DeepDive: A healthy questioning of psychiatric environments

Even though many people are affected by mental health problems, there is a stubborn stigma attached to all types of psychiatric healthcare and patients. A stigma that causes shame, prevents people from seeking help and renders recovery more difficult. Reducing the stigmatisation of mental health is therefore a high priority in healthcare.

The role of architecture
Psychiatric care environments have long been characterised by a strict emphasis on safety, and visual and pleasant values have been made to take a back seat. Psychiatry has – with the best of intentions– been hidden from public spaces and shared spaces. No doubt popular cultural depictions of psychiatric healthcare have contributed to the image of stereotypical patients in bleak, sterile, confined settings. But shouldn’t the awareness that environments contribute to our well-being and promote recovery apply to psychiatric patients too? And can architecture help to reduce the stigma and prejudice?

“Indeed it can. For some time now there has been a healthy questioning of traditional psychiatric care environments. Swedish and international research shows that the care environment can be a key component of treatment in psychiatric healthcare,” says Cristiana Caira, Lead Architect at White.

Well-designed care environments reduce both the number of coercive measures and staff sick leave in psychiatry. This is shown by research from Chalmers led by Stefan Lundin, a practising architect at White. By comparing traditional care environments with more pleasant, softer alternatives, researchers were able to show that well-planned care environments provide well-being, stimulation and calm, and can be an important tool in shaping healthcare.

“Our aim with the new psychiatric clinic in Borås is to shape Sweden’s best psychiatry and with these premises we are well placed to do so. We distinguish ourselves in the design in that we have single rooms, very nice outdoor environments, small balconies and that it is spacious in a completely different way. We have learned a lot about the healing architecture thanks to White,” says Pernilla Jansson, Project Manager at Västra Götalandsegionen.

Knowledge that makes a difference in practice
We drew on these research insights when we designed the psychiatry block at Södra Älvsborg Hospital in Borås, which opened in autumn 2020. The relatively recently acquired awareness of the impact of care environments on recovery and healthcare processes has been absolutely crucial to the environments encountered by the patients here.

Normalising, neutralising and de-stigmatising psychiatric healthcare has been a clear aim of our work. To create natural shared spaces, the training facilities and wards are housed in the same building and there is a café in the entrance where students, relatives and patients can meet for a coffee. The interior has been designed to support patients in their recovery. The environments in the round-the-clock care unit enable patients to gradually move from their own zone – the care room – to a shared zone in the all-purpose room and day room, and then finally spend time in a completely open environment during their care.

The patient rooms have balconies and views of green spaces to improve well-being. The walls have wood panelling to soften the impression, and the furniture has been carefully selected to give the eye something to discover without creating too many impressions at once.

“Our starting point has been that the architecture must fulfil people’s needs for both safety and well-being. How do we make the environment the best it can be for patients? We have worked really hard to find interior details and furniture that can live up to the visual goal, while also meeting the strict material requirements regarding hygiene and safety,” says Susanna von Eyben, Lead Interior Designer at White.

The interior reflects the conviction that inclusive environments add value for patients and staff alike, without compromising on safety. No sharp edges – instead rounded, appealing shapes. The aim was to avoid hard furniture and use soft pouffes instead, which meet the requirements for function and safety while also enriching the visual experience.

Different needs
The requirements for healthcare environments can vary greatly. The needs in psychiatry differ from those in somatic healthcare, while the needs in adult psychiatry differ from those in child psychiatry. In the areas for child psychiatry the emphasis has been on giving patients plenty of opportunity to be themselves, just as they are. The furniture here embraces you with its design and can be a place to hide from the outside world for a while. The “safe back” concept has been used in the design of seats and shared spaces to increase the sense of security.

For the architects it has been a case of making the environments easy to understand and use, making sure that it is clear how to use a room when you enter it. After all, research shows that too many impressions increase patients’ stress levels. The colours of the walls, floors and interiors have also been chosen to strike a balance between stimulating visual impressions and calmness. It’s all to give each patient the best opportunities to recover, aided by new advances in knowledge.

“It’s our social responsibility to make sure that patients in all parts of the healthcare system get the best care for their own recovery. In the psychiatry block we’ve seized on the knowledge that harmonious, cosy environments make people feel better. Basically there’s nothing in the visual design that reveals it’s a high-security environment,” says von Eyben.