8 design strategies to enhance access to urban mental healthcare
March 31, 2021
March 31, 2021
It’s critical that design works to reduce the stigma for people living with mental illness and addiction
This article first appeared as “Balance for All” in Stantec Design Quarterly, Issue 11.
Today, we know that mental health care is something that affects everyone.
Traditionally, healthcare organizations favored isolated mental health facilities out of the way in the countryside. Increasingly, we see modern facilities woven in the urban fabric. Globally, healthcare organizations continue to rethink the siting of mental health facilities—to meet clients where they live, to boost their visibility, and to improve access. Societal stigma, ignorance, and prejudice about mental health care persists and remains a barrier to those seeking treatment. Our designs should work to reduce stigma for people living with mental illness and addiction, creating community connections that aid in recovery and support hope, dignity, and inclusion. We design spaces to support clients as they navigate their paths to health and create a safe space in which to interact with loved ones, clinicians, and fellow clients.
So, how should we design modern, purpose-built mental health spaces within urban cores? How can we keep spaces feeling as “normal” as possible to help break the stigma? How do we reinforce connections with the surrounding community? Two recent projects in Toronto, Ontario—Stella’s Place and the Centre for Addiction and Mental Health (CAMH)—show us that while the need for mental health care and support is universal, we don’t all access it the same way.
Stella’s Place is a registered charity that provides free, comprehensive services for people aged 16 to 29 who are experiencing mental health challenges. These include clinical treatment, group therapies, peer support and navigation, creative arts, fitness and wellness, as well as an online support app. Stella’s Place supports some 1,500 young adults each year, and our team helped this community shape its new home.
The latest phase of CAMH’s redevelopment project—which helps the hospital achieve its vision of inclusive and recovery-oriented mental health care—features the addition of two new buildings on Queen Street West: the eight-story McCain Complex Care & Recovery Building, and the seven-story Crisis & Critical Care Building. Stantec’s practitioners helped CAMH reach its vision with our partners on the Plenary Health team, PCL Constructors Canada Inc.
While quite different in scale and mission, there are numerous parallels between the two facilities in how design process and design elements can support our clients’ mission to connect to the community while supporting the well-being of users and staff.
The most valuable design advice comes from the occupants themselves. Young adults were the key stakeholders in designing the new Stella’s Place. The Stantec design team, all under age 35, share generational experiences with and have some sense of the mental health challenges that the young people at Stella’s face.
For Stella’s Place, we engaged in a collaborative process and had several visioning sessions early in the process with the staff as well as young adults who utilize its services to learn what they wanted in their new building.
The participants spoke freely. Nothing was off the table—even the most pie-in-the-sky ideas communicated a feeling that designers valued. If someone said, “I want a roller coaster at Stella’s Place,” we understood that to mean, “Okay, you want it to be fun, and light, and exciting.”
Capturing those feelings in our visioning session resulted in inclusion of space to accommodate yoga, cooking classes, games, and other opportunities to be “playful and fun.”
At CAMH, thoughtful insights from the community of patients, families, staff, and neighbors shaped our design. During design, the clinical staff “experienced” the building using virtual reality, gaining confidence in layouts and sightlines. And we sought and incorporated input from patients (inpatient and outpatient) who brought to light their personal experiences in outdated buildings and hopes for the new spaces. Patients reacted positively to the openness and lightness of the spaces they saw in renderings, appreciated the individual en suite washrooms for every bedroom, and shared their emotional and intuitive responses to the proposed colors and materials.
Biophilia theorizes that people feel better with views of nature or natural things. At CAMH, we used a sophisticated and biophilic palette for materials and finishes in interior public areas: wood-look and real wood, natural stone, porcelain, and terrazzo. We incorporated colors that the patients preferred, calming tones drawn from elements of nature such as water, sky, and foliage. Uplifting accent colors aid in intuitive wayfinding, reducing the need for institutional signage.
At CAMH, a simple design aesthetic energizes semipublic spaces—like activity rooms and teaching kitchens—for interaction and learning by locating their “face” toward the bustle of the city. Public areas like reception desks are infused with vibrant colors like bright yellow. As one young former patient said during a CAMH design consultation, “It feels more like a university campus space or a modern library than an institution.”
Vibrancy is a priority at Stella’s Place. For its young adult participants, comfort derives from a sense of belonging, and they want to see their bright personalities reflected in their surroundings. In client visioning, we heard: “I want it to be vibrant, and I want it to be happy and inclusive, and I want to show the raw materials of the existing building. I want to see brick and wood.” So, we sought to create lively spaces, to allow patients to build community—together. Building science testing on the exterior layers of brick determined that the walls provided adequate insulation, which meant that the client’s desire for exposed brick indoors could be fulfilled. We tested the existing thick timbers for load-bearing capacity and determined they could be fully incorporated into the warm, natural design.
One in two Canadians have—or have had—a mental illness by the time they reach age 40.
Overcrowding and congestion can cause agitation and add to an institutional atmosphere. At Stella’s Place, we designed open areas to avoid congestion and promote physical distancing. Inside, wide corridors with built-in benches and open concept gathering areas and lounges promote universal access and prioritize personal choice.
At CAMH, we felt that private spaces, like bedrooms and inpatient unit lounges, should be positioned away from busy streets and toward green spaces and courtyards. Our CAMH design consultations revealed a preference for soothing, softer colors, and homelike differentiation within these private spaces.
At Stella’s Place we were focused on curating common spaces fostering social interaction. While Stella’s only offers outpatient services, we learned that many of its users find places for a quiet moment alone equally important, so we’re including those, too.
The cohort of young adults at Stella’s Place spoke up for inclusive design. We agree that there really is no “average” person; spaces must accommodate a broad variety of users and experiences. So, we simulated walkthroughs of the space as a person with visual impairments, a person with a larger stature, a person with social anxiety, and as a person with a physical disability.
If we make mental health more accessible and visible, we counteract stigma. But more than that, forging strong community connections to service providers is a critical step in recovery.
CAMH, therefore, connects to the streetscape of a bustling arts district. The plan extended city streets further into the campus and interspersed treatment buildings with retail and housing. The new dedicated mental health emergency department is accessible by foot, public transit, or drop off by car. The facility should reach into the community for the client’s benefit, but it’s just as important to find opportunities to bring the neighborhood and its people inside.
The large library is among the newest amenities at CAMH that serve patients, staff, and the neighborhood. The highly visible auditorium highlights its role in public interaction and education. Fostering employment opportunities is an important part of CAMH’s vision for patient recovery. Its teaching kitchen offers patients a place to learn life skills and fully connects to the Toronto streetscape.
The former location for Stella’s Place was beloved by the staff and participants because they had customized it over the years. The design team plans to bring beloved elements from its original location—including brightly colored walls adorned with participants’ art, local custom-made furniture, and cozy beanbag chairs—to the new space.
Mental health spaces for youth need to allow for self-expression and creativity to happen. Encouraging opportunities for users to make their mark will strengthen the personal connection to the surrounding space.
Toronto’s Queen Street is an arts district known for its murals and art galleries. CAMH’s design converses with the local culture and features a therapeutic art program of its own. The program includes a variety of art from digital installations to sculpture, photography, large scale graphics on glass, and carved stone panels. Many of the artists whose work is featured in the buildings are former patients, and their pieces offer hope and beauty. Art in a mental health center can engage, act as a positive distraction, aid in wayfinding and landmarking, and tell inspiring stories.
The modern mental health crisis exacts a significant toll on our society. One in two Canadians have—or have had—a mental illness by the time they reach age 40. And mental illness is a leading cause of disability in this country, preventing nearly 500,000 employed Canadians from attending work each week.
No longer can we let mental health hide in the shadows. We need mental healthcare access on main street.