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Mental health and the built environment
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Satnam S. Kunar, Specialist Registrar in Psychiatry Birmingham & Solihull Mental Health NHS Trust
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satnam.kunar{at}bsmht.nhs.uk Satnam S. Kunar
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The built environment has direct and indirect effects on mental health. Personal control, socially supportive relationships and restoration from stress and fatigue are all affected by properties of the built environment (Evans 2003). A number of factors in the physical environment have been postulated that may affect mental well being including factors within the home and the immediate community (Guite et al, 2006). The study by Araya et al (Common mental disorders and the built environment in Santiago, Chile. British Journal of Psychiatry (2007),190,394-401) appears more methodologically robust than other similar work and highlights social factors that may be important aetiologies in the precipitation and maintenance of mental ill health. Research carried out in north London(Weich et al, 2002) and New York (Galea et al, 2005) has shown that the prevelance of depression is associated with a poor quality built environment, independent of an individuals socio-economic status. Harpham et al showed that almost a quarter of a sample from a low income community in Cali, Colombia were probable cases of mental illness and that poor education, unemployment, being female and a victim of violence were all potential risk factors for mental ill health. It should be noted that Santiago, London, New York and Cali are very different cities with different demographics and distribution of wealth, and that psychosocial interventions in one may not be appropriate in another. However, it is clear that the social environment of an individual is crucial to their mental health. As happened over a century ago in Europe and is currently occuring in Latin America and other parts of the "developing world", an industrialising and modernising society is unable to fulfill the functions previously carried out by families and local communities of looking after some of their most vulnerable citizens. These societies should however be aware of the mistakes made by Western nations in the past of institutionalising the mentally ill. This article and others clearly show the links between factors in the environment and the presence of mental disorder. The challenge is to manipulate these factors in a way that is both logistically and financially feasible within the context of each society or community in order to improve the mental health of that population. References Evans GW. The built envronment and mental health. J Urban Health. 2003. Dec;80(4):536-55. Guite HF, Clark C, Ackrill G. The impact of the physical and urban environment on mental well-being. Public Health. 2006. Dec;120(12):1117- 26. Weich S, Blanchard M, Prince M, Burton E, Erens B, Sproston K. Mental health and the built environment: cross-sectional survey of individual and contextual risk factors for depression. Br J Psychiatry. 2002 May;180:428- 33. Galea S, Ahern J, Rudenstine S, Wallace Z, Vlahov D. Urban built environment and depression: a multilevel analysis. J Epidemiol Community Health. 2005. Oct;59(10):822-7. Harpham T, Grant E, Rodriguez C. Mental health and social capital in Cali, Colombia. Soc Sci Med. 2004. Jun;58(11):2267-77. Declaration of interest: nil. Dr.Satnam Singh Kunar Specialist Registrar in Pychiatry, Lyndon Clinic, Hobs Moat Road, Solihull. West Midlands. B92 8PW. Tel: 0121 678 4802 Fax: 0121 678 4801 email: satnam.kunar@bsmht.nhs.uk |
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