Mental health and the built environment
The built environment refers to the man-made surroundings that provide the setting that we work and live in: buildings, parks, neighbourhoods and cities. But how can we modify this to improve people's mental health?
The Women and Equalities Committee are currently running an inquiry on disability and built environment, which provides the ideal platform to outline issues around provisions, accessibility and inclusivity in the built environment to protect and support people's mental health and wellbeing.
The design of the built environment needs to appreciate the widest aspects of disability, as well as diversity, envisaging built spaces through someone else’s needs from the outset. Any barriers in the physical environment can restrict or prevent certain groups from fully and independently participating in society.
For physical disability these barriers are now understood and legislated for, such as the inclusion of ramps and step-free access. But for those with mental health problems, dementia and learning disabilities, the requirements are less understood and therefore less implemented. While we recognise that designing buildings and public spaces that are accessible to all is a complex issue, the built environment is central to shaping communities and facilitating interaction.
At the first evidence session of the Women and Equalities Committee's inquiry, Jolie Goodman, manager of our Standing Together project, raised concerns that the design and construction of built environments is not keeping up with the evolving and complex requirements of the UK population. There are some examples of good practice for accessibility, improvements and engagement such as the development of dementia friendly environments across hospitals and other care settings.
An example from our later life work, the Standing Together project, facilitates self-help groups in retirement and extra-care housing schemes. In these groups, the built environment in which the members live is often a prominent topic for discussion.
Some concerns were expressed about the challenges of living in a new build for older people:
- "The instructions for the heating system are too complicated."
- "The front doors are fire doors, which are so heavy that I can’t manage to open my door."
This is clearly of relevance given our ageing population, which means that the demand for accessible housing will continue to grow and concerns and requirements of those in later life must be incorporated into the design and planning process.
What issues need addressing?
In relation to physical obstacles that prevent people working, a key issue is that people wouldn’t necessarily disclose having experienced mental ill health to employers because of fear of stigma and discrimination, which prevents employers from knowing that adjustments are required, such as creating a designated 'quiet zone' in the office for staff who want to take time away from their desks.
In relation to learning disabilities and dementia, employers are often not aware of the positive adjustments that could be made, such as clear labelling and signposting of bathroom and other facilities, avoiding confusing patterns on carpets and not having long mirrors in hallways as this can make navigation difficult.
This is still a relatedly unexplored area with limited evidence, so more research is needed into what other challenges and obstacles there are, followed by capacity building among employers on what works best.
Built environment affects us all
While it is especially important for people with mental health problems, dementia and learning disabilities that the built environment is tailored to particular needs, it is important to stress that we all have mental health that we need to look after, and our built environment is the stage upon which this care takes place.
Planning around our built environment with a recognition of the determinants of good mental health has universal benefit: access to green spaces, for example. Green space is beneficial for social cohesion through facilitating higher levels of social contact and social integration, particularly in deprived neighbourhoods.
Access to nature through purpose-built spaces creates a meeting space for all age groups and positively affects their social interaction and cohesion. Living near natural space has been related to crime reduction and increased neighbourliness. Opportunities for socialising and the strengthening of neighbourhood ties are provided by community gardens and club or group green activities. Building communities through participation in local nature activities increases a sense of community pride and strength.
Ensuring accessible, safe and secure built environments, that foster wellbeing catering and responding to the most vulnerable in society, is an integral part of preventing people becoming so unwell they require extensive health and social care services. We hope the evidence Jolie provided at the hearing, which stressed this interplay between the built environment and health, can be taken forward by the Women and Equality committee to ensure positive policy change.