Urban planning to promote the mental health of young children and families: a review of the evidence

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Urban planning to promote the mental health of
young children and families a review of the
evidence

• Dr. Anita Schrader McMillan
• Warwick University Medical School

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Objectives

• Objectives
• Engage public health and urban planning
  professions in inter-professional learning on
  urban environment and mental health of young
  children (gt12) and families.
• Outputs
• A training programme (2 half days)evidence
  summary appraisal questionnaire

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Strands of literature

• Urban poverty indirect threats (the way poverty
  affects parenting). Good parenting buffers
  against external stressors. Urban poverty
  direct threats of poor, dangerous, stigmatised
  environments
• Nature
• Social capital
• Children have a unique perspective on their own
  environment not shared by adults
• Childrens participation in planning enhances
  their sense of competence which enhances
  resilience

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Focus of pilot Coventry New Deal for
Communities area
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Cities and mental health

• Large cities are a relatively new phenomenon
• Changes in household composition
• Poverty lack of social capital (community
  organisation) lack of participation ( in some
  contexts race) associated with a range of risks
  to physical health (Young Foundation report on
  local wellbeing, 2008)

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Theme 1 Evidence of risk

• Indirect risks - affecting childrens parents,
  hence relationship and parenting quality (McLeod
  1993). Robust research on the effect of
  parenting on all aspects of childrens
  development
• Direct risks affect adolescents most obviously,
  but also younger children. Eg street design
  that enables crime the broken glass syndrome
  (several studies, eg Dalgards Tambs, 1997 in
  the UK)

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Indirect risks - parenting

• Housing design enables or disables social
  interaction of adults and children social
  capital play.
• Social isolation of families (especially women)
  is, cross-culturally, highly associated with
  child increased risk to children
• Aspects of environment can undermine social
  networks eg lack of interaction nodes the
  grid system of roads absence of places where
  people can congregate
• Housing security Arrears/repossessions have
  independent effects over financial hardship
  comparable to divorce and job loss (Taylor et al
  2007)

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• Direct and indirect risks often hard to separate
• Household crowding lower motivation in task
  performance restricted play learned
  helplessness. When crowding SES, higher
  preschooler aggression. Adults lowered
  responsiveness
• Noise - and childrens speech, cognitive
  development reading long-term memory
• Housing quality variety of negative outcomes
  inversely related to learned helplessness.
• (Systematic review by Evans, 2003)

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• Traffic volume restriction in outdoor play and
  smaller social networks for 5-year-olds with
  diminishment of their social and motor skills
  (Huttenmoser 1995 Tranter Pawson 2001)

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Lack of access to nature (limits play
interaction with adults social networks
cognitive development Taylor et al
1998).Playgrounds are not an adequate substitute
(Tranter Pawson 2001)
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Table 1 Developmental Tasks of Childhood
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Child mental health indicators UK

• Parenting
• Play
• Risk factors tend to be cumulative
• Resilience better than expected outcomes in
  spite of exposure to risk factors (
• How can regeneration promote resilience?

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Does urban regeneration, in and of itself,
necessarily improve mental health outcomes?

• Urban regeneration does not, in and of itself,
  necessarily increase mental health outcomes of
  adults (1 large scale study South Manchester
  Huxley, 2004) there may be sleeper effects
• The urban regeneration initiative failed to
  address the concerns of local residents and
  failed to remove restricted opportunities, which
  appeared to be the key factor (ibid. 280)
• Strong community organisations an be undermined
  by efforts to institutionalise them.

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Theme 2 Exposure to natural environments can
improve mental health

• Studies by Frances Kuo of greenspaces and child
  mental health
• Physiological effects when humans encounter,
  observe or interact with nature established and
  successful methods of nature-based therapy (eg
  horticulture, wilderness, animal contact)
• Natural environments foster recovery from mental
  fatigue and stress (Maller, 2005)

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Theme 4 Childrens participation in planning is
critical

• From perspective of developmental psychology
  Childrens participation in decision making
  increases sense of competence and agency
• This may begin to balance deprivation at home

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Ridley Grove school, Australia

• Children involved in planning and implementing
  use of waste land connecting primary and
  secondary schools
• Using a range of methods to educate children in
  spacial literacies (ways of thinking about space)
  and critical literacies how they would recreate
  the space
• Children created visual artifacts (models, maps)
  to guide the creation of the new space
• Cognitive and social skills
• Developmental competence in the real world
• Belonging
• Wish to become architects, to explore university

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Repairing urban space, Oregon, USA (Semeneza 2003)

• City Repair is non-governmental all work done
  by volunteers old and young adults, children,
  youth, homeless people
• Repair is physical, social and symbolic
  participation
• Examples of physical improvements
• Neighbourhood kiosks with bulletin boards for
  information exchange (news, sales, etc)
• Benches esp for older people decorated with
  stained glass mosaics
• Trellises at the corners of intersections
• Street murals in intersections
• Solar powered lanterns to light the streets in
  the evenings
• Planter boxes in non parking zones of
  intersections enforce no parking rules

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Intersection Repair project

• Significant improvements in mental health
  measures after the intervention (pre and post)
• Plt0.0001 - improved mental health
• 0.02 social integration
• 0.03 social competence

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Future policy and practice should incorporate the
following

• Participation of local residents with specific
  attention to preschool and primary school
  children in all aspects of the planning and
  regeneration process.
• Creation of green spaces for unstructured play
  (e.g. open spaces and parks)
• Improve housing including attention to noise
  levels and congestion in addition to overall
  housing quality and housing security.

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Conclusions

• Environments influence (i) parenting (ii) play
  (iii) social interaction (iv) development of
  childrens competence and resilience.
• Overall improvements in housing are associated
  with improved mental health of adults
• The process of regeneration is critical, as it
  can enable or disable social interaction/social
  capital.
• Childrens active involvement in planning and
  implementing changes in their environment can
  compensate for deficits in other areas of their
  lives promote resilience.
• Questions
• How do we mainstream the participation of
  preschool and primary school age children in
  urban regeneration?
• What are the effects of the coming recession on
  highest risk environments?