Design in Mental Health 2015 Keynotes
REHABILITATION UNITS The Trust also, he explained, had a number of rehabilitation units. He said: “Lots of mental health Trusts have farmed out rehabilitation services in recent years, a number to the private sector. Some such facilities are in pretty grim accommodation.” To illustrate the point, he showed the interior of a rehabilitation ward ‘next on my Trust’s closure list’, characterised by ‘a narrow, airless, windowless corridor’, and housed inside an old nurses’ home within a former asylum. He said: “The bedrooms are tiny, and are not en suite. We can do better. Rehabilitation care often lasts between one and two years, so again, think of someone experiencing accommodation like this for such a period and ask yourself: ‘Will they benefit?’” He then showed a contrasting photograph of a considerably more homely and spacious modem rehabilitation ward. Finally, he addressed the
How the character, ‘feel’, and design, of secure care spaces has changed – from stifling, airless, dark, and institutional (left), to light, homely, and well-equipped.
underestimate their importance. For example, although you may know the mechanics of sound, go onto a busy inpatient unit and reflect on how quiet or noisy it is for the service-users.” Having used their own professional skills, listened to others, and considered their own personal experiences, all those involved in designing, building, or running, mental healthcare units also needed to think about the conditions that generally only service-users really experience. John Short elaborated: “I doubt many in the audience here have spent 72 hours in a police cell, or 28 days away from home. Most of us in our working lives – once we’ve finished at school or university – will, for the next 40-50 years, only ever spend a maximum of two weeks on holiday away from home in one go. The rest of the time we go back somewhere we think of as home, and it’s very unlikely we will share that space with 16 other people, who are initially complete strangers to us. Remember that many of our service-users spend a lot longer than that in inpatient settings. In fact, some of my own Trust’s service-users spend more than 10 years with us.
SENSE OF TIME “We are England’s biggest provider of medium secure facilities. I have 250 medium secure beds, with an average stay length of years. While some of us may be able to bring our own experiences to our approach to design, very few can bring that sense of time. When you have finished your design and are wandering around your unit, look around and ask yourself:
16 THE NETWORK July 2015
‘If I had to be here for four weeks, two years, or 10 years, what would be the most important issues for me?’” John Short brought his presentation to a close by showing slides of a number of mental healthcare environments service-users might encounter on their patient journey. Beginning with a slide of a police cell, he said: “A number of our service users’ first contact with mental health services may be the inside of such a cell. If they are picked up under Section 136, they could be in one for up to 72 hours. I was delighted last year that were England’s first area to have no service-users detained in a police cell under Section 136. Would you want to experience somewhere like this cell for 72 hours, or would you rather be in one of our places of safety?”
Moving to places of safety, John Short said the key was how to make them more comfortable. Showing slides of a sparsely furnished such location, he asked: “If you are already distressed and haven’t’ slept, is this going to be sufficiently comfortable, or indeed calming, for you?” Looking next at several slides of acute wards, he said patients of his Trust spend, on average, about 27 days on them. His first slides showed an acute ward built in the 1990s which, despite being under 20 years’ old, the Trust now considered was ‘nearing the end of its life’. He said: “We used to build asylums that lasted 150 years, and now we have inpatient units we are embarrassed about 20 years after they came into service.” As a comparison of what could be achieved today, John Short showed internal and external photographs of an inpatient unit completed by the Trust five years ago, where the contrast – in terms of design, light, airiness, space, and aesthetics, was marked.
standard of accommodation in some secure facilities, saying: “My Trust has four medium secure units, the earliest of which (here he showed slides) was built in the 1980s, and which we may have to use for a further 4-6 years, despite it being increasingly dated. Again it features narrow corridors, and tiny bedroom areas, but some of our patients may be in these environments for 10 years, so again I would urge you to think about the effect of design quality on clinical effectiveness and patient experience – all are very important.”
‘VAST IMPROVEMENTS’ Looking, in contrast, at a slide of a secure care facility opened by the Birmingham and Solihull Mental Health NHS Foundation Trust just two years ago, notable for its attractive 21st century design and high quality facilities, John Short said the ‘vast improvements’ were clear. He told the audience: “I hope that, excellent though this facility is by 2015 standards, somebody in a similar role to me will be standing here in perhaps five years’ time saying: ‘This unit is already out-of date, but we have made these improvements based on listening to our service-users and staff.’ Hopefully I have given you some good and useful thoughts on the issues of quality, but also on just using your senses, including with a service-user perspective. Although I often spend half to three-quarters of an hour on an unannounced visit to our inpatient units, all I get during that time is a snapshot. Go back at different times of day, and see what your inpatient units are like in the evening or at weekends, and try and get your head around the fact that our patients spend longer there, living with relative strangers, than any of us do in our lives. “The impressions that you and your colleagues gain from this pretty simple measure will be an invaluable guide in your quest to provide care in really high quality facilities that impact positively on all who use them.”
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Photos courtesy of Birmingham and Solihull Mental Health NHS Foundation Trust.
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