Environments for Recovery

Figure 2: At this rehabilitation unit the layout incorporated a system of courtyards for assessment bedrooms and communal living residential units, providing an ‘adaptable and practical’ environment.

Coaching and nurturing On ‘Coaching and nurturing a facilitative partnership’, he said: “A facilitative partnership can only exist where the physical environment enables it.” Andrew Frankel-Caine felt this required removing physical barriers and obstacles to the nurturing relationship, such as unnecessary walls and doors; bunches of keys – ‘consider a single fob’, and ‘other perceived power symbols’, such as alarms and radios. “Instead,” he advised, “consider discreet equipment.” His other recommended steps included removing window panels and ‘spyholes’ from bedroom doors, and ‘designing so that half-dome security mirrors are not required in bedrooms or on corridors’.

Maximising opportunities for engagement Considering the third essential component of a good recovery environment, he said: “The design needs to maximise opportunities for social engagement, peer support, and partnership working. Recovery is unlikely to happen in isolation. Service-users need opportunities to engage with each other, and with those who are supporting them. The design should thus be as open plan as possible, with natural light, and good air circulation.” A central hub bistro/café type area was becoming ‘a popular feature within innovative designs’, and should provide a shared communal space ‘to maximise engagement and development of supportive relationships’. The debate then moved to the second

question, Could architects create one ‘recovery- focused design’ that suits all services? This was also addressed by Andrew Frankel-Caine, who believed the answer was ‘No, one design does not fit all’. However, the ‘philosophy of recovery’ needed to be ‘embedded into each and every service model’, while the design of the environment would need to adapt and flex ‘depending on the complexity of the client group’ and associated clinical risk factors, and to consider the individual needs of the service- user population (including ‘complexity, diagnosis, and difficult behaviour’).

NOT A LINEAR PROCESS He said: “Recovery from mental illness is not a linear process, and will be a process of peaks and troughs; therefore the environment needs to be flexible to deal with a range of complex behaviours during both wellness and relapse.”

16 THE NETWORK J a n u a r y 2016

Nevertheless, he noted, recovery was ‘a philosophy which all mental health services should embrace’, and, regardless of the complexity of the service, the underlying principles of recovery were the same, and should be factored into the environmental design. An effective recovery environment should: • Give the service-user a feeling of self- worth, and make them feel valued.

• Promote the development of positive relationships, and a good quality of interaction between staff and service- users.

• Stimulate emotional well-being. • Create a homely, comfortable living environment.

• Be light and airy, with good natural light and air circulation.

• Minimise ‘power differentials’ between staff and service-users.

PERSONALISING BEDROOMS Equally, Andrew Frankel-Caine said, bedrooms should be personalised, and provide a safe and healthy space for sleep and relaxation; the environment should be free from loud and distracting noise, and all areas should promote inclusion, and aim to remove any physical barriers which could impede staff and service- user contact. He added: “Ways should be found to keep rooms such as the kitchen and laundry open, rather than locking them off; glazed screens, rather than solid walls, should be used where appropriate, and providers should adopt a positive, risk-taking approach that is solution- focused – a ‘can do’, not a ‘can’t do’ approach.” The aim, he said, should be to find innovative and creative ways within the building design to empower service-users – ‘more difficult, but extremely empowering’.

PERSONAL APPROACH EXAMINED Question three in the debate – What approach have you previously taken in designing a range of recovery environments? – drew particularly

‘The design needs to maximise opportunities for social engagement, peer support, and partnership working’

Andrew Frankel-Caine said: “I don’t perceive the service-user’s core needs as any different to my own.”

on practical experience, and was answered by Alex Caruso. Showing a slide of a Medium/Low Secure Unit (Fig. 1), he explained: “This is one of the first medium secure units for women that I got involved in when I came to this country. At the time my experience was predominantly in the domestic sector, and I found using the domestic vernacular conducive to creating a less traumatic admission experience. Such an experience can be frightening, so it is important that the first impression is welcoming and caring, using familiar and non-institutional materials, with cheerful and varied colours and textures. “The layout facilitated social interaction and contact with service-users. We used natural light wherever possible, providing restorative views of landscaped areas. Access to the outdoors was via airlock systems. “Safety and security is obviously particularly

important,” he continued, “but it is even more important to achieve it discretely. That is why the volume of the building facing the access road was at human scale, while the reminder was scaled to match the 5.2 metre high fence. “It was an environment designed to be completely anti-ligature. A few years ago I went back to visit, and had a great reaction from the residents, and was delighted with the warmth they greeted me with when they learned of the steps taken with the design.”

Locked/open rehabilitation More recently, the architect said he had been involved with a number of rehabilitation environments, where ‘the emphasis on security

Images courtesy of Alex Caruso, aca+i.

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