Streets account for the majority of our calculated urban space. Defined loosely, the ‘streetscape’ refers to the natural and man-made elements of our streets. The Torbay Streetscape Guidelines elaborates on this simple definition to include: “design quality of the street and its visual effect, particularly how the paved area is laid out and treated. It includes buildings, the street surface, and also the fixtures and fittings that facilitate its use – from bus shelters and signage to planting schemes.” One of the determining factors of a prosperous city is the sustainable design of its streetscapes. However, this prosperity is mostly focused on functionality and often fails to fully leverage the mental impact of design elements on pedestrians and passengers.
 
When looking at the visible landscape, humans can be affected in many ways that encompass aesthetic appreciation, health and wellbeing. Personally I feel more calm and at ease during a walk or drive alongside a stretch of trees and greenery as opposed to towering buildings, blank facades, grey sidewalks and seemingly endless armies of lampposts. Research exploring the health effects of viewing landscapes confirms my experiences, observing that in some instances, the built urban landscape can indeed pose a negative effect on our mental health and wellbeing. For instance, exposure to monotonous features in streetscapes have been associated with sadness, stress, and even addictions. On the other hand, research consistently finds natural landscapes to be positively correlated with mental health and wellbeing, an effect that can be achieved in the urban environment. A recent cross-sectional study examining urban tree density and anti-depressant prescription rates in London, UK identified a decrease of 1.18 prescriptions per thousand population in areas with a per unit increase in trees per km of street. The study suggests that street trees seem to be a positive urban asset that may play a role in preventing and mitigating mental health problems, and a body of research corroborates this finding. Increasing arbor planting can increase sidewalk functionality, but of course it can have practical implications, including the risk of making roadway functionality more difficult. Thus the choice of whether to install urban trees in streetscapes often falls into the hands of citymakers – and lawmakers. Ensuring that these designers, planners and decisionmakers are aware of the population mental health implications of their decisions is important.
 
Streetscapes also have an element of auditory interaction with our senses. Our body is wired in a way in which the function of our auditory reflex is somewhat dependent on the tranquility of our immediate environment. Therefore, when considering soundscape, the visual scene is likely to be an important modifying factor in our auditory perception. An evaluation of the effect of natural sounds in conjunction with road traffic noise and visual components in urban streets concluded that the “acoustic comfort factor related to soundscape quality considerably influenced preference for the overall environment at a higher level of road traffic noise.” The most popular of 'nature sounds' was found to be birdsong. On the other hand the sound of falling water was actually found to reduce the soundscape quality if the road traffic noise level happened to be too high. A mixture of functionality and auditory-visual street features, such as artistic acoustic highway noise barriers will serve well to promote mental wellness as well as providing a system of transport from one location to another.
 
It’s time to recognize that the immediate environment including the often-unwavering streetscape, which we have become involuntarily accustomed to, plays a vital role in shaping a significant part of our mental wellbeing. Along with having street elements, such as road signs, to guide and protect our physical body, we also need to have streetscapes that nourish our mind.

Last winter I had an experience that changed the way I saw urban design.
 
It was mid-February. It was one of those days that was so cold that the city seemed to be blanketed in a mist of ice. Certainly not a day one wanted to spend outside for too long. I was on my bike, waiting to cross an intersection in downtown Edmonton. That winter was the first that I had decided to participate in winter cycling. I bought an old beater mountain bike and outfit it with some studded tires. It was the best decision I had made in a long time. Winter cycling is a lot of fun.
 
So, there I was waiting at the light, which seemed to be red for an eternity. To my right, there was a pedestrian waiting for the light to change as well. He wasn’t wearing a winter jacket, or gloves for that matter. He appeared to have mobility issues. He was pushing a shopping cart which I later realized was doubling as a makeshift walker. We looked at each other and had a moment of shared frustration as we were patiently waiting for the crosswalk man to appear. The delayed crossing allowed us time to share some small talk, so I decided to jump off my bike and stand with my new acquaintance, who I’ll call John.
 
The time finally came that we were given permission to cross. I walked with John as he slowly moved one foot behind the other whilst pushing his cart over the ruts in the snowpack made by vehicles. It was a visibly taxing process for him, and difficult for me to watch. The occupational therapist in me grew agitated with the lack of accessibility this man experienced. We neared the midway point in the intersection when the menacing stop hand began to flash, and quickly went to a full stop.  The lights had changed and we were stuck in the middle of the intersection. That’s when John said it.
 
“Sometimes I think this damn city is trying to kill me!”

John had made a valid point. While there wasn’t an explicit intention to harm him, by virtue of the way the infrastructure was designed, John was regularly put in harm’s way.
 
I have, on many occasions, uttered a similar sentiment. I primarily use cycling and walking to get around the city. I’ve cursed under my breath while waiting at signaled crosswalks that seem to take forever to allow pedestrians to cross only to give them a very short time to do so. On a regular basis, I dodged cars while attempting to use a crosswalk to get across Whyte Avenue and 102 street (Whyte Avenue is a pedestrian rich area in the Edmonton neighbourhood of Old Strathcona). I had a near miss almost every day. And I have the privilege of being an able bodied person that can quickly step back as an unknowing driver almost runs over my foot.

Reflecting on these issues, I was reminded of a workshop I took this past summer given by the Stanford Design Thinking School. I see the problems I identified as primarily an issue of design, or rather the lack of thoughtful design. Design thinking helps in creating services and products that put the user experience at the core of the design process. The foundation of the approach lies in the "empathy" step - empathizing with the user and caring about how they feel. Empathizing is done through observation of the user as well as qualitative interviewing. When something is designed with empathy in mind, the result is an experience that meets the user's needs.
 
Assessing John's experience, I'd argue that his perspective wasn't taken into account when designing that intersection. Having significant mobility issues made waiting for excessive periods of time without moving difficult. Add to that the severe cold. When he finally had the opportunity to cross, the ruts in the road created additional challenges for him. And to top it off, the time given to him to cross was certainly not enough, and left him stranded in the middle of an intersection fearing for his life.
 
John's experience with using that crosswalk was riddled with anxiety. Speaking with him afterwards, he stated: "Sometimes I feel invisible here". That really sat with me.
 
I was quite bothered by John's disclosure. To me, (beyond it being a matter of safety) it came down to dignity. John, and many others like him are hard-pressed to be able to navigate their cities with dignity. Something as seemingly trivial as pedestrian infrastructure has huge implications on how people see themselves. Having to dodge speeding vehicles on marked crosswalks (without adequate signalling to alert drivers) could communicate that that person's particular experience is not worthy of concern. Or that their safety isn't a priority.
 
So, why should we be concerned about dignity? While writing this piece, I was taken back to work I did as an occupational therapist while at the Centre for Addiction and Mental Health in Toronto.  Something I tried to be cognizant of was the concept of “dignity moments” – that I would make the utmost effort to support the dignity of my clients in every interaction I had with them. This was embodied in the way I spoke with my clients, the nuances of my body language, and the general demeanor in which I engaged with them. The reality was that most of the people I supported lived in abject poverty, had experienced significant oppression (i.e racism, gender-based violence, mental health stigma), and generally had negative experiences with numerous systems. The cumulative impact of these negative experiences took a toll on their sense of dignity.
 
I believe there is a lesson in this for cities. I’d be curious to see how built space would manifest if transportation engineers contemplated how to facilitate dignity moments for the people that used urban infrastructure.
 
It’s also important to recognize that people like John spend almost all of their time navigating and living in the urban environment.  I’d contend that the homeless are one group who most intensively access the built environments of our cities, so should have a voice in the process that goes into building the urban environment.

What would our urban landscape look like if we acknowledged that homelessness was a pervasive issue and that people did in fact live in public spaces?

We’ve seen the opposite; in cities around the world, measures have been taken to make public spaces inhospitable to the homeless. In London, a developer installed “anti-homeless” spikes to deter those looking for a place to sleep. In Tokyo, park benches were designed to make sitting and sleeping uncomfortable. And, if we’re going to explore how urban design influences our mental health, we need to acknowledge that the prevalence of mental health issues in the homeless is higher than the non-homeless populations. We have to build cities for everyone – not just the privileged.
 
I think that we have some way to go when it comes to improving the pedestrian experience in our cities. I believe that it should be at the top of our list of priorities. I think street vibrancy depends on it. I also strongly believe that cities need to be inclusive in their design; this requires that we acknowledge that not everyone drives a car (due to choice or affordability) - and that this should be reflected in the design of our streets and roadways. Design of our spaces governs our lives. It determines the way we move and the way we experience the world and accordingly influences how we see ourselves. More attention needs to be paid to this as we build our cities. While these issues may seem inconsequential to some policy makers, I am convinced that dignity lies in the details.

“If you listen, you can hear it.
The city. It sings.
If you stand quietly, at the foot of a garden, in the middle of a street, on the roof of a house.
It’s clearest at night, when the sound cuts more sharply across the surface of things, when the song reaches out to a place inside you.
It’s a wordless song, for the most part, but it’s a song all the same, and nobody hearing it could doubt what it sings. And the song sings the loudest when you pick out each note.”
 
It was reading those opening phrases from Jon McGregor’s novel, “If Nobody Speaks of Remarkable Things” that first inspired me to think more deeply about the ways we experience urban places and the ways in which total urban sensory experience affects our lives. That was probably the exact moment that I started, consciously, to shift the emphasis of my work a little, away from conventional spatial planning and more towards urbanism and placemaking; using “planning” as just one the tools in the box for shaping places that work well for the people who use them.
 
Assessing the "form" and "character" of places is standard activity for planners and urban designers. The basic aim is to identify and evaluate factors that make one place different from another and contribute to each place’s identity. Various methods are used; most focus on how a place looks and - often quite superficially - how its buildings are used.
 
So, what is missing from conventional approaches to urban analysis? In short, pretty much everything apart from appearance and use. Urban planning and design professionals try to understand a place mostly through their eyes when, in reality, sight is only one of the senses through which places are experienced.  It would, in theory, be possible to measure spatial relationships in a particular place in England, for example; to codify them and then to reproduce a similar place in the Caribbean, or in China or Africa or Australia - or just about anywhere else. It would be possible to replicate the building designs and materials (and there are examples of this having been done) and even, perhaps the uses - but it is very unlikely that the place "recreated" would be identical to the original place except in the most superficial ways. What would be missing? The smells, the sounds, the tastes, the feel of the air, the rhythms, vibrations and movements - almost everything that combines to really make each place unique.
 
There are already bodies of work, exploring particular aspects of this. There are studies, for example, of "soundscapes" and "smellscapes", and the ways these are perceived by people without full sight, becoming embedded in the mental maps they employ when moving around their neighbourhoods.
 
Research also shows significant influences of music on mood, behaviour and mental state. It suggests that rhythm plays a fundamental role in this and has strong effects on the brain. It seems logical, therefore, to assume that the sound and the rhythm of the place in which a person spends time may influence their mood and mental state. Ironically, whist this seems to be accepted with little question commercially (with a substantial and highly profitable area of business built on it - “Muzak”) the concept barely surfaces in planning and spatial design thinking and, from reactions I have received, it seems likely that many in those professions may be skeptical about the relevance of something so apparently abstract.
 
Research has provided evidence that people’s mental well-being is also influenced by “green” surroundings and by contact with nature; by the presence or absence of other people; by the quality of the air being breathed and by other sensory experiences.
 
When managing urban change, we need to understand, as deeply as possible, all the ways that places influence people and their mental well-being; the ways in which a place’s sound, feel, smell, taste... influence the experience of people who spend time in or around it - or simply pass through it. I believe that the combined sensory experience of the places in which they live or work or learn or play  can have profound effects on people’s well-being – both physical and mental. Changes affecting any of those sensory aspects may have significant impacts that should be - but generally aren’t - taken properly in to account in the planning, design, development and management of the urban environment.
 
That, then, is the challenge: to develop methods for identifying the deep and unique character of a place as experienced through all the senses available to us, and then to make use of this - managing urban change with an awareness of the multi-stranded relationships between sensory experience and well-being.

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

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

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

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

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

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

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

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

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

Where do you work, and what exactly do you do?

I’m Assistant Professor of Urban Design at Tarbiat Modares University in Tehran. I’ve taught Masters students of urban design for 7 years. Also, I’m managing urban planning and design branch of SAP consulting engineers where in a group, we are doing professional projects all over Iran.
 
How did you first become interested in researching the link between urban design and mental health?

My research concentration is quality of urban public spaces especially those where people can meet each other, sit, spend time and talk together. That’s why my PhD thesis title is: Finding the Essence of Sustainability in Urban Plazas. Referring to the values of urban public spaces show their direct effects on health: physically and mentally. Pedestrian-based urban spaces can encourage exercise with associated physical health benefits – for example reducing the risk of heart attack, diabetes, colon cancer and bone fractures. They provide a space for formal and informal sports and games. Also they provide opportunities for relaxing, talking to friends, reminding memories, watching urban events, happiness, etc, all of which can have effects on reducing stress and enhancing mental health. Certain quality criteria in urban spaces can introduce close relationships to mental health like vitality, safety, comfort, etc.

Also, one of my favorite courses in the Masters program of urban design which I’ve taught for 7 years is urban design methods and techniques. During these years, I’ve worked on different urban public spaces of Tehran with a number of students and I’ve found interesting local effects of urban public spaces on mental health.

How much interest is there in this subject in Iran?

An increasing interest to the subject can be seen during these two decades. It’s been accompanied with creating new urban public spaces (especially parks) in big cities like Tehran. A number of studies concentrate on the effects of green spaces on mental health which has roots in historical background and beliefs of Iranian people. Also, urban experts in Iran have started mutual research with human sciences experts which provide a new vision in this way.

Can you give any examples of projects in Iran where urban spaces have been designed to help improve mental health?

I think projects which connect urban life to nature have quick effects on mental health in comparison to other urban projects. When such a project provides maximum pedestrian space the effect is accelerating. In my idea on of important urban spaces that designed according to these characteristics is Chitgar artificial lake which  opened  2 years ago and it is progress. This project is introducing a new waterfront in Tehran. The combination of water, forest and huge pedestrian area with a great view to the mountains provides a space where people can decrease stress of urban life of Tehran.

Are there other great examples of urban design/mental health projects elsewhere in the world that you find inspiring?

As I mentioned in last question, I'm interested in all projects that connect pedestrian spaces to nature, enhancing mental health. During my travel to Europe this summer I found Copenhagen inspiring in this way where creative waterfront urban spaces like Copenhagen Wave has been designed. Also through visiting Danish Architecture Center plan for creating new urban spaces, I found their organization and products far from other cities.

What research are you currently working on that relates to urban design and mental health?

My background is in quality of urban spaces, and most of my research relates to mental health. For example I published the first paper on the quality assessment of pedestrian streets in Iran 5 years ago. With the cooperation of Ms. Reisemaeili, we studied the first pedestrian street of Tehran with the name of Saf streets. A primary result of the paper demonstrates the mental security of women in this space associated with making the street pedestrianized.

Two of my current research projects are directly related to urban design and mental health. In the first one as an master thesis in cooperation of Mr.Pezeshki and Dr. Elahi (who is psychologist) we have worked on decreasing fear in through urban design guidelines in a unique neighborhood of Tehran based on criminal records. In the theoretical part of research, we have tried to introduce a bridge between the psychological point of to fear and urban spaces. The results are in progress to publish as a book. I‘ve conducted the research by qualitative and quantitative methods.

The second research in cooperation of Ms.Samavati and Dr. Naghdi ( who is sociologist) we’re working on happiness in urban spaces. The case study is the pedestrian zone of Tehran's historic center. The research is in progress and as primary results I can point a model that shows happiness in urban spaces relates to quality of life, quality of urban spaces, urban spaces amenities and personal believes of people. I hope to share the results with the Centre for Urban Design and Mental Health as soon as possible.

What are the main challenges you have seen in improving mental health through urban design?

I think the main challenge especially in developing countries is the lack of pedestrian based urban spaces. Cities are dominated by cars and their pollution (air and sound) has bad effects on mental health. Also the lack of good quality urban spaces caused people refuge to personal spaces like houses. This phenomenon instigates internality that declines mental health.

What are the big opportunities in urban design and mental health?

Each country and each city needs healthy people for development. Urban design products like new cities, urban spaces, etc. have direct effects on citizen health. In good quality urban spaces people can feel a sense of satisfaction, central to which is their mental health. I think if urban designers all over the world added 1 square meter to pedestrian areas and green spaces, the enhancement of mental health is several times more than 1 meter, because in everyday life people can feel the effects of urban designers.

What would you like to see the Centre for Urban Design and Mental Health achieve?

First, I congratulate on starting this inspiring movement which helps urban designers to be more conscious during urban design process. I like that the Center tries to create a network of specialist with this background all over the world and is publishing the results of their studies. Also this Center encourages close relation of urban designers and human scientists in the way of mutual meetings, conferences, etc.

Which is your favorite city in the world, and why?

Such a difficult question! Each city has the potential to be my favorite. From the mental health point of view I can say Shiraz is my favorite which is the man city of Persian land and also is the city of poem. Although the urban spaces of the city have not developed well during these years, you feel a unique sense in the city that in my idea relates to insight of people to the world. People of Shiraz are very easy going and friendly. They live in the moment and this can be perceived in urban life.

LinkedIn profile

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

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

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

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

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

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

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

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

Works cited:

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

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

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

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

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

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

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

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

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

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

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

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

The Centre for Urban Design and Mental Health is planning to launch a new, biannual journal in early 2016.

This online journal will help address the challenge of there not being many journals explicitly publishing research on the links between urban design and mental health right now. We plan to run thematic editions,  the first of which will focus on the concept of 'conscious cities', building on the op-ed that UD/MH fellow Itai Palti recently authored with Moshe Bar in The Guardian; Itai Palti will be our guest editor for this first edition.

A 'conscious city' builds on the idea of a 'smart city', combining data, technology and planning techniques to improve urban mental health and well-being. We are seeking submissions from architects, planners, policymakers, psychiatrists, psychologists, public health practitioners, and others that address one of two questions:

• How can cities better measure/capture/understand the mental health needs of their populations that could be addressed through urban design?
• How can cities use that knowledge to improve mental health through urban design?

Do you have a relevant research paper, case study, review, comment piece, photograph, book review or other relevant content, (or a good suggestion for the journal's name)? If yes, please submit for consideration to [email protected] along with your name, place of work/study, and your current location. See below for technical details. Submission deadline: 11th December

FURTHER DETAILS AND SUBMISSION GUIDELINES
This journal is not currently peer-reviewed. Editorial decisions will be made by Layla McCay (UD/MH Director) and Itai Palti (UD/MH Fellow and Guest Editor of the edition). The journal will be open-access. The style of writing and terminology should be clear, succinct, interesting, and accessible to multi-disciplinary professionals including scientists, psychologists, architects, planners, interior designers, planners, policymakers, etc.

Research papers: up to 4,000 words (and note we value succinct writing). Please include a 200-300 word abstract including introduction, methods, results, conclusion, and a short comment on what your findings mean practically for those working in urban design/mental health. Please include 1-3 relevant photographs (with description and any attributions). Please ensure your paper is fully referenced, with a link associated with each reference.

Comment pieces/op-eds: up to 600 words, including photographs where relevant.

Case studies: up to 300 words, and please include 1-3 photographs (with description and any attributions)

Book reviews: up to 300 words

Other: please get in touch with us to discuss format of other article types

by Layla McCay, UD/MH Director

EVENT REPORT: an interesting research event launching a series of discussions on feeling good in public spaces, hosted by the UK's ARCC Network at the Wellcome Trust in London, 18th November 2015.

It is unusual to attend an event that is specifically focused on the nexus of urban design and mental health. All too often in discussions about how urban design can improve health and wellbeing, the focus is on physical health, specifically on active cities. Of course physical activity can have great impact on mental health, but when it comes to a specific focus on mental health opportunities, in the words of one urban planner, ‘we haven’t a clue’.
 
It was therefore particularly interesting that the UK Climate Impacts Programme chose to host the first in a series of discussions focused on that very question, with the inaugural event kicking off at the Wellcome Trust in London on 18th November 2015.  An audience that included designers, planners, developers, academics, and health professionals gathered for a fascinating and diverse series of talks.
 
Georgina Hosang from Goldsmiths, University of London summarized the links between urban life and mental health, highlighting the differences in prevalence of various mental illnesses in urban versus rural areas in the UK, highlighting increased urban rates of depression, alcohol and substance dependence, and schizophrenia. In particular, she highlighted the need for for urban designers and planners to help create spaces in the city that increase social capital, a key factor that reduces the risk of developing mental disorders. She highlighted the London Mood Project, using mobile phones to map people’s mood in different geographical locations in London. If you’re in London, why not download the app and get involved.
 
Rhiannon Corcoran from the University of Liverpool started the discussion of how to measure and understand the implicit and explicit effects of urban places on peoples’ feelings, thoughts and behaviour (slides). She showcased the Prosocial Space Programme and introduced research that measured people’s responses to photographs of different types of urban spaces, anticipation of threat as they walked through various areas of a city, and surveys of what people felt made a positive place to live. A different method of measuring the effect of people’s interactions with the urban environment on their mental state was discussed by Panos Mavros from the Centre for Advanced Spatial Analysis, UCL, who has interestingly been using portable EEG machines to measure people’s brainwaves as they walked around urban streets (slides).
 
Antonio Caperna from the International Society for Biourbanism talked us through evolutionary theories for biourbanism (slides). His theories of why humans respond positively to nature were based on the brain’s affinity to the viewing of fractal patterns (naturally occurring, complex patterns found in nature), and he argued that architecture should reflect this inherent affinity. He argued that throughout history, the body has evolved itself to its environment, and current adaptations to urban life include stress, fear, anxiety and aggression, and that we can employ principles of biophilia in urban design to enhance human interaction with the built environment.
 
From the perspective of the Centre for Urban Design and Mental Health, my focus was on why mental health has been sidelined in urban design discussions, prioritisation and investment. In my view (summarised in this New Statesman op-ed) a combination of stigma, concerns about the complexity of the causative factors of mental illnesses, and a vicious cycle of non-prioritisation have led to mental health becoming the Cinderella of urban design and health integration. I highlighted key areas that we believe hold particular potential for urban design in improving mental health and would benefit from further research (for more detail, see slides):

• conscious cities (collecting and using data to improve urban mental health)
• exposure to nature
• older people’s mental health (including reducing depression, anxiety and disorientation caused by dementia)
• transportation (particularly the question of how to optimise commuting)
• extracting lessons from mental health-sensitive design of healthcare facilities and applying them to the wider urban environment
• sound, colour, art, and other sensory opportunities
• traumascapes (where a traumatic event, including war, terrorism, or disasters such as extreme weather events, earthquakes, etc) has happened in a particular place, how can urban design contribute to reducing individual and public distress caused by that place)
  

 
To take mental health to the ‘urban design ball’, we must not ask just what urban design can do for mental health, but what we can do to increase the knowledge, data, profile, prioritisation, and implementation of mental health improvement as part of urban design. It must be a matter of researchers, urban designers, planners, policymakers, engineers, and public health professionals explicitly asking that question when developing their plans and projects.
 
One major theme from this event was the challenge of accessing and translating high quality research into practical urban design: “we need evidence to back up our hunches” when it comes to mental health promotion through urban design. We must undertake, publish and share more research and experience, and find ways to translate all this information and experience into practical, evidence-based guidelines, while guarding against a one-size-fits-all approach.
 
Mental health can and should be at the urban design ball. This is why the Centre for Urban Design and Mental Health is planning the launch of a new journal (call for papers out now), and is publishing research, ideas, and case studies on this Sanity and Urbanity blog (submit yours) to increase the discussions, research, and people’s access to the research. We are planning discussions, consultations, and guideline development. That’s what we’re doing. As a designer, policymaker, planner, health practitioner, engineer, researcher… what will you do to help get Cinderella to the ball?

UD/MH slides from the event:

See all the slides from the event here.

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

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

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

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

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

 Do you have an interesting research project that might make a good submission? Let's see more mental health-focused presentations this year. Submit before December 8th.

Topics that may be of particular interest:

Symposium on Geography and Urban Health

Research Collaborations: Scientific collaborations in geography and urban health, Urban health and heath geography, Collaborating to advance global urban health policy
Environmental Health: Disease mapping, Assessment of the impact of environmental exposures on health, Exposure monitoring utilizing real-time GPS/GIS methods, Disease ecologies
Behaviors: Mobilities and health, Spatial analysis of substance abuse and treatment, Social environments and mental health
Healthcare Service: Health disparities and inequalities, Global health research and public health initiatives
Methodologies and technologies: Methodological issues in health research, Spatial uncertainties in health studies, CyberGIS and high performance computing in health studies, Geospatial big data and health, Crowd sourcing of geospatial data for health research, Health and global health service delivery initiatives

International Conference on Urban Health

Urbanization AND Health: what interactions? New paradigms, concepts, methods, and tools, Disciplinary advances vs inter-disciplinarity: what challenges?, Interest of comparative approaches: why, how?, Research and action
Urban Health at the intersection of urban environment, social determinants and places: Urbanization and Health disparities, inequalities and inequities, Specific risks factors in urban context   
Urban Environments: what specificities? Urban Environments as places of demographic, epidemiologic, nutritional and health transitions?, Globalization, migration and urban health
Urbanism, Health and Wellbeing: Built environment, Pollution: air, noise, etc, Transportation, Green spaces, sport
Health indicators, spatial analysis and mapping: new tools, new methods: Spatial analysis: interest, conditions and limits, Mapping Disease: areas at risks, cluster, diffusion, etc.
Research and action: Collaboration; interaction of researchers; stakeholders, Setting and development of priorities, Assessment and evaluation: ongoing; process and outcome/impact
Urban health policies: Governance and policy frameworks, Health in all policies, A culture of evaluation: why, how?, Capacity building: infrastructure; training in & researching urban health & health geography

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

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

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

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

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

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

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

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

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

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

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

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

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

References 

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

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

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

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

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

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

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

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

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

What are your research interests, Greg?

I work in the nexus of biology and psychology, studying the impacts of nature experience on human cognitive function, mood, and emotion regulation.
 
You've just published a research study that looks at the links between nature and mental health. What got you interested in this subject?

My interest in this area comes from a desire to investigate the value that natural landscapes may provide for people with respect to mental health.  Following in the footsteps of the compelling work before me in environmental psychology, I set out to determine whether I would obtain empirical evidence for the impact of nature experience on cognitive function, mood, and emotion regulation, using the tools of psychology.   I also want to explore ways of incorporating this evidence into urban design and decision making.

Briefly, can you describe what your study involved?

38 people came into the lab and filled out a questionnaire on their current levels of rumination (repetitive thought focused on negative aspects of the self). They also underwent a brain scan. They were randomly assigned to a 90-min walk in either a natural setting (a park near Stanford) or an urban setting (beside a busy street in Palo Alto).  Upon completion of the walk, participants filled out the rumination questionnaire again, and underwent a second, follow-up scan.  We analyzed whether there was a differential change in nature vs. urban walkers in both self-reported rumination (the questionnaire) and in a part of the brain that has been shown to be active during rumination (the subgenual prefrontal cortex). 

What did your study find?

Participants who went on a 90-min walk through a natural environment reported lower levels of rumination and showed reduced neural activity in an area of the brain linked to risk for mental illness compared with those who walked through an urban environment.

How do you believe that exposure to nature achieves this impact on people's mental health?

This is an active area of exploration for us — and we hope to publish some findings on this soon.

Given that your study involved healthy participants, do you think the nature exposure is more likely to help prevent depression, or could it also be helpful for people who are already depressed?

We do not know the answer to how nature experience will impact rumination in depressed individuals, as our study focused on healthy participants.

What are the practical implications of your study's findings for urban planners, designers and developers?

More work needs to be done in this arena, but our work, along with the work of others, is helping to contribute to an overall body of evidence that nature experience provides benefits to human cognitive function and mood.  This knowledge can inform the ways in which urban planners incorporate nature into cities, and provide accessible natural landscapes for urban and suburban residents.  It can also provide support for conservation of open space and wilderness areas in policy design.

What's next for you in your research? (And what would you like to see other researchers address on this topic?)

We are exploring our hypothesis that emotion regulation shifts are a possible causal mechanism for the cognitive function and mood benefits that we have observed to be resultant from nature vs. urban experience.  I hope that other researchers continue to explore both the characteristics of the impacts of nature experience, possible causal mechanisms, and how these impacts may or may not be moderated by individual differences.

For people who want to learn more about the links between nature, urban design, and impact on mental health, what other research studies or other resources do you recommend they might like to read?

There is more to list here than room allows, but I would start with a great textbook which was recently published entitled Environmental Psychology by Linda Steg (Editor), Agnes E. van den Berg (Editor), Judith I. M. de Groot (Editor)— it includes a great overview of theory and some of the classic studies in this area.

Learn more about Greg Bratman's study:

Read the original research paper in the Proceedings of the National Academy of Sciences of the United States of America.

Read about the research in the New York Times. 

Watch Greg talk about his research in this video:


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

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

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

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

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

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

Where are you originally from, and where do you now live and work?

I grew up outside of Austin, Texas, and moved to DC for graduate school; I have been here since – I live in the city and work in the city and walk to and from.

Which is your favorite city in the world, and why?

I really haven’t travelled enough; but of my travels, I most frequently find myself in my Aunt’s small town of Ipswich, Massachusetts, north of Boston. We visit the neighbors, pick vegetables straight from her garden and sip tea on the sun porch; it is always a pleasurable break from a downtown life.

What sort of work do you do around the intersection of urban design and mental health?

I have a Master’s Degree in Interior Design where I focus on infusing the built environment with health using research and principles of Evidence-Based Design. My focus area is the healthcare environment, both physical healthcare and mental healthcare. I have recently begun to engage with our Urban Planning group to take the elements we use on the interior scale, and expand those to the building and city scale.

How did you end up working at this intersection?

One of my first projects out of school was an adolescent behavioral health residential facility. And it was built like a jail. We take oaths as designers to protect the “health, safety and welfare of the public”. And to me that meant I had an obligation to protect everyone who needed safe and healthy spaces – especially those most vulnerable and in need of healing.

What particularly interests you about the link between urban design and mental health?

Simply the fact that designing our cities to support mental health is missing – and there is so much potential and so much need. Mental healthcare in general is still not at the preventative stage that physical healthcare is moving towards. Designing surroundings that help foster positive mental health for the millions who living in and moving to cities could create a positive mental revolution.

Can you describe an example of good urban design that positively impacts mental health?

Choice and control in the urban environment has the most potential in my mind. Individuals move to urban centers for opportunity. And that should not be restricted to job opportunity. City dwellers should have options of how to get to and from places, safe and healthy opportunities of commuting. Giving the person a right to choose their path creates a great foundation for positive mental health because it provides control; when individuals feel as though they have no control over their situation – big or small - their mental state deteriorates.

What sort of challenges do you see in urban design for mental health?

The challenge will be breaking the stigmas of talking about mental health issues; regardless that a quarter of our adult population suffers from poor mental health. I believe many urban planners are already on the verge of creating healthier cities, through physically active cities; mixed use cities; sustainable cities; but we need to embrace open conversation on what those achievements in urban planning can do for a citizen’s mental health and explore further opportunities.

Why do you think people don't focus enough on the link between urban design and mental health?

Because mental health is “easier” to discuss when it can be isolated to an individual (i.e. “well, he was crazy”) and not at a larger, societal scale. Violent tragedies go back to gun laws and race issues and not so much how we are shaping our citizens, mentally.

What would you like to see the Centre for Urban Design and Mental Health achieve?

Draw attention to the issues; bring people together to find solutions. Talk, talk, talk!

It has been a very exciting week for UD/MH. Tuesday was our grand launch and very first interdisciplinary dialogue. We were delighted with the turn out at the British Embassy - architects, urban planners, physicians, policymakers, epidemiologists, artists, mental health advocates, and many others turned out to drink wine, eat cheese, and engage in vigorous interdisciplinary debate: how can we design better mental health into our cities? Read all about it (and see some photos) here. We are hoping to get the video up next week. Plus, Layla McCay was interviewed for Cities Today, and wrote about mHealth, urban design and mental health for TechChange , while active transport guru Chris Hamilton published a version of his UD/MH launch presentation on Mobility Lab. 

Where are you originally from, and where do you now live and work?

I was born in Washington, D.C., raised in its suburbs, and currently live in the Bloomingdale Neighborhood near U Street in the District. I just finished 23 years with Arlington Department of Transportation and am embarking upon private practice in my new hometown of Key West.


Which is your favorite city in the world, and why?

I love traveling and my favorite cities include Heidelberg, Vienna, Montreal, San Francisco, Seattle, the District and Key West. I’m moving to Key West in the fall because it’s compact, vibrant and historical. It’s very walkable and bikeable. And you can eat and play outside twelve months a year. We don’t own a car in D.C. and won’t in Key West.

What sort of work do you do around the intersection of urban design and mental health?

I help cities make it easy to use active transport options like bike, walk and transit instead of driving. This makes individuals, companies and places more green, healthy, prosperous and happy.

How did you end up working at this intersection?

In looking for hooks to change people’s behavior from driving cars to instead using transit, biking and walking for commutes and everyday trips, research tells us that people who use these options to car driving are healthier and happier and less stressed. So we use these facts (among others) to market these options.


What particularly interests you about the link between urban design and mental health?

The world is becoming more urban. As the population expands in the coming decades, this will only become more so. We can’t repeat the mistakes of our most recent past where here in North America we built dispersed, environmentally and economically unsustainable, un-healthy car-dependant places. We can reverse this trend. And change is starting to occur in some progressive cities. Recent work and research points out that our physical environment can influence our mental and physical health. City governments have a huge influence over that built environment. Cities control the development approval process and so can influence what and where the private sector builds. And cities control a quarter to a half of our land, depending upon how you measure it, when you account for streets, parks and rights of way. As the emerging mental health research gets better, there’s an amazing opportunity to use this data to help us retrofit and build healthier places.


Can you describe an example of good urban design that positively impacts mental health?

Streets that are built for people. That means streets that prioritize people who walk, bike and use transit rather than cars. It looks like wide sidewalks and protected bike lanes. It means prioritizing public space for plazas, small to large, where we can eat, shop and congregate. These streets are less stressful and more healthy and happy places than car-centric streets. My favorite examples here in the District, because I use them a lot, include the 14th Street Corridor and 17th Street in Dupont Circle.

What sort of challenges do you see in urban design for mental health?

Changing the status quo can be difficult. Especially if that change is seen as taking something away from people who are use to the way life use to be. So every time we prioritize people and take away on-street parking or take away a traffic lane to replace it with a parklet or plaza or for walk-bike-transit space, someone will cry foul. The biggest challenge is the political will to make these changes.

Why do you think people don't focus enough on the link between urban design and mental health?

I don’t think people focus on it because it’s an emerging science. It has only been recently that planners have realized the connection between the built environment and physical health.

What would you like to see the Centre for Urban Design and Mental Health achieve?

That’s why it’s so exciting to see the Center for Urban Design and Mental Health come onto the scene. This new think tank can contribute to making the places we live better by getting us to consider more than the bottom line. In the end, we’ll all be healthier.

Follow Chris on Twitter @chrisrhamilton

Welcome to our Monday Meeting series, where we interview people working in, and thinking about the links between urban design and mental health. Today, meet Sandro Galea. 

How did you become involved in working in urban mental health?

I have been interested in how cities influence health throughout my academic career, motivated by a recognition that the urban environment was rapidly becoming the most ubiquitous context shared by many of us. Cities shape how we think, feel, and behave, the water we drink, food we eat, air we breathe. It has long seemed to me that cities represent the classic driver of population conditions (including health), which, if understood, can result in the improvement of human health.

What are some of the more interesting pieces of work you have done on urban mental health?

We have long investigated how the urban environment influences common mood-anxiety disorders, showing for example that quality of the built environment is associated with greater incident depression, independent of individual-level factors. Other work has focused on urban social networks, violence, and mental health for example.

Why is making the link between mental health and urban design important?

Designing urban environments to maximize the potential for healthier populations presents an extraordinary opportunity to improve the health of millions who live in cities worldwide.

What's one of your favorite examples of urban design efforts to improve mental health?

I quite like the illustrations provided by Jan Semenza in my book Macrosocial Determinants of Population Health (Chapter 23) about the Sunnyside Piazza project in Oregon.
 
Where do you see the main opportunities in leveraging urban design to improve mental health?

I think a clear understanding of the elements of urban design that influence health, paired with intervention efforts can be key

What are you currently working on with the World Health Organization?

Our group is leading an analysis of the World Mental Health surveys, working with collaborators worldwide, on understanding how cities and mental health are linked. Data from this project should be emerging shortly.

Do you have a message for those who work in urban design?

I think the link between urban environments and health is promising and could, if well understood, result in improvements in population health that is matched by little else.

We are very excited indeed to have confirmed our launch event and first interdisciplinary dialogue: 7th July at 6:30pm at the British Embassy in Washington DC, and you're invited. 

Join urban thinkers and doers from architecture, design, transport, urban planning, healthcare, academia and more for  dynamic, diverse presentations, conversations, and drinks to celebrate the launch of the Centre for Urban Design and Mental Health. 

Featured Speakers

Chris Hamilton - Improving population mental health through urban transport

Sara Hammerschmidt -  Land use for better mental health

Jamie Huffcut -  Integrating the principles of good mental healthcare design into the city

Yonette Thomas - Geospatial thinking in urban mental health

Robert Zarr - Prescribing parks over pills for children's mental health 

Timing
6pm Join us to toast the launch of UD/MH with wine and cheese
6:30pm Formal Program
7:30pm Networking and informal discussions
8pm End

Sign up now

It is always inspiring to walk along New York City's High Line Park. Once disused, elevated rail tracks have been transformed into an overground walkway filled with greenery, places to sit, ice cream to eat, and views to enjoy. 

The first time I visited the park, several years ago, it was calming and relaxing and contemplative - now the huge influx of visitors has made it very much less so, but still the access to close encounters with trees and shrubs, along with the art and views both of the city and out to the water, and the opportunities for private moments even amongst the crowds are some of the things that draw people there. 

Layla McCay, UDMH Director
I took the photograph at the top of this blog while visiting Medellin, Colombia, and forgot about it until I was thinking about photographs for this website. It seems an apt basis for the first post on the UDMH blog. Medellin is a fascinating place. Named the world's most innovative city, they have shifted from a setting of danger and fear to an urban environment to be proud of. On the day I took this photograph, I visited one of the city's poorest areas to experience their game-changing public transport innovations, and admire their beautiful library. I was enchanted by the 385-metre long escalator and the 2km-long cable car, both linking this previously isolated area with the rest of the city (and in the other direction, providing easy, affordable access to a beautiful mountain park). Strolling through the streets en route to the library, I noted the numerous community spaces and the beautiful use of murals. I particularly loved the mural of a bus as it combines my delight at street art and my appreciation of public transport.

To start off our blog, here's my op-ed from the Huffington Post that was inspired by that trip, musing upon the future of reading and the library as a third space: Why We Should Let Go of Nostalgia and Embrace the Evolution of Libraries.