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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.

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Image: By Moyan Brenn from Anzio, Italy – Tokyo, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=40604084

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