Creating mentally healthy communities
Dr. Trevor Hancock
2 October 2017
The communities in which we live are both physical places and social spaces, and both affect mental wellbeing. A report released by the California–based Prevention Institute in September delves into this issue. (In the interests of transparency, I volunteer on their Executive Advisory Board, although not involved in the preparation of this report.)
Beginning with a framework that identifies factors in the community most related to medical conditions that show the greatest disparity (and thus are related to environmental, social and economic conditions and the behaviours they shape), the Institute looked at how those factors relate to mental health. They found seven factors in the broad categories of ‘People’ (our social spaces), ‘Place’ and ‘Equitable opportunity’ that “have a particularly strong impact on mental wellbeing”.
There are three social factors – Social networks and trust, Participation and willingness to act for the common good, and Norms and culture; three aspects of the physical environment – Look, feel and safety, Housing, and Arts and cultural expression; and one in the area of equitable opportunity – Living wages & local wealth. Since I dealt with poverty last week, I will focus here on the ‘People’ and ‘Place’ factors.
The report notes the considerable body of evidence that “strong social networks and connections correspond with significant increases in mental and physical health”, as well as less violence and addiction and even improvements in academic and economic performance. These strong and positive social connections must be built in families, networks of friends and in schools, workplaces and places of worship – even through connection with pets and therapy animals.
A related strategy is to build community capacity to participate and act together to improve things; there is a positive and reciprocal relationship between community and individual empowerment and there is good evidence that empowerment has significant health impacts. This can include efforts to build a more participatory democratic system. Evidence from Brazilian cities such as Porto Alegre and Belo Horizonte has linked participatory budgeting with improvements in housing, utilities such as water and sanitation, health centres and cultural and recreational facilities, all of which are themselves determinants of health.
The third social factor – which is related to the first two – is to change the community’s culture and social norms. We have seen this with respect to smoking and to drinking and driving, both of which are now much less socially acceptable than they were a few decades ago.
Now we see efforts to change the social norms around bullying in school and on the internet, gender and racial discrimination and harassment in the workplace, domestic violence and other issues that have led to significant mental health impacts. The report notes “Positive social norms that foster inclusion and respect for all persons can enhance individual self-esteem and wellbeing”.
The physical environment also has an impact on mental wellbeing. Unattractive, poorly-maintained neighbourhoods are more common in disadvantaged groups. People living there are less likely to have good-looking schools, good parks nearby, shade trees, attractive streetscapes or public art. Moreover, access to attractive, safe, walkable neighbourhoods and parks facilitates physical activity, which in turn improves mental health.
Unpleasant environments convey the message that ‘you don’t matter’, which makes peole feel neglected and worthless, less empowered and less able to take action on these issues. Arguably, people living in such neighbourhoods actually need extra investment in higher quality, better maintained built environments to make up for the deficits in the determinants of mental health that they experience in many facets of their lives.
Then there are the homes we live in. Being homeless is of course a major threat to mental wellbeing, but poor housing quality is also a threat to both mental and physical health, as is insecure tenure. We also need to look at how housing design supports – or fails to support – social connection; high-rise buildings are generally worse performers here.
Finally, there is good evidence that “music, dance, and all forms of artwork foster mental wellbeing”, as well as community solidarity; the report suggests ensuring that people have access to the spaces and resources needed for artistic expression.
Like Rome, mentally healthy communities cannot be built in a day – but they can be built.
© Trevor Hancock, 2017