Designing For Recovery
no-go areas’, which he found ‘difficult to get my head around.’ He told the conference: “I deliberately haven’t told you which hospital I was in, but I don’t think it was particularly any worse than many others. It was an extremely clinical environment; had those awful clinical cupboards, caked paint, bare walls, and was tatty. The outside space was also awful; it had been grassed over at some time, but much of the grass was worn away. Inside the facility, we couldn’t personalise our rooms, not being allowed to put anything up on the walls. You had to order a noticeboard from the Estates Department to do this, and we had very little say in improvements in the service.
NOT CONDUCIVE TO RECOVERY “The lack of attention to the design, and the poor quality of the environment, were certainly not conducive to recovery, and I was very glad to be out of there.” He added: “A lot of secure hospitals are out in the country, a long way from villages and towns, and at this hospital the bus service was only two hourly – far from ideal.” He added that while there were now secure hospitals, built new or redeveloped in the intervening years, and recognised for the standard of build and environment, better transport links should ‘remain a priority’. The My Shared Pathway group had, Ian Callaghan explained, developed ways and means of having a say in improvements in recent years. He said: “We have done this through community meetings and a Patients’ Council, and now have input into how mental health settings can be improved.” Discussing the My Shared Pathway –
Recovery and Outcomes project in a bit more detail, he explained: “At the time that the project started a lot of us were getting very dissatisfied about not just where we were living, but also the fact that there appeared very little recovery focus in secure care. The emphasis was all on risk, security, and safety. It was unclear what we were there to achieve. In many cases it felt like we were locked up, and the key was virtually thrown away, so many service-users got together across the country and we decided that what we would try to bring back was a culture of change and a system re-design.”
STILL A WORK IN PROGRESS Ian Callaghan acknowledged that this was ‘still a work in progress’, explaining that he now organises nine regional Recovery and Outcomes groups, which seek to improve care planning through collaborative meetings. He said: “I think that what has happened in those processes is a move toward more emphasis on the physical environment and the design we are all hoping to try and achieve.” The speaker explained that the Royal College of Psychiatrists now undertakes ‘peer reviews’ of all medium secure and low secure units annually; individuals from two units visit to look at the quality of the care and the
‘The emphasis was all on risk, security, and safety. It was unclear what we were there to achieve’
Some key elements
My recovery journey • Hopelessness to hopefulness. • Grasping opportunity. • Variable and elusive. • Realistic expectations. • Back into the outside world. • Did my environment help or hinder?
recovery.” He felt the notion that people in seclusion could still have good social engagement and interaction with others was ‘spreading’, and he cited, as a good use of technology in this area, the interactive video and audio walls of the type pioneered and indeed shown by Dutch company, Recornect with its Cowall, as an example of how well technology could be incorporated into seclusion units in mental healthcare facilities.
MULTI-FUNCTIONAL
“He said: “Sometimes these devices simply allow opening of the blinds, or dimming of the lighting, but, as with the Cowall, functions can include selecting the television you watch, or the music you listen to, and the ability to communicate with others through social media.” Ian Callaghan had spoken to the inventors of the Cowall, who had explained that the system has already been successfully piloted in a number of Dutch mental healthcare facilities.
physical environment. In his role as a patient reviewer for the Royal College’s Quality Network for Forensic Mental Health Services, Ian Callaghan described how, the previous day, he had visited a former nursing home converted into a unit. He said: “Especially noticeable features were the long corridors, with photocopiers in them. It was a first floor ward; what they had done with what would have been a day room was simply chop it in half, with one small ‘half’ for activities. In the other they had pulled the walls down and converted it into an outside space. This very limited space was overlooked by one of the wards, which was not ideal. In my view it is very difficult to effectively convert facilities built for another purpose.”
A ‘SENSE OF ISOLATION’
Ian Callaghan said his lasting impression was one of ‘a sense of isolation’. There was very little natural light, or the ability to effectively control the heating. He added: “One positive element, however, was a sensory room. Interestingly though, some of the staff ‘tutted’, and said they didn’t really understand why this room was needed. Conversely, the service-users loved it.” Talking about the unit’s seclusion suites, Ian Callaghan described these as ‘grim’. He said: “I wonder how many of you in the audience have either seen, or been in, a seclusion suite and had the door locked behind you? It’s an awful feeling. Obviously it has a purpose; it is to keep people safe. In fact one of the phrases I have heard coined is: ‘Recovery is possible from seclusion to social inclusion’, meaning it is quite possible to be secluded and then make a good
Despite a clear need for them, he said there remained many mental healthcare facilities ‘without sufficient meeting room provision’. He said: “Such facilities therefore don’t provide a good environment for service-users to get together, carry out activities, and engage socially.” While he recognised the financial implications of more space for meeting rooms, he believed such spaces were an ‘absolutely essential part of the recovery process’. Equally important were activity and recreation rooms; nor, ideally, should there be situations where those service-users wanting to use a gym could only access it once a week due to having to share it with so many other people.
VARIED ACTIVITIES
He added: “I love this peer review role, because I get to go around lots of different units. Some of the newer ones have activity facilities like motorbike maintenance areas, a graphic design department, and a bricklaying area. Absolutely fantastic. However,” he warned, “some Trusts are too worried about health and safety and simply haven’t got anywhere to put these facilities. This is a great pity, since some of the service-users may be able to turn a new activity, and the associated learnings, into a profession when they leave secure care.” While in his early days in the mental healthcare ‘system’ he found himself accommodated in ‘tatty, tired, and dispiriting buildings’, he had been heartened to see on one of the exhibition stands the progression from ‘something that absolutely looks like a hospital, to something which is designed really well, with colour, curves, and a carpet’. He said: “Some carpeting for example, can make a real difference to an otherwise clinical area, adding a homely, more welcoming feel. I appreciate ,” he added, “that certain items have to be a particular shape, for example furniture
‘My lasting impression was one of a sense of isolation. There was very little natural light, or the ability to effectively control the heating’
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