Design in mental health: building environments that support well-being and longevity

President Xi Jinping and other leaders have group photos taken with the recipients of national medals and national honorary titles of the People’s Republic of China in Beijing, on Sept. 29

Analysis

Mental health reports have been a recuring theme in the press over recent months: There has been a rise in suicides among young people in Hong Kong (SCMP), and Macau’s 2023 suicide rate is much higher than the global average (MDT).  As a further indicator, Internet Gaming Disorder affects 14% of the gaming population in China and 12% in both Hong Kong and Macau (recently reported in the Asian Journal of Psychiatry). A problem common to all areas is that mental health professionals are in short supply and demand on the rise. Mind HK estimates that 1 in 7 Hongkongers will experience a mental health disorder during their life and only one quarter will seek professional help for it.

In battling mental health crises, local organisations and governments are working on awareness campaigns to reverse the traditional stigma and to encourage individuals to seek help and for families to offer support rather than hide behind any sense of shame. China Daily reported on Shanghai Mental Health Center producing special mooncakes to raise awareness about mental health over this last holiday.

A number of influential studies are available to advise on what individuals can do to live and age healthily. In association with National Geographic and with funding from the National Institute on Aging, Dan Buettner and a team of demographers studied census data and identified five areas where people are living longer known as the Blue Zones.

The major finding was that longevity occurred in these areas because the environment fostered a lifestyle of longevity.  It did not take effort or will-power to live a healthy or happy life. Regular activity was nudged by gardening and walking, kneading bread, and using hand tools. Their positive outlook on life minimized stress through prayer, ancestor veneration, napping, and even happy hours with friends. Centenarians could articulate their sense of purpose: other studies have replicated the importance of purpose with a Canadian study indicating people with a sense of purpose had a 15 percent lower risk of dying. The US National Institute of Aging found people with a sense of purpose were living up to 7 years longer. Reflective of this power of purpose a number of 80- and 90-year old citizens were awarded national medals and honorary titles by Xi Jinping last week in recognition of their contributions to improving the lives of others (and one would say vice versa).

Of critical importance in the Blue Zones is connection. Family came first and multi-generational living was common. This averted loneliness. We have evidence that loneliness can reduce longevity by about 8 years, supporting the UK’s decision to have a Minister for Loneliness! Social circles are also helpful to maintain healthy habits as we tend to be similar to the five closest people around us. The author John Steinbeck articulated this age-old knowledge for which science has now provided evidence: “A sad soul can kill you quicker, far quicker, than a germ.”

Another body of knowledge offers a recipe for human success. Robert Waldinger and Marc Schulz’ book The Good Life reports on findings from the 86-year Harvard Study of Adult Development. The research has followed 268 Harvard-educated men since 1938.  A second cohort of 456 disadvantaged inner-city youths, who grew up in Boston neighborhoods in the early 1940s, has been included. There is now a Generation 2 study of 1,500 of their offspring.

Echoing the findings from The Blue Zones, the Harvard research found that those who reported being lonelier were more likely to experience mental health problems, to engage in risky physical health behaviours, and to use more negative strategies to cope with stress.

This impressive body of research recommends we modify our typical pursuits of money, achievement and status. Rather than main aspirations, they can be used as resources to help us achieve purpose. Money can allow us to acquire important things we need for well-being like good food, healthcare, secure housing; achievement leads us to goals that give us purpose, and status gives us the social respect that can be used to effect positive change for our community as exemplified by China’s national awardees.

Both the above studies and broader science says good relationships keep us happier, healthier and help us live longer.  The AIA Healthier Together Survey reports different ways that this is achieved. In China, asking people about their feelings to maintain quality relationships through meaningful conversations and in Hong Kong being physically active and having a hobby are important for feeling engaged in life.

Given this knowledge of the power of relationships and lifestyle to prevent mental and physiological illness, it is validating to note that the 2016 Healthy China 2030 Blueprint includes a focus on prevention as part of the core principle of scientific development. Much of that knowledge is already embedded in traditional ways of living and in community wisdom.

When health outcomes start to place a burden on the health system as we are beginning to see across the GBA, much wellness potential can be achieved by encouraging communities to have confidence in using existing wisdom. Institutional frameworks then help people reach a long health span by building economic and other support infrastructure to ensure healthy lifestyle choices become the default mode.  It is not so much that people do not know, but that good choices are often not available, less convenient, not as socially desirable or are less affordable.

From healthy aging to the young, greater awareness is now available about the rise in mental health issues caused by social media use among adolescents. Hong Kong child and adolescent psychiatric patients have increased by 50% from 2011/12 to 2015/16 which accords with other global data.

Over-protected in the real world and under-protected in the virtual world, children are what is known as anti-fragile. They need to be tested and stressed to become resilient social beings and to develop cognitive capacities through face-to-face social interaction. Smart phone technologies have become experience-blockers at the same time we have cocooned our children. A slew of books and documentaries have been published discussing the “great rewiring” such as The Anxious Generation (Jonathan Haidt), Stolen Focus (Johann Hari), and the upcoming Channel 4 documentary currently being produced in the UK, Swiped: The School That Banned Smartphones. Produced by Bold Print Studios, it will document a 3-week experiment with a group of 13-year-olds who will be giving up all of their modern technology. The University of York and the producers will be meticulously monitoring the effects on their health, such as sleep, Hear Rate Variability, brain function, reaction times, and memory.

In this context, the 2021 Ministry of Education’s banning of phones in mainland schools and Instagram’s teen account setting are logical protective responses to the mental health concerns, cognitive impairment, loneliness (paradoxically) and social disfunction we have been observing the last decade and now scientifically verified. The criticism of Meta is that they did not go far enough and the burden still sits with the parents to control social media behaviour. Johann Hari recommends the community bands together in like-minded groups to support the parents who might otherwise fall to pressure to acquiesce to harmful levels of social media use.

We know that much can be done individually and in community to improve mental health and physical outcomes. However, critical to this is environmental conduciveness. When governments and leaders talk about policy direction, a useful question to ask is whether the economic system, which those policies influence, is an effective incentive system for businesses, governments and individuals to support communities: for there is nothing more important than healthy individuals, thriving communities and the maintenance and regeneration of a flourishing living planet. By Leanda Lee, MDT, Contributing editor, scholar