Why cultural ecosystem services matter most: Exploring the pathways linking greenspaces and mental health in a low-income country.

Exposure to urban greenspaces promotes a variety of mental health benefits. However, much of the evidence for these benefits is biased towards high-income countries. In contrast, urban areas in low-income settings that have the highest rates of urbanisation remain understudied. Given the increasing burden of mental ill-health associated with urbanisation in low- and middle-income countries (LMICs), there is a clear need to better understand the role urban greenspaces play in mitigating mental ill-health. Here we use a novel combination of research methods (participatory video, focus groups and the Q-methodology) in a rapidly urbanising low-income city (Kathmandu, Nepal). We explored residents' perspectives on ecosystem services, and the pathways linking greenspaces to mental health. Residents indicated that greenspaces are linked to mental health through pathways such as reducing harm (exposure to air pollution and heat), restoring capacities (attention restoration and stress reduction), building capacities (encouraging physical activity, fostering social cohesion and child development) and causing harm (human - wildlife conflicts, gender discrimination). It is likely that a combination of such pathways triggers mental health impacts. Of all ecosystem services, cultural services such as providing settings for recreation, or intellectual or mental interactions with greenspaces involving analytical, symbolic, spiritual or religious activities were most preferred. Our findings emphasise that cultural ecosystem services provide a fundamental basic need which all people, including low-income residents, depend on to participate meaningfully in society. Urban greenspaces therefore play a pivotal role in reducing the burden of mental ill-health for low-income residents in LMICs. Greater efforts to increase the quantity, quality and accessibility of greenspaces may help to address current health inequalities in LMICs.