THERAPEUTIC DESIGN


A ‘human’ approach to Places of Safety


Alice Green, Associate Principal, Architecture and Urbanism, Mental Health, at Arcadis, argues that not enough thought has been given to the design and feel of what are known as ‘Places of Safety’ to date, with some patients starting what could be a lengthy inpatient stay in dreary, intimidating, and institutional admission and assessment spaces. She considers how an ‘ideal’ such environment might look through Arcadis’s own Halcyon ‘concept’ Place of Safety.


The starting point to receiving mental healthcare support can sometimes begin at a crisis point, with a police officer, working in partnership with the local health network, taking a person to a Place of Safety or ‘136 suite’, where they are assessed by a healthcare professional within a 24-hour period to decide on the next steps for treatment. The King’s Fund reported that unfortunately, in the UK, people are not getting healthcare support early enough to prevent detention, despite national aims for interventions. This has led to a 45% increase in reported detention cases since 2017.1 The Royal College of Psychiatrists document, CR 159: Standards on the use of Section 136 of the Mental Health Act 1983 (England and Wales),2


describes how there


is a shortage of appropriate facilities, and argues that more are needed to prevent inappropriate use of police custody and Accident and Emergency Departments. It goes on to describe the need for sufficient rooms within the Place of Safety to meet the local need. The law keeps evolving to try to


protect patients and the public when moving people to Places of Safety, but the environment of the destination itself is only briefly mentioned in HBN 03-01,3 and the aforementioned Royal College of Psychiatrists document,2


with reference


to some environmental factors, safety, robustness, and observation. It appears that such facilities are seen as a place to contain, detain, and assess, rather than a place to potentially aid the recovery process.


The patient experience It is noted by the Royal College of Psychiatrists that more research is needed on the patient and carer experience in the UK in relation to 136 suites.2


Above: Dual, symmetrical, pitched roofs are domestic in scale, giving a less institutional feel. Left: An axonometric drawing of the Halcyon building.


and a lack of research on the benefits of providing a more therapeutic Place of Safety, such locations are often very basic in nature, with bright lighting, reverberating sound – due to the use of hard, durable surfaces, and often bland, with very little in the way of visual interest for fear of creating a triggering environment. There is also no evidence to support an environment devoid of art, visual interest, high quality furniture, and biophilic design being in any way beneficial for 136 suites.4


In fact, the What we have


learnt in some cases is that this can be an extremely traumatising journey. Imagine being at a very low point in your life, and being taken unwillingly into an unfamiliar environment? For a mental health patient in the UK, involuntary admission to is highly sensitive,


THE NETWORK | NOVEMBER 2024


and has common issues with other countries relating to perceived coercion, dignity, and human rights. Since being taken to a Place of Safety is sometimes the gateway to people’s admission, the experience has the potential to set the tone for the rest of the individual’s experience, severely impacting overall speed of recovery and duration of stay if the patient is admitted to a mental health inpatient ward. Patient outcomes can vary, with some patients going straight home after assessment. Due to concerns over safety features


opposite can be said in terms of aiding recovery for general health and wellbeing. Against this backdrop, how can we improve this experience and give people the best chance to de-escalate, enabling a rapid assessment? As designers, we should be looking for opportunities to humanise this journey – from the point of entry to the facility.


Investing in Places of Safety Although it might seem inappropriate to compare a Maggie’s Centre or a Macmillan Centre to a Place of Safety due to the


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