Physical Environment includes the physical space in and around the school building, as well as physical safety more broadly. Healthy physical spaces includes access to safe walking and biking spaces, access to safe drinking water, adequate lighting, ventilation and good air quality free of mold, dust, mildew and other toxins. A safe environment also considers other threats to the school environment such as violence, crime, traffic injuries and response to natural disasters and other emergencies.
Implement a Comprehensive School Environmental Health Program as outlined by the Environmental Protection Agency that addresses: cleaning and maintenance practices; preventing exposure to toxins; improving air and water quality; and an integrated pest management plan.
Consider the amount of green space on and around the school campus. Research has found that neighborhoods with access to greenspace reported lower levels of depressive symptomatology, anxiety and stress.
Establish a comprehensive school safety plan that includes both physical and psychological safety measures, threat assessment procedures; crisis plans and school safety response teams. Ensure the development process includes representatives from local law enforcement, first responders, relevant governmental entities as well as school mental health professionals (counselors, psychologists, social workers, nurses), staff, families and students.
National Association of School Psychologists curriculum and training PREPaRE provides school-based mental health professionals and other educational professionals training on how to best fill the roles and responsibilities generated by their participation on school safety and crisis teams.
Mental Health by Design: NYC Public Schools
The impact of design on health has been well documented in New York City. From the development of aqueducts to the establishment of architectural building codes, there is a precedent in designing built environments to improve health outcomes.
In December 2016, the New York City Department of Health and Mental Hygiene (DOHMH) launched Mental Health by Design (MHxD), an innovative pilot aimed at promoting and improving student mental health by enhancing the design of physical environments.
MHxD aimed to:
Support school communities in enhancing physical spaces in NYC public high schools to promote emotional wellness and health equity;
Empower students to reimagine their school spaces and promote mental health among their peers;
Assess the feasibility of implementing a mental health-focused active design strategy in schools.
MHxD awarded design services to 15 NYC public high schools through ThriveNYC, New York City’s comprehensive roadmap to promote the mental health of all New Yorkers. Schools were granted the opportunity to work with design professionals and transformed 6 exterior spaces (three gardens, an outdoor classroom, an outdoor mural, and a green space) and 9 interiors (three mindful/meditation centers, an audio booth, a student art exhibition space, a mural, a student lounge, a restorative/retreat room, and a lobby redesign). The spaces were identified by students and the school community as a need at the school to help students pursue wellness-promoting activities such as mindfulness, physical activity and self-expression.
MHxD built upon the DOHMH Active Design in Schools (ADS) program, an initiative assisting NYC public schools in transforming their built environments to support physical activity and health. Active design, an evidence-based approach to the development of neighborhoods, buildings and spaces to support health, served as the guiding principle for both ADS and MHxD.
Equity was engineered into the process by setting application criteria that supported schools exhibiting high economic need and demonstrated shared decision-making and diverse ways of gathering input from the school community. Students were valued as the experts of their spaces and received training from Hyperakt, a social impact design studio, in designing community-facing campaigns promoting mental health as part of the MHxD Student Development Lab.
According to the 2015 High School Youth Risk Behavior Survey data, 29.4% of NYC public high schoolers reported feeling sad or hopeless almost every day for two or more weeks; 29.9% of students reported this nationwide. In addition, 8.3% of NYC public high school students reported having attempted suicide one or more times in the past 12 months, compared to 8.6% nationwide. The proportion of NYC students eligible for free or reduced-priced lunch is 79.9%, significantly higher when compared to state (50.2%) and national (52%) levels. In NYC, black and Hispanic students account for almost 70% of the NYC school population, 13.5% of students are English language learners and 19% are students with disabilities.
Higher levels of economic insecurity and social factors like race and ethnicity mirror levels of disease and health; the presence or absence of these factors can determine health outcomes. Furthermore, high school students experience unique stressors related to adolescent development, college preparations, and other systemic and interpersonal factors. Because students spend a large portion of their day at school, the school building and surround present a unique opportunity to positively impact health through built environment enhancements.
Conclusions and Recommendations
Using a public mental health framework informed by ThriveNYC and the Active Design in Schools program, with a particular focus on community partnerships, DOHMH successfully piloted an active design intervention that promoted mental health, youth engagement, and health equity. The following are five key conclusions and recommendations:
With appropriate resources and time, it is feasible to implement active design strategies aimed at increasing mental health awareness and opportunities for improving student mental health within high schools. Securing additional funding to maintain the spaces and mental health programming on an ongoing basis is also recommended.
The commitment of one strong school staff member to champion the project is essential for implementation; involvement of multiple school-based stakeholders can support long-term sustainability and minimize champion burnout.
Engaging students and youth as partners in guiding active design projects intended for them, while providing leadership and learning opportunities such as the MHxD Student Development Lab, can meaningfully enhance the project’s scope and facilitate authentic youth participation.
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 Beyer, K.M.M., Kaltenbach A, Szabo A, Bogar S, Nieto FJ, Maleki KM. Exposure to neighborhood greenspace and health: Evidence from the survey of the health of Wisconsin. Int. J. Environ. Res. Public Health 2014, 11(3), 3453-3472; doi:10.3390/ijerph110303453
 Brock, S.E., Nickerson, A.B., Reeves, M.A., Conolly, C.N., Jimerson, S. R., Pesce, R.C., & Lazzaro, B.R. (2016). School crisis prevention & intervention (2nd Ed): The PREPaRE model. Bethesda, MD. National Association of School Psychologists.
 Mental Health Roadmap. Thrive NYC Website. https://thrivenyc.cityofnewyork.us/. Accessed February 27, 2019
 The MHxD service package amounted to approximately $22,000 per school
 Active Design Toolkit for Schools. Center for Active Design Website. https://centerforactivedesign.org/activedesigntoolkitforschools. Accessed February 27, 2019
 Active Design Guidelines: Promoting Physical Activity and Health in Design. New York City Website. http://www1.nyc.gov/assets/doh/downloads/pdf/environmental/active-design-guidelines.pdf. Accessed February 27, 2019
 New York City Department of Health and Mental Hygiene. Epiquery: NYC Interactive Health Data System - Youth Risk Behavior Survey 2015. [October 24, 2017]. https://nyc.gov/health/epiquery
 Equity and Excellence for All: Diversity in New York City Public Schools. https://www.schools.nyc.gov/docs/default-source/default-document-library/diversity-in-new-york-city-public-schools-english. Accessed February 27, 2019
 Center for Health Equity. New York City Department of Health and Mental Hygiene Website. https://www1.nyc.gov/site/doh/health/neighborhood-health/center-for-health-equity.page. Accessed February 27, 2019
Brooklyn College Academy Brooklyn, New York Students in the improved space- courtesy of Reyes Melendez
International School for Liberal Arts, Bronx, NY "Sala de Escape (Sala de Salud Mental)" or "Mental Health Escape Room" - courtesy of Reyes Melendez
Brooklyn College Academy Brooklyn, New York Students using a meditation bowl - courtesy of Reyes Melendez
MHxD Student Development Lab posters - courtesy of Hyperakt