NO ONE ALONE
M EN TAL HE ALT H I N A N U R B A N D A N IS H C ON T E X T A N E W APPRO A C H AND ARCHITE CTURAL S T RAT E G I E S F O R ME NTAL HE ALT H T R E AT M E N T M alina I annon e ( 1 5 0 3 9 5 ) - 3 8 . 6 7 6 c h a r a c t e r s
Ma l i na I annone KADK - Ur banis m & S o c i e ta l C h a n g e 10 EC T S Wr it t en A s s i g n me n t Ti tl e: ' No O ne A lone -' A n e w a p p ro a c h a n d a rchi tectural strategies f or m ent a l h e a l th tre a tm e n t' Dece m ber 2019 Su per v is or s : Chri stine B jer k e Jo nna M ajgaar d K r a ru p
TABLE OF CONTENT Motivation
4
Abstract
6
Introduction
7-8
Theory
9-11
Method
12
Sick cities: urban sprawl and mental health
14-17
From institutionalization to privatization
18-21
Spatiality of psycological treatment
22-23
Casestudies
24-34
• •
Headspace, Denmark Experiment ‘Can the solution fo stress be found in nature?” by TV2Fyn
Observation
35
Healing architecture
36
Discussion: from invisible to visible
37
Conclusion
38
Bibliography
40-42
MOTIVATION I live in a city that is branded to be the “happiest”, most “liveable” place on earth, meanwhile my closest family and friends are suffering from one factor that is not included in those awards and calculations – their mental health. The physical environment and lifestyles we have in the cities seems to lead to lonely, stressed, anxious citizens. Today, half a million Danes are suffering from a mental health disorder and there are three times more youths with depression today than in year 2000 1. This is a very negative development, which we cannot ignore. A close family member of mine was treated with an eating disorder and anxiety as 13-year-old and was ‘cured’ and released from the hospital a few years ago. After this hard experience and getting back to ‘normal life’, she still has some mental issues but was not offered any psychological help. Then she was in a situation where she would have to either pay the average price of 1032 kr. for 45 minutes 2 for a psychologist without public grant – or deal with it herself. This is an example of how the lack of accessible mental health treatment leaves people to themselves with their mental illnesses, and how it creates an exclusive system for only the richest in society.
4
But I wonder why should it should cost money to get psychological treatment when it doesn’t cost to recieve physical treatment? I would also like to see more accessible and variated psychological treatment facilities. Places in the urban context that could function as a place for anyone and also create a community. New approaches that opens up for alternative and various treatments for everyone – rich or poor. I believe that a mentally healthier future is not only possible, but essential when talking about sustainability. Sustainability is not only about creating sustainability regarding energy, transportation, materials, waste etc. – our overall obligation is to create cities and communities that govern also sustainable lives. It is about human lives as well. Architecture is about creating a build environment that can create better lives and is a tool for handling societal changes. Societal challenges, such as increasing mental illness, become an architectural challenge as individuals are part of an eco-system, and the build environment a part of this too. There is a lot at stake as mental health is one of the key challenges of today’s rapidly urbanizing world. In Denmark, the mental health disorders are highest in the cities, and people with a mental disorder dies up to 10 years earlier 3 than an average Dane. As architects we can play an important role in discussing and ensuring a certain quality of the build environment and plan the cities to be more socially sustainable. This calls for a change, where architecture can play an important part in creating sustainable, ‘happy’ selves in liveable cities.
1 Health Sector of Denmark, The Health Data Service, Report, 06.02.2018. 2 Sundhed.dk, The Patient Manual, 3 DR, Article by Emilie Aagaard, 25. OKT. 2019, https://www.dr.dk/nyheder/viden/kroppen/psykisk-syge-i-danmark-doer-op-til-10-aar-tidligt
ABSTRACT
RESEARCH QUESTION
Finally, I will discuss the significance of the spatial qualities simultaneously with the role of the architect and the welfare state in relation to developing a future strategy for psychological treatment that could form openness and a better understanding about this increasing problem. Correspondingly I am proposing to include mental health statistics to The Happiness Index 8.
6
What is the spatial qualities and organization of the psycological treatment in Denmark, and whitch stuctural and social change is necessary to implement an alternative approach?
This paper aims to develop an understanding of the societal and spatial consequences of the growing number of Danes, especially young ones between 16-24 years old, with mental health issues. The mental health burden is a growing problem globally. Denmark had in 2010 the second place on the OECD list of countries with the highest use of anti-depressive medicine which had doubled in just a decade 4. Fortunately, today Denmark is number eight on the list, which reflects the lowest usage in ten years. At the same time a triple higher number of young Danes are dealing with depression, anxiety and stress since year 2000 5, and every fifth Dane deals with a mental illness at some point in their life 6. In contrast, Copenhagen is one of the most ‘Livable’ cities and Denmark is awarded the second place at the list of ‘The happiest Country in the World’ 7 - yet our mental health is not included in this calculation. This paradox is the starting point of my research. The paper begins by defining what mental health is in today’s society, to then analyzing the structural background and political aspect of the existing mental health care system. These two factors are then combined with exploring the extent of the impact architecture can have. Later I will investigate the spatial qualities of the existing treatment facilities in Denmark and compare it to the chosen case studies that exemplifies accessible, alternative non-governmental health treatment.
4 5 6 7 8
Zetland, Article by Kristine Dons Christiansen, 1.05.2018 Danish Patients, Article 'Antallet af unge med depression er tredoblet', last visited: 11.12.19. The Social Network - Psychically Vulnerable. Facts-page. Forbes Magazine, Article ' Ranked the 10 happiest countries in the world in 2019', 28.03.2019 World Happiness Index, Countryeconomy.
INTRODUCTION WHAT IS HEALTH? The question of what are the necessary conditions to guarantee well-being and happiness has been a topic of philosophical exploration throughout human history 9. How we define health changes constantly as our awareness, knowledge and society develops. The World Health Organization now defines health as;“not as the absence of ill-health but as a state of complete physical, mental and social well-being” 10 The definition of health has been changing due to cultural, economic and societal changes, and now includes "an awareness of the interrelationships between social and psychological, as well as medical, factors. The way in which an individual functions in society is seen as part of the definition of health, alongside biological and physiological symptoms. Health is no longer simply a question of access to medical treatment but it is determined by a range of factors related to the quality of our built environment 11”. In many years there have been mainly a focus on the physical health, but we see a change coming. With technological improvements, industrial and scientific development we see an overall a higher quality of life in Denmark. Our basic needs are fullfilled, and for that reason we focus more on the life itself and not survival. But are we really feeling any better? The answer might be no since the burden of psychological disorders are a growing globally.
7
A GLOBAL CRISIS IN A NATIONAL CONTEXT This paper focuses on this worrying global crisis seen in a national perspective, choosing Denmark as the context. Mental illness accounts for 25 percent of the disease burden in Denmark 12. The quantity of mental disorders have increased with more than 10% annually the recent years 13 and we experience children all the way down to 8 years suffering from mental disorders 14. In Denmark you are ‘lucky’ if you suffer from a pysical disorder rather than a psycological one, because the treatment hereof is free and much more accessible in contrast to psycological treatment.
9 Our Happy Life, page 31 10 World Health Organization: The determinants of health. 11 World Health Organization: The determinants of health. 12 Danish Nursing Council, Article ' Nu skal der gøres noget ved Danmarks største sygdomsbyrde ' 28.06.2018 . 13 Population survey of the Danish Psychotherapist Association through the research institute YouGov (2016) 14 Politiken - Debate, Interview by Rasmus Helmann, 'Drop Præstationsræset - send dit barn på en gåtur i skoven i stedet', printed 23.11.19
“What we measure affects what we do” 18
8
Stiglitz, Sen
This imbalance between physical and psychological treatment accessibility and the growing burden of mental illness is of the overall challenges in today’s society and architecture. More people die of suicide than terror and we are building terror protection all around Copenhagen but what about the mental health of our people? I will be using Marc Augé’s theory about ‘Non-places’ in addition to the theory by Michel Foucault about the Self. Seeing the individual as a result of its surroundings, I will be discussing the role of the architect and the role of the welfare state. If we are only physical and not mentally well taken care of, and people end up taking their own lives or dope themselves with anti-depressives, what does that then tell us about the ‘most liveable city in the world’ 15, Copenhagen? In the last decade, a staging number of lists of wellbeing indicators, happiness indexes, and psycho-physical well-being ranking, commissioned and produced by private institutions and governments alike have transformed the range of tools available to policymaking to plan and give shape to the city 16. All these have been introduced after the crisis in 2008, a moment when a new system of values seems necessary to face economic, and mostly ideological, crisis and when late-capital- ist societies need new way of measuring progress. These tools provoke a rethinking in our idea of how the state might take care of us 17. But when mental health is difficult to measure precisely and is not in- cluded in all of the measurements, we tend to over- see the need hereof when planning our cities, and as a result people with mental illnesses are excluded in society. As in reality they become invisible. Shame, isolation and becoming invisible seem to go hand in hand, creating ‘non-individuals’ hidden around in ‘non-places’ as powerless shadows. The research will ultimately be proposing to rethink mental health treatment in order to make it visible and hereby break the invisibility which is part of the stigmatization. This demands a space that can be both healing and preventing, which the case studies are examples of. Let us make Denmark ‘liveable’ - mentally as well.
15 CphPost, Article 'Copenhagen named the most liveable city for eropeans' 15.02.19. 16 Our Happy Life, page 30 17 Our Happy Life, page 31 18 Our Happy Life, page 32
THEORY Writing this paper I have chosen to include the theory of both a philosopher and an anthropologist. They represent to different oriented theories – the philosopher Michel Foucault’s theory is about the self, politics and power. On the other hand the anthropologist Marc Augé present the theory of Non-places, which is seen as a spatial byproduct of the supermodernity. I am using the theories to have a specific interpretation on the individual and the society, from which we have to challenge in order to handle the mental health crisis. I will use the theory to support the point of the self being a result of the surroundings and therefore it requires awareness from the city planners and architects as well as the politicians. We have to rethink the ‘truth’ about mental health disorders and break the stigmatization in relation to create a structural change. THEORY BY MICHEL FOUCAULT
9
“Do not demand that politics restore the rights of the individual as defined by philosophy. The individual is a product of power. What we need is a non-individualization through multiplication and displacement, various combinations. The group should not be an organic bond that unites hierarchical individuals, but a constant dynamo of de-individualization” 20 Foucault
Using the French philosopher Michel Foucault’s theory, I will be focusing on the self and power. When Foucault writes about the past, especially the period from 1650-1850, it is at the same time a con- temporary criticism because many ways of thinking from this period still characterizes our society today 19.Foucault is seeking to de-neutralize our cultural patterns of notions. So inspired by Foucault it is fundamental to create a new notion of what mental health is and the treatment hereof. By looking at the problem from an architectural perspective, his theory of the self as being a product of its surroundings draws attention to the architect. Foucault is proposing that individuals be asking “What am I?” and not “Who am I?” 21 and for that reason focusing on the local, concrete and material question as a historical product. In a situation where a growing number of Danes are suffering from mental illnesses they are excluded and the illness will according to Foucault be defined as insanity and alienation - a duality Foucault almost constantly focusses on.
19 Book, 'The empty human - introduction to Michel Foucault', page 8. 20 Book, 'The empty human - introduction to Michel Foucault', page 14. 21 Book, 'The empty human - introduction to Michel Foucault', page 17.
Power is a name that gives a complex strategic situation in a given society in his theory. Power is control of other people’s fields of opportunity – also the opportunity to get treatment. Foucault’s philosophical and political endeavor, is not about finding truths or replacing past mistakes with true alternatives. Foucault’s current diagnoses, on the other hand, seek to uncover the potential conditions of the prevailing truths, power attachment, real modes of action, and possible weak, vulnerable points. It is not about changing people’s consciousness or what they have in mind - but about changing the political, economic and institutional regime of truth production 22. He supports the idea of rethinking the existing elements of our society and strives to achieve a cognitive freedom, breathing spaces, for rethinking and ingenuity 23 NON-PLACES BY MARC AUGÉ Marc Augé is a French anthropologist, who presented the theory of Non-Places in his book of the title ‘Non-Places: An Introduction to an Anthropology of Supermodernity’. Augé coined the phrase ‘non-places’ to refer to anthropological spaces of transience Marc Augé that could not hold enough significance to be regarded as ‘places’ 24. For example a hotel room or a supermarket is a non-place. These are places that Augé think results in a profound alteration of awareness: something we perceive, but only in a partial an incoherent manner 25. The non-places are an example of societal and spatial bi-products of the modern society that we often experience as invisible due to the lack of identity, history and interaction with these.
10
“An ever-increasing proportion of our lives are spent in supermarkets, airports and hotels, on motorways or in front of TVs, computers and cash machines“ 26
22 Book 'Sindssygdom og psykologi', page 45. 23 ‘The empty human - Introduction to Michel Foucault‘, page 7 (Translated by author) 24 Non-Places: An Introduction to an Anthropology of Supermodernity, page 122 25 Publication by Carla Riu Dolz, Behance, last visited: 11.12.19 26 Non-Places: An Introduction to an Anthropology of Supermodernity (1995) by Marc Augé.
Chris Forsuth
Tata Tominaga
Sarah Peters
METHOD I have used qualitative and quantitative data to get an overview of the extend of the mental health crisis nationally in Denmark. Most of the quantitative data is from Denmark’s Health Care Department and studies made by the public sector. The qualitative data is a semi-structured interview, books, articles, and photographs from a site visit and from the internet. Faucault’s theory is used to determine a theoretical and philosophical view of the individual. ‘A pair of glasses’ through which I will be seeing the Self as a result of its surroundings and this cohesion leads to the discussion of the role of the architect. Another theory called ‘Non-places’ by Marc Augé is used to highlight the societal changes in modernity. A result hereof are some spatialities we did not predict and only experience in a fragmented manner. This is set in relation to how we perceive mental health issues - in the same partial and incoherent manner as Augé describes how the ‘non-places’. results in a profound alteration of awareness.
12
I chose to include two case studies in this paper to exemplify alternative mental health treatment. The first case is Headspace which is a non-governmental initiative led by volunteers. Headspace has 18 centers around Denmark, where young people from 18-24 27 can have a talk with one of the volunteers about his / her problems. Their slogan is ‘someone to talk to’ , and this slogan has proven to be very helpful for youths to connect to Headspace. The second case is a nature-therapy experiment produced as a serie of 4 episodes by TV2Fyn called ‘Is the solution for stress to be found in nature?’ 28. Besides the case studies, I will describe a field observation I did in Athens of the so called Metropolitan Community Clinic 29, which had a big impact on my view on health care. My discussion is about accessibility of physical vs. psychological treatment and how mental treatment could go from being invisible non-places to visible in order to break the invisibility of people with mental illness, which is a core part of the shaming and stigmatization.
27 Headspace webpage, 'about us', last visited: 11.12.19 28 TV2Fyn, Serie 'Is the Solution to stress to be found in nature?' (3 episodes), 19.12.2018, last visited: 11.12.19 29 Metropolitan Community Clinic, webpage.
SICK CITIES U R B A N S P R AW L A N D M E N TA L H E A LT H Urban life and mental health is a correlation that we must be deliberate about since more than 50 percent of the world’s population lives in urban areas and this proportion is projected to increase to 70 percent by 2050 according to UN projections 30. Despite many benefits of urbanization, studies show that the mental health of urban dwellers is negatively affected by their city environment, with greater prevalence of mental disorders. We need to be alert to possible links between urban sprawl and mental health as the build environment continues to evolve, and the mental health disorders continues to boom large in absolute and relative terms in Denmark’s national health profile. Evidence shows that mental health illness has been increasing in tandem with postwar growth of urban sprawl 31, which is proven to be the case in Denmark. The highest rates of mental health illnesses areto be found in the biggest cities 32 and therefore the amount of psychologists are also highest represented there.
14
So why is it that the larger the settlement you live in, the more likely you are to become mentally ill?
Psycologists in Denmark
Source: Danish Association of psycologists, edited by author.
30 Article, 'Sick cities: why urban living can be bad for your mental health' by Leo Benedictus, The Guardian, 25.02.19 31 Book, Urban Sprawl and Mental Health 32 The Psyciatri Fund, webpage.
WHO?
Men vs. Women 10,9%
1 out of 3 danes
suffer from a mental disorder during their life Source: Bedre Psykiatri
Men
Women
Psycological disorderes distributed by sex and most frequent age
15,5% 25-34
16-24
16-24
25-34
35-44
35-44
Women
Men
Source: Bedre Psykiatri
Source: Bedre Psykiatri
WHERE? 26-30% 21-25%
The proportion of Danes sufferign from psycological disorderes distributed by geography
11-20% 6-10%
Diseases in Denmark
Psycological disorders 25% Other diseases Cancer 17% Circulatory 15%
Source: Ritzau
Source: Bedre Psykiatri
FOR WHAT? Psychiatrists per 100.000 people
40%
13
Reasons for going to a psycologist
%
50
25% 18%
11%
15
10
9.5
(2014)
25
26%
20
0 25 https://www.theguardian.com/cities/2014/feb/25/city-stress-mental-health-rural-kind Japan USA Personal income Sorrow or a Depression or Anxiety Stress sadness
traumatic experience
Source: Foreningen for psykologer
Russia
Denmark
China Country
Vietnam
Philippines
India
Source: World Health Organisation
Islands Brygge Havnebad, edited by author
16
The uniform perception of the “happy” life in the city is an unsustainable urban model that we as architects should challenge since 35 to 40 percent of health is determined by one’s physical environment, including public access to green spaces and outdoor recreation 33. Planning has shaped the city as a network interconnected public spaces offering qualities of experiences. The importance of public space is based on the function of creating room for interaction with others, seeing strangers and informal conversations which all are essential factors for humans well-being. Understanding of the 'meaning of public spaces' in this approach requires looking for relations between the urban structures and the culture of usage of space. There are three main issues, which should be considered with regard to this: physical features, including distribution, shape and size of forms defining the space, distribution and behavior of users 33. A key factor in the relation between public space and mental health is safety. Places where you feel welcome and can be who you are; free but still protected.
33 Article, 'The secret to good health may be a walk in the park', by Jane E. Brody, The Newyork Times, 03.12.18. 34 'The meaning of Public Space' by H. Hanzl
The Black Square, Nørrebro, Copenhagen Source: The book 'Critical City ', edited by author.
�If architecture is not just built matter, but the embodiment of values, ideologies and affects, then the production of images has to be understood as a substantial aspect of the production of architecture in its real form.� 36
17
Pier Vittorio Aureli
The so called 'Black Square' in Copenhagen is an example of how a sanitation of an earlier socially challenged and criminal area. Safety had to be established in terms of making it an attractive public space. Furthermore it is representing how architecture can help ensuring a socially connecting Den- mark. We are moving closer and closer together in the metropolitan area and other major cities, while several smaller cities and rural areas are experiencing relocation. Here lies a major task for architects, landscape architects and planners in ensuring quality in this development, just as architecture can counteract the tendencies of ghettoization by creating an inspiring and sensual framework for the common life 35.Architecture can help us to develop as human beings. Nevertheless we as architects cannot solve this problem alone, one must even so consider which contribution the field of architecture can give. Architects can think on a national level, see structures and connections, see things in an eye level and has understanding of scale and structures which eventually could be an consistently significant capacity. An ideological vacuum arose when architects and urbanists stopped producing manifestos and urbanist utopias in 1980s. At the same time, one of the modern movements most potent ways of linking beauty with morality, idealism and social change was lost. How can we as architects save the 21st centuries architecture from being about speculation, to ensuring a mentally liveable country?
35 'Arkitekturpolitik - Mennesker i centrum', The Danish Government, february 2014. 36 Manet: Images for a World Without People by Pier Vittorio Aureli
FROM
I N S T I T U T I O N A L I Z AT I O N T O P R I VAT I Z AT I O N The treatment of mental health has developed over time due to the changing perception and definition of mental illness over time.
18
In stone age an evil spirit was seen as the course of mental illness, and 'removed' with a cut out in the sculpt. Later on more relaxing treatments was introduced. A so called ‘House of the Mad’ 37 was the term for houses which in the middle ages were arranged as a repository in various places in Europe to house the mentally ill. In Denmark there were no such houses around that time, but instead mentally ill people were housed around the hospitals. The first psychiatric hospital was Sankt Hans from 1816 38 which had a healing approach to treatment. Later on, an awareness of nature´s effect on health occurred in the 19th century. Examples here of are sanatoriums, that opened around Europe, and in the beginning they were only treating the physical illnesses mostly tuberculosis. Most of the sanatoriums were built in the mountain areas, because doctors believed that the clean fresh air had a positive effect on respiratory genes. The sanatoriums were furnished with large sun decks where patients laid in beds or sun loungers and enjoyed the sun and the fresh air overlooking the mountains. Most European sanatoriums were located in the Swiss Alps, but a number of sanatoriums were also erected in isolated forest areas in Finland 39. In Denmark Skodsborg Bathing Sanatorium 40 opened in 1898 which was oriented towards nature and water treatment.
37 38 39 40
Det Etiske Råd, publication 'The Society and the mad - power and powerlessness in the Psyciatry', 2012. https://docplayer.dk/19331663-Psykiatriens-historie-i-danmark.html, ’Psykiatriens historie’ Diploma project programme, 'SET' at KADK, 'Center for mental wellness' by Michel Enghoff Hansen. Universitypress, description of the book 'Skodsborg Badesanatorium'
Paimio Senatorium by Alvar Aalto, Finland,
Nacadia, Hørsholm, Denmark
Skodsborg Badesanatorium, Skodsborg, Denmark
400 years b.c.
The Greeks believed that mental disorders were due to erroneous composition of the body's fluids . This was called humoral pathology. The treatment of insanity was rationally conditioned. As a relief, hot baths, herbs, rubbing under the feet and tailored shock effects were used.
Mideavel age
According to the church, the world was divided in battle between God and the Devil. It was believed that the insane was possessed by an evil spirit and the treatment consisted of exorcism. The concept of ‘mad houses’ arouse as a place primarily for dangerous insanity.
1789
During the Great French Revolution it came to an end with the old hospital system, where the poor and sick had hitherto been merged. The idea of creating institutions where the insane could be treated on a scientific basis and in a social-moral manner.
1816
The first psychiatric hospital based on healing was established in Denmark. It was Sct. Hans Hospital in Copenhagen
1900
The German psychiatrist Emil Kraepelin was the man made the division of the mental diseases into two: the exogenous diagnoses and the endogenous psychoses. The first were consequences of something external. The endogenous diagnoses, covered something that came from within, independent of the external influences.
1938
Denmark got its first law about insanity, which was to secure the patients' legal position towards the doctors.
1950s
Great improvements in the field of psychopharmaceuticals (medicines used in physical / biological treatment of the mentally ill). One of the great inventions revolutionized psychiatry was antidepressants.
1956
The first position opened for a psycologist in Denmark
1971
The year the ‘Happiness-pill’ was invented. The usage of the pill began to dramaticly increase from 1988-2006 in Denmark.
2019
First trial period of free psycological treatment for youths in Denmark for18-24 years olds.
21
With time they found out that the sanatoriums also had a beneficial effect on patients with psychological disorders. Back then they were called ‘hysterical’ and could now spent several months in the mountains and then afterwards return to their everyday life. Simultaneously as this development, a great progress in psycopharma in 1950s meant introducing of the anti-depressive medicine 40 which Danes today are the world 8th most frequent users of 41. The institutionalization of the treatment went up until the 1970’s. An important person in the transition into de-institutionalization was the Italian psychiatric Franco Basaglia, who worked towards democratizing the psychiatry and social inclusion from the 1960s until the 1980s 42. His ideas spread towards other countries and resulted as a structural change of the psychological treatment in Denmark. The de-institutionalization converted mainly into privatization of psychological treatment apart from psychiatric treatment which today still is institutionalized. Overall going from institutionalization to privatizing psychological treatment meant going from medical and physical treatment to a mental treatment. In addition it led to psychological treatment being split out into society as we see it in today's Denmark. According to Foucault "the de-institutionalization men that the mad were freed from the immediate chains just to be imprisoned in a far more effective cage: their own individual but institutionally promoted spins of guilt and humiliation - simultaneously the change of societal values due to capitalism, creates further pressure on the human being as it is focusing on the productive, value increase, and accumulation" 43.
40 Danish Psycologist Assotion, timeline. 41 https://www.zetland.dk/historie/sO0ERMWw-a8DEYJ9z-edde1 42 US National Library of Medicine National Institutes of Health, Photography and radical psychiatry in Italy in the 1960s. The case of thephotobook Morire di Classe (1969) 43 'The empty human - Introduction to Michel Foucault', page 102 (Translated by author)
SPATI AL I T Y O F PSY CH O L O G I C A L TR E AT M E N T
22
Going from institutionalization to privatization meant that treatment facilities moved to private places. Psychiatry is still institutionalized and a part of the public health sector. There are only a few psychotherapeutic centers 44 that are governmental around the bigger cities like Copenhagen and most psychological treatment is private and some with support from the government. A great change in spatial qualities presented itself as a consequence of this privatization. Most of the offices are implemented into existing buildings resulting in a decentralized structure. The required spatial qualities needed changes from being larger spaces into smaller rooms oriented towards a 1:1 conversation which is the exclusive form of psychological treatment in Denmark. Feeling safe and comfortable has become an important criteria when meeting a psychologist. The aim is to create an intimate atmosphere, gathered around a seating area from where personal and intimate talks can be out folded. The whole setting is confidential, what happens behind the closed doors is invisible and hidden from the “public� eye.
44 Psyciatry, Region Hovedstaden. Overview of the Centers in Copenhagen.
A typical psycologist's office Source: Kognitiv Terapi KBH
A very positive
Positive
1% 16%
46%
Negative or very negative
$ Average treatment cost for a patient M
DE
2.250 kr
65%
AN D
Danes who dosen’t feel they know enough about mental health
SOCIETAL PROGRESS 75%
R
O
Average waitingtime, psycologist
Danes who think it is more socially acceptable to suffer from a psysical disorder rather than a mental one.
N
O
SA TI
I
AN
G
10 weeks
Table 1 - Reseach by Bedre Psykiatr, Edited by author
“It is not about changing people's consciousness or what they have in mind - but about changing the political, economic and institutional regime of truth production” 45.
23
Foucault
45 46 47 48
PERCEPTION OF THE TREATMENT The cost of the psycological treatment creates an exclusive system and the long waiting time makes it insufficient. The need for alternatives can be indicated by looking at the expand of non-governmental alternative treatments such as the therapygarden Nacadia by Realdania 46. When projects like these are fonded privately, they end up being a few and often temporary. That leeds us to think about the role of the welfare state and the lack of actions to meet the increased demand. The necessity exists. The preception of mental health treatmens is by almost half of the Danes 'negative or very negative' 47 .Have in mind that one out of ten Dane is suffering from a mental disorder which means that probably one in an average family. That is worrying. In addition to this a recent survey shows that 3/4 Danes believe it is more socially acceptable to suffer from a physical than a mental illness 48. However to create more accessible psycological treatment, there is a need for a structural change in addition to breaking the stigmatization.
'The empty humanbeing - An introduction to Michel Foucault', page 44 Realdania - Project 'Nacadia' Measurement by Capacent Epinion for Better Psyciatry. Measurement by Capacent Epinion for Better Psyciatry.
24
CASE STUDIES
In reaction to the lack of accessible treatment and the ‘very negative or negative impression of the treatment of the mentally ill’ non-governmental alternatives has occurred. I have chosen to focus on to examples hereof, that represents accessible treatments organized by volunteers.
CASE 01: HEADSPACE The first case study is the non-governmental initiative Headspace, which is the initiative with most users and is mostly wide- spread throughout Denmark.
CASE 02:
NATURE-THERAPY EXPERIMENT
25
The experiment by TV2Fyn is representing also a non-governmental nature treatment. An alternative approach to psychological treatment. The result is remarkable.
26
CASE 01
HEADSPACE
DEN
MARK
Source: Headspace
Headspace is an example of an alternative and preventive mental health treatment. An initiative which started in 2013 in recognition on the fact that there were no institutions or entities that gives early and preventive psychological treatment to youths, who are in serious risk of being ill if no help offered. Today Headspaces are has in total and 450 volunteers and 18 centers. Every young from 12-25 years can use the centers. 68% of the users are girls/ women and 32% are boys/men, and the average age is 18,5 years. Rambøll has made an evaluation of Headspace, and it shows that it costs around 370.000 kr. to establish a Headspace center 50. It is primarily the municipality and government funds that secure the operation of the centers along with using volunteers as the contact person and listener, and it has not been proved yet if it is a economical gain or cost for the society yet. But what has been proved is, that every third visitor feels less lonely or sad after talking to a volunteer from Headspace a couple of times 51.
49 Headspace, webpage 50 Publication 'Evaluation of Headspace' by Rambøll for the Health and Elderly Minestry of Denmark, july 2019. 51 Publication 'Evaluation of Headspace' by Rambøll for the Health and Elderly Minestry of Denmark, july 2019.
Aalborg
Herning
Hensingør
Aarhus Horsens
Billund
Roskilde
Fredericia
8
København
Odense
Esbjerg
Aabenraa
28
Headspaces, Denmark
The interesting thing about Headspace seen from an architect's point of view, is the spatial environment at the facilities. The Headspace Centers are located inside existing buildings mostly with a small sign outside showing the logo of Headspace. Inside the headspace facility it is a warm atmosphere and decorated as if it was a living room so the youths can get a feeling of a safe and comfortable atmosphere. As a Headspace user described: "feeling like when you are coming home to your own apartment" 52.
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The rooms are oriented towards an informal conversation. Due to the fact that the person you talk to is a volunteer with no required experience with psychology, the role of the volunteer is to be a listener. In a time where both parents are working fulltime, and the youth feel a growing pressure, this is a popular and helpful place for many. It is an example of free preventive treatment for the youth, and one could imagine that a future with a growing mental health crisis would create a demand a such place for the rest of the Danish population as well.
52 Publication 'Evaluation of Headspace' by Rambøll for the Health and Elderly Minestry of Denmark, July 2019.
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CASE 02
NATURE
EXPERI
MENT
Source: TV2 Fyn
The nature-treatment experiment 'Can the solution for stress be found in nature?' was led by two Danish researchers and motivated by a concern for youths in region South-Denmark, where 40% feels stressed. It is filmed by TV2Syd in tree episodes, in which the audience follows four adolescents through the nature-treatment. Simon Højmark is one of the researchers, and is also a nature advisor. His aim is to use the nature to in four days help these four adolescents who all are suffering from mental stress, by taking them away from their everyday life, turn of their telephones and do mental exercises with them. This is an example of alternative psychological treatment that is not oriented around the conversation with a psychologist but instead contact with nature. After the four days, all of the four adolescents feel that their level of stress is lower after the experiment and is in better contact with themselves.
53 TV2 Fyn Experiment, Serie (episode 1) , 19.12.2018
“I need to get away from everything” Participant in the experiment Signe Marie Skovsted, 19 years
Nature is by this experiment proven to be very efficient in relation to psychological treatment. In Sweden, it has been possible to get nature on prescription as a remedy for stress since 2006 54. The prescription is visiting one of seven different farms surrounded by beautiful nature. Results from Swedish research show that patients' connection to health care falls by 26 percent after natural therapy. After traditional treatment, the figure is 8 percent 55. Comparing Headspace to the nature-therapy experiment (case 02), the nature is not incorporated in any aspects of the treatment where it is the main element in the treatment in the experiment.
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One thing is in common when comparing the architectural aspects in the two cases; it is about making people feel safe, included an part of its surroundings, and here surroundings has a great significance. Simon Højmark describes it as "where we think is beautiful, makes us feel safe" 56. This is why the architect's role has a great importance when creating treatment facilities in the future as the architectural effect on patients is also indirect, but significant. It welcomes and nurtures them with its friendly atmosphere, and it gives dignity and presence to their situation and mental needs 57. Finally natures beauty reminds people of beauty in life, which may have disappeared for a while in their personal lives, but it is still ever present.
54 55 56 57
POV International, 'Natur på recept mod stress – mens vi venter' by Birgitte Sølvstein, Featured in Liv & Mennesker, 1.6.2017 TV2 Fyn Experiment, Serie , 19.12.2018 TV2 Fyn Experiment, Serie, 19.12.2018 ‘Can Architecture Affect Your Health?” (Page 36)
These 3 exercises are examples of how to destress useing nature as the main element. Semi-individual orientation
QUIET WALK THROUGH NATURE
UGH
Individual senseing exercise
LYING AND SENSEING
NG
Group oriented exercise
A CIRCLE AROUND THE BONFIRE
THE
Graphic by author
Pictures from episode 1-3 of 'Can the solution to stress be found in nature' by TV2Fyn
The case studies clarify the potentials of alternative treatment combining structure and spatiality. These examples can be seen as inspiration for creating differentiated types of treatment and understanding the interplay between humans and its surroundings. There are no accessible and visible space for the psycological ill (besides Headspace for the youths) at the moment. One could imagine that potentially the Non-places could change character and become a place. Now these places are everyone's and no ones and dosen't have a function or identity. At the same time the psycological ill don't even have a non-place to go. After all, there were sanatoriums back in the 19th century whitch were well-considered design for mental treatment. However they are closed down now or transformed into luxurious spas. So one is left to ask; where are those places today in these 'liveable' city of ours? Nowhere. What is left is an unvisible psychologists office.
Non-places
Visability
‘Semi-places’
Visible
Invisible
Not excisting
Hospitals
Psycologist
Supermarkets, highways, ‘left-over ’spaces
Accessibility
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Real places
Facilities
Places
The mentally ill only have a free place to get help if it is a serious or acute matter. This are the psychiatric hospitals, but otherwise there is no place to seek help unless they are able to pay for a psycologist. There excists no middle ground.
Open for everyone
Excluding payment scheme
For everyone and no one. we are all passing through.
METROPOLITAN COMMUNITY CLINIC ATHENS, GREECE
USERS: EVERYONE USAGE: AMBULATORIE, FARMACY, PSYCOLOGIST, DENTIST AND HEALTH CLINIC
A recent studytrip brought me to Athens, where I visited the Metropolitan Community Clinic in Elliniko . It is located in what looks like a one-floor house, with a parking lot outside and no greenery. It is clear that the ressourses are limited. The spaces are quite simple and looking from the outside it is not a warm environment. But actually, it is. This place made a great impression on me, by being a unique facility, where all kind of health care is for free and accessible for everyone. It was opened right after the economic crisis in 2008 due to a incresing number of Greeks not being able to finance their medical treatment. Another effect the crisis brougt, was a greater number of people in need of psycological help. This place have helped now 71.000 Greeks, driven by donations from around Europe and volunteers. There is no else clinic like this in Europe. It is an observation that showes how non-governmental initiatives can be nessecary in times of crisis and especially how mental health treatment can be free for everyone.
Psycologist's office
NURSE
PSYCOLOGIST
WELCOME DISK
OBSERVATION
Eventhough I am aware that this example is taked out of a different context, it shows how the values are the ones who determines the actions. Even in Greece, at their most criitical point after the economic crisis in 2008, a group created this highly valuable possiblity to get help
FARMACY
DOCTOR STORAGE DOCTOR
DENTIST
Diagram - Plandiagramme
$
Donations Funds Vulenteers
HEALING ARCHITECTURE ‘Revolution can be avoided by good architecture.’
36
Le Coubusier
Emotional capitalism, the experience economy, and the philosophy of wellbeing might be swallowing up a certain idea of architecture, landscape and the city. In this context 58, it is crucial that architects are aware of the importance of the aesthetical qualities when creating a mental sustainable future for Denmark as one Self is a product of its surroundings1. In this relation nature could play an important role when doing so. When we have parks and open spaces, then the non-self becomes visible - and we have a city where we can be seen – and see others – and thereby reconnect as human beings and not only as resources stored away in functional buildings where we are to eat and sleep, so we are well rested resources ready to produce and consume more. Proven in the nature-therapy experiment by TV2Fyn nature has a positive and rapid effect on an unclear, restless mind. Our lives are becoming more and more high tech, which need us to balance this with high touch 59. High touch means the opportunity to rest and re-connect to one self and others that comforts and protects us remembering that we are parts and interconnected. Hyper-comfort in society has not created comfort for the mind. More likely it has supported a hyper-efficient lifestyle where the individ- ual is seen as a production resource, but not necessarily as a human resource, with experiences and emotions effecting its mental state. Changing this requires that we stop listening to today's many experts who describe us to 'the good life' through their 'objective scientific studies' that show us that humans do such and such 60. Below the surface of the scientific varnish, we behave in the reverse order. Our values color the science of ourselves. Nine out of 10 Danes say, that they would like the state and municipalities to a greater extent involve civil society organizations to solve social problems such as loneliness 61. If this is to be the case, mental health has to become a visible part of the city planning and part of the debate about urban develop ment. Designing a city for everyone – not only the healthy ones.
58 Critical City by Kristoffer Weiss 59 Futurist Anne Skare Nielsen 60 Kronik 'Psykiatrien skriger på et nyt menneskesyn', Information, 12.06.2016 61 Frivilligrådet, Article 'Hvem skal hjælpe danskerne ud af ensomhed?', 20.03.2019.
DISCUSSION
FROM INVISIBLE TO VISIBLE
37
"The biggest danger is to pretend not to see what is happening; only the invention and practice of new democracy of the world citizens will protect us from devastation. We need democracy which can stand up to the monster which presents itself” Negri 2012 64
62 63 64 65
The discussion about mental health is a part of a greater societal discussion beyond function and aesthetics. It is crucial to reflect on how we treat disorders as it reflects in our perception of it. The fact that physical and not psychological treatment is free results in 3 out of 4 Danes thinking that it is socially more acceptable to suffer from a physical rather than a mental disorder 62. In addition the treatment is not being visible but rather hidden away in society today. To change this, a structural change is needed. Here it comes down to which role we demand the welfare state to have However one might argue that it is a private sensitive matter having a physical disorders so therefore it becomes a 'quiet' topic. However it is slowly beginning to be brought to attention. The Danish Association of Psychiatrics has collected 42.000 signatures for improving psychological treatment in Denmark and delivered them to the parliament in Denmark in November 2019 63. Urban planners should consider new opportunities aimed at the improvement of population’s mental health, putting research into action through policies, plans, design and development actions. Debating the right to space and how the city can produceequality public spaces can play a significant role. As architects we can effect but not change the treatment by ourselves. We can contribute by possessing an understanding of scales, structures and spatial qualities. In creating a 'liveable' city, both city planners and architect must consider who the city is liveable for 65 - clearly not all when mental health is not included in those measurements. Let us stop praising those awards that doesn’t include mental health meaning a third of all Danes and instead look at how a country like Denmark with a strong welfare state could create a healthier and mentally sustainable future.
Reseach by Bedre Psykiatri Psykiatrifonden. https://www.psykiatrifonden.dk/nyheder/2019/underskrifter-afleveret-paa-christiansborg.aspx Fear and Space page 38 Citical city by Kristoffer Weiss, page 17
To change this view on mental illnesses, Foucault’s theory is arguing that “it is not about changing people's consciousness - or what they have in mind - but about changing the political, economic and institutional regime of truth production” 66. The negative perception of mental treatments can be seen as result of also the prioritization in the health care system. Therefore it is a structural change and a change of the political, economic and institutional regime of the truth production behind mental health . For creating a societal progress in order to establish a structural change, different parameters becomes essential. The stronger the specific parameters are, the more powerful it becomes. However with no supply or enough attention while there excists a high demand, the significance of the societal progress becomes weak.
N
Y
M
O
N W W elfa ea re lth
O
EC
T
s ice rv r Se bou La
Y PL ES P C U S UR
SO
G
R
R
ES
T 66 'The empty Humanbeing - An Introduction to Michel Foucault' , page 45
O
Time
T
AN IS
Network
P
Technology
O A L T I TI IO C N S
s
38
D
E
SOCIETAL PROGRESS N Va ego lue tiat s ion
T
PL
AN
O
M
PE
n tio ita cil rol Fa ont C
AL V E
T
DE
O
TI UA
Social development circle Source: Fear & Space, edited by author
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CONCLUSION In one of the worlds so called 'happiest countries', 1 out of 3 Danes suffer from a mental disorder during their lifetime 66. This paper has been exploring the spatial qualities and organization of the psychological treatment in Denmark. The aim is to create an alternative approach and understanding of the definition of liveable cities including mental health as an important factor. Today psychological treatment is privatized hereby reflecting lower societal priority compared to physical treatment. In addition treatment is inaccessible for many people due to the high prize and long waiting lists. Headspace is an example of a non-governmental free alternative to preventive mental health care for the youth. But there are still no initiative that is for everyone meaning that most Danes are left alone with their mental disorder. An increasing number of different people of all ages are suffering and with different needs. Needs a society like ours should consider and accommodate. With a growing number of mental illnesses in Denmark 67, there must be an endeavor to create a better functioning mental health treatment with a better balance between physical and psychological treatment. For this a structural change is needed which would generate an improvement in perception, knowledge, understanding and acceptance of mental health. The main treatment form today is medical treatment and 1:1 conversation with a professional psychologist. This results in undiversified spatialities which are centered around a private conversation behind closed doors. An invisible conversation with invisible Selves searching in the mysterious shadows of the mind. By going from invisible to visible, the architect´s role becomes important as the physical environment is important for peoples well-being and the individual is seen as a part and a result of its surroundings. A future alternative treatment must be accessible for everyone and more differentiated, in which nature treatment should be considered as it has proven to be very effective – and for free. How unsustainable should our “happy” societies become before this dimension and these lives become visible? We should not ignore it any longer 68 – let us leave no one alone in the land of non-spaces.
66 Bedre Psykiatri, Fakta. 67 Health Data Department, Report 06.02.2018 https://sundhedsdatastyrelsen.dk/da/nyheder/2018/psykiske-lidelser-boern_unge_06012018 68 DSR, 'Nu skal der gøre noget ved Danmarks største sygdomsbyrde' af Michael Bech, 28.06.2018 , https://dsr.dk/politik-og-nyheder/nyhed/ nu-skal-der-goeres-noget-ved-danmarks-stoerste-sygdomsbyrde
BIBLIOGRAPHY BOOKS • “Can Architecture Affect Your Health?”, Charles Jaencks. ArtEZ Press, 2012. • "Critical City - The success and failure of the Danish welfare city", Kristiffer Lindhardt Weiss, The Danish Architectural Press, 2019. • “Urban Sprawl and Public Health - Designing, Planning and building for health Communities”, Howard Frumkin, Lawrence Frank, Richard Jackson. Island Press, 2004. • “Our Happy Life - Architecture and Well-Being in the Age of Emotional Capitalism”, Francesco Garutti, Sternberg Press, 2019. • "Fear & Space - The view of young designers in the Netherlands", Contributions: Benjamin Barber, Joshua Karant, Moritz Küng, Bert de Muynk, Mark Pimlott, Jacob Voorthuis, edited by Urban Affairs, Nai Publisher, 2004 • "Det tomme menneske - Introduktion the Michel Foucault" , Dag Heede, Museum Tusculanums Forlag, 2000. • "Non-Places: An Introduction to Anthropology of Supermodernity", Marc Augé, Le Seuil, 1992.
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ARTICLES • POV International, 'Natur på recept mod stress - mens vi venter' by Birgitte Sølvstein, 1.6.17, https://pov.international/natur-pa-recept-mod-stressmens-vi-venter/ • CphPost, 'Copenhagen named the most liveable city for Europeans', 15.2.19, http://cphpost.dk/news/copenhagen-named-most-liveable-city-for-europeans.html, • Medical Daily, 'Park and greenery tied to improve mental health', 6.1.14, https://www.medicaldaily.com/parks-and-greenery-tied-improved-mentalhealth-city-dwellers-266475 • Dezeen, 'Cameron Clarke, Close to Home , Mental health Beijing Architecture, https://www.dezeen.com/2019/09/04/cameron-clarke-close-to-homemental-health-beijing-architecture/ • Frivilligrådet, 'Ny undersøgelse - hvem skal hjælpe danskerne ud af ensomhed', https://www.frivilligraadet.dk/nyheder/2019/3/19/ny-undersgelse-hvemskal-hjlpe-danskerne-ud-af-ensomhed • 'The secret to good health may be a walk in the park', by Jane E. Brody, The Newyork Times, 03.12.18, nytimes.com/2018/12/03/well/move/the-secret-togood-health-may-be-a-walk-in-the-park.html. • Zetland, 'Engang var danskerne nogle af klodens største forbrugere af lykkepiller. Det er ved at ændre sig. Hvorfor?' , 1.5.18. https://www.zetland.dk/ historie/sO0ERMWw-a8DEYJ9z-edde1 • Danske Patienter, 'Antallet af unge med depression er tredoblet', https:// danskepatienter.dk/politik/temaer/unge-med-sygdom/antallet-af-unge-meddepression-er-tredoblet • Forbes Magazine, 'Ranked the 10 happiest countries in the world in 2019', 28.03.2019, https://www.forbes.com/sites/duncanmadden/2019/03/28/ ranked-the-10-happiest-countries-in-the-world-in-2019/#6886028348a5, • DSR, 'Nu skal der gøres noget ved Danmarks største sygdomsbyrde', https://dsr.dk/politik-og-nyheder/nyhed/nu-skal-der-goeres-noget-ved-danmarks-stoerste-sygdomsbyrde, 28.06.18, • Tv2Fyn, 'Findes løsningen på stress i naturen?', https://www.tv2fyn.dk/ artikel/findes-loesningen-paa-stress-i-naturen, latest visited • The Guardian, 'Stress mental health rural kind', https://www.theguardian. com/cities/2014/feb/25/city-stress-mental-health-rural-kind, 25.02.19, • Berlingske Tidende, 'Hvorfor koster psykologhjælp penge når behandliger af fysiske lidelser er gratis?' https://www.berlingske.dk/kommentarer/hvorfor-koster-psykologhjaelp-penge-naar-behandling-af-fysiske • Videnskab.dk , 'Derfor bliver unge stressede' , https://videnskab.dk/kultur-samfund/derfor-bliver-flere-unge-stressede latest visited: 11.12.19
• • • •
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WEBPAGES • CountryEcnonomy, Demography, https://countryeconomy.com/demography/, latest visited: 11.12.19 • World Health Organization, https://www.who.int/hia/evidence/doh/en/, latest visited: 11.12.19 • Psykiatrifonden, Viden - Fakta. https://www.psykiatrifonden.dk/viden/fakta. aspx, latest visited: 11.12.19 • Information, Stress, https://www.information.dk/emne/stress, latest visited 10.12.19 • Angstforeninger, Angst hos børn og unge, https://www.angstforeningen.dk/ index.php?page=angst-hos-born-og-unge, last visited:10.12.19 • Homepage for the futurist Anne Skare Nielsen, https://universalfuturist.com/ da/anne-skare-nielsen/, last visited: 11.12.19 • Information, Kronik, ' Psykiatrien skriger på et nyt menneskesyn', 12.6.16, https://www.information.dk/debat/2016/07/psykiatrien-skriger-paa-nyt-menneskesyn, last visited: 11.12.19 • Frivilligrådet, 'Ny undersøgelse - hvem skal hjælpe danskerne ud af ensomhed?', 20.3.19, https://www.frivilligraadet.dk/nyheder/2019/3/19/ny-undersgelse-hvem-skal-hjlpe-danskerne-ud-af-ensomhed, last visited: 11.12.19 • Region Hovedstaden, Psykiatri, Centre og sociale tilbud, https://www.psykiatri-regionh.dk/centre-og-social-tilbud/Psykiatriske-centre/Psykiatrisk-Center-Koebenhavn/Sider/default.aspx, last visited: 11.12.19 • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361699/ - US National Library of Medicine • National Institutes of Health • Danish Psycologist Association, Timeline, https://www.dp.dk/om-dp/ dansk-psykolog-forening-70-aar/#tidslinje, last visited: 11.12.19 • Realdania, Projects, Nacadia therapy-garden, https://realdania.dk/projekter/ terapihave-i-arboretet, last visited: 11.12.19 • University Press of Southern Denmark, book discription, http://www.universitypress.dk/shop/skodsborg-badesanatorium-3669p.html, last visited: 11.12.19 • Behance, Webgallery, 'From places to Non-places', https://www.behance. net/gallery/48599663/From-Places-to-Non-Place, last visited: 10.12.19 • Homepage, Headspace Denmark, https://www.headspace.dk/om-headspace, last visited : 10.12.19 • Homepage for Metropolitan Community Clinic, http://www.mkiellinikou.org/ en/, last visited: 10.12.19 • The Patient Manual, https://www.sundhed.dk/borger/patienthaandbogen/sociale-ydelser/sociale-ydelser/behandling/psykologbehandling/ , last visited: 10.12.19
DOCUMENTS • Det Etiske Råd, 'Samfundet og de gale', 2012, http://www.etiskraad.dk/~/ media/Etisk-Raad/Etiske-Temaer/Psykiatri/Publikationer/2012-06-19-samfundet-de-gale.pdf Samfundet og ”de gale”- Magt og afmagt i psykiatrien • KADK, SET, Diploma project programme, 'Center for mental well-being' by Michael Enghoff Hansen, 2014, https://kadk.dk/sites/default/files/project-downloads/afgangsprogram_center_for_mental_velvaere.pdf • Research Gate - Publication 'The Meaning of public spaces' by M. Hanzl, Lodz University of Technology, Poland, ttps://www.researchgate.net/publication/263277308_The_meaning_of_public_spaces ,latest visited: 11.12.19 • Scapegoat, issue 03, Manet: Images for a World Without People by Pier Vittorio Aureli , http://www.scapegoatjournal.org/docs/03/03_Aureli_ManetImages.pdf, latest visited : 11.12.19 • Regeringen, 'Arkitekturpolitik - mennesker i centrum', Feb 2014, https:// kum.dk/uploads/tx_templavoila/Dansk_lobende.pdf • Sundhedsstyrelsen, ’Sygdomsbyrden i Danmark’ , 30.9.16, https://www.sst.dk/da/sygdom-og-behandling/~/media/C3ACA2467BEE41B49726532872563FFA.ashx • Det Nationale Forsknings og Analysecenter for Velfærd, VIVE – Viden til Velfærd, ’Børn og Unge i Danmark, Velfærd og trivsel', 2018, https://www. vive.dk/media/pure/10762/2240313 • Evaluering af Headspace by Rambøll Management Consulting for the Health and Elderly Ministry of Denmark, 21.6.19, https://www.sum.dk/~/ media/Filer%20-%20Publikationer_i_pdf/2019/Evaluering-af-headspace-juli-2019/evaluering-af-headspace.pdf • Research Gate, 'The Meaning of public spaces' by Malgorzata Hanzl, Lodz University of Technology, Poland, june 2013, https://www.researchgate.net/ publication/263277308_The_meaning_of_public_spaces FILMS • Serie produces by TV2 Fyn, 'Findes løsningen på stress i naturen?', 3 episodes, 19.12.18, Fotographs: Anders Høgh, Frederik Helm, Malte Jørstad, Ole Holbech, Jonas Bertelsen, Masoud J. Poulia. Journalists: Malthe Jørstad, Frederik Helms. Graphic: Niklas Kjæsgaard Larsen. Photos: Louise Koustrup, https://www.tv2fyn.dk/findes-losningen-pa-stress-i-naturen/findes-losningen-pa-stress-i-naturen-23.