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Author: Erin Sharp Newton  Photo: Denniz Futalan When cities are destroyed by disasters, when people are displaced, and when divisive uncertainty fractures the landscape of humanity, the human response is fear, desperation, disconnectedness, grief, and trauma. In collective compassion and collaborative commitment, society can invest in strength, spirit, and substance to support the needs of all those facing such traumas. By embedding spaces and systems into our cities that provide refuge, recovery, and healing, we create environments that nurture both individuals and communities.  Photo: Kelly (Pexels) The Urgency of Mental Health in Crisis This year's 2025 World Mental Health Day theme, "Mental Health in Humanitarian Emergencies," underscores the urgent need to support the mental health and psychosocial well-being of people affected by crises. Natural disasters, conflict, and public health emergencies leave deep emotional + neurological + psychological imprints. At the Centre for Urban Design & Mental Health, we focus on how environments profoundly shape mental health outcomes, particularly in contexts of recovery and resilience. Just as cities can negatively impact mental health and well-being, they can also be intentionally designed to restore safety, foster connection, and nurture psychological resilience.  Photo: Josh Fields Insights from the Centre's Work The Centre's Journal for Urban Design and Mental Health and Sanity + Urbanity Forum are curated to provide valuable insights into urban design and mental health. The work of our large network of people invested in this space reflects a growing recognition that the physical and social fabric of cities plays a central role not only in fostering mental well-being but also in enabling recovery after disruption. The following examples are just some examples that illustrate how researchers, practioners, and stakeholders have approached this challenge. These examples offer evidence, precedent, and reflection on how the built environment can become both a site of vulnerability and a source of healing:
A Call to Collaboration in Crisis As we observe World Mental Health Day 2025, let us reflect on the role of urban environments in shaping mental health outcomes during humanitarian emergencies. It is essential for everyone (including architects, planners, scientists, developers, government officials, health and social care providers, school staff, and community groups) to come together. Through collective, collaborative, compassionate, pro-active and pro-social work, we can ensure the most vulnerable have access to the support they need while protecting the well-being of everyone. If you are looking to contribute to this ongoing dialogue, consider submitting your work to our platforms:
 Photo: Ludwig Kwan Global Resources & History: World Mental Health Day World Mental Health Day has been observed on 10 October since 1992, launched by the World Federation for Mental Health in partnership with the WHO, to advance awareness, reduce stigma, and galvanize advocacy for mental health globally.
References
Burkly, H. (2019). Washington, D.C., USA: An urban design and mental health case study. Journal of Urban Design & Mental Health, 6(13). Centre for Urban Design & Mental Health. King, J. (2018). Air pollution, mental health, and implications for urban design: A review. Journal of Urban Design & Mental Health, 4(6). Centre for Urban Design & Mental Health. https://www.urbandesignmentalhealth.com/journal-4---air-pollution-and-mental-health.html McCay, L., Suzuki, E., & Chang, A. (2017). Urban design and mental health in Tokyo: A city case study. Journal of Urban Design & Mental Health, 3(4). Centre for Urban Design & Mental Health. https://www.urbandesignmentalhealth.com/journal-3---tokyo-case-study.html Palti, I. (Ed.). (2016). Conscious cities. Journal of Urban Design & Mental Health, 1. Centre for Urban Design & Mental Health. Shafique, T. (2017). Lonelitopia: How urbanism of mass destruction is crushing the American dream. Journal of Urban Design & Mental Health, 2. Centre for Urban Design & Mental Health. https://www.urbandesignmentalhealth.com/edition-2.html Ward, K., & Sharp Newton, E. (2018). Applying the concept of Root Shock to urban renewal plans for Charlotte’s Marshall Park. Journal of Urban Design & Mental Health, 5. Centre for Urban Design & Mental Health. https://www.urbandesignmentalhealth.com/edition-5.html Gleizes, S. (2016). The digitalization of traumascapes. Journal of Urban Design & Mental Health*1(6). Centre for Urban Design & Mental Health. https://www.urbandesignmentalhealth.com/journal1-digitaltraumascapes.html Author: Erin Sharp-Newton, M. Arch  At the Centre for Urban Design and Mental Health, I’m proud to highlight the work of my colleague and Centre Fellow Dr. Agnieszka Olszewska-Guizzo, President of NeuroLandscape. In partnership with the EU-funded GreenInCities project and aligned with the New European Bauhaus, she and her team are applying cutting-edge research in real time, on city streets, with the goal of understanding how cities affect our brains and experience. This innovative work brings neuroscience to life outside controlled environments, using wearable technology to explore how our surroundings shape brain activity, stress levels, and emotional responses. We move from theoretical speculation to data-driven insight into how our environments help or harm our mental health.  What is Neurourbanism? Neurourbanism is a rapidly evolving interdisciplinary field that examines the relationship between the built environment and the brain’s function. It synthesizes neuroscience, urban design, environmental psychology, public health, and technology to better understand how urban settings influence mental well-being. As I see it, neurourbanism offers a vital lens for designing cities that nurture mental health, moving beyond functionality toward spaces that actively support our cognitive and emotional needs. Dr. Olszewska-Guizzo captures this well: “We have been building cities without truly understanding their impact on us… Neurourbanism is unlocking this mystery. It is the key to designing cities that don’t just function, but feel - cities that nurture mental health, encourage creativity, and foster human connection.” You can read her full article here.  Tools Bringing Neuroscience to Urban Design Within the GreenInCities consortium, the NeuroLandscape team has been developing two innovative tools aimed at advancing urban design through neuroscientific data: 1. The Neurourbanism Assessment (NUA): A neighborhood-scale mental health evaluation tool that integrates portable brain imaging (using EEG) with real-time environmental measurements such as air quality, noise levels, and landscape aesthetics. The NUA captures immediate brain responses to urban stimuli, providing objective data about how specific urban environments affect well-being in a simple form – a single numeric value, called NUA index. This tool supports the New European Bauhaus (NEB) mission to enhance urban spaces aesthetically and functionally, while aligning with broader Urban Regeneration (UR) goals by pinpointing areas that could better promote public mental health. 2. The Mental Health Digital Twin (MHDT): A sophisticated simulation platform that merges neuroimaging data with psychological and environmental metrics to model brain activity under varying urban conditions. The MHDT allows planners and designers to virtually test proposed interventions, predicting their potential mental health impacts before implementation. This tool embodies the integration of neuroscience with AI and urban data analytics, guiding evidence-based decisions for healthier cities. Together, these tools provide a robust framework that bridges neuroscience, mental health, planning, design, and policy, advancing the future of urban development and interventions, grounded in human-centered science.  Beyond Interdisciplinary: A Transdisciplinary Movement While many describe Neurourbanism as interdisciplinary, perhaps we should consider it the term transdisciplinary as well. Neurourbanism integrates a vast spectrum of disciplines: neuroscience, architecture, environmental psychology, landscape design, psychiatry, epidemiology, computer science, AI, sociology, and public policy. But it also has the power to transcend academia by involving municipalities, urban planners, designers, and the public in testing and applying this science in real-world, accessible contexts. This breadth and collaboration are both challenging and essential. At the Centre for Urban Design and Mental Health, we witness firsthand how integrating diverse expertise and perspectives generates deeper understanding and more innovative solutions. It is definitely not always the easier path, as there is an inherent complexity in bridging the gap between urban design and mental health, as well as the disconnect often found between academia and practice. This is exactly the point, and thus our approach - to address the gaps, disconnects, and diverse ways of addressing mental health, which is ultimately a common issue to all. Neurourbanism exemplifies this approach by not only generating knowledge but actively transforming how we think about and build our cities.  Capturing the Brain in Context: Methods and Data What distinguishes Neurourbanism from traditional urban health studies is its direct measurement of brain responses in situ. Rather than relying solely on self-report surveys or laboratory experiments, researchers use portable neuroimaging tools, such as wearable EEG, alongside spatial sensors and environmental data collection methods. Collecting this neurophysiological data in real urban settings allows for novel insight into how specific environments modulate stress, attention, and mood. Combined with geospatial analysis, computer vision, and AI algorithms, this multidisciplinary approach can capture the nuanced relationship between the brain and the city. Despite early skepticism from some neuroscientists who favored controlled lab studies, advances in wearable technology and data analytics are rapidly shifting the field and providing data, feedback and insight not achievable equally in labs. In labs there are missing elements, and in surveys there are subjective aspects that affect outcomes. While this space is in some ways new territory, and not without error or shortcomings, the progress still promises critical new intel for designing interventions that are grounded in physiological experience and measurable validity.  Neurourbanism Now Urbanization continues to accelerate worldwide, and with it, mental health challenges such as stress, anxiety, social isolation, and cognitive overload become more prevalent. These issues are shaped by the physical and social fabric of our cities. Neurourbanism offers a scientific pathway to diagnose these urban mental health challenges and respond effectively. By linking neuroscience with design and policy, it provides planners, architects, and decision-makers a clearer picture of how environments affect psychological well-being, and provides tools to create spaces that actively support mental health.  Current Research In Nova Gorica, Slovenia, the NeuroLandscape team is piloting their Neurourbanism tools and methods. Their fieldwork is part of a larger effort to assess and transform urban environments based on how they influence mental health at the neurobiological level. Using mobile mobile EEG headsets, they are collecting real-time brain activity data as participants walk through selected urban routes. Additionally, environmental measurements (air quality, sound levels, temperature, humidity, and the visual quality of landscape) is also assessed. The research is designed to compare different urban neighbourhoods and typologies (such as dense commercial zones, quiet residential areas, and green parks) to evaluate how various stimuli affect emotional states, stress regulation, and cognitive load. Participants' subjective perceptions are also gathered through questionnaires and interviews, allowing researchers to correlate physiological responses with personal experience and spatial context. This approach provides a holistic view of how specific spatial characteristics such as visual openness, natural elements, and noise exposure, etc. can elevate or alleviate stress. The data collected is then processed using AI algorithms and spatial mapping tools, feeding into the development of the Mental Health Digital Twin (MHDT) and Neurourbanism Assessment (NUA) to inform practical, evidence-based urban planning recommendations in more places around the world. The next phases of this study will take place in Helsinki, Finland, and Athens, Greece (key sites in the GreenInCities project) where the team will continue to apply and refine these tools. Their hope is to work closely with city planners to guide sustainable urban transformation efforts that prioritize mental health. (You can follow the team’s step-by-step experimental procedures and access a comprehensive FAQ here.)  Stay Tuned If you are interested in how neuroscience, data, and urban design can converge to create healthier, more liveable cities, I encourage you to follow this evolving field closely, through the work of people such as Dr. Agnieszka Olszewska-Guizzo, her team, and our other UDMH fellows. We will continue to share more on how the integration of brain science into urbanism has the potential to revolutionize how we conceive and shape our lived environments.    Additional Reading & References: Adli, M., et al. (2017). Neurourbanism: towards a new discipline. The Lancet Psychiatry, 4(3), 183-185. Vigliocco, G., et al. (2024). Ecological brain: reframing the study of human behaviour and cognition. Royal Society Open Science, 11(11), 240762. Tewari, K., Tewari, M., & Niyogi, D. (2023). Need for considering urban climate change factors on stroke, neurodegenerative diseases, and mood disorders studies. Computational Urban Science, 3(1), 4. Andreucci, M.B., Russo, A., & Olszewska-Guizzo, A. (2019). Designing Urban Green Blue Infrastructure for Mental Health and Elderly Wellbeing. Sustainability, 11(22), 6425. Beute, F., et al. (2020). Types and characteristics of urban and periurban green spaces having an impact on human mental health and wellbeing: a systematic review. EKLIPSE Expert Working Group. Norwood, M.F., et al. (2019). Brain activity, underlying mood and the environment: A systematic review. Journal of Environmental Psychology. Moore, T.H.M., et al. (2018). The effects of changes to the built environment on the mental health and well-being of adults: Systematic review. Health & Place, 53, 237-257. Gascon, M., et al. (2017). Outdoor blue spaces, human health and well-being: A systematic review of quantitative studies. International Journal of Hygiene and Environmental Health, 220(8), 1207-1221. Van den Berg, M., et al. (2015). Health benefits of green spaces in the living environment: A systematic review of epidemiological studies. Urban Forestry & Urban Greening, 14(4), 806-816. Olszewska-Guizzo, A., Sia, A., Fogel, A., & Ho, R. (2022). Features of urban green spaces associated with positive emotions, mindfulness and relaxation. Scientific Reports, 12(1), 20695. About the Author
By: Hadiya J. Khuwaja In the global conversation about urban parks and mental health, one dimension often remains understated: how women perceive and navigate safety in public parks. While parks are celebrated for their restorative benefits - offering peace, stress relief, and a vital connection to nature - for many women, especially in culturally complex contexts like Islamabad, Pakistan, parks are not unconditionally accessible havens. They are contingent spaces, where the promise of well-being is unbalanced by persistent concerns about safety, visibility, and belonging. Islamabad, the capital city of Pakistan, is nestled at the foothills of the Margalla Hills and offers a unique urban backdrop. It is the country’s only purpose-built city, designed by Greek architect Constantinos Doxiadis, who envisioned it as a series of zones with quadrilateral residential sectors carefully integrated with public parks and green spaces. At its heart lies Fatima Jinnah Park – commonly known as F-9 Park – a sector-wide green space envisioned as Islamabad’s central hub for public recreation and leisure.  Detailed map of Islamabad showcasing the city’s sector-based layout, major green spaces, and urban parks. (Source: Ontheworldmap.com (©2021))  Illustrative map of Islamabad displaying key sectors, roads, and green zones, including parks and natural areas that shape the city’s spatial layout. (Source: Orangesmile.com)  Aerial view of Islamabad with the iconic Faisal Mosque framed by the Margalla Hills, illustrating the city’s green urban fabric and zoning layout. (Source: Xinhua News) Compared to other cities in Pakistan, Islamabad enjoys a relatively abundant provision of parks and natural areas. Yet, as is common across much of South Asia, public spaces remain predominantly male-dominated. The city’s formal planning, while orderly and green, cannot fully insulate women from the social and environmental dynamics that continue to shape their experiences of urban parks. Drawing on my recent research – a mixed-methods study examining park access and mental well-being in Islamabad (part of my graduate thesis research at NUST Islamabad) – a layered reality emerges: women’s engagement with parks is deeply intertwined with spatial justice, emotional security, and the right to public space. The study, conducted with 354 participants across Islamabad’s major urban development zones, revealed notable gender imbalances. Only 26% (n=91) of respondents were female, while 74% (n=263) were male (Graph 1).  Figure 1 Among all respondents, approx. 10% (n=34) cited safety and security concerns as barriers to park visitation. Strikingly, 70% (n=24) of those who raised safety concerns were women, compared to just 30% (n=10) men, highlighting how safety is not just a design issue, but a lived gendered experience that restricts equitable access to parks (Graph 2).  Graph 2 This sharp disparity underscores not only women’s heightened vulnerability within public spaces but also their limited engagement with them. The low proportion of female participants may itself reflect broader structural barriers – social norms, safety fears, and mobility restrictions – that systematically discourage women’s active presence in urban parks. Parks as Potential Sanctuaries – If Safe This tension between the potential and the reality of parks came into sharp focus in early 2023, when a woman was assaulted by two armed men in Islamabad’s Fatima Jinnah or F-9 Park - one of the largest and, ostensibly, safest public parks in the city. Despite interventions such as linking over 200 park cameras to the Safe City Authority and increasing police patrols, another deeply unsettling event occurred in early 2025. Late in the evening, a mother and daughter were assaulted and mugged in the same park. The suspects attacked the women, robbed them, and warned they “shouldn’t be in the park at this hour” - a chilling reminder of the gendered boundaries imposed in Pakistan’s male-dominated public spaces.  Aerial view of a part of F-9 Park, Islamabad (Source: Friends of F-9 Park, Facebook page)  Aerial image of F-9 Park, Islamabad, highlighting its expansive layout and centrality in the city. (Source: Google Earth)  A presentation panel showcasing the layout and design of F-9 Park, Islamabad. (Source: Archnet.org) In my study, respondents consistently emphasized that parks hold significant potential to enhance mental health – offering relaxation, optimism, and emotional restoration. Yet, this potential was not unconditional. Safety concerns were not peripheral; they were central. Key concerns included:
Spatial Justice and Gendered Access This raises a critical question: If parks theoretically exist for all, but practically exclude women, can we truly call them equitable urban spaces? In Islamabad, safety issues are less about isolated incidents and more about chronic structural neglect – embedded in physical design, maintenance, and governance. These gaps manifest in several ways:
 Kachnar Park (I-8), one of the city’s most active sector-scale parks, becomes poorly navigable at night due to non-functional light poles. (Source: TikTok/@r.akeel)  Sunrise to sunset at Kachnar Park, I-8 – though the lamp posts add charm, their non-functionality highlights persistent safety concerns.  Jacaranda Park (G-11) features a jogging track with no streetlights at all, raising serious safety concerns for evening visitors. (Source: Google Photos)  Night-time scenes from G-11/1 Park reveal how poor lighting, scattered puddles, and empty benches can transform public spaces into zones of unease - amplifying feelings of vulnerability, especially for women and families. The park lacks basic security infrastructure, leaving it poorly maintained and particularly unsafe after dark. (Source: Google Photos) Even larger parks like F-9 Park, often seen as vibrant in daylight, experience a dramatic shift after dusk:  F-9 Park. (Source: Author) During the day, families and individuals use its open paths and shaded walks, showcasing its potential as an inclusive public space.  F-9 Park. (Source: Author) But after sunset, dim (or no) lighting and dense tree cover create poorly visible zones, making the park feel fragmented and unsafe, particularly for women and solo visitors. The central pavilion called Baradari glows in the distance as surrounding areas remain dimly lit, highlighting uneven illumination and the contrast between formal landmarks and underused open spaces at night.
 A visibly neglected “Ara Park” in sector G-13/3, where the absence of greenery, street lighting, and security measures is stark - despite being surrounded by residential buildings. (Source: Author) A lone woman on a worn-out bench and a mother with her toddler in a sun-drenched but unshaded clearing, both underscoring the lack of care and inclusive design. (Source: Author)
 I-10 Sector Parks, Islamabad – closed gates, broken benches, and poorly maintained landscapes reveal a broader pattern of neglect in public park infrastructure. These conditions not only limit accessibility but also deter women and families from feeling welcome or safe in spaces meant for community recreation. (Source: Google Photos)  F-10/2 Park, Islamabad – a faded signboard, overgrown greenery, and a makeshift barrier reflect neglect and restricted access, diminishing the park’s usability and sense of welcome. (Source: Google Photos) For women, navigating parks means navigating not only the physical landscape but also the psycho-social landscape - assessing, calculating, and often retreating. Mental Health: The Uneven Promise When women felt safe, parks provided a multitude of mental health benefits: calmness, rejuvenation, clarity of thought, and a rare reprieve from daily pressures. When they felt unsafe, the very same spaces became sources of anxiety, exclusion, and compounded stress. This paradox - parks as both healing spaces and sites of tension - is not unique to Islamabad. From London’s night-time public realm debates to Mexico City's pink public transport initiatives, gendered safety concerns shape how women globally engage with urban environments. Islamabad’s experience mirrors a broader global urban challenge: When parks are designed without a gendered understanding of safety, they risk reinforcing inequality, even as they aspire to promote public health and well-being. Toward Solutions: Designing for Women's Safety and Inclusion Several design and policy interventions are urgently needed to reclaim parks as inclusive, healing spaces:
 F-10/2 Park, Islamabad (Source: Author) Final Reflection In her book Death and Life of Great American Cities, Jane Jacobs - ahead of her time - emphasized that urban safety relies not on isolated security measures but on "eyes upon the street" - organic, community-driven oversight. Drawing from examples of several city parks, Jacobs stressed that parks must be busy, lively spaces to feel safe and inviting. Empty or poorly used parks, no matter how beautifully designed, often become areas of danger and neglect. Successful parks, Jacobs explained, share key traits: they offer a diversity of uses, are bordered by active streets and buildings, and attract a mix of users throughout the day. In contrast, parks that are isolated, monotonous, or serve a narrow demographic tend to fail, lacking the continuous, casual surveillance provided by a vibrant community. Islamabad’s parks often lack this vibrancy, leaving safety fragile and access unequal, particularly for women. Poor lighting, disconnected layouts, and minimal passive surveillance contribute to parks becoming isolated, especially during critical evening hours. In a city where women’s presence in public spaces is already constrained by cultural and social barriers, the absence of "eyes on the park" heightens their sense of vulnerability. To truly realize parks as safe and inclusive spaces, urban planners must move beyond installing security cameras and posting guards. Instead, they must design environments that naturally encourage diverse, everyday use - families picnicking, elderly people strolling, teenagers playing sports. It is this constant, pluralistic presence that weaves an invisible yet powerful net of safety, embodying the vision Jacobs laid out for truly vibrant and secure public spaces. Public parks are powerful equalizers - but only when they are truly public. When women must navigate these spaces with fear or restraint, the health and social benefits that parks promise become unevenly distributed, undermining their fundamental purpose. As we reimagine healthier, more inclusive cities, the everyday safety and dignity of women must shift from being a peripheral concern to a central design priority. Because the right to safety, serenity, and joy in public space should not depend on one’s gender - it should be guaranteed.  F-9 Park, Islamabad (Source: Author) About the Author
 Speaking of Psychology: Designing cities to improve mental health, with Jenny Roe, PhD On the Speaking of Psychology podcast by the American Psychological Association, environmental psychologist Dr. Jenny Roe shares how urban design can play a powerful role in shaping mental well-being, and why cities must be built with psychological health in mind. Dr. Roe is a Fellow at the Centre for Urban Design and Mental Health and co-author of Restorative Cities, written alongside Centre founder Dr. Layla McKay. Her insights are rooted in evidence and advocacy, calling for a new kind of city: one designed to heal. Here are a few takeaways worth reflecting on: Nature isn’t a luxury, it’s a lifeline Access to greenery, no matter how small, helps reduce stress, restore focus, and improve mental health outcomes. From city parks to street trees and rooftop gardens, the evidence is clear: nature heals. The built environment can connect or isolate us Thoughtfully designed public spaces, walk-able neighborhoods, and inclusive design help build trust, connection, and belonging, which are all key for resilient communities. Equity in design is essential The benefits of restorative urban design shouldn’t be reserved for the privileged. Dr. Roe advocates for inclusive planning that reaches all communities, especially those historically and systemically under-served. Big changes aren’t always required Even temporary or small-scale interventions, like pop-up parks or traffic-free zones, can make a measurable impact on mental health. Cities like Paris and New York are showing what’s possible From green corridors to car-free initiatives, cities around the world are beginning to prioritize mental well-being in their planning. Dr. Roe’s message is simple but urgent: mental health should be a central goal of urban planning and design isn't just about aesthetics, it's about health, dignity, and human connection. APA Podcast Post: About Jenny: Restorative Cities Book:
by Jacob King, UD/MH Associate and junior doctor practising in the UK Published in the prestigious Journal of the American Medical Association last week at long last those of us interested in green space and mental health have a city-wide experimental study, and it’s good news! (South, Hohl, Kondo, MacDonald, & Branas, 2018) KEY FINDINGS
Until now, green spaces in one’s urban environment have been shown to confer a range of mental health benefits to their local populations only in observational epidemiological studies. In the most common type of these studies, snapshots of a populations’ access to green space and their mental health are measured at the same moment in time. These methodologies are of course hindered by problems for inferring causality. The relationship between green spaces and mental health is a hugely complex one. There are a long list of ways in which the benefits are explained. The most well-evidenced mechanisms to date are: promoting exercise and socialisation, reducing exposure to air and noise pollution, reducing stress and restoring attention, and building senses of community and place attachment . These mechanisms, among many others, are hugely complex and very difficult to adjust for in observational studies despite best efforts. A common criticism which therefore arises from observational studies is whether the effect could be caused by any one of a thousand factors associated with green spaces, which could be good for mental health. Furthermore, the observational studies so far have reported widely variable results. Some have demonstrated impressive reductions in anxiety (de Vries et al., 2016) and depressive symptomatology (Triguero-Mas et al., 2015). While others have shown virtually zero impact at all (Houlden, Weich, & Jarvis, 2017). These variable results are likely in a large part due to the many confounding factors. In response, study after study, commentary after commentary, has been crying out for experimental style studies - natural experiments or randomized control trials (RCTs) – the benefits of which allow for the single issue of interest to be studied in isolation from the disruptive noise of the complex co-factors in the relationship. In RCTs of sound methodology we can be quite confident that the results we see are due to the factor we are interested in. Step forward Eugenia South and her colleagues from the University of Pennsylvania and their RCT set in Philadelphia. Green fingered Philly Initially concerned with the high burden of mental health conditions, and in light of the then fledgling evidence for green space benefit, researchers extended their work which had previously shown reductions in crime rates following neighbourhood improvement projects to consider mental health outcomes (Kondo, Hohl, Han, & Branas, 2016). By early 2013 city officials in Philadelphia had identified nearly 45,000 lots of unused vacant, often derelict brownfield land across the city. Given such an opportunity authors designed their methodology to include three study arms into which randomly selected plots, grouped together into local clusters of a 0.25 mile radius, would be allocated. The first arm would be left as they were at present. The vacant plots in the second arm would be tidied up, and the third would be “greened”. The researchers would then be able to differentiate whether the “greenness” of the spruced-up space itself contributed anything to outcomes. Random plots were selected from the master list, and random plots also from the list and within a 0.25 mile radius were included in the cluster. To be eligible for the study, lots were to be less than 5500sqft, deemed to be abandoned, and stricken with ‘blight’, for example that there was evidence of fly-tipping (dumping), abandoned cars, or numerous police reports concerning crimes associated with the lot. In total 110 clusters were formed, containing 541 lots. Over a period of two months gardeners from the Pennsylvania Horticultural Society transformed the third of these vacant plots allocated to the “greening” arm, and tidied the third in the second arm, they will continue to maintain these lots monthly for the foreseeable future.  Before and after examples of greening the vacant lots. Used without permission of copyright holder for educational purposes. License held by JAMA network and authors. Gardeners were instructed to follow a strict, replicable, modification process of grading the land, cleaning debris, planting grass and a small number of trees, and enclosing the space with a wooden fence with openings, in the aim of avoiding future dumping. What impact on locals’ mental health? In their study researchers randomly selected individuals living within the catchment areas of clusters and administered questionnaires before the intervention, and again after the intervention. There was a 77.4% success rate at interviewing the same people post-intervention at 18 months, achieving a final sample size of 342 subjects used in analysis. Questionnaires primarily consisted of key demographic information, financial status and a measure for mental health status. The short form “Kessler-6 scale” is a quick screening tool widely used for assessing poor mental health. Each question concerns a key symptom of psychological distress: nervousness, hopelessness, restlessness, depressive feelings, worthlessness, the feeling that everything is an effort, and a summary result which gives a good approximation of overall mental health and psychological distress. An annoying limitation of the short form Kessler scale is that we cannot make clinical judgments about the results: we can only identify the presence of depressive symptomatology, rather than making a diagnosis of clinical depression. However the two are of course highly related. On to the results. Between individuals living in clusters which were greened versus those which were not, authors demonstrated significant reductions in two of the sub-categories of the K-6: depressive feelings were reduced by 41.5% and feelings of worthlessness by 50.9%(!) All other components had major drops in prevalence too. The combined figure showed impressive community wide reductions of psychological distress by 62.8% (95% CI, −86.2 to 0.4; P = 0.051). In the second arm of the study, tidying up the lots compared to no intervention produced weaker result than greening did, and while the prevalence of all psychological categories decreased, non came close to a real significance (a strong likelihood of true difference); overall psychological distress for example was reduced by 30.1% (95% CI, −74.7 to 93.2; P = 0.49).  Adapted from South et al., 2018. A table showing pre/post intervention differences in those clusters which were greened (arm 3) and those which were not altered (arm 1). Furthermore, and importantly, in line with other studies of green spaces in local communities and mental health outcomes (Roe, Aspinall, & Ward Thompson, 2016), evidence from this study suggests that these benefits are even more pronounced for those individuals with low incomes (in this study judged to be household income under $25,000 pa). Notably, feelings of depression dropped in this sub-group by 68.7%, (−86.5 to −27.5; P < 0.01). All other aspects dropped by large amounts, but with wide confidence intervals and without strong evidence of a true difference. In short, authors, and readers, can conclude from this presented data, that the greening interventions conducted by these gardeners notably reduced the overall number of citizens with poor mental health, and has been especially good for reducing the number of people with depressed feelings, particularly for those with low incomes. A call to arms for communities The evidence presented by South and her colleagues marks an important point for green space / mental health research. For the first time, this is large scale, experimental data, which provides key, and long-needed reassurance that the work of observational studies to date is replicable when the complex web of confounding factors are evaporated away. Furthermore this study offers much to the way in which to think about green space within urban design. Especially in conjunction with this team’s previous work on the reductions in crime rates in ‘greened’ neighbourhoods, this paper adds to the conversation about the mechanisms of action of the now-undeniable benefits of green neighbourhoods to the mental health of their residents. Recent emphasis in the debate had been placed on active use of green spaces, but this study may now shift thought back towards passive or indirect observable functions of green spaces (such as attention restoration, stress reduction and protection from nuisance environmental exposures), and promotes greenery as a key facet of improving the quality of neighbourhoods, given tidying the area alone produced only marginal benefit. Next, we must ask environmental psychologists to consider why South’s interventions delivered improvement to rather specific facets of psychiatric symptomatology (depressive feelings and worthlessness specifically: the authors propose a renewed sense of local authorities caring about their communities as a possible explanation). Hence whether specific mechanisms of green space produce specific mental health symptom benefits? In this sense, facilitating other mechanisms with other flavours of green space interventions, perhaps larger green spaces for promoting recreation, and as community foci, other facets of psychiatric symptomatology will be addressed for an overall multifaceted tackling of community psychiatric burden. Other important areas for consideration now should be the replication of these results across other cities, with larger sample sizes, and more rigorous, clinically validated assessments. More than ever, we should feel renewed in a community focused approach to urban (re)design. That efforts in renewing small scale (and very small scale) blighted vacant lots in our communities (some clusters only renovating 5 lots to produce such improvements in mental health) is to be of benefit. It is highly likely that these small projects are achievable for many communities. Authors further report that these initiatives are affordable too: in their previous work, greening improvements of this kind cost on average US$1,597, plus US$180 in yearly maintenance. Local government structures can now add “improving the mental health of my community” to the long list of reasons for revitalising derelict land that is perhaps too small and financially unappealing to property developers. Otherwise, in the spirit of work which has suggested community involvement and directorship of a community’s spaces is of multifaceted benefit through building a sense of community, of place, and of stewardship, councils might look to devolve authority of these small projects to community groups themselves. When all is said and done improving mental health is not the only outcome of improving the quality of local communities, but it is a major player in an interconnected web of community, environment and health, which the work presented here by South and colleagues could more reliably inform and encourage local and national decision makers to take a little more seriously. READ THE STUDY HERE References de Vries, S., ten Have, M., van Dorsselaer, S., van Wezep, M., Hermans, T., & de Graaf, R. (2016). Local availability of green and blue space and prevalence of common mental disorders in the Netherlands. British Journal of Psychiatry Open, 2(6), 366-372. doi:10.1192/bjpo.bp.115.002469 Houlden, V., Weich, S., & Jarvis, S. (2017). A cross-sectional analysis of green space prevalence and mental wellbeing in England. BMC Public Health, 17(1), 460. doi:10.1186/s12889-017-4401-x Kondo, M., Hohl, B., Han, S., & Branas, C. (2016). Effects of greening and community reuse of vacant lots on crime. Urban Stud, 53(15), 3279-3295. doi:10.1177/0042098015608058 Roe, J., Aspinall, P. A., & Ward Thompson, C. (2016). Understanding Relationships between Health, Ethnicity, Place and the Role of Urban Green Space in Deprived Urban Communities. Int J Environ Res Public Health, 13(7). doi:10.3390/ijerph13070681 South, E. C., Hohl, B. C., Kondo, M. C., MacDonald, J. M., & Branas, C. C. (2018). Effect of greening vacant land on mental health of community-dwelling adults: A cluster randomized trial. JAMA Network Open, 1(3), e180298. doi:10.1001/jamanetworkopen.2018.0298 Triguero-Mas, M., ., Dadvand, P., Cirach, M., Martínez, D., Medina, A., Mompart, A., . . . Nieuwenhuijsen, M. J. (2015). Natural outdoor environments and mental and physical health: Relationships and mechanisms. Environment International, 77, 35-41. doi:http://dx.doi.org/10.1016/j.envint.2015.01.012 About the AuthorJacob King is a UD/MH Associate and junior doctor practising in UK. His main interest concerns the association between green space exposure and mental health, and how we can design interventions to promote this relationship.
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