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Developing concepts for early mental health prevention and treatment using
the built environment

Article in The European Journal of Public Health · September 2020

DOI: 10.1093/eurpub/ckaa165.977

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Jonas Rehn-Groenendijk Evangelia Chrysikou

Darmstadt University of Applied Sciences University College London
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v358 European Journal of Public Health, Volume 30 Supplement 5, 2020
health and the environment unite all three disciplines by
connecting health to the built environment. We characterise
this holistic interconectedness of space, health and society as
ecopsychosocial (Chrysikou, 2019) and we will use it as the
underlying theory of the workshop. Spatial interventions could
support prevention or disease-fighting mechanisms. We briefly
mention anthropocentric examples related to space and
vulnerability from the field of therapeutic architecture. The
aim is to utilise those spatial features that could affect
vulnerable people’s physiology and perception. This approach
does not replace medical intervention or treatment. Contrary,
it aims to support healthcare professionals, carers and patients
optimizing the healthcare delivery and recovery processes and
subsequently reduce efforts required to overcome stressful
situations through restaurative environment. This ecopsycho-
social system would is more helpful for of low diagnostic and
interventional accuracy such as mental illness (Christensen et
al., 2009).
References:
Christensen, CM., Grossman, JH. and Hwang, J. (2009) The
innovator’s prescription. New York USA: McGraw-Hill
Chrysikou, E. (2019) Psychiatric institutions and the physical
environment: combining medical architecture methodologies
and architectural morphology to increase our understanding.
Journal of Healthcare Engineering, vol. 2019, Article ID
4076259, 16 pages
Hillier, B. & Hanson, J. (1984) The Social Logic of Space.
Cambridge: Cambridge University Press
Marmot, M. (2015) The health Gap: the challenge of an
unequal world. Bloomsbury Publishing, London
Building capacity for public urban mental health –
example of Reflecting Citizens workshops
Marija Jevtic
M Jevtic1,2
1  To what extent people with mental health disorders
Faculty of Medicine, Institute of Public Health of Vojvodina, University of
Novi Sad, Novi Sad, Serbia
2
Research Centre on Environmental and Occupational Health, Sc, Université
Libre de Bruxelles, Brussels, Belgium
Contact: marija.jevtic@uns.ac.rs
Novi Sad is a shelter of six languages, and the place of
encounter of different cultures, of nurturing diversity through
jokes, recipes, literature, music, works of art. Diversity and
colourful customs in Novi Sad are not just the reflection of
positive movements, but also serious events, wars, big
migrations, internal and external migrations. Today Novi
Sad (and our region) are home of 21 ethnicities, with six
official languages, complicated administration, and wish to live
in peace.
Having in mind the contents and matrix which are developing
in the Reflective citizens (RC) workshops, the idea was born
that RC could become part of all activities of the city of Novi
Sad, as tool to develop the dialogue of citizens in cultural
spaces of Novi Sad, the European capital of culture in 2021.
The idea that Reflective Citizens migrate (move) through
different cultural spaces and that thus (in contact with cultural
contents) hypotheses, ideas and actions are born, which will in
positive communication make contributions to the signifi-
cance of all cultural values, is justifiable and in time gives a
visible, positive result.
Reflecting citizens workshop could be seen as a method for
building capacity concerning developing innovative concepts
for public urban mental health.
Reflective Citizens workshops contribute in improving health
in community through fostering dialogue and mutual reflec-
tion. Also, Reflective Citizens workshops are open space for all
citizens who want to contribute to dialog, multiculturalism,
tolerance, thus contributing quality of life, social environment
and mental health also.
Patient engagement, autonomy, access to mental
care services – the case for integrated care in Crete
Elena Petelos
E Petelos1,2, M Papadakaki3, C Lionis1
1
Clinic of Social and Family Medicine, Department of Social Medicine,
University of Crete, Heraklion, Greece
2
Health Services Research, CAPHRI Care and Public Health Rese, Maastricht
University, Maastricht, Netherlands
3
Department of Social Work, Hellenic Mediterranean University, Heraklion,
Greece
Contact: elena.petelos@med.uoc.gr
Access to comprehensive primary care (PC) services is
imperative to address the complex biopsychosocial needs of
patients with mental illness and their families, while it holds
the potential to safeguard mental health and enhance resilience
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in communities. Integration of mental health and social care
services in primary care has not yet been achieved, while access
to such services for the mentally ill is still hindered by patient-,
provider- and system-oriented barriers. Improving service
integration, quality and access requires active engagement of
patients and families in the design and planning of services.
Interprofessional collaboration, interdisciplinary approaches
and sound deliberative processes are only the start of initiating
discussions to establish the needs of local communities.
Mapping care paths, involving stakeholders and engaging in
practice-based research are impeded by the organisation and
design of care provision, including siloed processes and
semantic ambiguity in establishing common ground.
Academic centres ought to act as hubs for bringing together
all actors, creating living labs and addressing the needs of
people in urban and rural areas. The case study from Crete will
focus on the following questions:
 What actions are needed to improve access of people with
mental health disorders to PC services and how could PC
mediate effective communication with mental health
services?
experience violence, abuse or discriminatory behaviour in
PC?
 To what extent PC services recognize and facilitate
autonomy, self-determination and inclusion of people with
mental health disorders?
 To what extent stakeholders and PC services engage people
with mental health disorders in decision making process and
local governance?
 To what extent educational interventions for PC practi-
tioners could result in the reduction of discriminatory
behaviour and safeguard the dignity among people with
mental health disorders?
Developing concepts for early mental health
prevention and treatment using the built
environment
Jonas Rehn
J Rehn1, E Chrysikou2,3
1
Darmstadt University of Applied Sciences, Darmstadt, Germany
2
The Bartlett Real Estate Institute, UCL, London, UK
3
Clinic of Social and Family Medicine, Department of Social Medicine,
University of Crete, Heraklion, Greece
Contact: jonas.rehn@h-da.de
After the brief initial input presentations outlining relevant
aspects such as the eco-psychosocial approach as well as facts
regarding the context of the case study Crete, a co-creative
multidisciplinary workshop is being facilitated that aims at
developing concepts for early mental health prevention and
treatment focusing on innovations in the built environment.
Touchpoint inventory for urban public mental health offerings
The key methodology of the workshop follows principles from
experience design (Risbon et al., 2018) and service design
(Stickdom et al., 2018) using the touchpoint inventory. The
overall workshop is divided into two main phases. In the first
phase participants will be divided into two groups. One of

them will outline a chronological journey for early mental
health interventions for stereotypical mentally ill person (e.g.
preventive information, low threshold support groups, and so
on). The second group will collect places and elements of the
built environment that surf as a basis for interaction
(’’channels’’) by which services for mental healthcare and
prevention can be submitted (e.g. Shops, public places, coffee
shops, libraries etc.).
In the second phase, results of both groups will be collected
using a spreadsheet. All participants are then asked to ideate
concepts for ‘‘touchpoints’’ at the intersection of both groups
20.E. Round table: Health tourist and health
promotion: introducing the European Charter for
Sustainable Health Tourism
Organised by: EUPHA Health promotion section, PROMIS, Sicilian
Health Government, CEFPAS
Chair persons: Luı́s Saboga-Nunes - EUPHA-HP, Roberta Arnone - Italy
Contact: saboga.nunes@gmail.com
The goal of this workshop is to bring health tourism (HT) to
the public health perspective, raise awareness for viable HT in
the context of the Sustainable Development Goals (SDG),
while introducing the ‘‘European Charter for Sustainable
Health Tourism’’!
Mobility and the EU open market, have incremented a new
trend in the European global economy, based in HT. In 2017
of the general tourism in the EU28, 5% was due to HT. It is
expected that this share will increase in the near future. The
concept of HT needs to be refurbished since it does not
represent only medical tourism (that is the object of an
increasing set of regulations among member states) but it
includes also wellbeing and wellness (e.g with spa and quality
of life tourism) that is not scrutinized by treaties, international
or even national regulatory agencies. Citizens, therefore, play a
major role in the marked demand of HT, either by being active
actors in the procurement of services or commodities
(Prosumers), or by being passive consumers (Passumers) of
a strategic market not always aligned with well-being and
quality of life. Therefore, the need for a ‘‘European Charter for
Sustainable Health Tourism’’ is a set of references to increase
health literacy about HT and its real impact in public health.
Moreover, the aim of this workshop is to study opportunities,
offer examples and discuss on how to develop, evolve and
improve health promotion practices by actions taken at the HT
setting. First we want to invite the audience to discuss HT from
the salutogenesis perspective; In a second moment an
interregional point of view of the Silver Economy will frame
the conceptual framework on HT; a third presentation will
look at a particular case of HT and public health and the added
value of multilateralism; from here the participants will be
invited to consider the particular case of Health and Wellness
tourism in Sicily; the final presenters will look at HT in the
perspective of the Reference Sites Collaborative Network. This
workshop will use interactive methodologies of participation
so that the audience will be actively involved in the discussion
and wants to offer a forum for public health researchers,
practitioners and policy-makers interested in HT and meth-
odological insights and will allow discussing results, facilitate
exchange, and support further synergies between countries.
Key messages:
 The goal of this workshop is to raise awareness for
sustainable health tourism in the context of the SDG, by
proposing the adoption of the first ‘‘European Charter for
Sustainable Health Tourism’’.
View publication stats
16th World Congress on Public Health 2020 2020–01 v359
of elements. These concepts can serve as a conceptual starting
point for more comprehensive developments on design for
early mental health interventions.
References:
Risdon, C., Quattlebaum, P., Rettig, M. (2018) Orchestrating
experiences. Collaborative design for complexity. Brooklyn,
New York: Rosenfeld Media
Stickdorn, M., Hormess, M., Lawrence, A., Schneider, J. (Hg.)
(2018) This is service design doing. Applying service design
thinking in the real world; a practitioners handbook. First
edition. Sebastapol, CA: O’Reilly
Downloaded from https://academic.oup.com/eurpub/article/30/Supplement_5/ckaa165.977/5915921 by guest on 09 October 2020
 Explore how in European Countries (study cases) health
tourism answers health promotion principles for a more
sustainable society.
Homo Salus: the master mind behind health tourism
Luı́s Saboga-Nunes
L Saboga-Nunes1,2,3
1
Institute of Sociology, University of Education, Freiburg, Germany
2
NOVA National School of Public Health, Universidade, Comprehensive
Health Research Center (CHRC), Lisbon, Portugal
3
Institute of Environmental Health, ISAMB, Faculty of Medicine, Lisbon,
Portugal
Contact: saboga.nunes@gmail.com
Background:
Health tourism (HT) (e.g. wellness tourism, thermalism & spa,
medical tourism based in the delocalization of disease curative
segments) is pervasive today in different formats. Hubs of high
tech and nature spots are the basis for this increment of
services. HT although present in the course of human history,
has conquered a new social dimension today. Mobility and
easy access to travel, are ingredients that fueled this segment,
while a culture of health promotion (of all human dimensions
- physical, psyche, spiritual and social) diversified the marked
offers and services. The focus on health (salus, in latin) is the
basis for the HT industry, contributing to a new ethos: the
homo salus. Implications of HT need to be dissected and basic
concepts integrated, as a glossary of terms and references and a
charter of HT, from the public health perspective, are
introduced to participants.
Methods:
Document and stakeholder analysis help explore the Health
Impact Assessment (HIA) of HT towards a knowledgeable
civic society.
Results:
In the EU28, HT contributes 0.3% to the economy (2017). HT
has hindrances but represent also a set of benefits since it may
contribute to health (per see) and moreover decrease
pharmaceutical consumption and reduce health costs through
disease prevention. For this to take place a set of (compe-
tences) health literacy needs to empower the health tourist so
that the benefits of HT become sustainable. Therefore, the
concept of health needs to be clarified since the commonly
used idea of WHO (1948) of what health is, do not fit into the
overall social representation of HT.
Conclusions:
The advent of the Homo Salus as a Prosumer, is aiming at the
creation of health (salus+genesis) i.e. the quest is to become in
a better condition moving towards the health end of the dis-
ease continuum. Salutogenesis as a framework can contribute