Writing Sample: Greenspace & Mental Health Research Paper (Fall 2021)

Greenspace & Mental Health Research Paper

Alexandra

Purvis Smith

Bloustein School of Planning & Public Policy 970:532: Bridging Public Health & Urban Planning

Dr. Karen Lowrie December 19, 2021

Greenspace & Mental Health Research Paper

The mental health impacts of access to greenspace connects the fields of public health and urban planning because current research in both fields show a strong connection between spending time in parks and nature and mental health benefits. Additionally, planning professionals often have a large amount of influence over where parks and other forms of greenspace are sited within their communities. Given the prevalence of mental health concerns and disorders in the United States, planners may be in a unique position to promote better mental health for community members by thoughtfully choosing the sites of parks and other greenspace in their communities.

This paper will analyze how access or lack of access to parks and greenspace may impact the mental health of a community, including what residential proximity to greenspace is associated with mental health benefits and any size or quality thresholds greenspace must meet in order to promote mental health benefits. Focus will be placed primarily on access to greenspace in cities, as rural communities can be in a different situation regarding amount of municipal planning activity as well as access to greenspace. The background section of this paper will provide an overview of the current state of mental health in the United States, how cities are theorized to affect mental health, and the connections between mental health and greenspace. An overview of this paper’s methodology will also be included in the background section. The analysis portion will take the form of a literature review of the current research regarding the connection between access to greenspace and mental health benefits, with focus being placed on research findings that can inform specific, measurable, and actionable planning interventions. The recommendations portion will suggest research-backed strategies that municipalities can use to promote better mental health within their communities, including both policy and urban design

strategies. The recommendations will also include areas within this issue where further research or additional data is needed.

Background

Current Status of Mental Health in the United States

The National Institute of Mental Health reports that “Nearly one in five U.S. adults live with a mental illness” (U.S. Department of Health and Human Services, n.d.). The Centers for Disease Control and Prevention (CDC) found that over 11% of adults in the U.S. experience “regular feelings of worry, nervousness, or anxiety”, and almost 5% of adults in the U.S. experience “regular feelings of depression” (Centers for Disease Control and Prevention, 2021). However, these numbers may be even higher: Johns Hopkins Medicine estimates that as many as 26% of adults in the U.S., “suffers from a diagnosable mental disorder in a given year” (Johns Hopkins Medicine, n.d.). Additionally, Johns Hopkins Medicine also estimates that “Approximately about 18% of people ages 18- 54 … have an anxiety disorder in a given year,” while “approximately 9.5% of American adults ages 18 and over, will suffer from a depressive illness ... each year” (Johns Hopkins Medicine, n.d.). The COVID-19 pandemic may be one factor causing the prevalence of mental health issues in the U.S. to increase: a survey report published by the CDC in March of 2021 found that between December of 2020 and February of 2021, “the percentage of adults with recent symptoms of an anxiety or a depressive disorder increased from 36.4% to 41.5%” (Vahratian et al, 2021). The noticeably higher numbers of this survey report could suggest that mental health issues in the United States may be more prevalent than numbers of diagnosed mental health disorders may suggest, as there are numerous cultural, personal, and financial factors that may deter someone suffering from one or multiple mental health issues from seeking treatment.

Current Status of Mental Health in Cities

The mental health picture for urban and suburban areas in the United States is complex, and mental health issues may even vary by the size of a city (Stier et al, 2021). Overall, mental health is generally found to be worse in cities than in rural communities, and urbanization on a global scale is correlated with higher rates of mental health issues (Gruebner et al, 2017; Stier et al, 2021; Srivastava, 2009). One study, published by the Proceedings of the National Academy of Sciences in the United States of America (PNAS), compared cities of different sizes in the U.S. and found that smaller cities may have higher rates of depression relative to larger cities (Stier et al, 2021). The CDC has found that whether someone has been treated for a mental health issues does vary based on whether they live in an urban or rural context: “While the percentage of adults who had received counseling or therapy decreased as level of urbanization decreased, the percentage who had taken medication for their mental health increased with decreasing urbanization level” (Terlizzi & Zablotsky, 2020). Some aspects of life in an urban environment are correlated with worse mental health outcomes: including urban noise and light pollution (Gruebner et al, 2017). One paper, titled Cities and Mental Health, reviewed meta-analyses of correlations between living in urban areas and mental health problems (which included anxiety, stress, mood disorders, anger, as well as some psychiatric disorders) and found that “living close to major streets or airports increases exposure to traffic noise and pollution and is associated with higher levels of stress and aggression” and that “urban light exposure may further influence the circadian rhythm and change sleeping patterns with known consequences for mental well-being” (Gruebner et al, 2017). Overall, the paper reported that “urban air, water, and noise pollution can have substantial effects on the mental health of urban populations” (Gruebner et al, 2017). One researcher from the field of neuroscience, Mazda Adli, has put forth an idea called “Urban

Stress”, positing that the stress of living in cities can negatively impact a person’s physical and mental health (Adli, 2011, p. 1-2). Reporting that “urban dwellers have a 20 percent higher risk of developing anxiety disorders, and a 40 percent higher risk of developing mood disorders”, Adli theorizes that the chronic stress associated with living in cities (due to noise, a less “controllable” environment, and disruption of “chronobiological rhythms”) is causing worse mental health for city residents (Adli, 2011, p. 1-2). These links between urban environments and mental health illustrates the critical need for urban planners to consider the mental health of their community in their planning efforts, and to work together with public health officials to address this widespread public health issue. Strategically incorporating greenspace into cities and neighborhoods may be one method of helping to improve mental health via urban planning, connecting the fields of public health and urban planning.

Greenspace and Mental Health

The field of urban planning has long been connected with the field of public health, and many historical planning movements were responses to public health crises (Peterson, 1979). Over time the two fields gradually separated, but are being reintegrated today (Duhl, Sanchez, & World Health Organization, 1999; Corburn, 2004). The link between work in urban planning’s jurisdiction and mental health outcomes has emerged more recently and is one connection illustrating the need to reintegrate the two fields (Corburn, 2004). One way in which the urban planning field intersects with community mental health relates to the inclusion of greenspace in cities, and in the past few decades, a significant amount of research has established a link between time spent in greenspace and improved mental health outcomes as well as more general positive mental health benefits. Greenspace has been shown to reduce anxiety and symptoms of depression, lower feelings of stress, boost self-esteem, and improve peoples’ moods and

emotional states. The Gruebner et al paper, Cities and Mental Health, referenced above, found in their analysis that in urban contexts, greenspace provides benefits to “mental well-being”, and that “greater access to green space and better walkability was associated with less depression” (Gruebner et all, 2017). Other researchers have found that spending time in nature is “restorative”, can help people to “recover from mental fatigue”, and that even a short amount of time spent in nature has beneficial effects on mood (Hartig, Mang, & Evans, 1991, p. 21-24). Spending time in parks has been found to improve “emotional wellbeing”, and can improve selfesteem and mood (Barton, Hine, & Pretty, 2009). Another study compared the effects of walking indoors, viewing a nature indoors, and taking a walk in nature on high cortisol levels. After finding that outdoor walk in nature resulted in the lowest cortisol levels, they explained “that walking in nature may reduce stress levels to a greater extent when experiencing higher real-life stress levels” (Olafsdottir et al, 2020) Interestingly, Olafsdottir et al draw an explicit connection between their research and possible urban planning interventions. They conclude their paper with this recommendation: “Overall, the findings have important implications for local authorities to advocate the therapeutic agency of nature walks and views and to provide the public with easy access to nature-rich places where people can relax either passively by viewing nature or actively by walking in nature” (Olafsdottir et al, 2020)

Greenspace has been found to be correlated with mental health as it can be an ‘escape’ for city residents from the various stressors that accompany city life, and neighborhoods with more greenspace are also associated with better mental health overall for residents (Guite, Clark, & Ackrill, 2006; James, Banay, Hart, & Laden, 2015). Finally, there is research suggesting that communities of lower socioeconomic levels might experience more benefits from greenspace access, relative to communities at higher socioeconomic levels, making greenspace development

a potentially useful strategy for planners to use to promote environmental justice in their communities (Gascon et al, 2015).

One area where the link between better mental health and nature or greenspace is already being utilized in the built environment is architecture’s concept of biophilic design. The concept of biophilia refers to the idea that “humans have co-evolved with nature and that we carry with us our ancient brains and our need to connect with and affiliate with nature, to be happy and healthy” (Beatley & Newman, 2013). Applying this concept by including nature in buildings, the architecture and interior design fields have found that “research at the building scale shows strong positive relationships between the presence of natural daylight, fresh air and greenery, with increases in worker happiness and productivity”, and that bringing nature into the architecture and design of buildings “is associated with improvements in positive mood, cognitive performance and even creativity” (Beatley & Newman, 2013). Timothy Beatley is one pioneering researcher in this field, and he extends this concept of biophilia beyond architecture and into city planning and urban design, coining the term “biophilic cities” – defined as “Biophilic cities are cities that provide close and daily contact with nature, nearby nature, but also seek to foster an awareness of and caring for this nature” (Beatley & Newman, 2013) This concept of biophilia has been utilized by architects and interior designers to create buildings that foster better mental health for their users, and can be utilized at the city-scale to benefit residents’ mental health as well: “Green neighborhoods and more natural living environments have been associated with reductions in stress and increased levels of physical and mental health” (Beatley & Newman, 2013). One way that planners and public health professionals can strategically make use of this concept is by examining how close city residents need to be to

greenspace, and what kind of greenspace is most beneficial to have access to, in order to reap the mental health benefits.

Methodology

Given the clear connection between greenspace and mental health benefits, this paper will utilize a literature review methodology Current research literature will be analyzed that sheds light into the specific question of how access to greenspace impacts community mental health, and whether any residential proximity or size or quality thresholds of the greenspace must be met to correlate with mental health benefits. Emphasis will be placed on peer-reviewed research studies that provide answers to this paper’s research questions. The purpose of this analysis will be to attempt to identify research-based best practices for planning for access to greenspace that promotes better mental health.

Analysis: Literature Review

Published in 2017, a study from Australia titled “Public Green Spaces and Positive Mental Health – Investigating the Relationship Between Access, Quantity and Types of Parks and Mental Wellbeing” examined how proximity to parks can encourage positive mental health. The researchers, Lisa Wood, Paula Hooper, Sarah Foster, and Fiona Bull, found that parks need to be within about 1 mile (1.6 km) of peoples’ homes to have a strong correlation with better mental health (Wood, Hooper, Foster, & Bull, 2017) They also found that positive mental health increases when the number of parks within the one mile of a person’s home increases (Wood et al, 2017). This finding held even for very small parks (the study included greenspace as small as pocket parks in their analysis) (Wood et al, 2017). Overall, this study found that the size of accessible greenspace did not matter as much for correlation with better mental health as did simply having some form of greenspace withing walking distance of home (Wood et al, 2017).

This study also examined overall greenspace area (total square miles of greenspace within a neighborhood or community, for example) to understand if that measure was also correlated with mental health (Wood et al, 2017). They found that it was strongly correlated with mental health, and that as the total area of greenspace increased, so did the community’s overall positive mental health (Wood et al, 2017). Once again, this finding was held true even when the greenspace was in the form of multiple small parks (as opposed to fewer larger parks) (Wood et al, 2017). This study only included positive mental health benefits in their research, so this research does not speak to specific outcomes from mental health disorders (Wood et al, 2017). Still, the focus on positive mental health benefits, and the very specific and actionable findings of this study, means that the one mile metric could have broad applicability to communities, if included in urban planning tools such as comprehensive plans and other types of land use plans.

Another study performed in Los Angeles, California, also examined how specific measured levels of access to greenspace (measured by residential distance from parks) interacts with mental health outcomes. Titled “Proximity to Urban Parks and Mental Health”, the authors of this study, Roland Sturm and Deborah Cohen, found that for low-income and minority neighborhoods in urban settings, the distance from home to greenspace that was correlated with mental health benefits from greenspace was less than the previous study suggested (Sturm & Cohen, 2014). Sturm and Cohen found that having access to greenspace within a quarter of a mile from of a residence was strongly related to improved mental health in the neighborhoods they studied (Sturm & Cohen, 2014). They found that having access to greenspace within a half of a mile from a residence was also related to having better mental health overall, but the relationship was not as strong as with the smaller distance (Sturm & Cohen, 2014). This study included improved mental health outcomes from mental health disorders as well as overall

mental well-being, potentially broadening the applicability of this study (Sturm & Cohen, 2014).

Additionally, this study’s focus on low-income and minority neighborhoods, and the difference in their findings from the Wood et al study, shows there may be nuance regarding the socioeconomic makeup of neighborhoods and how close greenspace needs to be to be considered ‘accessible’ and to provide mental health benefits (Sturm & Cohen, 2014; Wood et al 2017)

However, these findings regarding specific measures of access to greenspace may be moderated by other factors such as the how safe the accessible greenspace is or is perceived to be (Orstad et al, 2020). Researchers Stephanie L. Orstad, Kristin Szuhany, Kosuke Tamura, Lorna Thorpe, and Melanie Jay found that safety was an important factor for residents to make use of nearby parks, and that “the benefits of living near greenspace may depend on park conditions such as adequate safety” (Orstad et al, 2020). This is another important consideration for planners to balance along with access to parks. Their study suggests it is important to ensure that community members and nearby neighborhood residents feel safe spending time in nearby parks and greenspace in order for the mental health to be benefitted (Orstad et al, 2020).

Another very recent study, titled “Exposure to Urban Green Space May both Promote and Harm Mental Health in Socially Vulnerable Neighborhoods: A Neighborhood-Scale Analysis in New York City”, examined this very issue of proximity versus safety of greenspaces and the resulting impacts on mental health. The researchers, Eun-Hye Yoo, John Roberts, Youngseob Eum, Xiaojiang Li, and Kevin Konty, found that in New York City neighborhoods, “people living in socially disadvantaged neighborhoods have the most at stake in terms of green space exposure” (Yoo et al, 2022). They explain that their research findings suggest that for lower income neighborhoods, greenspace that is perceived as unsafe or provides a place for unsafe activities to take place may cause negative mental health impacts for nearby residents

(Yoo et al, 2022). However, this study also found that “street-level visibility to greenery (which is not necessarily connected to public spaces) appears to serve the protective function” of providing mental health benefits, even in lower income neighborhoods, suggesting that greening neighborhoods for benefitting mental health can be done in other ways beyond developing traditional parks (Yoo et al, 2022)

Related to Yoo et al’s finding about “street-level greenery” is another study, published in 2013 (Richardson et al, 2013; Yoo et al, 2022). In this study, titled “Role of Physical Activity in the Relationship Between Urban Green Space and Health” the study authors found that neighborhoods with around fifteen percent of greenspace cover was strongly related with improved mental health outcomes for residents and as well as a lower risk of experiencing detrimental mental health problems (Richardson et al, 2013) However, above fifteen percent, the differences in mental health were not found to be significant (Richardson et al, 2013) This finding could present urban planners with an easy metric to operationalize – its specificity would make it an interesting and measurable goal for a comprehensive plan, for example (Richardson et al, 2013).

This leads into the second piece of this paper’s question, does the greenspace a person has access to need to meet any size and quality standards in order to have a positive effect on mental health? There is not broad agreement on this issue. One 2012 study by researchers in the Netherlands found that what they termed “quality of the streetscape greenery” was more correlated with promoting positive mental health than park quality in the neighborhoods they studied (Van Dillen et al, 2012). Tying back to the Richardson et al and the Yoo et al piece, this does suggest that overall ‘greenness’ of a neighborhood or urban area is influential on mental health. However, in another study (published 2014), researchers May Carter and Pierre Horwitz

found in their study titled “Beyond Proximity: The Importance of Green Space Useability to SelfReported Health” that greenspace needed to not only be withing walking distance of a person’s residence to be beneficial to mental health, but the greenspace also needed to be perceived as ‘usable’ to be correlated with better mental health for nearby neighborhood residents (Carter & Horowitz, 2014). But what specifically can planners consider to be ‘usable’ greenspace?

This leads to another study that may help to provide some specifics for that planners can work with. Researchers Jacinta Francis, Lisa Wood, Matthew Knuiman, and Billie Giles-Corti investigated this question in their 2012 study titled “Quality or quantity? Exploring the relationship between Public Open Space attributes and mental health in Perth, Western Australia” Francis et al found through their study that higher quality greenspace is very strongly correlated with better mental health outcomes for nearby residents, when compared to areas with larger quantities of lower quality greenspace (Francis et al, 2012). They found that greenspace elements such as good walking paths, thriving plant life, water features, and even the presence of birds were all features that contributed to high quality parks, and that these specific aspects of high quality greenspace were correlated with improved mental health (Francis et al, 2012).

Recommendations for Planning and Public Health Professionals

Multiple themes emerge from the above detailed research that can guide urban planners and public health professionals desiring to promote better mental health within their communities. First, it seems that parks need to be within an easy walking distance of a neighborhood to help promote better mental health for the neighborhood’s residents (Sturm & Cohen, 2014; Wood et al, 2017). Second, it seems that the size of a park may not matter for promoting good mental health; instead, it seems that a greater cumulative quantity of greenspace (even in the form of small parks and even street greening interventions) is more beneficial for

mental health (Richardson et al, 2013; Yoo et al, 2022). Third, there is some evidence suggesting that high quality parks are related to mental health benefits, but it does seem that more research on that questions needs to be done in U.S. cities (Carter & Horowitz, 2014; Francis et al, 2012). Fourth, safety of greenspace appears to be an important quality for facilitating mental health benefits via greenspace (Orstad et al, 2020 ; Yoo et al, 2022) Overall, these themes can provide urban planners as well as public health professionals a good starting point for beginning to implement different policies and strategies in order to make their communities more beneficial to positive mental health. But there are still many areas where there are many unknowns and more research is needed.

Recommendations: Areas for Further Research

Because this area of research is relatively new, with the majority of the findings very recently uncovered, there are many more areas within this issue that need to be researched First, more research into ways greenspace may affect specific mental health disorders or individual mental health issues (such as anxiety, for example) is needed. As this paper has detailed, there is strong evidence showing the connection between overall mental health improvements and access to greenspace. But there is not as yet a clear picture of the ways in which greenspace access might affect specific mental health disorders, such as anxiety or depression. It could be helpful for both urban planners and public health officials to understand more about whether greenspace access and particular qualities of greenspace can influence specific mental health disorders such as anxiety or depression, and this avenue of study could be a good next step for researchers working on these issues. For example, if a city’s planners, working with their local public health officials, identify concerningly high levels of depression, anxiety, or another specific mental health issue in their community, it would be helpful to know whether increasing greenspace can

specifically help improve that particular mental health issue. Implementing this recommendation for further research in this area will likely require partnerships between planning researchers, public health researchers, and researchers in medical fields.

Second, more data needs to be collected and made available to urban planners, public health officials, and researchers working in issues related to mental health (including city planning). There is a lack of comprehensive data on a broad spectrum of mental health issues in the U.S., and especially at a local level. Other common health issues are tracked across the U.S., and mental health issues need to be included as well – mental health is still health. For planners and public health officials specifically, being able to access and view comprehensive data on mental health (including anxiety, depression, mood disorders, psychiatric disorders, and more) mapped down to a very local level (including at the neighborhood or block level) could help planners identify neighborhoods that are in need of planning interventions such as more targeted greenspace investment to help improve mental health. This recommendation will likely require both increased data collection at the national level, involving public health professionals nationwide, as well as data collection at very local levels, requiring partnerships with public health professionals and care providers in cities and counties.

Another third area where more research would be helpful for municipal urban planners would be more information on the minimum density of plant life needed in a park or other form of greenspace for it to provide mental health benefits. Is there a threshold where too much plant life is associated with negative mental health impacts, such as feelings of unease or stress over perceived lack of safety? How much vegetation should planners include, or require to be included, in greenspace developments? Many cities have specific landscape requirements for developments, often varying by the zoning of the new development. If there were research-based

standards for how much plant life provided better mental health benefits, cities could translate those into their development ordinances to improve their residents’ mental health. Along similar lines, more research into how parks and greenspaces can be designed to facilitate real and perceived safety for users could also be very helpful for planners, given the research described in this paper regarding the connection between the safety of greenspace and the associated mental health impacts. This kind of research could be helpful both to urban planners but also to urban designers and landscape architects, possibly providing an opportunity for research partnerships on this topic.

Finally, additional research into greenspace access outside of residential contexts could help planners improve the environments of their cities as a whole in order to foster mental health improvements. It could be helpful to have additional research into how greenspace access near workplaces, along commuting routes, and in educational settings might influence mental health. How does access to greenspace from peoples’ workplaces impact their mental health? Would they take advantage of that access and utilize greenspace over a lunch hour, for example? Or how would additional greenspace on a university campus impact the mental health of students?

How would an increase in greenspace along children’s’ routes to school and on their school grounds affect the mental health of children in the U.S.? These are just a few examples of questions that could help expand planners’ understanding of how and where to implement more greenspace throughout the city as a whole, not just in neighborhoods. These kinds of studies are likely to be difficult and may require planners and public health researchers to partner with other disciplines such as geography to address the complicated spatial questions likely to arise in these kinds of studies.

Recommendations: Policies and Strategies for Greenspace that Benefits Mental Health

The above research suggests that mental health in communities and neighborhoods could benefit from a focus by city planners on providing a greater quantity of parks and greenspaces, in a range of sizes including smaller parks, as well as other forms of neighborhood greening (Carter & Horowitz, 2014; Francis et al, 2012; Orstad et al, 2020; Richardson et al, 2013; Yoo et al, 2022). The first recommendation for planners is to identify opportunities to infill urban areas, especially residential areas, with greenspace. For example, vacant lots in neighborhoods could be restored into small parks, community gardens, pollinator gardens, or rain gardens. Even on very small vacant areas, pocket parks could be a beneficial strategy for planners to employ in areas needing more greenspace. One challenge of implementing this recommendation is likely to involve maintenance and cost. For cities where that is the case and where there may not be a large budget or extra maintenance capacity, rain gardens consisting of low-maintenance native plants (which will also provide the co-benefit of assisting with stormwater runoff) may be a good alternative to more maintenance-intensive types of gardens (The Groundwater Foundation, n.d.). This could be a helpful strategy to employ in lower income and minority neighborhoods vulnerable to gentrification, and leads to the second recommendation. The second recommendation is for planners to specifically focus on increasing small parks as well as overall greening of neighborhoods in low income and minority neighborhoods, and avoid larger park projects. Researchers studying the relationship between gentrification and greenspace have found that while large park projects do tend to encourage gentrification, smaller parks generally do not lead to gentrification (Wolch, Byrne, & Newell, 2014). Because the mental health benefits of greenspace do not appear to be limited to larger parks but are also correlated with smaller parks, utilizing vacant lots for increased greenspace could be a useful strategy for urban planners

looking to improve mental health in low income and minority neighborhoods without risking the displacement that gentrification can cause. Even on very small vacant areas, pocket parks could be a beneficial strategy for planners to employ in areas needing more greenspace. Maintenance manpower and cost is likely to be a challenge for cities considering developing a greater quantity of greenspace. For cities where that is the case and where there may not be a large budget or extra maintenance capacity, rain gardens consisting of low-maintenance native plants may be a good alternative to more maintenance-intensive types of gardens. As the research has suggested that overall greening of neighborhoods is also beneficial to mental health, especially in lower income neighborhoods, planners (in partnership with public health officials) should also prioritize other greening strategies Increasing street trees may be one method of doing this, and other greening strategies used when developing green streets could help to increase ‘greenness’ of neighborhoods and promote better mental health, while also providing the infrastructure services that green streets provide (New Jersey Future, n.d.).

The third recommendation is to provide increased quantities of greenspace within easy, walkable distances from neighborhoods. For low income neighborhoods, the research suggests that this distance should be about a quarter of a mile, or at most a half of a mile (Sturm & Cohen, 2014). For other neighborhoods, distances up to a mile may be acceptable (Wood et al, 2017) But utilizing the smaller distance as a standard for greenspace proximity in planning efforts could also ensure that far more people are able to benefit from access to parks and greenspace. Older adults, children, and many other people may not necessarily have the ability or the time (or inclination) to walk one mile each way to a park. Additionally, they and many other people, depending on age, income status, disability, and other factors, may also not have access to a personal vehicle to drive one mile to a park. Developing more greenspaces towards the goal of

ensuring that communities and neighborhoods have access to greenspaces within one quarter to one half of a mile of their homes could increase greenspace accessibility for all different ages and abilities, and allow many more people to benefit from the mental health benefits of greenspaces. However, recognizing that planning for all residents to have access to greenspace within a quarter or a half mile of their place of residence is an extremely challenging goal for municipalities to undertake, there may be an opportunity for a phased approach here. Perhaps an interim goal of ensuring all residents have access to greenspace within one mile of their residence could be a starting point for cities with neighborhoods that do not meet that benchmark. Once that goal is reached, municipalities could begin to work on decreasing the distance even further until neighborhoods have greenspace within a quarter to a half mile. One challenge this recommendation may face is difficulty acquiring land for an increase in the number of parks and other types of greenspace, especially in more dense urban areas. Utilizing vacant lots for greenspace could help in areas that do have high amounts of vacancy. But in urban areas without high amounts of vacancy, planners may find implementing this recommendation to be very challenging.

The fourth recommendation is for planners to include goals of bettering community mental health in all relevant and appropriate land use plans. In the study by Sturm and Cohen, they suggest incorporating mental health as a goal in neighborhood improvement programs (Sturm & Cohen, 2014). However, it may be beneficial to include fostering positive mental health as a goal in other types of plans as well. Goals related to physical health and fostering a healthy community are becoming increasingly common to see in the strategic plans, comprehensive plans, and other types of land use plans of municipalities across the U.S. One logical extension could be the inclusion of mental health as a goal in these types of plans as well.

The previous recommendations listed in this paper could provide a starting point for specific objectives and strategies planners could employ to work towards a goal of encouraging better mental health in their communities. One challenge planners may face in getting this goal incorporated into planning documents is a lack of good, local data on the specific mental health status of cities and neighborhoods. This could provide an opportunity to work with their local public health officials to share any data and information that is known. Another challenge to this may be any lingering stigma in this country around discussing mental health or acknowledging the prevalence of mental health issues. If that challenge arises, placing an emphasis on the cobenefits (such as providing stormwater benefits and reducing urban heat) that increasing greenspace can provide could be an effective communication strategy

The fifth recommendation is for planners to focus on prioritizing quality over size when developing greenspaces (Francis et al, 2012). As development, installation, and maintenance cost is likely to be a challenge for all of these recommendations, a focus on smaller high quality parks may help to alleviate budget concerns that would accompany larger, more expensive park projects. Pocket parks could be a good low-cost strategy for planners to consider, as well as the aforementioned focus on developing small parks on vacant lots.

The sixth recommendation for planners is to include specific percentage goals for greenspace cover in neighborhoods in planning documents like neighborhood plans and comprehensive plans. Percentage goals for urban canopy goals, or renewable energy goals, are a commonly seen metric for cities to use in their comprehensive plans, and the Richardson et al study illustrates, this method of measuring greenspace may be helpful for city planners as well (Richardson et al, 2013). Implementing this type of percentage greenspace goal might encourage strategies like infill and general neighborhood greening as a way to reach a percentage goal,

which would work well with previous recommendations in this paper. Additionally, by encouraging smaller-scale greening strategies, this kind of goal may also benefit low-income and minority neighborhoods, as smaller greenspaces are not likely to cause gentrification but can still provide mental health benefits (Wolch, Byrne, & Newell, 2014) This kind of goal may face challenges from people unused to thinking about greenspace in this way, so communication strategies for this recommendation should include emphasis on the co-benefits to neighborhoods that infill and greenspace can provide, beyond mental health benefits.

Key Stakeholders for Implementing Recommendations

These recommendations are likely to be implemented by municipal urban planners, ideally in partnership with local public health officials. For many of these recommendations, municipal planners may also need to partner with private-sector landscape designers, urban designers, and urban planning consultants, as well as obtaining approval for these recommendations from local planning commissions as well as city councils. It will be helpful for planning staff and local public health officials to form partnerships in order to share local data and insights into their communities and to coordinate overlapping policies and initiatives.

Private-sector landscape designers, urban designers, and urban planning consultants are likely to be instrumental in creating the designs for urban greenspaces and implementing the more urban design focused interventions. They are the stakeholders who will likely choose specific elements and interventions to include in greenspace designs, so it will be important for both the municipal planning staff to set a vision for improving mental health through researched-based greenspace improvements in their community, and equally important for private-sector designers and consultants to be familiar with research-based methods and strategies for designing greenspace to promote good community mental health.

At the county, state, and regional levels, partnerships with county and state public health officials as well as regional planning coalitions or councils may also be beneficial for implementing the recommendations. County and state level public health officials may be able to provide helpful data on mental health needs in cities. Regional planning coalitions often have regional greenspace or open space plans for their regions which may provide opportunities and co-benefits for cities looking to increase greenspace to better the mental health of their residents. Community-based activists and advocacy groups could also use these recommendations to advocate for more investment in their neighborhoods. And because of the specificity and actionability of these recommendations (and the studies they are rooted in), community-based activists and advocates could also to hold their municipal planning departments accountable.

Conclusion

The past few decades of research has made it clear that greenspace does have a relationship with mental health. While research into the mental health benefits of increasing access to greenspace is a new and still-evolving field, the existing research shows exciting evidence that communities can truly experience better mental health with strategic greenspace interventions. With mental health becoming recognized as a serious health issue in the U.S., planners have a responsibility to help their community experience better mental health. A paper on this topic would be incomplete without recognizing that the COVID-19 pandemic is making the mental health situation in the U.S. even more dire (Vahratian et al, 2021). Although this is a sobering challenge for planners to confront, it may also provide an opportunity for planners to openly communicate with their communities about the benefits that increased investment in greenspace could provide, and to partner with public health professionals to begin to mitigate and help communities heal from the damaging mental health effects of this pandemic.

References

Adli, M. (2011). Urban stress and mental health. LSE Cities.

Barton, J., Hine, R., & Pretty, J. (2009). The health benefits of walking in greenspaces of high natural and heritage value. Journal of Integrative Environmental Sciences, 6(4), 261-278.

Beatley, T., & Newman, P. (2013). Biophilic cities are sustainable, resilient cities. Sustainability, 5(8), 3328-3345.

Bezold, C. P., Banay, R. F., Coull, B. A., Hart, J. E., James, P., Kubzansky, L. D., ... & Laden, F. (2018). The association between natural environments and depressive symptoms in adolescents living in the United States. Journal of Adolescent Health, 62(4), 488-495. Centers for Disease Control and Prevention. (2021, September 13). FastStats - Mental Health Centers for Disease Control and Prevention. Retrieved December 12, 2021, from https://www.cdc.gov/nchs/fastats/mental-health.htm.

Corburn, J. (2004). Confronting the challenges in reconnecting urban planning and public health. American journal of public health, 94(4), 541-546.

Duhl, L. J., Sanchez, A. K., & World Health Organization. (1999). Healthy cities and the city planning process: a background document on links between health and urban planning (No. EUR/ICP/CHDV 03 04 03). Copenhagen: WHO Regional Office for Europe.

Francis, J., Wood, L. J., Knuiman, M., & Giles-Corti, B. (2012). Quality or quantity? Exploring the relationship between Public Open Space attributes and mental health in Perth, Western Australia. Social science & medicine, 74(10), 1570-1577.

Gascon, M., Triguero-Mas, M., Martínez, D., Dadvand, P., Forns, J., Plasència, A., & Nieuwenhuijsen, M. J. (2015). Mental health benefits of long-term exposure to residential green and blue spaces: a systematic review. International journal of environmental research and public health, 12(4), 4354-4379.

Green streets: New jersey future. New Jersey Future | Working for Smart Growth: More Livable Places and Open Spaces. (2021, November 4). Retrieved December 20, 2021, from https://www.njfuture.org/issues/environment-and-agriculture/water-sewer/greeninfrastructure/green-streets/

Gruebner, O., Rapp, M. A., Adli, M., Kluge, U., Galea, S., & Heinz, A. (2017). Cities and mental health. Deutsches Ärzteblatt International, 114(8), 121.

Guite, H. F., Clark, C., & Ackrill, G. (2006). The impact of the physical and urban environment on mental well-being. Public health, 120(12), 1117-1126.

Hartig, T., Mang, M., & Evans, G. W. (1991). Restorative effects of natural environment experiences. Environment and behavior, 23(1), 3-26.

James, P., Banay, R. F., Hart, J. E., & Laden, F. (2015). A review of the health benefits of greenness. Current epidemiology reports, 2(2), 131-142.

Johns Hopkins Medicine. (n.d.). Mental health disorder statistics. Johns Hopkins Medicine. Retrieved December 13, 2021, from https://www.hopkinsmedicine.org/health/wellnessand-prevention/mental-health-disorder-statistics.

Mental health disorder statistics. Johns Hopkins Medicine. (n.d.). Retrieved December 12, 2021, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/mental-healthdisorder-statistics.

Olafsdottir, G., Cloke, P., Schulz, A., Van Dyck, Z., Eysteinsson, T., Thorleifsdottir, B., & Vögele, C. (2020). Health benefits of walking in nature: A randomized controlled study under conditions of real-life stress. Environment and Behavior, 52(3), 248-274.

Peterson, J. A. (1979). The impact of sanitary reform upon American urban planning, 18401890. Journal of Social History, 13(1), 83-103.

Rain gardens. The Groundwater Foundation. (n.d.). Retrieved December 20, 2021, from https://www.groundwater.org/action/home/raingardens.html

Richardson, E. A., Pearce, J., Mitchell, R., & Kingham, S. (2013). Role of physical activity in the relationship between urban green space and health. Public health, 127(4), 318-324. Srivastava, K. (2009). Urbanization and mental health. Industrial psychiatry journal, 18(2), 75. Stier, A. J., Schertz, K. E., Rim, N. W., Cardenas-Iniguez, C., Lahey, B. B., Bettencourt, L. M., & Berman, M. G. (2021). Evidence and theory for lower rates of depression in larger US urban areas. Proceedings of the National Academy of Sciences, 118(31).

Sturm, R., & Cohen, D. (2014). Proximity to urban parks and mental health. The journal of mental health policy and economics, 17(1), 19.

Terlizzi, E., & Zablotsky, B. (2020, September 23). Mental Health Treatment Among Adults: United States, 2019. Centers for Disease Control and Prevention. Retrieved December 13, 2021, from https://www.cdc.gov/nchs/products/databriefs/db380.htm.

U.S. Department of Health and Human Services. (n.d.). Mental illness. National Institute of Mental Health. Retrieved December 12, 2021, from https://www.nimh.nih.gov/health/statistics/mental-illness.

Vahratian, A., Blumberg, S. J., Terlizzi, E. P., & Schiller, J. S. (2021). Symptoms of anxiety or depressive disorder and use of mental health care among adults during the COVID-19

pandemic United States, August 2020–February 2021. Morbidity and Mortality Weekly Report, 70(13), 490.

Van Dillen, S. M., de Vries, S., Groenewegen, P. P., & Spreeuwenberg, P. (2012). Greenspace in urban neighbourhoods and residents' health: adding quality to quantity. J Epidemiol Community Health, 66(6), e8-e8.

Wolch, J. R., Byrne, J., & Newell, J. P. (2014). Urban green space, public health, and environmental justice: The challenge of making cities ‘just green enough’. Landscape and urban planning, 125, 234-244.

Wood, L., Hooper, P., Foster, S., & Bull, F. (2017). Public green spaces and positive mental health–investigating the relationship between access, quantity and types of parks and mental wellbeing. Health & place, 48, 63-71.

Yoo, E. H., Roberts, J. E., Eum, Y., Li, X., & Konty, K. (2022). Exposure to urban green space may both promote and harm mental health in socially vulnerable neighborhoods: A neighborhood-scale analysis in New York City. Environmental Research, 204, 112292.