The Tokyo-based psychiatrist Layla McCay says that though the prevalence of mental illness in Japan is comparable to other countries, people don’t talk about it much. “There can be more of a stigma associated with it than in the West,” she says. Only one in five people in Japan with mental illness seek help, while in the United States, that figure is at least one in two.

Though the Japanese may not discuss mental health as Westerners do, they are still concerned about it. “Urban policymakers in Japan often talk about the problem of stress and how to alleviate it,” McCay says. One example, karoshi, or “death from overwork,” often by stroke, heart attack, or suicide, is associated with high levels of stress. (Japan’s suicide rate is the fifth-highest in the world.) And hikkikomori are young people who withdraw from society and do not leave their homes for six months or more—a condition often triggered by high anxiety in response to pressure to succeed in school or work.

The Center for Urban Design and Mental Health, which McCay founded in 2015, recommends that cities incorporate four main themes into urban design to support mental health: green spaces, active spaces, social spaces, and safe spaces. For the past year, McCay has been conducting research on how Tokyo’s design fares.

McCay interviewed Tokyo-based public health specialists, academics, mental health specialists, urban planners, developers, and architects, and published the results of her findings in the center’s journal this month. She found a number of elements that promote mental health in the Asian megacity that metropolises across the globe might consider imitating.

Japanese government officials and planners tend to approach urban design with a view toward improving physical health rather than mental well-being, says McCay. But, she says, through this work, as well as a concern about stress, they are nevertheless creating public spaces, such as parks and walkable areas, that also shore up residents’ emotional well-being. “Thanks to their focus on greenery, walkability, and beauty, many of the spaces designed to help improve physical health exert similarly positive effects for mental health problems like anxiety and depression,” she says.   

One such initiative involves empowering citizens to create small green spaces all over the city. The Tokyo Metropolitan Government offers workshops that teach residents how to create green rooftops, wall surfaces, railroad areas, and parking lots, and offers tax incentives for such efforts. In addition, the 2003 Ordinance on the Promotion of Stylish Townscape Creation established a program in which Tokyo residents work with professional designers to plant and tend to greenery next to their property, spurring many to line the roads outside their homes with potted plants. “On these side streets,” says McCay, “it can feel like you’re walking through a park.”

In addition, these small roads have little traffic, which allows for a profusion of such greenery—and for pedestrians to dominate. McCay notes that Tokyo has managed to keep its cars and buses mostly to its main streets, so that just a block or two off the principal thoroughfares are tranquil, leafy areas conducive to walking, running errands in small shops, and social interaction. The layout is similar to Barcelona’s superblocks, but emerged more organically, largely as a result of the ubiquity and efficiency of Tokyo’s public transport, which is also mainly accessible via the busiest roads. Residents walk to and from bus and subway stops and eschew cars; the city’s automobile ownership rate is only .46 per household—similar to New York City.

The Japanese government also encourages its urban residents to partake in shinrin yoku, which literally means “taking in the forest atmosphere.” According to the report, this practice is “an opportunity for city dwellers to spend leisurely time in the forest without any distractions.” Tokyo has five official shinrin yoku trails west of the city that are easily accessible by train. Some companies include visits to them in their employee health plan.

McCay also found room for improvement. As Tokyo’s denizens spend a lot of time inside—in offices, but also shopping malls—the report encourages efforts to bring more greenery and light to these spaces. “Interviewees spoke about the need to maintain office workers’ circadian rhythms through exposure to light,” says McCay. “These questions are increasingly being posed in Tokyo as workplace stress is often in the news.”

McCay’s center is now looking into other cities’ track records, and the next will be Hong Kong. The center is also driving similar research for cities including Wroclaw, Poland; Montreal; and Morristown, New Jersey, and invites other researchers to contribute studies of their own cities.

“This is the first step in a process in which cities around the world learn from each other about urban design and mental health,” says McCay. “Even if societies think differently about mental health, the challenges are the same and the people are the same. We can all teach each other.”