THERAPEUTIC DESIGN Upon entry to the private areas,


patient users are met with an immediate piece of calming biophilic art, proven to consistently reduce stress and blood pressure,9


strategically located and


bathed in natural light from an overhead roof light. This is also where observation takes place – a spacious area with a window view for staff. The privacy and dignity of patient users is maintained via offset vision panels used by staff to observe the service-users. Upon entering the assessment spaces an immediate garden view is visible. The assessment rooms are generous in size, allowing plenty of space for interview and manoeuvring, with choices for resting. A fixed durable bed with soft bedhead cushioning, and a fixed robust window seat, cushioned with tough fabric and with a dining ledge, create a more home- like environment, while meeting safety standards. Blindspots are reduced due to strategic positioning of the bed, which assists with observation. Patients can control sounds, music,


lighting levels, and temperature. Evidence- grounded theory in healthcare design by Ulrich explores how personalisation and opportunities for control of a patient’s environment may result in stress reduction and diminished aggressive behaviours.10 The patient can also contact their family and friends. Further assessment rooms can be used flexibly to provide either a lounge space or sensory room, depending on patient user need. All areas have ample views to nature and biophilic art.


Summary Below is a quotation from Hannah Cadogan, Lecturer in Nursing at Roehampton University, and Representative for Lived Experience at the


Alice Green


Alice Green is an architect and interior designer, and has specialised in health for over 15 years. She incorporates ‘a holistic approach to design, with a focus on service user well-being and finding innovative ways to create cohesive healthcare environments’. She also sits on the Board of Directors of Architects for Health, a non-profit organisation that advocates for best practice in healthcare design.


Real wood panelling in areas such as the public spaces, and robust wood effect panelling in patient bedrooms, could provide sanctuary, fostering psychological comfort. Upon entry to the private areas, meanwhile, service-users are met with an immediate piece of calming biophilic art.


College of Nursing, taken from the CQC ligature guidance overview.11 ‘As a nurse myself, I know how easy it is


to concentrate on the measurable aspects of a risk or difficulty. You can easily create a tick box form to say you have door handles that can’t be used as a ligature point; in this you feel as a healthcare worker you can demonstrate that you have reduced the risk, which feels like a job well done. However, as a person who has suffered from severe mental illness and used mental health patient services, I have learnt from my own lived experience that the interventions that are not so easily measurable, such as therapeutic engagement, more often than not were the factors that reduced my risk of using a ligature.’ For the additional upfront capital costs of building in more beautiful spaces, could we see greater value in overall patient wellbeing and self-regulation affecting length of stay and overall recovery? Might this environment enable staff to deliver better patient-centric care from the outset? What impact could this have on the long-standing issue of attracting staff, including caregivers and police officers, and increasing staff wellbeing, thereby reducing staff turnover and stress-related illness, which impact revenue costs? Can we challenge manufacturers to develop and test a more suitable palette of materials that have the same robust qualities, but provide more choice for designers and patient users?


References 1 Mental Health 360: Acute Mental Healthcare for Adults. The King’s Fund, 21 February 2024.


2 CR 159: Standards on the use of Section 136 of the Mental Health Act 1983 (England and Wales). Royal College of Psychiatrists. July 2011.


THE NETWORK | NOVEMBER 2024


3 Health Building Note 03-01: Adult acute mental health units, section 8.143. Department of Health, 2013.


4 The Seclusion Issue. Design with People in Mind series. Design in Mental Health Network, May 2023.


5 The Psychological Impact of Wooden Interior Design. Medium. 7 November 2023 online. https://tinyurl.com/bdfmv7jf


6 Song I, Kwangsik B, Choyun K, Chorong S. Effects of nature sounds on the attention and physiological and psychological relaxation. Urban Forestry and Urban Greening. August 2023; 86: 127987.


7 The Sound Issue. Design with People in Mind series. Design in Mental Health Network. May 2018. https://tinyurl.com/ mt96u7xf


8 What is neurodiversity? Cambridge University Hospitals NHS Foundation Trust. https://tinyurl.com/5zep4ev8


9 Law M, Karulkar N, Braodbent E. Evidence for the effects of viewing visual artworks on stress outcomes: a scoping review. BMJ Open online.


10 Ulrich RS, Bogren L,Gardiner SK, Lundin S. Psychiatric ward design can reduce aggressive behaviour. Journal of Environmental Psychology 2018: 57: 3–66.


11 Reducing harm from ligatures in mental health wards and wards for people with a learning disability. Care Quality Commission. 21 November 2023. https:// tinyurl.com/5f4p7bd2


n


Further reading l Code of Practice, Mental Health Act


1983. Department of Health and Social Care. 15 January 2017. Last updated 31 October 2017.


l Assessment and Treatment under The Mental Health Act. NICE.


l Menkes DB, Bendelow GA. Journal of Public Mental Health 2014; (13)2. https:// www.brighton.ac.uk/_pdf/research/ ssparc/jpmh-s136-paper-20141.pdf


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