DiMHN GUIDANCE
symbolic boundaries, and what can happen to them over time, is key. For this latest booklet, we have tried to pull together some of the published data on experiences around COVID, and are really aware of the massive challenges it has presented to clinicians and ward staff managing mental health facilities. We have great examples from different countries – including on how heavy securitisation has had to be used in some spaces. The other point is that once a boundary is put in place, it doesn’t necessarily do the same thing over time. Boundaries change and have to be reinforced and reconstructed, and, thinking about – say – the lifetime of door, or a nurses’ station, and what can change around it, are also important.”
Study data on counter-intuitive consequences The authors of Borders & Boundaries had thus tried to think both about ‘making boundaries’, and, conversely, ‘breaking them’, and what this involves both materially and symbolically. They had also drawn substantial data from different studies demonstrating what Professor Brown dubbed ‘the counter-intuitive consequences of certain kinds of design’. He explained: “For instance, we have a good deal of material from Denmark on some designs that looked absolutely fantastic at the outset, but which – studied over time – were found not to have had the positive impact envisaged by the design team. For example, bringing outdoor spaces indoors without a plan of how to maintain them, and the ensuing risks, which proved an issue at the Slagelse Hospital in Denmark. We are also interested in both deliberate and unintended breaking of boundaries, and creating ‘third spaces’, and how these things can become blurred.”
Uneven evidence making comparisons difficult
Professor Brown closed by emphasising that the authors had attempted to ‘trawl as far as possible’ for evidence, but that it was often ‘very uneven’, especially when global comparisons were being made.
The Atrium at the Hellingly Centre, designed by Hannah Brown of healthcare arts charity, Hospital Rooms, which worked with artists, patients, and staff at Sussex Partnership NHS Foundation Trust ‘to create a series of extraordinary artworks’ for the forensic mental health unit in Hailsham, East Sussex.
The DiMHN was thus now focused on the optimal way to pull together evidence for such guidance publications, not only from the UK and Europe, but globally, as well as on ‘the challenges of making comparisons across very different care systems’. He said: “We have, though, tried to include a good range of global examples, and to make Borders and Boundaries really understandable and readable, so key information can be extracted quickly. We are also delighted to have had contributions from a lot of others – including artist, David Parkin, Jonathan Campbell, director of Estates and Facilities at North Manchester General Hospital and the DiMHN’s Vice-Chair, and a number of others. The multi-party involvement in the booklet’s production recognises that expertise on ‘borders and boundaries’ is everywhere – not just with designers, but equally with service-users, clinical teams, managers, architects, and manufacturers.” Professor Reavey concluded the session
on Borders & Boundaries by announcing that Research assistant and Doctoral
student at London South Bank University, Donna Ciarlo, another individual ‘instrumental’ in putting together the latest DiMHN booklet, had just been awarded a PhD scholarship by London South Bank University to investigate such topics further. Professor Reavey said: “I am delighted that the proposal I wrote with Donna is directly connected to the DiMHN. The idea is to create even more evidence around the impact and importance of the environment, both in mental healthcare facilities and community spaces.” Sections within Borders and Boundaries – an attractively illustrated booklet featuring photos from a number of modern mental healthcare facilities, and which includes references to published studies, and pertinent service-user ‘quotes’ – include: l The symbolic and psychological significance of doors and borders.
l Designing the central hub of a ward. l Making open spaces that foster relationships and community.
l Creating borders using sensitive lighting.
l Maintaining boundaries and privacy through sight and sound.
l Creating permeable boundaries during COVID.
l Using outside spaces to break down the boundaries of hospital care.
l Creating therapeutic spaces through radical design and collaboration.
‘Speakers Corner’ at the Woodlands acute adult mental health unit in Ipswich (operated by Norfolk and Suffolk NHS Trust), designed by Tim A Shaw at Hospital Rooms.
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To access a copy of Borders and Boundaries, or any of the other Design With People in Mind booklets, visit
www.dimhn.org to join the Network and access its resources. Philip Ross, said: “Membership is free to individuals, while we would encourage commercial companies accessing the Design with People in Mind booklets to consider joining the DiMHN, or to make a donation via the website to help us to continue our work.”
n OCTOBER 2021 | THE NETWORK
©Hospital Rooms/Damian Griffiths
©Hospital Rooms/Damian Griffiths
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