A New Tool In Improving Mental Health — Building Design

Buildings can be designed in ways that allow for more of the interior to be exposed to sunlight and nature. In the time of the pandemic, more sunlight in rooms can act as a natural disinfectant, and one study found that people had better mental health after taking walks through nature.

For decades, psychiatric hospitals were grim settings where patients were crowded into common rooms by day and dorms at night. But new research into the health effects of our surroundings is spurring the development of facilities that feel more residential, with welcoming entrances, smaller living units within larger buildings and a variety of gathering spaces. Nature plays a big role: Windows provide views of greenery, landscapes decorate walls, and outdoor areas give patients and staff access to fresh air and sunlight.

The new approach, promoted as healing and therapeutic, has produced environments that are more calming and supportive. And it feels particularly timely, given the surge in mental health issues created by the pandemic.

“We’ve been talking about this for a really long time,” said Mardelle McCuskey Shepley, chair of the department of design and environmental analysis in Cornell University’s College of Human Ecology in New York. “It’s only now that it’s gaining momentum.”

Even before the pandemic, the number of Americans affected by mental illness was at a new high. One in five adults was experiencing depression, bipolar disorder, schizophrenia, post-traumatic stress or some other malady, according to the National Institute of Mental Health. The rates were significantly higher for adolescents (about 50%) and young adults (about 30%).

Nearly a year into the pandemic, more people are suffering. Young adults and Black and Latino people of all ages are reporting increased levels of anxiety, depression and substance abuse, according to a survey from the Centers for Disease Control and Prevention. A recent Gallup poll showed that Americans felt their mental health was “worse than it has been at any point in the last two decades.”

Demand for treatment has soared, and the construction of mental health facilities has been outpacing that of other specialty hospitals. Last year, 40% of the specialty hospitals under construction were psychiatric hospitals and behavioural health centres, according to the American Society for Health Care Engineering.

Architecture and interior design firms with expertise in health care buildings have reported an increase in activity. At design firm Architecture+ in Troy, New York, one or two major mental health facilities are typically in the pipeline, with total construction costs for those projects at about $250 million a year, said Francis Murdock Pitts, a principal and founding partner. Last year, the firm was working on 16 large mental health projects totalling about $1.9 billion.

His firm and others like it have medical planners on staff who help translate research into “evidence-based” designs. “This isn’t just about being warm and fuzzy,” Pitts said.

For instance, exposure to nature has been shown to lower cortisol levels, a measure of stress. Adding healing gardens and other greenery can help soothe agitated patients and give staff a place to decompress.

Research specific to mental health care settings is also coming into play. Studies have shown that reducing crowding by providing private rooms and multiple communal spaces may lessen patient and employee stress and aggression. Lowering noise — eliminating unnecessary beeping of medical equipment, for example — can also help. If patients are less stressed, they may make faster and more lasting progress during treatment, experts say.

But because mental health issues vary widely, there is no one-size-fits-all design solution. And safety — for both patients and staff — remains paramount.

Codes and guidelines fine-tuned over many years have sought to eliminate room features that patients have used to harm themselves and others. Window glazing is made of polycarbonate compounds to reduce breaking. Doors are hung on quick-release hinges to allow staff to enter a room if a patient is barricaded in. Plumbing and other fixtures have been designed to prevent the possibility of hanging or strangulation.

Such safety measures are crucial, but “you don’t want it to get to the point where it looks prisonlike,” said Shary Adams, a principal at HGA, a national design firm. At the same time that the built environment must be engineered to ensure safety, there is also a move to give patients some control over their surroundings. Manual thermostats allow patients to adjust the temperature in their rooms, for example, and dimmer switches let them modulate the lights.

The location of mental health facilities is changing, too. Psychiatric institutions used to be tucked away, but today they are likely to be part of hospital campuses or otherwise conveniently situated. They often combine inpatient rooms for those who need round-the-clock monitoring and areas for outpatient services, allowing patients to shift to less intensive care in the same building.

Two Hours of Nature a Week is Key for Well-Being and Health

A new reason for wanting to preserve natural environments. There are many people today that are struggling with too much stress and health problems, and some good doctors have started prescribing time in nature because the evidence more and more shows its effectiveness.

Spending at least two hours a week in nature may be a crucial threshold for promoting health and wellbeing, according to a new large-scale study.

Research led by the University of Exeter, published in Scientific Reports and funded by NIHR, found that people who spend at least 120 minutes in nature a week are significantly more likely to report good health and higher psychological wellbeing than those who don’t visit nature at all during an average week. However, no such benefits were found for people who visited natural settings such as town parks, woodlands, country parks and beaches for less than 120 minutes a week.

The study used data from nearly 20,000 people in England and found that it didn’t matter whether the 120 minutes was achieved in a single visit or over several shorter visits. It also found the 120 minute threshold applied to both men and women, to older and younger adults, across different occupational and ethnic groups, among those living in both rich and poor areas, and even among people with long term illnesses or disabilities.

Dr Mat White, of the University of Exeter Medical School, who led the study, said: “It’s well known that getting outdoors in nature can be good for people’s health and wellbeing but until now we’ve not been able to say how much is enough. The majority of nature visits in this research took place within just two miles of home so even visiting local urban greenspaces seems to be a good thing. Two hours a week is hopefully a realistic target for many people, especially given that it can be spread over an entire week to get the benefit.”

There is growing evidence that merely living in a greener neighbourhood can be good for health, for instance by reducing air pollution. The data for the current research came from Natural England’s Monitor of Engagement with the Natural Environment Survey, the world’s largest study collecting data on people’s weekly contact with the natural world.

Co-author of the research, Professor Terry Hartig of Uppsala University in Sweden said: “There are many reasons why spending time in nature may be good for health and wellbeing, including getting perspective on life circumstances, reducing stress, and enjoying quality time with friends and family. The current findings offer valuable support to health practitioners in making recommendations about spending time in nature to promote basic health and wellbeing, similar to guidelines for weekly physical.”

Just 20 Minutes in Nature Reduces Stress Levels

A good prescription for a stressed out society.

Taking at least twenty minutes out of your day to stroll or sit in a place that makes you feel in contact with nature will significantly lower your stress hormone levels. That’s the finding of a study that has established for the first time the most effective dose of an urban nature experience. Healthcare practitioners can use this discovery, published in Frontiers in Psychology, to prescribe ‘nature-pills’ in the knowledge that they have a real measurable effect.

“We know that spending time in nature reduces stress, but until now it was unclear how much is enough, how often to do it, or even what kind of nature experience will benefit us,” says Dr. MaryCarol Hunter, an Associate Professor at the University of Michigan and lead author of this research. “Our study shows that for the greatest payoff, in terms of efficiently lowering levels of the stress hormone cortisol, you should spend 20 to 30 minutes sitting or walking in a place that provides you with a sense of nature.”

A free and natural stress-relieving remedy

Nature pills could be a low-cost solution to reduce the negative health impacts stemming from growing urbanization and indoor lifestyles dominated by screen viewing. To assist healthcare practitioners looking for evidence-based guidelines on what exactly to dispense, Hunter and her colleagues designed an experiment that would give a realistic estimate of an effective dose.

Over an 8-week period, participants were asked to take a nature pill with a duration of 10 minutes or more, at least 3 times a week. Levels of cortisol, a stress hormone, were measured from saliva samples taken before and after a nature pill, once every two weeks.

“Participants were free to choose the time of day, duration, and the place of their nature experience, which was defined as anywhere outside that in the opinion of the participant, made them feel like they’ve interacted with nature. There were a few constraints to minimize factors known to influence stress: take the nature pill in daylight, no aerobic exercise, and avoid the use of social media, internet, phone calls, conversations and reading,” Hunter explains.

She continues, “Building personal flexibility into the experiment, allowed us to identify the optimal duration of a nature pill, no matter when or where it is taken, and under the normal circumstances of modern life, with its unpredictability and hectic scheduling.”

To make allowances for busy lifestyles, while also providing meaningful results, the experimental design was novel in other aspects too.

“We accommodated day to day differences in a participant’s stress status by collecting four snapshots of cortisol change due to a nature pill,” says Hunter. “It also allowed us to identify and account for the impact of the ongoing, natural drop in cortisol level as the day goes on, making the estimate of effective duration more reliable.”

Nature will nurture

The data revealed that just a twenty-minute nature experience was enough to significantly reduce cortisol levels. But if you spent a little more time immersed in a nature experience, 20 to 30 minutes sitting or walking, cortisol levels dropped at their greatest rate. After that, additional de-stressing benefits continue to add up but at a slower rate.

“Healthcare practitioners can use our results as an evidence-based rule of thumb on what to put in a nature-pill prescription,” says Hunter. “It provides the first estimates of how nature experiences impact stress levels in the context of normal daily life. It breaks new ground by addressing some of the complexities of measuring an effective nature dose.”

Hunter hopes this study will form the basis of further research in this area.

“Our experimental approach can be used as a tool to assess how age, gender, seasonality, physical ability and culture influences the effectiveness of nature experiences on well-being. This will allow customized nature pill prescriptions, as well as a deeper insight on how to design cities and wellbeing programs for the public.”