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Layla McCay on… urban design and mental health

Urban Voices #9, January 2021

Layla McCay

Director of the Centre for Urban Design and Mental Health

Layla McCay is a psychiatrist, international public health and health systems specialist, and adjunct professor of international health at Georgetown University. She set up UD/MH in 2015 to help increase interest, knowledge sharing and translational research to improve population mental health through smart urban design. Trained at the Maudsley Hospital and Institute of Psychiatry in London, Layla has a keen interest in the determinants of mental health, and a passion for the built environment and helping people love the places they live.

There’s been quite a lot of focus on how to design and plan cities to improve physical health – for example, looking at how to reduce obesity or respiratory problems. But urban design and mental health still struggles to gain recognition as a specialty in its own right. The few specialists working in this area struggle to get funding or get published. There is also the simple question of finding each other.

UDMH tries to provide all of these things. It brings together mental health and public health experts, urban designers, architects, planners, geographers, engineers, among others. By translating between the different sectors working in this multidisciplinary nexus and capturing what their research is really saying, UDMH gives city-makers the practical and theoretical tools to actually implement change.

We talked to Layla about urban design and mental health in the coronavirus era, delving into its intersections with social and environmental justice and what can be done to improve urban mental health in these strange and uncertain times.

The pandemic is raising a lot of questions about how we plan our cities for both mental and physical health. And it’s highlighting the importance of creating more liveable and equal cities. What are the main issues emerging out of the pandemic when it comes to urban design and mental health? 

The pandemic has suddenly highlighted that many of us are living in confined places in very close proximity to millions of other people. Cities have historically been places where plague, cholera, and other infections have spread. But as infection has done to different degrees in history, this pandemic has triggered public debate about urban design and health. It has really highlighted some of the inequalities in the city. For example, when your movement is restricted to your local area, you start to realise that there are huge disparities in what your local area offers to you. For example, some people have access to beautiful parks nearby where they can enjoy mental and physical health benefits, while others live at a distance from any sort of green space and lose out on these benefits.

So, this whole experience has made us ask: how can we live close together in a way that is good for everyone’s mental well-being? How can we design cities in a way that doesn’t drain us, crowd us or exhaust us, but actually bolsters us and enables us to fully take advantage of the social, cultural and economic opportunities that cities offer? It’s a really delicate balance but think that is where urban design thinking is going to be in the future.

“So, this whole experience has made us ask: how can we live close together in a way that is good for everyone’s mental well-being?”

To me, there are four central issues arising when it comes to factors associated with the pandemic that have implications for urban design and mental health:

1) People’s resilience

Whenever something challenging or stressful happens, we deal with it differently depending on how much resilience we have. All sorts of things contribute to our mental resilience -personal and social factors are key, but how the places we live are planned and designed also plays a role.

For example, opportunities for physical activity, neighbourliness, and local access to environments that feel restorative contributes to how mentally well you are at the beginning of a crisis – and the extent to which people can maintain that resilience.

Image by: Chan Lee. Source: Unsplash

2) Healthcare accessibility

How easily you can access both physical and mental health care when you need it affects our mental wellbeing. It can be stressful to be far from the help we might need during a pandemic. This means it is important to have access to local health facilities – but also that we may need to repurpose public facilities to deliver new vaccine centres and field hospitals, for example, sometimes in a matter of days. In countries around the world, the pandemic has shown us that, in future, we should design public spaces that are more flexible and ready to adapt to a multitude of situations, so that they can meet our evolving and sometimes urgent needs.

3) Hygiene

Many people around the world face huge barriers to accessing hand washing facilities, which are essentially one of the important ways for preventing the spread of infections, including COVID-19. When the pandemic started, I looked around and realised that public hand washing facilities are not really available anywhere in London –even more so when public toilets were closed to reduce COVID-19 transmission. Now there are hand sanitising facilities spread around the city where they previously did not exist. The world over, we need to think more about designing ways for people to maintain hygiene and sanitation in the streets as they as we go about our daily business.

4) Social distancing

Another opportunity, and possibly the most interesting in the context of urban design, is how to design public thoroughfares in ways that enable social distancing where there is a need. There are two things that are interesting here. The first, which has been very prominent in urban design and planning discussions over the past year, is, of course, how we design cities so that people can move around them safely and in distanced ways. We’re already seeing the challenges of physical distancing on narrow pavements. We have long known that the amount of space for pedestrians in the public realm is very limited: cities often have huge roads and skinny little pavements, with locations that create crowding, such as road crossings and narrow passages.

So, it’s been fascinating to see that in many cities, including London, there have been various initiatives to widen the pavements and narrow the roads and, in some cases, close down the roads all together! We’re suddenly seeing that it’s possible to design cities so that people have more space. I think there’s also going to be a lot of thinking around the design of housing as well. There’s a lot of overcrowding in housing design and this will really need to be addressed to reduce the risk of spreading disease.

"Another opportunity, and possibly the most interesting in the context of urban design, is how to design public thoroughfares in ways that enable social distancing where there is a need. A related challenge for urban design that supports mental health and wellbeing is the importance of maintaining social connectedness despite maintaining physical distance."

A related challenge for urban design that supports mental health and wellbeing is the importance of maintaining social connectedness despite maintaining physical distance. Local social connectedness in a pandemic very much depends on your neighbourhood. What are your relationships with your neighbours? How do you feel about them? What’s the ambience in your neighbourhood? Where are the opportunities to be social – without getting too physically close? The pandemic has really raised questions about how we foster neighbourliness.

Layla McCay on… urban design and mental health

Image by: Lynda Hinton. Source: Unsplash.

There have been a few researchers talking about the potential negative impacts of social distancing on placemaking and urban conviviality. Some fear that social distancing will have a long-term impact on how we create a sense of community, particularly in public spaces. What’s your view on that? 

It’s an incredible risk. But it’s a risk that we, as the urban design and planning community, need to turn into an opportunity. Many of us have been confined to our neighbourhoods, far more than we ever have been in the past. These restrictions have resulted in our neighbourhood design and social ambience meaning more to us now than possibly they have before, when we could just hop on a train and go somewhere else for the evening. The local is more relevant than ever.

When people are stuck in their homes, they may feel isolated in all sorts of different ways. They may feel anxious, lost, even depressed. The challenge during a pandemic is that we can’t do the usual sort of placemaking interventions – like a community festival – that could foster a deeper sense of community. But people still desperately want that. It is intrinsic to people’s mental well-being. People want to feel part of something. So, we’re going to have to think a bit more creatively. Pre-pandemic, we may have thought we had found the right ways of designing social belongingness into physical neighbourhoods – we’d perhaps become a bit complacent.

But in this new context, we are thinking more about how to innovate to create convivial ambience in a neighbourhood when people’s behaviours have to be different. I don’t have the answers to that, because this is all very new, but we have seen examples already across the world. From the ‘clapping for carers’ initiative in the UK to the balcony concerts in Italy and Spain.

"But in this new context, we are thinking more about how to innovate to create convivial ambience in a neighbourhood when people's behaviours have to be different."
What would be your top urban design intervention for mitigating the effects of pandemics?

I have many. First, an appreciation for high quality local green space and prioritizing that in design. Second, dedicating more of the public realm to pedestrians so that people have space to move. Third, designing places in neighbourly ways so that people are able to have social connections, regardless of the physical nature of things. We’re all using cities together, so how can we do it in ways that make us feel like we all belong?

There’s a saying: never waste a good crisis. Around the world, urban planners and designers and people who really care about placemaking are thinking, “this is possibly our moment to make cities healthier and safer places”. So now is really the time to rethink city design.

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