Architects, interior designers, service operators, and product manufacturers have an opportunity to create a new generation of supportive and therapeutic environments for the delivery of modern mental health and dementia services, but will need to focus on the positive and not be so risk averse.

This was the message from industry experts at the 2022 mental health & dementia facilities forum, held in the Cotswolds last week.

The annual event, organised by Stable Events, sister company to mhdf magazine publisher, Stable Publishing, offers suppliers of specialist mental health and dementia products and services the opportunity to meet key decision-makers involved in the design and construction of health and care facilities.

I am starting projects where I am going to buildings and finding people working in a context designed at another time, for another purpose, with another philosophy – buildings that are fundamentally inappropriate and stigma inducing

As well as a series of pre-arranged meetings, the forum also featured three keynote sessions, fronted by experts from the field of mental health and dementia design.

Recovery-centred design

And they were united in their desire to improve the built environment for all those who live and work in health and care settings.

In the first speaker session Francis Murdock Pitts of Architecture +, who had travelled from Martha’s Vineyard in Massachusetts to attend the event, compared the approaches to the delivery of mental health services in the UK and the US.

And he called for a more recovery-centred design approach, telling delegates: “We have inherited a mess.

“I am starting projects where I am going to buildings and finding people working in a context designed at another time, for another purpose, with another philosophy – buildings that are fundamentally inappropriate and stigma inducing.

“If we looked at preventative care and recovery, we would be far better off.

“We do not know the cure for mental illness, but when we approach conditions like diabetes and cancer it is about preventative care, rather than assuming a cure. We need to use this approach to mental health.

As architects we do not just provide services to the mental health industry, we are part of the system – and all of us need to do a better job

“At the moment there is a tendency to see the mental illness and forget about the human being.

“Buildings need to be safe and reduce stigma, self harm, and violence; but design strategies also need to be underpinned by choice and privacy with a range of settings and experiences, social and spacial management, and access to outside spaces.”

The bigger picture

Teva Hesse of C.F. Møller Architects added: “As architects we do not just provide services to the mental health industry, we are part of the system – and all of us need to do a better job.

“We design a product or a building to be anti ligature and as robust as possible, but that’s just entry-level requirements. That’s not doing the job and it’s forgetting about the other part of people – the bigger part.

“We need to move on as an industry, beyond entry level, and come up with something much more humane.

“We are always looking at the negative things and all the bad things that might happen, but we can’t make environment focused just on risk.

“We have to make environment where people can do the things they like to do, particularly at a time when we may be depriving them of their liberty.”

We need to move on as an industry, beyond entry level, and come up with something much more humane

He said that research carried out by the practice as part of its work to develop the new Springfield University Mental Health Hospital in Tooting found that violence, rather than self harm, was the most-prominent issues in psychiatric units, together with boredom, which is a design driver often overlooked in the creation of new environments.

“There is pressure on staffing and cuts coming, so we have got to focus on what activities patients can do on their own and be willing to accept some of the risks,” he added.

“The environment has to be less sterile and the acoustic environments we create are often terrible.

A balancing act

“Of the 20,000-plus incidents we looked at in our research, we did not record any ‘dirty protests’ and that is often used as an excuse for not implementing acoustic treatment in mental health units.”

And he called on product manufacturers to normalise design, telling the forum: “We need to destigmatise mental health facilities.

“If we look at products, they should not look like mental health products.

“We need to make them robust and anti-barricade and anti-ligature, but make them look like something we would want to have in our own homes.

“We must get away from making environments just clinically safe, as that cannot be done.

“For example, having a garden in a mental health unit is a risk, but not having one is detrimental to health and wellbeing.”

Delegates also heard from Mark Nugent of Medical Architecture, who questioned whether the tendency to build purely single-storey mental health units was the best solution moving forward.

Specified in Healthcare Building Notes guidance as ‘the preferred design for psychiatric facilities’, but without reasons being given; he provided case studies of two-storey developments in the UK which are creating additional community-based services for patients.

Clock View Hospital in Liverpool and Blossom Court in Haringey, north London, are both helping to create a new benchmark for design, with service users on the upper floors able to access safe outdoor terraces.

Meeting demand

Nugent said: “Blossom Court was a constrained urban site and has been designed so that high-risk patients are housed on the ground floor and lower-risk patients on the first floor.

“Each floor has all the services – including de-escalation and seclusion rooms – so staff do not have to manage patients up and down the stairs.

“In this sense, a two-storey approach fits naturally into the urban context and helps to destigmatise mental health.

“By building two-storey mental health units in cities, we are putting services where people live, closer to their loved ones.

“We are taking just as much space, but getting twice as many patients on the site, and that is crucial to meeting the increasing demand for beds.”

And, financially, the approach also brings benefits.

The cost per square metre of space for a single-storey development is around £6,600, while a two-storey development is £5,900, representing an 11% saving.

Inclusive design

In the second speaker session, delegates heard from Maarit Heinonen-Smith of Arcadis IBI Group, who gave a case study of the Heathlands Integrated Health and Care Home, an innovative collaboration between Bracknell Forest Council, Frimley Clinical Commissioning Group (CCG), Frimley Health NHS Foundation Trust, and private operator, Windsar Care.

The unique partnership has resulted in a facility which provides a 20-bed step-down unit, funded and operated by the NHS and aimed at relieving the strain on hospitals by providing extra care services for elderly patients who do not need to be in an acute setting, but cannot yet return home.

Alongside this facility is a council-funded 46-bed dementia care home, which will be run by Windsar Care.

And Maria Luigia Assirelli of Floyd Slaski explored design principles for people with autism, telling the audience that ‘inclusive design is not just about someone in a wheelchair, but looks at everything that effects people’.

It’s a long journey from planning a new building to putting it into use, so how do we make sure people become engaged and stay engaged?

The afternoon ended with Lesley Palmer from the University of Stirling unveiling a new online tool to support families, businesses, and professionals to make homes, premises, and public places more accessible to an ageing population and those living with dementia.

The Environments for Ageing and Dementia Design Assessment Tool (EADDAT) combines the latest research on designing for cognitive change with the expertise of leading architects based at the University’s Dementia Services Development Centre (DSDC).

Online design support was also addressed in the final speaker session, where Sarah Waller from the Association for Dementia Studies and the University of Worcester spoke about its new assessment tool which will help those delivering dementia care to improve environments.

Rules of engagement

Stakeholder engagement was another theme running through many of the discussions, with designers urged to spend more time getting feedback and comments from staff and service users.

Melanie Relf of Lexica provided a framework for consultation, which likened the work of architects to that of private investigators.

She said: “It’s a long journey from planning a new building to putting it into use, so how do we make sure people become engaged and stay engaged?

“It’s about asking who do we need to be there? What is their role? Is anyone missing? Are people being given time to engage and attend meetings? And what are their hopes and fears?

“We also need to agree the rules of engagement, for example do things have to be signed off?

The forum provides the perfect opportunity to see what is out there and to speak to people one to one in a more-informal setting

“And we need to be clear and transparent about any constraints and incorporate joy into the consultation process.”

Finally, manufacturers were introduced to a new testing and certification scheme for mental health products, developed by BRE and the Design in Mental Health Network, which for the first time was a partner at this year’s forum.

Testing times

With the first products currently going through the testing process, BRE’s Sean Taylor urged manufacturers to send in innovations so mental health operators could be reassured that new products meet the very-specific needs of psychiatric units in terms of safety and robustness.

Speaking at the event, Matthew Balaam of Oxford Architects said: “I attend this event every year and find the one-to-one sessions and the speaker sessions extremely informative.

“On the first day of the mhdf I did a deal with Kingsway Group for seven or eight doors for a mental health unit at Hillingdon Hospital. I had a very-quick turnaround time for this project – just eight weeks – and by meeting them here I was able to discover that they could deliver in this timeframe, which is brilliant.

“I am also looking to do a deal with a first-time attendee and was speaking to another company about its products and realised they sold fittings I was not aware of, so I will be talking to them further about where we can use these on future projects.

“The forum provides the perfect opportunity to see what is out there and to speak to people one to one in a more-informal setting.”