In recent years, poor Mental Health as an issue has received an increase in publicity and awareness. The World Health Organisation defines Mental Health as:
“a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
Mental Health issues span a wide range of disorders including anxiety, depression, bipolar disorder, PTSD, dementia and Alzheimer’s disease. Statistics show an increase in the number of diagnoses of ‘common mental disorders’ (such as anxiety or depression) over the past several decades (Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing England, 2014).
Although there are many possible reasons for this increase in diagnoses, statistics show that, at a time when more people around the globe are living in urban areas (approximately 54.5% of the global population in 2016, and increasing, according to the UN), certain common mental health disorders, like anxiety and depression, have a higher frequency in urban settings relative to rural areas (The current status of urban-rural differences in psychiatric disorders, Peen et al., 2009). In this blog I hope to outline how and why we ought to design our urban areas to combat Depression and Anxiety, two of the most common mental health disorders.
What are Depression and Anxiety?
Depression is a mood disorder manifested as prolonged states of depressed mood resulting in loss of pleasure and interest and potentially leads to disturbed sleep, loss of appetite and poor concentration. The term ‘anxiety’ is an overarching term referring to a number of related but distinct anxiety disorders. These include ‘generalised anxiety disorder (GAD)’, ‘social anxiety disorder’ and ‘panic disorder’ (specific phobias are also sometimes classed as an anxiety disorder).
Depression and Anxiety disorders are amongst the most commonly diagnosed mental health illnesses. In England in 2016, statistics found that:
3.3% of people suffered from Depression
5.9% of people suffered from GAD
2.4% suffered from Phobias
0.6% suffered from Panic disorder
7.8% suffered from a mixture of anxiety and depression
Overall accounting for about 20% of the population. Considering that 1 in 4 people in the UK are estimated to experience a mental health problem each year, Depression and Anxiety disorders account for a large proportion of this (statistics taken from Mind, the mental health charity).
Mental Health is important on a personal level but also on a macro level. The OECD suggests that the indirect cost to the economy due to mental illnesses causing people to take time off work accounts for about 4% of GDP. On top of that there are a direct costs due to care and medical treatment as well as the treatment costs from physical health problems which may result from untreated mental health issues. In effect, Mental illnesses create a cost to society and our urban areas so investing in design which helps to reduce or prevent these issues is worth doing from an economic standpoint as well as social health one.
Designing around Depression and Anxiety
Most of research into how Urban Design can affect health has thus far been related to physical health. The primary suggestions from this research are to increase the amount of Green Space in Urban Areas, promoting exercise and social activity whilst also improving air quality and phasing cars out of urban areas for similar reasons. These are strongly related to the ways in which Urban Design can benefit mental health. The Centre for Urban Design and Mental Health defines four key areas in which Urban Design can improve mental health under the umbrella title “Mind the GAPS“:
Green Space and access to nature: As well as linking to exercise, social space and air quality, green space is important to mental health according to a number of theories. Green space can help to relax the mind due to variety of natural aesthetics and interest. It can also facilitate the ‘need’ (according to Edward Wilson’s Biophilia theory) of human beings to be in contact with nature and other species.
Bute Park, Cardiff (source: http://bute-park.com)
Active Space for exercise: Exercise is often considered as helpful to mental well being as physical health. Over the past century city design has been increasing car-oriented with pedestrian spaces often hindered as a result. By creating spaces for dedicated exercise and also by pedestrianising parts of cities we can encourage more physical activity as part of dedicated and inherent physical exercise to help improve mental health.
Public Exercise Equipment, Beijing (source: http://spacing.ca/toronto)
Pro-social spaces to encourage positive social interaction: Not necessarily about creating dedicated social spaces, this aspect of design is more about encouraging activity on the street through the development smaller, walkable neighbourhoods, open public spaces and more interesting, human scaled streets. In this way indirect social activity can be encouraged making people feel less lonely and isolated. Direct social interaction can also be encouraged which can help to build self-confidence and empathy, again an important aspect of addressing mental health issues.
Stroget, Copenhagen (source: http://sourcethestation.com)
Safety in the city: A feeling of safety and security in a city is important to mental well being. Current design principles encourage security through street activity, natural surveillance, the clear demarcation of private and public separation and maintenance of the urban environment in order to make us feel safer without CCTV, high walls and barred windows (which incidentally can make us feel less safe rather than more). One element of this can be to encourage night time activity in cities in order to increase natural surveillance and activity at all times.
Newgate Street, Newcastle (source: https://newcastlecitycouncil.wordpress.com)
This design guidance comes from a combination of Centre for Urban Design and Mental Health and a lecture we received from our lecturer, Professor Tim Townshend, who specialises in the relationship between the Urban Environment and Health.
References and Links
World Health Organisation, Mental health: http://www.who.int/features/factfiles/mental_health/en/
NHS, Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014 http://digital.nhs.uk/catalogue/PUB21748
The current status of urban-rural differences in psychiatric disorders, Peen et al., 2009: http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2009.01438.x/full
Geographical variation in dementia: systematic review with meta-analysis, Russ et al., 2012: https://academic.oup.com/ije/article/41/4/1012/687680
Centre for Urban Design and Mental Health: https://www.urbandesignmentalhealth.com
Mind, Mental health facts and statistics: https://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems/#one
OECD, Focus on Mental Health: https://www.oecd.org/els/health-systems/Focus-on-Health-Making-Mental-Health-Count.pdf