It is a kind of membership that gives you access to a mental health facility. Unless you work there or are admitted as an inn, these publicly funded private spaces that house people at their most vulnerable are hard to get into.
Without research, it is difficult for architects to design well. The black box of acute mental health care facilities in New Zealand was opened to understand their purpose, how people experience them and what informs their architectural design.
Design is important. Mental health and wellbeing are promoted by a fit-for-purpose facility design. This is a no-brainer for people who work in these units.
The evidence base for the design of mental health facilities has been disorganized.
To understand how these settings serve their populations and if we can do better, we studied four acute mental health facilities around New Zealand.
We looked at policy documents and architectural plans and made site visits to take photographs, conduct a building survey and interview service users.
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The psychological aspects of healing are important.
Not fit for purpose
There was confusion about the purpose of mental health facilities. One facility had a written model of care, which is crucial for architects to understand what they are designing for.
The underpinning philosophy of care was the recovery model. Recovery principles and Indigenous Mori values should inform the architecture of these buildings.
The students were asked to come up with designs for mental health facilities that support recovery and Mori values.
Ruby Crooks is a member of the CC BY-SA.
A design that fosters connection, hope, identity, meaning, empowerment and safety is suggested by a recovery-oriented environment. This was not what we found.
While service users were relieved to get sleep, respite and diagnosis or treatment for their distressing symptoms and spoke highly of the staff compassion and quality of care, for many the acute mental health environment was confusing, frightening, disempowering, restrictive, boring and sometimes unsafe.
Name in vain
The naming of these units feels like institutional gaslighting. Lower-acuity facilities with the name "open units" typically have their doors locked. This is counter intuitive given the voluntary status of some patients.
There are warm-fuzzy, therapeutic-sounding names for the prison-like seclusion wings, often with Indigenous Mori names, implying such spaces are peaceful retreats when patients feel they are anything but.
There is hope. New Zealand has a goal of zero seclusion. We haven't built a facility without a seclusion wing.
Mind numbing
Service users talked about boredom in old environments. Many of the wards had TVs and a few dog-eared books, but there was little to do and activities were often limited.
Art rooms, sensory rooms and other occupational therapy spaces were often locked and unused due to a lack of staff or the ability to supervise.
It appeared that facility decision-making around recreation was questionable. Some people had exercise bikes located in the public reception, while others had a broken basketball hoop, and colouring-in and smoothie-making was central to some recreational programmes.
Lack of meaningful activities led some to start or restart smoking, which was the dominant activity observed in the internal courtyards. Fear of violence was cited as a major barrier to smokefree implementation.
Beds and meds
We were struck by the lack of options. Some staff described the main treatment as beds and meds.
Many service users were grateful for medication, but they were not happy with the lack of talking therapies and they just wanted someone to talk to. Service users were talking to each other.
There was a lack of consideration of gendered and cultural needs in the models of care, building design and layout. There were issues with acoustic and visual privacy in shared bathroom.
The look and feel of acute mental health buildings can affect peoples sense of recovery.
Ruby Crooks is a member of the CC BY-SA.
Mori values and cultural practices were not considered in the design of buildings and models of care in New Zealand.
New Zealand's mental health care facilities are more hospital-like or institutional than those in the UK, at a time when evidence suggests a more "domestic" look and feel of acute mental healthcare buildings would be more therapeutic.
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Design makes a place. The vision of aged care should be turned into reality.
Courtyards, which are critical in locked facilities to access fresh air, sunshine and nature, were often concrete pads with little to no nature. They didn't provide any therapeutic value.
There were some positives. Many staff told us that they stayed because the work was interesting, they loved the people, and that their work made a difference to peoples lives.
How we can do better
The buildings are not serving people well. The prospect of bulldozing the current stock might appeal, but without places to safely care for people experiencing profound mental distress, our most vulnerable may find themselves exiled from their homes and communities.
Some of the buildings we have are being completely rebuilt. In the interim, small changes to these environments can be made, including self-locking bedroom doors, built-in privacy controls and the provision of lockers to store valuables.
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Your home, office, and uni affect how you think. How do we know? We looked at their brains.
The model of care needs a more profound transformation. Alternative models of acute mental health care are about to change. New Zealand is re-examining care provision with a human rights lens.
We need to work together to create a mental health system that reflects the rights of Indigenous people. We need a suite of options and new models of mental health care to provide blueprints for our architects to design and upgrade our places of care.
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