CF Moller - Design by Evidence - Therapeutic Environments for Mental Illness

1. OSLO
STOCKHOLM
AALBORG
AARHUS
LONDON
COPENHAGEN

2. all photos by Hugh Diamond, ca. 1852, courtesy of the London Metropolitan Archives
Design by Evidence Therapeutic Environments for Mental Illness

3. RISK

4. RISK
Incidents
Abuse
Harrassment
Violent Behavior
Self Harm
Absconding
Personal Accidents
Fire
Illicit Drug Use
Slips, Trips and Falls

5. RISK
Incidents
Risk
Abuse
Harrassment
Violent Behavior
Self Harm
Absconding
Personal Accidents
Fire
Illicit Drug Use
Slips, Trips and Falls
Low Patient Morale
Low Staff Morale
Cold/Sterile Spaces
Unempowering Spaces
Unhealthy Environment
Unsafe Layout
Inefficient Layout
Over Budget/Over Time

6. Department of Health Guidance
Health Building Notes HBN’s & Health Technical Memoranda HTN’s
http://www.nationalarchives.gov.uk/doc/open-government-licence/

7. Department of Health Guidance
Health Building Notes HBN’s & Health Technical Memoranda HTN’s
• Does adherance to the guidance drive up costs through
overspecification of rooms and components? i.e. anti-ligature
fixtures and anti-barricade doors everywhere on the wards?
© Britplas http://britplas.com/projects_england_the_mount_leeds.html
© Kingsway Group http://www.kingswaygroup.co.uk/products/
hunter-anti-ligature-door-sets
Anti-barricade doors
Anti-ligature windows

8. Department of Health Guidance
Health Building Notes HBN’s & Health Technical Memoranda HTN’s
• Does the guidance adequately reflect the situation on wards?
Incident Totals by Ward 2009 - 2013

9. Department of Health Guidance
Health Building Notes HBN’s & Health Technical Memoranda HTN’s
• Does the guidance adequately reflect the situation on wards?
SUI’s (Serious Untoward Incidents) by Ward

10. Department of Health Guidance
Health Building Notes HBN’s & Health Technical Memoranda HTN’s
• Does the guidance adequately reflect the situation on wards?
Incidents by Cause Groups

11. Department of Health Guidance
Health Building Notes HBN’s & Health Technical Memoranda HTN’s
• Does the guidance adequately reflect the situation on wards?
Self Harm Incidents by Ward

12. Department of Health Guidance
Health Building Notes HBN’s & Health Technical Memoranda HTN’s
• Does the guidance adequately reflect the situation on wards?
Ligature Incidents by Ward

13. Department of Health Guidance
Health Building Notes HBN’s & Health Technical Memoranda HTN’s
• Does the guidance adequately reflect the situation on wards?
Barricade Incidents by Ward

14. Going Beyond the Department of Health Guidance
• where/when/how do incidents occur? Self Harm
Base Drawing © MAAP Architects

15. Going Beyond the Department of Health Guidance
• where/when/how do incidents occur? Violence/Abuse/Harrassment
Base Drawing © MAAP Architects

16. Going Beyond the Department of Health Guidance
• Design Principles
Acute Ward
built in 1931
Acute Ward
built in 2009
Base Drawing © MAAP Architects

17. Going Beyond the Department of Health Guidance
• Design Principles
Acute Ward
built in 1931
• Visibility
Acute Ward
built in 2009
Base Drawing © MAAP Architects

18. Going Beyond the Department of Health Guidance
• Design Principles
Acute Ward
built in 1931
• Visibility
Acute Ward
built in 2009
• Outdoor Space
Base Drawing © MAAP Architects

19. Going Beyond the Department of Health Guidance
• Design Principles
Acute Ward
built in 1931
• Visibility
Acute Ward
built in 2009
• Outdoor Space
• Avoidability
Base Drawing © MAAP Architects

20. Going Beyond the Department of Health Guidance
• Design Principles
Acute Ward
built in 1931
• Visibility
Acute Ward
built in 2009
• Outdoor Space
• Avoidability
• Dignity/Privacy
Base Drawing © MAAP Architects

21. Going Beyond the Department of Health Guidance
• Design Principles
Acute Ward
built in 1931
• Visibility
Acute Ward
built in 2009
• Outdoor Space
• Avoidability
• Dignity/Privacy
• Live/Work Zones
Base Drawing © MAAP Architects

22. Going Beyond the Department of Health Guidance
• Design Principles
Acute Ward
built in 1931
• Visibility
Acute Ward
built in 2009
• Outdoor Space
• Avoidability
• Dignity/Privacy
• Live/Work Zones
• Daylight
• Fresh Air
• Control/Choice
• Acoustic Quality
• Difficult Patient
Base Drawing © MAAP Architects

23. Going Beyond the Department of Health Guidance
• Design Principles
Acute Ward
• Visibility
built in 1931
Acute Ward
built in 2009
• Outdoor Space
• Avoidability
• Dignity/Privacy
• Live/Work Zones
• Daylight
• Fresh Air
• Control/Choice
• Acoustic Quality
• Difficult Patient
700 Incidents
Base Drawing © MAAP Architects
316 Incidents

24. Going Beyond the Department of Health Guidance
• Design Principles
Acute Ward
• Visibility
built in 1931
Acute Ward
built in 2009
• Outdoor Space
• Avoidability
• Dignity/Privacy
• Live/Work Zones
• Daylight
• Fresh Air
• Control
• Acoustic Quality
• Difficult Patient
SUI Incidents
Base Drawing © MAAP Architects
SUI Incidents

25. Going Beyond the Department of Health Guidance
• Design Principles
Victorian Ward
built in 1841
• Visibility
New Ward
built in 2005
Base Drawing © Nightingale Associates

26. Going Beyond the Department of Health Guidance
• Design Principles
Victorian Ward
built in 1841
• Visibility
New Ward
built in 2005
• Outdoor Space
Base Drawing © Nightingale Associates

27. Going Beyond the Department of Health Guidance
• Design Principles
Victorian Ward
built in 1841
• Visibility
New Ward
built in 2005
• Outdoor Space
• Avoidability
Base Drawing © Nightingale Associates

28. Going Beyond the Department of Health Guidance
• Design Principles
Victorian Ward
built in 1841
• Visibility
New Ward
built in 2005
• Outdoor Space
• Avoidability
• Dignity/Privacy
Base Drawing © Nightingale Associates

29. Going Beyond the Department of Health Guidance
• Design Principles
Victorian Ward
built in 1841
• Visibility
New Ward
built in 2005
• Outdoor Space
• Avoidability
• Dignity/Privacy
• Live/Work Zones
Base Drawing © Nightingale Associates

30. Going Beyond the Department of Health Guidance
• Design Principles
Victorian Ward
built in 1841
• Visibility
New Ward
built in 2005
• Outdoor Space
• Avoidability
• Dignity/Privacy
• Live/Work Zones
• Daylight
• Fresh Air
• Control/Choice
• Acoustic Quality
• Difficult Patient
Base Drawing © Nightingale Associates

31. Going Beyond the Department of Health Guidance
• Design Principles
Victorian Ward
built in 1841
• Visibility
New Ward
built in 2005
• Outdoor Space
• Avoidability
• Dignity/Privacy
• Live/Work Zones
• Daylight
• Fresh Air
• Control/Choice
• Acoustic Quality
• Difficult Patient
Base Drawing © Nightingale Associates
274 Incidents
2005
128 Incidents
2012 - 2013

32. Going Beyond the Department of Health Guidance
• Design Principles
Victorian Ward
• Visibility
built in 1841
New Ward
built in 2005
• Outdoor Space
• Avoidability
• Dignity/Privacy
• Live/Work Zones
• Daylight
• Fresh Air
• Control/Choice
• Acoustic Quality
• Difficult Patient
Base Drawing © Nightingale Associates
SUI Incidents
2005
SUI Incidents
2012 - 2013

33. Going Beyond the Department of Health Guidance
entrance
shared areas
entrance
Visibility
Avoidability
staff: back of house
quiet
garden
Zoning around Outdoor Spaces
social and activity spaces
active garden
patient bedrooms

34. Going Beyond the Department of Health Guidance
Entrances and Outdoor Spaces
Patient Areas: Bedrooms
Patient Areas: Day and Dining
Patient Areas: OT and Group Rooms
Staff Base and Visibility
Back of House and Staff Areas
Shared Areas

35. Department of Health Guidance
Health Building Notes HBN’s & Health Technical Memoranda HTN’s
• Does the adherance to the guidance create therapeutic
environments?

36. In Summary
• Potential to save costs due to Overspecification by studying
where/how/why Incidents occur
• Increased visibility, compact layouts and better design may
make it possible to reduce demands on Staff and/or Staff
numbers
• A risk-based approach leads to design for the ‘worst case
scenario’ and more custodial care
• An evidence-based approach leads to a balanced evaluation
of multiple risks and a focus on creating therapeutic,
normalised environments