mental health | ChangingMedia

Oct 18

The Architecture of Our Psychological Health

By Adam Conway | Health, The Global Is Local | 4 Comments

“A beautiful old mansion would be easier to redevelop than a home where someone was murdered.”

This week’s post by Lindsey Davis spurred me to think again about how our environment influences the way we experience the world around us, and the impact it has on our lives. Lindsey points out the balance that is struck when planners and city leaders determine that a neighborhood or area of the city would be better demolished than repaired.

Perhaps, she argues, these parts of the city should start a new story, free from the architecture that haunts their past.

I think she is probably right. Their present is the part that I have been thinking about, though, and the impact that living with a history and an environment may have upon the residents in any neighborhood. Each of us experiences Baltimore in a different way, and so that architectural impact is different for all of us, depending on our habits and our pre-existing constitution. Many of us cut a fairly narrow slice of the Baltimore pie (or whichever city or pastry you live in), because of where we work, study, play, or live, and the locations and routes between these activities vary for all of us.

This past weekend, the Baltimore Marathon (which I watched, but did not run) wound it’s way through much of the city, hitting the Inner Harbor, Druid Hill, Waverly, and many miles in between. The Baltimore Bike Party often has a similarly winding route, and I appreciate that both attempt to expose both residents and guests to parts of the city that typically do not get seen by tourists, commuters, and — more often than not — white people like myself.

There is no way to understand the city from the Johns Hopkins Homewood campus, or from the Inner Harbor, or from the Under Armor headquarters. The particular portions of the city that Lindsey makes reference to are not pretty, and in fact may be derelict or downright abandoned, but are integral to understanding what makes this place. Neighborhoods stricken by urban blight have an enormous impact on the financial, social, and psychological health of the city.

From a public health standpoint (which, I have argued before, is perhaps the best lens through which to analyse a human population), there are a number of concerns that urban blight brings up, including correlation with poverty, high disease burden, low literacy rates, crime and violence incidence, access to food and services.. the list goes on, of course. However, an issue that is harder to quantify is the psychological impact of a blighted neighborhood.

A 2002 article in the British Journal of Psychiatry linked found statistically significant associations between the built environment and rates of depression. Another study published in 2002, this one in the Journal of Social Science & Medicine, found that “neighborhood disadvantage was associated with higher rates of major depression and substance abuse disorder” among other negative psycho-social conditions.

This is not surprising. Think about your own home, and your favorite room or space in it. What are a few of the things that you like about it? Pick two or three of them and then meet me at the next paragraph…

Hi, welcome back. Although I can’t be sure, I strongly suspect that the things you like about your favorite room in your house have to do with beauty, comfort, positive memories or associations, or attractiveness. Now reverse that scenario, imagine your least favorite part of your home, and I would again be willing to bet a bowl of freshly roasted pumpkin seeds that the space you just identified has negative connotations, gives you feelings of dread, disappointment, or even disgust (if you’re struggling to get your walls out of the 1970s, I hear wood paneling looks great with a coat of white paint). Now scale these impressions to a street or a neighborhood, and the correlation with psycho-sociological outcomes starts to make a lot of sense.

It all comes back to the poverty/wealth disparity, in my opinion. Will money make you happy? Certainly not in isolation, but if it buys/rents you a decent place on an attractive street in a part of the city with strong civic engagement, then you’ve probably got a head-start on happiness compared to someone who lives sandwiched between abandoned buildings, has to rely on an unpredictable bus system to get to their job, and lives in one of only a half dozen occupied homes in a three block radius. Besides, once you’re in that nice neighborhood, there’s a good chance that grocery stores will be easier to get to, crime rates will drop, and transportation options will be better (well, maybe that last one is a stretch…).

The question that lingers for me is one that Lindsey also raised — is there a point where the “institutional memory” of a place is so malign that the only recourse is to remove the architecture of those memories? According to Lindsey, that may be the case. The individuals who collectively hold and live these institutional memories may be the most compelling reasons of all, however. Preserving a neighborhood of decay and bad memories is no way to effectively raise morale and standard of living. Instead, city planners may hope to cause social change through infrastructure improvements, a tired, but tried and true strategy that has had positive results in the past.

Mar 29

The Keys to Housing and Health

By Jasmine Arnold | Homelessness, The Race to End Homelessness | No Comments

Last week’s tragedy in Baltimore’s City Shelter showcased the many faults of homeless shelters. Both in Baltimore and nationally, these places can be overcrowded, unsafe, and not equipped to work with people who might be mentally ill or combating addiction. Having never stayed the night at a shelter, I am wholly unqualified to evaluate which of these shortcomings is the most serious, but my biggest gripe with shelters is something else.

The biggest fault of homeless shelters is simply that they are only ever meant to be temporary. The most commonly mentioned solution when people discuss homelessness actually does nothing to alleviate homelessness. Someone can stay in a shelter every night for a year- or longer- and be no closer to permanent housing. Homeless shelters are only a band-aid on a potentially deadly issue. Despite the human and financial costs to homeless shelters, these institutions do nothing to improve the lives of those who stay there.

Shelters, like band-aids, serve a purpose. Immediate resources are not unimportant, but they cannot be the only solution we offer those who experience homelessness in our cities. This week, fellow ChangeEngine author Robyn Stegman suggests that even when people are experiencing homelessness, they have the right to their own money and to make their own decisions. Housing First is the radical idea that people have a right to housing. Housing first programs focus on housing people as rapidly as possible, providing supportive services, and providing a standard lease (without mandated therapy).

For years, the path out of homelessness required jumping the hurdles of finding employment, remaining clean from drugs and alcohol, and maintaining a mental health regimen. Many programs that serve homeless citizens impose such rules on their clients before they will help find them housing. In 2005, Health Care for the Homeless, a Baltimore health care agency, moved 30 people who were about to be evicted from a local park into their own housing and found that nearly all of these individuals were able to remain housed. Having housing led many people to successfully secure an income and participate in mental health treatments.

Here’s the shocking thing about a program that doesn’t require its users to be clean, employed and seeking treatment before they are allowed a safe place to live: it works. In a New York City study, 84 percent of active drug users housed remained in their housing. This statistic is higher than what plenty of social service programs achieve by requiring clients to abstain from drugs and alcohol before “earning” housing. In Seattle, housing people who were chronically homeless and addicted to alcohol (without requiring clean time) not only allowed for most study participants to remain in housing — it reduced costs for the city by $2,449 per person, per month.

Baltimore’s 10 Year Plan to End Homelessness relied heavily on the Housing First Model when it was written in 2008. In Chicago, Housing First is one of three pillars of the plan to end homelessness and policy makers in Los Angeles, Boston, and New Orleans are discussing the merits of this practice. Earlier in 2013, consultants for Baltimore drafted a new version of the 10 Year Plan to End Homelessness, which mistakenly does not provide enough resources for Housing First to reach its full potential. Moving people experiencing homelessness into sustainable shelter should be a priority for any city that is looking to save lives and money. Revisions of the plan are ongoing.

For some reason, many people think that safe, affordable housing is a carrot we can hold up as an incentive to force others to make huge life changes. If shelters were used only as temporary places to stay instead of consolation prizes, we would see a dramatic decrease in not only the number of people experiencing homelessness, but also the number of people struggling with debilitating mental illness and addiction. Cities could literally hand people they keys they need to overcome addiction and maintain their mental health. Housing is not a prize for the healthy — housing is a human right.

IMAGE CREDIT: Pembroke Financial

Jan 22

A Look at the Loony Binsters

By Leanne Demery | Health | No Comments

Since “mental health” seems to be so much in the news due to the Newtown massacre, I thought I’d share a little insight on the history of how our country has dealt with mental illness.

Back in the day, people deemed to have a mental illness were left to be taken care of by family memberes. Those who didn’t have family were taken far away and stashed in institutions – rather like being quarantined. With industrialization and urbanization, families were no longer able to watch over those suffering full-time and the growth of mental asylums increased. Unlike general hospitals, which have been privatized and commercialized, mental health facilities have usually been left to the state. Also unlike hospitals, which have generally always increased in number, mental health facilities have generally increased in size since it was preferred that they stay on the outskirts of town.

At first, mental hospitals were filled with elders suffering from dementia. With the advent of nursing homes, mental health care became completely segregated. Indeed, until the popularization of psychiatry by Sigmund Freud’s visit to America in 1909, mental illness was never seen as something that could be treated or cured, but only managed. Even today there really aren’t cures for most mental illnesses – usually just sedatives and symptom depressors. Paul Starr, an expert in medical history, describes how these medications have allowed patients to be “more safely ignored” instead of treated.

The U.S. government has made only halting efforts to address mental illness over the years. When the National Institute of Health was founded in the late 1930’s a part of its budget was devoted to mental health research. And in the early 1960’s President John F. Kennedy made a push to create community health centers – a pilot program intended to link federal and community services for the mentally ill, but one that had little follow-through.

Looking back on this checkered history, it makes sense why so many would blame gun violence on those in “loony bins” even though only about three to five percent of people with mental illness actually commit violent crimes. We’ve mainly treated mental health in our country as a nuisance with shoddy institutions and stopgap remedies, never investing the time and money to develop better treatment for illnesses such as depression that plague about one in ten adults.

In my opinion, putting people in a database who have been labeled as being harmful to others is not going to do a darn thing. This proposal stems from a fundamental confusion – psych patients are not criminals. As an EMT in Chicago, I encountered many psychiatric patients and visited many psychiatric wards and institutions. Though we rarely give lobotomies any more, I found that mental health institutions are still eerily similar to the depiction in One Flew Over the Cuckoo’s Nest. Usually, when someone was labeled “harmful to others,” it was a patient who had become so angry at their environment and the way they were being treated that they lashed out with threats to hurt others. If any of us were cooped up in a place that resembled a jail, stripped of freedom and control over our own lives, the desire to hurt someone would probably not seem so insane.

If there’s any benefit to the current media circus over mental illness, it’s that a national discussion on mental health may help make people more aware that there are problems with how our country treats and views mental illness. And then maybe, just maybe, we can stop stigmatizing those who suffer and start to truly help them.