Editor’s note: Julze Alejandre is a health promotion specialist and a Hydro Nation PhD scholar at Glasgow Caledonian University. Ragene Palma is an urbanist, and studied International Planning and Sustainable Development MA at the University of Westminster. Both authors are Chevening alumni. The opinions expressed in this article are the authors’.
In 2020, better mental health was brought up to justify Manila Bay’s synthetic white sand filling and re-filling. But will this project really have the intended effect?
Assessment of the project’s social impact is still lacking.
Consider, first, the state of Filipinos’ mental health.
Before the global spread of coronavirus, anxiety and depression have been negatively affecting people’s quality of life — their productivity and social relationships. Mental health illness and retardation ranked third and fourth, respectively, in terms of disability types in the Philippines, while intentional self-harm ranked ninth as the leading cause of death among young adults. An increasing incidence of suicide among the younger population was also observed, having 2 out of 10 adolescent students who attempted suicide and 1 out 10 who inflicted self-harm. Additionally, a 2015 survey relating to drug dependency in the country exposed 1.8 million Filipinos who are currently drug and substance dependent and 4.8 million who are lifetime drug dependent. There were also 3 out of 10 sampled government workers in Metro Manila who experienced mental health problems during their lifetime.
This emerging mental health epidemic has been seen to be aggravated by the COVID-19 pandemic. Restrictive lockdowns that affect how people socialize and interact have a potential impact on mental health, which poses a global health concern. While lockdowns are designed to protect the vulnerable from contracting coronavirus, it also causes unintended consequences: the fear of contracting coronavirus and dying alone; unmet spiritual needs due to restrictions in attending faith-based activities; and poor social health conditions due to physical distancing, isolation, and restrictions in meeting friends and loved ones contribute to the risk of having mental health conditions such as depression and anxiety during the pandemic. Frontline healthcare workers also experience stress, fear, and anxiety due to the lack of support from the government in terms of safe working conditions, protective equipment, testing, underpayment, and delayed hazard pay. A study conducted during the first lockdown between March and April showed that 1 out of 4 respondents reported moderate-to-severe anxiety while 2 out of 10 reported moderate-to-severe depression brought on by the presence of COVID-19 symptoms, imposition of quarantine measures, staying at home, unnecessary worry, family concerns, fear of getting sick, and discrimination.
The Philippines’ Mental Health Act mandates that “mental health is a basic right of all Filipinos.” Despite this, mental health services remain to be underfunded making it inadequate, inaccessible, unaffordable, and inequitable to Filipinos. Stigmatization and social exclusion of people with mental health conditions and their financial status continue to affect health seeking behavior and quality of life. There is also a gap on the availability of evidence-based psychological interventions in local areas. The Mental Health Act aims to integrate mental health care in basic health and social care services — essentially in educational institutions, workplaces, and communities. This means expanding the mental health service delivery from the conventional facility-based service to a more accessible community-based delivery. Despite the pressure to implement this expansion, mental health services remain to be widely facility-based.
In light of the celebration of World Suicide Prevention Day last year, DOH together with WHO Western Pacific Region jointly emphasized that the “first step to [mental health] healing begins at home.” This underscores the need for community-based mental health care, which means bringing mental health services closer to every Filipino’s home. To this end, informal collaborations in education, justice, social welfare, and overseas worker sectors, including the development of guidelines for mental health first aid are already in existence. Despite these collaborative efforts, a link connecting the importance of recreation and environmental sectors to mental health improvement is missing.
Prescribing blue spaces
Social prescribing is one alternative strategy that aims to improve mental and social wellbeing without resorting to clinical interventions. People who benefited from social prescriptions are those with mental and social health concerns deeply rooted in worrying about other social determinants of health such as education; livelihood, neighborhood, housing, and inclusion in society.
Green or nature prescription is a variant of social prescriptions. This utilizes the health-promoting benefits of green spaces (e.g., parks) and blue spaces (e.g., water ecosystems like bays, seas and lakes).
While the benefits of green spaces on mental health have been widely circulated and even adopted in people’s homes, the health-giving benefits of blue spaces are associated with natural stress reducers namely good ventilation and fresh air (both important in reducing risks to coronavirus infection), reduction of heat island effect and noise, and soothing soundscapes (for example, waves lapping). These make blue spaces conducive places for physical and social activities such as swimming, running, sightseeing, or any structured or unstructured recreation. They are soft and fascinating escapes.
A quick social media survey showed some insights that for some, this escape means “freedom” and “adventure” within the “vastness, fragility, and depth” of blue environments. To others, going to blue spaces means connecting to a peaceful environment providing “solitude, euphoria, and refreshment.” Some equate this to a homey state characterized by tranquillity, and serenity. These demonstrate that time spent in nature can improve mental fatigue and concentration through unforced brain use, eventually restoring individuals’ attention capacity. The responses also support how water (which is essential in design) can transform our environments to be more spiritual and meaningful for its users.
Valuing water in our urban environment
Manila Bay has been the blue space in headlines. Yet, it is worth asking how connected Metro Manila’s urban populace is to it. Aside from those living, working, and regularly traversing Roxas Boulevard, some urbanites wouldn’t feel much affinity with this blue space.
In actuality, Metro Manila has many other blue spaces that are already accessible to the public. However, many are undervalued and uncared for. For instance, the Marikina-Pasig River and its tributaries traverse the metro, while numerous creeks and esteros stretch across patches of our urban fabric. Sadly, these water environments are almost always associated with flooding and danger, when there is so much potential in their location. Access is important in the urban dweller’s experience of blue spaces — imagine if we could cycle along clean waterways, cross-city, on the way to work.
So how can our cities utilize blue spaces and make things work for our mental wellbeing amid the pandemic? On a large scale, approaching blue spaces with an integrative framework, one with appreciation for ecosystem services, can outline how our cities can better plan together, instead of pursuing one-off initiatives. Rethinking nature as infrastructure is essential. The Philippines heavily relies on concrete, when natural elements, such as trees and waterscapes can provide more reliable services. Our rivers, for example, create distinct character in our places. They have the potential to provide healing or therapeutic landscapes, and elicit positivity and restorative elements into our immediate environments.
While ecological components are quick to come to mind when discussing blue spaces, such as conservation and biodiversity, integrating urban planning efforts with public health is critical on how we deal with this pandemic. Globally, research showed that engaging with blue-green spaces had a positive impact on mental health during lockdown. While procuring vaccines and reducing the number of new cases have been the priority in managing the pandemic response, there also exists the opportunity to create salutogenic city spaces, or environments that enable us to resist threats to wellbeing.
Continuing to live with the impacts of COVID-19 can be detrimental to Filipinos if we deprive ourselves of the benefits that nature, particularly blue spaces, can provide for our mental wellbeing. While many of us cope with finding natural touches while residing in limited spaces, and with the constraints our cities already face, addressing mental health — through ecosystem services, or through reconfiguring our environments — becomes vital. Particularly, importance should be put on how sectors — those in public health and in planning — can collaborate. It is imperative that perspectives and findings from this writing push policymakers to rely on science more, and decide which projects could lead to the betterment of our people and the environment they live in. Hopefully, the next conversations wouldn’t just be about Manila Bay, but how Filipinos begin to truly benefit from blue-green interventions, for the sake of their wellbeing.