A fresh approach to design the mental health & dementia facilities magazine APRIL 2023 PROJECTS Multi-level hospital set to revolutionise future design INTERIOR DESIGN Furniture key to refurbished psychiatric unit LANDSCAPING Exploring the impact of nature on mental health recovery p5 p10 p13
mhdf magazine 3 Contents APRIL 2023 Editor’s Note Design matters Increasingly, it is being recognised that the buildings from which mental health services are delivered play a critical role in patient wellbeing and even health outcomes. But it is not just the physical design of the structure itself and the room adjacencies that matter; interior design and landscaping are also key. In this edition of mhdf, we look at the role nature has on recovery, focusing on the delivery of gardens and links to outdoor space (p13). As David Kamp, president of Dirtworks Landscape Architecture, explains: “An often-overlooked, but intrinsic, element of any facility is the land it sits on, the views from its windows, and the seasonal changes that happen around it. So, exploring this design opportunity benefits everyone, including service users, the staff caring for them, and friends and family who visit. “No one said it would be easy, but the rewards are significant.” In our article you can read about the growing evidence base and work carried out at Ulster Hospital’s mental health unit to create an oasis for service users and staff. We also look at the importance of interior design (p10), with news of the refurbishment of a psychiatric unit in Nottinghamshire and the approach to furniture specification for the project. And in our Projects section (p5) we showcase some of the exciting mental health and dementia construction projects planned and underway across the UK, including the North View inpatient facility in Manchester, which will be one of the UK’s first multi-level psychiatric hospitals; and plans for a new unit at Glan Clywd Hospital in Wales. In the next edition we will focus on flooring and access control. 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 construction projects 10 INTERIOR DESIGN Furniture choice is key to Millbrook Mental Health Unit refurbishment 15 LANDSCAPING Exploring the role of nature and access to outdoor spaces for mental health service users North View mental health unit, Manchester. Gilling Dod Architects. 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 Plans for a new ‘world-class’ inpatient mental health unit at Glan Clwyd Hospital have been released, highlighting a fresh approach to the design of modern psychiatric facilities. Betsi Cadwaladr University Health Board’s plans for the new 63-bed unit and multi-storey car park were published before a full planning application was submitted to Denbighshire County Council in March. The new unit, designed by Powell Dobson Architects, will cost around £84.5m and will replace the hospital’s Ablett Unit and the older people’s mental health inpatient facility at Bryn Hesketh, Colwyn Bay. The designs have been developed following engagement with patients, carers, staff, partner organisations, and the wider community. Situated at the rear of the hospital site, the new building will deliver more beds and significantly-improved facilities for both staff and patients. CARE CLOSE TO HOME The plans include a 14-bed older person’s mental health ward and a 13-bed dementia care assessment unit with en-suite facilities and provision for families and carers to stay overnight. There will also be two purpose-built 16-bed adult wards complete with de-stimulation areas, which will provide a safe nursing environment for high-acuity patients, preventing the need for transfer First glimpse of world-class inpatient unit PROJECTS to other mental health units. And an assessment suite will enable some patients to be moved from the busy emergency department. In addition, more outdoor and therapeutic garden spaces are included, with the development designed to meet the highest energy efficiency standards, supporting the Welsh Government’s response to the climate emergency and the NHS’s net-zero carbon targets. To minimise environmental impact a first-floor deck is proposed over Car Park 3 at the front of the hospital, complete with electric vehicle charging points, and hospital managers are looking to reintroduce the Park and Ride scheme and make greater use of cycle to work and car share options, public and community transport schemes, agile and home working, and increased use of video and online technology for remote consultations. EMBRACING NATURE And biophilic design principles will be applied in the form of air-sourced heat pumps and photovoltaic cells on the roof of the new facility. Teresa Owen, executive director responsible for the health board’s mental health and learning disabilities division, said: “Our aspiration is to deliver a world-class facility that enables our hard-working staff to deliver the highest standards of care that our patients deserve in a modern, fit-for-purpose environment.” The ground and first floor of the new building will house patient spaces, with administrative offices on the second floor. The main entrance has been designed as a welcoming space, signalling both the entrance and primary circulation areas and promoting principles of healing and wellbeing through biophilic design. The palette of materials proposed for the exterior will blend in with the existing hospital campus while providing its own unique identity, with materials appropriate for dementia care and acute mental health environments. Key features will be the red glass cladding to the entrance, with the lower storeys in brickwork and the uppers storeys in PPC cladding panels. The landscape design includes a line of street trees along the main road, a feature garden next to the visitors’ waiting room, activity spaces, a therapies courtyard, and a dementia garden. Subject to further approval from Denbighshire County Council’s planning committee, the health board, and the Welsh Government, work on site should commence next summer, with the building accepting its first patients in the summer of 2026. The project was awarded under the NHS Building for Wales framework and the main contractor is BAM Construction. The design team also includes Ramboll (Engineering), Arup and Lorne Stewart (M&E), Soltys Brewster (Landscaping), and Tetra Tech (planning consultant) www.bam.co.uk www.powelldobson.com
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mhdf magazine 7 PROJECTS Plans unveiled for learning disability hub A planning application has been submitted for a new sustainable and inclusive Adult Learning Disability Hub in Inverclyde. Designed jointly by architects at Holmes Miller and Inverclyde Council, working in partnership with hub West Scotland, the £10m facility will be located in Brachelston Street on the site of the former Hector McNeil Memorial Swimming Baths. It will replace the current Fitzgerald Centre in Greenock and will provide daycare facilities and enhanced learning activity spaces for up to 50 adults with learning and physical disabilities. If planning permission is granted, construction of the centre is expected to start on site this summer. To deliver on Inverclyde Council’s net-zero carbon aspirations, a ‘fabric first’ approach to design has been adopted for the centre, which will result in an efficient and low-energy building. Carbon emissions will also be offset by a large array of roof-mounted solar photovoltaic panels. And, while the exterior design draws inspiration from Greenock’s famous Sugar Sheds, the internal layout has been developed through extensive consultation with senior managers, the health and social care partnership, service users, and their families. The aim is to provide an enhanced sensory experience for users with complex needs, such as autism, dementia, visual and perceptual impairments, and physical and sensory disabilities. Careful consideration has been given to materials, texture, colour, and acoustics and landscaping around the facility will build on the existing natural characteristics of the prominent site and complement the sympathetic nature of the building. Nada Shehab, project architect at Holmes Miller, said: “Our designs are for a building with a human scale and a modern distinctive character that takes subtle inspiration from prominent Greenock architecture. “It has been great working with a strong client group that has a clear vision of how good design can improve the lives and experiences of their service users and their community, both now and in the future.” Councillor Martin McCluskey, vice-convener of Inverclyde Council’s social care and social work scrutiny panel, added: “We promised people with learning disabilities and their families that the council would deliver a modern, state-of-the-art centre for them and their families and it is an exciting moment to get to the stage where we can start to see how this facility for the people of Inverclyde could look. “A great deal of effort has gone into getting us to this stage and while we await the outcome of the planning application, we can still celebrate this significant milestone as another major step towards delivering a new, state-of-the-art learning disability hub for the people of Inverclyde.” The project team for the new building also includes McLaughlin & Harvey as main contractor; Harley Haddow as civil and structural engineers; Davie & McCulloch as mechanical and electrical engineers; and Brown & Wallace as cost consultant. Iain Marley, chief executive of hub West Scotland, said: “The project team has been working closely with the council and the health and social care partnership to develop a great design which addresses the needs and aspirations of the service users and also incorporates a fresh, calm and welcoming environment for all building users.” www.holmesmiller.com www.mclh.co.uk An artist’s impression of the new hub. Holmes Miller Architects
8 mhdf magazine PROJECTS SETTING A BENCHMARK Work is continuing on the construction of a flagship new mental health inpatient unit on the North Manchester General Hospital site. The £105m facility will replace Park House, which is operated by Greater Manchester Mental Health NHS Foundation Trust, to provide a more-therapeutic environment for service users, including replacing dormitory-style wards with single en-suite bedrooms and creating a variety of internal activity spaces and outdoor therapy areas. And it will set a new benchmark within healthcare construction as it will be one of the first multi-level psychiatric units in the north of England. A traditional ground-breaking ceremony was held at the site in November and in January of this year contractor, Integrated Health Projects (IHP), completed demolition of all remaining buildings. Due to the size and nature of the land, new reinforced concrete retaining walls have been erected down the centre of the site, which also form the central access corridor for the new building. And stone gabion retaining walls have been built along the Crescent Road perimeter to support the external grounds and gardens. Other work has included building the foundations and the installation of prefabricated, structural steel frames. Once completed, the facility, which has been designed by Gilling Dod Architects and will be known as North View, will provide 150 bedrooms over nine single-sex wards, including a purpose-built Psychiatric Intensive Care Unit, seven adult acute wards for female and male adults, and one older adults ward. An assessment suite for people sectioned under the Mental Health Act is also proposed. And each ward will have direct level access to its own garden spaces, with the building design utilising an existing step in site levels. Sustainability is also at the heart of the new facility, with the building designed to be able to operate as a net-zero carbon facility, with no fossil fuels used in its heating system. www.gillingdod.com www.ihprojects.co.uk The new hospital is one of the first multi-level mental health facilities in the north of England
meet. connect. do business. the sustainable buildings & estates forum www.sbe-forum.co.uk 6th - 7th July 2023 The Belfry Hotel call now: 020 8288 1080 The collaborative journey to a net-zero built environment Share best practice, network and explore the latest sustainable projects, trends and innovations. With a dedicated seminar programme, “The collaborative journey to a net-zero built environment”, tailored meetings, drinks receptions, lunches and gala dinner. Our unique formula brings the community together providing the perfect platform to discuss the latest trends and developments whilst also offering endless networking opportunities. Attend as a supplier delegate As a supplier, you will have unprecedented access to the key decision-makers working on active sustainable projects. Book your place - [email protected] Attend as a project delegate If you are involved in the design, build or management of a sustainable project or estate masterplan join us as a complimentary delegate. Secure your space - [email protected] stable-events.co.uk [email protected]
INTERIOR DESIGN 10 mhdf magazine When Millbrook Mental Health Unit in Nottinghamshire closed for refurbishment, furniture choice was key for both the internal rooms and outdoor spaces. The unit provides inpatient and community psychiatric services for adults and older people, and Knightsbridge Furniture was commissioned to provide a range of products for the 46 en-suite bedrooms and communal areas. Products from its Cheetah, Zouk, Acron, Bebop, and Affinity ranges were used, as well as GoGo chairs and tables for staff-only areas. Each piece has been carefully considered and adapted to meet the needs of the residents and employees, with the Millbrook team working closely with Knightsbridge to discuss details of the pieces provided and the colour schemes of the facility. Director of design and development at Knightsbridge Furniture, Jason Brown, said: “The ward is designed to lend itself to modern healthcare and the pieces chosen have all been crafted to meet this objective, with an equal focus on comfort and style as well as safety and durability. “Our furniture ranges are easily adaptable to be weighted, and seamless with reinforced frames and feet, security screws, and further options to meet the highest safety and comfort standards.” He added: “Challenging environments as a whole have evolved rapidly in recent years to include more stylised elements. “Where once stood white, clinical spaces, residents of these facilities can now enjoy lots of colour, soft furnishings, and decor that makes communal and private areas feel more comfortable and calming.” www.knightsbridge-furniture.co.uk FURNITURE CHOICE KEY TO REVAMP Careful consideration was paid to ensuring the furniture co-ordinated with the interior colour scheme
mhdf magazine 11 What The sustainable buildings & estates forum 2023 When 6-7 July 2023 Where The Belfry, Sutton Coldfield Web www.sbe-forum.co.uk PREVIEW The collaborative journey to net zero The sustainable buildings and estates forum is a must-attend event for estates teams and suppliers across the higher education, healthcare, leisure, retail, commercial, and residential sectors. With sustainability impacting every aspect if the built environment – from the planning, design, and construction of new facilities, to the operation, maintenance, and renovation of existing stock – this one-and-a-half day networking event will give product and service suppliers the opportunity to meet key decision-makers from across all sectors. Organised by healthcare design & management (hdm) magazine’s sister company, Stable Events, it will create a productive networking environment through which project and supplier delegates can focus on forging long-lasting business relationships through a series of pre-arranged meetings. And, by matching supplier and project delegate schedules in advance, both parties can maximise their time at the event, with a minimum of 15 meetings taking place with those in charge of commissioning for healthcare estates. The event also includes a gala dinner and three speaker sessions exploring the opportunities and challenges to delivering sustainable estates. Stable Events spokeswoman, Jo Makosinski, said: “Few markets in recent memory have attracted as much interest, investment, and innovation as sustainability. “Whatever sector you operate in; for estates teams sustainability touches every aspect of your work – after all, a sustainable built environment is an ambition that unites the entire supply chain, from designer and builder to supplier and client. “And, as collaboration between key stakeholders is at the heart of good sustainable practice, it for this reason Stable developed the forum; to connect and engage the supply chain to ensure the most-appropriate solutions for building projects are achieved.” This year the speaker sessions will explore the ‘collaborative journey to a net zero built environment’ and will be chaired by Joel Callow, director of Beyond Carbon Associates. Speakers will include Alex Green, schools programme manager at Ashton, who will be exploring the role educational estates can play in a net-zero carbon society; Mike Sewell, plan zero director at MITIE, who will be talking about the challenges of delivering effective decarbonisation; and David Spiteri, director of sustainability at Wallace Whittle, who will look at some of the lessons learned to date. Project delegates signed up to attend the event are collectively responsible for more than £3billion worth of planned building projects across the UK and further afield. They include Taylor Wimpey, Sovereign, Inspire Design & Development, Coreus Groups, Elevate, Noble Consulting, MAC Construction Consultants, and Bondstone. And they will be looking to speak to suppliers of products and services that can help to support the net-zero carbon and wider sustainability drive. For more information about this year’s event, or to register for your place, visit the website at hb-forum.co.uk or email [email protected] The sustainable buildings & estates forum returns this July to provide a networking opportunity for all those involved in delivering environmentally-responsible and cost-effective buildings across all sectors
OUTDOOR SPACES The benefits of green space and being around nature are now well documented, but are often overlooked when designing mental health facilities, due mainly to cost pressures and concerns over security and safety. However, the COVID-19 pandemic, and the building body of evidence on the positive effect of outdoor spaces on mental wellbeing, are changing this and landscaping is now key to the design of psychiatric facilities both in the UK and further afield. David Kamp, president of Dirtworks Landscape Architecture, explains “An often-overlooked, but intrinsic, element of any facility is the land it sits on, the views from its windows, and the seasonal changes that happen around it. So, exploring this design opportunity benefits everyone, including service users, the staff caring for them, and friends and family who visit. A CO-ORDINATED APPROACH “The incorporation of outdoor space, whether for active use or passive respite, offers an exciting opportunity for designers to complement and expand the therapeutic programmes of mental health facilities. “Each has specific design requirements, though, including security, but a carefully-considered, co-ordinated design approach that takes advantage of nature’s restorative qualities can support them all.” And he said consultation is key when designing mental health gardens, as they need to meet the very-specific requirements of the particular service users – whether they be adults, older people, or children – and the various psychiatric conditions they may be suffering from. “I have designed mental health facilities for a range of individuals, including a secure psychiatric centre for patients admitted by court order,” said Kamp. “I start by listening to clinicians, staff, and regulatory officials to understand who they are caring for, what they want to achieve, and the framework they must work within to achieve it. “This initial conversation forms the springboard for a dialogue that continues through the entire project – from identifying appropriate exterior programmes, to refining detailed design, ensuring quality is maintained during construction, and establishing realistic, sustainable maintenance standards.” The Great Outdoors Improving mental health environments mhdf magazine 13 Research indicates that physical activity in nature, including ecotherapy practices, can promote psychological wellbeing ACCESS TO NATURE AND VIEWS OF THE LANDSCAPE ARE INCREASINGLY BEING LINKED TO IMPROVED OUTCOMES FOR MENTAL HEALTH PATIENTS Image: Erda Estremera on Unsplash
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OUTDOOR SPACES Health and safety issues take on another dimension when dealing with mental health and substance abuse, where design must address confusion, anger, confrontation, and even the threat of physical violence. “Working in mental health facilities challenged me to think deeply about partnering nature with such clinical services as dialectical behaviour therapy, a treatment designed to help people understand the relationship between their thoughts, feelings, and behaviours,” says Kamp. THE HARSH REALITY “It is often used for individuals who struggle with self-harming behaviours. “And, against such harsh realities, the consequences of design decisions are heightened exponentially, so every detail and condition must be examined from the perspective of posing a potential threat. “This includes, among other concerns, the layout of areas for activity, socialisation, and relaxation; the material and configuration of garden features and structures; toxin levels of plants; and the soil itself.” GOING ABOVE AND BEYOND He adds: “Thoroughness in design and execution is essential. Designers should consider going beyond simply meeting the criteria and guidance of relevant codes and reference standards.” While the evidence base is growing, specific design guidance for health trusts is still relatively sparse, with the Department of Health and Social Care’s Health Building Note 00-01: General design guidance for healthcare buildings touching merely on the benefits of landscaping for hospital entrances. Health Building Note 03-01: Adult acute mental health units goes into more detail, stating that: “Access to fresh air and outdoor spaces, and the opportunity for reflection and social engagement, all play a significant role in supporting wellbeing and recovery. “The external space accessed from the unit is viewed as a functional and therapeutic part of the service.” The document lays out several design considerations, including: • Provide park-like spaces with open grassy areas, herbs, textured plants, and shrubs that attract wildlife to alleviate stress and help service users feel more connected with nature • Raised flower beds may be considered as these could incorporate seating and support therapeutic activities • New sites should be large enough to provide more than just a buffer zone around the building • Units should provide a range of external areas for service users, staff, and visitors • Outdoor spaces should offer a range of activities, such as gardening, ball games, sitting, walking, resting, and quiet contemplation • There should be a shaded area and cover from inclement weather • Planting schemes should be imaginative, encourage use of the space, and reflect the passing of seasons • There should be level access from the unit to an external space and this space should be dedicated to the unit and designed so that service users can be easily observed • External spaces should be orientated to maximise sunlight and maintain privacy And it states that all service user areas and bedrooms should have external views, preferably onto gardens or courtyards, while maintaining the need for privacy. LOOKING OUT Where possible, views out to the wider community are also desirable to reduce the feeling of isolation and institutionalism which can arise from looking inward. More-recent design guidance has been produced by the Design in Mental Health Network. mhdf magazine 15 The Design in Mental Health Network’s guidance explores the body of research to date Planting schemes should be imaginative, encourage use of the space, and reflect the passing of seasons
OUTDOOR SPACES The Nature Issue is part of the network’s Design With People in Mind series and takes a look at the body of research to date. It states: “While 20th-centry developments, including deinstitutionalisation, community care, and psychopharmacology contributed to a reduced focus on the therapeutic role of natural environments in mental healthcare, the more-recent renewed interest in the restorative potential of nature within the concept of therapeutic landscapes suggests that a re-examination of asylum landscapes may be relevant today. “Although research examining the impact of natural features within mental healthcare environments is limited, research findings suggest that design which promotes exposure to natural elements may be associated with positive health outcomes including improved mood and reduced length of stay.” A DESIGN CHALLENGE As well as ensuring views of nature from windows throughout a building, the guidance also highlights the importance of service users being able to engage in outdoor activity. “Research indicates that physical activity in nature, including ecotherapy practices, can promote psychological wellbeing,” it adds. “Studies suggest that benefits of gardening interventions for people experiencing mental distress can include significant reductions in the symptoms of anxiety and depression and improvements in perceived quality of life.” Kamp adds: “Designers who choose to work in healthcare environments understand the added level of complexity and the sensitivity necessary to create an atmosphere conducive to healing and respite. “Environments for mental health take the design challenge one step further. “No one said it would be easy, but the rewards are significant.” www.dirtworks.us 16 mhdf magazine Studies suggest that benefits of gardening interventions for people experiencing mental distress can include significant reductions in the symptoms of anxiety and depression and improvements in perceived quality of life Image: Erda Estremera on UnSplash
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When the COVID-19 pandemic hit the UK, mental health was high on the agenda, and it was at this time that Belfast-based Urban Choice Design was asked to work with Jonathan Assorto-McIlwaine of McIlwaine Landscape Architects, on a garden for the psychiatric unit at Ulster Hospital. The brief was to provide a suitable indoor/outdoor room for staff and patients to be able to sit and enjoy, both for relaxation and also for consultations. And the designers’ vision was to create, not only a garden with landscaping and planting, but also a covered area with weather protection to enable the garden to be used 365 days a year. OPENING UP Kathryn McNaught, development director at Urban Choice Design, explains: “The timing was so fortuitous as this was just at the start of the pandemic and to be able to be involved in a positive way and help the local community hospital was a great honour to us a company. “The outdoor room takes the form of a Renson Patio Cover surrounded by glass sliding doors, giving a 360-degree view of the gardens and a feel of living in the garden. “The roof structure has rotating aluminium blades which open up so you can look up and see the sky, clouds, and sun – bringing the outdoors in, yet with the ability to completely close to keep out the rain when required. “This has the effect of connecting with nature, which promotes feelings of mindfulness, peace, and gratitude, all helping with anxiety, stress, and mental health issues.” The inclusion of glass sliding doors also provides easy access and allows full visibility into the structure, while maintaining a continual connection with the plants and nature in the garden outside. CONNECTING WITH NATURE “In addition, the glass doors allow exposure to natural light known to better help the body’s internal clock, leading to better sleep,” explains McNaught. The project involved consultation with the designers, hospital managers, and members of the mental health team to ensure the garden covered all aspects of safety for patients. “Outdoor space and living in your garden has so many positive effects on all of us, but, for this project, the importance was multiplied and the result has been a stunning garden with a relaxed area to sit, whatever the weather,” adds McNaught. www.urbanchoice.co.uk CASE STUDY OUTDOOR SPACES 18 mhdf magazine
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