Impact of urban and cultural landscape heritage on mental health: a systematic review and meta-synthesis

Abstract

Objective

The objective of this study is to understand how urban and cultural landscape heritage impact individual mental health, as well as the mechanisms through which these influences operate, by synthesizing existing published qualitative data.

Method

This paper employs systematic review and meta-synthesis to extensively collect and evaluate relevant literature. A total of 30 papers met the inclusion criteria and were analyzed using thematic synthesis. Through line-by-line coding, descriptive themes were identified, and the coded texts were summarized and categorized to provide evidence for thematic analysis. The study explores the mechanisms and effects produced by individuals participating in heritage environment interventions in non-clinical settings. The study protocol has been registered with PROSPERO, number CRD42024535811.

Results

The research proposes a heritage healing conceptual model, comprising three themes and 14 intervention elements: (a) restorative effects of nature and environment; (b) spiritual and religious practices; (c) culture, community, and identity. This model demonstrates the synergistic pathways through which heritage healing operates in mental health interventions, emphasizing the central role of heritage in promoting psychological well-being through a combination of natural environments, spiritual practices, and sociocultural factors.

Conclusion

The heritage healing conceptual model offers an innovative combination approach to therapy, forming a multidimensional therapeutic network. The findings reveal the key role of heritage healing in mental health interventions, particularly by enhancing individual connections with nature and cultural heritage to foster psychological recovery and emotional stability. Furthermore, participating in cultural activities and savoring the aesthetic beauty and tranquility of historical environments allows people to alleviate the psychological burdens brought about by fast-paced urban life while strengthening connections among community members. It provides new perspectives for designing effective mental health intervention strategies, suggesting that public health policies should pay more attention to integrating and popularizing non-medication intervention measures.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-24211-z.

Introduction

Globally, the heritage of urban and cultural landscapes demonstrates extensive application and significance in addressing mental health issues. Mental health problems are prevalent in contemporary society, eliciting a complex array of emotional, behavioral, and physical symptoms. For instance, common mental health issues such as anxiety and depression not only undermine social functions and quality of life but also adversely affect physical health [1]. Long-standing psychological stress, emerging in the wake of the coronavirus pandemic, may also trigger or exacerbate other physical health issues like heart disease and hypertension, thereby intensifying the overall health crisis [2]. There is still a disparity between the global burden of mental illness and the attention it garners. The World Health Organization reports that approximately 1 billion people globally suffer from mental disorders [3], highlighting that mental health is essential for individual well-being and societal progress. It implies that a person is in a favorable mental state, capable of recognizing and utilizing their abilities, effectively managing life and work stresses, and contributing to their community [4]. In a rapidly evolving world, cultural heritage serves as a source of psychological support and stability [5]. In recent years, heritage in both tangible and intangible forms have profoundly influenced individual and collective mental health. For example, many urban sites and buildings have been repurposed into public spaces such as city parks, providing citizens with places to escape their busy lives, relax, and spiritually reconnect [6]. By participating in these cultural activities and appreciating the beauty and tranquility of historical environments, individuals can alleviate the psychological burdens brought on by fast-paced urban living [7, 8]; religious heritage also aids individuals in coping with these stresses through spiritual solace and community support [9]; natural heritage like hot springs demonstrates significant effects on improving individual psychological states including stress reduction, enhanced concentration, and emotional stability [10]. Additionally, in the realm of intangible cultural heritage, practices such as Chinese herbal massage have proven beneficial for treating chronic pain conditions like rheumatoid arthritis [11, 12], while folk music plays a potential role in mood regulation and stress relief [13]. When engaging with cultural heritage, participants gain insights into the development of society’s material and spiritual civilization through their unique psychological and behavioral activities which lead to personal satisfaction [14]. These interventions not only address specific physical and psychological issues but also strengthen connections between individuals and their communities thereby enhancing quality of life. Whether through cultural landscapes that alleviate mental stress caused by environments marked by cultural disconnection or social isolation [15, 16], or through archaeological sites that promote greater inclusion for people with mental illnesses [17], various forms of cultural heritage engagement have contributed to varying degrees of health improvement globally [18, 19].

Urban and cultural landscape heritage has demonstrated widespread application and importance in addressing mental health issues in global [20, 21]. However, the mechanisms by which these heritages specifically influence mental health recovery, their effects, and their roles across different cultural contexts remain not fully understood. To delve deeper into these aspects, this study employs systematic review and meta-synthesis methodologies to explore how urban and cultural landscape heritage can intervene and improve individual mental health through specific elements. This research primarily addresses two questions: firstly, identifying and analyzing which specific elements within urban and cultural landscape heritage positively impact mental health; secondly, exploring how these elements interact to form effective therapeutic pathways. By addressing these questions, this study aims to construct a conceptual model that deepens the understanding of the potential value of heritage in mental health and offers new perspectives and approaches for mental health treatment.

Method

Inclusion criteria

After a systematic search, literature included in this review needed to meet the following criteria: (a) research articles; (b) written in English; (c) all included studies must involve research on heritage (urban or cultural landscape) and mental health; (d) the included studies must specify the heritage site (intervention object) and discuss its intervention effects on human psychological health, or address themes related to psychological or physical health, emotions, recovery, well-being, and similar topics. Articles were excluded if: (a) they did not involve heritage interventions related to mental health; (b) they focused on policies or environmental modifications unrelated to the current topic; (c) they were not peer-reviewed; (d) they were conference papers, news articles, or other non-research literature.

Literature searching

The literature search was conducted by two researchers simultaneously using five databases: ProQuest, ScienceDirect, Web of Science, Scopus, and Emerald. As of March 2024, the search terms used included: “urban heritage OR cultural landscape OR landscape heritage AND mental health OR illness OR health OR psychological rehabilitation OR healing OR well-being.” Following a systematic review process, duplicates were removed using EndNote, resulting in 2603 potentially relevant papers. To ensure a comprehensive screening process, one researcher initially screened titles and abstracts independently. Articles with unclear relevance at this stage were retained for full-text screening. This process yielded 373 eligible articles. These were then thoroughly reviewed by two researchers. In cases of disagreement, a third researcher was consulted for discussion. Ultimately, 30 studies were included that met the criteria for this research topic (see Fig. 1).

Fig. 1.

Screening steps for systematic literature review

Quality appraisal

Given that all screened literature utilized qualitative research methods, we followed the Critical Appraisal Skills Programme (CASP) Qualitative Checklist [22] for quality assessment. The CASP tool is specifically developed for evaluating qualitative research, systematically examining the strengths and limitations of studies, and is particularly suitable for health-related research fields [23], making it highly appropriate for the context of this review. The CASP quality assessment tool includes 10 qualitative questions covering aspects ranging from the clarity of research objectives, appropriateness of study design, transparency of the research process, suitability of data collection methods to the credibility and transparency of the results. The selected studies were scored for quality and relevance using the CASP tool (Appendix 1), with a high average score of 8.72. The assessment process strictly followed the PRISMA reporting guidelines, scrutinizing each study’s methods, objectives, questions, and outcomes in detail. These findings were systematically tabulated (Appendix 2). Any conflicts, disagreements, or discrepancies that arose during the review process were resolved through consensus among all researchers involved.

Data extraction and synthesis

Data were extracted simultaneously by two researchers, focusing on sample information, symptoms addressed by interventions, characteristics of the interventions, effects of the interventions, research elements, theoretical frameworks, qualitative analysis methods, and research findings. This systematic review utilized Thematic Synthesis [24], which includes three steps: coding text, developing descriptive themes, and generating analytical themes. This method is specifically designed for evaluating the effectiveness and acceptability of public health and health promotion interventions. All relevant texts were extracted and coded, with equal importance given to raw data and the interpretations of the authors [23]. The included literature was imported into NVivo (2020, R1) software for systematic analysis. Initial coding aimed to identify and extract key information and themes from the data. During this stage, coding included detailed records on aspects such as intervention types (e.g., urban heritage, cultural landscape heritage, intangible cultural heritage), intervention conditions (e.g., mental disorders, chronic diseases), characteristics of the intervention objects (specific objects and features of designated heritage), intervention contexts (considering cultural, geographical, and other environmental factors), sample demographic information (including age, gender, population groups), as well as detailed descriptions of intervention processes and effects. The subsequent analysis phase focused on developing and refining themes from these foundational data, particularly studying the impact of heritage (intervention objects) on health treatment outcomes. Through ongoing analysis and comparison of intervention effects, a second-order structure was gradually formed. To generate analytical themes, the entire study was considered holistically; data were extensively deconstructed and deeply understood. Through continuous iteration, theoretical saturation was approached. This process ultimately resulted in clear and coherent first-order themes.

Results

Characteristics of the included studies

This systematic review included 30 papers published between 1993 and 2023. Various qualitative methods were employed in the included literature (Appendix 3) including case studies (n = 21), thematic analysis (n = 11), semi-structured interviews (n = 9), and comparative studies (n = 8). Other methods such as theoretical framework application, field research, and historical analysis were also frequently used, alongside diverse approaches like phenomenological analysis, observation, and interviews. This indicates that researchers adopted a variety of methods to collect and analyze data based on different research subjects and objectives. Additionally, a statistical analysis of heritage intervention types was conducted (Table 1), covering religious cultural heritage (n = 8), cultural landscapes (n = 6), urban cultural heritage (n = 5), natural heritage (n = 5), intangible cultural heritage (n = 4), and archaeological sites (n = 2).

Table 1.

Summary of types of cultural heritage

Types of cultural heritage	1993	1996	2003	2010	2011	2012	2013	2014	2016	2018	2019	2020	2021	2022	2023	total
Archaeological Sites	1											1				2
Cultural Landscape									1		1				4	6
Intangible Cultural Heritage			1					1		1				1		4
Natural Heritage					1						1	1	1		1	5
Religious Cultural Heritage		1		1	2	1	2				1					8
Urban Cultural Heritage										2		1		1	1	5
total	1	1	1	1	3	1	2	1	1	3	3	3	2	2	6	31

In the theoretical data of the included papers, multiple theoretical frameworks were used to explore the interactions between health, treatment, culture, and environment. The concept of Therapeutic Landscapes was the most frequently mentioned framework, cited 17 times. It emphasizes that locations possess healing qualities due to their environmental characteristics, social structures, or cultural significance. Gesler defined therapeutic landscapes as “places where the physical and architectural environment, social conditions, and human perceptions combine to create an atmosphere conducive to recovery,” indicating places with specific attributes and reputations that provide comprehensive healing experiences—not only physically but also psychologically and spiritually [25–27]. Additionally, Health Geography was cited nine times; this field focuses on the spatial distribution of health phenomena and the geographic factors behind them, studying how spatial factors affect the health status of individuals and groups [28]. Cultural Geography and Ecosystem Services, including Cultural Ecosystem Services, also received significant attention. This highlights an increasing scholarly focus on the importance of natural ecosystems in providing services essential for human well-being and how geographical environments shape cultural forms. Researchers also focused on Mental Health, spiritual healing, Psychosocial well-being, Sense of place, and Place attachment—indicating a close relationship between individual health and inner spiritual states. The connection between a sense of place and emotional security is also crucial for discussion in line with the direction of this review study.

Participants and condition characteristics

This manuscript encompasses 30 research sites across 16 different countries worldwide, covering a diverse array of fields including multiculturalism, historical landmarks, natural landscapes, therapeutic practices, and spiritual rituals (Table 2). The research sites range from Lourdes in France to Quebec in Canada and Karnataka in India, spanning continents from Europe and North America to Asia, as well as locations in Australia and New Zealand. This presents a culturally and geographically diverse network of studies. These sites inclusively feature religious pilgrimage destinations, psychotherapeutic practice settings, historical cultural scenes, nature reserves, and both urban and rural environments. Participants ranged in age from 15 to 85 years and came from various cultural and ethnic backgrounds such as Québécois Canadians, Dong ethnic villagers in China, and Māori healers in New Zealand. This diversity illustrates the impact of different cultural groups on interventions for mental health. Some studies specifically focused on individuals diagnosed with severe mental illnesses, further enriching the diversity of participant characteristics.

Table 2.

Study participants, locations/objects, etc

Date/author	Home countries/regions	Study sites/subjects	participant	The main discovery
Religious cultural heritage
1996 [27]	France	Lourdes, France	Lourdes’s sample of the pilgrims covers individual pilgrims, large group pilgrims and group tourists and pilgrims, among others	Lourdes, has created a unique therapeutic landscape through religious beliefs, historical context, the sanctity of social beliefs, and locations.
2010 [39]	Canada	St. Anne de Beaupre Pilgrimage Site	Participants included pilgrims, church members, local residents, staff as well as the investigators themselves.	Pilgrims experience spiritual comfort and emotional satisfaction by participating in various religious rituals and activities, such as prayer, confession, holy water baptism, pilgrimage, etc. These activities not only enhance the sense of community belonging, but also have a positive impact on mental health.
2011 [37]	India	Karnataka	The sample consisted of folklorists, indigenous/traditional healers, and mental health practitioners	Karnataka Native healing emphasizes the environment, sacred power, and healing skills during the treatment process. And consultations with modern psychotherapy are increasing, suggesting the potential for developing comprehensive treatments that combine the advantages of both.
2011 [40]	Ireland	Holy Wells	Verbal narratives, conversations, and participant observations were collected by visiting the ten wells.	Through its physical environment, metaphorical narrative, and living practice, the holy well together forms a complex health performance space. Promote the multiple roles of physical, mental and mental health, and become a place for cultural practice and folk healing.
2012 [35]	German	Individuals involved in a specific spiritual ritual	Ten adults interested in spiritual rituals, with a mean age of 46.3 years, 90% were female, had good health, no mental disorders, and experience in religious rituals.	Spiritual rituals had a positive impact on participants’ spiritual and psychological quality of life, but no significant improvement in physical and emotional quality of life. These findings support the potential role of spiritual rituals as a promoter of mental and mental health.
2013 [41]	Ireland	Holy wells	The study sample included pilgrims, local residents, tourists, researchers and Ireland.	The Irish Holy Well is not only a healing landscape but also a symbol of physical and mental spiritual health. The Holy Well has its potential in providing mental and physical healing and its continuing importance as a place for healing and recovery.
2013 [42]	Italy, Israel, Portugal, France	St Peter’s Basilica, Stations of the Cross, Jerusalem, Our Lady of Fatima, Portugal, Our Lady of Lourdes, France, four specific Catholic web pilgrimage sites	Palmer	Online pilgrimage sites offer detailed virtual experiences, creating a space for spiritual healing and renewal for users by providing symbolic religious elements, and social interactions. Can make users feel the immersive experience, thus enhancing the possibility of healing and updating.
2019 [36]	Canada	Québécois, Montreal	N = 18, aged between 20 and 60 years, 11 female and 7 males, Montreal, Quebec, resident with severe mental illness, using French as their native language.	Quebecers in rehabilitation from severe mental illness found that natural and rural environment, Roman Catholic heritage, and French language and cultural identity have a positive impact on rehabilitation. Participants constructed a personalized rehabilitation landscape by interacting with these cultural and geographical elements.
Cultural landscape heritage
2016 [43]	Australie-Méridionale	Parkside Lunatic Asylum	Evolution of historical shelters (community healing), groups (people)	The landscape of the psychiatric hospital includes courtyards, decorative gardens, orchards and vegetable fields to assist treatment by providing natural beauty and meaningful activities. However, with the rise of modern pharmacotherapy, the status of these cultural heritages in mental health treatment has gradually declined, leading to the decline and functional transformation of the mental hospital landscape.
2019 [44]	Lettonie, Polo	the rehabilitation gardens and parks in Latvia	Historical texts and other materials	Rehabilitation gardens and parks have a significant positive impact on the physical and mental health of patients through the sensory stimulation of natural landscapes. These spaces can promote emotional balance and physical recovery through sensory experiences such as vision, touch, smell, taste and hearing.
2023 [45]	Harku municipality, Tallinn	Tallinn, the capital of Estonia, and the city of Haku in the west	5-bit Expert Panel, including space development, education, forest management, urban planning, and architectural design	The combination of specific natural environment types (e.g. garden and blue space) and contact types (e.g. aesthetic appreciation and spiritual, historical, symbolic experience) shows a strong positive link in promoting the well-being of Haku city residents.
2023 [46]	Guizhou, China	Dong bao ye	Villagers of Huanggang Dong Village (Huanggang Dong Village)	As a cultural landscape, the belief of “Dongbao Ye” is closely connected with specific elements in the natural environment (such as trees, stones, Bridges). Through a series of rituals and practices, it not only helps to promote the physical and mental health of individuals, but also enhances the sense of belonging to local culture.
2023 [47]	Galicia, Spain	Ribeira Sacra	Organizations and institutions involved in the tourism development in the Ribeira Sacra area	Walking as a cultural behavior has had a positive impact on individuals and society. Walking not only promotes the restoration and protection of historical paths, but also enhances the appreciation of natural and cultural heritage.
2023 [38]	New South Wales, Australia	Yuwaalaraay sacred site, Stolen Generations	N = 8, aged 51 to 80, with survivors (5 male), family members (2 female) and offspring (1 female)	It was found that participation in cultural camp activities facilitated reconnection of a stolen generation of Aboriginal older people with land and cultural heritage, bringing cultural pride, belonging and healing effects with positive effects on mental health and socio-emotional well-being.
Natural heritage
2011 [30]	New Zealand/Ireland	Te Aroha in New Zealand and Lisdoonvarna in Ireland	A comparison of two hot springs towns in Te Aroha, New Zealand, and Lisdoonvarna, Ireland.	With unique health and historical geographical features, comparing two spa towns in New Zealand reveals similarities in the concept of commercial health, the shaping of the therapeutic landscape, and the social identity controversy in the colonial context.
2019 [34]	Poland, Austria and Italy	Protected areas in Poland, Austria and Italy	N = 1392,476 Austrian (226 men, 250 women), 457 Italian (228 men, 229 women), and 459 Polish (218 men and 241 women).	The study found a relationship between protected areas (PAs) and health and well-being in Austria, Italy and Poland. Studies have found the importance of protected areas for social health and have highlighted the need to protect them.
2020 [48]	Gdańsk, Poland	The Coastal Strip	Historical texts and other materials	The coastal zone was assessed as having health-promoting traits and was identified as a place critical to public health. Demonstrated it as an important health promotion venue and highlighting the importance of protecting the zone.
2021 [49]	Japan, Chile, New Zealand	Ginzan Onsen Fujiya, Japan; Termas Geométricas, Chile; Polynesian Spa, New Zealand	site visits by the authors, statements from the architects, owner websites, architectural reviews and books, and journal and news articles.	Buildings in geothermal sites not only provide a physiotherapy environment, but also form a unique therapeutic landscape through the interaction of social, cultural and physical conditions. Research highlights the central role of culture and how these landscapes can enhance therapeutic effects through social interactions, emotional connections, and physical experience.
2023 [32]	Iceland, North Atlantic	the southern part of the Westfjords peninsula、Jökulsárlón glacial lagoon and the Central Highlands	The first author, she personally experienced three natural landscapes in Iceland	The study found that the three different natural landscapes in Iceland, through their natural, architectural, and symbolic environments, jointly produced three thematic outcomes: recovery, awe, and attention, bringing tourists the benefits of stress reduction, renewed attention, and enhancing physical and psychological well-being.
Urban cultural heritage
2018 [50]	Bristol, UK	Walkers in urban environments	N = 14,18 to 53 (mean 31.8), 10 white British, 2 white non-British and 2 Arab	Walking activity in an urban setting can be viewed as a restorative practice as it facilitates the sense of relaxation and positive affect reported by participants while also supporting the perception of attentional recovery.
2018 [51]	Iranian	The Niasarm Canal and its surrounding communities in Isfahan City, Iran	And n = 200, aged from 15 to 85 years, with 102 female and 98 male	As the blue and green space in the city, the canal significantly improves the physical health, mental health and social well-being of the residents. The canal promoted an active lifestyle, provided an environment for relaxation and recovery, enhanced community social interaction, and enhanced local identity as a cultural heritage.
2020 [52]	Alexandria, Egypt	Orabi Square、Masrah Al Salam and Zanqit Alsitat	N = 36, including merchants, street vendors, office staff, residents, students, as well as tourists and shoppers	The experience and importance of cultural memory within these sites is learned through a case study in Alexandria, Egypt. Found that grounded theory provides a nuanced understanding of how individuals experience their surroundings and the impact of cultural memory on their well-being.
2022 [53]	Poland, Germany	lunatic asylums: Kraków-Kobierzyn; Lubiąż; Weinsberg	Hospital staff	This study explores the potential applications of historical psychiatric hospital gardens in modern green therapy, analyzing the combination of historical therapeutic value of these gardens with modern green therapy and their practical applications and challenges in improving the physical and mental health of patients.
2023 [54]	Chengdu, China	Kuanzhai Alley	And n = 48,20 males and 28 females. The age span ranged from 18 to 81 years, with a mean age of 37.2 years	As a historical protection area, Kuanzhai Alley’s unique cultural atmosphere, appropriate spatial scale and heritage activities have had a significant positive impact on tourists. These factors help to eliminate loneliness, ease anxiety, and improve their happiness.
Intangible cultural heritage
2003 [55]	Ontario, Canada	The Anishinabek people of the First Nations reserve, including individuals of Odawa and Ojibway descent	N = 17, including 14 community members (9 women and 5 men), 2 community health center staff, 1 traditional healer, and 1 medicinal plant collector.	Research highlighted the importance of the land as a symbol of Mother Earth, and the importance of spiritual connections to the land for maintaining health. Furthermore, the concept of a therapeutic landscape needs to be expanded to include a more holistic perspective of health, including culture and native medicine, as well as an understanding of health and local relationships in different cultural contexts.
2014 [56]	Ireland	Romane-Irish Bath	No	As a therapeutic landscape, Roman-Irish bath invention and spread embodies core themes in assembly theory, including mobile networks, social material practice and controversial emergence. Moving from a venue focused on health and treatment to a space with more social and leisure attributes.
2018 [29]	Xinjiang, China	Sand Therapy Participants, STPs	N = 54, aged 30 to 90 years, 34 in the Kumtag Desert, 20 in Turpan City, 18 men and 36 women. Of these, 49 had specific health conditions, and five had uncertain health or health status.	Experience the pain of hot sand in the desert is interpreted as a therapeutic experience through their cultural belief in the balance of Yin and Yang and qi. Highlights that physical feelings of pain and discomfort can be viewed as means of health promotion, thus enriching the understanding of the therapeutic landscape.
2022 [31]	Aotearoa, New Zealand	Māori healers or rongoā practitioners	N = 8,75% were female and 25% were male, with an age range of 30 to 60 years or older. Among the participants, 63% were mana whenua and 37% were nga matawaka with a mixed whakapapa.	Maori traditional therapy (rongoa Maori) is a system based on complex cultural values and beliefs that emphasize the importance of considering cultural context during treatment and indicate the potential of combining gross margin traditional therapy with modern medical practice to support more comprehensive health management and treatment strategies.
Archaeological sites
1993 [25]	Greece	Epidauros	Written and oral history of the archives and other textual materials	The concept of a therapeutic landscape and its implementation at specific sites is the result of interactions by combining multiple dimensions of nature and the built environment, cultural beliefs, social relationships, and regionality. Together, these factors shape an environment that promotes physical and mental health
2020 [33]	Wiltshire, UK	the World Heritage Site of Stonehenge and Avebury in Wiltshire, UK	n = 35, divided into three groups with age span of 56 years and 53.3% females. The mean age of the first group was 56 years, 69.2% male; the mean age of the second group was 43.3 years; the follow-up participation of the third group was 41.6%.	The use of legacy as an environmental tool to improve mental health in the human Henge project for wellbeing. The use of archaeological landscapes, especially in the Neolithic and Bronze Age sites, has therapeutic effects in improving the mental health well-being of people with mental health problems.

In the analysis of interventions for health conditions (Table 3), a range of health issues were addressed including various types of treatments for both physical and psychological conditions. For instance, traditional Chinese medicine and natural therapies such as sand therapy [29] and hydrotherapy [30] were utilized to alleviate chronic pain conditions like rheumatoid arthritis, arthritis, and lumbar disc herniation [29–31], showcasing the significant role of natural elements in physical and psychological recovery processes. Additionally, traditional hydrotherapy practices dating back to the late 19th century employed diverse methods from sulfurous baths to electric baths to treat skin diseases and musculoskeletal pain [30]. Natural environments [32] and outdoor activities [33] also significantly improved emotional states, concentration levels, effectively managed stress, and facilitated psychological recovery [34]. Research suggests that spiritual rituals can promote emotional health and alleviate stress [35], such as pilgrimage activities that serve as spiritual journeys aiding individuals in coping with mental stressors and fostering emotional recuperation [36].

Table 3.

Summary of health conditions

Type of intervention	Health conditions	Description of the condition and treatment	ID
Urban cultural heritage	Stress and depressions	(World Health Organization reports) More than 25% of Europeans and 18% of Americans reported poor mental health, with stress and depression being the most common.	[50]
	Decreased happiness, fear, depression	During the global public health outbreak in 2019, social isolation and urban lockdown led to mental health being affected, manifested by decreased well-being, fear and depression.	[54]
	Loneliness and anxiety	The maintenance of social distancing forces people to seek emotional stimuli to cure post-traumatic psychological stress and stress syndromes, particularly loneliness and anxiety.	[54]
	Insomnia, depression, anxiety	Isolation and lockdown during the pandemic are seen as sources of stress. People who live in the same environment for a long time are more likely to develop mental illness, such as insomnia, depression, and anxiety.	[54]
	Insecurity	One college student experienced extreme difficulty during the pandemic and said he often felt insecure about the future.	[54]
	Sense of inferiority	A large amount of unemployment after the pandemic leads to individuals suffering from an inferiority complex and insecurity.	[54]
	Major Depression and Increased Anxiety	Mental disorders are increasingly diagnosed, especially after the pandemic outbreak, which significantly increased focal deficiency and major depression.	[53]
Religious cultural heritage	Mental illness	Considering the role of place and culture in the rehabilitation process is critical.	[27, 36]
	Chronic diseases such as eye problems, migraines, arthritis, rheumatoid arthritis and even lumps	Well water is used to regularly cure chronic or serious problems such as eye problems, migraines, etc.	[41]
	High fever, stomachache, headache, sleep disorders, body ache	Multiple manifestations of common physical and psychological associations in mental health departments.	[37]
	Mood swings such as extreme fear, feelings of guilt, disappointment, extreme desire, etc.
	Toothache, headache, backache, mental illnesses	The water in the wells of the Holy Land is used to relieve pain and is used to treat a variety of mental illnesses.	[40]
	Terminal illnesses, long-term chronic diseases	Terminally ill and chronically ill patients visit spiritual places seeking not only physical healing, but also support and relief on a psychological and spiritual level.	[39]
Cultural landscape heritage	Physical, emotional and psychological abuse	Survivors of Aboriginal peoples from the Stolen Generations recall the many types of abuse they suffered, including physical, emotional and psychological abuse.	[38]
	Disconnected communities, loss of language, disconnection from culture	After being forced to leave the community, individuals feel rejected by the community because of the changes when they try to return.	[38]
	Heart disease, cardiovascular disease, diabetes, depression, schizophrenia, etc.	Changes in lifestyle in modern society, especially lack of adequate exercise and chronic psychological stress, unhealthy living habits, constant exertion and lack of rest time can lead to a wide range of diseases.	[44]
	Mental illness	Provide therapeutic alternatives for people with mental illness, such as consideration in the natural environment.	[43]
	Weakness, cold and fever, vomiting, crying	Worship of the “bao ye” is a traditional form of healing and protection, in which patients seek health and protection by travelling to specific places (e.g. bridges, wind and rain bridges, etc.) to worship and pray on specific festivals or important occasions.	[46]
	Condition	The World Health Organisation (WHO) emphasises that health is not just the absence of disease, but a state of complete physical, mental and social well-being.	[45]
Archaeological sites	Mental illness	Everyone is at risk of coming into contact with mental illness at some point in their lives, and most participants found it difficult to live in society because of their mental illness, and they felt judged and discriminated against.	[25, 33]
Natural heritage	Stress, concentration, memory, irritability, depression	Natural environments and nature-related activities have a positive impact on improving an individual’s emotional state.	[34]
	Burnout, sleep disorders, psychological rehabilitation	Exposure to natural spaces and the outdoors contributes to positive mental health recovery, enabling people to cope with poor physical health and negative emotions.	[32]
	Skin diseases, rheumatism, etc.	Hydrotherapy can be used to treat a wide range of skin and bone problems.	[30]
Intangible cultural heritage	Rheumatoid arthritis	Integrating physical, spiritual and natural therapies through massage, chanting, hydrotherapy, rituals and herbs to promote physical and mental health and balance.	[31]
	Chronic diseases such as rheumatism, arthritis, leg pain, hand pain, etc.	Sand therapy is a traditional natural treatment for chronic conditions such as rheumatoid arthritis. The treatment involves the use of sand to cover specific areas of the body (e.g. legs, hands, back) to relieve pain.	[29]

Globally prevalent mental disorders severely impact individuals’ quality of life [33]. For example, feelings of fatigue [32], isolation [33], along with increased isolation measures during pandemics have exacerbated psychological issues such as anxiety and depression [37]. Moreover, in rural areas where there is a scarcity of professional medical personnel and limited drug supplies, services for mental disorders face significant challenges [37]. On a cultural level, transgenerational trauma and cultural disruptions such as physical abuse, emotional abuse, and loss of language have led to long-term psychological disorders [38]. These experiences affect not only individuals who directly experienced these events but also their family members and entire communities.

Meta-synthesis

In this study, we utilized NVivo software for open coding to conduct an in-depth analysis of various intervention elements for mental health recovery. By synthesizing the effects of 30 heritage interventions, we identified 14 intervention elements and further recognized three primary themes (Table 4). The first theme, “Restorative Effects of Nature and Environment,” encompasses elements such as walking recovery, the restorative sense of environment and place, resilience of natural environments, and the integration of natural elements with artistic activities. These elements highlight the positive impact of natural environments on individual psychological health and how psychological recovery can be promoted through the combination of artistic activities and natural elements. The second theme, “Spiritual and Spiritual Practices,” includes folk rituals and symbolic actions, spiritual recovery, emotional and spiritual connections, and spiritual transformation within communities. This theme explores how traditional and modern therapeutic methods support mental health by emphasizing the healing of the soul and emotional resonance. The third theme, “Culture, Community, and Identity,” involves community connections and interactions, historical linkages, cultural participation, restorative religion practices, as well as linguistic sensitivity and cultural identity in trauma healing. These elements underscore the role of community and cultural backgrounds in individual identity formation and how mental health can be promoted through enhanced cultural participation and community support. Each primary theme includes corresponding secondary constructs supported by detailed examination of research materials and key quotations extracted from them. These analytical results not only enrich our understanding of the diversity in mental health interventions but also provide important guidance for designing more effective intervention strategies within different cultural heritage contexts in the future.

Table 4.

Overview of combined coding results

Theme (First Order)	Intervention Elements (Second Order)	Characteristic Description	Partial Original Description (Third Order)	References
Restorative effects of nature and environment	Walking recovery	How walking can have the effect of restoring concentration and mental state by providing mental relaxation, promoting positive emotions, and stimulating reflection and environmental perception.	Walking as a restorative practice that helps to relax and reduce stress and improve emotional states [50]. Walking is a pleasurable and fulfilling experience of calmly viewing the landscape and enjoying the heritage of nature and the past [47].	[39, 40]
	Restorativeness of environment and sense of place	Enhance the individual’s experience of restoration and positive affective appraisal through emotional and cognitive connection to the historical context and cultural elements of the location.	The land is supportive of health and healing [55]. Māori believe deeply in the sacred power of this river, which guarantees safety and is an integral part of our traditions and customs [31].	[30, 31, 36, 40–42]
	Resilience of natural environments	Through exposure to the green (plants, trees) and blue (water bodies) environments associated with the canals, it enhances an individual’s sense of relaxation, security and belonging, which in turn facilitates social interaction and psychological healing for the residents.	When living in a green environment, body temperature and pulse rate decrease, breathing becomes steady, people become quieter or more relaxed, blood pressure decreases, and it is easier to cope with anxiety [44]. By walking and exercising in blue and green spaces, the canal helps them to have a more active life [51].	[32, 34, 43–45]
	Natural elements and artistic activities	By combining natural elements and artistic activities, such as walking, collecting plants to create art, the therapeutic potential of natural landscapes is utilized along with the positive psychological effects of artistic creation to enhance patients’ rehabilitation experience, aiding in emotional stability and psychological recovery.	The hospital organizes art therapy sessions that incorporate plant elements. During walks, patients collect flowers and leaves which they then arrange into bouquets and affix onto paper. Natural materials work effectively in occupational therapy because they offer more possibilities and sensory experiences [45].	[46, 47]
Spiritual practices and spiritual experiences	Folk rituals and symbolic actions	Physical and spiritual healing is sought through specific ritual acts. These rituals are not only acts of physical healing, but also contain deep cultural and faith significance, reflecting trust and respect for the healing power of nature.	Items related to the body, such as pieces of cloth from petticoats soaked in well water and hung on trees, a ritual that signifies the natural elimination of disease [41]. From an early age, villagers follow their elders in worshipping natural elements such as trees and rocks, and through dialogue with them, they achieve emotional communication and establish a connection with nature [46].	[48, 49]
	Spiritual recovery	Spiritual healing emphasizes a deep connection with nature and sacred places, achieving purification and healing of the soul through rituals and symbolic acts. This recovery includes not only physical health but also emotional and spiritual nourishment and growth.	The sacred well is manifested through the interactions of an individual’s soul with a series of emotional beliefs, narratives, and places [40]. Through certain rituals that purify the mind, body, and spirit, individuals are helped to see better things in life [55].	[31, 41, 48, 50, 51]
	Emotional and spiritual connection	Spiritual and emotional connections emphasize deep interactions with nature, community, and cultural traditions. These connections involve not only physical contact but also a dialogue between the mind and the environment.	Pilgrimage is a spiritual journey aimed at achieving closeness and reverence on a soulful level. Even if one cannot physically reach the sacred site, spiritual connection facilitated through digital media can also satisfy the needs for spiritual solace [42]. Spiritual rituals are primarily aimed at spiritual purposes, but they not only affect spiritual life but also impact the quality of psychological life [35].	[31, 32, 35, 37, 41, 52]
	Spiritual transformation and community	Individuals often experience profound changes on a spiritual level, which typically involve an enhancement of self-awareness and an awakening of consciousness. This process not only promotes personal spiritual growth but also strengthens the connections and sense of belonging among community members.	Sand therapy does not emphasize enhancing community cohesion through shared experiences and mutual support; rather, it involves a spiritual transformation and the establishment of a sense of community among groups [29]. During the pilgrimage process in Lourdes, individuals undergo psychological and spiritual renewal and transformation through interactions with other believers, participation in religious activities, and the spatial experience of a specific environment. This emphasizes the importance of community spirit for individual transformation [27].	[27, 29, 53]
Culture, community, and identity recognition	Community connections and interactions	Community connections are reflected in community activities such as gardening and street performances, which enhance residents’ positive emotions and social connections. This helps in attention restoration and stress reduction from daily life, thereby improving the quality of life and psychological health.	Participants they don’t like to be treated as ‘sick’ or ‘ill’ but like to be treated as a person interacting with other people [33]. When visiting Kuanzhai Alley, the cosy living atmosphere breaks down the invisible barrier between strangers and creates opportunities for communication. It is because of their friendly interactions that I am not so lonely [54].	[31, 33, 40]
	Historical connections	Observing and walking in historically significant places allow people to intuitively “feel” history, triggering positive emotional evaluations and deep reflections on the past.	I feel that there is history there, when I’m walking around there, I feel proud. I’m a Bristol person. Participants felt the efforts made by previous generations to construct “magnificent” churches and buildings, thus walking in historic areas made them feel proud of their city [50].	[40]
	Cultural participation	Participating in cultural activities, such as watching Sichuan opera, experiencing folk music, and learning about tea art, can effectively divert attention, reduce anxiety, and provide emotional satisfaction and a sense of security.	Some tourists have reported that participating in activities involving cultural heritage can alleviate their anxiety. Appreciating artifacts and experiencing heritage environments can provide a pleasurable psychological experience, regulate a better mood, and serve a therapeutic role psychologically [31].	[31]
	Religious restorativeness	The concept of religious restorativeness emphasises the role of religious sites and beliefs in promoting the psychological healing of individuals by deepening the impact of spiritual life beyond traditional religious practices through the enhancement of hope, faith and cultural identity.	Everyone who prayed was miraculously healed, and many visitors left happy and peaceful [39]. Asclcpius was both a god and a man, and he cured what others could not [25].	[25, 36, 54]
	Language sensitivity	Language is not only a tool for communication, but also an important element in building a therapeutic atmosphere and promoting cultural understanding and personal identity.	Some participants indicated that they wanted to access mental health services in the language of their choice and were opposed to any attempts at language or ethnic matching [36].	[36]
	Cultural identity and trauma healing	Participants helped to recover from historical trauma by maintaining and practising their Aboriginal cultural values, demonstrating the importance of cultural identity to the healing process of individuals and groups.	Being part of the Stolen Generations impacts health due to inherited trauma, which affects subsequent generations. Healing is facilitated through connections with family, community, cultural practices, and ties to their ancestral lands [38].	[38]

Restorative effects of nature and environment

This theme explores how natural and environmental factors facilitate spiritual and emotional recovery through physical activities, psychological relaxation, and artistic interactions. It highlights the significance of natural elements in health restoration, particularly how interaction with nature enhances individual psychological well-being and stress relief. It includes four intervention elements: (a) walking recovery; (b) restorative sense of environment and place; (c) resilience of natural environments; (d) integration of natural elements with artistic activities.

Walking, a culturally significant journey [39], not only alleviates stress but also fosters physical health, providing opportunities for reflection and contemplation [55]. Landscapes are not merely observed but internalized and experienced, redefining their presence and transcending their material significance through an understanding of their holistic meaning [39]. Outdoor activities, especially walking in natural settings, evoke positive physical and psychological responses such as pleasure, closeness, immersion, and self-awareness. These contribute to recovery from daily stresses and enhance well-being [56]. Urban walking can also be seen as restorative as it aids in relaxation perception and stimulates positive emotional responses [57]. Moreover, walking through historic urban areas can invoke feelings of awe and pride, particularly for those deeply connected to the place, making the experience especially beneficial for their emotional recovery [40].

The environment is not merely a physical space but a locus for perception and emotional connection [58]. Place attachment encompasses emotional bonds, memories, and values; it is an integrative interaction of an individual with a specific location on psychological, social, and environmental levels [59]. This attachment is rooted in an awareness of the historical and cultural significance of the place [60], shaped by social interactions and associated memories [61]. Both urban and natural landscapes serve as spaces for improving and harmonizing human health [43]. Studies indicate that personal connections to a place can stimulate positive emotions, enhancing interest in and engagement with the environment [40]. For instance, in Māori culture, landscapes and natural settings are regarded not only for their physical attributes but also for their intangible values such as cultural, historical, and spiritual significance, which are crucial in shaping and maintaining cultural identity [31]. Sensory experiences of the land—including sitting around a campfire, listening to bird songs, and observing trees and water bodies—foster a sense of belonging and healing [38].

Natural environments inherently possess a unique resilience [62]. Contact with nature can help reduce stress [63], offer an escape from daily life, and decrease anxiety [64]. Engaging with nature visually and through multiple senses stimulates positive emotions, promoting physical and psychological health, effectively accelerating the recovery process for patients [43]. Research shows that spending time in green spaces can reduce psychological stress indicators such as cortisol levels while improving attention capacity and emotional state [65]. Green spaces like psychiatric hospital gardens can become potent psychological and social support resources that aid individuals in coping with everyday stresses [47]; they promote relaxation and mental health, helping to reduce medication dependency and prevent mental disorders [66].

Artistic activities using natural elements represent an emerging and effective method for therapeutic and educational interventions utilizing nature [67]. In summary, interaction with natural environments and participation in nature-related activities can help regulate stress on a psychological level, enhance attention span and memory retention, reduce irritability, and promote recovery of mental health [68–70]. Engaging in creative expression activities using real natural materials such as leaves or flowers (e.g., making bouquets or decorations) allows participants not only to enjoy the creative process but also to achieve emotional release and a deeper appreciation of aesthetic values [71, 72]. For example, art therapy sessions in hospitals utilizing plant elements allow patients to engage in creative activities using collected natural materials (flowers, leaves) to create bouquets or three-dimensional artworks [73].

Spiritual practices and spiritual experiences

This theme emphasizes the purification and spiritual recovery of individuals through spiritual rituals, symbolic actions, and interactions with sacred sites. It explores the deep connections between spirit and emotion, and the process of promoting mental health and internal balance through community activities and cultural traditions, highlighting the holistic impact of environment, community, and culture. This includes four intervention elements: (a) folk rituals and symbolic actions; (b) spiritual restoration; (c) emotional and spiritual connections; (d) spiritual transformation and community.

In folk rituals, for example, meditation as a spiritual ritual allows participants to escape daily pressures and obligations, focusing on mental relaxation and positive spiritual experiences [35]. In sand therapy, direct contact with hot dry sand is considered a therapeutic method [29]. This natural, physical contact is not only a form of bodily healing but also symbolizes the healing power derived from cultural relationships [74]. In the Lourdes pilgrimage, spring water is regarded as a sacred object with healing powers. Although scientific analysis has not proven any special elements in the water, pilgrims undergo spiritual purification through contact with these waters [50]. These actions create a tangible connection point that triggers deep emotional responses and connections among participants. In these folk rituals, symbols and symbolic elements play a crucial role in shaping health outcomes, showing that health’s relationship with place is influenced not just by physical environments but also profoundly by cultural and symbolic meanings [75]. James Waldram suggests that health depends not only on physical treatments but also on symbolic healing to achieve balance at individual, social, and spiritual levels [76]. This perspective emphasizes that cultural symbols and symbolic meanings play a central role in maintaining health and the healing process.

Spirituality involves an individual’s inner experience and understanding of higher spirits and transcendence, primarily focusing on one’s inner world and perceptions of supernatural phenomena [77]. Spiritual restoration is achieved through participation in these activities leading to inner peace and purification—a form of rebirth or renewal [78]. This restoration often comes with profound personal insights and reevaluation of life’s meaning and purpose. Previous studies have shown a positive relationship between health and spirituality; spirituality not only has therapeutic effects in the context of illness but also provides protective benefits for overall health [79, 80]. For instance, pilgrimage is not only a practice of spiritual journeying but also involves a complex process including physical activity, psychological therapy, and mental health benefits that can promote multifaceted health benefits [81], as well as forming therapeutic impacts in contexts of illness [54].

In the context of emotional and spiritual connections, participants in sand therapy reported experiencing a profound psychological release after initial extreme discomfort [29]. This suggests that extreme physical experiences can deepen individuals’ awareness of their emotional states. If the expressive capacity of a landscape space can meet people’s emotional needs, it then evolves into a restorative environment that generates positive energy to heal one’s psychological-emotional state [43]. For example, in Maori culture, the land is not only a natural environment but also a sacred intermediary connecting healers, ancestors, and the natural life force [82]. The interaction between people and the land creates a spiritual connection, indicating that the land is not only a resource for physical therapy but also a source of deep spiritual and emotional connection [31]. Emotions occupy an important position in the study of therapeutic landscapes, emphasizing the role of cognitive and subconscious dimensions in triggering and experiencing therapy [83].

Whether participating in collective therapeutic activities or as part of a pilgrimage team, groups often develop a closer, more harmonious collective consciousness after experiencing common challenges [84]. Finding meaning in adversity and transforming this experience into one that aids others’ growth and healing becomes possible. Through acts of spiritual transformation, pilgrims create a therapeutic space that coexists materially and symbolically [85]. The fluidity and variability of therapeutic spaces mean that even in the absence of natural or pre-established symbolic structures (such as trees), pilgrims can still create a space with therapeutic significance through their own actions [86]. This indicates that therapeutic spaces are not static but constantly evolving and developing with the participants’ behaviors and interactions [50].

Culture, community, and identity recognition

The theme focuses on the significant impact of culture and community on individual mental health, emotional fulfillment, and identity recognition, revealing the roles of language and cultural identity in personal healing and community cohesion. It encompasses six intervention elements: (a) community connections and interactions; (b) historical connections; (c) cultural participation; (d) religious restorativeness; (e) language sensitivity; (f) cultural identity and trauma healing.

Community connections emphasize the importance of establishing support networks at both individual and collective levels. Through storytelling sessions and shared activities, community members can support each other and collectively address past traumas. For instance, in the Stolen Generations cases [38], people redefine familial relationships and provide a support network to aid each other’s healing by establishing survivor-led groups. Social interactions correlate positively with health, well-being, and quality of life, while reduced or absent social interactions may lead to social isolation and increased potential health risks [87].

Understanding and reconnecting with one’s community history is a fundamental therapeutic process for many participants. This is particularly true for those who have experienced cultural and familial disconnections in history. Reconnecting with this lost history helps them understand deeper aspects of their identity and address traumas caused by historical events. In Indigenous communities, truth-telling and recording the history of the Stolen Generations are crucial parts of the healing process [38]. Preserving the cultural memory of historical districts enhances individual and community psychosocial well-being, establishes place identity and attachment, improves quality of life, and supports sustainable social development [88].

Ongoing cultural participation is a vital aspect. Whether through language learning, artistic expression, or traditional ceremonies, active engagement in one’s cultural activities enhances individuals’ sense of self-identity and serves as a therapeutic tool to aid recovery from past traumas [89]. Cultural participation emphasizes the importance of maintaining and practicing traditional cultural activities to preserve cultural identity and promote mental health [90]. Participants reinforce their sense of self-identity and recover from trauma by continuing to practice Indigenous cultural values such as family-centeredness. During post-traumatic stress disorders triggered by pandemics, heritage tourism has been sought after for alleviating loneliness and anxiety effectively improving mental health [91].

Religious activities provide psychological comfort as tools for processing traumatic experiences. In some cultural contexts, religion plays a central role in healing processes. Religious beliefs offer a framework for interpreting life experiences and suffering while providing spiritual comfort and guidance; places with strong religious symbolism have special therapeutic effects within communities [26]. Thus, religious activities, especially those highly symbolic ones, offer a “calming” emotional experience particularly valuable for those recovering from severe psychological disorders [36].

Language is not only a tool for communication but also a means of cultural heritage. Respecting and using Indigenous languages can strengthen ethnic identities connecting them to ancestral traditions. Furthermore, using victims’ native languages during therapy may facilitate deeper emotional expression processing [36]. In various sociolinguistic environments language plays complex roles within therapeutic landscapes [92].

Indigenous cultural identity plays a significant role in individuals’ healing processes where family holds a central position even in the absence of biological families; healing relationships are established through shared traumas experiences [93]. This sharing understanding fosters healing recovery at individual community levels. The central role of family as an important cultural value aids people in recovering protecting their cultural identities [94]. For example, the cultural camp experience creates a sense of reconnection, cultural pride, well-being and place attachment. The experience emphasises belonging and healing [38]. Provides an experience of cultural identity through connection to the land and intergenerational healing through narratives of “returning” and “reconnecting” to the land [95, 96]. An individual’s health status is not only influenced by their personal experiences but is also closely related to their multiple identities such as their cultural background, community support, and emotional connection to the land.

Discussion

Implications for research: conceptual model

This systematic review analyzes and synthesizes existing literature to explore the impact of urban and cultural landscape heritage on mental health. We identified three primary themes: the restorative role of nature and environment, spiritual and religious practices, and the influence of culture, community, and identity. These findings offer a novel perspective through the Heritage healing conceptual model (Fig. 2), a comprehensive framework that integrates these elements into a complex yet synergistic therapeutic network to foster mental health recovery and enhancement. These themes are not isolated but interrelated, enhancing each other’s effects: natural environments facilitate psychological recovery through interactive modalities such as walking and art activities; spiritual and religious practices provide solace and community support through traditional and modern therapeutic methods; cultural heritage strengthens individual self-identity and belonging, enhancing connections among community members. This interaction creates a positive cycle, revealing the multidimensional role of urban and cultural landscape heritage in mental health interventions, offering new perspectives for designing effective mental health strategies, and suggesting integrative non-pharmacological measures for public health policies.

Fig. 2.

Conceptual model of heritage healing

However, compared to other theoretical models, the uniqueness and potential limitations of the heritage healing conceptual model are more pronounced. Compared with the Nacadia nature-based therapy model, the heritage healing conceptual model delves deeper into cultural and community dimensions but appears relatively abstract in terms of operationalization. The Nacadia model [97] centers on the restorative effects of natural environments, integrating cognitive therapy theories to provide structured horticultural activities as specific therapeutic interventions. Although it incorporates fewer cultural elements, its practice guidelines are clear and highly targeted. In contrast, the heritage healing conceptual model demonstrates greater theoretical depth through its multidimensional integration but still requires improvements in operational methods and efficacy validation. Additionally, compared with the conceptual horticultural therapy model [98], the uniqueness of the heritage healing conceptual model lies in its emphasis on the profound influence of cultural and historical contexts on mental health, while horticultural therapy primarily focuses on fulfilling emotional, social, and spiritual needs through human-plant interaction. This mechanism, based on concrete horticultural practices, is more intuitive but may be less adaptable and broadly applicable in diverse cultural contexts compared to the more comprehensive scope of the heritage healing conceptual model. Furthermore, when compared with the indigenous art-based healing model [99], the heritage healing conceptual model adopts a more holistic perspective by integrating culture and natural environments. However, it falls short in the specificity of art-based interventions and the refinement of spiritual healing design. The indigenous art-based healing model strengthens cultural identity through visual arts, music, dance, and storytelling, showing significant effectiveness in addressing historical trauma and individual psychological recovery. By contrast, the heritage healing conceptual model seeks to extract multidimensional healing effects from the broader interactions among culture, nature, and community.

In the context of rapid urbanization where natural environments may become scarce, reconnecting with nature through creating urban parks or engaging in outdoor activities can effectively alleviate psychological stress caused by disconnection from nature [100]. These urban parks and outdoor activity areas often incorporate local historical elements and cultural heritage, such as ancient garden designs and traditional vegetation planting patterns. They not only provide direct contact with nature but also enable visitors to experience and learn about local culture and history [101]. Participating in culturally enriched natural environment activities serves as a non-pharmacological means to alleviate anxiety and depression symptoms caused by life stress [102]. Additionally, in societies where diverse cultures and religious beliefs coexist, spiritual practices can help individuals find peace within their own cultural or belief systems [103]. For example, engaging in meditation or breathing exercises at historically significant religious sites can help adjust emotional responses and gradually restore psychological balance [104, 105]. The rapid development of globalization may marginalize traditional cultures; in this context, emphasizing local cultural activities (such as festivals or traditional art performances) to enhance local identity recognition becomes particularly important [106]. These activities are often held at places with significant historical backgrounds like ancient squares or inside historical buildings, allowing participants not only to celebrate the festival itself but also to experience firsthand appreciation for local heritage. For groups feeling isolated or unclear about their identity such as immigrant groups—in today’s cities where there is significant population movement—it is particularly important to participate in local community activities. By engaging in activities that preserve and celebrate local heritage (e.g., community-organized visits to local museums or participation in traditional craft workshops), immigrants can establish new social connections while strengthening their adaptation to the new environment’s historical background and cultural values [107].

Overall, the heritage healing conceptual model emphasizes the integrative role of natural, spiritual, social-cultural factors in promoting mental health providing a novel methodology for mental health interventions advancing strategies towards more humanized diverse effective directions.

Implications for interventions

In the field of mental health, traditional intervention methods often focus on clinical treatment and pharmacological interventions. However, with deeper research into environmental psychology and cultural psychology, increasing evidence suggests that environmental and cultural contexts play a crucial role in maintaining and promoting mental health. Compared to traditional models, the heritage healing conceptual model emphasizes the role of environmental and cultural heritage in creating therapeutic spaces. This model does not merely view natural landscapes as a backdrop or aesthetic element but investigates how natural environments can directly facilitate an individual’s recovery process through specific activities such as restorative walking and art activities [108, 109]. Additionally, it incorporates spiritual and religious practices into consideration, where folk rituals and symbolic acts (such as ancient rock art) can have profound spiritual impacts on individuals [110], and particularly highlights the influence of community and cultural identity on individual psychological health, such as among ethnic minorities [111]. This aspect is often overlooked in traditional intervention methods. By integrating community connections, historical links, and cultural participation, the model not only focuses on individual therapeutic effects but also considers how to promote the psychological well-being of entire community members through shared historical memories and cultural practices [112].

This integrated approach to healing that combines natural, spiritual, and socio-cultural factors demonstrates its innovation and value in several ways. Firstly, it may be more effective than singular treatments in addressing common modern issues such as excessive stress and emotional isolation. Secondly, at a strategic level, this model encourages policymakers and urban planners to reconsider public space design and urban development directions, urging them to include the preservation of historical cultural heritage as an essential part of enhancing public health welfare. In summary, the heritage healing conceptual model is not only a significant addition within the existing domain of mental health intervention methodologies but also challenges and expands our understanding of “healing.” It emphasizes viewing human health issues through the lens of heritage [113], attempting to address various psychological stresses in life such as those potentially brought on by COVID-19 [114], with notable sustainability and universality characteristics. It utilizes existing cultural and natural resources for healing purposes and can be adapted according to different national and regional characteristics. Therefore, when formulating public health policies, consideration should be given to incorporating such non-pharmacological interventions into mainstream healthcare systems and promoting this novel yet effective approach within public health systems.

Future directions and limitations

This systematic review acknowledges certain limitations in its research scope. Firstly, the data currently available on the heritage healing conceptual model is predominantly qualitative, including case studies, observational descriptions, and expert opinions. While these sources provide deep insights and understanding of the model’s potential value, they lack quantitative data and clinical trial evidence, which are essential to substantiate the effectiveness of specific interventions in treating concrete mental health issues such as depression and anxiety. In response to these limitations, future research should focus on incorporating quantitative methods and experimental designs to validate the actual efficacy of heritage resources in mental health interventions. Designing and conducting a series of quantitative studies and randomized controlled trials (RCTs) will be crucial steps to assess the specific roles and effects of heritage resources on various types of mental health issues. Additionally, further segmentation of different populations (such as age, cultural background, specific psychological states) regarding their responses to heritage resources will aid in designing more personalized and precise intervention strategies.

Moreover, conducting long-term follow-up studies to evaluate the impact of heritage resource interventions over extended periods on individual mental health is also essential. Such longitudinal data will help analyze the durability of healing effects and their potential dynamics over time. Furthermore, encouraging interdisciplinary collaboration is an indispensable part of advancing this field. Involving experts from environmental science, sociology, anthropology, and clinical psychology in the heritage healing conceptual model will facilitate a comprehensive analysis of how cultural and natural environmental factors influence human psychological health through complex mechanisms.

Conclusion

This systematic review, by analyzing existing literature, delves into the impact of urban and cultural landscape heritage on mental health. We identified three primary themes: the restorative role of nature and environment, spiritual and religious practices, and culture, community, and identity. These themes form a complex yet cohesive therapeutic network, constituting a Heritage Healing Conceptual Model that offers fresh perspectives for mental health recovery and enhancement. In this model, the restorative role of natural environments is combined with spiritual and religious practices, enhancing the depth and impact of meditation or ritual activities in historically rich natural settings. Additionally, spiritual and religious practices interact with culture, community, and identity to strengthen individuals’ sense of belonging and identity within their communities through participation in activities deeply rooted in cultural traditions. Cultural activities often revolve around showcasing natural resources and their historical significance, further reinforcing community solidarity based on shared goals and responsibilities.

The Heritage Healing Conceptual Model provides an innovative combination of healing modalities integrating natural environments, spiritual practices, and sociocultural factors into a multidimensional therapeutic network. This unique combination not only focuses on individual therapeutic outcomes but also considers how shared historical Heritage Healing memories and cultural practices can enhance the psychological well-being of community members as a whole [112, 115]. In this way, the Heritage Healing Conceptual Model effectively addresses common modern psychological issues such as excessive stress and emotional isolation [91, 116], while also prompting policymakers and urban planners to reconsider public space design and urban development directions. It encourages the protection of historical cultural heritage as an integral part of enhancing public health benefits [117, 118]. In conclusion, this review confirms the significant potential of cultural heritage resources in promoting mental health, providing novel insights and practical guidance for future research in related fields. It is hoped that future developments will see more on how such resources can be effectively integrated into public health systems to disseminate and implement this innovative and effective treatment approach.

Authors’ contributions

H.L. led the study, including the conceptualization, design, and coordination of the research. H.L. also played a significant role in the manuscript writing, including drafting the main text. T.X., A.Z., and J.S. contributed to the literature review, data collection, and analysis. X.L. provided assistance in the research process. L.K. and G.H. provided guidance and supervision throughout the research process. G.H. contributed to the interpretation of the findings and provided critical input during the manuscript writing and revision.

Funding

This work was supported by the Macau University of Science and Technology’s Faculty Research Grant (No.: FRG-24-049-FA).

Data availability

All data generated or analysed during this study are included in this published article.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.