'Obsession with risk' creating 'sterile and impersonal' mental health units

UK architects and trusts urged to pay less attention to guidance and more to improving the patient experience

Mental health trusts and building designers were this week accused of being ‘obsessed with risk’ and missing opportunities to create therapeutic environments that will enhance patient recovery.

What if the way we are building our units and organising and managing them in order to avoid risk is making the environment untherapeutic?

Speaking at the 2013 IHEEM Conference in Manchester this week, Teva Hesse, an architect at international practice, CF Moller, said that design guidance was often taken as gospel and resulted in ‘sterile and impersonal’ environments.

“There is a fondness for guidance in the UK and while there is tremendous value and knowledge in this, for example it can mandate that you need to have daylight and ventilation in a building, the guidance often does not talk about the quality of that daylight and ventilation.

“I have been on many wards that have been designed in line with guidance and almost without exception they tend to be very sterile and impersonal spaces.

“There is a lot of great experience there if you read it a certain way, but if you read it as gospel and all the ‘should dos’ become ‘must dos’ it makes it easier for people not to think creatively.

“It is about going beyond the guidance and looking at the bigger picture to create environments that are much more therapeutic and beneficial.”

One of the reasons why there is this dependence on guidance is because the UK is obsessed with risk, he added, claiming that efforts to prevent problems such as self harm and problem behaviour in mental health units, were also affecting the overall positive impact of the built environment.

“When we talk about mental health facilities, we inevitably talk about risk,” he told the conference. “But maybe it’s not risk; it is just how it is. Maybe some of these risks are just a factor of being on a mental health ward, like rain is just part of the weather.

“What if the way we are building our units and organising and managing them in order to avoid risk is making the environment untherapeutic?

“We have got to move away from looking always at the worse case scenario and instead take an evidence-based approach focusing on benchmarking and evaluating the risks so that we can create therapeutic environments.”

Once we go down that route enshrined in guidance then we, without a doubt, end up with sterile and impersonal spaces and that’s a real issue that we have to grapple with in the UK

Comparing the UK’s approach to mental health design to other countries, he said: “If you look at mental health wards in Denmark the patients get forks and knives and there are smoking rooms and objects that can be picked up and thrown at somebody. If we do not make these environments normal, how do we ever expect people to get better? Once we go down that route enshrined in guidance then we, without a doubt, end up with sterile and impersonal spaces and that’s a real issue that we have to grapple with in the UK.

“Certain elements of risk we can never get away from and the more we remove them the more the chance that on discharge things might go wrong. Mental health is about allowing for some types of risk and saying they will happen and that’s the challenge we face.

“If clients are focused purely on compliance with guidance then there are missed opportunities.”

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