Emerald | Facilities | Table of Contents

Including patients, staff and visitors in the design of the psychiatric milieu: Notes from the field.

literatinetwork@emeraldinsight.com (Nathan Perkins) — Tue, 19 Mar 2013 00:00:00 +0000

Abstract

Purpose - Participation by patients, staff and visitors in healthcare design and planning offers multiple benefits in addressing the complex challenges of creating salutary environments. The aim of this paper is to present varied approaches of participatory design and planning at psychiatric facilities. Design/methodology/approach - Three case studies are described in which participatory methods were used to engage users in decision-making. Findings - Including patients, staff and visitors in design programming resulted in identifying design programming issues that addressed specific needs of users.Research limitations/implications - The limitations of this reported work are that design outcomes measures are difficult in principle and practice.Practical implications - Designers and planners of specialized facilities can benefit by incorporating participatory methods in their work.Originality/value - The case studies present applied research spanning a 15-year period and should be of value to hospital administrators and designers.

Collaborative Design: Outdoor Environments for Veterans with PTSD

Tue, 19 Mar 2013 00:00:00 +0000

Abstract

Purpose - Providing veterans diagnosed with post-traumatic stress disorder, their families, and staff opportunities to experience physical and mental restoration in outdoor environments designed based on evidence is important. This paper explores the relationship between evidence-based collaborative design of outdoor environments and their potential capacity to contribute to a veteran’s journey to wellness.Design/methodology/approach - There is no existing precedent in the peer-reviewed literature linking positive health outcomes associated with outdoor environments to veterans with PTSD. This review of the literature is conceptualized as a means to extrapolate these benefits to this unique population.Findings - Access to nature improves physiological and psychological health outcomes. A collaborative design approach ensures that design outcomes meet specific populations’ needs.Practical implications - Many veterans are reluctant to seek established treatments for PTSD, fearing threat to future military service and limited available resources. Innovative treatments- access to sensitively designed outdoor environments and/or a re-examination of established treatments and the environments in which they are provided supports best practice approaches to ameliorating the debilitating effects of this disorder.Originality/value - An inter and/or trans-disciplinary team approach to design and programming of outdoor environments for veterans with PTSD blends landscape architecture with occupational therapy to ensure both form and function are achieved, thus positing positive health outcomes.

Spaces for differences: dwelling after deinstitutionalization

Tue, 19 Mar 2013 00:00:00 +0000

Abstract

Purpose - This paper reports on the architectural findings from an interdisciplinary research project on housing and social integration of people with Severe Mental Disorder (SMD) in Brazil after deinstitutionalization. It first presents the need for a qualitative evaluation of the way people with SMD deal with their living spaces (house and city). It then describes the method adopted to approach people living under control—in Therapeutic Residential Services (SRTs) proposed by the State as the only alternative model for those leaving psychiatric institutions—and people living alone—with little psychiatric assistance and no dwelling support provided by the State. It then concludes with a discussion of the observed dwellings pointing towards the need to accommodate differences in any housing model adopted by the State.Design/methodology/approach - The architectural findings from a major qualitative interdisciplinary study which allowed a direct observation person to person interactions and social-spatial dynamics during the daily routines of people with SMD. Findings - Those living in SRTs are much more obstructed by institutional control than those living alone. Despite the difficulties and vulnerability of those living alone because the lack of support, they end up with greater autonomy and social integration. Originality/value - Most research on the subject approaches objective housing issues focusing on statistical results. This research evaluates qualitative dwelling issues, shedding light on issues that might not be immediately visible using other methods. Findings should be useful for policy formulation on housing for people with SMD.

Accessibility for mental healthcare

literatinetwork@emeraldinsight.com (Evangelia Chrysikou) — Tue, 19 Mar 2013 00:00:00 +0000

Abstract

Purpose - Patients’ movement in mental health facilities is frequently compromised for reasons quite apart from real physical incompetence. The paper finds that accessibility within mental healthcare facilities is a more complex an issue than universal accessibility standards generically allow for. Design/methodology/approach - Several mental healthcare units (in both Great Britain and France) are reviewed and analysed while they are occupied and running. The focus of the study is on restrictions of movement and the use of universal accessibility devices. The data is part of a broader exploratory study of facilities for mental healthcare, which used empirical, comparative and user inclusive methods. Findings - Mental health facilities are rarely designed for the model of care and staffing regimes which they will house. This discordance between the physical and organizational milieu inevitably compromises accessibility, even though patients tend to be physically able. Outdoor access, vertical circulation and the accessibility of bathrooms are particularly affected.Research limitations/implications - Models of care, management and staffing requirements, therapeutic needs of patients and interpersonal relationships should be considered for accessibility during planning, in addition to traditional accessibility devices and design. Furthermore more research is needed to address the ways that accessibility devices need to be altered to comply with the psychosocial elements.Originality/value - This paper readdresses the traditional view of accessibility, suggesting the paradigm needs to be better developed and nuanced for mental healthcare facilities.

Lost in Space: The role of the architectural milieu in the aetiology and treatment of schizophrenia.

literatinetwork@emeraldinsight.com (Jan Alexander Golembiewski) — Tue, 19 Mar 2013 00:00:00 +0000

Abstract

Purpose - Psychological and epidemiological literature suggests that the built environment plays both causal and therapeutic roles in schizophrenia, but what are the implications for designers? Design/methodology/approach - A translational exploration of the dynamics between the built environment and psychotic illness, using primary research from disciplines as diverse as epidemiology, neurology and psychology.Findings - The built environment is conceived as being both an agonist and as an antagonist for the underlying processes that present as psychosis. The built environment is implicated through several means: Through the opportunities it provides. These may be physical, narrative, emotional, hedonic or personal. Some opportunities may be negative, and others positive. The built environment is also an important source of unexpected aesthetic stimulation, yet in psychotic illnesses, aesthetic sensibilities characteristically suffer from deterioration. This paper focuses on the role the built environment plays in psycho-environmental dynamics, in order that negative effects can be avoided and beneficial effects emphasised in architectural design. Research limitations/implications - The findings presented are based on research that is largely translated from very different fields of enquiry. Whilst findings are cogent and logical, much of the support is correlational rather than empirical. Originality/value - Never before has architecture been so explicitly implicated as a cause of mental illness. This paper was presented to the Symposium of Mental Health Facility Design, and is essential reading for anyone involved in designing for improved mental health.