DESIGN BEST PRACTICE
Collaborative research delivers valuable insights
Freelance writer, Debbie Giggle, talks to Antonio Lourenco, Global Product manager at Altro, about what the flooring and wall cladding specialist dubs ‘an innovative collaborative research project to assist safety and wellbeing in acute mental health wards through better design of buildings, components, fixtures, and fittings’.
Acute mental health units present particular challenges for health estate managers, in terms of the specification and maintenance of building components, fixtures, and fittings, but these practical everyday aspects are known to have a direct impact on clinical outcomes. The Department of Health and Social Care stresses that: ‘The environment provided by acute mental health services is a crucial element in the delivery of positive therapeutic outcomes for service- users, their safety, and the safety of staff and the wider community’.
Designing and maintaining high-secure units is problematic, as patients have complex needs that are not generally experienced in other clinical settings. Developing building components and fittings for use in wards of this type is also challenging, as manufacturers have limited opportunity to study the everyday demands of acute mental healthcare settings when designing products for these applications. In this article I will be reviewing the latest guidelines for acute mental health wards from the perspective of the health estate manager, and will report on an innovative collaborative research project which has delivered tangible benefits for those involved in creating and maintaining high-secure wards.
Guidelines
Recognising the specific demands of these clinical settings, Health Building Note 03- 01: Adult acute mental health units, published by the Department of Health in 2013, provides health professionals (as well as parties involved in the creation and maintenance of such facilities) with detailed guidance. The purpose is to ‘inform the planning and design of inpatient facilities that are fit for purpose, provide value for money, and support the delivery of key service objectives and policy drivers’. The HBN explains that, to achieve these goals, the acute unit should: l provide comfort and a therapeutic environment for people at a time of acute distress and vulnerability who may be at risk from themselves, or who may harm others.
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Altro Whiterock Digiclad Custom is created by reproducing a photographic image or vector art onto Altro Whiterock wall cladding. Also pictured are Altro Orchestra soft vinyl flooring – designed particularly for where comfort and sound reduction are key, and Altro Wood Safety flooring – an ‘attractive, general purpose, 2 mm wood-effect vinyl flooring’ available in a range of designs with different plank sizes and shades.
l mitigate the effects of living in a restricted space with strangers, by preserving privacy, dignity, and control over the environment, as far as possible.
l ensure appropriate levels of safety and security.
l support meaningful activities, and provide a high-quality environment.
l allow for the separation of different groups on the basis of gender, vulnerability, physical frailty, and acuity of illness.
Striking the right balance The need to create a comfortable, non- institutional atmosphere, which provides privacy and dignity for patients, has to be balanced with the imperative for safety of patients and staff. Wards have to be designed, and building components need to be specified and installed, to avoid harm to individuals in the event of deliberate damage or breakage. The guidelines note that: ‘Careful consideration should be given to the selection and detailing of products and components, to ensure that they are suitably robust and appropriate for a mental healthcare setting. While damage and wear and tear will inevitably occur, the
physical environment in a mental healthcare setting is likely to suffer more frequent damage’.
The implications of damage to building components, fixtures, and fittings, can also be far more serious in these clinical settings, and the guidelines stress that spaces should be ‘designed, constructed, and furnished, to make self-harm or ligature as difficult as possible’, providing optimum potential for patients to ‘participate in life on the ward and actively engage with staff, but minimise the risk of self-harm or injury to others’. The guidelines recommend that health estate teams should plan for ‘more frequent redecoration or refurbishment than in other settings’, advising that maintenance checks on furniture and fittings should be carried out more frequently.
Impact of a well-maintained environment
It is emphasised that ‘maintaining a high standard in a building indicates to service- users that their environment is an important part of the caring process’. The pressures placed on acute mental health units across the UK mean that the
APRIL 2020 | THE NETWORK
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