Chrysikou, E; (2011) Architecture for the mentally ill: Analysis of therapeutic spaces for clients with severe conditions. Doctoral thesis , UCL (University College London).

Abstract

The closure of big psychiatric institutions moved clients into the community. Since then, 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 the extent to which design can be therapeutic for them. The thesis revisits and re-evaluates the concept of domesticity. It proposes that more “domestic” environments, with respect to clients’ needs, could contribute to the therapeutic procedure. The project proposes new ways to identify the degree the domesticity of the buildings. Ten buildings are analysed based on three independent variables: safety/security, competence and personalisation/choice. The cultural character of care indicates a comparative approach, so Acute Mental Health Units in the UK are compared and contrasted with French “Foyers de Post-cure”. The 7 year study compares the provision of care in 5 UK and 5 French units and involves the participation of clients and staff. Three research methods are employed: semi-structured interviews, questionnaires and architectural auditing of the buildings. 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 tendencies to self-harm are high among clients. The building has to cope with, 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 this might require spatial adaptations. The competence of clients is examined as means to identify their potential, and to highlight any needs, including adaptations to the environment, to allow them to be as active as their condition allows. In this sense, domesticity has to come to terms with clients’ capabilities, so that their stress is not increased by their inability to cope, or their initiative replaced by poor assessment of their potential. Personalisation and choice refers to clients’ opportunities to interact in the facilities in ways that comply with the therapeutic regime. When considering the therapeutic regime, particular attention is paid to institutional practices that may deprive clients of these supportive elements, and a careful note is made of oversimplified architectural references to domesticity, as well as of activities or practices that are not considered domestic. The effects of the environment on clients are examined with respect to these three parameters. 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 including availability of internal options, like activity and access to spaces. The study concludes with design guidelines that enhance therapy. Recommendations are not only made for planners, architects and staff operating the units, including facilities and estates and therapeutic teams, but also for client groups.

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