Author Archives: Nikolas Rose

The Urban Brain at the Brocher Foundation – January 2019

The Urban Brain Lab: Mental Health, Migration and the Megacity (M3)

Report from the Brocher Foundation, January 2019

Nikolas Rose, Global Health and Social Medicine, King’s College London

 

In the fabulous, snowy and sunny environment of the Brocher Foundation, on the banks of Lac Léman just outside Geneva, our M3 teams from Shanghai, São  Paulo and Toronto gathered, together with key urban mental health researchers from several other groups, to assess the current state of our joint work on urban mental health.  In addition to several presentations from each group, we were joined by colleagues from Urban Transformations, and from three of the innovative ‘Thrive’ partnerships who are developing policies and practices for supporting mentally healthy cities – in New York (ThriveNYC), London (ThriveLDN) and Toronto (ThriveTO).  Our aim was to share findings and methods, and explore pathways for durable impact – how might one build on research on urban mental health to shape policies and practices for mental health friendly cities.[1]

 

Of course, when it comes to mental life and mental health, to speak of  ‘a city’ immediately threatens to mislead analysis.   Although there is an increasing literature on ‘urbanicity’ effects on mental health, the blanket idea of ‘the urban’ homogenises a multitude of different ‘environments’ experienced by those who inhabit them (Manning, KCL, London; Fitzgerald, Cardiff) .  Presentations using deep ethnography coupled with interviews showed some of this complexity (de Souza Santos, Oxford; Hatch, KCL, London), in some cases combining these with scales and other measures of mental health, and linking these to the mapping of migration and urban space (Andrade and Carvalho, São  Paulo; Mackenzie and Roche, Wellesley, Toronto).  Several groups at the workshop – notably those from London (Rose. KCL, London), Berlin (Bister, Bieler, Niewöhner, Humboldt) and Lausanne (Söderström, Neuchâtel)- were seeking alternative ways to conceptualise the urban at a more appropriate scale and form for our focus on mental health and lived experience.  In particular, presentations from these groups sought to build on James Gibson’s reconceptualization of environment-animal relations in terms of ‘affordances’ that make certain ways of acting possible, together with ideas from human geography, notably those of ‘ecological niches’.  In thinking of niches, these groups drew on a range of ideas to explore not only ‘urban stress’ but also spaces and tactics of urban solace.  These included Jacob von Uexküll’s conception of the Umwelt, approaches from cognitive ecology and notions of ‘the extended’ and ‘embodied’ mind, and work on the ‘image’ of the city, from the classic papers by Kevin Lynch to Stanley Milgram’s mental maps.  The niche that individuals inhabit is not only shaped materially by the organization of space, buildings, streets, parks, shops and cafes, not only characterised by a specific set of exposures to noise, pollutants and bugs, and not only lived through connections and transactions with multiple others, but imbued with – perhaps even constituted by – meanings, memories and affects.    What research methods might enable these concepts to be put to work in exploring the shaping of mental life and mental health – we explored the possibilities of ‘go alongs’ or walking interviews, video diaries, linking those to trajectories through space, time and interactions with mental states, perhaps through wearables, or apps enabling momentary assessment of mental states and their contexts (notably the Urban Mind app, Mechelli, KCL, London) – these offered many new research possibilities that our groups were exploring.

 

The workshop also marked the fact that our three years of research in Shanghai on mental health, migration and the megacity was drawing to a close. What had our group learned?  We had discovered quite a lot about how mental disorder is patterned in cities like Shanghai, and especially how that pattern is affected by recent dynamics of migration (Manning, KCL, London; Li, KCL, London).  The literature provides mixed evidence as to whether migrants have worse mental health, but does convincingly demonstrate that migrants are socially excluded, and this is associated with worse mental health.  However ethnographic work by Lisa Richaud (Fudan School of Public Health), working closely with Ash Amin (Cambridge), suggests that migrants have many strategies for managing the stress that is inherent in their precarious life situations, even, for example, when the very factories that employ them are razed to the ground as Chinese cities seek to ‘move up the value chain’.  While many migrants who experience mental distress may simply return to their home villages, these ways of managing stress may explain the relative lack of apparent mental ill health among many living in those situations.  Strategies include the use of minor diversions for managing ‘dead’ time; the acceptance of city interventions to clear out illegal dwellings and factories; a persistent psychological orientation to home villages, for example paying only cheap rents so that they can save to send money to their home villages, their use of affordances in the city, such as libraries and bookshops as public space for personal rejuvenation.  While Richaud found a complex mix of aspirations and hope in the coffee shops, where young migrants fear that they will become ‘salted fish’, with few hopes for the future, her overall observation is the migrants do have difficult lives, but that they are very good at developing strategies of ‘endurance.’

 

Nevertheless, there is evidence of mental ill health in other domains.  For example, research by our colleagues at Fudan University’s School of Public Health (Fu, Dai, Gao, Wang) found small but significant differences between migrants and locals in the prevalence of common mental disorders, with older migrants showing strikingly higher levels of depression measures on standardised scales.  And while relatively few migrants present themselves for support at out-patient mental health clinics, our colleagues at the Shanghai Mental Health Centre (He, Zeng, SMHC) presented suggestive findings from those that do present themselves to mental health professionals – who tend to be younger and better educated than the average among migrants – indicating, not surprisingly, that they report high levels of dissatisfaction with income and jobs, together with disappointed dreams.

 

It is also clear that government policies intersect with the experience of mental disorder in the city on many ways (Shao, SMHC).  First, of course, social exclusion is intensified by the hukou system, which deprives those who have rural status from accessing some health and social benefits while they live in the city, and has consequences for housing, for secure employment, and for children’s education.  While the plans arising from China’s new Mental Health Law focus on the development of community services and have many good ideas in principle, but (in common with cities in many parts of the world) there has been little concrete action to develop these.  For example, there have been attempts to establish community services, and those that there are – such as a weekly clinic for people who experience mental health problems at one community hospital – are little used.  Indeed in some cities outside Shanghai, such as Hangzhou, rather than an expansion of community services, new psychiatric hospitals are being built.

 

Despite migrants making up around one third of the population of Shanghai, their mental health was not a policy priority when our research commenced.  Three possibilities for transforming this situation emerged in discussion.  The first would entail increasing access from migrants to the booming on-line ‘psy complex’ that is currently largely utilised by Shanghai’s more affluent residents.  Second, to address structural issues of exclusion, it is necessary to address the policies that mean that migrants are not treated as full citizens of the cities where they work, for the hukou system sustains dynamics of social exclusion that are not conducive to mental health.  Third, in the light of presentations from colleagues in Thrives (Belkin and Peterman, Thrive NYC; Griffiths, ThriveLDN; Acco-Weston, ThriveTO), there was a strong case for mega-cities like Shanghai to join with the new international policy discussions as to how to make these cities ‘thrive’, so that the challenges of mental health are fully integrated within projects to develop ‘healthy cities’.

 

[1]     A number of papers from the Urban Brain programme on Mental Health, Migration and Megacities are forthcoming in a special supplement of the journal International Health in 2019.