ARCHITECTURE & DESIGN
Empowering service- users can aid recovery
Teva Hesse, Design director at 4D Studio Architects, explores whether ‘designing out risk’ in inpatient mental healthcare facilities has resulted in service-users having little to do apart from eating, sleeping, and watching TV. He argues that this places excessive, and possibly unnecessary, burdens on staff, as most activities must be managed, led, and supervised, and suggests giving service-users greater individual empowerment to engage in meaningful pursuits.
At a time when mental health staff resources are overstretched, this article explores the possibility that allowing service-users to engage in meaningful activities independently, or with some degree of supervision, might allow some nursing shifts to function with fewer staff. The new inpatient mental healthcare facilities at the Springfield University Hospital in South London are test cases to see whether designing for therapeutic benefit generates better outcomes. The initial data shows a significant reduction in incidents. Perhaps the path to safer environments doesn’t only mean designing out risks. Maybe environments where service-users feel comfortable in their surroundings, and are empowered to engage in meaningful activities of their own choice, can lead towards a safer model of mental healthcare.
Designing out risk The design of mental healthcare facilities is never removed from a consideration of risk. There are two ways of dealing with that risk: design out the risk, or design around it. Designing out risk is the prevalent attitude of NHS management, consultants, designers, and clinicians. The guidance is permeated with considerations of risk. The industry that provides products for mental health facilities is likewise directly responding to the possibility that terrible things can, and on rare occasions, do, happen. This means that mental health products and facilities are designed primarily to address risks of self-harm or violent attack; as a result, they are heavy, uncomfortable, visually unappealing, and stigmatising. They reinforce the subtle but unmistakable message of underlying control, threat, and danger. Take a ward as a whole – and ‘designing out risk’ is often synonymous with the provision of sterile, custodial environments. Patients’ viewpoints are solicited on occasion, but carry much less weight than those of facility or clinical managers. It is worth considering that removing risks to facilitate the daily running of a ward may encourage the very behaviours that clinicians seek to avoid. Perhaps the well-
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Above: The Trinity Building at Springfield University Hospital. Right: The entrance to the Shaftesbury secure building.
meaning and competent efforts to make a ward safe from a management perspective translate into a lack of meaningful activities and self-empowerment from a patient’s perspective. First, a few difficult questions. When
an inpatient’s stay is compounded by constant TV, heavy medication, and depressing surroundings, is it any surprise that these environments produce so many negative outcomes / incidents? (Note that serious incidents, in turn, require more staff on wards, and consume considerable administrative time). Is it possible that – along with clinical diagnoses – frustration, boredom, and monotony, contribute to negative and destructive behaviours? Why is the provision of engaging, comforting, and therapeutic surroundings so readily surrendered in favour of compliance with robust anti-barricade and anti- ligature initiatives? Does any professional participant in the design process truly advocate for the aspirations of the service- users and on-ward staff that will occupy the facility? How are these views weighted
The Project team
l Architect: C.F. Møller Architects UK. l Landscape advisor: Farrer Huxley. l Project manager: Appleyard & Trew. l Structural engineer: Walsh. l MEP engineer: Arup. l Quantity surveyor: Gardiner & Theobald.
l Fire engineering: Socotec. l Arts curator: Hospital Rooms. l Acoustic engineer: Anderson Acoustics.
l Main contractor: Sir Robert McAlpine.
l Development manager: STEP Springfield Tolworth Estates Partnership.
NOVEMBER 2023 | THE NETWORK
copyright Mark Hadden
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