Summer has arrived in London. A time of year where everyone seems just a little happier, a little friendlier, and a little more open to each other. It was under this sunshine that on Tuesday 13th June, I headed off to a seminar at University College London, funded by the UCL Grand Challenges & British Council Newton Fund on “The Built Environment, Social Networks & Mental Wellbeing: Cross-disciplinary & International perspectives”. The seminar brought together a wide variety of academics and practitioners working in the interdisciplinary fields of urban planning, architecture and public health, providing a rich platform for introduction, reflection and discussion.
 
Using fiction to imagine and experience urban space
Across the afternoon, several speakers introduced their work and approach to the themes. Opening the session was Amy Butt, an architect, lecturer, design tutor, and researcher. Her  work explores how fiction can draw out the human, emotional complexities of everyday urban life, exploring the relationships between people and place. “Strangeness is a vital point of reflection”, she notes, “and science fiction novels are an opportunity to imagine and empathically experience urban space”. Exploring the emotional sense of vertigo experienced in high rises through the 1975 Robert Silverberg novel “The World Inside”, Butt describes the feeling as an unbearable attack on one’s sense of self, a sense of coming apart, a dislocation of the soul:
“how can you create a sense of place when their grounding is mystifying?”

A good urban space is a used space
COHESION, presented by Dr Linda Ng Fat and Dr Leandro Garcia, is a UK-Brazil project funded by UCL Grand Challenge and the British-Council Newton Fund. Set up in 2016, it explores the effects of high-rise, high density housing in various countries. In its first year, COHESION undertook a comprehensive literature review (to be published), and will continue to further review the influence of living in high-rise buildings on social cohesion and mental health and wellbeing. Professor Laura Vaughan from the Bartlett School of Architecture gave a comprehensive and quick fire introduction to the history of housing planning and social aspects. Vaughan introduced the work of Space Syntax, which seeks to understand the relationship between spatial design, the use of space and long term social outcomes.  The use of mapping to reveal connectivity and patterns helped understand the role of spatial layout in community dynamics and network creation. The layout of a housing project for example, makes the difference between neighbourliness versus isolation, and a community where frequent casual meetings are encouraged is more likely to thrive.

“Spatial accessibility shapes movement, and movement leads to copresence” Vaughan notes in closing, “A good urban space is a used space, the spatial nature of human society.” Furthermore, and a recurring theme throughout the afternoon, is that more research is needed, as there is a gap in the ethnographic social studies of architecture.

Copresence: a precursor to interaction
Dr Paula Barros from the Universidade Federal de Minas Gerais, explored the influence of physical design on social interaction within 3 squares in her native Brazil. Through behavioural mapping, her research explores the various contentions between spaces of conflict versus spaces of encounter in public spaces, and how copresence is a necessary precursor to interaction. Identifying ‘delight’, ‘comfort’ and ‘protection’ as factors into favoured spaces (such as on props or edges to sit or rest), she notes that there is a lack of cross-cultural perspectives in the field. By understanding the response to user needs will only lead to higher quality public spaces. Additionally, Barros points to a need to further understand how landmarks support social sustainability.
 
Schizophrenia: does where you live matter?
Dr James Kirkbride, Reader from the Division of Psychiatry at UCL, opened his talk “Mind Over Matter: Does the Built Environment Affect Mental Health” by first making a distinction between common mental disorders and psychotic disorders. Common mental disorders, such as anxiety and depression, are, he pointed out, very different experiences from psychotic disorders, such as schizophrenia, though they are often confusingly bulked under the same heading. Furthermore, there is an important distinction to be made between mental wellbeing, mental health and mental disorders, and that each have very different experiences and consequences for people.

Kirkbride’s primary expertise is the study in incidence of schizophrenia in East London, and the potential link to inequality in social environments. He found that the strength of evidence varied. The extent to which there are social or environmental causes of schizophrenia remains unknown, though urban births are associated with a higher risk of developing the disorder. As a result, Kirkbride set up Psymaptic, “a free online prediction tool for healthcare planners, commissioners and other key stakeholders who require accurate and reliable data on the expected incidence of psychotic disorder in England & Wales. The tool gives instant access to the expected incidence of psychotic disorder in different regions of England & Wales, based on their sociodemographic and socioeconomic profile”.

Injustices in access to the 'right to the city'
From Reading University, Dr Richard Nunes followed this with a more personal presentation on the journey of his research on mental health and the city, particularly in his work exploring the connection between environmental change and mental health research. Nunes noted the limits of what urban design can achieve if enduring injustices of access to the 'right to the city' persists, that there was still so much to do in terms of re-connecting design/planning with mental health, as well as the difficulties of working with people across various disciplines. The links between environmental change and mental health research remain patchy and under-explained. A strong linear-causal relationship continues to be pursued, with a gap emerging between subjective and objective dimensions of environmental change and mental health research. Moreover, Nunes states, “people are not randomly distributed into space! Remove that [idea] and we can start to try and understand the causality of mental health”. This was complemented by Dr Pedro Morais, Adjunct Professor at Uni-BH, Brazil, who gave a presentation on the height & historical meanings and contexts of high rises across three continents, Europe, USA and South America.  His presentation addressed the issue of cultural associations or social preconceptions of high rises and the discontinuous city.

What if people left work feeling better than when they arrived?
Ankita Dwivedi Senior Associate from Gensler posed a closing question “What if people left work feeling better than when they arrived?” She discussed workplace design, stress and psychological well being, identifying that stress, anxiety and depression need to be tackled within the workspace as a case for action, as the potential rewards for businesses are huge. She asserted that the workplace is a microcosm of society and provides an opportunity for intervention, with the appropriate design and implementation in workplaces connecting to many further health pathways.
 
Research gaps and next steps
The day's discussions revealed an exciting and wide variety of work and entry points into the interdisciplinary connections of the built environment, social networks and mental health. However, what quickly became clear is that there is so much more research needed and encouraged. I walked away from the seminar wanting to do and understand more. As Nunes and Vaughan note, there is a gap in the ethnographic social studies of architecture, as well as efforts to reconnect design and planning with mental health. This, as Morias’s presentation elaborated on, needs more transnational comparisons, to understand the differences, similarities and learning curves from different contexts. Amy Butt’s creative approach to understanding high rises and their emotional experience though science fiction is an inspiring take on often invisible issues. It begs the question: what other ways of seeing and understanding the urban environment could reveal our emotional experiences of it? The afternoon was an excellent opportunity to network and hear from a wide variety of academics, practitioners, policy makers as well as the general public, and points to an ever growing interest and drive for more research.

By Leigh Stringer, workplace strategy expert and author of The Healthy Workplace

The built environment has a profound effect on our mental health and the building industry is uniquely positioned to lead the way.  To quote Dr. Richard Jackson, University of California Los Angeles School of Public Health (previously director of the U.S. Center for Disease Control's National Center for Environmental Health), "We now know that developers and architects can be more effective in achieving public health goals than doctors in white coats."

As a workplace consultant, I always have been aware of the importance of the built environment on health.  But it wasn’t until I started research for my book The Healthy Workplace a few years ago, and met with a long list of physiologists, neurologists, anthropologists, physicians, ergonomists, nutritionists and sleep exerts, that I realized the full impact of design not only on our health, but also on our well-being and performance.  The truth is, I’ve always thought about worker health as one item on a long list of project goals – along with saving money, being environmentally responsible and meeting my client’s business needs.  But after digging deeply into the research on health, I have started to believe that human health should be the foundation of workplace design and of business too.  Why?  Because companies thrive on the innovation and abilities of their people, and if employees are sick, overweight, stressed, sleep-deprived or disengaged, they prevent the company they work for from thriving and maintaining a competitive advantage in the marketplace.
           
So how can the built environment play a more meaningful role, particularly as it pertains to mental health?  Here are five strategies I have found to be particularly compelling:

1. Provide workers choice on how, when and where they work

Epidemiological studies from Karasek and Theorell show that regardless of their job function, workers who feel more in “control” of their work and work environment are less likely to suffer from heart disease and stress.  Find ways to build flexibility and choice into the work environment for your clients, including where, when and how they work. This might mean helping set up a work-at-home or flexible schedule policy, reconfiguring the work area to better suit individual preferences (like installing a treadmill desk or second computer monitor) or providing multiple settings for employees to work.

2. Nurture “biophilia” 

We have a strong desire to be in and among nature. It’s only natural – for most of human history we spent all of our time outdoors.  This preference, referred to biophilia and popularized by E.O. Wilson, suggests that there is an instinctive bond between human beings and other living systems. There is mounting evidence that biophilic environments can improve stress recovery rates, lower blood pressure, improve cognitive functions, enhance mental stamina and focus, decrease violence and criminal activity, elevate moods, and increase learning rates. Interestingly, biophilia-based design can be manifested in many ways: 

• The most obvious way is to incorporate real plants, water, and views to nature into buildings. 
  
• Another way is to create “natural analogues” which are one degree of separation away from true nature, such as materials and patterns that evoke nature, including artwork, ornamentation, biomorphic forms or the use of natural materials. 
  
• A third way to use biophilia is by the configuration of space – by organizing interior environments or a man-made outdoor landscapes using similar elements to natural environments.
  

This “stair gym” (below) not only encourages mental health visually with a landscape-themed environment, but also encourages aerobic exercise, which has been shown to boost mood and reduce anxiety and depression.

3. Reduce acoustical and visual distractions

Noise is an issue in almost every workplace environment.  Workers need acoustic (and visual) privacy, when desired, for personal regeneration.  Interestingly, noise can enable or disable productivity, depending on individual preferences and the type of work being done. The key is our ability to control what we hear.  Psychologically, studies show that when people have a degree of control over the noise in their environment, they are less distracted by it.  Contrary to popular belief, noise interruptions during simple, mundane tasks can be just the stimulation needed to be more productive. Interruptions caused by noise during complex work, however, require a longer period of time to re-orient, and continued interruptions are likely to have negative effects on mood that reduce the motivation to resume work.

4. Install “circadian” lighting

Our internal circadian rhythm or biological clock regulates the timing of periods of sleepiness and wakefulness throughout the day. This rhythm is controlled by a part of the brain at the back of the eye, which is triggered by changes in natural daylight.  Unfortunately, most of the workforce spends 90% of the day indoors, which plays havoc with the human sleep cycle.  To combat this, consider installing a circadian lighting system designed to trigger wakefulness into your next workplace design. Circadian lighting in workplaces takes into account natural and artificial light, a certain intensity of light at the desktop height level, and the presence of high light levels for a certain amount of time during the day.  Even if your workspace is lit at 500 lux, which is more than enough light for reading and most work tasks, it will not necessarily reset sleep schedule.  Note that the light that is important to our circadian rhythm is different from the light that is important to our visual system because of the spectral difference in the light sensitivity of our photoreceptors.  Special LED lights are required if we want to use them to increase our wakefulness or help us sleep.

5. Locate workspace by a park

Proximity of the office to parks and other recreational facilities is consistently associated with higher levels of physical activity, healthier weight status and improved mental health. Not all design projects involve moving your clients to a new location, but if they do, consider including building selection criteria that include access and views to nature.

We will address the opportunities of pro-social interaction in the workplace in a future article.

Around a quarter of people in urban Tokyo are said to regularly participate in shinrin yoku, or ‘forest bathing’. This Japanese practice was made official by the Ministry of Agriculture, Forestry and Fisheries in 1982. It means spending leisurely time experiencing the forest with all five senses. The point is to walk slowly and mindfully, appreciating the sounds, sights, smells, feel and taste of the forest, far from the screens and chaos of city life. Substantial research has found associations between spending this time in the forest and improvements in physiological and psychological indicators of stress, mood hostility, fatigue, confusion and vitality, including reductions in heart rate and blood pressure.

I love hiking and I usually find it serene. So how does  shinrin yoku differ from the ordinary hiking experience? First, only a  limited number of specific forests in Japan have been designated as official shinrin yoku sites. Designation requires a wide variety of criteria to be met, from ensuring visitors can experience the forest with all five senses, to having specifically tall trees, to scientifically recording health impact, to ensuring trained forest assistants are on hand.

None of these assistants were in sight when I got off the train at the only official shinrin yoku site within Tokyo’s borders: Okutama Forest. But the woman in the visitors’ office kindly provided me with a hand drawn photocopy of the routes and marked one for me in pink highlighter pen. Then, with her vague point in the right direction, I was sent on my way.

The other hikers who had been on my train inexplicably vanished and soon I was alone in the forest, ready to find out how shinrin yoku differs in practice from ordinary hiking in a forest. Without a proper guide, and being a little too much of an urbanite, I don’t know if I really found out. But since you didn’t get to join me, I will bring you inside the experience by welcoming you into my thought process over an hour and a half, one sunny Tuesday morning.

Walking down these steps, I see so many trees and greenery. I smell the forest. I hear the burbling river. It’s so serene. So quiet.

I hope it’s safe that I came here alone.
 
Oh my goodness, what’s that noise?
 
Oh, it’s my paper map crinkling in my hand. So 1990s. How lovely to have escaped technology. Better look at the map. Hmmm the route is very unclear. Cross this bridge? Maybe not. Oops, I think this is the wrong direction. Reverse. Google Maps has destroyed my orienteering skills!

Oh, but I do have my phone. Okay, let’s check Google Maps.
 
Google Maps doesn’t have this route. Hmmm this is not very relaxing so far. Oh, but here’s a sign, and it's in English. I apparently just walked the Okutama Fureai Shinrin yoku course, Hikawa Ravine without even realizing.
 
That wasn’t a very dramatic ravine. Or shinrin yoku experience. Onwards.

Oh, a paved road. That’s partly disappointing and partly reassuring. Also, a vending machine. Mmm cold lemonade. Delicious. Not sure that’s the taste of the forest the shinrin yoku experts had in mind.
 
Hmmm the directions to the next route are written in Kanji. I’ll ask Google Translate.
 
Urgh, Google Translate is bad at reading kanji carved into wooden direction posts. But I do recognize that one kanji means mountain. Think I’ll go the other way.
 
That was the wrong way. Reverse. Ouch, these ferns are jagging into my leg.
 
Aaargh a wasp! Or could it be one of these deadly Japanese hornets?
 
Pep talk time. Come on, enjoy the nature.
 
Oh okay, maybe this is the next forest bathing entrance. Japanese people clearly like to keep their signs subtle…
 
No, that was someone’s garden.
 
Oh okay, THIS is the entrance. Yes! Forest therapy. The Toke Trail. Now we’re talking! This is cool. The other therapy trail felt like just an ordinary hiking trail. This one is fancy. It has gravitas. It starts with a well kept, modern little hut. Oh, it’s locked. Hmmm maybe Tuesday morning is a sub-optimal time for forest bathing. Is the whole trail closed? No. Onwards!

How lovely that they have a special little train track and carriage for people in wheelchairs or who have other mobility challenges. Also, the walking trail is nicely kept, covered in chipped wood. The mountain views are beautiful. The trees are so tall. The sun is so bright.

Hmmm, better stop and put on some sun lotion.

Come on, be more mindful!
 
Oh this is nice. Charmingly designed. Lots of little chairs and tables of different types, tastefully blend into the scenery, encouraging you to linger and appreciate the scenery. Little viewing stations where you can curl up in a nook and look directly out into the forest. Maybe I’ll do that later. Wonder what the long, sloped table is for. Probably should have come on a weekend – they probably have activities. It’s so secluded today. I’m the only person here. So lovely.

Oh gosh, it’s a snake. Okay, freeze. Assess.

Yup, it’s a snake. It’s quite long. About a metre long. And it’s turned to look at me.
 
Why is there nobody else on this path?
 
Is it a poisonous snake? How would I know?

Google: Okutama forest snakes dangerous?
 
Google result: 'The world’s deadliest snakes', '25 of the world’s most venomous snakes', '10 most poisonous and most dangerous snakes in the world'.
 
I may have to stand here frozen forever.
 
Facebook: 'Alone in the forest and too scared to walk past a snake. I knew hiking alone was a harebrained scheme. He’s looking at me. Help!' (photo attached)
 
Facebook result: One like, three open-mouth emoji faces from urban friends.
 
Twitter: 'Snake etiquette please? March past him and hope for the best? Turn around and abandon walk?' (photo attached)
 
Twitter result: 'Doesn’t seem to be a viper which is good, so I’d walk past slowly, trying not to disturb him/her.'
 
Duly chastened for making gender assumptions about snake. Close eyes and dash past, in direct contravention of the slow walk instruction. Snake does not pursue. Though I am convinced he/she does for about 100 metres.
 
Heart pounding. Remember the research about the heart rate-reducing properties of the therapy walk. Alas.
 
Walk more rapidly than appropriate for a therapy walk. See a twig. Scream preemptively in case it’s a snake. Why is there nobody else on this path?
 
Pass hut number two. Locked again. Has yoga things inside. It would be nice to do yoga while looking out at the forest. But it’s not for me, apparently. Onwards.
 
Aaargh a… twig. Okay. Stop this. Enjoy the nature.
 
What’s that noise?! Oh, my map crinkling again.
 
Aaaargh something’s on my face. Oh, a spider web.
 
Not relaxed. Text friends to tell them I’m still alive. They are at work and unmoved.
 
Hut three.
 
Tell Twitter I’m still alive. Twitter asks if I have a bear bell. I do not, but suddenly recall the jangling of bells from fellow hikers on the train. And the picture of a bear outside the station accompanied by Japanese writing I failed to read.
 
Apparently I now have to sing to protect myself from bears. Relaxation is further diminishing (along with that of any person within earshot – of which there still appears to be none).
 
Thank goodness, a paved road.
 
Oh, I mean Awwww, what a shame the therapy walk is over.
 
Oh, a ten minute walk down the road and I can pick up the Fureai Shinrin Yoku path again.
 
Aaaargh, what was that?
 
A twig.
 
I see three helicopters overhead. I wonder if Twitter has sent someone to rescue me.
 
Another signpost, another Google Translate fail. But aha, do I see the character for station? I believe I do.
 
I’d brought a picnic but am too paranoid to eat it til I’m back in town and there are no more scenic picnic tables.
 
Well that was a bit embarrassing. I think I did shinrin yoku wrong…
 
On the train back to the city. All the hikers’ bear bells are jingling as they serenely look at me, and they seem to be thinking: 'well, if you brought your laptop on shinrin yoku, you were already doing it wrong'.

Physical characteristics of an environment that promotes good mental health

The day was focused around the presentation of cases of innovative, evidence based designs stretching from corridors and bedrooms, to bridges, gardens and entire psychiatric hospitals within the community. From each of these designs evolved a few recurring themes. Notably, that certain physical characteristics of environment are favoured for mental health promotion: open spaces, bountiful light, quietness, greenery, and cleanliness. Social spaces were considered essential, and multiple speakers highlighted the importance of spaces which function communally, designed to increase conversation and group activity. Yet the opposite was also deemed important: there should also exist spaces which are personal, isolating and foster feelings of security, ownership, and separateness. Finally, the need for spaces which are able to facilitate fruitful occupation was repeatedly identified. As such, designers seek to achieve an appropriate and accessible mix of social and asocial environments between which people can choose according to will .

The environment required of a psychiatric hospital is vastly different to that required of other settings. In particular, security must take top priority, there must be detailed environmental assessment for ligature points, and an understanding of which spaces are conducive for relaxation as much as being propagatory of violence and distress becomes key. While these priorities may pose a challenge to  architects aiming to design a sense of freedom into their building, arguably this challenge should be tackled in much the same way as “designing mental health” into non-institutional settings.

Bringing good design from the psychiatric hospital to the wider community

Designing for mental health is often focused on the psychiatric hospital, and while this is important it is right that more emphasis is now being placed on non-institutional settings: the workplace, home and community milieu. Perhaps there is public health benefit to be realised from assessing the few core architectural features which promote mental health and studying how we can incorporate these, not only into psychiatric hospitals but into all architectural design projects. Simple design features like changing the colour of flooring or walls, the height of the space, and setting ‘boundary markers’, can establish psychological zones: demarcating personal quiet spaces from communal social spaces. Innovative ‘greening’ methods may introduce nature inside, or better yet, creative use of lighting, windows and exploiting pretty surrounding views can metaphorically do the same job. Access to gardens or an orchard (as in Bethlem Royal Hospital) and the ability to wander and observe the changes in the seasons may have some effect in breaking one from the monotony of a sterile interior, providing another route towards emotional and psychological comfort.

In acknowledging that architecture can fulfill the functional needs expected of it (a psychiatric hospital being secure, a place of business being productive, a residential space being cosy etc.), we accept that certain behaviours can be architecturally promoted or deterred. At this conference several projects were presented showcasing attempts to change individual behaviour for public mental health benefit. The first among these took on the task of structural environmental intervention for suicide prevention.

Preventing suicides at the Derry Foyle bridge.
 
The prevention of jumping from buildings and bridges has been a focus of discussion across the globe. Infamously one Chinese factory insensitively installed netting around the outside of its building to catch its workers who would jump. In Northern Ireland, the Foyle bridge in Derry/Londonderry is known widely as a local 'suicide hotspot'. A folk narrative has developed around the bridge, drawing people from across the surrounding areas to this spot, as Beachy Head does in England, to kill oneself in a ‘traditional’ way.

The Our Future Foyle programme, funded by the Royal College of Art among other partners, aims to break this narrative and prevent suicides from the Foyle bridge. With multiple facets, the first step of this programme will revitalise the area surrounding the bridge with community events and business opportunities. Individuals attempting suicide often prefer to do so alone and out of sight of others. Therefore, by increasing footfall in the area through commercialising and pedestrianising the river bank and improving transport links, it is hoped that people will be dissuaded from jumping from the bridge.

The next step concerned the role of suicide barriers on bridges. Often these barriers themselves are devoid of artistic thought and become an extension of the suicidal narrative of a building or bridge: “Those barriers are there to stop people jumping off”. This project aims to install functional art, a series of connected five metre tall metal reeds, to echo the reeds on the river bank below. While acting functionally as a suicide barrier, the reeds will also feature multi-coloured lights at their peaks, which can be changed by those promenading past, creating new narratives associated with this place.

This idea of urban design is striking, especially if it is eventually proven effective in preventing suicides. By changing the narrative of a space, its social typology, and incorporating functional architecture - both social and physical barriers to suicide attempts - we wait to see if there is an effect on the prevention of suicide, a major mental health outcome.

Asylum in the heart of London
 
The location of psychiatric hospitals is an important facet of urban design, making bold statements about society’s relationship with psychiatric patients. Historically this has been a point of contention. In London for example, as the city expanded outwards, asylums which had previously been on the outskirts of the city were pushed further and further back into the surrounding countryside. While the ethos of 19th century moral therapy also often included natural retreat, the “Not In My Back Yard” stance of many of London’s population unquestionably contributed to the construction of newer asylums in the surrounding countryside.

Yet this trend is now evolving, and an example is the imminent revitalisation of the Springfield University hospital, an old asylum built within large grounds in South West London. The grounds will be turned into new community homes, with a new psychiatric hospital at its heart. Wards will be built above shops. According to the architects' drawings, there will be a view from inside these rooms of happy attractive people bustling around a communal square, shopping, and enjoying the sun. What may at first appear to be an attempt to commercialise prime real estate in London may turn out to play a key part in destigmatising psychiatry and rehabilitating patients to community living much more readily than an isolated and unintegrated asylum of old.

MadLove: a designer asylum
 
Following their success as an exhibit at The Wellcome Gallery earlier this year, MadLove: a designer asylum is a service user-led art movement aiming to collectively design the “most crazy, bonkers, mental asylum we dare dream of”. A space which is both safe and nurturing of madness the lead artists, both service users themselves, suggest that psychiatric hospitals can often be more punishment than love. After multiple rounds of consultation a collaborative plan was developed and showcased.

The MadLove design features tree-house style accommodation on a grassy hill, and a central hub with shops and occupational space. Someone is always available here to talk or relax with. The sounds of birds and the sea breeze (which carries in the smell of baking bread) can be heard around the asylum. There are no fences and residents come and go as and when they please. The results of their extensive service user consultations are freely available online.

Architecture is just one tool of the urban planner, but it is essential in propagating mental health benefit to a city’s residents. In closing the conference, one architect made a plea to the audience - seconded by service users and psychiatrists alike - that design should be first, evidenced based, and more importantly built in collaboration with those who will live and work in their buildings and environments. The need for both evidenced based design and participatory design strikes at the heart of how architecture can foster effective mental health-promoting features of design, and reduce the often emotional and physical imposition of a building's primary function: security, sanctuary, or productivity alike.

UD/MH is often asked about how mental health principles can be applied in different conflict and post-conflict situations. This week in the medical journal The Lancet, a review was published on the public health impact of 'explosive remnants of war'. The researchers highlight that beyond the physical injuries landmines and exploded or unexploded ordinance can cause to displaced people returning home after conflict, they also seem to exert significant impact on people's mental health. This can include anxiety, depression, and post-traumatic stress disorder (though a direct causative link could not be made). These mental health effects can occur even where the explosives are present but have not caused injury.

The paper does not speculate at length upon the reasons that these explosives may be linked to mental health problems. I wonder if an important contribution is how they can affect the meaning of a place.

The concept of ‘home’ is important for people’s sense of belonging, and as such, affects their mental health and wellbeing. Place is the canvas onto which people project their personal and shared memories and expectations. A place feels like ‘home’ because it brims with personal landmarks (the café at which we spent hours laughing with friends, the first apartment we lived in, the park bench from which our child leapt, playing astronaut). For many, home is, by definition, a safe place (or at least there are places where we know we can go to feel safe). Yet when people return home after conflict, they sometimes find that conflict has changed the meaning of the place that was once home. It is difficult to recognise. Personal landmarks become superimposed with physical and memory landmarks of fear and pain and sorrow and unease and trauma. When people lose the ability to reliably differentiate between safe and threatening, their perception of home evolves into a traumascape of disconnection and distrust.

Urban design has an important role to play in helping the feeling of a place revert to 'home' after conflict. This means healing without forgetting: reducing the physical scars of conflict, and designing a place that engenders confidence and pride, that supports mental health and wellbeing, such as reliable infrastructure, green spaces, social spaces, places to walk and exercise, and places to feel safe. Engaging residents in designing the right approach to rebuilding can have benefits in also rebuilding the community: strengthening social capital and trust, while empowering people to take control of a place and help bring back the meaning of the place as a home they recognise.

Explosive remnants of war, such as landmines, can confound these efforts, because a place can never feel entirely safe. War is still just beyond the doorstep. In avoiding and fearing the open spaces where people might otherwise have exercised, socialised, relaxed, and enjoyed nature, the prospect of finding home may be held in a state of suspended animation. People cannot trust their home not to harm them, and so they wait, walled in and tense.

The Lancet paper reports that international support for mine action is declining. And yet it is an essential part of rebuilding - not just physical rebuilding, but a rebuilding a community's trust that they are home.

For more on this topic, read UD/MH Fellow Sophie Gleizes on traumascapes.

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

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

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

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

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

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

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

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

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

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

References
 

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

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

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

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

Key findings that are relevant for planners and designers

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

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

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

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

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

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

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

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

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

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

by Layla McCay, UD/MH Director

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

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

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

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

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

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

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

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

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

Friday 7th April is World Health Day, and this year the World Health Organization has announced the theme, which is depression: let's talk. Depression is the leading cause of ill health and disability worldwide. More than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. People who live in cities have up to 39% increased risk of depression. This is important for architects, city planners, and other urban designers. So, in line with the World Health Day theme, #letstalk about #designagainstdepression.

What is depression?

Depression is an illness characterized by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks. In addition, people with depression normally have several of the following symptoms: a loss of energy; a change in appetite; sleeping more or less; anxiety; reduced concentration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide.
- World Health Organization

What does urban living have to do with depression?

The physical and social environments of urban life can contribute both positively and negatively to mental health and wellbeing. There are three main reasons that city life is associated with increased depression:

1. Pre-existing risk factors: Some of the reasons for people moving to the city also happen to be risk factors for depression: for example, poverty, unemployment, homelessness, existing physical and mental health problems, previous trauma, personal crises, family break up, addiction, and immigration. This  leads to a population who are particularly vulnerable to depression.
2. Social factors: People with many of these pre-existing risk factors often encounter negative disparities in the city, such as physical and psychological segregation into neighborhoods characterized by poverty and social challenges, engendering feelings of injustice and hopelessness, and experiences of prejudice and discrimination that may affect mental health.
3. Environmental factors: The urban setting can affect people in two key ways: increasing stimuli, and stripping away of protective factors.

• Overload: People who live in the city experience an increased stimulus level: density, crowding, noise, smells, sights, disarray, pollution and intensity of other inputs. Every part of the urban environment is deliberately designed to assert meanings and messages. These stimuli trigger action and thought on a latent level of awareness, and become more potent as an inability to ‘cope’ sets in. This can have the effect of overload: increasing the body's baseline levels of arousal, stress, and preparedness, but also driving people to seek relief: quiet, private spaces; over time this urge may evolve into social isolation associated with depression and anxiety, and also forms the basis of the ecological hypothesis of schizophrenia.
• Erosion of protective factors: People who live in the city may find that they have less access to the factors that are protective for good mental health compared to those in rural areas. For example, they may have diminished access to nature, fewer opportunities to integrate exercise as part of their daily routines, and reduced leisure time as increased time is spent at work and commuting around the city. People may find themselves feeling unsafe, having less privacy, and even less sleep, due to factors like crowding, light, noise and stress. Rural to urban migration often sees people leaving behind their strong social networks of friends and family, and it takes time to develop similarly supportive social capital in the city. This may particularly be the case as urban dwellers may be reluctant to engage in social interactions, to avoid overstimulation, due to safety concerns, or because of the reduced likelihood of future relationships with each individual they encounter.  As these protective factors erode, people become more vulnerable to developing mental health problems.

So how can urban design help reduce the risk of depression for people living in cities?

• Design green space into the city: There are important relationships between accessible green spaces and mental health and wellbeing. Access to natural settings in neighbourhoods and in the course of people’s daily routines is likely to improve and maintain mood, and help prevent depression.
• Design active space into the city: Regular exercise is as effective as anti-depressants for treating mild-moderate depression, and a key opportunity for promoting good mental health. Action opportunities can be embedded into people's routines as they move around the city, from improving walkability and bikability infrastructure to traffic calming, reliable public transport, and access to exercise facilities in the city for all.
• Design pro-social space into the city: One of the most important opportunities for preventing depression is natural, positive social interactions, from close, confiding relationships to feeling part of a community. Urban places should facilitate social interaction (while also ensuring opportunities for privacy to avoid overload), eg. compact, walkable neighbourhoods with street benches on which to rest, mixed-land use with welcoming shopfronts and amenities, fine-grain street fronts (long, monotonous blocks of featureless walls can make people prone to ruminations), and multi-use public open spaces where people can get together for cooperative community events with opportunities for participation and volunteering.
• Design to improve sleep: Sleep is one of the most important protective factors against depression. And yet cities can erode sleep patterns with increased ambient noise, light pollution, and crowding. Sirens, alarms, vehicle traffic noise, noises from adjacent homes, and construction work may all be more likely in the city, and urban residents are more likely to sleep at times that do not match with their biological clock. Good building insulation, street trees, walls, and other noise barriers can help prevent urban noise from disrupting sleep, as can traffic restrictions. Street lighting can be oriented downwards to reduce residential light pollution.
• Design for safety: A sense of safety and security is integral to people’s mental health and wellbeing. People are deterred from taking advantage of green, active and pro-social opportunities in the city if they fear for their safety. Whether fear of crime, traffic, or getting lost (for example for people with dementia), improving safety can increase people's access to these opportunities.

Learn more detail about these opportunities on our website.

ACTION: What can I do today?

Let's fill the internet with great design to reduce depression. For World Health Day, the Centre for Urban Design and Mental Health is kicking off a #udmhflashmob - all day on April 7th:

1. Take pictures of places in your city or share your firm's work encapsulating some of the design elements that help #designagainstdepression (click here for more info). Upload  to Twitter (tag @urbandesignmh) and/or Instagram (tag @urbandesignmentalhealth). State the city, the design features of interest, and use the hashtags: #worldhealthday  #udmhflashmob and even #designagainstdepression Bonus: you'll get some air, exercise, and walk around green spaces while you take the pictures, improving your own mental health while you do this.
2. If you don't have pictures, just tag us on Twitter and write about your suggestions and links to how architects, urban planners, designers, geographers, engineers and more can contribute to #designagainstdepression on #worldhealthday
3. Follow the hashtags, look at everyone's photos, comment, learn and be inspired about how you can integrate mental health promotion into your projects.

While the whole world is talking about depression for World Health Day, let's make sure they think about the important and innovative roles that designers and other citymakers can play in preventing depression and promoting better mental health and wellbeing for the population.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We look forward to seeing and sharing your pictures.

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

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

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

THE URBAN PENALTY

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

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

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

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

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

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

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

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

AN EXEMPLAR

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

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

A WELL-DESIGN PLACE

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

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

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

I love people-watching. Most urban designers do. The more people in a public space, the better. The more diverse, active, extroverted, connected, playful, and affectionate people are with each other, the more there is to see and do. In this sense, the more insane a crowd is, the more livable and healthy is a city. My research on people-centered urban design does not aim to eliminate insanity from everyday life in cities. I rather seek to better understand which factors of the urban environment are stressful to pedestrians and particularly vulnerable people and how urban design can better support them in using public space.

Current city living has been related to various manifestations of stress and a higher risk for mental health problems (Lederbogen, et al., 2011). Lederbogen et al. (2013) have named a set of influencing factors for urban social stress including infrastructure, socio-economic factors, noise and environmental pollution. These remain open questions:

• Which factors of the built environment are critical in influencing subjectively perceived urban stress (PUS)
• How do these factors interact? 
• How can these factors be addressed by planning and urban design to maximize pedestrian comfort?

 
This blog entry reports on a few findings in two recent publications, in which my colleagues and I from TU Darmstadt have introduced a framework of environmental factors and spatial analysis tools shown to be useful to describe and even predict PUS in open public spaces (OPS). In a first step, environmental properties have been constructed for a sample of OPS in the city of Darmstadt, Germany, using the space syntax framework (Hillier & Hanson, 1984). These were paired to users’ ratings of spatial qualities such as loudness and subjectively perceived safety and stress (figure 2). Isovist vertice density has been shown to be weakly associated to users’ ratings of safety (r=.365, p=.09, Pearson), while global and citywide integration of a street segment have been shown closely related to PUS (r=0.432, p=0.04, Pearson) (Knöll, Neuheuser, Li, & Rudolph-Cleff, 2015). City-wide integration of streets has been closely related to actual amount of car traffic. Our findings may underline the importance of traffic calming, speed limits and walkability for measures to reduce pedestrians’ perceived stress levels.

In a recent journal article, the data has been analyzed using different types of multivariate models with the aim to predict ratings of PUS with a highly explained variance and significance (Knöll, Neuheuser, Cleff, & Rudolph-Cleff, 2017). Open space typologies (park, square, courtyard, streets) were found to be the best predictors for PUS, followed by building coverage ratio, isovist vertices numbers and syntactical characteristics (Figure 3). The isovist characteristics in particular, revealed interesting new insights and research questions. For example, visibility, as the relative size of the area that can be overseen from a given point in a space, was found positively related to users ratings of perceived stress. This was contrary to findings previously reported in indoor spaces. And it is somewhat surprising, since visibility of pedestrians by car drivers is key to reduce traffic injuries and improve overall actual pedestrian safety. In other words, people seem to feel most stressed in those areas of busy squares and streets where, in theory, they should be safest from car traffic. We conclude that to further study the isovist characteristics and their relation to percieved stress should be a priority in future research. Visibility and the geometric shape (“complexity”) of urban environments are factors that can be influenced by urban design measures such as street furniture, trees and facades (Knöll, Neuheuser, Cleff, & Rudolph-Cleff, 2017).

A model has been presented that uses a combination of environmental properties and achieves a predictive power of R2=54.6% (Knöll, Neuheuser, Cleff, & Rudolph-Cleff, 2017). These results are a first attempt to predict more complex emotions such as perceived urban stress by analyzing factors of the built environment and using standard planning tools such as GIS and Space Syntax. They extend existing models that have predicted tranquility in green spaces (Watts, Pheasant, & Horoshenko, 2014) or activities and spatial experience in streetscapes (Bielik, Schneider, Kuliga, Valasek, & Donath, 2015). The framework may be useful to architects and neuroscientists alike, who seek to identify or visualize urban configurations likely to be perceived as stressful and seek to further investigate pedestrian comfort by pairing environmental factors with geo referenced, psychophysiological effects.

References

Bielik, M., Schneider, S., Kuliga, S., Valasek, M., & Donath, D. (2015). Investigating the effect of urban form on the environmental appraisal of streetscapes. In K. Karimi, L. Vaughan, K. Sailer, G. Palaiologou, & T. Bolton (Ed.), Proceedings of the 10th International Space Syntax Symposium (pp. 119:1-13). London: Space Syntax Laboratory, The Bartlett School of Architecture, University College London.

Franz, G., & Wiener, J. M. (2008, April 3). From space syntax to space semantics: a behaviourally and perceptually oriented methodology for the efficient description of the geometry and the topology of environments. Environment and Planning B: Planning and Design , XXXV, pp. 574-92.

Halblaub Miranda, M., Hardy, S., & Knöll, M. (2015). MoMe: a context-sensitive mobile application to research spatial perception and behaviour. In Department of Geosciences and Natural Resource Management (ed.), Human mobility, cognition and GISc. Conference proceedings. November 2015, (p. 29-30). Copenhagen.

Hillier, B., & Hanson, J. (1984). The Social Logic of Space. Cambridge: University Press.

Knöll, M., Neuheuser, K., Cleff, T., & Rudolph-Cleff, A. (2017). A tool to predict perceived urban stress in open public spaces. Environment and Planning B: Urban Analytics and City Science.

Knöll, Martin, Environmental factors and tools to analyze perceived stress in open spaces. ANFA 2016: CONNECTIONS – BRIDGESYNAPSES. 23rd-24th September 2016, La Jolla, CA: Academy of Neuroscience for Architecture. Video

Knöll, M., Neuheuser, K., Li, Y., & Rudolph-Cleff, A. (2015). Using space syntax to analyze stress perception in open public space. In K. Karimi, L.  Vaughan, K. Sailer, G. Palaiologou, & T. Bolton (Ed.), Proceedings of the 10th International Space Syntax Symposium (pp. 123:1-15). London: Space Syntax Laboratory, The Bartlett School of Architecture, University College London.

Lederbogen, F., Haddad, L., & Meyer-Lindenberg, A. (2013, December). Urban social stress - Risk factor for mental disorders. The case of schizophrenia. Environmental Pollution .

Lederbogen, F., Kirsch, P., Haddad, L., Streit, F., Tost, H., Schuch, P., et al. (2011, June 23). City living and urban upbringing affect neural social stress processing in humans. Nature , 474, pp. 498-501.

Watts, G., Pheasant, R., & Horoshenko, K. (2014). Predicting perceived tranquillity in urban parks and open spaces. Environment and Planning B: Planning and Design , 38 (4), pp. 585-94.
 
Acknowledgments

I am grateful to my co-authors Dr. Annette Rudolph-Cleff, Professor of Design and Urban Development, Yang Li, PhD Candidate, both Department of Architecture, Katrin Neuheuser, PhD Candidate, Dept. of Human Sciences, TU Darmstadt, and Dr. Thomas Cleff, Professor of Quantitative Methods for Business and Economics at Pforzheim University, Germany.

Psychologist Eric Greene, in his first of a series for Sanity and Urbanity, discusses the links between depth psychology and architecture.

With this observation coming from architect Christopher Alexander, I would like to throw my hard-hat of depth psychology into the construction site of urban design and mental health. First, allow me to explain what I do and how this builds upon the discussion, and to sketch the similarities between depth psychology and architecture.

A depth psychologist is, simply put, any psychologist who includes the unconscious in their understanding of the mind. The job of a depth psychologist is to analyze dreams, speech, fantasies and images of the mind and the world which function as a kind of subtext to the surface symptom. The founder of this tradition is generally identified as Freud then Jung.
             
The practice of analysis is popularly conceived of as occurring in an office by a therapist with a patient. But the field extends far beyond this practice. Consider this quote from Freud: (1930) in Civilization and its Discontents (a more literal translation is ‘the disease in culture’):

This quote suggests that culture and all that it contains could be the context that makes people sick, and therefore, itself could and should be analyzed. Additionally, both Freud (1895) and Jung (1963) often used the metaphor of a house to describe the mind. Jung, in fact, constructed a literal house and often referred to it as an extension of his mind. Since its inception, depth psychology has been linked to architecture. But how?

My thesis is this: The foundation upon which our modern buildings and minds are constructed is the same. This foundation is not a material foundation but rather it is an idea, or image, if you will. The image is characterized by its isolation, alienation, emptiness— all conditions which lead to dis-ease or mental illness. The reification of this image has reached its peak today. In order to change the mental illness of our culture, we need to rethink this foundational idea. Both post-modern critiques of architecture and psychotherapy are pointing the way forward to rethink our cities in terms of its relationality, not its isolation, in order to create a more mentally healthy world.
 
1. Strip Bare the Patient
             
Since Freud, many depth psychologists continued to analyzed the world in relation to mental health. Freud’s student, Bruno Bettelheim, in The Mental Health of Urban Design, continued with Freud’s thesis: the world can make us sick. Bettelheim (1979) asks:

 Bettelheim argues that the carelessness with which a home is constructed— in this case, the projects created mostly for the African-American poor in America— becomes internalized in the mind of its inhabitants, and they come to know their first world as one which does not care for them. Then, they lack the hope that beyond their immediate horizon is a world which welcomes them. The construction of the space colonizes the inhabitant’s physical and mental landscapes. Generalizing this theme for our purposes, one could say, that the spaces in which we live project onto us just as we project onto them.

It is on this precise notion—that of the world projecting onto us—that the student of Jung, James Hillman, staked an important claim: psychotherapy strips bare the patient’s psychology to its utopian essentials by withdrawing its projections from the world. Hillman (1970) claims that this process exacerbates the disease of isolation or alienation. The problems are not just all in our minds. We have had 100 years of psychotherapy and the world has gotten worse, precisely because we internalize all of the world’s problems as if “the end of the world were an inner problem”(Hillman, 1993; Hillman, 1998, 129). As a result, we have become anesthetized by the subjectivism of psychotherapy (Hillman, 1970). To break free of this emptiness and isolation, in order to restore mental health to the world, Hillman (1970), like Bettelheim, argues that we need to recognize that psychology is everywhere and in everything, that each thing sparks with its “eachness” or particularities. In other words, mental illness is not just in a person’s head. It is also in our cities, our buildings, in the whole of civilization, and these things projects onto us.
 
2. Strip Bare the Building
             
The progression of architectural design in modernity seemed to follow a similar historical path. Architect Irata Isozaki, in the introduction to Kojin Karatani’s (1995) Architecture as Metaphor, narrates that architecture has passed through three crises. The first occurred when the ‘bible’ of architecture, Vitruvius’ The Ten Books on Architecture, became relativized. The vacancy left from this displacement was filled by a new orientation of “Architecture as Art” (Isozaki in Karatani, 1995, x). The second crisis occurred when that art became institutionalized and oppressive. The new orientation of modern architecture was, then, “Architecture as Construction” (Isozaki in Karatani, 1995, xi). The idea was to strip its subject bare of the projections or decorative elements (i.e., art) and construct buildings from basic elements towards a utopia. This left buildings “skeletal” (Isozaki in Katajani, 1995, xi). The movement reached its fruition in the middle of the twentieth century.
             
We are, according to Isozaki, still in the third crises. Architecture, like so many things in post-modernity, suffers from a loss of the metanarrative, and the  orientation is one of a “loss of subject” (Isozaki in Katajani, 1995, xii). This strange characterization means that buildings are seen as projects which are separated from, and indeed colonize, the communities in which they are built; and, they contain no elements of humanity. This is why architect Christopher Alexander (in Landy, 1990) states these “buildings [today] make you feel like death…[they are] constructed with the absolute intent to destroy emotion…[and] they alienate you”. In short, the world we live in projects alienation and mental illness onto us.

3. The Foundation
             
These two monuments of study— architecture and psychotherapy—are founded upon a mutual image. This image is characterized by bareness, isolation and alienation. It has affected the spirit of our culture and makes us feel mentally unhealthy.
             
If the goal is to create sane urban life, we ought to begin with an image of buildings which engenders hope and humanity. They would be constructed with an eye towards beauty, focus on the particularities, consider the relationship to its parts and to the community at large. If we can hope to create a healthier future—a future which promises movement beyond the horizon of our felt sense of isolation and alienation— we can begin by caring for our cities and buildings— the places which we can and should call home.
             
 
References
 
Bruno Bettelheim, “Mental Health and Urban Design,” in Surviving and other essays. (NY, 1979), pp. 201.
 
Breuer, J. & Freud, S. (1895).  Studies in hysteria. New York, NY: Hogarth.
 
Freud, S. (1930). Civilization and its discontents. New York, NY:  W.W. Norton and Co.
 
Hillman, J. (1970). Re-visioning psychology. New York, NY: Harper and Row.
 
Hillman, J. (1993). We’ve had one hundred years of psychology and the world is getting             worse. New York, NY: Harper.
 
Hillman, J. (1998). The thought of the heart and the soul of the world. Los Angeles, CA:          Spring.
 
Jung, C.G. (1963). Memories, dreams, reflections. New York, NY: Vintage.
 
Karatani, K. (1995). Architecture as metaphor: language, number, money. Boston,       Massachusettes: M.I.T.
 
Landy. Places for the Soul: the Architecture of Christopher Alexander. (1990).               Christopher Alexander.

Switzerland-based urban planner Silvia Gugu provides her takeaways from the conference "Happy City - Faire la ville par l’événement" (December 9th 2016 at the Haute École Spécialisée de Suisse Occidentale in Geneva). A collaboration between the Geography Department at the University of Geneva and the Swiss Geographic Association, this one-day conference brought together academics and professional citymakers to explore the potential of one-off events in helping to create a “happy city”.

The "Happy City" agenda was famously articulated by geographer and writer Charles Montgomery in his 2013 book Happy City. Transforming our Lives through Urban Design. This book brings  together evidence from psychology, neuroscience, public health and behavioural economics to discuss the ways in which urban design affects psychological wellbeing. It has generated spin-offs such as the Happy City Labs in Vancouver and Geneva, where a key focus is on devising urban events that foster social interaction and a sense of ownership of public space. 

Disrupting the urban rhythm

Over the past decades, community, commercial, arts and leisure events have been frequently designed as disruptions of the urban rhythm, temporarily altering urban form, function and social relations. Many are organized by administrations and are primarily attributed to the competitive neoliberal ethos that calls for cities to build their unique brand in the global economy. Others are initiated by individuals or associations, falling into the recent category of tactical (do-it-yourself / guerrilla / lighter-quicker-cheaper / pop-up) urbanism; in other words, grassroots attempts to re-inject agency in the relationship between residents and their environment.  Leisurely and convivial, urban events are malleable instruments that can fit neatly into any of the quality-of-life-oriented urban agendas developed since the 1970’s, such as: Cities for People, Participative Cities, Creative Cities, Liveable Cities, and of course, Happy Cities.

Event-based urbanism

The conference considered both grassroots do-it-yourself interventions, and official policies of ‘event-based urbanism’, highlighting their effects on urban form and function. The talks remained theoretical and exploratory; nevertheless, they opened interesting questions about the way events can mediate the relationship between the urban environment and psychological well being by changing mood and behaviours. Here are a few takeaway hypotheses:

Urban events may make us happier by providing additional aesthetic stimuli  

Several speakers referred to how urban events alter the urban aesthetics and our perception of it, making use of a broad range of props and techniques, from images, lights and installations to highlights, reframing and unexpected vantage points and narratives.

Urban events are by definition designed and staged. They are often initiated to beautify and render cities more attractive; and they may be accompanied by physical urban improvements in order to ensure adequate “display windows” (public or private venues).  Some are primarily itinerant or episodic ambiances (the circus, the fun fair, the Christmas market, Park(ing) Day – which transforms parking lots into green patches). They play down the familiar and the unremarkable and place the emphasis on memorable, festive choreographies.

Events can thus stimulate the senses and create feelings of awe and discovery in an otherwise familiar environment.  Lea Sallenave (University of Geneva) showed for example how street art festivals draw attention to neglected corners; stimulate physical and sensorial apprehension of the city through unexpected trajectories and critical commentaries.

This temporary increase in aesthetic stimuli and capital seems to be popular with the residents that can directly benefit from them (but less so with the ones that feel left out). While urban form is slow to evolve and adapt to new taste, urban events can quickly respond to current expectations by cladding physical infrastructures with new shapes, colours and accents, thus allowing for a continuous symbolic and material renewal of the environment.

Urban events may make us happier by negotiating between social interaction and privacy

Many participants stressed the relational logic of urban events, most of which are designed for social interaction, attracting large numbers of people in the public space and providing a reason for eye contact and conversation. The mere collective consumption of an experience fosters bonding and belonging, and the pro-active participation in public life facilitates “eudaimonia”, Aristotle’s idea of happiness as self fulfilment through benefiting others, a fundamental concept in the “Happy City” theory.

Importantly, the episodic nature of events allows for equilibrium between the need for social interaction and for privacy. As pointed out by Diego Rigamonti (AIDEC), quality of life is a subjective assessment of a complex environment that has to function for everyone, hence conflicts are inevitable – we desire more events as opportunities to encounter others but we don’t want the mess and risks that come with them; we like densification as long as it does not happen in our neighbourhood etc. The temporary nature of urban events appeases such conflicts by allowing conflicting interests and needs to take their turn. 

Urban events may make us happier by changing urban uses in favour of desired activities

A prominent and much-cited application of the event in city-making is the temporary adjustment of land uses or the subversive reprogramming / occupation of space in favour of activities preferred by the community. Many of these started as DIY, illegal uses enabled by loopholes in legislation or tolerated due to being temporary. Some were adopted as permanent changes, showing how, thanks to its temporary nature, tactical urbanism can negotiate with legal and institutional frameworks.

Moreover, examples cited at the conference demonstrated that temporary uses, together with the “tactical” approach, have been embraced by planners and administrations to respond to  immediate needs and expectations (small green spaces, beach-volleyball fields, snack bars, community gardens, family spaces or simply loosely-articulated structures that permitted people to assign them meaning and function).

Urban events may make us happier by allowing us to exert agency on our environment

There seemed to be a consensus among conference participants that, whatever their source, urban events stand in opposition to the 20th century approach to planning cities. The latter presumes a vision: a finite, virtuous state of equilibrium, to be reached through a strategic plan – an instrument that aims to control both internal and external environments, leaving nothing to chance. In contrast, urban events are a way of refocusing the attention on the city as something that happens, as a process not a product, a continuous transformation that we witness and in which we can choose to participate or not. By providing opportunities for participation, they render the city more “open”. The universal appeal of tactical urbanism, which operates primarily through small and temporary, but scalable interventions, lies precisely in presenting urban change as a matter of choice, not of resources or power.

Events may keep us happy by appeasing permanent change

Throughout the conference, the most iterated role of events was simply taking the edge off drastic urban change brought by new technologies, policies or projects.

Speakers from urbaplan noted that events can facilitate the popularization of a technical discourse, rendering it accessible, reframing issues by using play, invitation, celebrations, and appeals to emotion (climate change activism quickly comes to mind as a prominent example). Nicolas Nova (HEAD) talked about events such as fun fairs as itinerant laboratories for testing and diffusing behaviour-altering technologies (the cinema, the automobile, elevators, moving sidewalks etc). Thus, technologies that could otherwise be perceived as unsettling or outright dystopian could be experienced in ephemeral, fun doses, and introduced “tactically”.  Primed by marketing, the public is reassured by the ephemeral and fragile nature of temporary installations, and is more willing to test them.

Luca Pattaroni (EPFL) noted that events are easily assimilated as experimental, exploratory, pilot changes. In other words, events introduce change without requiring immediate or drastic behaviour adaptation.  The same logic was outlined by Giovanna Ronconi from the Republic and Canton of Geneva, who presented a version of the lighter, quicker, cheaper approach to urban change, centred on temporary, reversible interventions to facilitate shared decision making, the legitimization of projects by testing the response to the conflicting needs of residents, and use of little resources, which can stimulate creative solutions. 

Urban events may not make everyone happy

The limitations of urban events emerged less compellingly at the conference. However, it was acknowledged that event-based urbanism can be just as frustrating as any other urban development process, particularly if it doesn’t consider participative decision making (even grassroots, guerrilla and tactical interventions are often the initiative of a small group of people or an individual, not of the entire community exposed to them). Urban events can be a source of noise, environmental pollution, stress, and annoying disruptions for those who don’t want or cannot partake in them. These nuisances may extend far beyond the interval when the events manifest, accompanying the preparatory work that goes into assembling and dismantling them. Depending on their nature and scale, they can entail significant security costs and risks; for example, gatherings are a preferred target of terrorist and criminal attacks. Just as these events may create the illusion of safety, they can also instil the fear of crime. Besides, it was pointed out, not everyone feels happiness is the ultimate banner for urban action.  

Are these potential negative effects justified by the happy city aspirations? After all, urban events cannot claim to actually improve most day to day living conditions that affect psychological wellbeing (housing quality, work conditions, commuting time): they are based in the public space, tend to be leisure-related and reserved for free time. This also means that they favour the segments of society with ample leisure time.

Concluding thoughts

The current practice of seeking to transform cities through events acknowledges that people have evolving and conflicting needs: for varied cultural and aesthetic stimulation, for different urban uses, for social interaction as well as for privacy, for freedom as well as structure and control, for change as well as stability. It promises to lead to happier cities by addressing these needs on a rotating basis, by temporarily altering urban form, function, and social interactions. The approach is used by both grassroots organizations and administrations to test and diffuse urban change gradually. As we are running out of space in cities, perhaps a key to our mental wellbeing could be better use of our time through cyclical or nomadic opportunities.

At the World Health Organization’s 9th Global Health Promotion Conference in Shanghai last month, WHO director Margaret Chan pronounced: “Health can no longer be addressed by the health sector alone”. In doing so, she set the tone for this interesting event, which, as Chan stated, meant "changing the living environments in which people make choices about their health-related lifestyle." Non-communicable diseases (NCDs) were of particular interest, with  the Health Minister of Mauritius, Anil Gayan, stating that "NCDs are the modern weapons of mass destruction”. The Lord Mayor of Cork, Ireland further proposed: “It’s our responsibility and obligation as city managers to promote good mental health.”
 
It was in this context that I was invited to speak about urban design and mental health to an audience of international city mayors and other policymakers and experts (see slides). I explained the central place of mental health within the WHO’s definition of health, and that good mental health is integral to achieving thriving, resilient, sustainable cities. I discussed how the city wears away many of our protective factors for good mental health, such as access to nature, strong social networks, sleep, security, privacy, and more. But conversely, the city has the potential to strengthen our mental health and wellbeing, leading to happier healthier citizens with increased education, employment, health and economic potential. But how?
 
We discussed the Centre for Urban Design and Mental Health’s Mind the GAPS framework: any urban design policy can (and should) be assessed for its basic impact on mental health depending on the extent to which it creates access to green, active, pro-social and safe space. The presentation received a great deal of interest from cities around the world interested in integrating mental health into their policymaking and design.

Interestingly, the potential of designing the built environment to promote and support good mental health is still not widely recognised. The other speakers at this session focused less on structural and system opportunities to improve population mental health, and more on important but traditional issues: access to treatment and rehabilitation, and changing attitudes to reduce stigma and improve social inclusion.
 
However, built environment innovation did feature strongly in a session on physical activity. Robert Geneau from Public Health Canada led the way, stating that ‘the built environment can improve physical activity’ (the A of UD/MH’s Mind the GAPS framework) and described the shared training that Canada’s public health and urban planning professionals undertake to help make this a reality. While some ideas in the session focused on sports participation, there was a clear wider understanding that promoting physical activity is not simply about sports: walkability and bike infrastructure in cities were at the heart of these discussions, culminating in a call for us all to make better cases for city investment – and for setting shared targets owned by several government departments to improve leadership and accountability.
 
Speakers at other sessions had further interesting ideas. For example, if people are increasingly using shopping malls, how can we target their physical activity and mental wellbeing in that setting (a question that was also raised at Tokyo's Innovative City Forum a month ago)? The question of how to build ‘liveable, beautiful, safe cities’ started to emerge – along with the conviction that health is a political choice. But politicians must be supported with better health literacy and social mobilization if we are to systematically integrate health promotion into all policies – and build better mental health into cities.

Policy makers, planners, researchers and urban dwellers are beginning to understand that health issues in cities are increasingly found in the ‘noncommunicable disease’ realm of mental health. The recent (2016) report by the World Health Organisation aims to address the link between this public health issue and the potential of open, green spaces to have a remedying effect.

There has been sustained historical interest in the links between green spaces and improved health, but the mechanisms and reasons behind such links have not always grounded in empirical evidence. Interest in how green spaces can improve health has recently encountered a resurgence, especially in the context of finding practical urban approaches. Rather than explicitly offering solutions, the new WHO report gathers evidence from studies that have been conducted all over the world to establish similarities and patterns and set the groundwork for a new research toolkit to update this field of study in the context of the 21st century – and importantly, to influence policy and practice.
 
What does the report say about mental health in cities?
The report identifies the potential for the urban environment to engender mental health problems and a lack of general wellbeing as a ‘major public health issue’. Mental health problems can affect anyone in society, at any time in their life, with effects that can be short-lived or have a life-long impact. While it is clearly important to ensure people can receive support and treatment for mental health problems, this is not the only approach, and nor should it necessarily be the first approach. We should look to providing sustainable, preventative measures that reduce the risk of developing mental illness and help maintain good mental health. As Morris et al. (2006) suggests, at the personal level this approach not only improves people's wellbeing; it also reduces the strain placed on healthcare facilities in cities. Furthermore, the report recognises wider socio-economic benefits of good mental health such as a healthier, more productive workforce needing less sick leave due to disorders like depression or anxiety.

The New Urban Agenda is an ‘action-oriented document which will set global standards of achievement in sustainable urban development, rethinking the way we build, manage, and live in cities through drawing together cooperation with committed partners, relevant stakeholders, and urban actors at all levels of government as well as the private sector.’ It was adopted at the Habitat III conference in Quito in October 2016 and one of its stated priorities is to improve human health. So what does this mean for mental health?
 
The Shared Vision for the New Urban Agenda: equal use and enjoyment of cities

The ‘shared vision’ proposes that all inhabitants, without discrimination, are able to inhabit and produce just, safe, healthy, accessible, affordable, resilient and sustainable cities that foster prosperity and quality of life for all. The vision prioritizes people-centered, age and gender-responsive, and integrated approaches to urban development that specifically take into account the needs of women, children and youth, older persons and persons with disabilities, migrants, indigenous peoples and local communities. This is summarised in the document's principles which talk about enhancing liveability, health and wellbeing, safety and public participation, eliminating discrimination, and ‘adopting healthy lifestyles in harmony with nature'.

Where is mental health explicitly mentioned?
 
Within the implementation plan for the New Urban Agenda, commitment 67 for sustainable urban development states:
 
“We commit ourselves to promoting the creation and maintenance of well-connected and well-distributed networks of open, multi-purpose, safe, inclusive, accessible, green, and quality public spaces; to improving the resilience of cities to disasters and climate change, including floods, drought risks and heat waves; to improving food security and nutrition, physical and mental health, and household and ambient air quality; to reducing noise and promoting attractive and liveable cities, human settlements and urban landscapes, and to prioritizing the conservation of endemic species.”
 
What commitments within the New Urban Agenda will specifically help address urban mental health in the context of urban design?
 
While a wide range of the commitments will benefit population mental health, some of the key commitments include:

• Recognition that the spatial organization, accessibility and design of urban space, as well as infrastructure and basic service provision, together with development policies, can promote or hinder social cohesion, equality and inclusion. (25)
• Promotion of safe, inclusive, accessible, green and quality public spaces including streets, sidewalks and cycling lanes, squares, waterfront areas, garden and parks, that are multifunctional areas for social interaction and inclusion, human health and wellbeing, economic exchange and cultural expression and dialogue among a wide diversity of people and cultures, and that are designed and managed to ensure human development and build peaceful, inclusive and participatory societies, as well as to promote living together, connectivity and social inclusion. (37)
• Enabling of participation and engagement of communities and stakeholders in the planning and implementation of policies, including the social production of  habitat. (31)
• Enabling adequate, affordable, accessible, resource-efficient, safe, resilient, well-connected and well-located housing with special attention to the proximity factor and the strengthening of the spatial relationship with the rest of the urban fabric and surrounding functional areas. (32)
• Promotion of equitable and affordable access to sustainable basic physical and social infrastructure for all, including sustainable mobility. (34)

 
The supportive network to deliver the New Urban Agenda: further commitments

• We will support the provision of well-designed networks of safe, accessible, green and quality streets and other public spaces that are accessible to all, free from crime and violence, including sexual harassment and gender-based violence, considering the human scale,  and measures that allow for the best possible commercial use of street-level floors, fostering both formal and informal local markets and commerce, as well as not-for-profit community initiatives, bringing people into public spaces,and promoting walkability and cycling with the goal of improving health and well-being. (100)

• We will work to adopt, implement and  enforce policies and measures to actively protect and promote pedestrian safety and cycling mobility, with a view to broader health outcomes, particularly the prevention of injuries and non-communicable diseases… We will promote the safe and healthy journey to school for every child as a priority. (113)

• We will promote access for all to safe, age-and gender-responsive, affordable, accessible and sustainable urban mobility and land and sea transport systems, enabling meaningful participation in social and economic activities in cities and human settlements, by integrating transport and mobility plans into overall urban and territorial plans and promoting a wide range of transport and mobility options, in particular through supporting safe, affordable and sustainable infrastructure for public transport as well as non-motorized options like waking and cycling – prioritizing them over private motorized transportation. (114)
  

 
With a focus on integrated work between planning, transport, and other departments, clear support for multi-stakeholder partnerships, and an explicit acknowledgment of the impact of cities on mental health, the New Urban Agenda offers interesting potential for investments and action in urban design to improve mental health.

Further Reading: New Urban Agenda

Biophilia is our deep-seated connection to nature. It helps explain why the rhythm of crashing waves and the crackling of fire captivate us; why a view of nature can enhance our creativity; why shadows and heights instill fascination and fear, and why gardening and strolling through a park have restorative healing effects.
 
Routine connections with nature can provide opportunities for mental restoration, during which time our higher cognitive functions can sometimes take a break. Cognitive functioning encompasses our mental agility and memory, and our ability to think, learn and output either logically or creatively. For instance, directed attention is required for many repetitive tasks, such as routine paperwork, reading and performing calculations or analysis, as well as for operating in highly stimulating environments, such as when crossing busy streets and navigating urban places.

The mental health benefits of nature are important to understand as our world continues to rapidly urbanize and our cities simultaneously expand and densify. In less than fifteen years more than 60% of humans will live in urban places and there will be thirteen new megacity regions according to the UN. As we continue to select urban places to live, urgent attention must be given to embedding nature and natural systems into urban design to connect people to nature and safeguard our health and wellbeing. If we are not careful, our commute and daily experience within these urban places will be nothing more than glass, steel, and concrete.

Biophilic Urban Acupuncture

On approach to this is urban acupuncture, a socio-environmental theory that combines contemporary urban design with traditional Chinese acupuncture, using small-scale interventions to transform the larger urban context. Just as the practice of acupuncture is aimed at relieving stress in the human body, the goal of urban acupuncture is to relieve stress in the built environment. Urban acupuncture is intended to to produce small-scale but socially catalytic interventions in the urban fabric. No needles necessary. 

Biophilic Urban Acupuncture (BUA) is the theory that threads and nodes of biophilic interventions in specific urban places can help improve people’s moods, connect people to place, and help improve mental health. Biophilic urban acupuncture blends two very important design concepts, biophilia and urban acupuncture.

BUA has higher levels of effectiveness in dense cities versus suburban places due to the ease of pedestrian mobility. A resident that lives in a dense city will spend at least some time each day outside just by the fact that they will be walking to transit stations, walking to work, or walking to get a meal. (Though BUA is also of benefit in suburban places, the auto-centric street design and sprawled land-use in suburbs typically does not lend itself to high quality biophilic opportunities.)

Small BUA interventions
Biophilic interventions do not need to be grand in scale to be effective. Positive impact on self-esteem and mood has been shown to occur in the first five minutes of experiencing nature (Barton &Pretty, 2010). Daily, unintentional exposure should be a priority when planning a BUA intervention. The intervention should be placed in a location that receives a large number of users but is embedded into an everyday habitat or commute. Smaller BUA interventions should be placed in locations throughout the city in a web-like structure, so that users with different destinations will encounter biophilic experiences, no matter their destination or purpose of travel.

Larger BUA interventions
The larger biophilic experience should be placed in an area of the city that can serve a substantial proportion of the population and should include as many biophilic patterns as possible. These are typically parks such as the Olmsted designed Central in New York City or the Tommaso Francini designed Luxembourg Garden in Paris. Large parks that are centrally located within a city and connected by good transit will provide a robust BUA experience to a greater number of residents than parks located in the periphery. 

BUA Examples

In the urban environment, there are two ways to capitalize on the multi-sensory attributes of water to enhance the experience of a place. First, simulating or constructing water features (water walls, fountains, or falls; aquaria; water imagery) in the built environment—indoors and out—creates positive effects for inhabitants. Although, it is worth mentioning that water and energy-intensive installments may create other issues. Second, it is possible to amplify the presence of naturally occurring water (lakes and ponds; streams, creeks, and rivers; rainfall; arroyos) to help inhabitants become increasingly aware of the surrounding environment. The Fountains and Water Features of NYCA space with a good Presence of Water condition feels compelling and captivating. Fluidity, sound, lighting, proximity and accessibility each contribute to whether a space is stimulating, calming, or both.

The Trees of NYCA space with a good Visual Connection with Nature feels whole, it grabs one’s attention and can be stimulating or calming. It can convey a sense of time, weather and other living things.

MillionTrees NYC is a citywide, public-private program that has planted one million new trees across the City’s five boroughs over the past decade. Beyond the numerous ecological benefits, strengthening New York City’s urban forest plays a positive role in helping inhabitants reduce stress and bolster self-esteem, mood, and parasympathetic activity.

PopUp Forest: Times Square is emulating the pop-up restaurant experience by transforming a public plaza in Times Square into a large-scale, temporary urban forest installation. The goal is to foster a movement to re-define cities with nature in mind and to create an urban oasis for wildlife while helping New Yorkers get more familiar with nearby nature.

Biomorphic forms & patterns are symbolic references to contoured, patterned, textured or numerical arrangements that persist in nature. A space with good biomorphic forms & patterns feels interesting and comfortable, possibly captivating, contemplative or even absorptive.

Biomorphic subway art illustrates how this concept has been implemented in New York City subway stations. The passageway between 42nd Street and 5th Avenue includes artistic depictions of natural systems such as tree roots and animal burrows, and the Jay Street/Metro Tech Station depicts glass mosaic art with various animal species, including starlings, sparrows, lion fish, parrots, tiger beetles, and koi fish.

DIY Biophilic Urban Acupuncture

Biophilic Urban Acupuncture does not need to hinge on large budgets or city agencies to have dramatic impact. You can play a role in integrating BUA elements in your neighborhood now. Here are a few strategies to help you get started:

Seed bombs are balls made from volcanic red clay or compressed soil containing different varieties of native species seeds that can fit in the palm. Usually other additives are included in the ball such as compost or humus to provide microbial inoculants. They can be dropped or tossed onto vacant lots or public places that are in need of beauty and vegetation. Seeds that support pollinators such as honey bees or butterflies are better as they will reinforce the Visual Connection to Nature and Connection to Natural Systems biophilic patterns.

WHERE: Seed bombs work well in places that have exposed soil and in places that are difficult to access.
HOW: What was once strictly a DIY project, seed bombs can now be purchased online, in stores, or even from vending machines.  

Tree pits are areas around urban trees that provide a small pervious surface for the roots to breath and absorb water. These can be transformed from a small often neglected patch of soil into a strong BUA intervention. If done with care, you can plant flowers or root bulbs in the pits. Additional interventions could be small benches around the tree pit which will create a reason for people to linger under the tree reinforcing the biophilic response.
WHERE: Most trees that are located in public right-of-way (ROW) are the responsibility of the community to take care of. Check with your neighbors about which tree pits are available to improve.
HOW: Using a hand cultivator, loosen the topsoil as this is usually compacted. Spreading a thin layer of mulch will help the tree absorb water and reduce evaporation. Plant in-season flowers and enjoy!

Guerilla gardening is the act of planting vegetation in spaces that the gardeners do not have the legal rights to use. These sites are typically abandoned or areas that are be substantially neglected. BUA can have large impacts in these neglected areas via guerilla gardening because the intervention is typically noticed and appreciated by the community regardless of who did it, and taken care of for years. This intervention supports the connection with natural systems, visual connection with nature, and non-visual connection with nature biophilic patterns

WHERE: Typically, guerrilla gardening occurs in spaces that are vacant or underutilized spaces. This intervention originated in NYC in the 1970’s by residents throwing balloons filled with local seeds, water, and fertilizer into empty lots.
HOW: This BUA intervention is best done with a group of neighbors and/or friends. Locate the site that is in need of the garden and make a plan for the plantings and improvements. Pre-planting site work may need to be done such as cleaning up junk, trash, and debris.

Conclusion

We know that cities will continue to morph. We also know that we enjoy listening to a water fountain, seeing a butterfly, or watching leaves shake with the help of a slight breeze. Let’s work to ensure that Biophilic Urban Acupuncture is part of the toolkit to help shape the places where we want to live.

Last week I attended the Innovative City Forum 2016 in Tokyo. Bringing together designers, artists, thinkers and citymakers to imagine our future of our life in the city, I was fascinated to see what themes and ideas would emerge from my first Tokyo-based city event. Amid the talk of self-driving cars, various uses for drones, and designing for a lifestyle in space, I extracted some insights into urban design for better mental health over the next 35 years.
 
The most interesting theme that emerged was an understanding that the purpose of urban spaces is changing. With the increasing digitalization of our lives, our physical urban space needs to assert new roles and meanings. If we can sit in the comfort of our own bedroom and use digital and networked tools to conduct our work (emails, teleconferences, etc) and play (streaming music and movies, shopping, etc), then what exactly is the purpose of going outside at all? How do 21st century urban places need to update to deliver more relevant functions for this increasingly digital population?

The consensus seemed to be the need to nurture better pro-social functionality of space: the communal experience and face-to-face interactions that facilitate positive social connections and support our mental health and happiness. Public outside spaces and buildings alike need to be designed in ways that extend better invitations to draw the public into them and encourage social interactions. New technologies like augmented reality to create communal public experiences that engage people with place might emerge as part of an evolving approach to delivering place-based entertainment that cannot be obtained at home.

The other main function of public spaces that was recognized was the opportunity to access nature. There was some discussion of integrating more trees and grass into the exteriors and sightlines of building design (including the design of the first human habitat in Mars!), as well as the design opportunities offered by trees and nature to help bring taller buildings down to the human scale.
 
Following on from recent thinking on the mental health impact of 'boringness', I was intrigued to hear from various speakers opposing the trend of ‘faceless perfection’, where homogenous, unchanging materials are used to create boring, sterile urban landscapes which people struggled to connect with. There was much discussion of the potential benefits of exposing and embracing imperfections as part of the design, rather than trying to correct them, and using new technologies like 3D printing to expand our design paradigms.

Associated with that theme was the question of urban identity in a world where cities are becoming increasingly homogenous. With chain shops and restaurants dominating many city center, the speakers argued that urban design needs to better reflect and promote the intangible culture of a place to help people feel part of a shared local identity, and the question of how to build a city’s heritage into its new developments (while remaining dynamic and avoiding the trap of getting trapped in a particular era of a city’s heritage). The surge of shopping centre popularity came up, and with it, a question: since people’s wellbeing benefits from pedestrianized, walkable, pro-social, safe green spaces, how can we better design shopping center to deliver these components, and can they promote better mental health as much as similar design features within a city center?

We have been shaken by the terrorist attacks which have recently occurred in Europe. There is no doubt that terror organizations have inspired or helped, if not recruited, many of the perpetrators. Of course many motivators can contribute to these types of attacks: inspiration provided by other perpetrators, violence in the media, the ease with which weapons can be acquired... The list could go on, and these factors undoubtedly play an important role. And yet, we are also reminded of the attacks staged by angry young men in the US and other countries who shoot at strangers without any motive other than their own resentment, marginalization and alienation. To understand what has motivated this spate of terrorist attacks, it is hard not to wonder about the roles of frustration, a wish to get even, or the desire of the perpetrator to not only to commit suicide, but to take others along with them. And in considering how these motivations may have developed, it is important to consider the built environment in which these feelings germinate.

If we look at where many perpetrators of terrorist attacks in Europe come from, we discover that peripheral urban areas as the Parisian banlieu or districts as Molenbeek in Belgium are somewhat overrepresented. Many such dormitory towns have become ghettoes where a particular social and/or ethnic identity may predominate. Of course there are many positive aspects of people embracing their cultural identity and forming communities with others who share their language, culture and religion: these types of communities can support people's wellbeing. It is also perfectly possible to be part of such a community, and still be an active and well-integrated part of wider society. But the design of many of these dormitory towns may be making this less likely.

Many dormitory towns offer bleak views of identical high-rise apartment blocks surrounded by lawns in a sorry state, parked cars, and empty streets, and their design helps preclude the wider integration that we see in the traditional city. Residents of these towns may have few opportunities to see, meet or interact with people outside of their immediate social circles, other than children in playgrounds and people hurrying to or from their apartments. This setting can create feelings of isolation that can turn to segregation - and with this comes resentment, suspicion, alienation, and a feeling of 'us and them'. 

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.