ARCHITECTURE & DESIGN
expected and some surprising dimensions. The first outright conclusion was that each ward and service-user group had a unique incident profile. There were virtually no ligature incidents on Older Persons’ wards, but slips/trips/falls was the major incident type. The opposite was true for an Adolescent Acute ward. As expected, self-harm and ligature incidents took place overwhelmingly within private spaces: bedrooms and en- suites, which drove home the imperative to make unsupervised spaces as free of ligature risk as possible. These findings also point to the fact that while mental health guidance, construction, and products, are geared for a one-size-fits-all model, there are no two wards, or indeed no two patients, that fit the same profile. A striking observation was that on
all wards the major incident type was violence/abuse/harassment, which typically accounted for over half the total number of incidents. Corridors were the primary zones for violent incidents. To design around this risk, we pioneered the principle of ‘avoidability’ – the ability to take an alternate route to avoid an undesired interaction. Other layout principles were derived
from this research, and in-depth discussions with service-users and staff. These include locating common rooms adjacent to a centralised nursing base, freely accessible gardens at the centre of wards, ample windows to assist orientation, group rooms with multiple exits, and bay windows to increase the connection between inside and outside.
Reasons for robustness The research pointed to another very important fact: the majority of service- users are not involved in incidents, do not barricade themselves, or engage in self-harm. The necessity for robust mental health design arises in response to a small minority of acutely unwell patients. Is there a clinically acceptable means of balancing the demands of a few very challenging patients with a focus on providing a peaceful and comforting refuge for all patients?
As objective research, our study had some clear limitations. We realised that this research was entirely focused on ‘negative’ metrics. It didn’t consider how a ward environment might promote beneficial, therapeutic outcomes such as nights of sound sleep, satisfaction with mealtimes, learning new skills, helpful interactions with staff, access to music, or other positive experiences. A focus on risk and risk mitigation is only part of the work, and perhaps it is time to focus on how mental health environments can deliver beneficial experiences as a means towards risk mitigation. Over several years of engagement and multiple visits to every ward and specialist service, a set of primary design aspirations repeatedly surfaced in our consultations; these became the guiding principles for
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Above: Springfield artwork in the Hospital Atrium by Yinka Illori. Right: Springfield artwork in the hospital Atrium by Sutapa Biswas.
our mental health design work: l Less dreary: Creating ward environments that avoid monotony. Providing opportunities to engage in beneficial, self-guided activities.
l Greener and freer: Free access to gardens and outdoor space, with as large and varied external garden spaces as possible.
l Quieter: Full sound insulation between rooms. Acoustic dampening of airborne sound.
l Brighter: Ample daylight and views of the sky. External views.
l Fresher: Plentiful fresh air and natural ventilation. Comfort cooling of common rooms.
l Safer: ‘Avoidability’ – providing a choice of routes to get from A to B. Good sightlines and visibility for both staff and service-users.
l Avoiding stigma: A hospital where service-users, staff, and carers, feel comfortable, valued, and safe.
We believe that access to gardens and nature is a key to creating calming and therapeutic environments in mental healthcare facilities. Proximity to plants and greenery contributes to wellbeing, and provides space to ‘decompress’. Gardens offer a connection to the passing seasons and daily changes in weather. Abundant natural light aids in the regulation of sleeping patterns. We aimed for building occupants to inhabit the zone between indoor / outdoor environments through the provision of glazed viewing areas, corner lookouts, window seats, and large skylights. The Springfield University Hospital buildings incorporate 28 planted courtyards – for service-users, staff, and visitors. They offer a range of activities, such as gardening, exercise, ping-pong, outdoor dining, gentle walking, resting, and quiet contemplation. Each outdoor garden has a different
character to create a variety of smells, textures, and appearances. All ward gardens have been designed to be easily
observed from the central nursing station/ ward base. All gardens have step-free, direct access for service-users. Many gardens are designed with planting beds so that service-users with the inclination might assist with the upkeep of ward gardens.
Meaningful activity As noted above, ‘designing out risk’ has resulted in service-users having little to do apart from eating, sleeping, and watching TV. This model of care places excessive, and possibly unnecessary, burdens on staff resourcing, as most activities must be managed, led, and supervised by staff. It also leads to the loss of agency for patients in furthering their own recovery. For inpatients there are a lot of hours
in a day to fill, so within the Springfield University Hospital, we have tried to create wards that encourage self-engagement of service-users. We worked with Trust clinicians to find ways of promoting individual empowerment to engage in meaningful pursuits. Trinity and Shaftesbury wards include built-in nooks where patients can make their own tea/ coffee, read, play games, sit outside, and garden. There are also dedicated rooms to cook, exercise, dance, sing, paint, listen to music, pray, meditate, work, use a computer, and participate in group or individual consultations, etc. We have sought to turn the risk paradigm around, and start by imagining activities that are possible for service-users to undertake independently with an acceptable level of risk, according to their level of acuity and individual desires. Improving facilities for staff is not an optional ‘nice to have’. In order to attract and retain a dedicated and well-motivated staff, the Trinity and Shaftesbury buildings have incorporated the following into the design: l Staff workrooms and administrative office areas have natural daylight and views to landscaped spaces.
NOVEMBER 2023 | THE NETWORK
copyright Sam Whatman
copyright Gabrielle Aquadro
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