ESTATE REDEVELOPMENT
A CGI of a service-user bedroom.
imperative to reduce ligature points in mental health environments. We noticed that two types of incident – barricading and ligature – are mentioned above all else in the guidance. We were interested in finding out exactly what types of incidents occurred, as well as where and when they occurred. For most building typologies there is a great deal of source material to draw upon that examines end-user behaviour within various types of spaces. Strangely, we could not find any reference guides that studied behaviour on inpatient wards in order to inform and improve our design. This is despite the fact that inpatients often have long stays entirely within mental health facilities, and without a doubt the impact of these environments on their well-being and lived experience would be considerable.
In order to get a clearer picture of what actually occurs on a ward, our practice asked for and obtained anonymised incident data of over 20,000 incidents that occurred on wards from 2007 to 2011. As architects we had the ability to plot this incident data on the existing layouts of wards, to see if any conclusions could be drawn between architectural form and the frequency or severity of incidents. We compiled this research on our own time in the hope that it would lead us to understand what types of layouts could be considered safer than others (see Figs 1 & 2).
Some ‘surprising dimensions’ After many months the picture that emerged had some expected, and some surprising, dimensions. It is difficult to generalise this work into ready conclusions, as each ward and service-user group had a unique incident profile. On the older persons’ ward we studied there were virtually no ligature incidents, but slips/trips/falls was the major incident type.
THE NETWORK | OCTOBER 2020
A Non-Forensic internal atrium.
The opposite was true for an adolescent acute ward. As one might expect, self- harm and ligature incidents took place overwhelmingly within private spaces – bedrooms and en-suites – which drove home the imperative to make these unsupervised spaces as free of ligature risk as possible.
We discovered that on all wards the major incident type was violence/abuse/ harassment, which typically accounted for over half of the total number of incidents. Corridors were primary zones for violent incidents, which puzzled us until we realised that on most wards, corridors are the spaces where service-users pass each other without necessarily wanting to, or being able to avoid each other. This led to a realisation that far more design attention needed to be given to corridors – spaces that the guidance only mentions to set out minimum widths. From studying incident data and layouts we saw that, in so far as possible, new designs should incorporate ‘avoidability’ – the ability to take an alternate route to avoid or escape an undesired confrontation. This raises the importance of circulation space way beyond the narrow confines of the target
Project Team
Architect and Landscape Architect: C.F. Møller Architects UK.
Project Manager: Appleyard & Trew. Structural Engineer: Walsh. MEP Engineer: Arup. Quantity Surveyor: Gardiner & Theobald. Fire Engineering: Trenton. Acoustic Engineer: Anderson Acoustics. Catering Consultant:
Sterling Foodservice Consultancy. Access Consultant: Jane Simpson Access.
‘gross to net’ calculations which have been the traditional approach.
Establishing a clear baseline We put a lot of effort into this study before we began to consider its limitations. As objective research it was impossible to establish a clear baseline; how would the same inpatient group have behaved in a different or better setting? Over the four- year period of study, each ward had experienced a steady turnover of staff and service-users. From discussions with service-users, a ward with a poor layout or outdated facilities, but with dedicated staff, was a better, safer place than the opposite. The quality of care is primarily determined by the commitment and engagement of the clinical and support staff, and it is impossible to quantify that in a series of graphs and charts.
We have also come around to the idea that this research was entirely focused on ‘negative’ metrics. At the very least we should begin to focus more time on how a ward environment either promotes or inhibits beneficial, comforting experiences. These might include whether there are spaces that allow a range of private or group activities, what types of self-initiated activities are available, nights of sound sleep, satisfaction with mealtimes, or other happy moments. A focus on risk and risk mitigation is essential, but if undertaken to the exclusion of other considerations invariably leads to more austere, custodial environments, which may bring about the kinds of incidents they seek to avoid.
Springfield University Hospital designs The Trust arranged visits to every ward and specialist service so that we could meet with and listen to patients. At this point in time, we have logged over 600 events with service-users, clinicians, staff, and carers in
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©C.F. Møller
©C.F. Møller
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