A mental health facility should be designed with an aim to create a space where patients are well cared for, rehabilitation and reintegration is encouraged and one that imparts awareness, education and training to family members who act as care takers, writes Hosmac architects.
When you think of psychiatric hospital, it won’t be surprising if leather restraints, straightjackets, isolation rooms, barred window, big white corridors with flickering lights and shock therapy pop up in your head. Books and movies, too have portrayed “mental hospitals” in similar light, like a nuthouse or lunatic asylum— the intimidating Oregon State Hospital in One Flew over the Cuckoo’s Nest, the restraint beds and chains in the fictional bestseller The Girl with the Dragon Tattoo, the unforgiving Arkham Asylum in Batman Begins, and who can forget Hannibal Lecter’s eerie cell in Silence of the Lamb. Point being, such hospitals are generally considered negative; a dull space where people are detained rather than healed; a jail-like place with wide corridors. Although practices in patient treatment have evolved, the image of exclusion and imprisonment persists.
The possibility of architecture acting as a catalyst to bring a change to this clichéd mindset has drawn attention to an important question: can architecture contribute to the fight against prejudice and stigma? It is a significant mediator that transmits the real and current picture of psychiatric institutions to society. Should its architectural design be such that it gives a hotel-like atmosphere, where the patients feels they will be cared for? Or, should it be such that the patient realises he/she is in a hospital setting? Should contact with the society be encouraged or should patients feel protected in a well-designed space, considering their physical and mental needs?
Mental health facility design is a critical component of patient care. The design tremendously impacts planning of healthcare systems in these facilities. The staff, the services that are offered and its efficiency, as well as expectations and perception patients have about themselves, are largely based on facility design. Its design impacts users at different levels of building interface that include architectural and interior design. Architectural considerations include introduction to the facility, building aesthetics, accessibility, inclusions of nature in built form and physical access to these spaces, the layout and configuration of space. The interior design considerations include furniture, flooring, wall colour, texture, trim, use of artwork and other aesthetic features. Recommendation of the WHO on psychiatric services and architecture from 1959 states that familiarity with places and persons increases the patient’s sense of security.
A mental hospital differentiates from its counterparts by the quality of interactive spaces. An individual suffering from mental issues like depression secludes himself/herself in a shell. Hence, it is important for this individual to interact with doctors and others. Healer-patient relation contributes to an important treatment process and their interaction should not be limited to treatment room. It is through designing these spaces tactfully that one can initiate interaction outside treatment room.
Adults, who are used to controlling their lives and being autonomous, come into a system in which every detail of their daily routine is prescribed, thus making them completely dependent. Therefore it is very important to provide each patient with an opportunity to control his/her immediate environment as much as possible. This may include the level of lighting, type of music, seating options, and also access to kitchen facilities, where snacks or meals can be prepared by patients themselves. A patient’s sense of competence is encouraged when spaces are easy to find, without asking for help .
Building layout should be simple with obvious travel paths and clear signage, so that visitors and patients do not need to ask for help. It should also support the feeling of security. Openings and access to plants that change with the seasons, as well as the availability of clocks, provide decor and information as part of the daily activities, and allow for orientation in time.
Some important questions to consider include:
- How to respect privacy of a patient in his/her room and simultaneously create a secured space maintaining good visibility, with no hiding spots?
- How to allow the patient to communicate with the external environment (to beneﬁt from the city) with the window being locked?
Each hospital management must decide which of the factors are most important to them. For e.g. using electronic security systems; patients can be given a small bracelet that they can wear around their wrists granting them seamless access to different areas of the facility based on their privilege level.
An individual room should be comfortable, have mixed spaces and allow for sufficient movement. Furthermore it should encourage interactions by creating an area for small groups of people. The patient will gradually gain confidence to use spaces that are designed to accommodate even more number of people in one central setting, mimicking the life they will eventually have in the community.
Create a secure access to outdoors so that patients can enjoy sunshine and fresh air as this is an important aspect of the healing process. Emphasis on incorporating natural light and exterior views generates a positive influence on mental well-being. These outdoor spaces should be designed for the specific needs of those dealing with mental or psychological challenges. At the same time, it is crucial for such facilities to be secured. Creating an opportunity for individuals to relate on a spiritual level supports treatment and including it in the design concepts is recommended.
Psychiatric facilities and treatment ideologies are subject to quick and frequent changes. Practices have evolved considerably in the last decades, and options for patients have to be adapted constantly. Therapy rooms, in particular, have to be built in a flexible and multi-purpose way. This allows not only for different activities in the same space, but also prevents unnecessarily quick obsolescence.
- Mental Health Facilities Design Guide. (Dec 2010) Published by department of Veteran’s Affairs
- Part 2.1 (On the handling of mentally ill)
- The Architecture of Hospitals by CorWagenaar
- WHO, Psychiatric services and architecture. : Pg 26
www.wbdg.org (whole building design guide)