Spotlight On: Mental Health

Over the years, thanks to united efforts by public health experts, doctors, government officials and advocates, the U.S. has made significant progress to promote mental health, increase availability to support services and reduce the stigma surrounding behavioral mental health issues.

As part of these efforts, since 1949, May has marked Mental Health Awareness Month in the U.S. It’s a time to raise awareness, reduce stigma and look to solutions and policies to support mental health issues. Notably, 1 in 5 U.S. adults grapple with mental illness, and the pandemic further thrust the need for solutions into the spotlight. The WELL Mind concept promotes mental health through policy, program and design strategies that seek to address the diverse factors that influence cognitive and emotional well-being.

IWBI sat down with Dr. Renee Christensen, our Mind concept lead, to discuss the intersection of mental health and the indoor spaces where we spend the vast majority of our time. With more than 20 years in the field, Dr. Christensen has also served as an instructor helping support Mental Health First Aid since 2017, a global training program focused on helping people identify, understand and respond to signs and symptoms of mental health and substance use challenges.

Can you tell us a little bit about your background, including what led you to focus on the relationship between the built environment and mental health?
I have spent a majority of my career working in public and private mental health organizations. From the Department of Mental Health under the U.S. Department of Health and Human Services to regional Community Mental Health Centers, I witnessed many changes to how we understand mental health and the political landscape that affected mental health services, and my research background helped direct my path to focus on the impact of the built environment on mental health.

Deinstitutionalization, which began in the U.S. in the 1950s, coincided with a broader definition of mental health and the shift in the responsibility of services from the federal government to individual states. The converging factors combined to create an environment in which states had to scramble to develop a system of care which not only included proactive approaches that embraced a new definition of mental health but also provide intensive services for individuals with severe and persistent mental illnesses. What emerged from these circumstances was a new model that combined housing and care. My research has focused on how these new models provided the required supportive services. Through that research, I identified multiple elements in the built environment that could negatively affect a resident’s prognosis such as privacy, security of tenure, territoriality and institutional routines. For example, both of the studied residential facilities included communal areas shared by at least one other resident, so residents are forced to display all behavior publicly. Self-care happens as a public display. During meal-times, residents line up to receive their meals on trays and their daily activities revolve around medication times. These institutional practices interfere with the resident’s ability to engage in home-like activities, increase institutionalized behaviors and contribute to learned-helplessness.

How do you see the built environment impacting mental health, and what can we do to promote better mental health through design and policy?
Historically, there was not an imminent need to study the impact of the built environment on mental health because our ancestors did not spend as much time indoors as we do today–which is approximately 90% of our lives! However, as people are increasingly living in urban areas–and spending more time indoors–our built environment is having an even greater impact on our mental health. That being said, we still do not have a holistic understanding of the interaction between mental health and the built environment. We have been successful in identifying some environmental elements that impact our mental health, and progress has been made to incorporate that knowledge into how we design our buildings.

For example, we understand the benefits of spending time in natural environments, so we have worked to do more to incorporate biophilia into building design. Other human needs, such as connection, privacy and restoration continue to be areas that could be addressed more in how we design and operate our buildings. Understanding basic human needs and translating them into environmental design is a difficult task that requires a multidisciplinary approach. In addition, policies, which guide practices within the built environment, play a major role in how it supports mental health. My previous work in institutions illuminated how someone’s environment can provide opportunities, but organizational policies often play a stronger role governing the interaction between the building and the occupants. For instance, if an employer’s policy regarding breaks during work hours is inadequate, employees are not likely to engage in restorative activities.

Could you discuss some specific features of the WELL Mind concept, and how they work to promote mental health in buildings and spaces?
Restorative Spaces (M07) is a good example of how building design should be supported by policies to support mental health. The design of the restorative space provides occupants an opportunity to unwind and recharge; however, if policies interfere with the use of that space, then that could complicate the potential benefits. Mental Health Education (M04) is another good example of efforts to promote mental health through increasing awareness, revealing misconceptions, decreasing stigmatization and normalizing conversations regarding mental health issues.

In your opinion, what are some of the biggest challenges to overcome in order to create truly people-first, spaces that support mental health?
Historically, the cause of mental health conditions have been attributed to supernatural, genetic or hereditary factors. More recently, other social and cultural factors have been included. Technological advances have allowed researchers to measure the impact of the built environment on mental health. Emerging studies are linking environmental elements with neuroinflammation and damage to brain structures. Elevating studies like these, which indicate the impact of the built environment on mental health, is the biggest challenge. Creating spaces that promote mental health and well-being require intentional design strategies, which support a broad range of basic human needs.

IWBI’s 2023 State of Workforce Well-Being Poll, conducted by The Harris Poll, found more than half of full-time employees (54%) acknowledge that their mental or physical health could be negatively impacted by their physical work environment. How do you see the role of the workplace influencing mental health?
Most adults around the world spend a majority of their time ‘at work’ and, for many workspaces, efficiency or economy controls the design decision-making process. Often, too little effort is placed on understanding the needs of the people who were expected to be productive in these spaces. This status quo reigned for many decades. In a sign of progress, this poll illustrates that people understand the role of their workplaces in their ability to achieve their full potential. With increased awareness, I think people, more and more, will demand healthy work environments, or gravitate to employers that ensure healthy workplaces.

What advice do you have for building owners, developers, and designers who want to prioritize mental health in their projects? What steps can they take to create healthier spaces for everyone?
Providing healthy spaces should no longer be considered a ‘nice to have.’ Healthy spaces are not a luxury; healthy spaces are a basic human right. Building owners, developers and designers have a moral imperative to provide places, which at the bare minimum, do no harm to their occupants. WELL’s evidence-based features provide many strategies that contribute to the health and well-being of the people who spend time there and, holistically, they can provide environments in which people thrive, make positive contributions to their communities and create a more sustainable world.

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