Weaving mental healthcare spaces into the neighborhood
August 20, 2019
August 20, 2019
Design can help increase mental healthcare access for city dwellers
When I was growing up, we often discussed mental health and wellness in our home. My mother, a psychiatric nurse for nearly three decades, was highly cognizant of mental health as what the World Health Organization calls “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to his or her community.” She encouraged us to take “mental health days” home from school and later as adults, from work, to reconnect with family or to recharge. She showed our family and friends a lot about the value of building community and resilience, always speaking openly and compassionately about mental health.
Little wonder then that this drove my design career interests toward serving the community and mental health. My thesis project was the adaptive reuse of an existing school building converted to supportive housing for people living with mental illness. It featured communal spaces (for art and activity, sunny laundry rooms, a green roof) where residents could socialize, as well as office and meeting spaces for clinical staff. I was curious how my project might combat loneliness, encourage residents to connect in their communities, and provide them with access to needed support. “Hope House,” as I called it, exemplified an empathetic approach to design that has driven me in professional practice.
Both my mother and I were interested in the healing aspects of community in relation to mental health. Today, the importance of community in mental health is embodied in the Recovery Model of Care, a holistic, person-centered model that is becoming the new standard for mental health care and has gained broad acceptance in North America.
The Guidelines for Recovery Oriented Practice provided by the Mental Health Commission of Canada emphasize the ideas of hope, dignity, and inclusion, and state that “recovery means living a satisfying, hopeful, and meaningful life. … It starts with the fundamental belief that not only is recovery possible, it should be expected regardless of diagnosis or situation.”
In the US, the Substance Abuse and Mental Health Services Administration describes recovery as “a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential,” with four major dimensions: health, home, purpose, and community.
As designers we must ask ourselves how can we support this care model with the physical environment? Our designs should reflect the vision of reducing stigma for people living with mental illness and addiction, creating community connections that aid in recovery. Our intention is that the physical environment we design will support clients as they navigate their paths to recovery and interact with loved ones, clinicians, and fellow clients.
What have we learned about designing for mental health spaces that connect to community? Below, I explore some of the key aspects of creating buildings that support the well-being of clients, care partners, and staff in a context of recovery.
Our designs should reflect the vision of reducing stigma for people living with mental illness and addiction, creating community connections that aid in recovery.
Traditionally, healthcare organizations favored isolated mental health facilities in the countryside, but now we see modern facilities woven in the urban fabric. Globally, healthcare organizations continue to rethink the siting of mental health facilities—both to meet clients where they live (increasingly in urban settings) and to boost their visibility and encourage access.
Downtown Toronto, Ontario, is home to the 27-acre Centre for Addiction and Mental Health (CAMH) campus, once the site of what was called the Provincial Lunatic Asylum. The original site was surrounded by a brick wall that quite literally kept patients in and the community out. A multiphase redevelopment plan intended to break down barriers and continue to strengthen ties to the community is underway with two new buildings due to open their doors in 2020.
CAMH connects to the streetscape of a bustling neighborhood. It’s part of the city fabric. Several of its buildings front on Queen Street West, voted “one of the coolest neighborhoods in the world.” City streets have been extended further into the campus and treatment buildings are interspersed with retail and housing. In one new building opening in 2020, the dedicated mental health emergency department is accessible by foot, public transit, or drop off by car. CAMH’s design welcomes the neighborhood.
For many providers, expanding access to mental health services includes enabling online remote access to services—a natural fit for generations that have grown up with virtual technology. There’s strong evidence that online mental health therapies work—as seen in a recent pilot project undertaken by OTN, that looked at virtual solutions for anxiety and depression. In design, we must consider aspects of virtual connections such as room layout, furnishings, appropriate color back drop, and appropriate audio/video equipment.
We know that ample daylight and views to the outdoors are good for everyone—clients, care partners, and staff. Access to semi-public and public green spaces on site are a key feature in many hospitals. Security measures in these green spaces at mental health facilities can be handled sensitively—for example, the third-floor courtyard at the Ron Joyce Children’s Health Centre in Hamilton, Ontario, affords great views through large panes of safety glazing and a pergola that provides shade but is high enough not to be a ligature risk.
Sophisticated and biophilic palette for materials and finishes provide us with inspiration for interior public areas and inspire well-being. At CAMH, we used a combination of wood-look and real woods, natural stone, porcelain, and terrazzo. Welcoming and uplifting accent colors aid in intuitive wayfinding. As one young former client said during a CAMH design consultation, “It feels more like a university campus space or a modern library than an institution.”
Simple design strategies can energize semi-public spaces—like activity rooms and teaching kitchens—for interaction and learning by locating their “face” toward the bustle of the city and infusing them with vibrant colors.
Private spaces, like bedrooms and inpatient unit lounges, should be positioned away from busy streets and toward green spaces and courtyards. Our client design consultations revealed a preference for soothing, softer colors and homelike differentiation of spaces through color.
Toronto’s Queen Street is known for its murals and art galleries. It’s an arts district.
CAMH’s design converses with the local culture and features a therapeutic art program of its own. The mosaic seen at right (in the photo at left) in a CAMH building lobby was a group effort by an artist and clients. Art in a mental health center can engage, act as positive distraction, aid in wayfinding and landmarking, and tell inspiring stories.
Thoughtful insights from the community of clients, families, staff, and neighbors shaped our designs for CAMH. During design, the clinical staff “experienced” the building using virtual reality, gaining confidence in layouts and sightlines. And we sought and incorporated input from clients (inpatient and outpatient) who brought to light their personal experiences in outdated buildings and hopes for the new spaces.
Clients commented on 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. They preferred colors that call to mind elements of nature such as water, sky, and foliage.
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.
CAMH features spaces that can be used by any member of the community; my husband plays basketball in the CAMH gym weekly. A teaching kitchen located on the ground level with views to Queen Street will offer clients a place to learn life skills. Creating and fostering employment opportunities is an important part of CAMH’s vision for client recovery. The on-site café is staffed by former clients and open to the public. A large library will serve clients, staff, and the neighborhood. The new building’s highly visible auditorium highlights its role in public interaction and education.
Recovery from mental illness is a process in which friends, family, and community are as important as clinical support. When we design for mental health, we strive to embody the optimism and empowerment of the recovery model of care. My hope is that our work creates physical environments that support us all in leading fulfilling lives, in our best state of mental health and wellness.