DiMHN GUIDANCE
The reception at Foss Park, a new mental healthcare facility for adults in York and older people designed by P+HS Architects for Tees, Esk and Wear Valleys NHS Trust. Right: Outside space at Foss Park, which has four 18-bed wards – two adult single-sex wards, and two for older people.
considering the views, experience, and input, of both service-users and the staff caring for them when compiling any new evidence-based guidance.
Expert-by-experience’s view At this point Katharine Lazenby, an expert- by-experience and a People Participation Worker at East London NHS Foundation Trust, took to the podium to focus on the latest guide. She explained that it had ‘grown out of’ conversations between her, Professor Reavey, and Steve Brown, Professor or Health and Organisational Psychology at Nottingham Trent University, about the impact of COVID-19, and the resulting isolation, on those living with mental ill health. Having spent most of her 20s in psychiatric care, ‘in and out of hospital’, being sectioned a number of times, and spending lengthy periods on inpatient wards, Katharine Lazenby said she had found herself ‘thinking back to that time quite often’ when the UK first entered lockdown in March 2020. She said: “I reflected that there was much about being in isolation and lockdown that resonated really strongly with me being sectioned – having your liberty removed, and living in an environment where there were clear rules on what you could and couldn’t do.” COVID-19 had also, she felt,
‘really shifted some of our relationship with boundaries within our own home environment’ – with many having to navigate for the first time the experience of living and working in the same space. She said: “Suddenly the boundaries of what is ‘work’ and what is ‘home’ space would have changed quite radically, and we faced the challenge of how to divide up our spaces to maintain some sense of wellbeing.”
Managing boundaries
One of the areas covered in the booklet is ‘The symbolic and psychological significance of doors and borders’.
THE NETWORK | OCTOBER 2021
With such thinking in mind she, Professors Reavey and Brown, and Donna Ciarlo, a Research Assistant working with Professor Reavey at LSBU, had begun thinking more about what ‘borders and boundaries’ mean in the context of a mental health ward. She elaborated: “When you think about it, a lot of inpatient care revolves around managing boundaries. Certainly in my own experience, thresholds and borders in the ward meant conflict much of the time. Boundaries between the patient that ‘belonged’ to them, and, conversely, those that belonged to staff, were antagonising, and often a source of conflict and tension.” With these concepts in mind, Katharine Lazenby said the collaborators on the latest DiMHN Design with People in Mind booklet had been keen to draw on existing research, evidence, and testimonies on what these boundaries mean to both service-users and staff, say on a mental health ward. She said: “The question was what these physical borders and boundaries mean symbolically and psychologically to the people living in and working in that space. Equally, when we consider the characteristics of a truly therapeutic relationship, it is characterised by empathy, communication, and connection, all of which effectively cross over boundaries. We thus need to think about how design on a ward can foster this, rather than reinforcing disconnections and separation, with an ‘us and them
dynamic’ between patients and staff, which is so harmful.”
Importance of ‘edge spaces’ recognised
Professor Steve Brown of Nottingham Trent University said: “Corridors, entranceways, doorways, and nurses’ station ‘milling’ areas in mental healthcare units tend to be where lots of different things are happening.”
Here Professor Steve Brown explained to delegates that although the initiator for this latest Design With People in Mind booklet had been the borders and boundaries brought by COVID-19, “for me and Paula coming from the academic side, we have been undertaking social research in secure units for about 10 years, and have realised that the these ‘edge’ spaces are really incredibly important spaces, where all kinds of things happen, sometimes in highly visible, and at times a less visible, way. So, corridors entranceways, doorways, and nurses’ station ‘milling’ areas in mental healthcare units tend to be where lots of different things are happening.” Professor Brown continued: “We often use the terms ‘borders’ and 'boundaries' interchangeably. While they have similar meanings, we can generally concur that a border is where space runs out, and the boundary the demarcation line. We know boundaries are permeable – they differentiate two kinds of spaces. In a mental healthcare facility they are thus not just glass and wood – they are also symbolic – it really matters which side of the
nurses’ station you are on, or whether you’re in the bedroom or the corridor. Simultaneously, the boundaries can become permeable, and Katharine had some really nice input on the problem that occurs when a space set up for one thing – say a dining space or bedroom – is then used for something else – such as a therapeutic encounter. That creates considerable ambiguity in such spaces.
COVID’s impact on mental health facilities
“Thinking about how that works,” Professor Brown continued, “how we use different materials and designs to mark these
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