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.” 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:
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. 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.”
