ARCHITECTURE & DESIGN
The entrance approach at Aspen Wood is ‘intentionally oblique’ to remove the stress of approaching a large arrival zone.
There are approximately 1.3 million people with a learning disability in England, including over 950,000 adults aged 18 or over. Compared with people without a learning disability, people with a learning disability tend to experience poorer physical health, poorer mental health, and significant health inequalities. The latest LeDeR (Learning from lives and deaths – People with a learning disability and autistic people) report, for 2021, states the median age at death for people with a learning disability as 62 years. This is significantly lower than the median age of death of 82.7 years for the general population. LeDeR also reports that 49% of deaths were from an avoidable cause which could have been prevented by good quality healthcare, compared with 22% of deaths for the general population (as reported by ONS). Although similar in nature, and often overlapping in presentation, Learning Disabilities and Autism are not the same. Autism affects how the brain processes stimulus from the outside world in ways that are neurodivergent compared with neurotypical individuals. In comparison, learning disorders are neurological conditions that directly interfere with how someone learns.
The challenge / design context Designing productive and appropriate environments for service-users with learning disabilities and/or Autism ASD, requires a bit of a reset in terms of design approach. No one size fits all, and the diversity of acuity, need, and sensory triggering, is huge. This diversity means that ward environments need to cater for all of the patient cohort, and offer significant choice and flexibility to deliver a true healing environment that promotes wellbeing. Nursing around learning disabilities is relational, so from experience we look at not only ward size, but also at arrangement and zoning. This informs bed clustering designs, radial forms, and sometimes, single occupancy ‘flat-like’ living units. Service-users with learning disabilities
struggle with ‘multi-use’ spaces. Environments need to be intuitive, obvious,
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A biophilic design approach, with green lightwells, living walls, and abundance of gardens, and a blurring of the inside/outside thresholds, was a key feature at Aspen Wood.
NOVEMBER 2024 | THE NETWORK
and predictable, with uses clearly defined and consistent. This goes against previous cost-driven philosophies around multi-use/ adaptable spaces in mental health wards, and serves to make LD environments more space hungry/£ when benchmarked. Clustered bed arrangements also tend
to generate duplication around room types and an increased circulation percentage. Coupled with smaller ward sizes generally, and a prevalence for natural light/larger corridors, this also can contribute to higher build £/per patient benchmarking. Sensory design is critical in any LD/
ASD design, and this can impact heavily on costs – for example factoring in acoustic separation, immersive therapy environments, smaller room occupancies, and even streamlined joinery detailing. Overstimulus/detail fixation syndrome is prevalent, so great care is taken to design out visual ’clutter’ in the interior environment, e.g. as regards built- in joinery, window design, and even brickwork patterning.
Another major part of LD design
involves transitions, boundaries, and thresholds. Moving from one set of stimuli to another can be a trigger for LD service- users, so our designs build in ‘pause
spaces’ at said thresholds to allow this to be managed, and the transition anxiety controlled. Personal territory and visual markers help create ‘spatial rules’ to allow service-users to navigate these spaces and provide a degree of control. Prevalent in bedroom designs, this also translates into the wider ward and unit design.
Natural light and visual linkages The use of natural light and visual linkages to the landscape also drive the configuration of LD wards, meaning that single-sided corridors are common, and that the prevalence of glazing, albeit controlled/manipulated for anti-glare, is commonplace.
Landscape and setting are probably the single biggest design driver in LD design, helping create a real sense of place and connectivity with the outside world. Landscape design is high on the agenda for any engagement strategy, with service-users heavily involved – from the outset through to completion. Landscape and setting play a big part in site location for LD facilities, and are among the key critical success factors, as laid out by NHS England. (i.e. close to community, close to mental health services support, and
Courtesy of Christian Smith
Courtesy of Christian Smith
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