important in terms of fostering a sense of community.
 
The topophilia hypothesis suggests that humans possess a genetic bias to form bonds with local place which may have evolved due to the need to learn and share knowledge related to local nature for survival. It has been predicted that bonding with place is a critical element of mental health.
 
Further research is required to investigate the validity of the theory, however if significant evidence can support this, it would provide greater weight for urban design to encourage connection of place through nature and green space.
 
The challenge for urban design
 
Nature and green space in an urban environment could be viewed as the heart of building a healthy and happy community, as connecting with both nature and community is arguably an innate need we have as humans. However, green space is limited in urban environments.
 
Urban design needs to rethink how nature is integrated into our cities and ensure that the community is involved in projects that promote green infrastructure and urban greening to build a sense of community and place. Some inspiring initiatives are listed below:

• Biotope city: A concept that encourages the city to be seen as part of nature not as separate landscapes to address environmental, social and ecological issues; nature and urbanity can coexist together. This perspective recognises the calming impact nature has and unites community through education around urban gardening, farming, planting, providing outdoor space that builds a sense of place and community. A project is currently underway in Austria, Vienna.
• Walkable cities: There is an increasing body of evidence that shows walkable environments build a sense of community through increasing local connections and engagement with neighbourhoods. In London, Lea River Park is being developed, which includes the creation of Leaway Park; a walking route connecting previously separate public spaces.
• Community urban greening projects: Community ownership is key to embedding a project at a local level and increasing sense of place. In Portland, Depave support communities to reclaim pavement and replace with greenery and plants with volunteers. Parklets, (originating in San Francisco) create a social space with greenery in urban streets, benefiting both residents and local businesses, increasing a sense of community through social activity. 

 
Wellbeing can be constructed in our cities. In many urban societies, material wealth is traditionally viewed as the path to happiness: a wardrobe of disposable fashion, a better and faster car, a bigger house. We know that this isn’t necessarily a positive influence on wellbeing.
 
Perhaps through a greater focus on connecting with nature in our cities, we can build more resilient communities where everyone can have the opportunity to experience an increased sense of place and belonging in the world in which they live.
 
‘The happiest man is he who learns from nature the lesson of worship’
Ralph Waldo Emerson, ‘Nature’, 1836

A new digital edition of the book Unpleasant Design was published last month. We caught up with one of the editors, Selena Savic, to learn more about unpleasant design and its potential for positive and negative impact on mental health in the city.

You've just published a new edition of your book, Unpleasant Design. What exactly is 'unpleasant design'?
 
Unpleasant design is an approach to design that intentionally restricts the use of objects and spaces. It is thus not failed design, but rather, a successful, deliberate design to prevent certain behaviours. Often these design interventions are targeted to prevent behaviours that have not been formally banned, but that people may deem unwanted in public spaces. For example, while there may be no ban on people skating, hanging out, or sleeping rough in the city, these decisions can be made quietly between the contractor and the designer, without public participation. In unpleasant design, the decision is often hidden in the design.

Can you give us some examples of unpleasant design in the urban environment?
 
In the book, we divided unpleasant designs into unpleasant objects and unpleasant devices. This taxonomy brings on one side a large number of seating designs that prevent rough sleeping, obstacles to skating, anti-urinating corner installations, and surfaces that prevent attaching stickers and climbing. On the devices list, we include the infamous mosquito device (a high pitch buzz that annoys teenagers), blue lights (obfuscating veins and preventing intravenous injections), pink lights (emphasizing skin blemishes in teenage population to deter them from the area) and CCTV systems enhanced with facial recognition and motion tracking (thus theoretically capable of discriminating against skin colour, outfits and gait).

What are some of the ways in which unpleasant design in the city could impact people's mental health and wellbeing?
 
The most obvious link I see between unpleasant design and wellbeing is the prohibition of rough sleeping. While it is obvious that simply making a bench "unsleepable" is not in any way addressing the problem of homelessness (people don't stop being homeless because a bench is uncomfortable), this kind of design also sends a hostile and careless message to the whole population. Not only is it evident from interventions like this that social diversity and inclusion is not on the design agenda, but it is also okay to repel people like pests.

Does unpleasant design have particular impact on the mental health of certain groups of people?
 
Absolutely. Unpleasant design can exclude groups like teenagers or homeless people from spaces without any possibility for negotiation and without even questioning the ethics behind this. Some would argue that the solution is to create dedicated spaces, for example where skaters can safely perform their tricks without bothering others. However, imagine if this approach was applied to all groups that those making design decisions find incompatible with their own preferences for the use of urban spaces? What if homeless people were only allowed to be where other homeless people are; if square meters of publicly accessible space were allotted to youth based on their number in the area; if older people had no opportunity to be in contact with youth? How could a frictionless society function without the opportunity for negotiation between any of the conflicting entities? What would happen when they met somewhere by chance? Designing people out of space is particularly dangerous for young people as it deprives them from the possibility to learn and adapt to the society and to the needs of other people.

Are there any positive aspects to 'unpleasant design'?
 
I couldn't say that there aren't. Obviously, unpleasant design helps the majority keep the space in the shape they deem pleasant. Children can play in parks where benches are clean and free to use. People are not endangered by wild skaters running along urban furniture. Toilets with blue lights have not been possessed by drug addicts. However, I would like to stress once more that these benefits are only short-term and unsustainable. All these behaviours we design against will take place elsewhere. And the message of exclusion grants the right to people and institutions to create their own little oases of law, which is not always in the best interest of majority.

What are the messages from the book for architects and city planners?

We need to be able to negotiate the use of public space. We need to talk about unpleasant designs before we implement them. We need to make it very clear what unpleasant designs are against. Unpleasant design can also be subverted, as beautifully shown by artists and activisits whose work we published in our book.

Why did you decide to create this book?

At first, we wanted to collect examples of unpleasantness in public space and show that there is a language and an intention behind these. During this process, we learned about many other groups and collectives who were doing this type of work. We decided to create a compendium of designs and reflections on the topic, hoping to spur the debate among design professionals, city planners and other interested parties. We think we succeeded in that, as the book has proved to be a resourceful reading for anyone interested in the topic.

What's new about the new edition?

The new edition is digital only, and contains some updates and new stories. For example, there is an interview with a design office which explicitly specialises in unpleasant designs, Factory Furniture.

Finally, which is your favorite city and why?

 I like cities a lot. I don't have a favourite one. Lausanne is a very pleasant city, it treats people with dignity. There are very few instances of unpleasant design against homeless people (there are not many homeless people either, so that's probably why) and there is a general tendency to design public space for flexible use. The view on the lake is also winning over many other beautifully designed cities. Apart from Lausanne, I love the agitated relaxedness on the streets of Belgrade, the monumental fragmentation of venues in Vienna and other unique contradictions that appear in cities I have spent time in.
 
WHAT NEXT?

• Read more about unpleasant design here.
• Buy the book here.
  
• Think more about the pros and cons of unpleasant design in the context of our Mind the GAPS framework for urban design to improve mental health here.
  
• Contact Selena Savic on Twitter @jazoza
  

by Martin Knöll, Junior Professor at Technische Universität Darmstadt Department of Architecture in Germany, and head of the Urban Health Games Research Group, and Jenny Roe, Professor of Design and Health and the Director of the Center of Design and Health at the School of Architecture, University of Virginia in the US.

“Hey, what’s going on here?”
 
A pop-up Pokemon Go event on a street corner in Edinburgh was causing a real buzz last week among young people on a hot summer day, stopping to chat and take in a glass of ice-cold lemonade. The success of Pokemon Go is gigantic and it is good news for health and urban design. Specifically, if we - users, developers and urban designers /researchers - begin to collaborate on how we can use AR (augmented reality) gaming to design our cities for active engagement amongst our sedentary populations, particularly young people.

Young people playing at a Pokemon Go Gym in Darmstadt’s central park Herrngarten.
Source: Martin Knoll.

It seems obvious that there is an immediate effect of gaming on many players’ daily activity, social interactions and mental wellbeing.  Many of the tweets at #PokemonGo testify how this is happening in synergy. 

Source: Twitter

More research will be needed to show how intense the physical activity really is, how it is determined by players’ age, gender, health disposition and usual activity patterns, and the strength of the social and mental wellbeing benefits. Also, it will be interesting to see how the hype and the intense usage will translate to change long term health behaviours and motivations.
 
But the Pokemon hype is really good news as it helps to change peoples’ attitude towards the quality of physical places and (potentially) offers potential to use digital technology to plan, design and maintain our cities for health and wellbeing outcomes.

People spend more time outside gaming, not only watching on the smartphone screen, but also interacting with their surroundings off-screen. We have found that players interact in various ways with their smartphones and physical surroundings while playing an AR game:

Participants of the AR game Stadtflucht while following a breathing exercise on the River Main harbour (a,b,c) running a slalom (d,e,f) and finding objects to capture. (Source: Knöll, 2016).

After playing the game prototype for 30 min, users reported they were more aware of their environments, and had discovered new features in the environment, prompting excitement and curiosity (Knöll 2016 & Halblaub Miranda and Knöll 2016). Curiosity is an integral component of mental wellbeing linked with motivation and meaning in life. Learning to see places differently, being curious as we navigate our everyday environments, ‘taking notice’ can all help catalyse mental wellbeing .
 
In order to make the most out of this hype for health, though, how best can developers, users and researchers collaborate to analyse how people use and interact with their physical environment in game? Where do they enjoy playing? Where are the challenges?  What places are people hesitant to visit and pick up a Pokemon? Where do people fear? What do the they think of the places? The game developer, Niantic’s first game Ingress motivated players to exercise in their every day life by combining the history and accessibility of urban environments with a virtual story. It was the first commercial success of games, in what may be called an “urban exergame”(Knöll, Dutz, et al. 2014). It was already known to generate much data on where people move and spent time. It was hypothesised that this information was also used to optimize the functionality of Google maps (Purdy 2014)
 
We have used tools such as apps and location based games to gain data on how users perceive their places and how they engage with the urban environment. These prototypes were experimental, but still showed potential to gain more spatially detailed, age specific data from users that would usually participate in co-design events (Knöll 2016 & Halblaub Miranda and Knöll 2016). Can you imagine what we could do, if we could develop these tools together and analyse the data that is being collected by millions of users in cities world wide?
 
Pokemon Go has made a huge step from Ingress in this respect. Players seem to spend more time with a Pokemon while being in a real physical space. It has also been reported that a lot of the social interaction around Pokemon Go takes place informally outside of the game and in physical sites (Webber und Brewster 2016).
 
Such a process, of course, would have to include users in a participatory design process. Also, it would have to balance game experience with the real world planning content. But, there is first approaches that show how this may work. What is missing is new collaboration between research and IT companies. This success story of Pokemon Go is to bring people out and about, as witnessed on our street corners this summer. In order to make it more sustainable – for both game engagement and positive health and wellbeing outcomes, there needs to be a discussion on how users may allow research to access data to identify and visualize how the physical environment can be improved to boost walkability, stress recovery, social interaction and playing smartphone games in public spaces.

Whilst the media is flagging cautionary tales about Pokemon Go, does the game really pose any more risk than texting whilst walking? Is allowing our young people to adventure forth into adventurous space really posing a threat to their wellbeing? Surely – whilst urging sensible precautions – we need to allow our young people the right to roam as ‘free rangers’ in our cities?

Halblaub Miranda, Marianne, und Martin Knöll. „Stadtflucht - Learning about healthy places with a location-based game.“ Navigationen - Zeitschrift für Medien und Kulturwissenschaften, 2016. http://dokumentix.ub.uni-siegen.de/opus/volltexte/2016/1004/pdf/Navigationen_Playin_the_city.pdf
 
Knöll, Martin. Bewertung von Aufenthaltsqualität durch Location-Based-Games - Altersspezifische Anforderungen in der Studie "Stadtflucht" in Frankfurt am Main.“ Herausgeber: Gesine Marquardt. MATI Mensch - Architektur - Technik - Interaktion für demografische Nachhaltigkeit. Dresden: Fraunhofer IRB, 2016. 266-77. https://www.researchgate.net/publication/284725664_Bewertung_von_Aufenthaltsqualitat_durch_Location-Based-Games_-_Altersspezifische_Anforderungen_in_der_Studie_Stadtflucht_in_Frankfurt_am_Main
 
Knöll, Martin, Tim Dutz, Sandro Hardy, und Stefan Göbel. „Urban Exergames – How Architects and Serious Gaming Researchers Collaborate on the Design of Digital Games that make you move.“ In Virtual and Augmented Reality in Healthcare 1, Herausgeber: Minhua Ma, Lakhmi Jain, Anthony Withehead und Paul Anderson, 191-207. London: Springer, 2014. http://link.springer.com/chapter/10.1007%2F978-3-642-54816-1_11
 
Webber, Jordan Erica, und Kate Brewster. The Guardian. 18. July 2016. https://www.theguardian.com/technology/2016/jul/18/pokemon-go-uk-developers-augmented-reality (Zugriff am 25. July 2016).

Trees present an excellent opportunity for planners to help enhance urban mental health and wellbeing. But choosing the wrong trees can be more detrimental to urban communities than having none at all. To make the most of urban green spaces, both tree characteristics and spatial thinking need be considered early on in the planning process. In this article, we will explore common challenges in choosing trees in urban design and how five tools can better support planning and build more vibrant, healthy urban communities.

The ‘wrong trees’ can do more harm than good

These tools are important because despite the best of intentions, implementation problems often occur at the neighborhood scale when the ‘wrong trees’,  or trees unsuitable for a place’s specific urban variables, are brought into the built environment. For example, city planners plant beautiful Ginko bilboa trees along local roads to contribute to the city’s beautification project. The intention is to increase shade, safety, health and happiness across the local community - all laudable aims. However, over time the trees grow too large for the city’s infrastructure and budget. The branches begin to destroy electrical lines, crack underground water pipes, fall onto cars during winter storms, and litter pounds of smelly fruit every spring. The city  becomes frustrated and cut down the trees... only to replace them with smaller, younger Ginko trees. So where did they go wrong?

How to choose the ‘right tree’ for mental health, wellbeing… and for tax dollars

In the US, the Arbor Day Foundation advocates The Right Tree in the Right Place framework, emphasizing that proper planning is vital to achieve the outcome of healthy urban green spaces. They describe trees that will “cool your home in summer and tame the winter winds… grow well in the soil and moisture of your neighborhood… be properly placed to avoid collisions with powerlines and buildings.” Furthermore, thousands of city tax dollars can be prevented in sidewalk and electrical repairs if planners match trees to the urban locations in which they will be planted.

Tree characteristics to consider for sustainable urban design:

• Height, canopy spread, form, and shape
• Growth rate
• Soil, sun, and moisture
• Fruit
• Temperature extremes in your region - hardiness zone
• Urban variables (soil compact, road salt, contained space, toxicity to pets, etc.)
  

Tool 1: Tree Finder Wizard (for the US)

But how to identify the right tree for a particular location? For instance, a local coffee shop in New York City wants to plant a few trees above the front patio to give customers shade. But there are electrical lines 50 feet above ground, there’s limited planting space for roots, partial shade, and the northeast winters are harsh. So what should they do?

One helpful tool they can use is the Tree Finder Wizard tool, developed by the American Arbor Day Foundation. This tool identifies the right tree species for any community in the US based on the variables of zip-code, soil, height, growth rate, spread, and aesthetics desired (fruit, evergreen, deciduous, etc.) | website

Tool 2: National Tree Benefit Calculator (for the US)

The Right Tree Right Place framework is an important first step towards using trees to help achieve healthier communities and more impactful outcomes. However, getting the information and facts to the right people is another challenge. Evidence of economic improvement can form a persuasive argument that helps turn ideas into action. Whether it’s city officials, policy makers, neighborhood HOAs, or school principals who need to be persuaded, the free National Tree Benefit Calculator is an effective tool to communicate specific economic benefits of urban trees and diversity of tree populations. While it does not yet consider health benefits, it calculates the monetary benefit of trees based on tree species, age, and size based on potential improvements in stormwater, property value, energy usage, and air quality |  website

Tool 3: Google’s SketchUp

However, city planning doesn’t only mean city effort. Local non-profits, businesses, and homeowners can too create designs for public spaces, backyards, and community gardens using the right tree right place framework and free 3D spatial design tools.

SketchUp is Google's free design software. It incorporates a few landscape templates to help get a project started. In SketchUp, one can upload a photo and create objects from scratch easily on a laptop to help plan tree design within a given landscape. | website

Tool 4: Garden Visualizer

The Marshalls Garden Visualizer lets a beginner user design a garden or small public space with stunning 3D quality. Photos of community structures and buildings can also be uploaded and displayed in the backdrop | website

Tool 5: Mappler K2

Predicting future trends and integrating community input early on into the design process are challenges that city and regional planners encounter regularly. Where do community members want more trees? In what areas do we need more trees to improve safety, mental health, and healing? How can a city streamline input and provide effective solutions? Mappler is a free crowdsource mapping tool and a mobile data collector app to easily conduct assessments and identify community needs across a city scale. It is a tried and true tool to collect diverse inputs on a large scale to help identify community issues, needs, and successes. | website | community asset mapping

A prime example of the use of Mappler was in New Jersey where local residents entered the location of road potholes. Local officials then used this input to prioritize areas of operation and improve road conditions. When each road was fixed, they were able to input a comment to notify the public that the issue they identified had been fixed.

This same process can be used for identifying other community needs, for instance the tracking and maintaining of urban forests as demonstrated by Casey Trees in Washington DC (online map).

These tools can contribute to smarter urban planning that will achieve the wide range of positive impacts - and help avoid the unintended pitfalls - of planting trees to improve community life.

Do you have a great tool to suggest? Please add a link and description in the comments section.

What is the 'New Urban Agenda'?

In October, countries all over the world will be adopting a 'new urban agenda' at the Habitat III meeting in Quito, Ecuador. The New Urban Agenda “will drive the achievement of the 2030 Agenda for Sustainable Development, especially Goal 11, of making cities and human settlements inclusive, safe, resilient, and sustainable”(Preamble,p.1). After extensive input from a wide range of consultations, issue papers and policy papers, a New Urban Agenda (Zero Draft) has recently been released. This is the first draft of a global framework of actions for housing and sustainable urban development that will continue to be commented on, discussed and revised until the Habitat III meeting where a final version will be agreed upon.

What's in the UN's Zero Draft?

The Zero Draft document consists of a declaration on Cities for All, and an implementation plan for the New Urban Agenda: transformative commitments for sustainable urban development; effective implementation; and follow-up and review. The Zero Draft delineates a vision of sustainable urbanization that is people-centered and promotes equality and inclusion for all, including women, children and youth, older persons, persons with disabilities and people in vulnerable situations, such as refugees, migrants and displaced persons. The draft document stresses the need for access to adequate housing, quality public space, public goods and services, livelihoods and work. “We envisage cities and human settlements…putting people in the center, and offer quality of life beyond the mere provision of infrastructure and services.” (5(a), p.2)  It also calls for the design of cities resilient to natural and man-mad hazards, and underlines the importance of participatory processes in the formulation, implementation, monitoring and budgeting of urban policies and plans.  

Where is mental health in the New Urban Agenda and the Zero Draft?

So where does mental health fit into the 175 paragraphs of the document? Cities that commit to working towards implementing the New Urban Agenda vision will, in developing inclusive, safe, resilient and sustainable urban environments, also promote and sustain the physical and mental health of their inhabitants. Indeed, well-being and health are mentioned throughout the document, underlining the interaction between the urban environment and health:  “Cities are human creations, places in which we aspire to enable inhabitants to lead peaceful, healthy, prosperous, and free lives with full respect of human rights for all”(p.1). The city proposed by this draft is sensitive to such elements of urban life that may impact well-being, addressing discrimination, equitable access to resources, adequate housing, public spaces and opportunities for work. 

What does the Zero Draft say about urban planning and design for better mental health?

The important role of urban planning and design in influencing behavior and determinants of mental health is specifically stressed in the Zero Draft: “spatial organization, patterns and design of urban space together with development policies can promote or hinder social cohesion, equity, and inclusion, as well as the reduction of poverty and hunger.” (A22, p.5) Public space in particular is noted for its potential role in influencing human behavior and well-being by "enhancing social interactions and political participation, promoting socio-cultural expressions, embracing diversity, and fostering safety and social cohesion” (5e, p.2)  Green public spaces are underlined for their “positive impacts on health and well-being”(71, p.10)  as well as for their provision of ecosystem services. The draft also considers elements of city design that can impact people's emotional and social lives by enhancing or impeding access to goods, services and opportunities: for instance, whether a person can reach work, health care centers, or healthy food; enjoy a walk in the park; and interact with others in a safe neighborhood.

Participatory processes are mentioned multiple times for their role in generating a sense of belonging and ownership of the city, which help promote civic engagement and a sense of empowerment.  The draft is clear that city dwellers should therefore have the opportunity to participate “in the formulation, implementation, monitoring, and budgeting of urban policies and plans, strengthening effectiveness, transparency, and accountability." (5g, p.2)
 
As urban populations grow, the need to research, design and maintain cities that support the physical, social and emotional needs of its inhabitants will continue to be an important task.  The Zero Draft of the New Urban Agenda underlines relevant issues needed to address in this endeavor and calls for global commitments to make urban life better for all.
 
The Zero Draft and most updated revisions can be found at: https://www.habitat3.org/zerodraft where you can provide feedback to them until 7th July.

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

What exactly is public life, and why does it matter to mental health? That is the question I sought to understand when I participated in the Gehl Institute's Act Urban conference in Philadelphia, US last week, focusing on ‘public life’.
 
Jan Gehl himself presented an argument of ‘urban invitations’. His premise is that people interact with their built environments based on the invitations that our environments extend to us. Great, continuous bike lanes invite us to cycle to work. Wide, attractive sidewalks invite us to walk. Benches invite us to sit, rest, and interact. Parks invite us to play and run. And roads invite us to drive. When it comes to strategically designing cities, the question Gehl poses is: who do citymakers really want to invite… and to do what? The answers enable more strategic planning for the cities we want.

Gehl describes his utopian city as safe, democratic, friendly, healthy, beautiful, livable and lively, a city that would prioritise pro-social interaction, where city dwellers feel part of communities, exert positive agency on their environments, and participate actively in so-called ‘public life’.
 
Many of his aspirations have important parallels with the growing research on how to design better mental health into a city. Here at the Centre for Urban Design and Mental Health we recently developed an evidence-based framework called ‘Mind the GAPS’ that helps consider opportunities for urban design for better mental health, where GAPS stands for green, active, pro-social and safe places. Good public life, as envisioned by Jan Gehl and the Act Urban delegates last week, has much in common with these principles: prioritising access to parks and green space, delivering opportunities for exercise and learning, developing communities that foster good social capital, and improving a city’s safety can all have positive impact on a city's mental health.

As part of Act Urban, UD/MH held a workshop on urban design for mental health where delegates from such diverse provenance as Google, AirBnB, architecture firms, Kaboom! children’s play organization, and public art projects assessed a local city street for the feelings it evoked – and proposed intuitive improvements to reduce stress, depression and anxiety (recognising that spaces are systems, and addressing one element in isolation is of course not always the most helpful approach). The results were varied: better use of design and building materials to reduce unpleasant sound, reduction of confusing visual ‘clutter’ in streetscapes, installing street benches to invite sitting and socialising, and introducing colour and ‘adventure’ opportunities to engage children as they walk along a busy street. Workshop participants cited lack of eye contact as a potential inhibitor of pro-social interaction and wondered if there might be a role for urban design in triggering eye contact in an appropriate way to help catalyze positive social interactions.
 
Perhaps the most interesting part of the discussions for me was the question of how to practically achieve a city that promotes better public life and mental health. Designers, planners and developers can help educate, create demand and produce great projects – but ultimately, practical delivery means bringing a diverse range of stakeholders on board: the community needs to demand it and contribute, the clients need to want it, and the policymakers, financers, real estate brokers, regulators, garbage collectors and even the fire department all need to be ready to facilitate the practicalities of a grand vision becoming a great public place.
 
Engaging these different people is important because as Gehl emphasizes, ‘half-hearted infrastructure’ is not enough to persuade people that our city genuinely means the invitations it seems to extend to us. Inviting us to bike means system changes to make biking a fast, cheap, safe option, integrated with other public transit systems. Inviting us to walk means ensuring there are pedestrian walkways and good sidewalks that continue across small side streets, wide and shady, with safe crossings. And inviting us to participate in public life needs to be an invitation extended to whole communities, inclusive of diverse socioeconomic status, race, ethnicity, mental or physical health, sexual orientation, and any of the other myriad differences that make up every great city population.

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.

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

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

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

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

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

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

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

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

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

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

Key policy implications proposed by the report

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

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

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

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

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

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

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

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

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

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

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

by Claire Malaika Tunnacliffe
PhD student, Bartlett School of Architecture, London UK

With billions of people on the planet, the majority of us now live in vibrant, urban centres. And every single one of us will experience our city it in a different way. There may be similarities in how we choose to move – walking, running, bus, underground, train, cycling -  each of these motions creating a rhythm, but the pace at which we move, the frustrations we will encounter and how we will react to these, the people we will meet, the detours to our local shops we will make, the things we will buy, will be individually ours. Our daily flows are uniquely ours, and the constant is our mind, our internal dialogue.

Through these flows we move within a backdrop of street messages, a constant beckoning from the sidelines of our lives, occupying almost every inch of these surfaces, a cacophony of adverts to make us more attractive, more successful, to eat cleaner, leaner and meaner, to own the latest gadgets and cars, what books to read and what films to see. It can often feel, like we live in an age of distraction. These encounters foster few opportunities to pause, to be self aware and check in with ourselves, but rather create a more critical voice – why aren’t we more of something or other or everything?
 
Among these, there are the tags, the graffiti and street art. Using stickers, paste-ups, posters, sharpies, pens and spray cans, these straddle an illegal and legal divide. Orchestrated by individuals and communities alike, their intention and agency varies, their messages political, environmental, economic or social, individualistic or revolutionary. These moments act as retorts, a response and a confrontation. But they also forge lines of connectivity, of empathy and of dialogue. These creative sites, both surfaces that have legal permission to be painted on as those that are illegally appropriated hold an important value in our current societies – they provide a valuable opportunity to understand how a place feels. 

It is in the existences of spaces which allow for expression and vulnerability that we begin to create emotional and compassionate spaces. These spaces, from the large blank wall to the corner of a bus stop, pose questions, left to be answered or simply to be witnessed. From the large murals created by artists, to the scribbling of a name, ‘i woz ere’, or a swear word, these are acts of creative place making – born out of a desire to leave a trace and occupy space. These create social interstices, pauses in our everyday routine that open up lines of connectivity.
 
It is in the opportunity to be allowed to state how a person feels, through the cathartic process of letting it go in a space, for it to be empathically received by others. It is in the large murals, which foster community engagement and wellbeing. It is in the opportunities to be creative, and to pause in the humdrum routine of everyday life.

Having these lines of connectivity means breaking a long standing taboo around discussing how we actually feel. When we embed this into the very fabric of our urban environment, the very fabric which is all too often a cause of our mental health issues, we can begin to see a catalyst for real change – for raised awareness and understanding, and in bridging the gap between people. Art is a powerful tool for transformation, and when its messages are taken into the streets, into the environment in which our daily lives play out, art becomes an opportunity to interact and create new lines of understanding. By grabbing a spray can, a pen, or a paint brush, we open a space for self-expression and vulnerability, but also for a sense of place and belonging, to be seen and heard. When we begin fostering these dialogues on mental health, we allow for the opportunity to heal and grow together. In this way, we move away from talking about mental health as a purely individual experience to recognise that it is also a collective experience.

I am fascinated by the space in between these two spaces, one which is not defined as illegal or legal but just a free flowing space, open, available. Does it really exist? The danger of having to define everything as an either/or; right or wrong. And what if things just were? There is something to be said about the importance of uncontrolled zones of self-expression in public, in being able to grab, pen, spray can or chalk and just express. With an increased number of mental health services shutting down in London, and accessibility becoming increasingly difficult and expensive, I believe that a part of this, however big or small, is creating opportunities for people to be seen, heard and witnessed. I have far more questions than answers at this stage of my research, but I believe that it is in both designing for spaces in as much leaving the opportunity for these spaces to emerge naturally, in tune with how a place feels and flows. It is a combination of an uncontrolled, free space of expression alongside opportunities to express more clearly in public spaces – needs, desires, worries, pain, that contribute to the wellbeing of our communities and our urban spaces.

by Sharon VanderKaay

Public health hazards often hide in plain sight. Up until the early 1970s, shoe stores commonly performed foot x-rays as a sales gimmick. Smoking on airplanes was considered acceptable by the public until the 1980s. Not long ago, the odd person who expressed concerns regarding toxins, pollution and junk food was dismissed as a “health nut.” That these things are harmful to our health may appear glaringly obvious today, but I can remember when their consequences seemed either vague or invisible.

Widespread tolerance for health hazards tends to linger for decades after alarming evidence begins to emerge. We are still in the early days of asking questions about the immediate and cumulative mental health implications of dismal, soulless and energy-draining built environments. It may be many years before the full impact of consuming a steady diet of visual junk food will be known through in-depth research. Eventually we may have hard evidence that links anger, depression and crime to growing up in a visually deprived setting. It’s possible that these effects might even be measured and reported on some future Asphalt-Anger Index.

In 1982 two social scientists introduced the broken windows theory which aimed to show a link between what people see and anti-social behavior. Their theory stated that negative activities are deterred when visual signs of deterioration are replaced by signals of caring about a place, such as the repair of vandalized windows. Recent research by Sanford DeVos and Chen-Bo Zhong indicates that exposure to fast food signs impede people’s ability to experience happiness. Much urban health research at this point has been focused on identifying sources of pathology (what causes dis-ease) rather than what conditions actively cause well-being (that is, not just the absence of dis-ease or to “do no harm”). Currently, Colin Ellard is doing exciting research regarding the neuroscience of urban design in terms of both positive and negative implications. Ellard writes for a diverse audience on how the places we inhabit affect our minds and bodies.

While a critical mass of scientific evidence is being conducted, we can also take advantage of low tech, low cost approaches to accelerate public demand for places that nurture our psyche. For instance, through the use of facilitated walks, informal conversations, photo essays and short explainer videos, we can change what people expect from their public spaces. An important aspect of awareness-raising is the movement to democratize design by making urban design issues relevant and interesting to a wider range of citizens, rather than relying on dense planning jargon and remote theories.      

Soon I will be leading my fourth Jane’s Walk on the theme of becoming a better critic. Jane’s Walks happen through volunteers in 85 cities in 19 countries. Launched in Toronto in 2007, these walks are an ongoing tribute to the memory of urban activist Jane Jacobs, building on her spirit of neighborhood awareness and advocacy. During my particular walk we analyze what we see in terms of the city's vital signs: variety, nature, authenticity, legacy and energy. Similar to art history appreciation, these inquiry-based, “moving conversations” give participants a framework that encourages them to diagnose how they feel in their own habitat.

Other approaches to raising awareness for elements that contribute to urban mental health are example-filled videos and photo essay “slide explainer” presentations. The slide explainers highlight specific elements of healthy urban places such as public seating, public markets, and street level animation.       
Together these human-to-human communication efforts are aimed at cultivating better critics and citizen advocates. Their simple message is that anyone can learn to see how places make them feel.  

Nélida Quintero is an environmental psychologist, licensed architect, and American Psychological Association NGO Representative at the United Nations. In the first of a series for Sanity and Urbanity, she explains the upcoming UN Habitat III process and where mental health fits in.

Why the UN is so interested in cities

People are moving to cities in ever-increasing numbers around the world.  Cities provide opportunities for work, and access to better services and education.  Higher population densities attract greater investment, so resources become more centralized.  While years ago, decentralization and distributed workforces and services seemed to be a growing trend in developed countries, the conversation on human settlements globally has been recently centered more on mega-cities and urbanization, as increasing numbers of people move into cities.  By 2050, 66% of the world’s population is expected to live in urban areas, according to the United Nation’s’ World Urbanization Prospects Highlights (2014).
 
Cities benefit from the concentration of human labor and talent and present a more efficient way to invest capital, given that it may be more efficient to direct financial resources to a smaller number of large hospitals, work centers or schools to serve many than to distribute such resources to multiple smaller hospitals, work centers and schools distributed in lower concentration settlements, for instance.  Thus, regional development that emphasizes investment in smaller towns or villages may be more difficult to finance for many countries.   The greater availability of jobs, health services and educational opportunities attract people from areas where such services and opportunities are scarce, such as smaller towns and rural areas. Though around half of urban dwellers currently live in cities of 500,000 inhabitants or less, by 2030, there will be 41 mega-cities with more than 10 million inhabitants, according to the United Nations’ projections.  
 
There are many positive aspects to city living that support physical and mental well-being and health, such a greater availability of resources and opportunities, but as cities grow and the demands of the available resources increases, conditions develop that might have an uneven negative impact on urban populations.  Planning and designing cities that grow very rapidly can be challenging. Overcrowding and uneven accessibility to resources, among other issues, can lead to environments that can undermine well-being and health. 

The UN is currently talking Habitat III - but where did it come from? What were Habitat I and II?

This continually accelerating process of migration into cities and towns and increase in urban populations, was already recognized in the 70’s by the international community.  Given this rapid process of unplanned urbanization, which was particularly noticeable in developing countries, the need for sustainable urbanization approaches became clear, which prompted the United Nations General Assembly to convene the first Habitat conference in Vancouver in 1976.  At this conference, the creation of the United Center for Human Settlements (UNCHS-Habitat), now the United Nations Human Settlements Programme (UN-Habitat) was proposed.  The Second United Nations Conference on Human Settlements, Habitat II, took place in Istanbul, Turkey in 1996.

So when is Habitat III and what will happen?

The Third United Nations Conference on Housing and Sustainable Urban Development, Habitat III, will be held in Quito, Ecuador from October 17th to October 20th.  At this meeting, UN countries will agree on a New Urban Agenda, based on the Habitat Agenda developed in Istanbul in 1996.  The New Urban Agenda will serve to guide the process of urbanization worldwide, informed by a long preparatory process.  As part of this process, experts from around the world have drafted 22 issue papers and recommendations from 10 policy units, currently accessible for review on the Habitat III website.  

Each issue paper looks at researched topics related to the urban environment, underlining conditions that may need particular attention and guide policy recommendations developed by the Habitat III Policy Units.  In turn the Policy Units have drafted ten policy papers that will inform the development of the New Urban Agenda to be completed and reviewed in Quito. The Policy Units are made up of 20 experts each, representing different geographic areas and constituencies. These experts were nominated by Member States and stakeholders and appointed by the Secretary General of the Conference, in consultation with the Bureau of the Preparatory Committee for Habitat III.  The objectives of the Policy Units are to explore research and highlight expertise and findings on specific themes, and draft policy recommendations relevant to these themes that address approaches toward sustainable urban development.
 
The six areas addressed by the 22 Issue Papers are focused on:

• Social Cohesion and Equity –Livable Cities
• Urban Frameworks
• Spatial Development
• Urban Economy
• Urban Ecology and Environment
• Urban Housing and Basic Services.

The ten Policy Papers are:

• The Right to the City and Cities for All
• Socio-Cultural Urban Framework
• National Urban Policies
• Urban Governance
• Capacity and Institutional Development
• Municipal Finance and Local Fiscal Systems
• Urban Spatial Strategies: Land Market and Segregation
• Urban Economic Development Strategies
• Urban Ecology and Resilience
• Urban Services and Technology and Housing Policies.

Member states and other stakeholders involved in the process continue to provide comments and input on these papers.

Where does mental health and wellbeing fit into the Habitat III papers?

While the importance of accessibility to health services, the interaction of health and the environment, and the beneficial impacts on health of sustainable approaches feature prominently in the Issue and Policy Papers, terms such as mental health or mental illness, psychological health or well-being are not used as frequently - though mental health and well-being are addressed in connection to urban conditions and stressors, such as inadequate urban infrastructure and income inequality.  The Issue Paper on Public Space, for instance, refers to the research connecting green space to mental health and stresses the need for inclusive, connected, safe, and accessible public spaces.  The importance of providing, as well as maintaining, green public spaces to enhance health is also highlighted in the Urban Spatial Strategies: Land Market and Segregation Policy Paper. The Inclusive Cities Issue Paper recommends developing strategies that enhance well-being for older persons and that relate to healthcare accessibility and safety, financial security, and age-friendly features in community life and entertainment.             

Some of the research on the interaction of physical places and mental well-being is mentioned in the Housing Policies Policy Paper.  In the notes, it refers to a paper entitled Housing, Health and Happiness by Cattaneo.  In Cattaneo’s paper, improvement of housing conditions through the replacement of dirt floors with cement floors in Mexico, was correlated not only to fewer infections, but also to lower rates of depression and perceived stress, as well improvements in cognitive development and increased satisfaction with housing and quality of life, underlining the impact the physical characteristics of housing can have on health and well-being.

So what happens now?

The first draft or Zero Draft of the New Urban Agenda is expected to be completed in May, 2016 by the Habitat III Bureau and the Secretariat, ahead of the conference in Quito.  In the meantime, the preparatory process involves various events and regional meetings around the world.
 
For additional reading and information:
www.habitat3.org
www.citiscope.org
www.esa.un.org/unpd/wup/highlights/wup2014-highlights.pdf 

by Ingrid Bremer, UD/MH Associate
 
To coincide with World Happiness Day this week, the latest World Happiness Report has just been published. The Report surveys people in 156 countries to better understand the national and regional distribution of 'happiness' and identify global 'happiness inequalities'. Of course 'happiness' is a complex term - the report defines it as an evaluation of self-reported quality of life satisfaction. Six key variables were used to help explain international variation in happiness: GDP per capita, social support, healthy years of life expectancy, freedom to make life choices, generosity and freedom from corruption.

Countries found to have the highest ranking of happiness (2013 – 2015) included Denmark (1), Switzerland (2), Iceland (3), Norway (4) and Finland (5). The countries with the lowest rankings of happiness were Benin (153), Afghanistan (154), Togo (155), Syria (156) and Burundi (157). Full results here.

While the World Happiness Report does not measure mental health per se, the Report has some interesting findings. Social support, income and healthy years of life expectancy were found to be the largest contributors to the differences in happiness between the top 10 and bottom 10 countries. In particular, the underlying social fabric of a society, including quality of social capital, was found to be integral to resilience in the face of a crisis, such as an economic crisis or natural disaster; indeed, in the event of such a crisis, the Report suggests that where there is good social support, people’s happiness may actually increase as a function of being able to work together with others towards a common good.
 
The rise in scientific and policy interest in sustainable happiness is evident. Countries such as Bhutan, Ecuador, United Arab Emirates and Venezuela have even designated ministers to coordinate their national efforts, and the concept of achieving ‘happy’ populations is increasingly a focus of citymakers around the world. By underlining the importance of good social support in achieving population-level happiness, this Report shows the potential for urban designers to play an active role in helping improve happiness in communities through pro-social design that enables opportunities for positive social interactions among local communities. This #WorldHappinessDay that's worth thinking about.

by Graham Marshall
Prosocial Place Programme

On 23rd February 2016 Graham spoke at the UD/MH  Dialogue and launch of the Journal of Urban Design and Mental Health at the Wellcome Trust in London. This is the transcript of that talk.

by William Heard
Chicago School of Professional Psychology, US

By the year 2030 more than 70% of the population will be living within densely packed cities across the world. While living within groups has been a staple of our society, beginning with the early cavemen, there has been a shift in the environments that we call home. Over the course of the last few centuries, we have begun creating environments that are more organized, and packed with more people than ever before. Densely-packed cities are one example of the environments that we have cultivated in order to help deal with over-population. These cities bring with them a host of positive attributes to our health and well-being. For instance, James Hamblin (2014) mentions that cities that contained more compact street networks also showed lower levels of obesity, diabetes, high blood pressure, and heart disease.
             
However, along with the positive physical effects, research has shown countless negative effects on a person’s mental health. One such effect comes from the never-ending amount of stimulation that the body receives from walking around in the more densely packed areas of the cities. This stimulation puts a relentless demand on our ability to pay attention and process information. Sullivan and Chang (2011) state that if a person does not receive respite from stimulation, their brains will become fatigued to the point where they become inattentive, socially withdrawn, irritable, impulsive and accident prone. Similarly, chronic noise pollution can also contribute to children's behavioral problems in schools and daycare centers around the world. Furthermore, in the book Happy city: Transforming our lives through urban design, Charles Montgomery found that psychotic disorders, including schizophrenia, were the most common in neighborhoods where the people had the thinnest social networks. Along with schizophrenia, older adults who lack strong social ties show higher rates of mortality, suicide and overall decreased health.
             
Isn’t it contradictory to create spaces that are meant to be as efficient as possible when those very places are actively preventing us from reaching our peak? Luckily, along with the research on how our mental health is influenced by the environment we live in, there has also been a ton of research on how to counteract the negative influences. While the number of proposed approaches are endless, a few show promise in promoting positive environments for mental health.

One of those ideas uses green and blue spaces within urban environments to decrease stress and mental load. Wells and Evans (2003) found that the impact of life stress lowered among children who lived in neighborhoods that had natural settings. This buffering effect was replicated with adults and the elderly as well. Wells speculates that green spaces increase variability in an urban setting, thereby moderating the over-stimulation effects if people are able to see them.

Another possible explanation could be that natural settings inspire people to mingle and build social connections, thus bringing us to another well-established resiliency factor that decreases the negative effects of the urban environment. While the way we interact with our built environments is important, our overall resilience appears to come from social connections that we form and the natural settings that foster them. Social networks and the perception of social belonging and support are a buffer against depression, anxiety, and other adverse consequences that come along with living in environments that cause mental fatigue. It appears that realtors' “location, location, location” mantra has more to it than resale value; Montgomery (2013) found that the person’s social ties could be determined by the distance they traveled for work, and that the farther you travel, the less of a network you create. More specifically, it appears that people whose commute more than 45 minutes, one way were 40% more likely to get a divorce, showing that social ties aren’t just important for your overall mental health; they can also impact relationship vitality.

Much like New York’s High Line park, Chicago’s answer to the lack of green spaces within the city was to build the 606, an elevated walkway that features greenery, parks and other outdoor activities for the community. Another option is to build below. Having run out of room to build green spaces above ground, New York also created an underground park that uses filtered light to grow a natural setting.

Major cities in the United States are doing their best to find unique ways to address the unwanted mental health effects of urban settings. I am curious though: do you feel they are doing enough to foster resilience within their populations, or should they being doing more? What potentially odd but creative ideas do you have?

by Katarzyna Klijer, UD/MH Associate

The Centre for Urban Design and Mental Health's second dialogue took place in London with  five diverse speakers each talking for five minutes about their particular perspectives and experience at the nexus of urban design and mental health.
 
Layla McCay, the Centre’s Director, launched proceedings, and also launched the new Journal of Urban Design and Mental Health, on the theme of conscious cities, including a rather delightful video to introduce the topic.

1
Wendy de Silva, Architect and Mental Health Lead for the design and technology practice IBI Group was first to the stage. With extensive experience in designing facilities for mental health care, including awards for innovation and best in class design, Wendy discussed what the design of healthcare facilities to support the mental health of people in hospital can teach us about how to to leverage urban design to support mental health in the wider urban environment. With a focus  on the recovery model of care, she emphasized the importance of creating places in which people feel safe, relaxed, in control, and part of a community. She proposed a range of design opportunities to support mental health such as creating free access to outside space, and empowering people to participate in useful, ordinary daily activities.

2
Lucy Saunders from Transport for London discussed the mental health opportunities in transport, specifically the Healthy Street Approach in London. Lucy emphasised the strong connection between physical activity and mental health and with 80% of London's public space being streets, she made the case that streets should be designed to provide a more conducive environment for people to socialise and be more physically active.  She discussed whether we need to think about the monetary value of doing so, to help understand and demonstrate the benefits, and enable comparisons with values already ascribed by planners to moving traffic.

3
Graham Marshall discussed the Prosocial Place Programme, which he established in partnership with researchers at Liverpool and Middlesex Universities. The objective of this programme is to develop an integrated evidence based approach to urban planning, design, development and stewardship.  In particular, they seek to find ways to create spaces that promote positive social interaction and belonging to improve wellbeing. Graham made the case that cities must be designed for wellness rather than only focussing on ensuring they are "well designed", and good stewardship is integral to good urban mental health and wellbeing. He called for us to switch from discussing the 'built environment' to talking about the 'living environment' to refocus priorities in architecture, planning, and other placemaking activities; to shift from an objective of 'survival' to that of 'thrival'.

4
Dinesh Bhurga, professor of Mental Health and Cultural Diversity at the Institute of Psychiatry at King’s College London and President of the World Psychiatric Association discussed the opportunities for urban design in addressing public health. Professor Bhurga highlighted that the rates of people with anxiety, depression and addiction are much higher in urban areas compared to non-urban areas, and that urban design plays a role in developing an environment that is supportive or detrimental to mental health. He proposed that key risk factors to be addressed to improve urban mental health are unemployment, poor parenting, and overcrowding, and with half of mental health disorders emerging before the age of 15, he identified schools as an important opportunity for positive impact - including through good design. He concluded that  "mental health is far too important to just be left to the experts", and encouraged the citymakers in the room to take action.

5
Georgina Hosang, a lecturer at Goldsmiths, University of London and London Mood Project lead shared her experiences representing the Centre for Urban Design and Mental Health at the Unites Nations Urban Thinkers event in Kuching, Malaysia, and how mental health is currently fitting into wider Habitat III thinking. She led a participatory session of international participants that identified key barriers to the systematic integration of mental health thinking into urban design as being stigma and lack of knowledge.

DISCUSSION
After the presentations, the diverse audience from academia, architecture, interior design, transportation, urban planning, mental health, and a range of other professionals provided some energetic discussion that extended over to the reception, and lasted until the lights were turned off at the venue. Topics included whether attachment theory could apply to cities (the verdict: yes, probably); mental and physical health are two sides of the same coin and must be addressed together; positive social interaction is a key component of urban design to improve mental health, and that all the professions involved in designing and developing cities have a responsibility to talk about mental health to help reduce stigma and discrimination and drive positive impact.

Coming soon to the website: more photos of the event and videos of the presentations.

by Matthew Williams PhD
Independent Researcher / Sustainable Urban Mobility Consultant, IIGH-UNU
 
Does the way we move around our cities make us, and the planet, healthier or indeed happier? 
 
In order to answer this question, we need to take a step back to understand why we move around our cities as we do today.  In the twentieth century, car companies, urban planners, and national governments focused more on GDP than well-being, sold us private transport. Car corporations, backed by national governments, built lots of cars, planners laid out sprawling cities to accommodate them, city officials invested more in road infrastructure than public transit, and advertisers told us we needed a car to be happy and show our peers we were successful.
 
In many cities, such as Atlanta and Kuala Lumpur, people have been left with no alternative but to buy a car, unless they cannot afford one. Then getting around the city can be very problematic. The result in many cities is private automobile-dominated transport systems, with entrenched transport inequality. In other words, while the ‘haves’ drive cars, low-income groups take the bus.  These groups also have diminished access to workplaces and social gatherings with friends and community groups when public transit is infrequent or of poor quality in cities built for cars. The Brazilian politician and urban planner, Jamie Lerner, writing in the New York Times in December 2015, points out that cars take up more space than humans, and the average 50 square metres of space that a car occupies when parked at home and at work, is equal to the size of a family home or workplace in many countries. What if, as Lerner asks, this space was available instead for small businesses? Instead of ‘each to his own’ in their private car bubble, we could replace the social isolation of car-dependent neighborhoods with the heightened sense of community found in more coffee houses, bookshops, pocket parks and walkable streets.
 
By 2030 the number of cars on the world’s roads is anticipated to double to 2 billion. Much of that demand is coming from the burgeoning middle classes of China and India as they embrace the advertiser’s promise of ‘freedom’ and status on the open road, an illusion which slowly unravels with each traffic jam. However, a century of the car has revealed that such car dependence has known health and well-being impacts, falling into 5 areas:

1) road deaths and injuries, an annual average of 1.2 million deaths globally, according to a 2015 WHO road safety report
2) respiratory illness, cardiovascular disease and cancer associated with air pollution
3) obesity, diabetes and cardiovascular disease related to physical inactivity
4) social isolation and higher rates of depression in car-dependent neighborhoods
5) social and health inequalities, a sense of social exclusion of non-car owners, who nevertheless must breathe the pollutants emitted by cars.
 
But the health of people and the environment are inseparable. The transport sector is the greatest contributor to greenhouse gas emissions which cause global warming. Climate change is leading to more extreme heat events, the effects of which are more intense in cities because of the urban ‘heat island’ phenomenon. The urban poor also suffer more from water-and-food-borne gastrointestinal infections, and vector-borne (e.g., dengue fever) diseases due to climate change.
 
So, the way we move around our cities can make us sick, or even kill us in other ‘distant’ ways, not just on the road. The best hope may be to stop driving cars which burn fossil fuels, and use active transport such as walking and cycling, as well as mass transit.

However, we should acknowledge that cars do afford certain freedoms. They allow us to look after family members, for example, by transporting children and elderly parents to medical treatment, give us access to social networks and education and employment, and satisfy the consumer desires of some. However, the collective cost to society has been too high. As Jamie Lerner also said, ‘Cars are the cigarettes of the future’. 
 
So, no, cars have made neither us, nor the planet, healthier. And while individuals may experience a brief spike in happiness as with any consumer purchase, and derive happiness from looking after family members with cars when necessary, cars are not an enduring source of personal happiness. Collectively, the impact of many cars, their infrastructure (roads, parking space, gas stations), noise and emissions, degrades neighbourhoods and diminishes our happiness and well-being.
 
We have now awakened to the fact that our cities have been designed primarily to move cars, rather than people. And, as the preeminent urbanist Jan Gehl poignantly reminds us, a city can be designed for cars or designed for people, but not for both.
 
While the automobile has a place in the mobility mix, active transport such as walking and cycling and mass transit options such as light rail and Bus Rapid Transit are more desirable for a number of reasons. Firstly, they are designed for everyone, not only for people with the means to afford a car. They promote individual health by making us more physically active and reduce pollution-related illness. Less carbon-emitting cars on the roads means less greenhouse gas emissions. And when cities are designed for people, rather than cars, public space is reconfigured towards more walkable neighborhoods, which encourage social interaction and build social cohesion within communities. And as the famous twentieth century urbanist Jane Jacobs wrote in the 1960s, more walkable neighborhoods means ‘more eyes on the street’, the best and most natural form of security.
 
When most people rely on public transit, namely middle class and low-income groups, social equality is strengthened, and non-car owners suffer less from the fumes of cars they cannot afford. Children can walk and cycle without fear of being hit by cars, the elderly are more inclined to venture outdoors, and green space is restored to spaces previously occupied by cars. And our sensory landscape becomes more attractive, when the sound of cars and the smell of their fumes give way to the underlying sounds of the city itself, and the smell of fresh air.
 
Its is clear then that active transport , combined with public transit, makes us and the planet healthier, and makes for happier, more connected communities. Re-imagining mobility from a people-centred prism has had great results. In Mexico City, for example, new bike share systems are proving popular with women especially, a group that is often more vulnerable to transport exclusion, mostly due to safety fears.  In Copenhagen, the preferred mode of transport for almost half of the population is the bicycle, and as the city ‘s Green Wave initiative is rolled out to make Copenhagen the world’s first carbon neutral capital by 2025, wireless LED lighting embedded in bicycle paths uses sensors feeding into software to provide information to cyclists about traffic conditions ahead.
 
But as we embrace this technology, we must not lose the lesson of the twentieth century – that mobility should be designed first and foremost for people, whose happiness and well-being is found in the social ties of strong walkable, human-scaled communities free of car fumes and the threat of traffic injury.
 

by Giulia Melis
SiTI, Politecnico di Torino, Italy
 
Since ancient times, we have known that the place where we live can impact our health. Cities have always been shaped and restructured according to the needs and priorities of the time.  The Roman Empire, for instance, created a model for the planned city: with its rigid morphologic and geometric rules, the typical Roman settlement provided basic facilities and infrastructure for its inhabitants, ranging from thermal baths, to aqueducts and sewers. During the Industrial Revolution, cities had to face a new challenge: overcrowding, industrial dumps, and bad hygiene conditions were helping the spread of infectious diseases, and working class suburbs were growing too fast, without any concern about the quality of life in those areas.

That’s how laws about urban décor, cleanliness and sanitation started to be discussed: the Public Health Act (UK, 1948) is one of the first examples. This Act linked the urban design of a city with the spreading of epidemic diseases, and tried to prevent it by moving industrial production out of the city core. This model lasted until recent decades, when deindustrialization and various crises meant the need for new paradigms.
Nowadays, modern cities are starting to wonder not only how to create a healthy environment to protect the spread of epidemics, diseases, violence etc., but also how to enhance the quality of life of their citizens and their wellbeing. The waves of New Urbanism are questioning our lifestyles, and starting to re-consider the social component of city life as fundamental for granting us happiness and fulfilment.

That’s why, as a group of researchers coming from the architectural and medical domain, we became interested in mental health in our cities. As urban planners, we were interested in understanding which urban features most significantly affect our daily life, in order to identify the most urgent and promising intervention opportunities towards less-stressful urban living. And as public health experts, we wanted to know if the effects are equally distributed among the population, or whether some groups are experiencing a higher burden?

The Research

We chose an Italian city, Torino, where a huge dataset on population health is available, and looked to see if the numbers confirmed our initial theory. While a lot of researchers have already presented evidence of the importance of urban trees and parks, which can have a profoundly beneficial impact on psychological wellbeing and general mental health, not many studies have analysed the urban built environment in its complex functioning. We therefore gathered data both on the structure of the city (how dense it is, where are the parks for recreational activities, which is the mix of functions in one area) and its services (is the nearest library placed within an accessible distance? is the area well-served by public transport? Are there public sport facilities? Cinemas, theatres? etc) and we looked for connections between this data and the consumption of antidepressant drugs in the city.

The Results

Our research suggests that good accessibility to public transport, as well as a dense urban structure (versus sprawl), could contribute to a reduced risk of depression, especially for women and elderly, by increasing opportunities to move around and enjoy an active social life.

Women (of all ages) and older people (age 50 to 64) were found to be prescribed fewer antidepressant drugs when they lived in places reached more quickly by bus or train, and in places with taller average building heights, compared with counterparts in more remote or sparse areas. That connection held up even when social factors were taken into account. This means that if everybody had the same level of education, same citizenship, and were all in employment, all living in a neighbourhood that had equivalent levels of crimes and social and physical disorder, there would still be differences in antidepressant consumption according to how well the area is served by public transport and to the density and liveliness of the neighbourhood.

Challenges and decisions with the method

Antidepressant consumption is quite a strong indicator in mental health. Taking antidepressants implies that you have recognised you have a problem, actively sought help from a doctor, received a diagnosis and a prescription for antidepressant medication, and started treatment. This is a long way from starting to feel that you may be stressed or depressed. We used this indicator in our research as we were looking for solid evidence, but by doing so, it is likely that our results underestimate the phenomenon of stress and depression in the city, thus setting the stage for further and more accurate investigations and reflections.
Of course the range of density that we were able to test was limited to that of a typical European city; this range does not include the extremes of US cities sprawl and high density (which are both known to have negative effects on health).

Also, this type of large-scale data analysis can’t pinpoint causal mechanisms. But it’s not hard to speculate why transit and density might reduce stress: the former relieves the need to drive everywhere (and to own a car); the latter enhances the potential for social connectivity. For older populations, in particular, both aspects help guard against feelings of isolation or loneliness. They also stand in contrast to remote suburban living that “can have a serious impact on mental health, particularly when it results in forgone trips”.

The Conclusion
There’s still a lot to understand about the key stressors of city life, but sound advice to urban planners could already be launched: in order to address health inequalities, urban policies should invest in the delivery of services that enhance resilience factors, above all a good public transport network, in a careful and equal manner, throughout the city.

by Tracy A Marciano

Urban Planning as a means to organize people, places, concepts and practices has an interesting history. As civilization progressed, urban planning followed a parallel trajectory,  reacting to practices that outlived their usefulness. With each era, large scale redesign was at the forefront of change with small pockets of improvement on the periphery.

Contemporary discourse about urban health is primarily focused on green spaces and walkability. While both are important in the urban fabric, they are not absolute measures of ideal public health and their results are hard to quantify against the variations in symptoms and treatments for mental disorders. Introducing concepts from other fields and recalibrating them into plausible urban design initiatives is a potentially interesting approach to improve mental health in cities. In particular, as urban areas gain momentum, exploring concepts from eastern medicine such as acupuncture, aromatherapy (or horticulture therapy), directional alignment with the sun and the moon, nocturnal gardens, botanical soundscapes and energy balancing might be applied to exert a positive impact on mental health in modern cities.

As populations migrate towards urban centers at an accelerated rate, advancing improved health strategies - rather than utopia - is often being achieved through incremental improvements.

A recent movement is New Urbanism, or tactile urbanism, which seeks to align with sustainability, preservation of existing buildings and walkability.  However, as with past attempts at planning perfect cities, such as The Garden City movement, individual experience, public mental health and most importantly, the causation and impact of mental health problems have been largely excluded from the dialog.

Jamie Lerner, who served three terms as the mayor of Curitiba, Brazil uses urban acupuncture as the philosophy behind his successful initiatives.  Urban acupuncture is the mature cousin to tactical urbanism, which has suffered a bit of backlash lately as a trendy, high-concept practice of questionable long-term impact. Lerner writes in his book “Industrious mediocrity is gaining ground, along with merchants of complexity: the bean-counters and the inconclusive, never-ending researchers. But sometimes, just one stroke of creativity is acupuncture powerful enough to make progress.”

In 2007 University of Minnesota published a paper about their collaboration with Blue Cross and Blue Shield of Minnesota. This paper highlighted key findings about how to increase accessibility to nature to address mental health problems. Their research also found that social networks are important and that mental health is connected to fundamental public health issues but did not offer developed solutions with measurable results.

In most cities, areas that create tension and erratic energy and areas that can exacerbate anxiety, depression and isolation are evident. If cities are viewed as a biological system and receptive to holistic wellness plans, the philosophy of urban acupuncture may be an ideal platform to improve heath. For example, if obstructed walkways and clogged streets create tension and anxiety, a small area, such as an acupressure point along a vertical meridian line, could be addressed rather than attempting a complete urban redesign.  

Green space is prevalent in urban planning. However, an actual plan for the green space is often missing. Green space can mean a small strip of grass, or a few trees added as an afterthought. Applying other eastern principles, such as aromatherapy would be a progressive addition to the design phase. For example, if there is a lack of people using a public space where there is ample seating, adding a vertical garden with aromatic herbs may draw people to the area. Aromatherapy, or a fragrance garden, on a large scale could enhance individual experiences while reducing stress and anxiety. It also gives purpose to a vertical garden aside from aesthetics.

Incorporating vespertine gardens (night blooming) would help understand that urban areas have enormous potential after sunset; and would also align with solar and lunar lighting during the design phase. Nocturnal plants are more fragrant and assist visually impaired individuals when combined with other sensory plantings. Using balance between day/night, light/dark can create enough stability to reduce tension and anxiety.

Urban acupuncture is an intriguing starting point to reconsider conventional urban planning and design. It highlights that we are at a critical moment in time when all stakeholders can think about long term plans and how those plans will have a positive impact on mental and public health in urban centers.