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mental health & dementia
News archive - July 2014
Not just bricks and mortar
“We are at a crossroads, with the potential to change the way society feels about mental health.”
This was the take-home message from speakers at the 2014 Design in Mental Health Conference, who revealed a step change in the way project teams are approaching the design and development of new mental health facilities.
“There are genuine reasons for optimism,” added Paul Farmer, chief executive of mental health charity, Mind.
“For far too long mental health has been swept under the carpet and we need to try to find a way to embed good design principles across the NHS and beyond.
“We need to work on the built environment. It should be stimulating and pleasant and designed to address the needs of individuals. Even small details can be changed at relatively low cost to make a positive impact.”
Challenges within the market, speakers said, include ongoing pressure to make mental health units ligature-free environments.
This balance between keeping vulnerable patients safe, and creating a homely environment that promotes recovery, is key.
Same old rubbish
James Fitton of Mental Health Strategies said: “Service users are expecting more of services, but all too often I find service users accepting the same old rubbish.
“Risk is a big deal in mental health, but this idea of risk aversion is getting worse. We have got to start looking at the needs of patients and we need to design services from a completely different base. This will lead to quite different solutions in terms of the premises from which care is delivered.”
Creating environments that are homely was a top priority for patients, who also addressed delegates at the event.
Kevin Booth, a long-term mental health service user and member of the SEED Project, organised by Lancashire Care NHS Foundation Trust, said: “It is frustrating to be under constant observation when using mental health services as you want to be able to do things yourself. It is about weighing up safety and security against providing an environment that helps you to get better. It is important to keep that human touch.”
Sam McCumiskey of Mersey Care NHS Trust added: “We don’t want a blanket approach where anti ligature is the overriding factor.
“If every fixture and fitting is anti ligature, then it is not a normal environment that will aid recovery.”
The UK has a lot to learn from its international counterparts when it comes to this obsession, according to Dr Jan Golembiewski from Medical Architecture. He said: “If you think design is all about bricks and mortar, then you are wrong. We can really improve the lives of people who are suffering through good design. We can design to enable learning and recovery, as well as for safety and security.
“Instead we find that anti ligature and risk aversion is the first priority. It seems like we are designing for the minority who are a danger to themselves and others, rather than the majority.
“These are recovery environments where people go to get better and to develop skills for real life. That is why I would like to see less emphasis on negative behaviour. If we have to make things anti ligature, then let’s make sure they don’t look like it.”
Less is more
Teva Hesse of C F Moller Architects told the conference: “I do not like the word risk. We are always going to have negative incidents in these environments and rather than design them out, we need to mitigate them. I am not saying anti ligature is not an important design factor in some areas, for example bedrooms and en suites, but in other areas it is not necessary.
“In other countries there is much less emphasis on risk aversion and my fear is that this risk-obsessed approach will lead to a situation where service users do not have enough stimulation.”
Other priorities for building design include ensuring there is good natural daylight and air flow and access to safe and secure outdoor spaces and courtyards.
“We need to get as close to the home environment as we can,” said Adrian Dallison, director of estates and new business at the Priory Group.
“We sometimes get frightened about inspections and regulations, but it is possible to spend less money that we currently do in the public sector and to build things more efficiently and that better meet the needs of mental health patients.”
Central to success is involving service users in the design process, he added.
“The most successful schemes start with the people who are going to use the building, not necessarily clinicians,” he said.
“Let’s consider who is going to live there and ask how they will use the building, then work around that.
“Sometimes it is evident to me that people have said ‘that’s good enough’. I find that narrow minded. When we look at buildings, if it isn’t good enough for me, then it isn’t good enough for someone with a mental health problem.”