Will Doig

Modern life is killing us

Writer, Salon, Aug 13, 12.

Tagged with quality of life, economy, cities, health, green space

Remember all that buzz about how the length of your commute affects your happiness? “A person with a one-hour commute has to earn 40 percent more money to be as satisfied with life as someone who walks to the office,” wrote Jonah Lehrer, God rest his soul, in 2010. (Can probably assume that wasn’t a Bob Dylan quote!) Turns out going to work not only stinks, it leaves psychological scars.

The studies were treated as a revelation, but why? We’re all well aware that our surroundings — maniacal bosses, dreary weather, cable news — mess with our heads. And yet, we haven’t historically made mental well-being a lodestar when it comes to urban design. “We’re at the point where we’re just getting people to think about the mental health implications of the urban environment,” says Lynn Todman.

Todman, an urban planner, is the principal investigator behind a new report that establishes a Mental Health Impact Assessment for her field. To be presented at a conference in Chicago next month called “The Social Determinants of Urban Mental Health,” the MHIA will codify ways that cities can build for happier, mentally healthier residents.

For years, cities have conducted Health Impact Assessments (minus the “Mental”) to make sure developments and infrastructure decisions don’t harm residents’ physical health. “But almost never something like depression or ADHD,” says Todman. Which is odd, when you think about how much energy is expended correcting mental health problems, and how those problems come back to haunt cities.

Often in unexpected ways. The circuitous link between physical environment and psychological well-being is complex enough that it can’t always be solved by simply adding “restorative” green space. “Food deserts have implications for more than obesity rates. What we’re learning now is that nutritional content is associated with aggressive behaviors and problems at school,” says Todman. “We’ve learned that when a child grows up in a distressed neighborhood, her stress hormones are chronically elevated, which is correlated with early menarche, which makes her predisposed to early pregnancy.”

That’s not to say green space isn’t important, of course; the impact of parks on urban mental health is well documented, and poor neighborhoods do tend to have fewer of them. But conditions like blight and crime can be an even bigger factor. A 2005 study of low-income African-American outpatients at a mental health clinic in Atlanta found 43 percent met the criteria for PTSD, which is less shocking when you consider that 83 percent of them had experienced some form of “severe trauma,” like a “potentially lethal attack” or a sexual assault.

The psych community has worked hard to expand mental health services to people in such neighborhoods. But even as access has expanded, the depth of treatment has thinned. “If you’re talking about the population of individuals with less severe disorders, like anxiety and depression as opposed to schizophrenia or bipolar, more low-income people are receiving treatment than before. But the treatment they’re receiving is rather shallow, and a lot of it is oriented around medication and delivered through primary care,” says Mark Olfson, a professor of clinical psychiatry at Columbia University who tracks mental health services.

A study by Olfson found that while the number of people being treated for depression rose by 2 million between 1998 and 2007, the number of people actually sitting down with a therapist declined dramatically — especially in groups with less money and schooling: “individuals of Hispanic ancestry, adults with 12 or fewer … years of education, Medicaid beneficiaries, and unemployed adults.” (African-American psychotherapy rates declined too, but only by a couple of percent, perhaps because they were already substantially lower than average.)

Money can explain a lot of this — limited-coverage insurance plans encourage patients to get some pills from their primary care doctor rather than sit down with a therapist week after week. But another piece of the puzzle is cultural. Jooyoung Lee, an assistant sociology professor at the University of Toronto, has been studying how gunshot victims in inner-city Philadelphia interact with the mental health care system.

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