DESIGN IN MENTAL HEALTH 2022 KEYNOTES
Good access to the outdoors was cited as one of the key factors that could aid de-escalation, both staff and service-users noted.
user and staff relating.” She continued: “As I’ve already mentioned, the seclusion room being ‘an antithesis of its purpose’ was mentioned by numerous staff and service- users, with many staff very distressed about having to put people in seclusion. This accords strongly with Steve’s comments, yet it seems that seclusion is still frequently used. “In the unit we undertook our research
in, there was a ‘green room’, intended to serve as a de-escalation room, but when we visited, all the furniture was out, and it was being used as another seclusion room. So, clearly, there was something going on on the ward, whereby even de-escalation wasn’t working, people were being sent straight to seclusion, and different rooms were being re-purposed for seclusion. I think the staff were very frustrated, and found it very anxiety-provoking.”
Consequences of an ‘unconducive’ setting Prof. Reavey said she felt that had the rest of the ward, and the wider environment, been operating in the way they should have been – with positive staff / service- user relations, and had the setting itself been ‘suggestive of connection, belonging, and trust’, there would, perhaps, have been fewer instances of seclusion. Her final focus, she explained, would be
‘how, when seclusion is used’, service-users and staff both talked about how trust is ‘dismantled’. “So,” she explained, “while relations on the ward between staff and service-users might generally be positive, the moment seclusion is used, that is dismantled.” This was because – as a number of mental healthcare personnel in
There was a widespread perception that the seclusion process put an additional ‘barrier’ between staff member and service-user.
the research had stressed – it put ‘a divide’ between them and the service-user. The Professor said: “It also puts a boundary in place, both physically – because you’re shutting the door on that person, but also psychologically – because you as a staff member have asserted control, and assumed agency in that situation. There’ll clearly be instances where you have to do this, but they do take away control from the service-user.” It was, she said, ‘very difficult to re-build that trust subsequently – especially when the threat of seclusion remained’.
A broader research project “What we are suggesting from this initial work,” the Professor told delegates, “is a broader research project – which we’re putting together currently with a number of architects and designers – which will need to understand what are the qualities of an environment of an acute ward? Not just how seclusion is being used, but the entire environment, i.e. ‘What’s the atmosphere like?’, ‘Are there opportunities for relating, communicating, and engaging?’, and ‘How does the environment itself either encourage and facilitate that, or shut it down?’ We also, of course, need to know how we can build in psychological safety to the environments people are accommodated within.”
Low stimulation Another ‘really important issue’ was that many seclusion rooms were designed ‘according to the principle of low stimulation’. Professor Reavey said: “So, we spoke to a number of staff members who talked about there being white walls,
Prof. Paula Reavey: “This very preliminary research suggests that people’s state of mind is built into the environment, and that’s exactly how we should be reading it, as well as reading how we should then manage seclusion rooms”
THE NETWORK | NOVEMBER 2022
and no stimulation, which cannot be really good for service-users when they are in an agitated state. We would question the evidence for such colour schemes etc. In fact, evidence in psychology suggests that when people hear voices, for example, the worst thing you can do is play ‘white noise’ to them, or remove stimulation, because that just amplifies voices. So, can we design evidence-based design spaces, and understand how agitation might be relieved, or soothed, by the environment, because currently, a space with a crash mat on the floor, a white wall, and ugly ceilings, is not perhaps the best place for a person to de-escalate and to calm.”
Building an evidence base Prof. Reavey explained that the researchers wanted to build an evidence base. She said: “I would also, most importantly, talk about psychological safety, and the fact that such environments impact directly on staff / patient relations. Thus when we’re tempted to say: ‘That person has been being problematic, or troublesome, or agitated’, because they’ve been diagnosed with schizophrenia, I think that that’s a very limited take on what’s going on. I think what we have to understand is how environments affect particular staff / patient relations – we need an ecological model of psychology, not a limited model, or a model determined by the diagnosis. “This,” she said, “goes beyond the personal qualities of both the staff and the service-users; it’s a relational state afforded by the environment itself. This very preliminary research suggests that people’s state of mind is built into the environment, and that’s exactly how we should be reading it, as well as reading how we should then manage seclusion rooms. So, seclusion rooms are part of this much, much, broader problem of environments and people.” This closed the presentation by Professors Reavey and Brown, and the session Chair, Cath Lake of P+HS Architects, opened the floor to questions.
n 13
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34
