“I was in a shared room, blue curtains divided the 4 beds. There was a window and I could see the light but I couldn’t see out the window from where my bed was. The room had a door on it and outside was a long corridor with the nurse’s station at the end, the nurses were inside their fish bowl behind a glass screen. That’s where they dispensed the medication…There was a garden but I’d lost the will to enjoy anything, I couldn’t leave my bed, I wasn’t in a good space. The environment wasn’t great but I wanted help.”
Karen, inpatient public mental health unit.
One in five Australians are affected by a mental illness¹ and 45% of Australians aged 16–85 will experience a high prevalence mental disorder² . Mental illness is not discriminatory so there is the possibility this statistic could be you, me or your neighbour next door. At times people with a mental illness become so unwell they require admission to specialised psychiatric care in a hospital or clinic setting. In 2015-16, there were approximately 245,000 mental health-related admissions to public and private hospitals³, the average length of stay was 16.7 days.⁴
The physical environment of mental health facilities matters, and plays an important role in positive therapeutic outcomes for people admitted for treatment. I was falsely under the impression that patient centred design and the health benefits of our physical environment was a relative new principle in architecture. I was surprised to find that the built environment for psychiatric facilities was historically an important element considered as part of the treatment of mental illness. In 1796, the York Retreat in York, England was one of the first purposely built mental health facilities. It was based on the ‘Moral treatment movement’ a social movement which focused on social welfare and individual rights. The buildings designers wanted to create a place of refuge, that was safe, calm and comforting, with generous landscaped gardens. It was an institution that would resemble a home.⁵ The retreats Architect noted (quoted in Piddock), “if the outside appears heavy and prison-like it has considerable effect upon the imagination.” ⁶
Around the mid-1800s over in America advocates were calling for change and improved treatment of the mentally ill. Dr Thomas Kirkbride, a psychiatrist, devised the Kirkbride plan, based on the earlier York Retreat principles. Again the physical environment played a part in treatment, “Dr. Kirkbride was contingent on his theories regarding the healing of the mentally ill, in which environment and exposure to natural light and air circulation were crucial”.⁷ These were large multistorey institutions, with a winged floor plan often built in an ornate Victorian era style set on minimum of 100 acres. Similar buildings based on these plans were built in Australia. Now however, through unintentional consequences buildings of this configuration or ’asylums’ are a style which is stereotype and used in media as a representation of fear and ironically stigmatising mental illness the opposite outcome of its architects intensions, but I digress….
In the mid-20th Century due to governance problems, overcrowding, neglect, mistreatment of patients, decline in funding, coupled with developments in psychiatry, such as advances in psychotropic drugs and changes in theories of psychiatry many asylums were closed and there was a deinstitutionalisation. Patients were moved out and treated in the community or hospitals which is where we find many of the mental health facilities today. Many of the existing inpatient public mental health units are conversions of hospital wards, which are not conducive to the care and healing of people unwell with a mental illness.
“It used to be a hospital ward now it’s been converted to a psych ward, it was depressing for everyone patients, staff and visitors. There was a small TV room with a piano in it and it was next door to the shared patients rooms. There was a courtyard surrounded by walls but it was too cold to sit outside, there were lino floors and no colour….. no colour in the garden everything was grey, even the food was grey…when I was admitted to a private clinic it was a converted hotel, so the environment was a lot nicer, large lobby, private rooms, ensuites, views to the ocean, it even had a gym”. Max, inpatient both public and private mental health facility.
Over a century ago, 1895, Architect Henry Bibby wrote, (quoted in Edginton),
“In no class of building can an architect make himself more felt as a lasting benefactor to the occupants then in a lunatic asylum, and, in order that he may be armed with every possibility of success in arranging his plans, he must to some extent study the ways and mode of life of those for whom he provides”. ⁸
So over a century later architects are now using evidence based research to understand the ‘mode of life’ to positively influence the design process. A 2014 research study by Sheahan outlined critical attributes to a successful mental health facility including: Natural light, Elimination of environmental stressors (noise, glare), Safety, Security, Observation, Avoidance of visual disturbance (calm, spacious environment), Colour, Group interaction (Private rooms, other flexible spaces), and Access to nature.⁹ So have we come full circle? And back to where it all started in 1796? What matters is that future facilities take into consideration all these elements and creatively design an environment ensuring no added stressors are placed on patients whose coping mechanisms are already strained. These buildings need all the comforts of a 5 star hotel and more because this is no holiday.
1 Black Dog institute. “Facts and figures about mental illness”. Accessed March 28, 2018, https://www.blackdoginstitute.org.au/docs/default-source/factsheets/facts_figures.pdf?sfvrsn=10
3 Australian Government, Australian Institute of Health and Welfare Mental health services in Australia. Overnight admitted mental health related care. 1. Accessed March 28, 2018. https://www.aihw.gov.au/getmedia/b1dfe818-b085-49d9-b7b8-1992ba332413/Overnight-admit ed-patient-mental-health-related-care.pdf.aspx
5 Edginton, Barry. “Moral architecture: The influence of the York Retreat on asylum design”. Health & Place,Vol 3. No. 2. 91-99, Elsevter Science, Great Britain.(92) https://ac-els-cdn-com.ezproxy.library.uwa.edu.au/S1353829297000038/1-s2.0-S1353829297000038-main.pdf?_tid=94aef101-cd1c-46c9-ae46-6161c38ffb2d&acdnat=1522227936_4f0cf770a521e4160eafc99989607029
6 Piddock, Susan. “A Space of Their Own: The Archaeology of Nineteenth Century Lunatic Asylums in Britain, South Australia and Tasmania. Contributions To Global Historical Archaeology”. Springer Science & Business Media, 2007. (52).
7. Wikipedia contributers, :Kirkbride plan,” wikipedia, The Free Encyclopedia, https://en.wikipedia.org/wiki/Kirkbride_Plan (accessed march 28, 2018.
8 Edginton. “Moral architecture: The influence of the York Retreat on asylum design”. (91) https://www.sciencedirect.com/science/article/pii/S1353829297000038
9 Sheahan, Michaela. “Future directions in design for mental health facilities”. Hassell, July 2014, p6. Accessed March 28 2018. https://www.hassellstudio.com/docs/final_futuredirections_designformentalhealth_2014.pdf
1 Claire Sewell. “The York Retreat. The Retreat near York (1813)”. Centre for the history of Medicine, Warwick. Accessed march 28, 2018. https://warwick.ac.uk/fac/arts/history/chm/outreach/trade_in_lunacy/research/yorkretreat/
2 Wikipedia contributers,”:Kirkbride plan, Lithograph Wikipedia Kirkbride.” Wikipedia, The Free Encyclopedia, https://en.wikipedia.org/wiki/Kirkbride_Plan (accessed March 28, 2018)
3 Wikipedia contributers,”: Aradale Mental Hospital. Façade of the Ararat Lunatic Asylum in 2011.” Wikipedia, The Free Encyclopedia, https://en.wikipedia.org/wiki/Aradale_Mental_Hospital (accessed march 28, 2018)
4 Jagusiak, Christina. “Lessons from a psych ward.” Staya Live Yoga blog. http://www.satyaliveyoga.com.au/2015/04/29/lessons-psych-ward/
5 Webster, Michelle. “Gallery: Inside our new mental health facility”. Illawarra, Mercury. May 9 2013. Accessed March 28, 2018. http://www.illawarramercury.com.au/story/1490977/gallery-inside-our-new-mental-health-facility/
6 Kane, PROJECTS | Victoria, Dandenong Hospital Mental Health. Accessed March 28, 2018. http://www.kane.com.au/project/dandenong-hospital-mental-health
7 Sapphire. Gold Coast University Hospital (GCUH) – Mental Health Unit. Accessed March 28, 2018http://www.sapphirealuminium.com.au/index.php?task=projects&num=110
8 Victorian state government, Austin health Victorian Health and human service building aurthoiy, Austin Health – Short Stay Observation Unit & Psychiatric Assessment and Planning Unit. Accessed March 28, 2018
9 Victorian state government, Victorian Health and human service building aurthoiy. Orygen & OYHCP Redevelopment, Accessed March 28, 2018.https://vhhsba.vic.gov.au/health-infrastructure/orygen-oyhcp-redevelopment
Interviews Surnames withheld.
Max (March, 28, 2018) Personal Interview
Karen (March, 28, 2018) Telephone Interview
Anne ((March, 28, 2018) Telephone Interview