Health advocates rate America’s mental health system somewhere between “a big mess” and “a continuing crisis.” The statistics aren’t reassuring: From 2009 to 2011, states cumulatively cut $1.6 billion from mental health programs. Nearly 40 percent of people with severe mental illness went untreated in 2012, while one in four adults experience mental illness in a given year.

Mental illness are invisible, leaving people to suffer in isolation. Social stigma leads to detachment. Contributing factors remain ignored.

This situation reminds me of a previous state of affairs. When modern observers discuss Cholera outbreaks in nineteenth-century London, they commonly express incredulity: How could people not realize that contaminated drinking water leads to disease? John Snow‘s insight seems obvious now, but the association wasn’t clear 160 years ago. Public officials simply didn’t know how to structure their communities for public health.

While we know how to prevent infectious diseases with good community design today, we still don’t know how to shape our institutions to promote mental health.

While there are plenty of ways our built environment puts people at unnecessary risk of bodily harm, evidence is mounting that the structure of our communities also affects psychological well-being. Some associations are clearer than others, and it’s not clear what type of community is best for public mental health. It is clear, however, that it’s time to start examining how we can structure our institutions—including our built environment—to benefit of everyone’s mental health.

Here are four ways in which the built environment affects public mental health:

1) Commuting by car introduces avoidable stress into people’s daily lives.

While many people insist that they enjoy driving, virtually no one enjoys their commute. Researches have established that driving leads to acute stress for decades. A MIT study found that driving a car can induce as much stress as jumping out of a plane. The stress burden of operating a screaming metal death trap far outweighs that of any other daily task, according to the study. Since 94 percent of people drive to work without any other passengers, a lot of stressed out people are on the road.

Chronic stress is a problem in itself, but it’s also been linked to anxiety, depression, digestive problems, weight gain and heart disease. According to Dr. Howard Frumkin in Urban Sprawl and Public Health, “More recently, studies of professional drivers such as truck drivers, bus drivers, and taxi drivers, have consistently shown an increased risk of cardiovascular disease, despite selection against these disorders at the time of hiring and during medical follow-up.”

Road rage is symptom of this toxic practice: Pent-up frustration leads to outbursts, which are both plainly unhealthy and dangerous. Most people take commuting as a given, but it’s time we examine it more closely.

2) Suburbia’s lack of public spaces limits social interaction, leading to isolation.

Several scholars have taken note of the decline in American life in the last 50 years. Most notably, Robert Putnam made the case in Bowling Alone: The Collapse and Revival of the American Community that the nation’s social capital is an alarming in decline. From The New York Times:

It wasn’t just voter turnout and grass-roots political activism that had declined since 1960 or so. Membership was falling in the old-line do-gooder organizations, from the P.T.A. and the League of Women Voters to the Elks and the Shriners. Informal ties of all sorts were unraveling, and Americans were becoming an ever more isolated, cynical and anomic lot — detached from civic life, deprived of the social networks that develop when communities are more closely knit. The rueful example contained in the title lent Putnam’s argument much of its mass appeal: Americans still bowled, sure, but Putnam had discovered that they were much less likely to do so in leagues than they had been three decades ago. They were lonely bowlers now, making their strikes without benefit of a hearty clap on the back or a beer bought by the guys.

Putnam did not singularly blame suburban sprawl, but it’s hard to imagine a contributing factor as powerful as the built environment. Having grown up in Marietta, Ga., I have experienced this disassociation firsthand. In the suburbs, connections between neighbors are, at best, superficial. Sharing no public spaces with them except the road, you lack any meaningful venue for extemporaneous interaction.

“There’s a simple rule of thumb: Every ten minutes of commuting results in ten per cent fewer social connections. Commuting is connected to social isolation, which causes unhappiness,” Putnam told The New Yorker.

While it may seem obvious, a meta-analysis of academic studies established an inverse relationship between amount of social capital and incidence of mental illness. This finding makes intuitive sense: with fewer connections to rely on, it’s harder to deal with adversity.

I can only speak from my own experience when I say that I have spent the most isolated weeks of my in Marietta.

3) Sedentary habits associated with car dependence exacerbate mental ill-health.

While the stress linked to commuting is easy for people to recognize in their own lives, it’s harder to quantify the time losses of lengthy commute.

Thomas James Christian of Brown University published findings in 2009 that found “small but highly significant associations” between commute length and unhealthy habits: “Each minute spent commuting is associated with a 0.0257 minute exercise time reduction, a 0.0387 minute food preparation time reduction, and a 0.2205 minute sleep time reduction.”

While such numbers seem small, they add up. While commutes aren’t the only impediments to healthy habits, they are certainly a significant factor. According to the Harvard School of Public Health, car-dependence in general makes exercise harder to incorporate into people’s daily lives:

A number of studies have looked at whether living in a “walkable” neighborhood—one that has sidewalks, crosswalks, stores, and leisure destinations—has a positive effect on physical activity, and in turn, body weight. […] Some studies have found that living in more walkable neighborhoods […] is linked to higher rates of physical activity (1,36,37) and lower body mass index (BMI) levels (38–40).

Though certainly not a cure-all, exercise is an important preventative measure and treatment for several common mental health conditions such as anxiety and depression. According to Mayo Clinic, exercise helps alleviates depression by releasing endorphins, reducing immune system chemicals, and increasing body temperature—all while increasing confidence.

Inasmuch as city structure promotes or discourages physical activity, mental health is also affected.

4) Yet, urban areas don’t have better psychological health compared to suburban areas.

Like I said at the beginning of this post, we don’t know how to structure our communities to promote mental health. The brain is too complex and the causes too multifaceted to draw simple conclusions. In terms of mental health, we may as well still be drinking 1854 Thames poo water.

That’s why, when you study the association between urbanity and incidence of mental illness, you reach counterintuitive conclusions.

According to an analysis by UChicago’s J. Eric Oliver , the only factors relevant to predicting mental health were population density and affluence. Residents of wealthier neighborhoods with higher density were “more likely to report depressed mood and dissatisfaction with their neighborhoods.”

, the only factors relevant to predicting mental health were population density and affluence. Residents of wealthier neighborhoods with higher density were “more likely to report depressed mood and dissatisfaction with their neighborhoods.” People living in cities exhibit higher brain activation in regions that regulate stress, according to a 2011 study. Furthermore, growing up in a city is associated with long-term increased activity in other regions that regulate stress.

A 2004 academic study found that “s prawl significantly predicts chronic medical conditions and health-related quality of life, but not mental health disorders.”

Conclusion

In total, it’s hard to draw conclusions on urban design from existing research on mental health. The factors that isolate people living with mental illness exist in every community in America, regardless of composition. Even if we don’t know the key to cultivating mental health, we can still shape our built environments in ways that promote health in general and psychological well-being as much as possible.

Endnote

If your mental state has been interfering with your daily life, you should consider seeking assistance. These 11 signs for depression listed by Morningside Recovery and this diagnostic test from Psychology Today can help you assess if counseling would be beneficial for you.

Top photo: Glen Scott via Flickr

Middle photo: Dean Terry via Flickr