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Volume 37, Issue 3 (2022)
GeoRes 2022, 37(3): 327-337 |
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Received: 2022/04/13 | Accepted: 2022/08/1 | Published: 2022/07/1
Received: 2022/04/13 | Accepted: 2022/08/1 | Published: 2022/07/1
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Haghighat Naeini G, Farahani H, Fanaei S. Pathology of Urban Regeneration Programs in Terms of Mental Health: The Experts’ Perspective. GeoRes 2022; 37 (3) :327-337
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1- Department of Urban Planning, Architecture and Urban Planning Faculty, Art University, Tehran, Iran
2- Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
2- Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
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Introduction
The experience of relying on physically oriented urban planning processes in various cities worldwide has produced unfavorable outcomes, particularly in the social realm. These shortcomings paved the way for alternative theories that, in addition to the physical form of cities, also considered other dimensions such as social and economic aspects. This paradigm shift in the foundations of urban planning theories has undoubtedly manifested in practice, and what is now recognized as the evolutionary progression of urban regeneration approaches has emerged as a result of this shift in perspective [Roberts et al., 2017]. In this context, the urban regeneration approach, as a comprehensive policy for addressing urban problems, took shape with the onset of globalization in the 1980s and became linked with the sustainable development paradigm in the 1990s [Bonyadi, 2012]. One of the key objectives of this approach, beyond preventing and addressing urban problems is the enhancement of residents’ quality of life and the livability of targeted areas and neighborhoods, which are often deprived regions [Urban Regeneration Corporation of Iran, 2014; Izadi, 2018]. Thus, the topic of health, and particularly its psychological dimension, has been an implicit yet underexplored objective within the urban regeneration approach.
Although health may appear to be a transient concern within urban policies, it has become evident that, due to its connection with all dimensions of life in cities, it has been incorporated into the agenda of urban regeneration projects. However, the impacts of such projects on various dimensions of health, including mental health, remain insufficiently understood [Boyle et al., 2020; Corcoran, 2020; Garretsen et al., 2020; Murray & Landry, 2020; Kearns et al., 2020]. Mental health, as one dimension of overall health, encompasses the cognitive, psychological, emotional, and affective states of individuals. Feelings of self-satisfaction, self-confidence, positive personality traits, and the absence of negative emotions contribute to mental well-being, whereas stress, anxiety, anger, and similar feelings lead to psychological distress [Grover & Singh, 2019]. Accordingly, mental health refers to the balance individuals establish between themselves and their living environment, a balance within which they function and engage in daily activities [Hjelm, 2012; Huber et al., 2011; Bircher, 2005]. This dynamic view of mental health highlights the relationship between people’s living environments and their mental well-being, beyond individual differences and personal capacities.
In line with the principles of positive psychology, which examines the conditions and processes that lead individuals, groups, and communities to flourish and function optimally [Seligman & Csikszentmihalyi, 2014] urban studies on environmental factors affecting citizens’ mental health have increasingly focused not only on identifying environmental stressors and their negative effects but also on recognizing urban spaces and developments that are not stress-inducing and may, in fact, promote mental well-being. In reality, beyond individual differences and personal characteristics including family background urban planning and design processes and their resulting products influence citizens’ mental health. Here, “product” refers to the built environment, its physical and natural aspects, as well as the relationships and interactions individuals experience within the social environment.
With respect to mental health and urban regeneration projects, a wide range of interventions, such as promoting physical activity, improving housing quality, enhancing neighborhood quality and reputation (both internal and external), increasing safety and security, improving neighborhood aesthetics, creating employment opportunities, increasing income, enhancing public welfare, strengthening individuals’ sense of dignity and recognition (including all groups and vulnerable populations), addressing their concerns throughout the regeneration process, empowering individuals (e.g., enhancing their ability to control and make decisions affecting their lives), promoting community empowerment (e.g., involving residents in the regeneration process), supporting personal development, addressing disturbances and pollution caused by project implementation, and mitigating stress arising from imposed conditions during and after the project may influence the mental health of citizens and residents in targeted urban regeneration areas [Bond et al., 2012; Kearns et al., 2012; Kearns et al., 2013; Mason & Kearns, 2013; Curl et al., 2015; Baba et al., 2017; Boyle et al., 2020; Corcoran, 2020; Garretsen et al., 2020; Murray & Landry, 2020; Kearns et al., 2020].
Based on the aforementioned points and the existing theoretical literature regarding the effects of urban regeneration programs on citizens’ mental health, it can be argued that a “mental health–supportive urban regeneration program” must possess specific characteristics and attributes to adequately respond to mental health needs. However, urban regeneration as currently practiced in Iran suffers from serious shortcomings and fundamental weaknesses in this regard. Therefore, one key topic concerning the role of regeneration projects in supporting the psychological dimension of citizens’ health is the analysis and diagnosis of these programs from a mental health perspective. Conducting such an analysis allows for the examination of the mechanisms involved in regeneration and, based on this diagnosis, the redirection of regeneration processes toward those compatible with mental well-being. Hence, the aim of the present study was to identify and diagnose the shortcomings of urban regeneration programs so that these programs may be aligned with mental health indicators and thereby support citizens’ psychological well-being.
Methodology
The method employed in this study was survey-based and implemented through two distinct techniques: semi-structured interviews and the completion of a weighted questionnaire by experts. In addition, relevant documentary data were collected from various sources and examined alongside the survey analysis. Sampling was carried out using the snowball method, resulting in the identification of 17 experts across three groups: Academic researchers, urban regeneration specialists, and managers within Tehran’s urban governance institutions. The criterion for ending the sampling process was theoretical saturation of responses [Willig, 2013]. Subsequently, the interview content was analyzed using open and axial coding techniques.
Data collection took place during autumn and winter of 2021. Paradigmatically, the study focused on urban regeneration projects defined within the fifth term of urban management in Iran (2017–2021).
A qualitative questionnaire with four questions was used to guide the interviews. The results obtained from the interviews were categorized into primary and secondary codes and subsequently transformed into a quantitative questionnaire consisting of 39 Likert-scale items (five-point scale). This second questionnaire was distributed among specialists to assess the positive and negative dimensions affecting mental health in urban regeneration projects, based on the experts’ practical experience in preparing such programs. The results were analyzed using the "impact spectrum" method [Bazargan et al., 2007].
To validate the questionnaire, the Content Validity Ratio (CVR) was used. Six faculty members and specialists familiar with the study’s subject evaluated each questionnaire item using a three-point scale based on the method described by Farahani & Roushan Chesli (2019): Essential, useful but not essential, and not necessary. The total scores for each item were assessed using the Lawshe formula [Farahani & Roushan Chesli, 2019], and items with a CVR value below 0.99 were removed. Consequently, only the most important items were included in the final quantitative questionnaire. Reliability was assessed using Cronbach’s alpha with a pilot sample of 30 respondents. The overall reliability coefficient for the questionnaire was 0.79, indicating an acceptable level of internal consistency.
The geographical context of this study is the city of Tehran. In fact, the urban regeneration programs considered here refer to projects that were planned or implemented within the Tehran metropolitan area. Actions conducted under urban regeneration in Tehran based on the national regeneration policies approved by the Supreme Council of Urban Planning and Architecture of Iran in 2018 include several types of interventions, such as: housing rehabilitation, renovation and structural strengthening, development and upgrading of urban and neighborhood-scale public amenities and services, enhancement of utility networks, and development of urban spaces [Supreme Council of Urban Planning and Architecture of Iran, 2018].
Findings
The findings of this study are presented in three thematic sections. The first section describes the dimensions and components of a mental-health-oriented urban regeneration program, aiming to elucidate its characteristics based on the principles and theoretical foundations of the urban regeneration approach. The second section examines the inefficiencies inherent in the current process of preparing urban regeneration plans in the country. Finally, the third section evaluates the degree to which each consequential dimension of urban regeneration affects mental health.
Dimensions and Characteristics of Mental Health–Oriented Urban Regeneration Programs
Content analysis of the interviews revealed a set of characteristics for urban regeneration programs that support mental health features that have received limited attention in the theoretical literature on urban regeneration. These dimensions essentially represent the external effects of regeneration projects and encompass both positive and negative impacts.
Based on the results, urban regeneration programs may influence mental health through eight positive and four negative dimensions. The positive dimensions include: Enhanced social interactions and collective action, improved environmental quality, respect, attention to children, sense of identity and place attachment, safety and security, strengthened self-confidence and self-actualization, and reinforcement of altruistic and charitable values. The negative dimensions include: disturbance of comfort, stress and anxiety, discrimination and inequality, and insecurity. These dimensions can be incorporated into impact assessment questionnaires during and after project implementation.
Inefficiencies in the Current Process of Preparing Urban Regeneration Plans
Urban regeneration in Iran, in its current conventional form, diverges substantially from its theoretical foundations and paradigmatic origins. As a result, many projects are labeled as “urban regeneration” merely in name, while lacking substantive regeneration content and thus failing to meaningfully promote citizens’ health and mental well-being.
Interview findings identified 37 types of inefficiencies that hinder the realization of mental-health-supportive regeneration programs. These inefficiencies fall into three major domains:
(3) monitoring and evaluation.
Inefficiencies in policy-making constitute the most critical and fundamental challenge, shaping and reproducing weaknesses across all subsequent stages. This issue is not limited to regeneration programs but pertains more broadly to the national system of urban development decision-making and policy-making. Although human needs lie at the core of urban regeneration theory, the principal challenge in Iran concerns the identification and prioritization of these needs. The planning and policy system prioritizes physical needs over social ones. The absence of a social perspective in intervention programs, including regeneration results in the neglect or distortion of the principles that originally shaped the philosophy of urban regeneration. Consequently, a non-participatory, top-down, and sectoral decision-making structure emerges, producing adverse consequences over time.
Furthermore, a combination of political, managerial, institutional, and individual factors directs spatial planning policies toward project-oriented, opaque, unaccountable, and non-public approaches.
The process of preparing and approving regeneration plans has long been criticized by urban development experts. The standardization of terms of reference has transformed regeneration from a “social process” into a “time-bound project.” The removal of process-orientation leads to abrupt, accelerated, and top-down planning. However, rapid preparation does not equate to rapid implementation; rather, inadequate allocation of time for preliminary studies and design leads to unforeseen complications during execution, extending projects far beyond their intended timelines. Additionally, structural deficiencies within the system contribute to the marginalization of mental health considerations. One of the most significant weaknesses is the dominance of physical-infrastructural committees in steering the entire regeneration process, while non-physical committees, responsible for mental health–related functions, are generally absent from key decision-making meetings. Social and cultural barriers to citizen participation further reinforce the prescriptive nature of these programs.
The third domain concerns the evaluation of regeneration programs, which could potentially address aspects of citizens’ mental health needs. According to the findings, experts almost unanimously agreed that evaluation and monitoring mechanisms are intentionally removed from planning structures by key policy-makers, and oversight bodies function more as interventionist than supervisory institutions. Social, environmental, and health assessments are typically neglected. Although interviewees were divided into those who opposed and those who supported the use of such assessments, there was consensus that project impact evaluation must form an integral part of the urban planning process rather than being relegated to the margins. Crucially, all urban projects generate externalities, both positive and negative, and psychological impacts are among these externalities. However, such effects are never assessed in Iran. Consequently, mental health is marginalized across policy-making, plan preparation and approval, and implementation evaluation, highlighting the need for a fundamental revision of the terms of reference and the overall process of plan preparation and execution.
Assessment of the Impact of Regeneration Consequences on Mental Health
To evaluate the intensity of the impact of each consequential dimension of urban regeneration on mental health, a questionnaire using a five-point Likert scale was administered. Experts rated each item from 1 (lowest level of impact) to 5 (highest level of impact). The midpoint score was 3. The overall mean for each main parameter was calculated by summing responses to its corresponding items. The impact level of each of the twelve main dimensions was then determined using an impact spectrum:
These findings clearly demonstrate that every urban project generates external effects on residents that must be systematically assessed, yet such effects are not evaluated in any national project. The most significant positive effects of regeneration on mental health were the development of public spaces and the improvement of urban environmental health. The most significant negative effects included increased property prices, followed by anxiety regarding potential forced displacement and the creation of vulnerable or unsafe spaces.
Discussion
The present study sought to address the following three questions:
Another issue related to the first question is that most existing studies have examined urban regeneration programs primarily in terms of their direct physical and environmental impacts on mental health, including improvements in housing and neighborhood quality, access to public services, safety and security, transportation, neighborhood aesthetics, physical activity, employment, knowledge enhancement, empowerment, and social equity (Mehdipanah, 2014; Davidson et al., 2013; Egan & Lawson, 2012; Lawson & Kearns, 2010). By contrast, non-physical, intangible, psychological, sensory, and symbolic effects have received far less attention. The present study identified a wide range of non-physical and psychological effects of urban regeneration programs, including stress and anxiety, self-confidence, self-actualization, respect, sense of belonging, socialization, collective agency, attention to children, charitable behavior, and altruistic values.
Regarding the second question, the results revealed that the barriers hindering the achievement of mental-health-supportive urban regeneration lie within the mechanisms of policymaking, preparation, approval, implementation, and monitoring of these programs. To better integrate mental health into urban regeneration initiatives, these mechanisms must be reformed. Findings from Javan Majidi et al. (2020) show that the uniformity of terms of reference for regeneration programs in diverse contexts, including historic districts and informal settlements has led to their ineffectiveness. Moreover, the policymaking approach underlying these programs is functionalist in nature and primarily based on economic considerations, resulting in the neglect of their social aspects. A consequence of this issue is the gentrification of neighborhoods and the displacement of original residents, indicating the failure of such regeneration programs (Masoud et al., 2019; Abachi et al., 2018).
Additionally, the evaluation and monitoring stage of programs constitutes one of their most critical points of vulnerability. In all countries, this stage represents the most precise phase of project management (Davidson, 2022; Lin et al., 2021). The advantage of evaluation is that continuous feedback minimizes errors and deviations, allowing for timely and effective solutions to unforeseen problems (Davidson, 2022). In practice, implementation and evaluation are not separate processes; they proceed concurrently. As shown by Heravi and Mohammadian (2019), deficiencies in monitoring systems represent one of the major gaps in the management of urban projects in Iran. Tracing the reasons behind the elimination of the evaluation and monitoring stage in urban regeneration programs revealed that this issue primarily stems from the country’s flawed governance and management paradigm, which one respondent likened to a “fiefdom management model.” In this model, managers prioritize retaining their position above all else, and managerial actions, decisions, and policies are primarily oriented toward preserving the manager’s status rather than advancing the program itself. Consequently, in such a structure, attention to mental health and the assessment of project impacts on citizens’ psychological well-being carries little significance.
Finally, the third research question examined the nature of the effects of urban regeneration programs on mental health in Tehran. Findings from this section indicated that, in assessing the impacts of urban regeneration interventions, in addition to understanding the problems these interventions seek to address, it is essential to consider how they are implemented. Individuals’ control over these processes, the creation of social capital, and supportive social networks that enhance self-esteem and efficacy can reduce environmental stressors and depressive symptoms. Conversely, processes that restrict opportunities, marginalize residents, and neglect community needs have adverse psychological impacts and foster feelings of hopelessness toward such interventions, a phenomenon also discussed in Rogers et al. (2008) and Baba et al. (2017). A clear domestic example is the construction of the Imam Ali Expressway, which lasted more than ten years. During this period, residents within the project boundary, knowing they would eventually have to sell their homes to Tehran Municipality, faced prolonged uncertainty and an ambiguous future. Studies by Kheireddin et al. (2016) and Mozaffari et al. (2017) indicate that many of these residents were forced to relocate to lower-income neighborhoods. Sudden increases in property prices, essentially selling homes below value while facing inflated market prices pushed households into areas significantly lower in status than their original neighborhoods, generating numerous psychological consequences. Yet such impacts are never assessed in project evaluation systems.
The researchers faced several limitations in conducting this study, which future research can help address. The impact assessment carried out here was a preliminary evaluation designed to determine the potential significance of each indicator. Undoubtedly, these effects can be assessed more comprehensively through standardized questionnaires administered to residents of target neighborhoods and other groups benefiting from urban regeneration programs. Such surveys could be conducted before, during, and after the implementation of urban regeneration initiatives.
Conclusion
Based on the findings of this study, the relationship between urban regeneration programs and citizens’ mental health encompasses all the characteristics embedded in project planning processes, the resulting designed environments, the socio-economic conditions influencing these processes, and the manner in which such programs are implemented. Collectively, these factors may affect physical and social well-being and, indirectly, mental health; or they may directly influence mental health indicators, such as stress, anxiety, psychological pressure, tension, insecurity, fear, and perceived deprivation through changes in individuals’ lifestyles or their socio-economic status. Another key conclusion is that urban regeneration, in its original aims and principles, possesses an inherent capacity to support mental health. However, the way such programs are formulated in Iran, characterized by the absence of a human-centered approach to urban space and the dominance of physical, architectural, and design-oriented perspectives—has failed to empower residents living in distressed neighborhoods. Consequently, these programs have not only fallen short of promoting mental well-being but have themselves become factors contributing to further deterioration of citizens’ mental health.
The analysis of the positive and negative impacts of current urban regeneration programs on citizens’ mental health indicates that, in their existing form of preparation and implementation in Iran, these programs generate more negative than positive outcomes. Therefore, a transformation in the theoretical and methodological frameworks, along with a revision of the terms of reference and the procedures for preparing, implementing, and monitoring these plans, is imperative.
Acknowledgments: None is reported by the authors.
Ethical Permission: None is reported by the authors.
Conflict of Interest: This article is derived from a portion of the third author's doctoral dissertation, entitled “Developing an Evaluation Framework for Assessing the Impacts of Sustainable Urban Regeneration Projects on Citizens’ Mental Health,” conducted under the supervision of the first author and the advisement of the second author at the Faculty of Architecture and Urban Planning, University of Art, Tehran, in 2022.
Authors’ Contributions: Haghighat Naeini GH (First Author), Methodologist (25%); Farahani H (Second Author), Methodologist (25%); Fanaei S (Third Author), Principal Researcher / Discussion Writer (50%).
Funding: This research was conducted using the authors’ personal funds
The experience of relying on physically oriented urban planning processes in various cities worldwide has produced unfavorable outcomes, particularly in the social realm. These shortcomings paved the way for alternative theories that, in addition to the physical form of cities, also considered other dimensions such as social and economic aspects. This paradigm shift in the foundations of urban planning theories has undoubtedly manifested in practice, and what is now recognized as the evolutionary progression of urban regeneration approaches has emerged as a result of this shift in perspective [Roberts et al., 2017]. In this context, the urban regeneration approach, as a comprehensive policy for addressing urban problems, took shape with the onset of globalization in the 1980s and became linked with the sustainable development paradigm in the 1990s [Bonyadi, 2012]. One of the key objectives of this approach, beyond preventing and addressing urban problems is the enhancement of residents’ quality of life and the livability of targeted areas and neighborhoods, which are often deprived regions [Urban Regeneration Corporation of Iran, 2014; Izadi, 2018]. Thus, the topic of health, and particularly its psychological dimension, has been an implicit yet underexplored objective within the urban regeneration approach.
Although health may appear to be a transient concern within urban policies, it has become evident that, due to its connection with all dimensions of life in cities, it has been incorporated into the agenda of urban regeneration projects. However, the impacts of such projects on various dimensions of health, including mental health, remain insufficiently understood [Boyle et al., 2020; Corcoran, 2020; Garretsen et al., 2020; Murray & Landry, 2020; Kearns et al., 2020]. Mental health, as one dimension of overall health, encompasses the cognitive, psychological, emotional, and affective states of individuals. Feelings of self-satisfaction, self-confidence, positive personality traits, and the absence of negative emotions contribute to mental well-being, whereas stress, anxiety, anger, and similar feelings lead to psychological distress [Grover & Singh, 2019]. Accordingly, mental health refers to the balance individuals establish between themselves and their living environment, a balance within which they function and engage in daily activities [Hjelm, 2012; Huber et al., 2011; Bircher, 2005]. This dynamic view of mental health highlights the relationship between people’s living environments and their mental well-being, beyond individual differences and personal capacities.
In line with the principles of positive psychology, which examines the conditions and processes that lead individuals, groups, and communities to flourish and function optimally [Seligman & Csikszentmihalyi, 2014] urban studies on environmental factors affecting citizens’ mental health have increasingly focused not only on identifying environmental stressors and their negative effects but also on recognizing urban spaces and developments that are not stress-inducing and may, in fact, promote mental well-being. In reality, beyond individual differences and personal characteristics including family background urban planning and design processes and their resulting products influence citizens’ mental health. Here, “product” refers to the built environment, its physical and natural aspects, as well as the relationships and interactions individuals experience within the social environment.
With respect to mental health and urban regeneration projects, a wide range of interventions, such as promoting physical activity, improving housing quality, enhancing neighborhood quality and reputation (both internal and external), increasing safety and security, improving neighborhood aesthetics, creating employment opportunities, increasing income, enhancing public welfare, strengthening individuals’ sense of dignity and recognition (including all groups and vulnerable populations), addressing their concerns throughout the regeneration process, empowering individuals (e.g., enhancing their ability to control and make decisions affecting their lives), promoting community empowerment (e.g., involving residents in the regeneration process), supporting personal development, addressing disturbances and pollution caused by project implementation, and mitigating stress arising from imposed conditions during and after the project may influence the mental health of citizens and residents in targeted urban regeneration areas [Bond et al., 2012; Kearns et al., 2012; Kearns et al., 2013; Mason & Kearns, 2013; Curl et al., 2015; Baba et al., 2017; Boyle et al., 2020; Corcoran, 2020; Garretsen et al., 2020; Murray & Landry, 2020; Kearns et al., 2020].
Based on the aforementioned points and the existing theoretical literature regarding the effects of urban regeneration programs on citizens’ mental health, it can be argued that a “mental health–supportive urban regeneration program” must possess specific characteristics and attributes to adequately respond to mental health needs. However, urban regeneration as currently practiced in Iran suffers from serious shortcomings and fundamental weaknesses in this regard. Therefore, one key topic concerning the role of regeneration projects in supporting the psychological dimension of citizens’ health is the analysis and diagnosis of these programs from a mental health perspective. Conducting such an analysis allows for the examination of the mechanisms involved in regeneration and, based on this diagnosis, the redirection of regeneration processes toward those compatible with mental well-being. Hence, the aim of the present study was to identify and diagnose the shortcomings of urban regeneration programs so that these programs may be aligned with mental health indicators and thereby support citizens’ psychological well-being.
Methodology
The method employed in this study was survey-based and implemented through two distinct techniques: semi-structured interviews and the completion of a weighted questionnaire by experts. In addition, relevant documentary data were collected from various sources and examined alongside the survey analysis. Sampling was carried out using the snowball method, resulting in the identification of 17 experts across three groups: Academic researchers, urban regeneration specialists, and managers within Tehran’s urban governance institutions. The criterion for ending the sampling process was theoretical saturation of responses [Willig, 2013]. Subsequently, the interview content was analyzed using open and axial coding techniques.
Data collection took place during autumn and winter of 2021. Paradigmatically, the study focused on urban regeneration projects defined within the fifth term of urban management in Iran (2017–2021).
A qualitative questionnaire with four questions was used to guide the interviews. The results obtained from the interviews were categorized into primary and secondary codes and subsequently transformed into a quantitative questionnaire consisting of 39 Likert-scale items (five-point scale). This second questionnaire was distributed among specialists to assess the positive and negative dimensions affecting mental health in urban regeneration projects, based on the experts’ practical experience in preparing such programs. The results were analyzed using the "impact spectrum" method [Bazargan et al., 2007].
To validate the questionnaire, the Content Validity Ratio (CVR) was used. Six faculty members and specialists familiar with the study’s subject evaluated each questionnaire item using a three-point scale based on the method described by Farahani & Roushan Chesli (2019): Essential, useful but not essential, and not necessary. The total scores for each item were assessed using the Lawshe formula [Farahani & Roushan Chesli, 2019], and items with a CVR value below 0.99 were removed. Consequently, only the most important items were included in the final quantitative questionnaire. Reliability was assessed using Cronbach’s alpha with a pilot sample of 30 respondents. The overall reliability coefficient for the questionnaire was 0.79, indicating an acceptable level of internal consistency.
The geographical context of this study is the city of Tehran. In fact, the urban regeneration programs considered here refer to projects that were planned or implemented within the Tehran metropolitan area. Actions conducted under urban regeneration in Tehran based on the national regeneration policies approved by the Supreme Council of Urban Planning and Architecture of Iran in 2018 include several types of interventions, such as: housing rehabilitation, renovation and structural strengthening, development and upgrading of urban and neighborhood-scale public amenities and services, enhancement of utility networks, and development of urban spaces [Supreme Council of Urban Planning and Architecture of Iran, 2018].
Findings
The findings of this study are presented in three thematic sections. The first section describes the dimensions and components of a mental-health-oriented urban regeneration program, aiming to elucidate its characteristics based on the principles and theoretical foundations of the urban regeneration approach. The second section examines the inefficiencies inherent in the current process of preparing urban regeneration plans in the country. Finally, the third section evaluates the degree to which each consequential dimension of urban regeneration affects mental health.
Dimensions and Characteristics of Mental Health–Oriented Urban Regeneration Programs
Content analysis of the interviews revealed a set of characteristics for urban regeneration programs that support mental health features that have received limited attention in the theoretical literature on urban regeneration. These dimensions essentially represent the external effects of regeneration projects and encompass both positive and negative impacts.
Based on the results, urban regeneration programs may influence mental health through eight positive and four negative dimensions. The positive dimensions include: Enhanced social interactions and collective action, improved environmental quality, respect, attention to children, sense of identity and place attachment, safety and security, strengthened self-confidence and self-actualization, and reinforcement of altruistic and charitable values. The negative dimensions include: disturbance of comfort, stress and anxiety, discrimination and inequality, and insecurity. These dimensions can be incorporated into impact assessment questionnaires during and after project implementation.
Inefficiencies in the Current Process of Preparing Urban Regeneration Plans
Urban regeneration in Iran, in its current conventional form, diverges substantially from its theoretical foundations and paradigmatic origins. As a result, many projects are labeled as “urban regeneration” merely in name, while lacking substantive regeneration content and thus failing to meaningfully promote citizens’ health and mental well-being.
Interview findings identified 37 types of inefficiencies that hinder the realization of mental-health-supportive regeneration programs. These inefficiencies fall into three major domains:
- policy-making approaches,
(3) monitoring and evaluation.
Inefficiencies in policy-making constitute the most critical and fundamental challenge, shaping and reproducing weaknesses across all subsequent stages. This issue is not limited to regeneration programs but pertains more broadly to the national system of urban development decision-making and policy-making. Although human needs lie at the core of urban regeneration theory, the principal challenge in Iran concerns the identification and prioritization of these needs. The planning and policy system prioritizes physical needs over social ones. The absence of a social perspective in intervention programs, including regeneration results in the neglect or distortion of the principles that originally shaped the philosophy of urban regeneration. Consequently, a non-participatory, top-down, and sectoral decision-making structure emerges, producing adverse consequences over time.
Furthermore, a combination of political, managerial, institutional, and individual factors directs spatial planning policies toward project-oriented, opaque, unaccountable, and non-public approaches.
The process of preparing and approving regeneration plans has long been criticized by urban development experts. The standardization of terms of reference has transformed regeneration from a “social process” into a “time-bound project.” The removal of process-orientation leads to abrupt, accelerated, and top-down planning. However, rapid preparation does not equate to rapid implementation; rather, inadequate allocation of time for preliminary studies and design leads to unforeseen complications during execution, extending projects far beyond their intended timelines. Additionally, structural deficiencies within the system contribute to the marginalization of mental health considerations. One of the most significant weaknesses is the dominance of physical-infrastructural committees in steering the entire regeneration process, while non-physical committees, responsible for mental health–related functions, are generally absent from key decision-making meetings. Social and cultural barriers to citizen participation further reinforce the prescriptive nature of these programs.
The third domain concerns the evaluation of regeneration programs, which could potentially address aspects of citizens’ mental health needs. According to the findings, experts almost unanimously agreed that evaluation and monitoring mechanisms are intentionally removed from planning structures by key policy-makers, and oversight bodies function more as interventionist than supervisory institutions. Social, environmental, and health assessments are typically neglected. Although interviewees were divided into those who opposed and those who supported the use of such assessments, there was consensus that project impact evaluation must form an integral part of the urban planning process rather than being relegated to the margins. Crucially, all urban projects generate externalities, both positive and negative, and psychological impacts are among these externalities. However, such effects are never assessed in Iran. Consequently, mental health is marginalized across policy-making, plan preparation and approval, and implementation evaluation, highlighting the need for a fundamental revision of the terms of reference and the overall process of plan preparation and execution.
Assessment of the Impact of Regeneration Consequences on Mental Health
To evaluate the intensity of the impact of each consequential dimension of urban regeneration on mental health, a questionnaire using a five-point Likert scale was administered. Experts rated each item from 1 (lowest level of impact) to 5 (highest level of impact). The midpoint score was 3. The overall mean for each main parameter was calculated by summing responses to its corresponding items. The impact level of each of the twelve main dimensions was then determined using an impact spectrum:
- Scores between 1 and 2.33 indicated high impact,
- Scores between 2.33 and 3.66 indicated moderate impact,
- Scores between 3.66 and 5 indicated low impact.
These findings clearly demonstrate that every urban project generates external effects on residents that must be systematically assessed, yet such effects are not evaluated in any national project. The most significant positive effects of regeneration on mental health were the development of public spaces and the improvement of urban environmental health. The most significant negative effects included increased property prices, followed by anxiety regarding potential forced displacement and the creation of vulnerable or unsafe spaces.
Discussion
The present study sought to address the following three questions:
- What dimensions and components define the characteristics of a mental-health-oriented urban regeneration program?
- What barriers hinder the realization of mental-health-oriented urban regeneration in Iran?
- What does the manner in which urban regeneration programs affect mental health in Tehran reveal?
Another issue related to the first question is that most existing studies have examined urban regeneration programs primarily in terms of their direct physical and environmental impacts on mental health, including improvements in housing and neighborhood quality, access to public services, safety and security, transportation, neighborhood aesthetics, physical activity, employment, knowledge enhancement, empowerment, and social equity (Mehdipanah, 2014; Davidson et al., 2013; Egan & Lawson, 2012; Lawson & Kearns, 2010). By contrast, non-physical, intangible, psychological, sensory, and symbolic effects have received far less attention. The present study identified a wide range of non-physical and psychological effects of urban regeneration programs, including stress and anxiety, self-confidence, self-actualization, respect, sense of belonging, socialization, collective agency, attention to children, charitable behavior, and altruistic values.
Regarding the second question, the results revealed that the barriers hindering the achievement of mental-health-supportive urban regeneration lie within the mechanisms of policymaking, preparation, approval, implementation, and monitoring of these programs. To better integrate mental health into urban regeneration initiatives, these mechanisms must be reformed. Findings from Javan Majidi et al. (2020) show that the uniformity of terms of reference for regeneration programs in diverse contexts, including historic districts and informal settlements has led to their ineffectiveness. Moreover, the policymaking approach underlying these programs is functionalist in nature and primarily based on economic considerations, resulting in the neglect of their social aspects. A consequence of this issue is the gentrification of neighborhoods and the displacement of original residents, indicating the failure of such regeneration programs (Masoud et al., 2019; Abachi et al., 2018).
Additionally, the evaluation and monitoring stage of programs constitutes one of their most critical points of vulnerability. In all countries, this stage represents the most precise phase of project management (Davidson, 2022; Lin et al., 2021). The advantage of evaluation is that continuous feedback minimizes errors and deviations, allowing for timely and effective solutions to unforeseen problems (Davidson, 2022). In practice, implementation and evaluation are not separate processes; they proceed concurrently. As shown by Heravi and Mohammadian (2019), deficiencies in monitoring systems represent one of the major gaps in the management of urban projects in Iran. Tracing the reasons behind the elimination of the evaluation and monitoring stage in urban regeneration programs revealed that this issue primarily stems from the country’s flawed governance and management paradigm, which one respondent likened to a “fiefdom management model.” In this model, managers prioritize retaining their position above all else, and managerial actions, decisions, and policies are primarily oriented toward preserving the manager’s status rather than advancing the program itself. Consequently, in such a structure, attention to mental health and the assessment of project impacts on citizens’ psychological well-being carries little significance.
Finally, the third research question examined the nature of the effects of urban regeneration programs on mental health in Tehran. Findings from this section indicated that, in assessing the impacts of urban regeneration interventions, in addition to understanding the problems these interventions seek to address, it is essential to consider how they are implemented. Individuals’ control over these processes, the creation of social capital, and supportive social networks that enhance self-esteem and efficacy can reduce environmental stressors and depressive symptoms. Conversely, processes that restrict opportunities, marginalize residents, and neglect community needs have adverse psychological impacts and foster feelings of hopelessness toward such interventions, a phenomenon also discussed in Rogers et al. (2008) and Baba et al. (2017). A clear domestic example is the construction of the Imam Ali Expressway, which lasted more than ten years. During this period, residents within the project boundary, knowing they would eventually have to sell their homes to Tehran Municipality, faced prolonged uncertainty and an ambiguous future. Studies by Kheireddin et al. (2016) and Mozaffari et al. (2017) indicate that many of these residents were forced to relocate to lower-income neighborhoods. Sudden increases in property prices, essentially selling homes below value while facing inflated market prices pushed households into areas significantly lower in status than their original neighborhoods, generating numerous psychological consequences. Yet such impacts are never assessed in project evaluation systems.
The researchers faced several limitations in conducting this study, which future research can help address. The impact assessment carried out here was a preliminary evaluation designed to determine the potential significance of each indicator. Undoubtedly, these effects can be assessed more comprehensively through standardized questionnaires administered to residents of target neighborhoods and other groups benefiting from urban regeneration programs. Such surveys could be conducted before, during, and after the implementation of urban regeneration initiatives.
Conclusion
Based on the findings of this study, the relationship between urban regeneration programs and citizens’ mental health encompasses all the characteristics embedded in project planning processes, the resulting designed environments, the socio-economic conditions influencing these processes, and the manner in which such programs are implemented. Collectively, these factors may affect physical and social well-being and, indirectly, mental health; or they may directly influence mental health indicators, such as stress, anxiety, psychological pressure, tension, insecurity, fear, and perceived deprivation through changes in individuals’ lifestyles or their socio-economic status. Another key conclusion is that urban regeneration, in its original aims and principles, possesses an inherent capacity to support mental health. However, the way such programs are formulated in Iran, characterized by the absence of a human-centered approach to urban space and the dominance of physical, architectural, and design-oriented perspectives—has failed to empower residents living in distressed neighborhoods. Consequently, these programs have not only fallen short of promoting mental well-being but have themselves become factors contributing to further deterioration of citizens’ mental health.
The analysis of the positive and negative impacts of current urban regeneration programs on citizens’ mental health indicates that, in their existing form of preparation and implementation in Iran, these programs generate more negative than positive outcomes. Therefore, a transformation in the theoretical and methodological frameworks, along with a revision of the terms of reference and the procedures for preparing, implementing, and monitoring these plans, is imperative.
Acknowledgments: None is reported by the authors.
Ethical Permission: None is reported by the authors.
Conflict of Interest: This article is derived from a portion of the third author's doctoral dissertation, entitled “Developing an Evaluation Framework for Assessing the Impacts of Sustainable Urban Regeneration Projects on Citizens’ Mental Health,” conducted under the supervision of the first author and the advisement of the second author at the Faculty of Architecture and Urban Planning, University of Art, Tehran, in 2022.
Authors’ Contributions: Haghighat Naeini GH (First Author), Methodologist (25%); Farahani H (Second Author), Methodologist (25%); Fanaei S (Third Author), Principal Researcher / Discussion Writer (50%).
Funding: This research was conducted using the authors’ personal funds
Keywords:
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