Environments for Recovery

“My children are thriving, enjoy school, are engaged, happy, and on track to being very successful. So, if we want to have a positive impact on the life of another person, relationships are vital.”


Figure 6: Residents are able to personalise, and perceive as their own, spaces such as apartments and bedrooms.

or spoken to. Our interactions enable us to get to know the person better, understand them, find out about their aspirations, and work together to achieve their ambitions. This requires a high level of communication and partnership working, and a well-designed environment which facilitates this communication.”

He noted that a document produced by

Rethink in 2011 stated that ‘working in partnership is central to recovery-orientated practice’. It added: “This will involve teams developing, and experimenting with, ways of relating as partners to the people who use the service. The aim is to support people over time to have more responsibility for their own lives, and to break down any barriers which might exist caused by ‘us’ and ‘them’ thinking.”

A USEFUL ANALOGY Further emphasising the impact of good interpersonal relationships, Andrew Frankel- Caine said: “Let me use an analogy – I never achieved very much at school – I perceived my teachers as authority figures, who never really took time to get to know me, and did not enquire about my individual learning needs or style. I was just a ‘pupil’ among a class of pupils. I never felt supported. The teachers were distant, non-engaging, isolative, and curriculum-focused. I disliked school, and subsequently achieved very little. “I am pleased that teaching has since progressed enormously. My children have a very different school experience – based on a relationship with the teaching staff, who display empathy, warmth, and understanding of the children’s individual needs. Teachers take time to spend with the children on a one-to-one basis. The building design, teaching methods, and philosophy, have all changed, and are now student-centred and inclusive.

‘Many of the public still have a misperception of mental illness, and expect psychiatric hospitals to have a sterile, clinical environment’

18 THE NETWORK J a n u a r y 2016

Given this conclusion, Andrew Frankel-Caine said that, ‘based on the principles of recovery and a framework of partnership’, the purpose of a ‘recovery-focused rehabilitation environment’ should be to provide a team of people who can support service-users when they need it most, enabling such individuals to experience and gain ‘hopefulness, not helplessness’; new skills; a sense of

empowerment; new confidence; greater independence, and ‘improved daily structure and better coping strategies’. He added: “All of this, however, relies upon a physical environment which enables effective partnership working.” Question six, What are the most important considerations for an architect in terms of creating a design which supports rehabilitation?, was addressed by Alex Caruso, who said he believed that among the most important was ‘Reducing barriers within the environment and design’. Here he showed a series of slides illustrating different aspects of this particular principle, each intended to help give service-users back an element of control. Of the first (Fig. 3), he said: “In this facility we combined the space for the reception with the servery for the café/bistro. It was an opportunity to explore a solution that addressed access for wheelchair users and sensory impairment. The staff working in reception are part of the social gathering, and contribute to the perception of reduced barriers.”

AWASH WITH NATURAL LIGHT His next slide (Fig. 4), showed how, beginning with the initial sketches, the architects informed the design ‘not just with windows, but also by considering the way the light is directed and perceived’. Alex Caruso elaborated: “Natural light is the best form of light, bringing to life colours and textures, and playing a vital role in readjusting the circadian rhythm. Using different locations, sizes, and amounts of light, we can differentiate bright lounge areas from calmer and dimmer light in bedroom areas. To give individuals an element of control and privacy, we also integrate curtains coordinated with the interiors.”

The communal area of the high dependency facility shown in the next slide (Fig. 5) had been deliberately designed in a ‘non-clinical’ style, without a staff base. The result was ‘a richer environment, with endless opportunities for natural observation and contact between residents and staff, to prevent alienation’.

ABILITY TO PERSONALISE Alluding to the next slide (Fig. 6), Alex Caruso said: “We frequently seek to create spaces such as apartments and bedrooms that residents can

personalise and perceive as their own, with their own memories and roots. When working in the mental healthcare sphere, one size certainly does not fit all, so listening effectively to build up an accurate understanding of the particular patient group is fundamental to a successful healthcare outcome. “We investigate as many options as we can using sketches and 3D models, the latest guidance, and visits to successful schemes.”

IMPACT ON EMOTIONS AND ‘MOOD’ The seventh and final question addressed was: Can environmental design positively impact on the service user’s emotions? Andrew Frankel- Caine responded first. He said: “I believe that it is obvious that the design of the environment has a significant impact upon the speed of recovery. I don’t perceive the service-user’s core needs as any different to my own – go into a building which is dark, cold in colour, poorly designed, and uninspiring – and it will undoubtedly impact negatively upon your emotional state.

“Imagine working in a square office with little natural light, bare beige walls, and a lack of furniture – would this be an environment in which to be creative and inspiring? Similarly, dark, poorly designed, isolated, and sterile clinical environments will discourage recovery.” Such hostile environments might well, he said, also exacerbate symptoms of mental illness, foster hopelessness, create stress, lead to feeling undervalued, increase vulnerability, and reinforce a sense of personal failure. “Conversely,” he said, “the type of positive environment we have advocated will make the service-user feel valued, help retain their dignity, build their self-esteem and self-worth, increase their feeling of content, and help the individual feel proud of him or herself… culminating in them feeling accepted for who they are, rather than simply being viewed as per their diagnosis and set of symptoms.” As the presentation concluded, Alex Caruso

added: “They are all light and impalpable emotions. Mental health is often associated with social malfunction, but in truth it is the real perception of emotions. Conversely, creativity is a mixture of many emotions, and we believe that with a solution-focused approach the environment can help: • People to be themselves. • Reduce the stigma attached to mental illness.

• Promote independence, with open spaces for family to visit,

• Promote empowerment and partnership with end-users.

“To paraphrase Herman Hesse in Siddhartha: “We are not going in circles, we are going upwards. The path is a spiral; we have already climbed many steps.”

‘Ways should be found to keep rooms such as the kitchen and laundry open, rather than locking them off’

Images courtesy of Alex Caruso, aca+i.

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