Journal of Urban Design and Mental Health; 2021:7;10
CITY CASE STUDY
A Case Study of Urban Design for Wellbeing and Mental Health in Lagos, Nigeria
Funmi Akindejoye
Global Brain Health Institute, Trinity College, Dublin, Ireland
Uchenna Ezedinma
Brain Treatment Centre, Queensland, Australia
Nnenna Ike
Lund University, Sweden
Global Brain Health Institute, Trinity College, Dublin, Ireland
Uchenna Ezedinma
Brain Treatment Centre, Queensland, Australia
Nnenna Ike
Lund University, Sweden
Citation: Akindejoye F, Ezedinma U, Ike N (2021). A case study of urban design for wellbeing and mental health in Lagos, Nigeria. Journal of Urban Design and Mental Health 7;10
Abstract
There are increasing interests in the impact and contribution of urban planning and design on mental health disorders. However, studies are scarce around such concepts within the densely populated urban city of Lagos State, Nigeria. This study explores the literature and expands on experts' opinions on mental health within Lagos’s urban design and planning. The reviewed literature presents mental health in the context of Lagos’s past, present and future urban planning and design; and identified those factors in the government policies on urban planning and design towards improving mental health. Next, a qualitative analysis of opinions extracted following a semi-structured interview with experts was presented. Our findings show that improving mental health in Lagos requires awareness, a safe and aesthetic environment, access to public spaces, reliable transportation, affordable housing and wetland protection. Although this study suggests that political and socioeconomic factors limit Lagos state’s urban planning and design towards improved mental health, these factors provide opportunities for the state to be a model in Nigeria.
Introduction
Mental disorders are amongst the ten global cause of morbidity and mortality [1]. In Nigeria, 20–30% of the population are affected by one or more mental disorders which are often associated with poor awareness, misconception, stigmatisation, socioeconomic factors, and limited health care systems [2-8]. Population density and urban centre design are increasing risk factors for mental health disorders [4]. Lagos state is one of Nigeria's most densely-populated urban centres, and with rising rural-urban migration, there is renewed interest in urban design that focuses on improving mental health [9, 10].
Lagos state is one of the world’s fastest-growing megacities, with a population density of around 6,871 people per square kilometre [11]. As an economic hub, the state continues to attract interstate migration, which puts pressure on limited housing, transportation and urban design [9, 10]. Consequently, these are associated with high levels of stress and exhaustion, especially around daily commuting [12]. Studies show the impact of environmental stress on mental health disorders such as anxiety and depression [11-13]. For instance, insomnia, a common symptom of anxiety and depression, is linked to sleep disruption due to early hour commutes in Lagos [12, 14].
A study investigating the help-seeking behaviours of individuals attending the outpatient clinic for mental health services in Lagos identified depression as a common diagnosis [15]. The Lagos State mental health survey shows the prevalence of depression and generalised anxiety to be 5.5% and 3.5%, respectively. Such prevalence is considered higher within 18-24 years, female populace, the under or unemployed, and people with metabolic illness and functional disability or poor social support such as those who are separated/divorced or widowed spouses [8]. These confounders, alongside substances abuse, also exacerbate mental disorders and increases suicidal ideation [16, 17]. In the older population, a four-year (2007-2011) retrospective report on the mental health services rendered to 938 patients between 60 years and above in Lagos found psychotic disorders (34.8%) and Alzheimer’s dementia (5.5%) to be the most common reasons for seeking help [18].
Unfortunately, access to mental health services is limited, disproportionately costly and scarcely frequented due to inadequate funding, misconceptions, and the cultural context in Lagos [4, 7, 15, 19]. To comprehensively address the mental health needs in the state, the government launched a mental health policy towards implementing a mental health work plan in 2011. However, with the renewed interest in urban design and planning on mental health, the government policy and plan have to be considered through the 2019 framework developed by the Centre for Urban Design and Mental Health. This framework is summarised in the acronym: GAPS - Green, Active, Prosocial, and Safe places [20].
Urban planning is a systematic, dynamic, and strategic tool for projections and budgeting on a city’s future growth and development. A blueprint or master plan for a city, urban planning is a clear and coherent vision of how the city grows and respond to change in the near and long-term future. Such a document lays out the overarching vision for the city. It often can be a credible tool to gain insight into a local or state government area of interests, priority and motivation regarding the city. Further, it indicates the strength, weakness, opportunity and threats such as the impacts of sprawling dense population on pollution and mental health disorders in Lagos state.
Lagos state is one of the world’s fastest-growing megacities, with a population density of around 6,871 people per square kilometre [11]. As an economic hub, the state continues to attract interstate migration, which puts pressure on limited housing, transportation and urban design [9, 10]. Consequently, these are associated with high levels of stress and exhaustion, especially around daily commuting [12]. Studies show the impact of environmental stress on mental health disorders such as anxiety and depression [11-13]. For instance, insomnia, a common symptom of anxiety and depression, is linked to sleep disruption due to early hour commutes in Lagos [12, 14].
A study investigating the help-seeking behaviours of individuals attending the outpatient clinic for mental health services in Lagos identified depression as a common diagnosis [15]. The Lagos State mental health survey shows the prevalence of depression and generalised anxiety to be 5.5% and 3.5%, respectively. Such prevalence is considered higher within 18-24 years, female populace, the under or unemployed, and people with metabolic illness and functional disability or poor social support such as those who are separated/divorced or widowed spouses [8]. These confounders, alongside substances abuse, also exacerbate mental disorders and increases suicidal ideation [16, 17]. In the older population, a four-year (2007-2011) retrospective report on the mental health services rendered to 938 patients between 60 years and above in Lagos found psychotic disorders (34.8%) and Alzheimer’s dementia (5.5%) to be the most common reasons for seeking help [18].
Unfortunately, access to mental health services is limited, disproportionately costly and scarcely frequented due to inadequate funding, misconceptions, and the cultural context in Lagos [4, 7, 15, 19]. To comprehensively address the mental health needs in the state, the government launched a mental health policy towards implementing a mental health work plan in 2011. However, with the renewed interest in urban design and planning on mental health, the government policy and plan have to be considered through the 2019 framework developed by the Centre for Urban Design and Mental Health. This framework is summarised in the acronym: GAPS - Green, Active, Prosocial, and Safe places [20].
Urban planning is a systematic, dynamic, and strategic tool for projections and budgeting on a city’s future growth and development. A blueprint or master plan for a city, urban planning is a clear and coherent vision of how the city grows and respond to change in the near and long-term future. Such a document lays out the overarching vision for the city. It often can be a credible tool to gain insight into a local or state government area of interests, priority and motivation regarding the city. Further, it indicates the strength, weakness, opportunity and threats such as the impacts of sprawling dense population on pollution and mental health disorders in Lagos state.
Urban planning and design in Lagos
Due to changes in policies of successive governments, urban planning in Lagos has been erratic, disjointed and has paid little attention to the growing evidence of population growth and urban areas on mental wellbeing and mental disorders. Today, the Ministry of Physical Planning and Urban Development (2004 – date) is responsible for setting the state’s planning and development principles and approach. In 2013, a policy document titled ‘Lagos State Development Plan 2012 – 2025 (LSDP2025) was drafted by the Ministry of Economic and Budget Planning and set the vision for the state within the thirteen years [24]. The LSDP2025 harmonises all existing policy documents and development plans into one resource document and serves as the highest strategic framework for the state.
Figure 1: Aerial view of Lagos Island. Source: Nupo-Deyon-Daniel on Unsplash
Hence, this document forms the basis of our discussion on the city’s approach to planning and design for mental health. The LSDP2025 envisions that by 2025, Lagos will be Africa’s model megacity and global economic and financial hub that is safe, secure and productive. The state will focus on poverty eradication and sustainable economic growth through infrastructure renewal and development to attain such projections. This vision clarifies that the state’s primary interest lies in economic prosperity and human capital development. Nevertheless, examining how mental disorders fit within the context of the first and second part of the LSDP2025 document on urban planning is central, especially regarding green space, active space, prosocial space, and safe space across the lifespan [20].
Figure 2: Eko Atlantic project. Source: Eko Pearl Towers Blog
The LSDP2025 document describes the framework and strategy for achieving the vision of the LSDP through policies and programmes targeting economic, infrastructure and social and security areas. For instance, by the end of 2025, at least 40% of the state residents will own their own home, with the housing and construction sector raising employment and GDP growth. Other plans include improved power and transportation infrastructure aimed at reducing commute time through diverse transport systems that cater to the vulnerable. These measures will create a conducive environment for business, developing the resident’s labour skills and providing a planned physical environment. More so, the LDSP2025 highlights the MH benefit of a clean, green and safe environment through physical plans, provision of parks and landscaping and slum clearance.
Table 1: Status of LSDP2025 within different areas. Source: The Ministry of Physical Planning and Urban Development, Lagos
However, most of the state’s past physical plans are out-of-date, and many new areas have expanded or developed without plans. Of the ten planning areas in the state, only 50% have a Master Plan in use (Table 1). With certain parts of the state developing and operating without a deliberate urban design plan, the implications are numerous and wide-ranging, not the least, the economic, infrastructural, environmental, health, mental and social impact such outcomes have residents living and working in these places. These findings suggest that the LSDP2025 has not comprehensively addressed urban planning and shows that mental health and wellbeing are not a vital area of the LSDP. Such gaps further permit an investigation into Lagos state's urban design and its impact on mental disorders using the Centre for Urban Design and MH framework [20]. This study investigates the fundamental elements of urban design and planning on MH disorder in Lagos state.
Method
This case study was conducted in Lagos, Nigeria, using modified city case study methodology from the Centre for Urban Design and Mental Health. A search was conducted within the Lagos state government websites and official gazette and publications to identify relevant policy documents on urban design and planning and mental health/disorders. Retrieved resources were assessed, and relevant sections extracted for further analysis. Feedbacks and inputs from interviewees were also explored and included.
This study recruited ten participants for a semi-structured interview using a snowball sampling technique. Each participant responded to questions on their demography and perception of factors contributing to mental health, the prioritisation of MH by Lagos state, barriers, and opportunities for urban design towards improved mental health.
All interviews held between April-May 2021 and due to Covid-19 measures were conducted via Zoom virtual meeting platform, with each session lasting for an average of 35minutes. The interviews and questionnaires were administered using the English language, recorded and finally transcribed using the Otter Ai software®.
This study recruited ten participants for a semi-structured interview using a snowball sampling technique. Each participant responded to questions on their demography and perception of factors contributing to mental health, the prioritisation of MH by Lagos state, barriers, and opportunities for urban design towards improved mental health.
All interviews held between April-May 2021 and due to Covid-19 measures were conducted via Zoom virtual meeting platform, with each session lasting for an average of 35minutes. The interviews and questionnaires were administered using the English language, recorded and finally transcribed using the Otter Ai software®.
Results
The ten semi-structured interviews were conducted with Lagos based professionals comprising: three (3) Architects, two (2) Public health specialists, one (1) Psychiatrist, one (1) Art Designer, two (2) Urban planners/Academics and one (1) Urban sustainability advocate.
The demography of participants was five males, five females, aged 21-30yrs (1), 31-40yrs (3), 41-50yrs (4), 51-60yrs (1) and 61-70yrs (1). In terms of academic qualiications, there were six master’s degree, three bachelor’s degree, and one doctorate. Table 2 presents the responses of participants to the questionnaires administered.
The demography of participants was five males, five females, aged 21-30yrs (1), 31-40yrs (3), 41-50yrs (4), 51-60yrs (1) and 61-70yrs (1). In terms of academic qualiications, there were six master’s degree, three bachelor’s degree, and one doctorate. Table 2 presents the responses of participants to the questionnaires administered.
Table 2 Themes from opinions expressed by interviewees on urban design and MH and wellbeing in Lagos
Urban design factors considered to influence mental health in Lagos
- Reliable Public Transportation and Traffic Reduction
- Traffic
- Availability of Adequate and Affordable Housing
- Water and Electricity supply
- Homelessness: Access to adequate housing
- Fear of forceful eviction
- Access to Public Spaces
- Availability and Access to Green/Blue Spaces
- Availability of Walkways/Side Walks
- Safety and Security
- Wetland Protection
Factors considered to contribute to levels of prioritisation of mental health in urban planning and design in Lagos
- Prioritisation of economic gain
- Lack of policy enforcement by lawmakers
- Clients’ preference
- Lack of awareness and education of current actors
- Non-motorised transportation policy advocacy
Barriers identified for implementing MH in urban design in Lagos
- Government Issues
- Perception: Development as brick and mortar
- Poor policy enforcement
- Lack of applicable policy
- Lack of Impact Evaluation of urban projects
- Prioritisation of economic gain
- Excessive land reclamation and encroachment
- Misinformation and lack of awareness about mental health matters
- Education of professionals
- Lack of Inclusivity
Suggested opportunities for implementing urban design for mental health in Lagos
- Building the new Lagos sustainably
- Public-Private Partnerships
- Strategies from the 100 Resilient cities project
- Mental health education and awareness-raising at all levels
- Waterways transportation
- Global agreements
- Incorporation of mental health into existing agencies
- Decentralisation
Urban design factors considered to influence mental health in Lagos
Interviewees identified several components of urban design and planning that they consider to influence mental health and wellbeing in Lagos. These components include: reliable public transportation and traffic reduction, availability of adequate and affordable housing, access to public spaces, access to green/blue space, availability of walkways/sidewalks, safety and security, and wetland protection.
Reliable public transportation and traffic reduction
Traffic
Issues around traffic reduction, reliable transportation and ease of mobility were common themes suggested by most respondents. Respondents indicated that transportation was a major contributing component to the wellbeing of persons in Lagos, and that severe traffic and associated congestion was a crucial concern that hinders the ease of mobility around the state.
“About how we move around the city, we are very, very challenged in this part of the world…. public transportation is a headache, it's frustrating; it affects our mental state, no doubt…. even the congestion for people that have cars is enough to drive you crazy.” - Architect
“As far as mental health is concerned, the biggest issue in Lagos is traffic… how do we redesign traffic so that people do not spend the whole day in traffic and miss out on appointments, being anxious, and even coming up with other non-communicable diseases such as hypertension or heart disease.”- Public Health specialist
“Efficient transport system is important for our mental health so that we do not have so much stress commuting to places of our choice.” - Architect
“Transportation, ease of access to places, flexibility and mobility contributes to mental health because then you can get a job and earn a good salary and as a woman move from point A to B including picking up her children from school.” - Urban planner
“The number one thing I think that influences mental health in Nigeria is traffic, road design and the ease of movement.” - Art designer
“Being stuck in traffic, or having to move four hours, from the early hours of the morning to work, and then back from work. This movement and how it drains you.” - Architect
“The transport network, transportation systems, basically is not existent, nothing works. There are more people than modes of transport. So, it is pretty difficult to get around Lagos; there is always traffic.” - Psychiatrist
Reliable public transportation and traffic reduction
Traffic
Issues around traffic reduction, reliable transportation and ease of mobility were common themes suggested by most respondents. Respondents indicated that transportation was a major contributing component to the wellbeing of persons in Lagos, and that severe traffic and associated congestion was a crucial concern that hinders the ease of mobility around the state.
“About how we move around the city, we are very, very challenged in this part of the world…. public transportation is a headache, it's frustrating; it affects our mental state, no doubt…. even the congestion for people that have cars is enough to drive you crazy.” - Architect
“As far as mental health is concerned, the biggest issue in Lagos is traffic… how do we redesign traffic so that people do not spend the whole day in traffic and miss out on appointments, being anxious, and even coming up with other non-communicable diseases such as hypertension or heart disease.”- Public Health specialist
“Efficient transport system is important for our mental health so that we do not have so much stress commuting to places of our choice.” - Architect
“Transportation, ease of access to places, flexibility and mobility contributes to mental health because then you can get a job and earn a good salary and as a woman move from point A to B including picking up her children from school.” - Urban planner
“The number one thing I think that influences mental health in Nigeria is traffic, road design and the ease of movement.” - Art designer
“Being stuck in traffic, or having to move four hours, from the early hours of the morning to work, and then back from work. This movement and how it drains you.” - Architect
“The transport network, transportation systems, basically is not existent, nothing works. There are more people than modes of transport. So, it is pretty difficult to get around Lagos; there is always traffic.” - Psychiatrist
Figure 3: Lagos Traffic. Source: Lelia Croitoru, Jiyoun Christina Chang and Andrew Kelly: The Cost of Air Pollution In Lagos.
Availability of housing and associated amenities
Over 50% of the study respondents suggested that adequate housing (availability and affordability) is a key contributing factor to Lagos residents’ mental health and wellbeing.
“I feel like most people have been short-changed, especially people of a certain class. They are not necessarily well catered for in terms of the how and where of their housing.”- Architect
“There is a problem of overpopulation. That is why everyone wants to build something, just to house people. Because there are too many people and not enough houses.” - Psychiatrist
“We do not have adequate housing for every person that was meant to live in this urban environment that we call Lagos.” - Architect
Interviewees identified housing affordability as a crucial factor to housing in Lagos.
“Infrastructure wise, we do not have not enough housing, given available houses are not affordable for most people. This impacts on those mostly in the low and lower-middle socioeconomic classes.” - Psychiatrist
“Lekki, for instance, with some highbrow estate where the roads are spaced properly, and houses are properly spaced, in a way has some level of inequity, because the people that are well off, obviously, would end up living in saner environments in Lagos but the people that lower down the social ladder still face the problem of equity because they cannot afford to move to the better neighbourhoods.” - Public Health specialist
“If you cannot afford to buy houses or rent houses or get mortgages in those highbrow areas, you are still faced with the same issues.” - Public Health specialist
“If a poor person can easily access housing, then the middle class will be able to access housing, then the rich will easily be able to access housing. For instance, in the slum, there is a principle where they do not pay rent annually, they pay monthly.” - Urban sustainability advocate
Over 50% of the study respondents suggested that adequate housing (availability and affordability) is a key contributing factor to Lagos residents’ mental health and wellbeing.
“I feel like most people have been short-changed, especially people of a certain class. They are not necessarily well catered for in terms of the how and where of their housing.”- Architect
“There is a problem of overpopulation. That is why everyone wants to build something, just to house people. Because there are too many people and not enough houses.” - Psychiatrist
“We do not have adequate housing for every person that was meant to live in this urban environment that we call Lagos.” - Architect
Interviewees identified housing affordability as a crucial factor to housing in Lagos.
“Infrastructure wise, we do not have not enough housing, given available houses are not affordable for most people. This impacts on those mostly in the low and lower-middle socioeconomic classes.” - Psychiatrist
“Lekki, for instance, with some highbrow estate where the roads are spaced properly, and houses are properly spaced, in a way has some level of inequity, because the people that are well off, obviously, would end up living in saner environments in Lagos but the people that lower down the social ladder still face the problem of equity because they cannot afford to move to the better neighbourhoods.” - Public Health specialist
“If you cannot afford to buy houses or rent houses or get mortgages in those highbrow areas, you are still faced with the same issues.” - Public Health specialist
“If a poor person can easily access housing, then the middle class will be able to access housing, then the rich will easily be able to access housing. For instance, in the slum, there is a principle where they do not pay rent annually, they pay monthly.” - Urban sustainability advocate
Figure 4: Makoko Slum. Source: Rainer Wozny on Flick.
Furthermore, respondents raised other concerns about water and electricity supply, homelessness and fear of forceful eviction:
Water and Electricity supply
“It is time immemorial since anybody has had stable power. So, we know how that affects our mental health because I know how I feel if I do not have any power, and it is so hot, and it is like, I am losing my mind.” - Architect
“If you can get good housing, good amenities such as water, power, toilet facility……so you are not under stress about those things.” - Urban planner
Homelessness
Two key issues identified were access to adequate housing and fear of forceful eviction:
“We have so many homeless people in Lagos, living under bridges, uncompleted buildings, doing basic jobs just to make ends meet.”- Psychiatrist
“On average, there is always one form of eviction every week. People have been evicted from one part of the city every week. We have at least two or three major mass evictions every year, usually at the beginning of the year and towards the end. People are forcefully evicted from parts of Lagos creating a whole lot of unhappiness.” Urban sustainability advocate
“In December 2020, people in monkey village were evicted. People who live in slums constitute a lot in terms of population, and they are constantly living in fear of forced eviction.” Urban sustainability advocate
Access to public spaces
The majority of the respondents acknowledged access to public spaces to be crucial to improving mental health, citing examples of Lagos, including the Ndubuisi park, Tinubu park, and Terra culture.
“One of such components include open spaces, public spaces, accessible public space. I know over the last ten years, or so, there has been a deliberate policy by the government to open up community parks, and this has improved to a large extent, the sense of wellness. It was not measured though but we see people now choosing to spend time with their families and therefore enhance their wellbeing and wellness by visiting such places.” - Academic/Urban planner
“Using roundabouts for gardens or, rather, the idea of beautification is not a positive thing on mental health. But I think mental health is definitely about having spaces in the city that people can feel ownership towards, that people can feel safe in.” - Architect
“There are no publicly owned facilities conveniently available for people to go out and recreate.”- Architect
“How do you put a park in the middle of Lagos Ibadan expressway? Who is going to go there? But there is a giant park at Lagos Ibadan expressway, and there are two other giant parks in Alausa beside the government house; why do I want to go to the government house area or the Lagos state House of Assembly area because I want to go to a park? Parks should be in every neighbourhood and streets where children can easily access.” - Psychiatrist
Availability and access to Green and Blue spaces
Some interviewees identified green and blue spaces as important to Lagos residents’ mental health and wellbeing, identifying popular spots such as Beaches in Lekki, Lekki conservation park (LCC), Mayfair Estate and Victoria Garden City (VGC). However, one of the respondents noted that such spaces are limited, and available ones are inaccessible due to traffic and socioeconomic stratification.
“Having green spaces help with mental health, a sense that you can go to places a little bit serene, and a little bit quiet, surrounded by nature, but that needs to be done in a way that is accessible. We know a lot of the green spaces that have been designed for Lagos are inaccessible.” - Architect
“We do not have enough green spaces, and that impacts on mental health because there is nowhere for people to go and get away from the hustle and bustle of Lagos.” - Psychiatrist
“The best place that I have seen so far in terms of green space is VGC, which is what the name is: Victoria Garden City, they have the best green space that I have seen. The only problem for most people with VGC is not VGC itself, which is a well-laid out gated estate, but getting to VGC from other parts of Lagos is a nightmare - if you want to go from Lekki to VGC on a good day you are going to encounter much traffic.” - Architect
Water and Electricity supply
“It is time immemorial since anybody has had stable power. So, we know how that affects our mental health because I know how I feel if I do not have any power, and it is so hot, and it is like, I am losing my mind.” - Architect
“If you can get good housing, good amenities such as water, power, toilet facility……so you are not under stress about those things.” - Urban planner
Homelessness
Two key issues identified were access to adequate housing and fear of forceful eviction:
“We have so many homeless people in Lagos, living under bridges, uncompleted buildings, doing basic jobs just to make ends meet.”- Psychiatrist
“On average, there is always one form of eviction every week. People have been evicted from one part of the city every week. We have at least two or three major mass evictions every year, usually at the beginning of the year and towards the end. People are forcefully evicted from parts of Lagos creating a whole lot of unhappiness.” Urban sustainability advocate
“In December 2020, people in monkey village were evicted. People who live in slums constitute a lot in terms of population, and they are constantly living in fear of forced eviction.” Urban sustainability advocate
Access to public spaces
The majority of the respondents acknowledged access to public spaces to be crucial to improving mental health, citing examples of Lagos, including the Ndubuisi park, Tinubu park, and Terra culture.
“One of such components include open spaces, public spaces, accessible public space. I know over the last ten years, or so, there has been a deliberate policy by the government to open up community parks, and this has improved to a large extent, the sense of wellness. It was not measured though but we see people now choosing to spend time with their families and therefore enhance their wellbeing and wellness by visiting such places.” - Academic/Urban planner
“Using roundabouts for gardens or, rather, the idea of beautification is not a positive thing on mental health. But I think mental health is definitely about having spaces in the city that people can feel ownership towards, that people can feel safe in.” - Architect
“There are no publicly owned facilities conveniently available for people to go out and recreate.”- Architect
“How do you put a park in the middle of Lagos Ibadan expressway? Who is going to go there? But there is a giant park at Lagos Ibadan expressway, and there are two other giant parks in Alausa beside the government house; why do I want to go to the government house area or the Lagos state House of Assembly area because I want to go to a park? Parks should be in every neighbourhood and streets where children can easily access.” - Psychiatrist
Availability and access to Green and Blue spaces
Some interviewees identified green and blue spaces as important to Lagos residents’ mental health and wellbeing, identifying popular spots such as Beaches in Lekki, Lekki conservation park (LCC), Mayfair Estate and Victoria Garden City (VGC). However, one of the respondents noted that such spaces are limited, and available ones are inaccessible due to traffic and socioeconomic stratification.
“Having green spaces help with mental health, a sense that you can go to places a little bit serene, and a little bit quiet, surrounded by nature, but that needs to be done in a way that is accessible. We know a lot of the green spaces that have been designed for Lagos are inaccessible.” - Architect
“We do not have enough green spaces, and that impacts on mental health because there is nowhere for people to go and get away from the hustle and bustle of Lagos.” - Psychiatrist
“The best place that I have seen so far in terms of green space is VGC, which is what the name is: Victoria Garden City, they have the best green space that I have seen. The only problem for most people with VGC is not VGC itself, which is a well-laid out gated estate, but getting to VGC from other parts of Lagos is a nightmare - if you want to go from Lekki to VGC on a good day you are going to encounter much traffic.” - Architect
CASE STUDY 1: Operation Green Lagos: Lagos State Parks and Gardens Agency (LASPARK)
Operation Green Lagos (OGL) was introduced in 2008 as a multi-faceted approach to developing green infrastructure in Lagos. The program objectives include:
(i)To restore order, improve quality of life in neighbourhoods, mitigate the effect of climate change and ensure environmentally sustainable, healthier and more visually pleasing society
(ii) To reclaim open spaces from all agents of environmental degradation and subsequent preservation of the biodiversity and ecosystems of the environment.
The mandate of Lagos State Parks and Gardens Agency (LASPARK) is to make Lagos greener and healthier through the creation and maintenance of functional and operational parks and gardens, planting and maintenance of trees. The agency identifies degraded, vacant and contaminated spaces and transforms such into parks and gardens. Example of such parks is the Tinubu Park and the Ndubuisi Kanu Park at Ikeja. As of May 2021, LASPARK had planted over seven million trees across the state in addition to the establishment of 11 public events park and 297 gardens in its efforts to deliver a clean, eco-friendly and sustainable city.
Operation Green Lagos (OGL) was introduced in 2008 as a multi-faceted approach to developing green infrastructure in Lagos. The program objectives include:
(i)To restore order, improve quality of life in neighbourhoods, mitigate the effect of climate change and ensure environmentally sustainable, healthier and more visually pleasing society
(ii) To reclaim open spaces from all agents of environmental degradation and subsequent preservation of the biodiversity and ecosystems of the environment.
The mandate of Lagos State Parks and Gardens Agency (LASPARK) is to make Lagos greener and healthier through the creation and maintenance of functional and operational parks and gardens, planting and maintenance of trees. The agency identifies degraded, vacant and contaminated spaces and transforms such into parks and gardens. Example of such parks is the Tinubu Park and the Ndubuisi Kanu Park at Ikeja. As of May 2021, LASPARK had planted over seven million trees across the state in addition to the establishment of 11 public events park and 297 gardens in its efforts to deliver a clean, eco-friendly and sustainable city.
Figure 5: Johnson Jakande Tinubu (JJT) Recreational Park. Source: Travel.blog
Figure 6: Ndubuisi Kanu Recreational Park. Source: Travel.blog
The coast offers another important opportunity for mental health and wellbeing.
“I think the main relaxation place is the beach; if people want to do something non-spiritual, it is the beach that they go to aside from eateries.” - Architect
“I think the main relaxation place is the beach; if people want to do something non-spiritual, it is the beach that they go to aside from eateries.” - Architect
Figure 7: Oniru Royal Beach. Source: Travel.blog
Safety and security
Safety and security were common among most interviewees, stating that activities such as walking, visiting public, green and or blue spaces may be impacted significantly by insecurity. Half of the respondents identified the availability of sidewalks as crucial to encouraging walking, which positively improves mental health.
Traffic safety
“We do not have dedicated walkways. Pedestrian walkways in cities just make people free. When there is a dedicated lane, I can walk freely on it and know that I am safe.” - Urban Sustainability Advocate
“Lagos is a city that is not well designed because we do not have sidewalks that you can walk on, we do not have places to walk; therefore, we do not get to walk that much. Some parts are not conducive, you may be walking, and a car run you over because it is not meant to be a pedestrian walkway.” - Architect
Lighting
‘Part of the fears around the city’s safety in terms of urban planning is street lighting. Where are the streetlights? These are the things that create challenges of happiness and feelings of safety in a city.”- Urban Sustainability Advocate
“Making sure that the spaces are well lighted and designed nicely. Open spaces where people feel safe as well. Because if you do not feel safe then this generally introduces anxiety.”- Art Designer
Crime
“Security is another issue. How safe you feel in a place affects your mental health.” - Architect
“All the roads are not safe for walking. The Lekki Ikoyi link bridge has now become a bit of a security risk because recently a lady who was walking on the bridge was attacked and was badly hurt.”- Architect
Wetland Protection
Water bodies and wetlands cover over 40% of Lagos’s total land area, and an additional 12% is subject to seasonal flooding [29]. About 30% of the respondents identified the protection of wetlands as an important factor in the urban design of Lagos because continuous encroachment into these wetland results in flooding. Respondents stated that the fear of flooding by Lagos residents impacts on their total wellbeing and happiness.
“Talking about the issue of wetland protection, we are doing a lot of brick-and-mortar building, and we do not even understand that there is land that needs to be kept.” - Urban Sustainability Advocate
“Developers reclaimed land from the water to build the housing estate, and now water is flowing back to another estate called Adeniji estate. Since that project started, people who live in Adeniji Estate have been forced to leave their estate.” - Urban Sustainability advocate
“We have to plan accordingly and get enough spaces that are open recreational areas, not just land, but also water; therefore, certain water bodies should be protected. But that is going to be at the expense of some developers' gain.” - Architect
''One of the biggest challenges of living in Lagos is flooding, and why do we have flooding? The major reason is that the wetlands in Lagos are fast disappearing. People are beginning to encroach more, claiming land from water, and the water is beginning to push back.” - Urban sustainability advocate
''With new estates coming up, what is the plan for the drainage system? But those developers have no solid plans about drainage systems.’’ - Urban sustainability advocate
Safety and security were common among most interviewees, stating that activities such as walking, visiting public, green and or blue spaces may be impacted significantly by insecurity. Half of the respondents identified the availability of sidewalks as crucial to encouraging walking, which positively improves mental health.
Traffic safety
“We do not have dedicated walkways. Pedestrian walkways in cities just make people free. When there is a dedicated lane, I can walk freely on it and know that I am safe.” - Urban Sustainability Advocate
“Lagos is a city that is not well designed because we do not have sidewalks that you can walk on, we do not have places to walk; therefore, we do not get to walk that much. Some parts are not conducive, you may be walking, and a car run you over because it is not meant to be a pedestrian walkway.” - Architect
Lighting
‘Part of the fears around the city’s safety in terms of urban planning is street lighting. Where are the streetlights? These are the things that create challenges of happiness and feelings of safety in a city.”- Urban Sustainability Advocate
“Making sure that the spaces are well lighted and designed nicely. Open spaces where people feel safe as well. Because if you do not feel safe then this generally introduces anxiety.”- Art Designer
Crime
“Security is another issue. How safe you feel in a place affects your mental health.” - Architect
“All the roads are not safe for walking. The Lekki Ikoyi link bridge has now become a bit of a security risk because recently a lady who was walking on the bridge was attacked and was badly hurt.”- Architect
Wetland Protection
Water bodies and wetlands cover over 40% of Lagos’s total land area, and an additional 12% is subject to seasonal flooding [29]. About 30% of the respondents identified the protection of wetlands as an important factor in the urban design of Lagos because continuous encroachment into these wetland results in flooding. Respondents stated that the fear of flooding by Lagos residents impacts on their total wellbeing and happiness.
“Talking about the issue of wetland protection, we are doing a lot of brick-and-mortar building, and we do not even understand that there is land that needs to be kept.” - Urban Sustainability Advocate
“Developers reclaimed land from the water to build the housing estate, and now water is flowing back to another estate called Adeniji estate. Since that project started, people who live in Adeniji Estate have been forced to leave their estate.” - Urban Sustainability advocate
“We have to plan accordingly and get enough spaces that are open recreational areas, not just land, but also water; therefore, certain water bodies should be protected. But that is going to be at the expense of some developers' gain.” - Architect
''One of the biggest challenges of living in Lagos is flooding, and why do we have flooding? The major reason is that the wetlands in Lagos are fast disappearing. People are beginning to encroach more, claiming land from water, and the water is beginning to push back.” - Urban sustainability advocate
''With new estates coming up, what is the plan for the drainage system? But those developers have no solid plans about drainage systems.’’ - Urban sustainability advocate
Perceived prioritisation of mental health in urban planning and design in Lagos
The majority of the respondents considered that mental health prioritisation is nonexistent or still very poor in Lagos. Some of the respondents stated that the low level of prioritisation of mental health is due to:
Prioritisation of economic gain
The high priority of commercialisation and economic gain above other considerations was identified as one reason mental health is not been prioritised in urban design; this is driven by the poor economic status of individuals and the government’s interest to increase commercialisation of the city.
“The Nigeria we find ourselves in does not make mental health a priority; the economic situation makes profit a higher priority for many professionals across the board. So, while mental health may be important to some built environment professionals, economic benefits tend to be more important.” - Academic/Urban planner
“They are looking for where to commercialise, that is why we see so much real estate development going on, on different corridors such as the Lekki Express corridor. People are sand filling unreasonably, like the Eko Atlantic and Orange Island, because it is just about the commercialisation of land value.” - Architect
Lack of policy Enforcement by Lawmakers
“But I think there is a low level of the Government in Lagos in enforcing standards, because virtually every year in Lagos buildings collapse, there are fatalities, and nobody will be held to account. Nobody is enforcing building codes.” - Public Health Specialist
Clients’ preference
“Client’s preferences are usually prioritised above general ethical consideration and issues of wellness and wellbeing.’’ Academics/Urban planner
‘’There is nothing like planning for people’s welfare in this state. Architects respond to briefs. You cannot do something that nobody wants.’’ - Architects
Lack of awareness and education of current actors
The interviewees explained that it is important to update the education professionals have received over the years because the social aspect of their practice was never considered in their education.
‘’They are the product of their training, issues around social, environmental consequences of some of their actions are not highlighted or prioritise; therefore, they practice along the same line.’’ - Academic/Urban planner
Non-motorised transportation (NMT) policy advocacy
‘’NMT policy compels by law that whenever you are developing infrastructure, road infrastructure, you have to put in place non-motorised lanes, but there is no law compelling that in Lagos and that is one thing that we have been advocating for in the last three years.’’ - Urban Sustainability advocate
‘’I designed a public facility for recreation. We were supposed to propose to Lagos State that they should have one at least one in each of the five administrative areas of Lagos state, with 24-hour zoning, open gym, cinema, sit-outs, etc. The twelve-hour zone library, the E-learning centre among others meant to be spread around some communities which will own them and use to recreate and learn skills, but the proposal never went far, because if they do not see where the monetary value comes from, then it is not a project.’’ – Architect
Prioritisation of economic gain
The high priority of commercialisation and economic gain above other considerations was identified as one reason mental health is not been prioritised in urban design; this is driven by the poor economic status of individuals and the government’s interest to increase commercialisation of the city.
“The Nigeria we find ourselves in does not make mental health a priority; the economic situation makes profit a higher priority for many professionals across the board. So, while mental health may be important to some built environment professionals, economic benefits tend to be more important.” - Academic/Urban planner
“They are looking for where to commercialise, that is why we see so much real estate development going on, on different corridors such as the Lekki Express corridor. People are sand filling unreasonably, like the Eko Atlantic and Orange Island, because it is just about the commercialisation of land value.” - Architect
Lack of policy Enforcement by Lawmakers
“But I think there is a low level of the Government in Lagos in enforcing standards, because virtually every year in Lagos buildings collapse, there are fatalities, and nobody will be held to account. Nobody is enforcing building codes.” - Public Health Specialist
Clients’ preference
“Client’s preferences are usually prioritised above general ethical consideration and issues of wellness and wellbeing.’’ Academics/Urban planner
‘’There is nothing like planning for people’s welfare in this state. Architects respond to briefs. You cannot do something that nobody wants.’’ - Architects
Lack of awareness and education of current actors
The interviewees explained that it is important to update the education professionals have received over the years because the social aspect of their practice was never considered in their education.
‘’They are the product of their training, issues around social, environmental consequences of some of their actions are not highlighted or prioritise; therefore, they practice along the same line.’’ - Academic/Urban planner
Non-motorised transportation (NMT) policy advocacy
‘’NMT policy compels by law that whenever you are developing infrastructure, road infrastructure, you have to put in place non-motorised lanes, but there is no law compelling that in Lagos and that is one thing that we have been advocating for in the last three years.’’ - Urban Sustainability advocate
‘’I designed a public facility for recreation. We were supposed to propose to Lagos State that they should have one at least one in each of the five administrative areas of Lagos state, with 24-hour zoning, open gym, cinema, sit-outs, etc. The twelve-hour zone library, the E-learning centre among others meant to be spread around some communities which will own them and use to recreate and learn skills, but the proposal never went far, because if they do not see where the monetary value comes from, then it is not a project.’’ – Architect
CASE STUDY 2: Public art in Lagos
Lagos state features several beautiful public arts ranging from sculptures to murals. Example of such works of art in Lagos include:
Lagos state features several beautiful public arts ranging from sculptures to murals. Example of such works of art in Lagos include:
Figure 8: Public art in Lagos.
8a. Canoe monument in Lagos Source: Agbebiyi Adekunle (Tadek Photography) on Wikipedia
8b: Falomo Under-bridge Art. Source: Africa-ontherise.com
8c. Graffiti work at Ozumba Mbadiwe Road, Victoria Island. Source: Lagos Culture Blog
8d. Wings Mural. Source: Kunle Adewale for AIMS project
8a. Canoe monument in Lagos Source: Agbebiyi Adekunle (Tadek Photography) on Wikipedia
8b: Falomo Under-bridge Art. Source: Africa-ontherise.com
8c. Graffiti work at Ozumba Mbadiwe Road, Victoria Island. Source: Lagos Culture Blog
8d. Wings Mural. Source: Kunle Adewale for AIMS project
Barriers identified for implementing mental health in urban design in Lagos
Government Issues
One of the common themes from the interviews was the government's policy direction, ranging from skewed perceptions of development to poor policy implementation.
‘’When you look at the policies, as far as I am concerned, they do not take environmental sustainability into consideration, mental health is not being paid attention to.’’ Urban Sustainability Advocate
Perception: Development as brick and mortar‘
"The idea of progress and developing being tied to concrete and pavement, and the eradication of greenery is very damaging to our mental health.’’ Architect
‘’The perception of those in governance that a developed city should be brick and mortar. The perspective that does not take into cognisance environmental sustainability. Our leaders are not in tune with the reality of the times.’’ Urban Sustainability advocate
‘’Lagos wants to become the next Dubai, not the next Lagos. So, the whole idea of development for Lagos that our politicians are pursuing is infrastructure, and everything has to be built with brick and mortar. We should build one huge hospital as against building and equipping, a lot of small health centres in different places, as against establishing small schools in poor communities.’’ - Urban Sustainability advocate
Poor Policy enforcement
‘Government is not living up to its responsibilities. Nothing typifies this more than the buildings that are collapsing all the time, across Lagos.’’ - Public Health specialist
‘’There is a federal government policy that provides that 1% of the total budget for a public building should be used towards arts and aesthetics for the building. So, you can commission artists to do something special. You have all these sorts of government policies, but where is it enforced?’’ Architect
Lack of applicable policy
'The reason the roads are congested boils down to policy. While there are many cars on the road, policy should have created a situation where you do not have ten cars ploughing the Lagos roads, with only one occupant in each car. If there were adequate public transportation that could carry those ten people, you would not have ten cars. Then there will be less chaos on the roads because there will be fewer cars ploughing the roads.’’ – Architect
Inadequate evaluation of impact of urban projects
‘The Government is not doing enough, and they are not able to necessarily calculate the impact in a way that where they can say that, for example, x% of people are not stressed out anymore, because ‘’y’’ commute took less time or because now people can walk 20 minutes a day or feel safe to walk down the streets or now depression has reduced by 20%. They are not able to calculate that. So, for them It’s difficult because they don’t have much data, in terms of quantifying their success’’ - Art Designer
Excessive Land Reclamation and Encroachment
‘As a planner, if you look at Lagos, I am sure you will find areas that are zoned for green spaces in the original master plan, but they do not exist. They have been loaded or commercialised rapidly.’- Architect
Mental health Misinformation and Lack of Awareness
Mental health in Nigeria and Lagos is associated with misinformation, a low level of awareness, and a culture of silence. Mental health conditions are mostly regarded as a taboo, a spiritual repercussion, or a hereditary illness. Most times, people with mental health conditions are ostracised from society.
‘People have misinformation about mental health. I mean, everybody just associates mental health with someone who is 'mad'. we know how our culture looks at people that have mental challenges - they are seen as people that are going to be ostracised from society.’ Architect
‘There are many reasons why mental health cannot be taken seriously in Nigeria. It is like a taboo subject, and then there is lack of information’’ - Architect
‘’It is seen as a spiritual problem in most cases and an inherited thing.’ - Architect
‘The entrenched system does not allow us to prioritise issues of mental health, which has to do with the culture of silence, ignorance on the part of the built environment specialist and the patriarchy that is entrenched in the system.’ - Urban planner
Education of Professionals
Currently most built environment professionals are not aware of the links between urban design and mental health thus do not consider the incorporation of mental health or collaboration with mental health professional in urban design. In addition, there is a shortage of mental health personnel in Lagos state. Study respondents resounded the need to invest more in the training of mental health personnel and the need to incorporate mental health into the curriculum of built environment professionals.
‘You have the built environment disciplines, architecture, civil engineering, quantity surveying, urban planning. Moreover, you find out that these are taught as hard sciences in Nigeria, as technical disciplines. The social contexts of these various disciplines are not elaborated, they are not prioritised in the training of professionals. So, when they go out into the market, or into the industry, they are the product of their training; issues around social, environmental consequences of some of their actions, are not prioritised.’ - Academic/Urban Planner
‘There is need for more health workers, more healthcare professionals in the mental health space.’ - Psychiatrist
‘There is a need to invest more in the mental health sector. Lagos State has one of the most functional psychiatric hospitals in Nigeria, that is Federal Neuro-Psychiatric Hospital, Yaba Lagos; the government should improve on the infrastructure so that more people can access care there.’’ - Psychiatrist
‘Mental health is a socio-physiological issue; thus, there is a need to work with medical and social workers, but where are the trained social workers in Nigeria? Social workers are supposed to be available in every local government, and be properly trained and equipped.’ - Architect
Lack of Inclusivity
Lagos is highly stratified by the socioeconomic divide, making most of its urban development components and amenities only available and accessible to the high-income minority group.
‘The system has been unfair and unjust to the majority; the majority has to come first. If you meet the needs of the majority, you meet the needs of the other people.’ - Urban Sustainability Advocate
‘There is also no inclusiveness, talking about gender aspects to development which we lack. For example, the nightlife in Lagos only favours men. It is only a man that can walk around and drive around feeling safe in the city of Lagos; it is not safe for women.’ - Urban Sustainability Advocate
One of the common themes from the interviews was the government's policy direction, ranging from skewed perceptions of development to poor policy implementation.
‘’When you look at the policies, as far as I am concerned, they do not take environmental sustainability into consideration, mental health is not being paid attention to.’’ Urban Sustainability Advocate
Perception: Development as brick and mortar‘
"The idea of progress and developing being tied to concrete and pavement, and the eradication of greenery is very damaging to our mental health.’’ Architect
‘’The perception of those in governance that a developed city should be brick and mortar. The perspective that does not take into cognisance environmental sustainability. Our leaders are not in tune with the reality of the times.’’ Urban Sustainability advocate
‘’Lagos wants to become the next Dubai, not the next Lagos. So, the whole idea of development for Lagos that our politicians are pursuing is infrastructure, and everything has to be built with brick and mortar. We should build one huge hospital as against building and equipping, a lot of small health centres in different places, as against establishing small schools in poor communities.’’ - Urban Sustainability advocate
Poor Policy enforcement
‘Government is not living up to its responsibilities. Nothing typifies this more than the buildings that are collapsing all the time, across Lagos.’’ - Public Health specialist
‘’There is a federal government policy that provides that 1% of the total budget for a public building should be used towards arts and aesthetics for the building. So, you can commission artists to do something special. You have all these sorts of government policies, but where is it enforced?’’ Architect
Lack of applicable policy
'The reason the roads are congested boils down to policy. While there are many cars on the road, policy should have created a situation where you do not have ten cars ploughing the Lagos roads, with only one occupant in each car. If there were adequate public transportation that could carry those ten people, you would not have ten cars. Then there will be less chaos on the roads because there will be fewer cars ploughing the roads.’’ – Architect
Inadequate evaluation of impact of urban projects
‘The Government is not doing enough, and they are not able to necessarily calculate the impact in a way that where they can say that, for example, x% of people are not stressed out anymore, because ‘’y’’ commute took less time or because now people can walk 20 minutes a day or feel safe to walk down the streets or now depression has reduced by 20%. They are not able to calculate that. So, for them It’s difficult because they don’t have much data, in terms of quantifying their success’’ - Art Designer
Excessive Land Reclamation and Encroachment
‘As a planner, if you look at Lagos, I am sure you will find areas that are zoned for green spaces in the original master plan, but they do not exist. They have been loaded or commercialised rapidly.’- Architect
Mental health Misinformation and Lack of Awareness
Mental health in Nigeria and Lagos is associated with misinformation, a low level of awareness, and a culture of silence. Mental health conditions are mostly regarded as a taboo, a spiritual repercussion, or a hereditary illness. Most times, people with mental health conditions are ostracised from society.
‘People have misinformation about mental health. I mean, everybody just associates mental health with someone who is 'mad'. we know how our culture looks at people that have mental challenges - they are seen as people that are going to be ostracised from society.’ Architect
‘There are many reasons why mental health cannot be taken seriously in Nigeria. It is like a taboo subject, and then there is lack of information’’ - Architect
‘’It is seen as a spiritual problem in most cases and an inherited thing.’ - Architect
‘The entrenched system does not allow us to prioritise issues of mental health, which has to do with the culture of silence, ignorance on the part of the built environment specialist and the patriarchy that is entrenched in the system.’ - Urban planner
Education of Professionals
Currently most built environment professionals are not aware of the links between urban design and mental health thus do not consider the incorporation of mental health or collaboration with mental health professional in urban design. In addition, there is a shortage of mental health personnel in Lagos state. Study respondents resounded the need to invest more in the training of mental health personnel and the need to incorporate mental health into the curriculum of built environment professionals.
‘You have the built environment disciplines, architecture, civil engineering, quantity surveying, urban planning. Moreover, you find out that these are taught as hard sciences in Nigeria, as technical disciplines. The social contexts of these various disciplines are not elaborated, they are not prioritised in the training of professionals. So, when they go out into the market, or into the industry, they are the product of their training; issues around social, environmental consequences of some of their actions, are not prioritised.’ - Academic/Urban Planner
‘There is need for more health workers, more healthcare professionals in the mental health space.’ - Psychiatrist
‘There is a need to invest more in the mental health sector. Lagos State has one of the most functional psychiatric hospitals in Nigeria, that is Federal Neuro-Psychiatric Hospital, Yaba Lagos; the government should improve on the infrastructure so that more people can access care there.’’ - Psychiatrist
‘Mental health is a socio-physiological issue; thus, there is a need to work with medical and social workers, but where are the trained social workers in Nigeria? Social workers are supposed to be available in every local government, and be properly trained and equipped.’ - Architect
Lack of Inclusivity
Lagos is highly stratified by the socioeconomic divide, making most of its urban development components and amenities only available and accessible to the high-income minority group.
‘The system has been unfair and unjust to the majority; the majority has to come first. If you meet the needs of the majority, you meet the needs of the other people.’ - Urban Sustainability Advocate
‘There is also no inclusiveness, talking about gender aspects to development which we lack. For example, the nightlife in Lagos only favours men. It is only a man that can walk around and drive around feeling safe in the city of Lagos; it is not safe for women.’ - Urban Sustainability Advocate
Opportunities for Implementing Mental Health in Urban Design in Lagos
Building the new Lagos sustainably
The planned and ongoing development of Alaro city and the Eko Atlantic city presents an opportunity for city planners to build sustainably. Alaro city is an integrated and mixed-use city planned for over 2000 hectares in the Lekki free zone. The Eko Atlantic city is a planned city of Lagos been constructed on land reclaimed from the Atlantic Ocean.
‘’While Lagos state is geographically the smallest state in Nigeria, it is fast-becoming the most industrialised…. There are plans to open new cities such as the Eko-Atlantic city, Ibeju-Lekki city - it’s like a new Lagos. Now that we are working on the new Lagos…. It is time for us to be intentional about building or planning these urban cities to be inclusive of physical and mental health. For example, in the new Ibeju-Lekki development area, there is much concern about its close proximity to the Dangote refinery and people are worried that noise, air pollution and even traffic issues may arise. We should start thinking of how to make things work, whether to start discussions with the refinery to start thinking of environmentally friendly ways to prevent pollution.’’ - Public Health specialist
Public-Private Partnerships (PPP)
Government involvement in the provision of infrastructure in PPP projects can increase the success and accessibility of such projects by low-income persons in Lagos.
‘’…most things that need to be done in this state of ours might have to be handled by the private sector because the private sector sees things as a business and they look at how they can create solutions to problems, and they know they cannot just make money, like how the government will budget an amount towards a problem and the allocated money gets embezzled or just disappears but with the private sector you have people that need to be responsible and accountable.’’ - Architects
Strategies from the 100 Resilient cities project
Lagos was among the 100 resilient cities (100RC) initiative by the Rockefeller foundation. An output of that 100RC initiative is developing the Lagos resilient strategy document aimed at making Lagos a more inclusive, innovative, and resilient city.
"Lagos is part of the 100 Resilient Cities programs signed by the Lagos State government and the Rockefeller foundation. This resilient city program had some strategies that were supposed to help develop the sustainable development of housing, urban planning, improve emergency responses and combat flooding.’’- Psychiatrist
Mental Health Education and awareness at all levels
'I think the first step is in information dissemination, education and making people understand that there is a relationship between mental health and urban design. Secondly, a series of workshops or programmes that will educate people on where and how these two things come together.’ - Architect
‘There is an opportunity to be more empathetic, and do some reorientation at the level of institutions, and at the level of the Ministry and the government.’ - Academics/Urban planner
Waterways transportation
‘We have not utilised the waterways as efficiently as we can. So that we congest all the roads but there are not any alternatives to how we move around the city.’ - Architect
Global agreements
'An opportunity exists especially within the framework of global agreements, like the SDGs, the one health model. The SDGs provide a pathway into exploring issues of mental health.’’ - Academics/Urban planner
Incorporation of mental health into existing agencies
‘Lagos State also has an agency on domestic violence and some other kinds of violence. Supposing the mandates of such agencies are expanded and given the empowerment and training to deal with health issues and advocate for it in the built environment, this will go a long way. Another agency whose work can be amplified along those lines is the Lagos state parks and gardens agency, they are responsible for parks around the city... their mandate also can be expanded to be more intentional about promoting wellness in urban space.’’ - Academics/Urban Planner
Decentralisation
‘One opportunity is decentralising, in terms of businesses, so that people can work and live closer.’’ - Art Designer
‘’I think if every State in Nigeria has at least, half or maybe a quarter of the level of development of Lagos, people will not need to leave their state, for instance if in my state I can get proper health care, I can attend a good school, I can get good housing and live the good life…People feel that once you are in Lagos, you have to be living the good life. And so, if they have at least one-quarter of the development that Lagos state have, they will not need to migrate to anywhere.’ - Psychiatrist
The planned and ongoing development of Alaro city and the Eko Atlantic city presents an opportunity for city planners to build sustainably. Alaro city is an integrated and mixed-use city planned for over 2000 hectares in the Lekki free zone. The Eko Atlantic city is a planned city of Lagos been constructed on land reclaimed from the Atlantic Ocean.
‘’While Lagos state is geographically the smallest state in Nigeria, it is fast-becoming the most industrialised…. There are plans to open new cities such as the Eko-Atlantic city, Ibeju-Lekki city - it’s like a new Lagos. Now that we are working on the new Lagos…. It is time for us to be intentional about building or planning these urban cities to be inclusive of physical and mental health. For example, in the new Ibeju-Lekki development area, there is much concern about its close proximity to the Dangote refinery and people are worried that noise, air pollution and even traffic issues may arise. We should start thinking of how to make things work, whether to start discussions with the refinery to start thinking of environmentally friendly ways to prevent pollution.’’ - Public Health specialist
Public-Private Partnerships (PPP)
Government involvement in the provision of infrastructure in PPP projects can increase the success and accessibility of such projects by low-income persons in Lagos.
‘’…most things that need to be done in this state of ours might have to be handled by the private sector because the private sector sees things as a business and they look at how they can create solutions to problems, and they know they cannot just make money, like how the government will budget an amount towards a problem and the allocated money gets embezzled or just disappears but with the private sector you have people that need to be responsible and accountable.’’ - Architects
Strategies from the 100 Resilient cities project
Lagos was among the 100 resilient cities (100RC) initiative by the Rockefeller foundation. An output of that 100RC initiative is developing the Lagos resilient strategy document aimed at making Lagos a more inclusive, innovative, and resilient city.
"Lagos is part of the 100 Resilient Cities programs signed by the Lagos State government and the Rockefeller foundation. This resilient city program had some strategies that were supposed to help develop the sustainable development of housing, urban planning, improve emergency responses and combat flooding.’’- Psychiatrist
Mental Health Education and awareness at all levels
'I think the first step is in information dissemination, education and making people understand that there is a relationship between mental health and urban design. Secondly, a series of workshops or programmes that will educate people on where and how these two things come together.’ - Architect
‘There is an opportunity to be more empathetic, and do some reorientation at the level of institutions, and at the level of the Ministry and the government.’ - Academics/Urban planner
Waterways transportation
‘We have not utilised the waterways as efficiently as we can. So that we congest all the roads but there are not any alternatives to how we move around the city.’ - Architect
Global agreements
'An opportunity exists especially within the framework of global agreements, like the SDGs, the one health model. The SDGs provide a pathway into exploring issues of mental health.’’ - Academics/Urban planner
Incorporation of mental health into existing agencies
‘Lagos State also has an agency on domestic violence and some other kinds of violence. Supposing the mandates of such agencies are expanded and given the empowerment and training to deal with health issues and advocate for it in the built environment, this will go a long way. Another agency whose work can be amplified along those lines is the Lagos state parks and gardens agency, they are responsible for parks around the city... their mandate also can be expanded to be more intentional about promoting wellness in urban space.’’ - Academics/Urban Planner
Decentralisation
‘One opportunity is decentralising, in terms of businesses, so that people can work and live closer.’’ - Art Designer
‘’I think if every State in Nigeria has at least, half or maybe a quarter of the level of development of Lagos, people will not need to leave their state, for instance if in my state I can get proper health care, I can attend a good school, I can get good housing and live the good life…People feel that once you are in Lagos, you have to be living the good life. And so, if they have at least one-quarter of the development that Lagos state have, they will not need to migrate to anywhere.’ - Psychiatrist
Discussion
Study respondents identified traffic congestion and public transportation as a vital component that contributes to the wellbeing of people in Lagos. About 40% of the registered cars in Nigeria are in Lagos [25]. Moreover, a typical Lagosian spends about 75% of an average working week (i.e. about 30 hours) in traffic each week [26], resulting in increased anxiety and depression among commuters and hindering workforce productivity [12]. The cause of such congestion ranges from road network access, the inadequacy of public transportation and employment challenges in the state. Noise pollution from cars, motorcycles and lorries were the most dominant noise that bothered the residents of Ikeja, Lagos [16]. The effect of such noise on residents includes sleeping disturbance, hearing damage, annoyance, and disturbances in mental health, such as emotional instability, anxiety, nausea, stress, headache, argumentativeness, and mood changes, increase in social conflict, neurosis, psychosis, and hysteria [16]. A Traffic Congestion and Health study in Lagos, 57% of respondents confirmed an increase in visits to medical facilities with higher spending on drugs and medication within the last four years associated with constant traffic-induced fatigue, inadequate sleep, poor diet, and pollution. 70% of the drivers reported increased anger driving during traffic congestion [27].
Respondents identified inadequate and unavailability of affordable housing as another component of urban design that influences wellbeing among the Lagos populace. The Lagos State Ministry of housing estimated a housing deficit of approximately 3 million units. Such deficits have led to homelessness and the proliferation of slums and informal settlements [25]. In addition, People living in waterfront communities in Lagos have been forcefully evicted in recent years by authorities citing safety concerns. Issues such as land ownership conflicts between land-owning families and settlers, land use planning inefficiencies, and the development needs of the government and slum proliferation have all contributed to forced evictions in recent years [28, 29].
Also identified is the protection of wetlands. Water bodies and wetlands cover over 40% of the total land area of Lagos, and an additional 12% is subject to seasonal flooding [25]. Over the years, wetlands in Lagos have undergone severe spatial changes from rapid urbanisation resulting in loss of biodiversity, loss of coastal vegetation, increased risk of human infectious diseases and more severe flooding [25]. Flooding is an increasingly significant threat to the human population and physical infrastructure in Lagos.
In addition, the access to and availability of green spaces were identified as contributing to Lagos residents’ mental health and wellbeing. A study evaluating the changes of urban green spaces in Lagos revealed a reduction of urban green spaces due to agriculture and settlement. The report recommended an effective policy for green planning education for city managers, developers, and risk assessment [30]. Assessing the extent of encroachments into the original acquisitions of FESTAC town in Lagos revealed that for the developed area of FESTAC, open green spaces reduced from about 0.2 km2 (20 ha) to only 0.003 km2 (0.3 ha), a 98% decrease [31].
Respondent recognised the availability of walkways as an urban design component that influences mental health. Urban dwellers need safe and aesthetic places to walk, cycle, jog, and connect to nature within the Lagos metropolis [32]. Environmental and health benefits of walking and cycling are achieved through decreased motor vehicle use leading to improved physical and mental health, reduced vehicle congestion and vehicle emissions [33]. One of the study respondents suggested that the NMT policy advocacy by civil organisations in Lagos indicates prioritisation of MH in urban planning and design. The NMT policy will compel by law the establishment of walkways for cyclists and pedestrians. A UN report highlighted that about 30% of Lagos’ mobility is on foot or by bicycle. The interaction between pedestrian and motorised vehicles in Lagos is unplanned and dangerous. There is almost no recognition of this mode, with few segregated traffic facilities for pedestrians and bicycle lanes [34]. As a result, pedestrians share the roadway with motorised transport [35].
To tackle these issues, the Lagos NMT policy proposes a bold set of interventions. A comprehensive approach to enhance conditions for cyclists, pedestrians, and other NMT users should include the following components: A progressive vision paired with quantitative goals for a 15-year planning horizon; Street design principles and standards; Built environment regulations; Street network planning guidelines that prioritise NMT; enhanced funding for NMT improvements and infrastructure; A more robust institutional framework for project implementation; and performance measures to monitor the effectiveness of the policy [35]. Safety and security are social issues influenced by urban designs and planning that affects mental health. These also threaten NMT as respondents expressed their concerns about poor street lighting and criminal activities, among others. These opinions and findings suggest that the prioritisation of MH in urban design be poor.
There have been recent approaches and development likely to support the MH of the Lagos populace. Such as Public art and murals. A study assessing the impact of sculptural installations in public spaces in Lagos showed that the sculptural pieces increase public appreciation and make the city vibrant [36]. The making of murals and sculptural art in public spaces shows how citizens should think, get connected, and respond to society socially, philosophically etc. These works of art in public spaces attract people to pose and take photographs against the painted background and gaze at them for aesthetic pleasure [37]. Beyond the use of sub-standard construction materials and weak construction supervision, the poor enforcement by relevant town planning agencies is the cause of building collapse in Lagos, which has become a common occurrence in recent years, often leading to loss of life [38]. Professionals in the built environment have noted that developers’ strict enforcement of the building code that will eliminate quackery from housing delivery is the solution to the persistent menace of building collapse [39].
The interviewees suggested some opportunities for implementing MH in urban design in Lagos. Such as through the implementation of the Lagos resilience strategy. Lagos was admitted into the 100RC program in 2017. The 100 Resilient Cities (100RC) project pioneered by the Rockefeller Foundation helps cities worldwide become more resilient to the physical, social, and economic challenges of a growing part of the 21st Century. The Lagos State Resilience Office (LASRO) was inaugurated in April 2019. LASRO released the first urban resilience strategy document, and it articulates an integrated approach to addressing the shocks and stresses the city experiences or might experience [25]. The Lagos resilient strategy envisions an innovative, inclusive, and prosperous city that leverages the appropriate governance and infrastructure mechanisms to empower its people to thrive, adapt, and grow sustainably [25].
Another opportunity identified is adopting the global agreements, especially the Sustainable Development goals (SDG). Through SDG 11, there is an avenue to improve urban development in Lagos by adapting to this global goal. However, there are significant gaps in the development approach of the city in localising the global agenda, such as paucity of data, weak institutional capacity, and poor governance strategies, which are significant impediments to mainstreaming SDG 11 in Lagos [40].
Finally, a common theme across study respondent is on MH stigmatisation and awareness. The culture of stigma and discrimination have driven by poor awareness has allowed misconceptions about mental illness to flourish. The widespread belief in supernatural causation of mental illness is likely to add to the difficulties of designing an effective anti-stigma psycho-education programme in Nigeria. However, there is a positive effect of education on mental illness stigma as persons who have a better understanding of mental illness are less likely to endorse stigma and discrimination [41].
There is an urgent need for regular public education, advocacy, and awareness MH campaigns to provide knowledge about the aetiologies of mental illness to reduce further the social stigma associated with mental illness. Persons who have better understanding of mental illness are less likely to endorse stigma and discrimination.
Respondents identified inadequate and unavailability of affordable housing as another component of urban design that influences wellbeing among the Lagos populace. The Lagos State Ministry of housing estimated a housing deficit of approximately 3 million units. Such deficits have led to homelessness and the proliferation of slums and informal settlements [25]. In addition, People living in waterfront communities in Lagos have been forcefully evicted in recent years by authorities citing safety concerns. Issues such as land ownership conflicts between land-owning families and settlers, land use planning inefficiencies, and the development needs of the government and slum proliferation have all contributed to forced evictions in recent years [28, 29].
Also identified is the protection of wetlands. Water bodies and wetlands cover over 40% of the total land area of Lagos, and an additional 12% is subject to seasonal flooding [25]. Over the years, wetlands in Lagos have undergone severe spatial changes from rapid urbanisation resulting in loss of biodiversity, loss of coastal vegetation, increased risk of human infectious diseases and more severe flooding [25]. Flooding is an increasingly significant threat to the human population and physical infrastructure in Lagos.
In addition, the access to and availability of green spaces were identified as contributing to Lagos residents’ mental health and wellbeing. A study evaluating the changes of urban green spaces in Lagos revealed a reduction of urban green spaces due to agriculture and settlement. The report recommended an effective policy for green planning education for city managers, developers, and risk assessment [30]. Assessing the extent of encroachments into the original acquisitions of FESTAC town in Lagos revealed that for the developed area of FESTAC, open green spaces reduced from about 0.2 km2 (20 ha) to only 0.003 km2 (0.3 ha), a 98% decrease [31].
Respondent recognised the availability of walkways as an urban design component that influences mental health. Urban dwellers need safe and aesthetic places to walk, cycle, jog, and connect to nature within the Lagos metropolis [32]. Environmental and health benefits of walking and cycling are achieved through decreased motor vehicle use leading to improved physical and mental health, reduced vehicle congestion and vehicle emissions [33]. One of the study respondents suggested that the NMT policy advocacy by civil organisations in Lagos indicates prioritisation of MH in urban planning and design. The NMT policy will compel by law the establishment of walkways for cyclists and pedestrians. A UN report highlighted that about 30% of Lagos’ mobility is on foot or by bicycle. The interaction between pedestrian and motorised vehicles in Lagos is unplanned and dangerous. There is almost no recognition of this mode, with few segregated traffic facilities for pedestrians and bicycle lanes [34]. As a result, pedestrians share the roadway with motorised transport [35].
To tackle these issues, the Lagos NMT policy proposes a bold set of interventions. A comprehensive approach to enhance conditions for cyclists, pedestrians, and other NMT users should include the following components: A progressive vision paired with quantitative goals for a 15-year planning horizon; Street design principles and standards; Built environment regulations; Street network planning guidelines that prioritise NMT; enhanced funding for NMT improvements and infrastructure; A more robust institutional framework for project implementation; and performance measures to monitor the effectiveness of the policy [35]. Safety and security are social issues influenced by urban designs and planning that affects mental health. These also threaten NMT as respondents expressed their concerns about poor street lighting and criminal activities, among others. These opinions and findings suggest that the prioritisation of MH in urban design be poor.
There have been recent approaches and development likely to support the MH of the Lagos populace. Such as Public art and murals. A study assessing the impact of sculptural installations in public spaces in Lagos showed that the sculptural pieces increase public appreciation and make the city vibrant [36]. The making of murals and sculptural art in public spaces shows how citizens should think, get connected, and respond to society socially, philosophically etc. These works of art in public spaces attract people to pose and take photographs against the painted background and gaze at them for aesthetic pleasure [37]. Beyond the use of sub-standard construction materials and weak construction supervision, the poor enforcement by relevant town planning agencies is the cause of building collapse in Lagos, which has become a common occurrence in recent years, often leading to loss of life [38]. Professionals in the built environment have noted that developers’ strict enforcement of the building code that will eliminate quackery from housing delivery is the solution to the persistent menace of building collapse [39].
The interviewees suggested some opportunities for implementing MH in urban design in Lagos. Such as through the implementation of the Lagos resilience strategy. Lagos was admitted into the 100RC program in 2017. The 100 Resilient Cities (100RC) project pioneered by the Rockefeller Foundation helps cities worldwide become more resilient to the physical, social, and economic challenges of a growing part of the 21st Century. The Lagos State Resilience Office (LASRO) was inaugurated in April 2019. LASRO released the first urban resilience strategy document, and it articulates an integrated approach to addressing the shocks and stresses the city experiences or might experience [25]. The Lagos resilient strategy envisions an innovative, inclusive, and prosperous city that leverages the appropriate governance and infrastructure mechanisms to empower its people to thrive, adapt, and grow sustainably [25].
Another opportunity identified is adopting the global agreements, especially the Sustainable Development goals (SDG). Through SDG 11, there is an avenue to improve urban development in Lagos by adapting to this global goal. However, there are significant gaps in the development approach of the city in localising the global agenda, such as paucity of data, weak institutional capacity, and poor governance strategies, which are significant impediments to mainstreaming SDG 11 in Lagos [40].
Finally, a common theme across study respondent is on MH stigmatisation and awareness. The culture of stigma and discrimination have driven by poor awareness has allowed misconceptions about mental illness to flourish. The widespread belief in supernatural causation of mental illness is likely to add to the difficulties of designing an effective anti-stigma psycho-education programme in Nigeria. However, there is a positive effect of education on mental illness stigma as persons who have a better understanding of mental illness are less likely to endorse stigma and discrimination [41].
There is an urgent need for regular public education, advocacy, and awareness MH campaigns to provide knowledge about the aetiologies of mental illness to reduce further the social stigma associated with mental illness. Persons who have better understanding of mental illness are less likely to endorse stigma and discrimination.
SWOT analysis
Strengths
|
Weaknesses
|
Opportunities
|
Threats
|
Lessons from Lagos that could be applied to improve mental health through urban planning and design in other cities
There is not significant evidence of direct efforts in Lagos to promote wellbeing and good mental health, or of the prioritisation of mental health in urban planning and design. However, the recent approach to public art and murals is worth noting. Studies of the impact of sculptural installations in public spaces in Lagos found they increased public appreciation and made the city vibrant. Activities of Lagos State Parks and Gardens Agency to deliver a greener Lagos is also worth noting. The delivery of outdoor parks and gardens, planting and maintenance of trees helps promotes good mental health and wellbeing for Lagos residents in an eco-friendly and sustainable manner.
Recommendations for Lagos to improve public mental health and wellbeing through urban planning an design
1. Mental health awareness and reorientation
There is an urgent need to increase awareness and education on mental health issues among the general populace, built environment professionals and government. Public health and mental health professionals, non-profit organisations, and educational institutes have a vital role in educating Nigerians.
2. Provision of adequate and affordable housing schemes
These schemes can be achieved with the provision of low-interest housing funds for housing developers, designing housing schemes with alternative low-cost construction materials, and adapting a monthly rent payment system as practiced in the slum housing system.
3. Expansion of public transportation
Improving and expanding the water transportation network system in Lagos state will reduce traffic and ease the mobility of people and goods across the city. Also, through the implementation of the Lagos State Strategic Transport Master Plan, which focuses on advancing the implementation of the intracity light rail network, Bus Rapid Transit (BRT) expansion, among others [29]
4. Policy development and enforcement
It is crucial to ensure the enforcement of already existing policies that will help address some identified urban design problems that affect metal health in Lagos, such as building codes and passing the non-motorised bill to law, among others.
5. Decentralisation
The shared development of other states in Nigeria will reduce the burden on Lagos state and encourage migration to other parts of the country besides Lagos.
6. Multidisciplinary collaboration
It is essential for building and environmental professionals to collaborate with health professionals in designing projects.
7. Investment in professional education in mental health
To make up for the shortage of mental health professionals in Lagos, the need to invest more in mental health training and education cannot be overemphasised.
There is an urgent need to increase awareness and education on mental health issues among the general populace, built environment professionals and government. Public health and mental health professionals, non-profit organisations, and educational institutes have a vital role in educating Nigerians.
2. Provision of adequate and affordable housing schemes
These schemes can be achieved with the provision of low-interest housing funds for housing developers, designing housing schemes with alternative low-cost construction materials, and adapting a monthly rent payment system as practiced in the slum housing system.
3. Expansion of public transportation
Improving and expanding the water transportation network system in Lagos state will reduce traffic and ease the mobility of people and goods across the city. Also, through the implementation of the Lagos State Strategic Transport Master Plan, which focuses on advancing the implementation of the intracity light rail network, Bus Rapid Transit (BRT) expansion, among others [29]
4. Policy development and enforcement
It is crucial to ensure the enforcement of already existing policies that will help address some identified urban design problems that affect metal health in Lagos, such as building codes and passing the non-motorised bill to law, among others.
5. Decentralisation
The shared development of other states in Nigeria will reduce the burden on Lagos state and encourage migration to other parts of the country besides Lagos.
6. Multidisciplinary collaboration
It is essential for building and environmental professionals to collaborate with health professionals in designing projects.
7. Investment in professional education in mental health
To make up for the shortage of mental health professionals in Lagos, the need to invest more in mental health training and education cannot be overemphasised.
About the Authors
Funmi Akindejoye is a Public Health specialist/researcher and an Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute, Trinity College Dublin, Ireland. She holds a Masters in Public Health degree in Environmental Health Sciences from the University of Ibadan. Her research interests include air pollution, urban design for human health, brain health and planetary health in general. She currently lives and works in Lagos, Nigeria.
@funmiakin_ |
Dr Nnenna Ike holds a PhD in Urban Design and Planning from the University of the Sunshine Coast, Australia. She lived and worked in Lagos City for many years but now works as a Research Fellow at Lund University, Sweden. Nnenna is actively involved in research in the fields of urban planning, human factors, and resilience engineering
|
References
1. Pryor, L., M.A. Da Silva, and M. Melchior, MHand global strategies to reduce NCDs and premature mortality. The Lancet Public Health, 2017. 2(8): p. e350-e351.
2. Ugochukwu, O., et al., The time is now: reforming Nigeria's outdated MHlaws. Lancet Glob Health, 2020. 8(8): p. e989-e990.
3. Nwachukwu, C., et al., Family Characteristics and MHStatus of Secondary School Students in a Rural Community in Southwest Nigeria. International Journal of MHand Addiction, 2021.
4. Ibrahim, A., The MHsystem in North-eastern Nigeria: A WHO-AIMS generated assessment of state of MHin a sub-Saharan African region. Nigerian J Psych. 2012; 10(3): 2- 7. 2012. 10: p. 2-7.
5. Abdulmalik, J.O., et al., Country Contextualization of the MHGap Action Programme Intervention Guide: A Case Study from Nigeria. PLoS medicine, 2013. 10: p. e1001501.
6. Okpalauwaekwe, U., M. Mela, and C. Oji, Knowledge of and Attitude to Mental illnesses in Nigeria: A Scoping Review. Integr J Glob Health, 2017. 1: p. 1-17.
7. Adewuya, A., et al., Prevalence and associated factors for suicidal ideation in the Lagos State MHSurvey, Nigeria. BJPsych Open, 2016. 2: p. 385-389.
8. Adewuya, A., et al., Epidemiology of depression in primary care: Findings from the MHin Primary Care (MeHPriC) project, Lagos, Nigeria. International journal of psychiatry in medicine, 2021: p. 91217421996089.
9. Obia, A., Emerging Nigerian Megacities and Sustainable Development: Case Study of Lagos and Abuja. Journal of Sustainable Development, 2016. 9: p. 27.
10. Aluko, O., The Impact of Urbanization on Housing Development: The Lagos Experience, Nigeria. Ethiopian Journal of Environmental Studies and Management, 2011. 3.
11. Oluwatayo, O., O. Olugbile, and A. Coker, Addressing the MHneeds of a rapidly growing megacity: the new Lagos MHInitiative. International Psychiatry, 2014. 11: p. 20-22.
12. Akorede, S. Employees in Lagos are stressed, burned out and exhausted because of 'hellish traffic'. CNN travel 2019 [cited May 2021 30]; Available from: https://edition.cnn.com/travel/article/traffic-stress-lagos-nigeria/index.html.
13. Gureje, O., et al., Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of MHand Well-Being. The British journal of psychiatry : the journal of mental science, 2006. 188: p. 465-71.
14. Francis, U.C., The MHstatus of taxi drivers in Lagos state, Nigeria. International Journal of Humanities Social Sciences and Education, 2015. 2(2): p. 142-51.
15. Coker, A., et al., Help-seeking behaviour of individuals with mental illness before pursuing professional MHcare services in Lagos, Nigeria. International Journal of Advanced Community Medicine, 2019. 2: p. 10-16.
16. Onuu, M. and O. Oluwasegun, Study of Road Traffic Noise Pollution and Impacts on Residents of Ikeja Local Government Area of Lagos State. 2015.
17. Adewuya, A. and E. Oladipo, Prevalence and associated factors for suicidal behaviours (ideation, planning, and attempt) among high school adolescents in Lagos, Nigeria. European Child & Adolescent Psychiatry, 2020. 29.
18. Adebayo, R., et al., A FOUR-YEAR REVIEW OF GERIATRIC MHSERVICES. IN A LAGOS BASED HOSPITAL, NIGERIA. Ethiopian medical journal, 2016. 54: p. 125-35.
19. Adeosun, I., et al., The Pathways to the First Contact with MHServices among Patients with Schizophrenia in Lagos, Nigeria. Schizophrenia research and treatment, 2013. 2013: p. 769161.
20. Layla, M., et al., Urban Design and Mental Health. 2017.
21. Agunbiade, M. and K. Ewedairo, A Review of the Lagos State Urban and Regional Planning and Development Law 2010: An International Perspective. 2014.
22. Akeem, O., O. Odunola, and A. Alabi, Planning Regulations and Implementation Mechanisms in Postcolonial Lagos. Journal of Globalization Studies, 2018. 9: p. 91-106.
23. UNITY, O.O.A., Lagos plan of action for the economic development of Africa 1980-2000.
24. Government, L.S. Lagos State Development Plan 2012-2025. 2012.
25. government, L.s. Lagos resilience strategy. 2020 [cited May 2021 30]; Available from: http://www.lagosresilience.net/Downloads/Lagos_Resilience_Strategy.pdf.
26. Obi, D. Lagos commuters lose 75% of weekly working hours to traffic. 2018 [cited May 2021 30]; Available from: https://businessday.ng/uncategorized/article/lagos-commuters-lose-75-of-weekly-working-hours-to-traffic/.
27. Fagbe, T., et al., Traffic Congestion and Health Information on Road Users' Safety and Wellbeing in Apapa-Badagry Expressway, Lagos, Nigeria. 2020. IOSR Journal of Environmental Science, Toxicology and Food Technology (IOSR-JESTFT): p. 41-48.
28. Adebayo, B. Thousands of Nigerian slum dwellers left homeless after mass eviction. 2020 [cited May 2021 30]; Available from: https://edition.cnn.com/2020/01/22/africa/nigeria-tarkwa-bay-evictions-intl/index.html.
29. times, P. Amnesty International condemns forced eviction of Lagos’ Tarkwa Bay residents. 2020 [cited May 2021 30]; Available from: https://www.premiumtimesng.com/regional/ssouth-west/374072-amnesty-international-condemns-forced-eviction-of-lagos-tarkwabay-residents.html.
30. Twumasi, Y., et al., Degradation of Urban Green Spaces in Lagos, Nigeria: Evidence from Satellite and Demographic Data. Advances in Remote Sensing, 2020. 09: p. 33-52.
31. Fasona, M. and A. Omojola, GIS AND REMOTE SENSING FOR URBAN PLANNING: A CASE OF FESTAC TOWN, LAGOS, NIGERIA. 2004.
32. Nnezi, U.-O. and A. Adesina John, SUSTAINABLE URBAN GREEN INFRASTRUCTURES AS A REMEDIATION TOOL FOR ENHANCED ENVIRONMENT AND LOCAL AIR QUALITY FOR METROPOLITAN LAGOS.
33. Woodcock, J., et al., Health and Climate Change 2 Public health benefits of strategies to reduce greenhouse-gas emissions: urban land transport. Lancet, 2009. 374: p. 1930-43.
34. Uwaegulam, C. ‘Millions die due to inadequate walking, cycling facilities’. 2016 [cited May 2021 30]; Available from: https://guardian.ng/news/millions-die-due-to-inadequate-walking-cycling-facilities/.
35. program, U.E. Lagos Non-Motorised Transport Policy. 2018 [cited May 2021 30]; Available from: http://airqualityandmobility.org/STR/NMTPolicy_LagosNigeria.pdf.
36. ONOBRAKPEYA, U., An Assessment of The Impact of Recent Sculptural Installations in Public Spaces in Lagos State Nigeria. NTAtvc: p. 210.
37. Oyinloye, M.A., E.T. Ijisakin, and S.A. Babatunde, Art and the Environment: Appraising Aesthetics Values of Visual Arts in Lagos.
38. Onwauanyi, N. Why buildings keep collapsing in Lagos and what can be done about it. 2019 [cited May 2021 30]; Available from: https://theconversation.com/why-buildings-keep-collapsing-in-lagos-and-what-can-be-done-about-it-113928.
39. BENJAMIN, S. Tackling unending building collapse in Nigeria. 2019 [cited May 2021 30]; Available from: https://www.blueprint.ng/tackling-unending-building-collapse-in-nigeria/.
40. Lawanson, T., B. Oyalowo, and T. Nubi, Global Goal, Local Context: Pathways to Sustainable Urban Development in Lagos, Nigeria. 2021. p. 13-35.
41. Brockington, I.F., et al., The community's tolerance of the mentally ill. Br J Psychiatry, 1993. 162: p. 93-9.
2. Ugochukwu, O., et al., The time is now: reforming Nigeria's outdated MHlaws. Lancet Glob Health, 2020. 8(8): p. e989-e990.
3. Nwachukwu, C., et al., Family Characteristics and MHStatus of Secondary School Students in a Rural Community in Southwest Nigeria. International Journal of MHand Addiction, 2021.
4. Ibrahim, A., The MHsystem in North-eastern Nigeria: A WHO-AIMS generated assessment of state of MHin a sub-Saharan African region. Nigerian J Psych. 2012; 10(3): 2- 7. 2012. 10: p. 2-7.
5. Abdulmalik, J.O., et al., Country Contextualization of the MHGap Action Programme Intervention Guide: A Case Study from Nigeria. PLoS medicine, 2013. 10: p. e1001501.
6. Okpalauwaekwe, U., M. Mela, and C. Oji, Knowledge of and Attitude to Mental illnesses in Nigeria: A Scoping Review. Integr J Glob Health, 2017. 1: p. 1-17.
7. Adewuya, A., et al., Prevalence and associated factors for suicidal ideation in the Lagos State MHSurvey, Nigeria. BJPsych Open, 2016. 2: p. 385-389.
8. Adewuya, A., et al., Epidemiology of depression in primary care: Findings from the MHin Primary Care (MeHPriC) project, Lagos, Nigeria. International journal of psychiatry in medicine, 2021: p. 91217421996089.
9. Obia, A., Emerging Nigerian Megacities and Sustainable Development: Case Study of Lagos and Abuja. Journal of Sustainable Development, 2016. 9: p. 27.
10. Aluko, O., The Impact of Urbanization on Housing Development: The Lagos Experience, Nigeria. Ethiopian Journal of Environmental Studies and Management, 2011. 3.
11. Oluwatayo, O., O. Olugbile, and A. Coker, Addressing the MHneeds of a rapidly growing megacity: the new Lagos MHInitiative. International Psychiatry, 2014. 11: p. 20-22.
12. Akorede, S. Employees in Lagos are stressed, burned out and exhausted because of 'hellish traffic'. CNN travel 2019 [cited May 2021 30]; Available from: https://edition.cnn.com/travel/article/traffic-stress-lagos-nigeria/index.html.
13. Gureje, O., et al., Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of MHand Well-Being. The British journal of psychiatry : the journal of mental science, 2006. 188: p. 465-71.
14. Francis, U.C., The MHstatus of taxi drivers in Lagos state, Nigeria. International Journal of Humanities Social Sciences and Education, 2015. 2(2): p. 142-51.
15. Coker, A., et al., Help-seeking behaviour of individuals with mental illness before pursuing professional MHcare services in Lagos, Nigeria. International Journal of Advanced Community Medicine, 2019. 2: p. 10-16.
16. Onuu, M. and O. Oluwasegun, Study of Road Traffic Noise Pollution and Impacts on Residents of Ikeja Local Government Area of Lagos State. 2015.
17. Adewuya, A. and E. Oladipo, Prevalence and associated factors for suicidal behaviours (ideation, planning, and attempt) among high school adolescents in Lagos, Nigeria. European Child & Adolescent Psychiatry, 2020. 29.
18. Adebayo, R., et al., A FOUR-YEAR REVIEW OF GERIATRIC MHSERVICES. IN A LAGOS BASED HOSPITAL, NIGERIA. Ethiopian medical journal, 2016. 54: p. 125-35.
19. Adeosun, I., et al., The Pathways to the First Contact with MHServices among Patients with Schizophrenia in Lagos, Nigeria. Schizophrenia research and treatment, 2013. 2013: p. 769161.
20. Layla, M., et al., Urban Design and Mental Health. 2017.
21. Agunbiade, M. and K. Ewedairo, A Review of the Lagos State Urban and Regional Planning and Development Law 2010: An International Perspective. 2014.
22. Akeem, O., O. Odunola, and A. Alabi, Planning Regulations and Implementation Mechanisms in Postcolonial Lagos. Journal of Globalization Studies, 2018. 9: p. 91-106.
23. UNITY, O.O.A., Lagos plan of action for the economic development of Africa 1980-2000.
24. Government, L.S. Lagos State Development Plan 2012-2025. 2012.
25. government, L.s. Lagos resilience strategy. 2020 [cited May 2021 30]; Available from: http://www.lagosresilience.net/Downloads/Lagos_Resilience_Strategy.pdf.
26. Obi, D. Lagos commuters lose 75% of weekly working hours to traffic. 2018 [cited May 2021 30]; Available from: https://businessday.ng/uncategorized/article/lagos-commuters-lose-75-of-weekly-working-hours-to-traffic/.
27. Fagbe, T., et al., Traffic Congestion and Health Information on Road Users' Safety and Wellbeing in Apapa-Badagry Expressway, Lagos, Nigeria. 2020. IOSR Journal of Environmental Science, Toxicology and Food Technology (IOSR-JESTFT): p. 41-48.
28. Adebayo, B. Thousands of Nigerian slum dwellers left homeless after mass eviction. 2020 [cited May 2021 30]; Available from: https://edition.cnn.com/2020/01/22/africa/nigeria-tarkwa-bay-evictions-intl/index.html.
29. times, P. Amnesty International condemns forced eviction of Lagos’ Tarkwa Bay residents. 2020 [cited May 2021 30]; Available from: https://www.premiumtimesng.com/regional/ssouth-west/374072-amnesty-international-condemns-forced-eviction-of-lagos-tarkwabay-residents.html.
30. Twumasi, Y., et al., Degradation of Urban Green Spaces in Lagos, Nigeria: Evidence from Satellite and Demographic Data. Advances in Remote Sensing, 2020. 09: p. 33-52.
31. Fasona, M. and A. Omojola, GIS AND REMOTE SENSING FOR URBAN PLANNING: A CASE OF FESTAC TOWN, LAGOS, NIGERIA. 2004.
32. Nnezi, U.-O. and A. Adesina John, SUSTAINABLE URBAN GREEN INFRASTRUCTURES AS A REMEDIATION TOOL FOR ENHANCED ENVIRONMENT AND LOCAL AIR QUALITY FOR METROPOLITAN LAGOS.
33. Woodcock, J., et al., Health and Climate Change 2 Public health benefits of strategies to reduce greenhouse-gas emissions: urban land transport. Lancet, 2009. 374: p. 1930-43.
34. Uwaegulam, C. ‘Millions die due to inadequate walking, cycling facilities’. 2016 [cited May 2021 30]; Available from: https://guardian.ng/news/millions-die-due-to-inadequate-walking-cycling-facilities/.
35. program, U.E. Lagos Non-Motorised Transport Policy. 2018 [cited May 2021 30]; Available from: http://airqualityandmobility.org/STR/NMTPolicy_LagosNigeria.pdf.
36. ONOBRAKPEYA, U., An Assessment of The Impact of Recent Sculptural Installations in Public Spaces in Lagos State Nigeria. NTAtvc: p. 210.
37. Oyinloye, M.A., E.T. Ijisakin, and S.A. Babatunde, Art and the Environment: Appraising Aesthetics Values of Visual Arts in Lagos.
38. Onwauanyi, N. Why buildings keep collapsing in Lagos and what can be done about it. 2019 [cited May 2021 30]; Available from: https://theconversation.com/why-buildings-keep-collapsing-in-lagos-and-what-can-be-done-about-it-113928.
39. BENJAMIN, S. Tackling unending building collapse in Nigeria. 2019 [cited May 2021 30]; Available from: https://www.blueprint.ng/tackling-unending-building-collapse-in-nigeria/.
40. Lawanson, T., B. Oyalowo, and T. Nubi, Global Goal, Local Context: Pathways to Sustainable Urban Development in Lagos, Nigeria. 2021. p. 13-35.
41. Brockington, I.F., et al., The community's tolerance of the mentally ill. Br J Psychiatry, 1993. 162: p. 93-9.