An international perspective on common issues

The booklets draw on existing study and research evidence, and published literature, ‘to inform a service-user centred approach to designing mental healthcare environments’. While previous booklets have focused on topics including the impact of sound and acoustics in mental healthcare settings, the benefits of ‘bringing in nature’, and at the ‘borders and boundaries’ service-users and staff experience, the latest ‘explores international perspectives’ to gain a better sense of how mental healthcare design has developed, and is practised, across the globe.

The authors, director and lead for the DiMHN’s Research and Education Workstream, and Professor of Psychology and Mental Health at London South Bank University (LSBU), Paula Reavey, Professor of Health and Organisational Psychology at Nottingham Trent University, Steven Brown, and Graduate Teaching Assistant and Doctoral Student at LSBU, Donna Ciarlo, explain in the introduction to The International Issue that ‘to gain a sense of the evidence across a wide range of countries’, they harnessed Rapid Evidence Assessment – ‘an increasingly well-established technique for collecting, sorting, and evaluating, published evidence’.

Drawing on study and real-world evidence / experience from countries including Australia, Norway, the Netherlands, Switzerland, Germany, Sweden, Canada, the US, South America, India, Egypt and Singapore, key topics covered include:

• The use of locked wards and restrictive practices;
• Opening up spaces and feeing safe;
• Designing to make people feel good;
• Biophilic architectural design and green spaces;
• Evidence-based design and built for ‘user’ purpose;
• Relationships and social spaces;
• Urbanisation and mental healthcare;
• Building for the future.

The attractively illustrated booklet, featuring colour photos of a number of well-designed indoor and outdoor mental healthcare spaces in different countries, highlights some of the lessons learned by those designing and operating such buildings through staff and service-users’ personal experience and published studies.

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For instance:

• Research in the Netherlands highlighted how closed psychiatric wards can ‘produce a range of negative psychological effects on patients’ – including feelings of humiliation, little or no opportunity for contact with nursing staff, and perceptions that ward rules were being ‘prioritised over provision of care’.
• A trial of an ‘open-door’ policy in a large specialist psychiatric facility in Cologne to see if this would reduce conflict and aggression found staff judged other interventions – including providing access to gardens and outside space, and reducing crowding and the use of de-escalation rooms – as more effective than opening doors alone.
• In A Finnish case study, at the Kupitaa psychiatric hospital in Turku, where ‘more secure’ practices were developed as staff and patients perceived an increase in risk, this perception in fact led to an increase in both security and risk. This was seen to be partly attributable to staff being ‘divided’ on the value of the measures imposed, and ‘a distorted working culture favouring rough handling and disparagement of patients’.
• In Japan, green spaces’ positive impact on mental health has long been recognised; for example, ‘urban design’ features such as ‘streetparks’, the ‘greening’ of inside public spaces, and blue light and nature images in train stations, have all been shown to be beneficial.
• Researchers in Australia have improved evidence-based design by involving mental health service-users via ‘virtual reality’ in the final building design.
• Data collected from staff who had re-located from three Swedish forensic psychiatric hospitals into new facilities showed a rise in job satisfaction, and staff rating the environment as ‘more physically, psychosocially, and person-centred’.
• In South Africa, where ‘adopting a patient-centred approach, and prioritising social relationships’, are core to therapeutic interventions, much of the population still maintains traditional beliefs on mental illness, and service-users often seek treatment from both healthcare facilities and traditional ‘healers’ and ‘spiritual advisers’.
• In Russia, where primary healthcare does not play a significant role in identifying and treating mental health issues, there is an argument for integrating mental health services using telemedicine and digital technologies, especially to communicate with those living in sparsely populated communities.
• In India, the built environment, cultural background, and stigma towards mental health, can make it hard for some to access mental health services. Consequently, mental health ‘apps’ are being developed to support certain groups, such as young people.
• Most Chinese hospitals use locked wards housing a mixed population of mental health patients, and tend to lack outside spaces.

The International Issue, is available to download free to DiMHN members at https://dimhn.org/resources/