A window of opportunity the mental health & dementia facilities magazine SEPTEMBER 2023 PROJECTS The latest mental health and dementia projects WINDOWS Key drivers behind the design of mental health windows FLOORING The impact of flooring in dementia care settings p5 p8 p13
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mhdf magazine 3 Contents SEPTEMBER 2023 Editor’s Note A focus on safety In June of this year it was announced that an inquiry into the deaths of mental health inpatients in Essex will become statutory, as the Government presses ahead with action to improve patient safety and boost the quality of mental health care in England. The Essex Mental Health Independent Inquiry was announced in January 2021 to investigate matters surrounding the deaths of inpatients across NHS trusts in Essex between 2000-2020. But, due to the challenges faced while running an independent inquiry – such as engaging former and current staff at the Essex Partnership University Trust (EPUT), and in securing evidence from the trust itself – a statutory inquiry will now have legal powers to compel witnesses, including those former and current staff of EPUT, to give evidence. Health and Social Care Secretary, Steve Barclay, further announced that, in October, a new Health Services Safety Investigations Body will be formally established and will commence a national investigation into mental health inpatient care settings. This is, of course, welcome news, as we all know the environment, in particular, plays a key role in the safety and wellbeing of service users. And, while the Government, increases its surveillance of inpatient settings, suppliers and manufacturers continue to play a key role. In this edition of mhdf, we look at two areas of environmental design that are having an impact on the lives of service users and staff. In our Windows feature, we look at how mental health window systems have evolved to combine safety with an improved patient experience (p8). We also look at how flooring specification can help to reduce slips, trips, and falls among people living with dementia (p13). In the next edition of mhdf we will be looking at mental health furniture and anti-ligature products. If you can help, email [email protected] Editor Jo Makosinski Sales director Julian Walter Production Nicola Cann Design Mary McCarthy Managing Director Toby Filby Publishers Stable Publishing Limited, SBC House, Restmor Way, Wallington, Surrey SM6 7AH, England. t. 020 8288 1080 f. 020 8288 1099 e. [email protected] In this issue: 5 PROJECTS The latest mental health and dementia projects 8 WINDOWS Key drivers behind the design of mental health windows 13 FLOORING The impact of flooring in dementia care settings Safevent windows - Britplas The publishers do not necessarily agree with views expressed by contributors and cannot accept responsibility for claims made by manufacturers and authors, nor do they accept any responsibility for any errors in the subject matter of this publication.
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mhdf magazine 5 PROJECTS Work on a new adult mental health inpatient unit in Manchester has reached another milestone. North View is a 150-bedroom specialist unit set to provide much-needed space and modern facilities for adults with mental health needs from across Manchester. Work on the £105m project started in August 2022, with the new unit anticipated to be completed and open in autumn next year. And the steel frame superstructure is now approximately 75% constructed and is due to be completed within the next few weeks. Once open, the unit will help improve the region’s mental health services and ensure service users can access the care they need in an environment designed to enhance and aid therapeutic recovery. To be operated by Greater Manchester Mental Health NHS Foundation Trust, the building itself is part of a wider vision to improve health and wellbeing for local people over the next 10-15 years. It will replace the Park House mental health unit, which currently serves as the inpatient unit for the area, but will be built in an alternative location on the hospital site. This will allow the new development to be fully constructed without disturbing current patients and the day-to-day operation of services. Designed by Gilling Dod Architects, the new building will see significant improvements to the patient experience, with spacious single bedrooms, each with a private en-suite shower room, as well as a variety of indoor activity areas, meeting rooms for family visiting, multiple gardens and spaces for therapeutic artwork, and a café. Work underway on mental health unit in Manchester North View has also been designed as an all-electric healthcare facility to support the NHS’s goal of becoming net zero, and will utilise heat pump technology to provide heating, cooling, and the generation of hot water. The building will also incorporate energy efficient-materials throughout, and roof-mounted solar power. www.gillingdod.com
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mhdf magazine 7 PROJECTS Subfloor preparation products from Bostik have been used in the redevelopment of St Ann’s Hospital in Tottenham. The scheme, which included the creation of a 74-bed mental health facility, was highly complex as the unit’s three blocks each had different requirements that needed addressing in different ways – for example some parts of the subfloor were made of concrete while others were made of plywood. Bedford-based flooring contractor, Blade Flooring, was appointed to install the floor coverings and worked with manufacturer, Bostik, to choose the right products. For the concrete areas, HYTEC E570 ONE COAT damp-proof membrane (DPM) was specified to suppress the residual moisture in the subfloor, followed by GRIP A526 UNIVERSAL PRIMER and SCREEDMASTER SL C540 FLOW smoothing compound, which provides improved workability and superior flow characteristics. For the plywood areas, once they had been primed, Bostik specified SCREEDMASTER SL C530 FLEX, a fibre-reinforced, heavy-duty smoothing compound particularly suited for application onto wooden floors. CHOOSING WISELY This varied approach continued into Blocks G and H where, again, some parts of the subfloor were concrete and others were plywood. In this case, however, there were a number of hydration cracks in the surface of the concrete and these were overcome with Bostik RENO P520 EASY, a crack repair system including a solvent-free, 2K repair resin and stitching pins, which can be mixed easily within its containers and dries in 30 minutes. Once the cracks had been filled in, the team primed the surface with GRIP A936 XPRESS, Bostik’s water-based primer with high grip and a fast drying time, before smoothing it with SCREEDMASTER SL C530 FLEX. And Block B required yet another approach, as there was Lytag screed present in parts of the subfloor. In some areas, this could be worked around, while in others it was so damaged it needed to be removed. ABRASION RESISTANCE In the areas where a new screed was required, Bostik advised Blade Flooring to apply a slurry mix of TECHNIS C720 FLOW – a pre-blended, rapid fluid screed, mixed with Bostik SBR- a co-polymer latex that toughens, waterproofs, and improves the chemical and abrasion resistance of screeds. Once the slurry mix was applied to the prepared substrate, TECHNIS C720 FLOW was again used to reinstate the levels where the Lytag screed had been removed. Once applied, TECHNIS C720 FLOW can receive moisture - sensitive floor coverings in as little as seven days. The team then primed the surface with GRIP A936 XPRESS, before a layer of SCREEDMASTER SL C540 FLOW was applied to smooth the subfloor ready for the adhesive and floor coverings. Ian Dennis, technical specification manager at Bostik, said: “This was a large project that involved modernising a sprawling 1950s hospital. “It was therefore necessary to advise Blade Flooring on a range of different subfloors, which were in various states of disrepair and had a number of requirements. GETTING THE JOB DONE “With a project like this, you don’t know what you’re going to find until you lift the flooring, and in this case, there was everything from Lytag screed to old pipework. “However, once our team had inspected the site, we presented a set of recommendations for how to prepare the subfloors and this enabled them to get the job done.” www.bostik-profloor.co.uk www.bladeflooring.com New mental health unit benefits from modern subflooring products
8 mhdf magazine WINDOWS Image: Alexandre Chambon on Unsplash There is growing acceptance that building design plays a central role in the wellbeing and recovery of hospital patients, not least those suffering from mental health conditions. In particular, access to, or views out onto, gardens and landscaping have been found to have a direct impact on stress levels and can even lead to reduced reliance on painkillers and other medication. And one key part of the design process is the choice of windows – which enable patients and service users, even those confined to their bedrooms, to experience the natural world around them. Fourteen years ago, Kevin Gorman, chairman of UK-based commercial glazing specialist, Britplas, invented the Safevent window, which can now be found in psychiatric units across the UK and further afield. A GAME CHANGER Initially developed for Mersey Care NHS Foundation Trust, the product was a game changer as it was the first window which could be installed in secure mental health units, but could be opened to allow a flow of fresh air into patient areas. The double sliding window has one glazed area and the other is fitted with a stainless-steel mesh. The sliding sash is glazed, sealing the mesh side when closed and is weather tight and draughtproof. In this way, the window provides natural light and ventilation, which can be controlled by service users, yet also helps to maintain a safe, secure, and anti-ligature environment to meet the requirements of mental health facilities. Since it was first launched, the product has been developed and improved through multiple iterations, all driven by feedback and requests from mental health trusts. Gorman said: “While safety and security have always been primary drivers when it comes to the design of windows for mental health facilities, recent years have seen a much-greater emphasis placed on the therapeutic aspects of product design. THE RIGHT SOLUTION “And this has meant a move towards larger windows to enhance light transmission and improved sightlines via the use of slimmer frames. “There is also greater awareness of the importance of tailoring product design A window of opportunity WE LOOK AT HOW THE PATIENT EXPERIENCE AND CARBON REDUCTION EFFORTS ARE INFORMING THE DESIGN OF MODERN MENTAL HEALTH WINDOW SYSTEMS
WINDOWS 10 mhdf magazine to specific user groups. So, for instance when it comes to older adult care, anti-ligature characteristics may not be such a major risk factor, but there can be a number of additional factors which must be taken into account, such as ease of use, familiarity with operation, visual cues, and so on.” Privacy and dignity are also driving R&D efforts in the industry. Gorman said: “Things like mirror film and integrated blinds are being used to great effect where privacy might otherwise be an issue, for instance in built-up areas or for the refurbishment of older buildings.” So, too, is carbon reduction impacting on manufacturing processes. Gorman explains: “Sustainability considerations are moving up the list of priorities with the Government’s drive towards net zero and thermal efficiency., and window performance is being constantly improved.” EARLY ENGAGEMENT When choosing windows for mental health new-build or refurbishment projects, Gorman advises specifiers to engage early with suppliers to make sure the windows are suitable for the user group. He adds: “Specifiers may wish to carry out their own testing, and your supplier should be happy to help facilitate this and to show you the results of prior relevant tests. “Also, look carefully at a supplier’s track record in the industry – What projects have they completed? How long have they been around? Are they financially secure? “As well as the product itself, consider the service element – does the supplier provide an end-to-end service, what sort of warranty is offered, and what are the lifecycle costs and considerations?” In the future, Gorman predicts that aesthetics and the patient experience will continue to underpin window design, together with the carbon net zero drive. PUSHING BOUNDARIES He said: “We have an R&D department that works full time on finding and making improvements to our existing products, and inventing new ones. “While our products will always focus on safety and patient usability, improving energy efficiency is key at the moment and we are currently looking at the full product lifecycle with a view to how we can do our bit to beat the Government’s emissions targets. “The adaptability of our products is also key, and we will continue to push boundaries with greater options for size, product combinations, and aesthetic impact. “For us, the best designs are usually the simplest ones and we have worked hard to pare back and simplify things like control mechanisms with the introduction of our Multask handle, which replaced three separate pieces of hardware.” For us, the best designs are usually the simplest ones and we have worked hard to pare back and simplify things Safehinge window restrictors can be easily retrofitted to existing windows, limiting disruption and reducing the cost Britplas created the Safevent window 14 years ago at the request of an NHS mental health trust Its window handles are designed to be anti ligature
mhdf magazine 11 WINDOWS Safehinge Primera has also spent the past few years developing its range of window restrictors and anti-ligature window handles to reflect the changing needs of mental health providers. In particular, it is taking a more-adaptive approach, enabling products to be procured which meet the particular needs of each mental health service. A spokesman said: “Ensuring window safety in mental health facilities and challenging environments is of paramount importance to create a secure and therapeutic environment for both patients and staff. ASSESSING THE RISKS “In high-risk areas, the implementation of fitted sliding windows critically enhances safety measures. “However, these high-risk solutions procure a higher cost and do not necessarily make economic sense for lower-risk areas or retrofit projects. “Instead of uniformly applying the same risk measures throughout a mental health facility, Safehinge Primera takes a risk-assessed approach to adapt to evolving risk and budget needs, conducted collaboratively with clinical experts. “This nuanced understanding empowers facilities to implement varying degrees of window restrictions based on the identified risks, thereby optimising the allocation of budget. “Such an approach ensures that the most-vulnerable areas receive heightened security measures, while less-critical areas can be managed with less-costly solutions, effectively striking a balance between safety and fiscal responsibility.” Patient wellbeing is, again, also a key driver in the development of window hardware. THE OUTSIDE WORLD The spokesman said: “Many window restrictors limit the view with integrated mesh placed within, or over, the glass, giving a more-institutional look and feel. “To Safehinge Primera, it is important that we focus on the patient’s recovery, allowing fresh air into a room, and an unrestrictive view of the outside world without grates or bars to spoil them. “Our restrictors do not limit the view, and the window pane itself is not covered or overlapped. “The restrictors and handles can also easily be retrofitted to existing windows, eliminating the need for very-expensive and disruptive window upgrade works and providing a cost-effective solution that strikes the perfect balance between accessibility and security, yet always prioritising patient wellbeing.” www.britplas.com www.safehingeprimera.com Ensuring window safety in mental health facilities is of paramount importance to create a secure and therapeutic environment Above: Safevent windows provide light and ventilation, but ensure the safety of mental health patients Left: Safehinge window restrictors provide an uninterruped view of the outside world Since its inception the Safevent window has been enhanced to meet the needs of trusts
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FLOORING Creating a safe space People living with dementia are twice as likely to slip or fall, and three times more likely to incur a serious injury as a result, compared to those without the condition. So, ensuring dementia care environments are designed to take account of, and minimise, this risk is paramount. And one area of focus for many architects and interior designers is flooring. Louisa Eyles, head of commercial marketing at flooring manufacturer, Amtico, explains: “Dementia symptoms include impairments such as cognition, vision changes, reduced colour and depth perception, and restricted mobility, so flooring is an essential part of dementia care facilities – and one of the most- important elements to get right.” Gemma Hart, specifications manager at Altro, adds: “The effect of falls on an older person can be devastating. “So, when considering how to minimise falls in care environments, we need to start by understanding how physical frailty and the dulling of senses associated with the normal ageing process affect how we interact with our environment.” And, for people with dementia, there are a number factors which increase the risk of a fall. Firstly, they are more likely to experience problems with mobility, balance, and muscle weakness. REDUCING THE RISKS In addition, hallucinations and not being able to make sense of the world around them can lead to confusion, isolation, and a lack of confidence in navigating an environment, which can also lead to an increased risk. Furthermore, medications that are used to treat the symptoms of dementia can put residents at a greater risk of falling as common side effects can cause drowsiness, dizziness, and postural hypotension, which is a drop in blood pressure when you stand up. Therefore, selecting the right flooring for care environments is crucial to resident and patient wellbeing. COLOUR Catherine Helliker, marketing manager at Danfloor, said colour and contrast are one of the most-important considerations when choosing flooring products. EXPLORING THE ROLE FLOORING SPECIFICATION HAS ON REDUCING THE RISK OF SLIPS, TRIPS, AND FALLS AMONG PEOPLE LIVING WITH DEMENTIA Image: Ray Mallick on UnSplash mhdf magazine 13 Main Image: Specifying carpet can help to reduce injuries from falls. Image, Danfloor Above: Specifying luxury vinyl tile (LVT) products, such as Amtico Signature or Spacia, ensures the flooring is nonporous, resistant to spills, and has antimicrobial properties
FLOORING She added: “Understanding and using Light Reflectance Values (LRVs) is essential when designing an interior that is easy to navigate and creates no barrier to movement.” LRV is a measure of the percentage of visible and usable light that is reflected from a surface when illuminated by a light source. It tells you how much light a colour reflects, and conversely how much it absorbs, and runs on a scale of 0%-100%, where zero is assumed to be black and 100% a perfectly-reflective white. And LRVs are particularly important when designing interiors for people living with dementia as they often experience a reduction in contrast perception and perceived saturation or vividness of colour. “Someone with dementia may see colours with LRVs that sit within an eightpoint difference as the same colour,” said Helliker. “Colours with a difference of more than eight points will be seen as contrasting and LRVs with a difference of 30 points or more will be easily distinguished. “The 30-point difference, therefore, can help with wayfinding and navigation.” But there is a fine line between too little contrast and too much. “A fear of using the bathroom or ensuite facility, for example, could be down to several factors, such as the colour or texture of the floor,” said Helliker. “If the colour of the bedroom carpet has an LRV of 30 and the flooring within the ensuite bathroom has an LRV of eight this would equate to a 22-point difference. “A person living with dementia may feel safe and secure in their bedroom, but when expected to use the bathroom they may feel like they are crossing over into a black hole, purely down to the colours of the two surfaces.” Lewis Cooper, spokesman for Forbo Flooring Systems, adds: “Dark-coloured floor coverings may be seen as deep holes that should not be stepped into; while a heavily-patterned design, flecked effects, or flooring incorporating a logo could become an obstacle to be avoided. “And shiny or sparkly finishes can appear as water and therefore present a slip risk which is not really there; while transitional strips – for example between carpeted areas and hard flooring areas – might create a barrier to the eye of a resident. “The effect flooring has is different for each person living with dementia and responses may vary from agitation and panic or hallucinations, to high stepping over a perceived obstacle, resulting in over balancing and the potential for falling, or bending down to pick something off the floor that isn’t really there – again creating a needless risk of falling.” mhdf magazine 15 ...A fear of using the bathroom or ensuite facility, for example, could be down to several factors, such as the colour or texture of the floor... Contrast is vitally important, particularly when moving from a bedroom to an ensuite Forbo’s SureStep safety flooring offers guaranteed lifetime slip resistance
FLOORING With this in mind, he advises choosing plain designs with tonal contrast to the walls and doors and matt finishes recommended to avoid any disturbing reflections. MATERIALS In addition to opting for the right colour for flooring, material choice is also critical. Eyles advises: “Specifying luxury vinyl tile (LVT) products, such as Amtico Signature or Spacia, ensures the flooring is nonporous, resistant to spills, and has antimicrobial properties. “Indeed, LVT is also available in safety flooring versions with enhanced slip resistance to further reduce the risk of injury to people with dementia.” Similarly, Forbo’s Surestep Laguna, Surestep Aqua, Surestep Wood, and Surestep Material safety flooring collections offer guaranteed lifetime slip resistance across a variety of designs, which have been accredited by the world-renowned Dementia Services Development Centre (DSDC) at Stirling University. The slip resistance of existing flooring materials can be enhanced through the application of coatings containing particles which increase the surface friction, said Alec Stacey, technical manager at Bona, a flooring renovation and restoration specialist. CARPET MAKES A COMEBACK And carpet is also making a comeback in dementia-friendly care environments, with studies showing that the softer material can reduce injuries caused by slips, trips, and falls. Research conducted by Healy studied the role of carpeted and vinyl floors in the injuries older patients receive when falling in the hospital. Out of a group of patients falling on the carpet, 17% sustained injuries, compared to 46% when falling on vinyl flooring. “Statistical analysis indicated that there was a less than 1% probability that the reduced rate of injury for those patients who fell on carpets was owing to chance,” explains Helliker. “Research also suggests that thicker carpets can decrease fracture rates, but in a care facility you must be mindful to select the correct thickness of carpet to allow for the use of walking aids and those people who tend to shuffle.” Carpet manufacturers are also concentrating their research and development efforts on ensuring products are easy to clean and designed with an impervious membrane to trap liquids and spills on the surface for easy removal. SPECIFYING THE RIGHT SOLUTION Offering advice to care home and hospital estates managers, Cooper said: “While careful consideration should be given to all floor coverings within a dementia care facility, maintaining a high level of slip resistance in bathrooms, wetrooms, or anywhere where food and drink is consumed it vital. “As such, it is important that appropriately-graded slip resistant flooring (safety flooring) is specified in these areas. “And, when specifying safety flooring, managers should opt for solutions where the slip resistance properties are sustainable throughout the lifecycle of the product. “It’s also worthwhile familiarising yourself with the safety flooring test methods and what those results mean in terms of contributing to the prevention of slips and trips, such as the Pendulum Test and the Ramp Test.” Eyles advises adhering to BS 8200:2018 Design of an Accessible and inclusive built environment (Part 2: Buildings – Code of Practice). And Hart told hdm: “Designing with empathy can make a huge difference to the everyday life of people living with dementia. “That means understanding how dementia affects those living with it, what that looks like to them, and why and how you can make improvements through design choices. “You’ll need to ensure you meet the legislation and guidance for dementia design, and there is a lot of useful information in those documents, plus a wealth of material from manufacturers. “A great starting point is Altro’s Design for Dementia CPD, which includes many practical examples, along with guidance and best practice examples and solutions, based on years of experience and real-world applications.” 16 mhdf magazine ... it is important that appropriately-graded slip-resistant flooring is specified... Forbo’s SureStep safety flooring offers guaranteed lifetime slip resistance
FLOORING MAINTENANCE Ongoing maintenance is also key. Stacey said: “it is important that flooring is maintained in the correct manner to retain physical properties such as slip resistance. “Floor maintainers should be assessed to ensure that they do not negatively impact on the surface. Similarly, insufficient or incorrect maintenance may result in premature wear. “Ideally, it should be possible to refurbish the flooring to avoid long periods of downtime which may be required for future replacement. This may involve a process of stripping and recoating the flooring while retaining the physical properties of the surface.” THE FUTURE Moving forward, flooring manufacturers are continuing to explore the impact of colour and material choice on the safety and wellbeing of people living with dementia. Cooper said: “Many manufacturers are now working with specialist companies to develop solutions suitable for dementia-inclusive health and care environments. “For example, at Forbo, we have been working with the Dementia Services Development Centre since 2017 to review and rate our floors in relation to dementia design principles and usability within a dementia-inclusive environment. “Specifiers and designers can now choose from an extensive selection of more than 1,000 products which have been accredited across the Class 1a, 1b and 2 rating system, which is based on the tonal contrast and pattern of products and their suitability for use. “In the future these partnerships will be increasingly important to ensure solutions are developed to drive the creation of safe, inclusive spaces.” Hart concludes: “Awareness of dementia-friendly design has increased massively in recent years, as well as wider inclusive principles for design for neurodiversity. “And this awareness will continue to drive product development, allowing intelligent interior design for health and care facilities, as well as education and public areas such as bars, museums, sports facilities that could make them more accessible for all.” www.altro.com www.forbo.com www.danflor.co.uk www.amtico.com www.bona.com ..it should be possible to refurbish the flooring to avoid long periods of downtime which may be required for future replacement 18 mhdf magazine Image: David Pisnoy on UnSplash
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