Innovation in architecture for mental health: report from the East London conference

Jacob King of the London School of Hygiene and Tropical medicine and UD/MH Associate reports from the Architecture and Mental Health Conference jointly run by Architects for Health and the Royal College of Psychiatrists on 19th May 2017.

It’s not very often that more than 50 psychiatrists and 50 architects sit down in the same room together. But, on the 19th of May in East London, UK, a meeting of these two disciplines aimed to review the role of architecture for mental health benefit, producing lively discussion, debate, and across-the-aisle learning.

There was recognition that environments which impede or affront our psychological and emotional needs cannot be conducive to good mental health. Emotional and psychological components of wellbeing include a sense of autonomy, freedom, and self-efficacy, and the environment must be able to accommodate this range of needs.

With this in mind, architectural answers can be designed into spaces facilitating self-efficacy and freedom wherever possible.

Components of design for mental health

Physical characteristics of an environment that promotes good mental health

The day was focused around the presentation of cases of innovative, evidence based designs stretching from corridors and bedrooms, to bridges, gardens and entire psychiatric hospitals within the community. From each of these designs evolved a few recurring themes. Notably, that certain physical characteristics of environment are favoured for mental health promotion: open spaces, bountiful light, quietness, greenery, and cleanliness. Social spaces were considered essential, and multiple speakers highlighted the importance of spaces which function communally, designed to increase conversation and group activity. Yet the opposite was also deemed important: there should also exist spaces which are personal, isolating and foster feelings of security, ownership, and separateness. Finally, the need for spaces which are able to facilitate fruitful occupation was repeatedly identified. As such, designers seek to achieve an appropriate and accessible mix of social and asocial environments between which people can choose according to will .

The environment required of a psychiatric hospital is vastly different to that required of other settings. In particular, security must take top priority, there must be detailed environmental assessment for ligature points, and an understanding of which spaces are conducive for relaxation as much as being propagatory of violence and distress becomes key. While these priorities may pose a challenge to  architects aiming to design a sense of freedom into their building, arguably this challenge should be tackled in much the same way as “designing mental health” into non-institutional settings.

Bringing good design from the psychiatric hospital to the wider community

Designing for mental health is often focused on the psychiatric hospital, and while this is important it is right that more emphasis is now being placed on non-institutional settings: the workplace, home and community milieu. Perhaps there is public health benefit to be realised from assessing the few core architectural features which promote mental health and studying how we can incorporate these, not only into psychiatric hospitals but into all architectural design projects. Simple design features like changing the colour of flooring or walls, the height of the space, and setting ‘boundary markers’, can establish psychological zones: demarcating personal quiet spaces from communal social spaces. Innovative ‘greening’ methods may introduce nature inside, or better yet, creative use of lighting, windows and exploiting pretty surrounding views can metaphorically do the same job. Access to gardens or an orchard (as in Bethlem Royal Hospital) and the ability to wander and observe the changes in the seasons may have some effect in breaking one from the monotony of a sterile interior, providing another route towards emotional and psychological comfort.

Leveraging architecture for behaviour change for mental wellbeing

In acknowledging that architecture can fulfill the functional needs expected of it (a psychiatric hospital being secure, a place of business being productive, a residential space being cosy etc.), we accept that certain behaviours can be architecturally promoted or deterred. At this conference several projects were presented showcasing attempts to change individual behaviour for public mental health benefit. The first among these took on the task of structural environmental intervention for suicide prevention.

Preventing suicides at the Derry Foyle bridge.
 
The prevention of jumping from buildings and bridges has been a focus of discussion across the globe. Infamously one Chinese factory insensitively installed netting around the outside of its building to catch its workers who would jump. In Northern Ireland, the Foyle bridge in Derry/Londonderry is known widely as a local 'suicide hotspot'. A folk narrative has developed around the bridge, drawing people from across the surrounding areas to this spot, as Beachy Head does in England, to kill oneself in a ‘traditional’ way.

The Our Future Foyle programme, funded by the Royal College of Art among other partners, aims to break this narrative and prevent suicides from the Foyle bridge. With multiple facets, the first step of this programme will revitalise the area surrounding the bridge with community events and business opportunities. Individuals attempting suicide often prefer to do so alone and out of sight of others. Therefore, by increasing footfall in the area through commercialising and pedestrianising the river bank and improving transport links, it is hoped that people will be dissuaded from jumping from the bridge.

The Foyle bridge: the view from the Derry city side. Photo credit: Wikimedia Commons.

The next step concerned the role of suicide barriers on bridges. Often these barriers themselves are devoid of artistic thought and become an extension of the suicidal narrative of a building or bridge: “Those barriers are there to stop people jumping off”. This project aims to install functional art, a series of connected five metre tall metal reeds, to echo the reeds on the river bank below. While acting functionally as a suicide barrier, the reeds will also feature multi-coloured lights at their peaks, which can be changed by those promenading past, creating new narratives associated with this place.

This idea of urban design is striking, especially if it is eventually proven effective in preventing suicides. By changing the narrative of a space, its social typology, and incorporating functional architecture - both social and physical barriers to suicide attempts - we wait to see if there is an effect on the prevention of suicide, a major mental health outcome.

New models of asylum

Asylum in the heart of London
 
The location of psychiatric hospitals is an important facet of urban design, making bold statements about society’s relationship with psychiatric patients. Historically this has been a point of contention. In London for example, as the city expanded outwards, asylums which had previously been on the outskirts of the city were pushed further and further back into the surrounding countryside. While the ethos of 19th century moral therapy also often included natural retreat, the “Not In My Back Yard” stance of many of London’s population unquestionably contributed to the construction of newer asylums in the surrounding countryside.

Yet this trend is now evolving, and an example is the imminent revitalisation of the Springfield University hospital, an old asylum built within large grounds in South West London. The grounds will be turned into new community homes, with a new psychiatric hospital at its heart. Wards will be built above shops. According to the architects' drawings, there will be a view from inside these rooms of happy attractive people bustling around a communal square, shopping, and enjoying the sun. What may at first appear to be an attempt to commercialise prime real estate in London may turn out to play a key part in destigmatising psychiatry and rehabilitating patients to community living much more readily than an isolated and unintegrated asylum of old.

MadLove: a designer asylum
 
Following their success as an exhibit at The Wellcome Gallery earlier this year, MadLove: a designer asylum is a service user-led art movement aiming to collectively design the “most crazy, bonkers, mental asylum we dare dream of”. A space which is both safe and nurturing of madness the lead artists, both service users themselves, suggest that psychiatric hospitals can often be more punishment than love. After multiple rounds of consultation a collaborative plan was developed and showcased.

MadLove: a designer asylum. Photocredit: MadLove, The WellcomeTrust, November 2016.

The MadLove design features tree-house style accommodation on a grassy hill, and a central hub with shops and occupational space. Someone is always available here to talk or relax with. The sounds of birds and the sea breeze (which carries in the smell of baking bread) can be heard around the asylum. There are no fences and residents come and go as and when they please. The results of their extensive service user consultations are freely available online.

Conclusion: evidence based design + participatory design = mental health

Architecture is just one tool of the urban planner, but it is essential in propagating mental health benefit to a city’s residents. In closing the conference, one architect made a plea to the audience - seconded by service users and psychiatrists alike - that design should be first, evidenced based, and more importantly built in collaboration with those who will live and work in their buildings and environments. The need for both evidenced based design and participatory design strikes at the heart of how architecture can foster effective mental health-promoting features of design, and reduce the often emotional and physical imposition of a building's primary function: security, sanctuary, or productivity alike.

About the author

Jacob King is a UD/MH Associate and fourth year medical student in UK. He is currently undertaking an MSc in Global Mental Health at King’s College London and the London School of Hygiene and Tropical Medicine. His main interest concerns the association between green space exposure and mental health, and how we can design interventions to promote this relationship. He attended this conference on behalf of UD/MH.