MENTAL WELLBEING

41. Nuffield Trust: https://www.nuffieldtrust.org.uk/chart/ categories-of-nhsspending-per-head

42. Royal College of Psychiatrists et al, Mental Health and the Economic Downturn: National Priorities and NHS Solutions, 2011

43. https://www. thelancet.com/ journals/lancet/ article/PIIS01406736(20)30460-8/ fulltext

44. https://www.who. int/whr/2001/media_ centre/press_release/ en/

45. Jaap Preen et al, The Current Status of Urban-Rural Differences in Psychiatric Disorders, Acta Psychiatr Scand, Feb 2010 https://www. ncbi.nlm.nih.gov/ pubmed/19624573

It is too early to judge whether the coronavirus crisis will have long-term effects on mental health. Mass quarantine has been described as the world’s largest-ever psychological experiment; and a literature review in the Lancet found numerous negative effects.43 Even if the immediate symptoms subside, the likely shrinkage of the economy resulting in joblessness and the demands on people to absorb sudden and dramatic changes are likely to have an impact on mental health, although much will depend on how things are handled as we come out of the crisis.

Before lockdown, the World Health Organisation reported (in 2019) that 450 million people worldwide were currently suffering from a mental disorder, making mental health one of the leading causes of disability and death.44

The WHO concluded:

• Determinants of mental health and mental disorders include not only individual attributes such as the ability to manage one’s thoughts, emotions, behaviours and interactions with others, but also social, cultural, economic, political and environmental factors such as national policies, social protection, standards of living, working conditions, and community support.

• Stress, genetics, nutrition, perinatal infections and exposure to environmental hazards are also contributing factors to mental disorders.

Research from a group led by Jaap Preen found that city dwellers were over 21% more likely to experience anxiety disorders. Mood disorders were also significantly more prevalent in cities - 39% higher than in rural areas.45

Clearly, we are in the middle of a crisis of mental health. The causes are complex: like most illnesses, mental health disorders are a combination of genetic and environmental factors. Too often, though, mental health is treated simply as an individualised problem. In the interaction between the human brain and the environment, it is mostly the human brain that is seen as failing and in need of

Vienna

treatment. But, as the psychologist and urbanist Chris Murray puts it: ‘Experience of place determines much of our development and wellbeing, and we should not separate the policies of one from the other.’46

Mental illness can be affected by personal stress caused by health, finances, relationships, or a sense of self worth - and also by collective stressors. Among wealthy nations, the rate of mental illness closely correlates with the level of economic inequality across society. The United States, for example, has extremely high levels of inequality and penalties for poverty, alongside very high levels of mental illness.47

Vienna is regularly cited as one of the world’s most liveable cities. Strict land-use codes mean that half the city is reserved for green space. Vienna (population 1.9 million) is a small city by contemporary standards but it is adding around 25,000 new residents a year, for which it builds about 13,000 new housing units.

A century-old tradition of social housing means that 62% of the population, including a broad swathe of the middle class, live in social housing. Strict rent controls mean that housing accounts for a much smaller percentage of outgoings than in most European cities. For an annual fee of €365 - one euro a day - citizens can travel anywhere on public transport. More than 73% of transport needs are met without the use of private cars.

Not coincidentally, Vienna has led the way in ‘gender mainstreaming’ its planning policies. In the new neighbourhood of Aspern, due to be home to 20,000 people by 2028, all the streets and public spaces are named after women (compared to traditional Vienna where 3,750 streets are named after men). The symbolism is backed up by an emphasis on better street lighting; traffic lights that prioritise pedestrians; plenty of benches and places to sit; and parks designed to allow girls’ play as well as boys’. Inside buildings there is pram storage; wide stairwells encourage social interaction; flat layouts are flexible. Buildings are low enough for residents to be able to keep an eye on the street.

Environmental stress is not, of course, exclusive to cities. The Brexit referendum in Britain suggested that town-dwellers were experiencing an acute loss of purpose and community. And climate crisis, fears of pandemics, financial insecurity, insecure work, relentless work performance measures, images of social perfection, and the attention economy of social media platforms can have just as much of an impact on people who live outside cities. But it is the case that the characteristics of urban settings - systems of technology and work, production and consumptioncan also make us feel uneasy.

Even those who are materially comfortable can feel overstretched by the ubiquitous presence of technology. It is hard to switch off. The video call can be a tyranny, while the pressure to respond to texts and emails immediately is draining. Even for messages of friendship. We are ‘always on’, always alert, always shadowed by the anxiety of not measuring up.

Digital technologies additionally promote a sense of being both ‘here’ and ‘there’. Even though we are physically present, we may be mentally elsewhere: focused, even if only momentarily, on something else that seems more insistent. Digital technology fragments our attention and detaches us from the places - homes and neighbourhoods - that should anchor us.

Meanwhile, work doesn’t always provide the underpinnings of stability that we feel it should, or imagine that it did for many, in the two generations before us.

Work in the gig economy is precarious, often involving long hours and multiple jobs. Even those in regular employment can feel insecure as occupations are disrupted by shifts in economic priorities, new technology, including AI, and competition. Those who are relatively financially well-off can feel they nevertheless live on tight margins, with few buffers to withstand shocks.

Add to this the sensory stress of living in big cities: the noise, the bombardment by advertising, the fumes, the crowds, the competing and jostling architectural styles, the sheer size of everything - and it is not surprising that people feel they need some respite, some place to be quiet and contemplative and to get back in touch with the world around them, and particularly with nature. Technology, congestion, overwhelming architecture and bustle are things we can cope with much of the time - but when they come without respite, we yearn to return to feeling more simply, solidly, fully human.

The Urban Realm

We often describe places as ‘soulless.’ Settings that are perceived as ugly, where there is endless asphalt, noise, pollution, and unkempt buildings, can have a lowering effect on the spirit, making people feel depressed. Places that are beautiful, on the other hand, can make people feel positive, conveying the impression that the world is stable and hopeful.

People want to live in cities that have character, atmosphere, something to nourish the soul. The city of Songdo in South Korea, which cost $40bn to develop from scratch on reclaimed land, opened in 2005 as a sustainable, low-carbon, high-tech, western-style city only two hours away from Tokyo, Shanghai and Beijing. Fifteen

48. https://www.citylab.com/life/2018/06/ sleepy-in-songdokoreas-smartestcity/561374/ 49. https://gothamist. com/news/robertcaro-wonders-whatnew-york-is-going-tobecome years on, only a handful of companies, universities and non-profits had moved there. Given a choice, people want more than convenience: they want a sense of place, civic identity and cultural sustenance.48

Believing that the built environment can have a significant impact on mood, Therme Group - and, in particular, Therme Arc and Therme Art - seeks to promote the transformative power of fine, uplifting buildings.

Alain de Botton argues that an aesthetically pleasing environment reminds us of our search for a life well lived, for fulfilment and happiness. Bad architecture, he insists, ‘is as much a failure of psychology as of design.’

Sir Richard Rogers has described architecture as ‘a physical manifestation of society’s wish to be civilised’. Therme Art is leading discussions about what imbues buildings with meaning and values in the face of constraints on resources and an imperilled natural world, engaging artists, architects, scientists, engineers, city planners and philosophers to think about what architecture can do to make cities civilised for the 21st century.

I’m sure we’re going to create a better world by connecting people again to nature, to humanity, and not just to the economy. In nature, you don’t have rightangles. Life is never straight, like natural material is never straight...we have to be aware that whatever you do in cities affects people’s lives.

FRANCIS KÉRÉ Architect of Therme Art’s Talks Pavilion at Design Miami 2018

Architecture and urban design have the power to exclude people, as well as include. The American master builder Robert Moses boasted to his biographer that he deliberately designed some overpasses on Long Island too low for buses to drive under, impeding access to some beaches for low income and ethnic minority groups.49

Exclusion doesn’t have to be deliberate: it can be the consequence of unconscious bias. Places which are legally and technically accessible to all may not be practically accessible to people with disabilities, to the old, to children, or to women. Planners need to think not only about whether they are providing libraries, but who is using them and who feels welcome in them. Security cameras that may feel reassuring for some, might, for others, seem more like an act of aggression. Young black men, for example, who may feel that the first assumption about them is always that their actions are suspect, criminal or illegitimate.

A human city has to combine practical solutions not only with beauty, but also with a wider sense of equity, access to opportunity, health, and participation in public life. Since humans have a profound need to be in touch with nature, a human city must at once have the power to move us, be connected to the natural world and sustainable.

Time

A linear sense of time is a relatively recent concept, different from the more circular and circadian sense of time that preceded it. What mattered most in the past were light, darkness, the weather, seasons and hunger. Time was conceived of in its relation to the natural world and our needs.

In cities, time is often seen as something that has to be used or lost: measured in financial terms by monthly repayments, or annual salaries. Time is literally money, no longer an expression of our needs, but something outside us that has to be chased down, its utility maximised.

This sense of having to be productive, to use time, can lead to what has been called ‘the urban accelerator effect’50 - a sense of time being speeded up. The city can feel like a clockwork machine, constantly demanding a faster pace and better performance of its inhabitants. Yet most of what we value - love, dignity, pride, respect - has nothing to do with performance or productivity. These aspects of our humanity cannot be bought - and, were you to try, you would immediately lose what is most important about them.

Sometimes, humans want to step outside time, to be in settings where it doesn’t much matter how many minutes have passed, where time is measured by experience or not measured at all. We seek places in which our relationship to the world becomes less instrumental and transactional; places in which time is not pressing, in which we do not feel harried, and where there is no pressure to be productive.

Cultures of ancient bathing rituals understand this. Therme facilities follow their lead, offering spaces of recreation, culture, reflection and meditation. In Undesigning the Bath, the classic design book on baths and bathing, Leonard Koren writes: ‘Bathing is best enjoyed in a place where you feel safe enough to put aside your social roles, relax your body armor, and open your psyche to the moment.’51

Smart Cities

We hear a good deal about smart cities and their potential to improve the urban realm, whether by lessening traffic congestion or reducing waste. Smart technologies undoubtedly have the potential to make city life more comfortable and sustainable - although the controversy over Waterfront Toronto, where there has been resistance to private control of the city’s data, suggests that a lot hangs on who exactly gets to be smart. Perhaps ways can be found to engage citizens not merely in (often unwitting) data collection, but also in shaping the questions asked of the data and how the results are used.

One problem, as far as mental health is concerned, is that the new ways of navigating knowledge have inequalities built into them. Some privileged groups own the power of data-mining and algorithmic analysis - social media platforms, market research companies, the security services. For the rest of us, there is simply too much information to comprehend. We don’t have access to the necessary, expensive, proprietary algorithms. As William Davies says, ‘“We” simply feel our way around while “they” algorithmically analyse results.’52 Most of us are thrown back on impulse and emotion to orientate ourselves. Davies argues that this reliance on instinct and ‘feeling’ is one reason for the current rise of populist politics and mistrust of authority.

Humans are essentially emotional creatures, and emotions will take over if we cannot find a way to temper our feelings with reason. In this sense, technology is quite bad for us, at least as currently organised. On the one hand, it makes the material with which we might reason more elusive: how can humans compete with vast datasets crawled by complex and mysterious algorithms? On the other hand, technology offers all kinds of stimulus to outrage, nervousness, and anxiety. Cities are such emotional places partly because it is difficult to be rational when there is too much to comprehend. We can’t think straight because we can’t get our heads around everything that’s going on. It is not surprising that many people have the sense that the world is slightly out of control.

It is easy to see how our perceptions of space, time and belonging can be undermined in cities, and how a sense of calmness and human rhythm is increasingly hard to find.

A Few Signs Of Resistance

Some cities have taken steps to reduce the sensory overload: São Paulo, followed by Chennai, and later by Grenoble and Tehran, have led the way in banning billboards.53 The Slow Cities movement, which began in Italy in 1999 as an offshoot of the Slow Food movement, has spread across the world.

Slow Cities

The Slow Cities movement promotes sustainable, green policies, emphasising a slower, more relaxed way of life. Slow Cities resist homogenising trends; they support local products, processes, crafts and events. The movement also recognises the need to embrace new technologies to improve the quality of the environment. While membership is currently limited to cities and towns with fewer than 500,000 inhabitants, the movement’s leaders say they would like to see its principles adopted in cities great and small.

Mass gatherings in which people can lose a sense of time, escape from pressure and be present in the moment are increasingly popular. This includes festivals of all kinds, such as the Winter Festival of Light in Helsinki, or Carnival in Rio or Venice; even marches, demonstrations and protests. The rise and rise of festivals testifies to a human need to escape into a different kind of relationship with the environment and other people, away from the clockwork demands of the city into nature, the arts, and a different kind of connectedness.

Therme Group recognises that people are more likely to feel positive if they have connections to the natural world through light, trees, plants and running water. The right to be in public parks during the coronavirus crisis became a topic of anguished debate in a number of cities as governments wrestled with conflicting impulses to protect health and allow people to be in green space for their mental health and exercise. In London, where some parks were closed and some open, it was reported that in the top 10%, one third of all land was taken up by private gardens, whereas in the poorest 10%, private gardens only covered one-fifth of land - complicating the debate with issues of equity.

Even small hints of the natural environment in urban settings can have a significant impact on wellbeing. People who live in sight of trees are healthier than those who don’t, as Rachel and Stephen Kaplan argued in their influential work on ‘restorative effects’. Too much attention focused on anything can lead to mental fatigue, they noted - and the remedy is to be found in nature.54

54. See, for example, Kaplan, Rachel; Stephen Kaplan; Robert L. Ryan (1998). With People in Mind: Design And Management Of Everyday Nature. Washington, DC: Island Press

In increasingly technological, high-rise, congested and polluting cities, there is a need for access to places that are clean, fresh and green, and which follow natural forms, colours and flows. Where it is possible to breathe freely and touch plants and water. Organic materials, maximum natural light and vistas that stretch the horizon help to create a sense of ease.

55. Reported in the Guardian: Elle Hunt, We do like to be beside the seaside, 4 Nov 2019

56. White, M. P., Depledge, M.H., Wheeler, B.W., Fleming, L.E.F., 2016. The ‘Blue Gym’: What can blue space do for you and what can you do for blue space? Journal of the Marine Biological Association of the UK, 96 (1), 5-12

Water, in particular, has a psychologically restorative effect. Spending time in and around aquatic environments has consistently been shown to have even greater benefits than those from green space, according to Dr Matthew White, a senior lecturer at the University of Exeter and an environmental psychologist with BlueHealth, an EU-funded project researching the benefits of blue space across 18 countries. The rewards of being in and around water include positive moods and reduced negativity and stress.55

The UK’s BlueGym research project, backed by the NHS, showed that we associate ‘blue space’ - areas of water - with feelings of greater happiness, and that ‘blue exercise’ - in and around water - is good for us. 56

Cities are not incompatible with green and blue space. There is no reason for cities not to be full of biodiversity. They would look different. They would need to be more localised because efficiency and streamlining would be less important than accessibility and resilience. But they would still be cities.

Singapore

At the time of its independence in 1965, Singapore was a city of slums, congestion, and almost no natural resources. Limited land meant that there was no choice but to go for highdensity development - which has, however, been carried out with a strong emphasis on pockets of green and blue space between the buildings. There are 3 million trees in the citystate; high-rise buildings are interspersed with parks, rivers, and ponds (which also help flood control).

Developers are required to include plant life - green roofs and walls, cascading vertical gardens - in any new building. The city’s extension at Marina Bay has created one of the largest freshwater city reservoirs in the world; 250 acres of prime real estate were set aside for nature, the Gardens by the Bay.

Singapore’s parks are currently being linked together to aid walking and cycling: eventually citizens will have access to several hundred kilometres of trails. Parks feature threegeneration playgrounds. The city’s innovative approach to housing, which means that 90% of Singaporeans own their own homes on long leases, allow for different configurations of households, including several generations.