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

1. 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

2. Objectives Objectives: Engage public health and urban planning professions in inter-professional learning on urban environment and mental health of young children (>12) and families. Outputs: A training programme (2 half days);evidence summary; appraisal questionnaire

3. �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 Children�s participation in planning enhances their sense of competence � which enhances resilience

4. Focus of pilot: Coventry New Deal for Communities area

5. 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)

6. Theme 1: Evidence of risk Indirect risks - affecting children�s parents, hence relationship and parenting quality (McLeod 1993). Robust research on the effect of parenting on all aspects of children�s 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)

7. 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)

8. 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 children�s speech, cognitive development; reading; long-term memory Housing quality: variety of negative outcomes; inversely related to learned helplessness. (Systematic review by Evans, 2003)

9. 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)

10. 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)

12. 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?

13. 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.

14. 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)

15. Theme 4: Children�s participation in planning is critical From perspective of developmental psychology: Children�s participation in decision making increases sense of competence and agency This may begin to balance deprivation at home

16. 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

17. 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

18. Intersection Repair project Significant improvements in mental health measures after the intervention (pre and post) P<0.0001 - improved mental health; 0.02 social integration; 0.03 social competence

19. 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.

20. Conclusions Environments influence (i) parenting (ii) play (iii) social interaction (iv) development of children�s 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. Children�s 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?