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.