“The true measure of any society can be found in how it treats its most vulnerable members.”
- Mahatma Gandhi
The design of a psychiatric unit requires more than just getting the safety stuff right. Of course, you have to do that, but unlike other types of healthcare, a psychiatric unit is a study in social dynamics and interpersonal relationships. Anyone who is familiar with the famous Stanford prison experiment knows how quickly a position of power can be abused. Hospitals work hard to train staff to be kind and compassionate; to focus on treatment over management; and to de-escalate with gentleness instead of violence. As an architect, I am interested in how the physical environment impacts this dynamic positively or negatively.
What message is sent to the staff and the patients when the staff sit at a central nurse station, with clear visibility towards every corner of the unit; when that nurse station is designed with high counters or even glass enclosure to “protect the staff”? What message is sent when patients must ask permission to gain access to a bathroom or to get a game to play? I think we know the answer, but how often is this considered in the design of these spaces? Based on many new facilities I have seen, not nearly often enough.
A recent client promoted the following phrase in the design of their facility: “maximum security outside, maximum freedom inside.” I like that. We all know that safety and security cannot be compromised—nor should they. That doesn’t mean that a psychiatric unit should look like a prison with a centralized guard station peering down at the inmates. With a little extra thought and the willingness to develop operational plans around the new design, we can flip this paradigm.
In the design of a space, think about how the patient’s social spaces feel. Are they comfortable, homey and flexible? Can a patient get up without worrying that they won’t have a seat when they get back? Can a patient do what they want while also avoiding the other patient that is agitating them? Variety, choice and flexibility are key. Have enough seats. Arrange them in a variety of more intimate groupings and provide plenty of elbow room.
Finishes also matter. A little investment in the quality of the space can go a long way. Don’t make the nurse station the beautiful object in the space. Make it as simple and plain as it can be so that the patient spaces can feel like they are at center stage. Use warm materials and calming colors. Use flooring to establish the importance of social spaces in the hierarchy of the space.
In the end, you have to ask yourself: If I had to spend a week or more in this space, how would I behave? If the answer is “badly,” start over and get it right this time!