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It Takes a Village

By Robin Harvey
Network, Summer 2008

Most mornings, when he’s not headed to part-time work at his downtown Toronto retail job, Eugene folds up his futon and has a quick decaf in his studio apartment. Then he walks along Bloor Street West to get a bite at a local fast-food joint.

The Toronto native has lived for almost three years now only a stone’s throw from the stretch of Bloor Street West across from High Park, the city’s largest and greenest park. The 23-year-old has been living with a diagnosis of bipolar mood disorder since he was in his teens and is balancing part-time retail work and finishing off his high school diploma. He loves the area and says “it works” for him because everything he needs is steps away, from his doctor’s office to the community centre where he works out and even the high school where he takes night credit courses. And the TTC, Toronto’s public transit system which takes him to work or downtown medical appointments, is less than three blocks away.

The result?

“I know people,” he says. “They know me. Especially, after I moved in, in the summer. Now, even if it’s cold, I can’t walk far in a day without saying ‘hi’ to somebody.”

Dan Leeming, a partner with the Planning Partnership in Toronto, says Eugene’s neighbourhood has the elements that make for good physical and mental health. For many it might seem strange to think of a “neighbourhood” as creating good mental health. But numerous studies are concluding that in many cases the design and makeup of our physical surroundings may be as important as genetics for our mental health. This new urbanism reflects society’s changing attitude toward mental health, planners like Leeming say. As mental illnesses come out of the closet, society’s causative role and its responsibility for helping support people who live with them, is being acknowledged on more than a medical level.

“Mental health disorders, depression and anxiety — they have tripled,” says Leeming, noting that depression “is a leading cause of disability in the world and has huge implications across society.” The planner recognizes that “mental health issues are still largely one of the great unspoken issues in our society but as we are more open we take new approaches.”

Increasingly, modern designers, urban planners and medical professionals believe the outside environment plays a much larger role than previously thought in the mental health of both individuals and communities. And they generally agree that the building blocks of a neighbourhood that fosters mental health are pedestrian-friendly streetscapes with a diverse mix of housing, business and retail, community and recreational land use. These are neighbourhoods designed, or that have evolved, to give residents quick access to most features of daily life that they need in order to give them more time to enjoy themselves, interact and participate — all elements that make for good mental health, they say. This new paradigm also takes a holistic approach, accepting the impact of everything from pollution and conservation, to personal safety and adequate lighting.

And nearby green space is a key element of the mentally healthy neighbourhood, research shows.

“The green space connection with nature has been found especially important for mental health, [and] not just to de-stress and for relaxation,” says Dr. Alan Abelsohn, one of the authors of “Public Health and Urban Sprawl in Ontario,” a report released in 2005 by the Ontario College of Family Physicians. Research has shown that having accessible green space nearby can also play a role in warding off mental illnesses in the first place. The physician’s report reviewed more than 150 studies going back more than a decade. All but one indicated that negative environmental factors, typically linked to what we would call “urban sprawl,” had an adverse effect on mental health.

A 2007 research review by the Simcoe Muskoka District Health Unit echoes Abelsohn’s comment on the need for access to green space to promote mental health. The review states that a nearby connection to nature increases job, home life and overall life satisfaction and meets “a plethora of emotional, spiritual and psychological needs.”

In addition, experts stress the need for transportation that does not depend on automobiles. Pedestrian-oriented, diverse use neighbourhoods improve overall mental health and discourage mental illnesses by increasing social engagement and decreasing isolation, says Dr. Patricia O’Campo, director of the Centre for Research on Inner City Health at St. Michael’s Hospital in Toronto and a social epidemiologist at the University of Toronto.

Fast Facts

12
Percentage of trips to the grocery store, work, the library or school are made on foot or by bicycle Canada.

20
Percentage of Canadians that report safety concerns keep them from walking or bicycling.

(Source: The Heart and Stroke Foundation of Canada)

Similarly, the family physician report stresses that when easily accessible public transit, bicycling and walking become the main ways people access work, school and convenience shopping, mental health benefits increase. “People who are more isolated and stressed are more depressed overall,” Abelsohn says. “If you can see lots of strollers and people pulling those small grocery buggies when they walk to shop, it is usually more likely to be a healthy neighbourhood. It promotes familiarity. People notice things with each other if something is wrong. It is conducive to more connection, more support.” Simply increasing physical activity by reducing long commutes cooped up in an automobile reduces stress and breeds better mental health, the research shows.

The doctors’ report cites how each additional 10 minutes of automobile commuting cuts down community involvement by 10 percent. This reducesa person’s “social capital,” or their investment in the community, adversely affecting everyone’s mental health.

The result?

Disconnected, isolated neighbourhoods, where people watch more television, spend more time on computers, have more fears about crime and little contact with their neighbours. Road rage — an extreme deterioration of mental health — also occurs in such anonymous, disconnected settings.

Leeming and other experts say creating meeting places, cafes, libraries, parkettes and urban squares on a scale where people can develop a sense of intimacy and ownership is crucial. This can increase safety and decrease crime, violence, substance abuse and their attendant stresses. Highly diverse and mixed housing uses seem to foster elements of tolerance and understanding and support for residents. “Within a streetscape block [with diversity] you develop a normalizing factor,” Leeming says. “You can have a four-person family, a single person, single parents, groups of people sharing a home for one reason, say students, but the block is still unified. And people get along pretty well.” Psychologically the stigma of differences falls away pretty quickly, he says, in what is described as “infill medium high-rise,” and a neighbourhood becomes moreopen and accepting.

O’Campo is conducting a soon-to-be released study of Toronto urban and suburban neighbourhoods that seeks to define elements promoting mental well-being over poor mental health. “People are able to identify the elements that matter,” O’Campo says. In the study, residents were asked to identify characteristics that made for both good and poor mental well-being in their neighbourhoods, and whether the neighbourhood studied was urban or suburban had little impact on the results. Easy nearby access to what could be broadly termed human supports and services — things like community resources, transportation, health care clinics, medical and health facilities and crisis intervention facilities — were ranked highest for promoting good mental well-being. Those things that increase “social cohesion,” such as friendliness and communication of residents, a feeling of a safe environment, and neighbourhood involvement and pride, were also important, as were physical elements, such as green spaces and natural environments, good lighting, walkable areas, usable sidewalks and bike paths.

When things “work” — as Eugene says — a neighbourhood fosters a feeling of safety, connectedness, community spirit and a sense of belonging that goes a long way to helping people stay mentally well. For Eugene, the benefits of living in a neighbourhood with high social capital, easy access to what he needs and green space for peace of mind are priceless. It reduces his stress and his sense of isolation, both of which are important in helping him cope with his illness.

“Some days half the battle is to know you are part of something bigger than yourself,” says Eugene. “Then you get inspired to do the things you have to do to stay well.”

Robin Harvey is a freelance journalist in Toronto.


Community Participation 101

“The desire for community — for basic human relatedness, support and common endeavour — is one of the most fundamental human impulses and is central to mental health.”

(From “Promoting Mental Health: Concepts, Emerging Evidence, Practice,” World Health Organization, 2005,www.who.int/topics/mental_health.)

“Cities that encourage people to move out of the isolation of their homes to discover a wide range of rewarding relationships may be the best form of mental health promotion we can invent.”

(From “Healthy Cities and Change: Social Movement or Bureaucratic Tool?” Francis Elaine Baum, Health Promotion International 8, no.1 [1993]: 31-40.)

“Health promotion interventions designed to promote healthier built environments need to find avenues for enhancing empowered community participation in the decisions that shape people’s surroundings.”

(From “The Relationship between the Built Environment and Wellbeing: A Literature Review,” Victorian Health Promotion Foundation, February 2000, www.vichealth.vic.gov.au.)


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