Professor Sarah Niblock, chief executive of UK Council for Psychotherapy (UKCP), calls for town planners, businesses, local authorities and NHS trusts to invest in fixed-term ‘psychotherapists-in-residence’ to inform planning and urban design decision-making
How can we improve mental health and wellbeing in the built environment? With further waves of Covid-19 restrictions coming into effect and our collective resilience wearing thin in the face of an uncertain future, high on the agenda is the question of how place leaders and city planners can help create homes, high streets, public spaces and urban infrastructure which enable humans not just to survive but to flourish.
Help is at hand from an unusual source. Psychotherapy offers a unique understanding of the human condition, which could add immense value to the work of urban planners and designers. Involving psychotherapy – with its rich repository of knowledge on what it is to be human and how we respond to our lived environments – would spur innovative, potentially far-reaching protective factors to ensure adults and children of all ages and backgrounds can develop and thrive.
We are now a predominantly urban species, yet we know very little about the impacts of urban processes on the existential, emotional and psychological make-up of city residents. UN figures show that 55% of the world’s population currently live in urban areas and this figure is expected to increase to 68% by 2050.
Cities are often associated with higher rates of most mental health issues compared with rural areas – an almost 40% higher risk of depression and a 20% greater risk of anxiety. There are elevated rates of psychotic disorders in densely populated areas. In the drive to grow our cities yet further, have the fundamental emotional needs of inhabitants been left behind?
Embrace a more human approach
It’s remarkable that planners and designers are really only starting to interrogate the emotional and mental implications of city life through the relatively new discipline of urban psychology, aided in no small part by the work of Chris Murray, Charles Landry and Mark Boyle who held a groundbreaking Urban Psychology Summit in 2019, bringing together researchers, psychotherapy experts and planners.
This is a momentous time for towns and cities if they are built to embrace a more human approach. Good mental health can improve people’s enjoyment, coping skills, and relationships, educational achievement, crime reduction, employment, housing and economic potential, as well as help reduce physical health problems, ease healthcare and social care costs, build social capital, and decrease suicides.
There is a huge mystique and some understandable fear over what psychotherapy actually is, so it is no wonder its applicability to the design of urban spaces may seem, initially, hard to fathom. If you search ‘what is psychotherapy’ online, you will be confronted with a standard answer that psychotherapy is a talking therapy for mental health problems. Yet psychotherapy offers us a rich discourse for the understanding of everyday life.
The World Health Organisation’s definition of mental health is: “a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”. This definition is relevant for urban designers because it also reflects key components of a thriving, resilient urban population.
Engaging with psychotherapists
Urban design needs to look beyond spatial solutions and engage with those who can help to formulate social and relational strategies – psychotherapists. Urban dwellers experience a constant overload of stimuli: noise, crowds, smells, sights, disarray, pollution are highly intensive and impactful inputs. Every part of the urban environment is deliberately designed to assert meanings and messages through a visual or sensory rhetoric. Not only does the city dweller find themself in a state of almost constant mental arousal, they may wish to shut themself away as a response with the potential for detrimental health impacts mentioned earlier.
I am urging organisations across a multitude of sectors to enlist a psychotherapist-in-residence, not to offer therapy per se but to assess presenting issues and potential solutions. Those charged with realising the expansion and generation of the urban environment of the twenty-first century would do well to take inspiration from some of the founding critical philosophers of twentieth-century modernity such as Freud and the theorists of the human mind that he inspired.
Through psychotherapeutically-informed planning, those healthy cities can move closer to becoming a reality; cities that are fundamentally designed to optimise wellness, creativity and innovation. Most efforts to improve mental health are still targeted at treating people who already have mental health problems. By embedding protective factors in the design process, such as nature access, physical activity, social interaction, sleep and safety into the city, urban design innovation can add value by helping strengthen the population’s resilience to aid good mental health and mental illness prevention and recovery.
Think about those postcodes beset with anti-social behaviour, underused community facilities. Is there something about how they make us feel that is at the root of the problem? Or perhaps it’s not so much the design or location but the way the development is thrust upon the community. We are living in times where we feel greatly unsettled by the pace of change. To the layperson, the language of urban development and planning feels inhuman, with a focus on ‘smart’, reflecting the desire for economic benefits via creation of an efficient infrastructure. A psychotherapist-in-residence with a foot in the shoe of the receiver of these messages can help organisations to recognise and better frame their language, both verbal and non-verbal.
Therapists hold an incredible repository of accumulated knowledge and the profession should be represented on planning committees, boards, governing bodies where they can communicate the human impact and potential to decision-makers, and imbue the rhetoric with more humanity.
Ensuring sustainable creativity and innovation
A development should not be designed based on some abstract idea of what we might like it to be. Put at its simplest, the city is for people, not in spite of them and should be co-created to ensure the sustainable creativity and innovation that can be harnessed through inclusivity and diversity.
It is vital that planners recognise and accommodate myriad human experiences and perspectives for the exponential growth of urban spaces to represent progress, not regression. Human-centred cities would help us to connect our innovation and creativity in ways that would allow us to thrive and grow. Once the new vocabulary is introduced, a world of possibility unfolds from person to person, generation to generation.
Professor Sarah Niblock
UK Council for Psychotherapy (UKCP)