Chrysikou, E; (2008) Safety and security in therapeutic environments for the mentally ill. In: Hignett, S and Norris, B and Catchpole, K and Hutchinson, A and Tapley, S, (eds.) Improving Patient Safety 2008 ''From Safe Design to Safe Practice''. (pp. pp. 351-355). Ergonomics Society: Loughborough.

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Abstract

The closure of big psychiatric institutions moved clients in the community. Various strategies have been employed for the treatment and care of the acute mentally ill. Scientific knowledge on the design of facilities is still limited. The purpose of the study is to explore client focused architecture in the community for clients in the acute stage of their illness or recovering from an acute episode, and to investigate if design can be therapeutic for them. The thesis revisits and re-evaluates the concept of domesticity. It is proposing that more “domestic” environments, with respect to clients’ needs, could contribute to the therapeutic procedure. The project intends to identify the degree the domesticity of the buildings. The buildings were analysed based on three compartment models: safety/security, competence and personalisation/choice. The cultural character of care indicated a comparative approach. The Acute Mental Health Unit in the UK and the French “Foyer de Post-cure” provided the research basis. The 7 year study set out to compare the provision of care in 5 UK and 5 French units and involved the participation clients and staff. Three research methods were employed: semi-structured interviews, questionnaires and architectural checking of the building. The issues of safety and security are examined in relation to the restrictions that may adversely affect the domesticity of the units. Yet, domesticity can seriously compromise the safety and security of the clients. Aggressive behaviour and tendency to harm themselves is high among clients. The building has to cope rather than ignore these facts. Furthermore, safety and security are juxtaposed to the competence of the clients as another possible cause of deviation from a domestic environment since it might require spatial adaptations. Also, safety and security are compared to regimes that relate to space personalisation and choice. The effects of the environment, in the form of the three parameters on clients are examined. The issues taken into consideration regard the size and layout of the unit, its location, connections to other services, its external appearance, decoration, fittings and furniture, availability of interior and exterior space. The study concludes with design guidelines that enhance therapy.

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