Ecopsychosocial parameters and mental health: the complexities of the psychiatric ward

Mental illness historically has followed an uneven path regarding the social integration and the therapeutic priorities of mentally ill people. This was reflected in the institutions that provided for mental illness, with emphasis shifting between custodial and somatic priorities. Gradually, mainly in North America and most European countries, big institutions have been replaced by networks of smaller facilities, known as community care, which introduced the psychosocial model prior to the pre-existing jurisdictional and medical models of treatment and care. These new environments display great variations in policy, service provision and care regimes, even in the same area. Architectural typologies for psychiatric facilities follow this experimental pattern. That hindered the creation of an established, evidence based methodology for psychiatric spaces. The gap was addressed with a patient-focused model, specifically designed for psychiatric facilities, the SCP model. It used methodologies of social medicine, corresponds to the 3 main care models of psychiatry and has been applied in several European contexts. It aids set a red line for medical planners and designers and the identification of areas for further research. A key area identified by the application of SCP model on awarded psychiatric buildings was the lack of understanding on the influence of ward layout to patient wellbeing. Following that, this research aims to promote our understanding of psychiatric space and help us promote our understanding on the mechanisms of the built environment against total institutions and their institutional practices. The locus comprised 2 acute psychiatric wards in London, belonging to different Mental Health Trusts, all part of the public healthcare sector. Each was evaluated using the SCP model, to identify the relation between policy, care regime and patient-focused built environment. Parallel, a syntactic analysis identified the social logic of the wards’ layout, in terms of hierarchies for the two main user-groups patients and staff, staff’s control of the ward in terms of supervision and patient privacy. The juxtaposition of medical architecture and space syntax provided new insights on how psychiatric space is used, as the analysis of the area surrounding the nursing station indicates. The different approaches regarding the gathering of people outside the nursing station, from institutional (unstructured behaviours or unrest) as interpreted by medical architecture to an expected social interaction to the most integrated point from the syntactic perspective, indicated that there is a new potential from the combination of the two methodologies. From the paper, it occurs that Space syntax could unearth underlying issues of social interaction and then the medical architecture methodologies could interpret these issues in the context of the therapeutic regime. That way, we can reach a better understanding not only of how medical spaces operate but provide new insights on the therapeutic regimes

Inclusive Urban and Rural Communities: The Bartlett Faculty Of The Built Environment “Commitment” On the Call For Commitments Of European Innovation Partnership (EIP) On Active and Healthy Ageing (AHA)

An environment incorporating, in its design principles, the knowledge of human physiology and perception and especially the physiology and perception of people across the lifespan, where multi-morbidities such as frailty and Alzheimer's might occur, is beneficial for all other aspects of care and everyday life and acts as their multiplier. This project is an innovative, experimental bottom up, multi-disciplinary, user-inclusive approach that has been created as part of the call of Commitment Actions of D4 action group, of the European Innovation Partnership (EIP) on Active and Healthy Ageing (AHA). The aim is to create synergies between regions to identify areas of future research together with practical scalable solutions applicable to living labs/reference sites. It identifies new design paradigms, informed by end-users' opinions on the care and treatment of ageing populations and for sustaining healthy societies free of sources of structural stigma. This includes transfer of knowledge and upscaling for frailty and fall-prevention through design technologies and the integration of healthcare facilities via holistic approaches. Partners cover the whole spectrum of stakeholder involvement: academia, central government, local authorities, regulatory bodies, start-ups, end-users and user-representatives, and small and medium sized enterprises (SMEs). They are multi and cross-disciplinary, including architecture, planning, IT technologies, transportation, healthcare, psychiatry, art-therapy, business administration, medical tourism and care provision. They collaborate in creating informal networks of partnerships on understanding the potential of innovation buildings, advance the state of the art through experimental and interpretative frameworks, advance the potential for scaling up and investment in successful solutions to collect, share, and disseminate promising practices to contribute to the silver economy

The SCP model: A three dimensional methodology for understanding, profiling and evaluating mental healthcare architecture

Purpose: Architecture for community based facilities for acute mentally ill people predominantly borrowed vocabulary and methodologies from neighbouring fields or relied to experimentation in order to accommodate the uneven and varied development of community psychiatry in the Western world. Mostly, the model used was normalization theory, a linear model of understanding, designing and evaluating healthcare facilities, originally developed for learning disabilities. This research supports that the domesticity-versus-institutional concept suffered from a number of limitations, especially since it was not originally constructed for acute mentally ill people. Methodology: To develop a methodology that fits mental healthcare architecture, a three-dimensional, comprehensive theoretical model has been created. The methodology puts together the dialectics behind mental healthcare: the idea of dangerousness that includes the danger of harm and self-harm, the idea of disability as a result of the illness itself or as an effect of institutionalization and the idea of social reintegration as expressed by clients reclaiming their role in decision making. Findings: The three parameters stated above are analogous to the three prevailing models of mental health care -- the jurisdictional, the medical and the psychosocial-- presenting an integrating three-dimensional grid of the various mental healthcare regimes and architecture. Those dimensions/parameters were safety and security, those of competence and of personalization and choice. The model created was named SCP from the acronyms of the parameters. Due to this flexibility, the model can be used for evaluating and defining the therapeutic environment of the facilities when combined with evaluation tools such as checklists, to highlight any limitations regarding the domestic character of those environments

A tale of two Countries: Comparing France and the UK to understand the elements of Psychosocially supportive design

For those conditions that medicine cannot provide a cure yet, non-pharmacological elements of care prove key. The built-environment comprises part of a psychosocially supportive regime. For psychiatry, both diagnostic and interventional accuracy prove challenging. This lack of effective therapeutic approaches resulted in interventional pluralism. The research explored the context of mental healthcare provision, emphasising on the building stock to identify common elements of psychosocially supportive environments. France and the UK, each adopting different models regarding hospitalization, provided the research locus. The case studies were ten facilities catering for the acute spectrum of diagnosis, yet still in the community. Data collection comprised plans and photographic record of the buildings, together with field notes and data from 115 semi-structured interviews of staff and patients. Field notes produced an architectural checklist of 215 points, analyzing each building to its institutional vs domestic traits. Architectural data where juxtaposed to interview data. One key finding was that the then dominant theory of normalization could not necessarily provide facilities that staff and users considered therapeutic. The second phase of the research explores facilities for their spatial morphology. Two new case studies were selected in the most acute end of the spectrum of community care, both in the UK. The initial methodology was retained but with the addition of Space Syntax. Results indicate that although countries differed, some elements retained global value, such as the importance of user involvement. Also, universal architectural methodologies, such as space syntax are not directly applicable to acute psychiatric environments evaluation. This combined to the uncertainty of psychiatric treatment, indicates that mental health is an area where considerable amount of research is required. Yet, despite practical difficulties of cross-border studies, involving more geographical contexts proves a very good starting point to increase a deeper understanding of the phenomena of psychiatric space

Accessibility for mental healthcare

Purpose: Patients' movement in mental health facilities is frequently compromised for reasons quite apart from real physical incompetence. Accessibility within mental healthcare facilities is a more complex issue than universal accessibility standards generically allow for. The purpose of this paper is to critically question the adequacy of universal design aids as the main way to deal with accessibility in facilities for the adult mentally ill in the community. / Design/methodology/approach: Several community mental healthcare units (in both Great Britain and France) are reviewed and analysed while they are occupied and running. The focus of the study is on restrictions of movement and the use of universal accessibility devices. The data are part of a broader exploratory study of facilities for mental healthcare, which used empirical, comparative and user inclusive methods. / Findings: Mental health facilities are rarely designed for the model of care and staffing regimes which they will house. This discordance between the physical and organizational milieu inevitably compromises accessibility, even though patients tend to be physically able. Outdoor access, vertical circulation and the accessibility of bathrooms are particularly affected. / Research limitations/implications: Models of care, management and staffing requirements, therapeutic needs of patients and interpersonal relationships should be considered for accessibility during planning, in addition to traditional accessibility devices and design. Furthermore, more research is needed to address the ways that accessibility devices need to be altered to comply with the psychosocial elements. / Originality/value: This paper readdresses the traditional view of accessibility, suggesting the paradigm needs to be better developed and nuanced for mental healthcare facilities

The social invisibility of mental health facilities

This booklet has been been produced and published by the research team of the Grand Challenges project ' The social invisibility of mental health facilities: Raising awareness on social exclusion in urban environments through artwork’. The publication of the book has been funded by the UCL Grand Challenges Small Grant

Residential Facilities for Psychosocial Rehabilitation: Planning Permit Regulations and Social Inclusion

Mental illness has presented a significant increase, currently affecting a quarter of the population. Yet, institutions are still responsible for preventing mentally-ill people from having integrated lives in the community. Existing planning legislation might contribute to this. A potential mechanism is the requirement for non-residential use of land for mental health accommodation and their subsequent characterization as ‘special buildings’. However, changes in mental health accommodation planning and licensing legislation could be more enabling for people’s social integration. This paper explores planning legislation in Greece, a country with an extensive network of community-based mental health facilities, and assesses the consequences of this legislation with regard to the integration of the country’s mentally-ill population, and how alterations to change of use legislation regarding accommodation for mental health affected national integration outcomes. The research was top-down, led by the European Commission and the Ministry of Health – the sample comprised 112 out of the 116 community-based facilities. The research highlighted those elements in the existing planning legislation that favoured segregated institutions. The use of land frameworks promoted the development of mental health accommodation in buildings designed for other purposes (i.e., industrial, logistics or offices) or in segregated areas. The research identified planning legislation as a key disabler of social inclusion. Then, alternatives were tested, including the redefinition of uses; a change that initially generated functional complications. The condition of altering uses alone proved inadequate, so new design guidelines were introduced to act as quality control mechanisms; a set of fit-for-purpose-guidelines incorporated into national legislation