Comment: Mental health ‘straight-jacketed’ by 19th-century infrastructure

We speak to Richard Coe, project director at Kajima Partnerships, about why the mental health estate is so vital to the delivery of world-class psychiatric services

Good mental health design is crucial to aiding recovery and creating a productive working environment for staff

A step away from the hospital-focused provision to one that combines acute care with supported residential accommodation provides an opportunity to move patients through the system more effectively and to ensure a continuum of appropriate care in a supported environment

The delivery of effective mental healthcare in the UK is currently hamstrung by two major issues: an antiquated, costly, hospital-based provision with an inadequate discharge pathway; and restrictive budgets.

Together, these factors have left the system struggling to bring mental healthcare in line with the standards required.

According to the Centre for Mental Health, the cost of mental ill health to the economy, the NHS, and society as a whole is £105billion a year. And this is set to grown unless we fundamentally alter the way in which mental health is perceived and treatment is delivered.

Change will come

Change is urgently needed to address these challenges and to modernise a system which is currently unsustainable and incapable of delivering the best outcomes for patients.

For many mental health trusts, the status quo cannot be allowed to continue.

The modernisation of one of the most-tired and cash-strapped real estate contingents of the NHS: the highly-fragmented mental health estate, will be critical in delivering this change.

How we design and build specialist care facilities for the treatment of mental health has the potential to modernise and streamline the care pathway, improve outcomes for patients, and positively alter the funding model, delivering both savings and additional income to NHS trusts.

Fundamentally, estate modernisation will enable mental health care to move to a system which places emphasis on rehabilitation and recovery, allowing patients to manage their own mental health in their own community, supported by greater integration with other health and care services - an important step away from the archaic, bed-based approach.

Arguably the most-important element of the design is the creation of a porous boundary between the hospital and its surroundings

This current approach is cost-ineffective. Rethink Mental Illness estimates that it costs £13 a day to support someone at home or in the community, a great deal less than the £350 a day it costs to treat someone in hospital.

A step away from the hospital-focused provision to one that combines acute care with supported residential accommodation provides an opportunity to move patients through the system more effectively and to ensure a continuum of appropriate care in a supported environment.

A world-class example of modern mental health design is the Slagelse Psychiatric Hospital in Denmark

Financing improvements

Estate modernisation also offers mental health trusts an opportunity to radically address funding constraints.

Mental health is one of the areas of the NHS estate with the highest percentage of disused space.

As it stands, the current model for mental health care, straightjacketed by a 19th-century infrastructure, means this growing demand will not be met

By bringing this back into commission, and potentially even repurposing the land for housing and schools, trusts could generate revenue, enabling improvements and changes to be self financed.

Both cost savings, and the additional income, could be reinvested in the trust, delivering important changes, improvements, and better patient outcomes.

A world-class example of this approach is the Slagelse Psychiatric Hospital in Denmark.

Completed in 2010; it presents a bold future porotype for mental health estate design.

Replacing numerous scattered departments, including an asylum opened in 1915, the 44,000sq m facility will provide 190 beds as well as outpatient facilities and is the largest and most-ambitious unit of its kind built in Denmark for over a century.

Arguably the most-important element of the design is the creation of a porous boundary between the hospital and its surroundings.

The park surrounding the psychiatric hospital is publicly available, reducing the patient's feeling of being trapped and enabling them to experience greater freedom of movement and connection to the surrounding community.

The key aim of this departure from the traditional design is to produce calm and safe environments for both staff and patients and a platform on which trusts can deliver first-rate care

In a further departure from the archaic model; the design of the new facilities will create modern, non-institutional environments, flooded with natural daylight, providing good acoustics and ventilation, and with access to the outdoors.

Intelligent LED lighting is also used throughout the facility to recreate the natural colour change of daylight throughout the day.

Intelligent LED lighting can be used to recreate the natural colour change of daylight throughout the day

Calm and safe

The key aim of this departure from the traditional design is to produce calm and safe environments for both staff and patients and a platform on which trusts can deliver first-rate care.

Evidence suggests that demand for mental health services in the UK will continue to grow.

As it stands, the current model for mental health care, straightjacketed by a 19th-century infrastructure, means this growing demand will not be met.

The first step in addressing this challenge and bringing mental healthcare in line with modern best practice must be to modernise the mental health estate - a task that is long overdue.

Images courtesy of Karlsson Architects and VLA. Photographs by Jens Lindhe/Jesper Ray Manlay.

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