‘Borders and boundaries’ and their significance explained

Dedicated sections discuss topics ranging from ‘The symbolic and psychological significance of doors and borders’, and ‘Designing the central hub of a ward’, to ‘Using outside spaces to break down the boundaries of hospital care’, and ‘Creating permeable boundaries during COVID’. Borders & Boundaries is the sixth Design With People in Mind booklet published by DiMHN to date, and, like its precursors, draws on a wide range of UK and international research, study, and real-life evidence, plus service-user and staff input. The attractively booklet, featuring photos of both internal and outside spaces in a number of modern mental healthcare facilities, provides easily readable, practical advice on, for instance, ‘Maintaining boundaries and privacy through sight and sound’, ‘Creating therapeutic spaces through radical design’, and ‘Creating borders using sensitive lighting’.

Borders & Boundaries references academic and scientific studies and their conclusions on how good demarcation of spaces in mental healthcare facilities, as well as a degree of flexibility in their use, and sufficient adaptability and blurring of boundaries between staff and patient-designated spaces, can aid recovery, leaving service-users feeling less ‘confined’, more in control of their environment, less anxious and frustrated, and potentially thus more receptive to treatment. Conversely, it warns that using a space considered by the patient to be their own ‘private space’ for an altogether different purpose – such as holding a therapy session in  a bedroom – can create a perception of staff overstepping boundaries, potentially resulting in conflict, mistrust, and anxiety.

One of the latest DiMHN booklet’s overriding conclusions, indeed, is that the use of spaces has both a physical and psychological / emotional impact on service-users, while staff need the ‘right’ environment to offer the best care – for instance with good soundproofing, adequate temperature and lighting control, and space in which to relax and ‘unwind’ off the ward. The section on ‘Maintaining boundaries and privacy through sight and sound’ highlights the importance of striking a sensible balance between security and safety on the one hand, and patient wellbeing and a degree of autonomy on the other, when it says that, while well recognised that a patient’s bedroom should be respected as their own private space (NAPICU, 2017) –  which allows some control over their psychological  boundaries, and the chance to can reflect on their past and future (Reavey et al, 2019) – an inpatient bedroom can also be a reminder of being detained on a forensic mental health ward when ward staff open or lock the door. While ‘technical risk factors’, such as removing doors to an en-suite bathroom, or use of clearly visible observational windows, may also reinforce the sense of detention, (Kanyeredzi et al, 2019), if patients can adapt and personalise their space without compromising security features, this may help to ‘blur’ the clinical design of the room.

The booklet’s co-authors were Professor Paula Reavey, Professor of Psychology and Mental Health at London South Bank University (LSBU), who leads DiMHN’s Research and Education Workstream, Professor Steven Brown, Professor of Health and Organisational Psychology at Nottingham Tent University, Donna Ciarlo, Research Assistant and Doctoral student at LSBU, and Katharine Lazenby, a DiMHN director, and People Participation Worker and expert-by-experience at East London NHS Foundation Trust.

To access a copy, visit www.dimhn.org  to join the Network and access its resources. DiMHN Chair, Philip Ross, said: “Membership is free to individuals, while we would encourage commercial companies accessing the Design with People in Mind booklets to consider joining the DiMHN, or to make a donation via the website to help us continue our work.”