The need for Mental Health Services & Design considerations

There was a repressed need and demand for Mental Health Services that were not addressed for decades. Then, more recently, there has been a reduction in stigma around the topic of mental health and growing acknowledgment of the importance of early diagnosis and treatment has pushed a trend toward greater investment in the treatment of mental health conditions.

In Australia, the New South Wales Government has announced $700 million for a Statewide Mental Health Infrastructure Program (SWMHIP). This investment is targeted to transform existing infrastructure to support new contemporary care models and provide specialist mental health units for children and adolescents, families, and older people. It will also improve the forensic mental health network and provide facilities, which help patients, reintegrate into normal life ( Ref: NSW Health infrastructure Website)

Planning and design of mental health inpatient units should support recovery-orientated models of service delivery which,

• Encourages self-determination and self-management of mental health and wellbeing
• Involves personalized care that is responsive to people’s unique strengths, circumstances, needs, and preferences.
• Supports people to define their goals, wishes, and aspirations.
• Involves a holistic approach that addresses a range of factors that impact people’s wellbeing, such as housing, education and employment, and family and social relationships; and supports people’s social and community inclusion.

In terms of creating a physical environment that supports recovery orientated mental health, services need to achieve the outcomes described below.

• Welcoming and supportive Consumers must have the facility to be admitted to an inpatient unit when community-based care is no longer an option. The environment needs to be homely, promote hope, and encourage family and friends to visit.
• High-quality interiors and quiet, safe and private spaces such as individual bedrooms and ensuites.
• A choice of spaces that provide private, semi-private, and social engagement opportunities.
• Suitable spaces to suit structured and therapeutic activities programs such as occupational therapy, life skills, and physical activities.
• Spaces to promote engagement with Family. This may include multipurpose spaces accessed from public areas where groups can meet.
• Spaces to meet with children in a safe environment.
• Access to phones and technology to maintain relationships and access community resources.

Provide a range of spaces and resources to assist in the self-management and achievement of goals by including a range of places such as a calm and quiet space, social space, entertainment and activity, daily living activities, access to outdoor space, access to relaxation space and sensory modulation space equipped with specialized equipment.

Holistic management of health Consumers admitted to an inpatient unit may also have a range of other health problems to manage. This may include providing clinical spaces to assess physical health. Access to activities that promote healthy lifestyles such as outdoor space and gyms.

Interior Decor:

The selection of color, artwork, and other decorative images in mental health facilities may vary depending on particular areas within a unit. The consumers using the facility may also influence selections (e.g. adolescent or Indigenous consumers).

Other décor considerations may include:

• Colors used in bedrooms, corridors, and interview and consult rooms should eliminate an institutional feel and aim to provide a home-like environment.
• Shared communal areas, quiet rooms, and seclusion rooms should aim to be uncluttered and simple rather than barren. Colors should be cool to reduce sensory overload. The lighting will be warm.
• Shiny surfaces on wall or floor finishes should be avoided, especially where those with cognitive impairment are accommodated.

Scale:

An appropriate scale in mental health inpatient units will assist in creating a safe and therapeutic environment as it increases in size.

Scale can be achieved by,

• Designing spaces that facilitate consumer choice (e.g. provision of smaller private areas, mid-sized semi-communal, and a large communal area or areas)
• Clustering bedrooms into ‘pods’ rather than large wings
• Avoiding overcrowding by planning space to accommodate the expected number of users
• Separation of zones such as bedrooms from communal activity areas
• A simple layout which reduces the need for signage.

Acoustics:

• Effective management of noise levels will improve the therapeutic nature of the environment and promote a sense of calm and a feeling of safety.
• Ceiling heights, wall and door construction, furnishings, and finishes need to be specified to optimize the acoustic environment and reduce unwanted noise.
• Areas requiring special attention include consult, treatment, and interview rooms.
• Bedrooms should be located away from larger communal areas.
• In acoustically-treated rooms, return air grilles should also be acoustically treated to avoid the transfer of conversations to adjacent areas.
• Door grilles should not be installed.

Safety:

Additional attention to detail is required in areas within mental health inpatient units that are not able to be constantly supervised by staff (e.g. consumer bedrooms and ensuites).

The design and construction of these spaces should minimize and wherever possible, eliminate risk.

Many anti-ligature fittings and fixtures will be selected to provide a flush finish and tamper-proof installation.

When planning the construction or anti-ligature refurbishment of a bedroom or bathroom for patients suffering from mental illness, it is essential in the design process to eliminate points where a cord, rope, or bedsheet can be looped or tied to a fixture in order to create a point of ligature, which may result in self-harm or in extreme cases, loss of life.

Unfortunately, many items that would be considered standard for a bedroom or a bathroom pose a risk of ligature and alternate products must be used in order to achieve the same function, yet provide a safe environment for both patients and staff.

Doors:

• In general, all doors are outward opening with vision panels and the door to the seclusion room must be wide enough to accommodate a person along with two escorts.
• Door locks are multipoint, heavy-duty, quickly secured and released, able to withstand a considerable amount of repeated and targeted force, and resist breakage.
• Anti-ligature door hardware must be used.

Ceiling heights must be minimum of 2700mm and corridor clear width must be at least 2000mm.

The physical environment and ambiance of an acute mental health inpatient unit will influence consumer recovery, outcomes, and the safety of those consumers and staff working within the service. This guideline provides overarching principles that seek to promote positive physical environments so that optimal recovery outcomes for consumers can be achieved.

There are numerous other details and standards to be met bearing in mind the varied nature of mental sickness. For detailed information, refer to Australasian Health Facility Guidelines.

References:

https://healthfacilityguidelines.com.au/health-planning-units

https://www.hinfra.health.nsw.gov.au/our-projects/project-search/statewide-mental-health-infrastructure-program