We should think more about the link between urban design and mental health

Some spaces can be good for the psyche. Image: Layla McCay.

With an increasing majority of the global population living in cities, the question of urban public health is expanding far beyond its traditional practitioners.

Urban planners, designers and developers are increasingly being asked how their plans and projects actively improve people’s health and wellbeing. But when answering that question, many currently overlook the very category of urban health that they might most effectively impact: mental health.

Much of the focus at the nexus of health and design at the moment is on the physical health risks – most especially those associated with our often-sedentary lifestyle, which can contribute to non-communicable diseases (NCDs) like heart disease and diabetes. This often means designing built environments that nudge people to be more physically active. But opportunities for health promotion extend beyond physical activity: the World Health Organisation defines health as a state of physical, mental and social wellbeing.

Most of us will experience symptoms of mental health problems in our life, and one in every four of us will have a mental disorder. From stress and sadness to attention deficit-hyperactivity disorder (ADHD), depression, biopolar affective disorder, schizophrenia, addictions, and dementia – mental health problems can affect every part of our lives. They can diminish our enjoyment of life, our coping skills, and our relationships; they can reduce our education, employment, housing and economic opportunities, incur healthcare and social care costs, and prompt suicide.

In fact globally mental health disorders cause more disability than any other NCD. This is particularly true in cities, where our risk of having depression increases by 40 per cent, an anxiety disorder by 20 per cent, and the risk of schizophrenia doubles.

With the huge impact of mental disorders on people’s health and wellbeing, and the increased mental health risk of that comes simply from living in a city, you might think that mental health would be an urban health priority. In fact, few policies or recommendations for healthy urban environments address mental health in any depth.

If the low prioritisation of urban mental health isn’t due to lack of need, or lack of opportunity, what is the reason? It seems to me that there are three main barriers.

The first is stigma, which can be a powerful barrier to achieving mental health impact in a wide range of fields. It may be deterring people from becoming vocal advocates for mental health, and from addressing it properly in their work. People often feel embarrassed or ashamed about having mental health problems, and may worry that discussing this will make people judge them more negatively than they would physical health problems.


This anticipation and reaction associated with mental illness stigma doesn’t just impact people with mental illnesses: concern about stigma by affiliation can influence decisions made by anyone from potential advocates to researchers, journalists, funders of healthcare or research, and even urban planners, designers and developers. Advocates for mental health can be reticent, and wonder: “By prioritising mental health in my work, will people make stigmatising assumptions about own my mental health?”

Another barrier is that the failure to recognise mental health as a priority is a self-fulfilling prophecy. Currently urban planners, designers and developers focus more on physical health than mental health. They showcase their designs, win prizes, and talk at conferences – and in doing so, create an impression that physical health is the health area of most opportunity in their field.

Even if this is not the case, the zeitgeist is inspiring urban design innovation around physical health. Without a similar movement for mental health, we inevitably hear much less about mental health in urban design plans, policies and projects, delivering less inspiration and motivation around mental health, despite the need and opportunity.

The third barrier is that mental health disorders sound complex – so we need to clearly understand and articulate how to improve mental health through urban design. Mental disorders have a wide range of contributing factors, like genetics, early experiences, family relationships, and social settings.

But physical health disorders are often just as complicated, and we don’t shy away from them. Perhaps it is simply easier for urban planners, designers and developers to access clear practical recommendations that help translate physical health research into practical urban design actions. That happens less for mental health.

There are many opportunities to improve population mental health through urban design. We can create places where people feel safe and confident. We can reduce noise to improve sleep. We can develop neighbourhoods that promote social interaction and belonging, while delivering privacy and security. We can reduce stress associated with commuting. We can design daily encounters with nature.  And there are many more options currently being explored.

Clearly mental disorders constitute an urban health issue that needs to be addressed, and offer an exciting opportunity for innovation in urban design. But how to overcome the challenges in translating research into urban design projects that genuinely improve people’s mental health?

The Centre for Urban Design & Mental Health is a new think tank aiming to harness and translate academic research alongside the ideas and experience of urban planners, designers and developers to help all of us better understand how to design better mental health into our cities. It is time to move beyond stigma, to clarify the opportunities, and start designing for urban mental health.

Layla McCay is director of the Centre for Urban Design & Mental Health.

 
 
 
 

Here’s a fantasy metro network for Birmingham & the West Midlands

Birmingham New Street. Image: Getty.

Another reader writes in with their fantasy transport plans for their city. This week, we’re off to Birmingham…

I’ve read with interest CityMetric’s previous discussion on Birmingham’s poor commuter service frequency and desire for a “Crossrail” (here and here). So I thought I’d get involved, but from a different angle.

There’s a whole range of local issues to throw into the mix before getting the fantasy metro crayons out. Birmingham New Street is shooting up the passenger usage rankings, but sadly its performance isn’t, with nearly half of trains in the evening rush hour between 5pm and 8pm five minutes or more late or even cancelled. This makes connecting through New Street a hit and, mainly, miss affair, which anyone who values their commuting sanity will avoid completely. No wonder us Brummies drive everywhere.


There are seven local station reopening on the cards, which have been given a helping hand by a pro-rail mayor. But while these are super on their own, each one alone struggles to get enough traffic to justify a frequent service (which is key for commuters); or the wider investment needed elsewhere to free up more timetable slots, which is why the forgotten cousin of freight gets pushed even deeper into the night, in turn giving engineering work nowhere to go at all.

Suburban rail is the less exciting cousin of cross country rail. But at present there’s nobody to “mind the gap” between regional cross-country focussed rail strategy , and the bus/tram orientated planning of individual councils. (Incidentally, the next Midland Metro extension, from Wednesbury to Brierley Hill, is expected to cost £450m for just 11km of tram. Ouch.)

So given all that, I decided to go down a less glamorous angle than a Birmingham Crossrail, and design a Birmingham  & Black Country Overground. Like the London Overground, I’ve tried to join up what we’ve already got into a more coherent service and make a distinct “line” out of it.

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With our industrial heritage there are a selection of old alignments to run down, which would bring a suburban service right into the heart of the communities it needs to serve, rather than creating a whole string of “park & rides” on the periphery. Throw in another 24km of completely new line to close up the gaps and I’ve run a complete ring of railway all the way around Birmingham and the Black Country, joining up with HS2 & the airport for good measure – without too much carnage by the way of development to work around/through/over/under.

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While going around with a big circle on the outside, I found a smaller circle inside the city where the tracks already exist, and by re-creating a number of old stations I managed to get within 800m of two major hospitals. The route also runs right under the Birmingham Arena (formerly the NIA), fixing the stunning late 1980s planning error of building a 16,000 capacity arena right in the heart of a city centre, over the railway line, but without a station. (It does have two big car parks instead: lovely at 10pm when a concert kicks out, gridlocks really nicely.)

From that redraw the local network map and ended up with...

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Compare this with the current broadly hub-and-spoke network, and suddenly you’ve opened up a lot more local journey possibilities which you’d have otherwise have had to go through New Street to make. (Or, in reality, drive.) Yours for a mere snip at £3bn.

If you want to read more, there are detailed plans and discussion here (signup required).