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Environments for Recovery


Figure 4: The


architects informed the design ‘not just with windows, but also by considering the way that the light is directed and perceived’.


Figure 3: Here, to help ‘reduce barriers’, the reception space was combined with the servery for the café/bistro.


had been shifted’, and ‘the environment was more empowering for the service-users, albeit in stages’. Showing a slide (Fig. 2), Alex Caruso said: “The approach we take for the admission experience here is retained, and the door to the outside world is in sight from communal areas, inviting service-users to access outdoor areas.” He explained that here the layout accommodated a system of courtyards for assessment bedrooms and communal living residential units, providing an environment that is adaptable and practical, ‘as well as being safe and robust to meet the demands of an extensive range of patient profiles’. The ‘usual’ perimeter fence had also been substituted by the building’s perimeter, ‘to provide a comfortable environment that reduces tension and promotes wellbeing’.


CHANGING PERCEPTIONS Question four, How can we influence the environment to alter the public and patient perception of mental health units?, was addressed by both speakers, beginning with Andrew Frankel-Caine. He said: “Many of the public still have a misperception of mental illness, and expect psychiatric hospitals to have a ‘sterile’, clinical environment, based on a medical model, and to look similar to how they appear in old Victorian film images of psychiatric care.”


Location, location


The location of a mental healthcare unit was, he argued, ‘absolutely critical’ to both the service-provider’s ability to facilitate a high quality recovery environment, and to it having strong links to its local community. The chosen location should ideally provide easy access to: • Road and rail networks. • Local shops and community facilities. • Colleges and other educational establishments.


• Community-based voluntary sector organisations.


• Dentists and other healthcare facilities. Supermarkets.


In addition, to encourage a strong feel of being part of the community, it should ‘provide access to full citizenship activities’ – ranging from voting and involvement in local community politics to library membership; and from


opening a bank account, and involvement with community groups and associations, to access to employment opportunities.


HOTEL RATHER THAN A HOSPITAL DESIGN


Moving away from ‘stereotyped designs and traditional interior modelling’ to a design ‘more on the principles of space, interior design, and, lighting’ should, he argued, be the goal. He said: “The environment should be designed with the service-user at its heart. Many such individuals will live in the unit for several years, 24 hours per day, 7 days per week. Service- users will respond positively to a high quality, well-designed environment, and this is likely to promote faster recovery.”


Alex Caruso then gave his own view on the questions of how a high quality environment could impact on public and patient perceptions of mental health units.


‘Homely’ environments


He said: “It is well-known that a high quality, ‘homely’ environment can have an impact on reducing stress and anxiety. That is why we create spaces with a residential feel – to smooth the transition from what residents would experience at home. The (potential) conflict between security and homeliness will always be there, but we continue to work with clinical teams that are open to exploring fresh and simple solutions while ensuring compliance with published guidance and regulations.” He continued: “Modern, safe kitchens, and suitable laundry facilities, are an important part of the recovery process, and are thus located so as to support service-user training in the use of domestic equipment, so that individuals can regain confidence before returning to the community.”


Relationship with the community Alex Caruso pointed out that the entrance to many mental healthcare units was also the main communal space – ‘if you like, the piazza that can help users see a progression in their journey from segregation to ordinary community living, with personalised support’. This ‘space’s’ location also played an important role in terms of


DEVELOPING HUMAN RELATIONSHIPS Question 5, Is there a way we can create an environment which encourages the development of human relationships through positive interaction, and how does this alter the emotion of the service?, was answered by Andrew Frankel-Caine, who told delegates: “Relationships are important, and are formed through interaction and engagement. Nobody could ever say that they had enjoyed a positive relationship with someone they had never seen


communicating autonomy and openness to the local community, and in social interaction and stimulation. He said: “Rather than providing an intimidating large space, our aim is to break down the space and shape of these communal areas to create opportunities for groups to congregate. Light, texture, and colours, are all used to create an inviting environment. We also use a specification that addresses noise reduction to enhance privacy, while acoustic panels can reduce reverberation that may disorient people. Equally, locating kitchens as a focal point of aromas that may help restore positive daily routines is another design element we use to create a balanced environment.”


Figure 5: The communal area of this high dependency facility was deliberately designed without a staff base.


THE NETWORK J a n u a r y 2 016 17


Images courtesy of Alex Caruso, aca+i.


Images courtesy of Alex Caruso, aca+i.


Images courtesy of Alex Caruso, aca+i.


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