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IHEEM - Mental Health Inpatient Services Design By Evidence

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CF Moller - Design by Evidence - Therapeutic Environments for Mental Illness

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IHEEM - Mental Health Inpatient Services Design By Evidence

  1. 1. OSLO STOCKHOLM AALBORG AARHUS LONDON COPENHAGEN
  2. 2. all photos by Hugh Diamond, ca. 1852, courtesy of the London Metropolitan Archives Design by Evidence Therapeutic Environments for Mental Illness
  3. 3. RISK
  4. 4. RISK Incidents Abuse Harrassment Violent Behavior Self Harm Absconding Personal Accidents Fire Illicit Drug Use Slips, Trips and Falls
  5. 5. RISK Incidents Risk Abuse Harrassment Violent Behavior Self Harm Absconding Personal Accidents Fire Illicit Drug Use Slips, Trips and Falls Low Patient Morale Low Staff Morale Cold/Sterile Spaces Unempowering Spaces Unhealthy Environment Unsafe Layout Inefficient Layout Over Budget/Over Time
  6. 6. Department of Health Guidance Health Building Notes HBN’s & Health Technical Memoranda HTN’s http://www.nationalarchives.gov.uk/doc/open-government-licence/
  7. 7. Department of Health Guidance Health Building Notes HBN’s & Health Technical Memoranda HTN’s • Does adherance to the guidance drive up costs through overspecification of rooms and components? i.e. anti-ligature fixtures and anti-barricade doors everywhere on the wards? © Britplas http://britplas.com/projects_england_the_mount_leeds.html © Kingsway Group http://www.kingswaygroup.co.uk/products/ hunter-anti-ligature-door-sets Anti-barricade doors Anti-ligature windows
  8. 8. Department of Health Guidance Health Building Notes HBN’s & Health Technical Memoranda HTN’s • Does the guidance adequately reflect the situation on wards? Incident Totals by Ward 2009 - 2013
  9. 9. Department of Health Guidance Health Building Notes HBN’s & Health Technical Memoranda HTN’s • Does the guidance adequately reflect the situation on wards? SUI’s (Serious Untoward Incidents) by Ward
  10. 10. Department of Health Guidance Health Building Notes HBN’s & Health Technical Memoranda HTN’s • Does the guidance adequately reflect the situation on wards? Incidents by Cause Groups
  11. 11. Department of Health Guidance Health Building Notes HBN’s & Health Technical Memoranda HTN’s • Does the guidance adequately reflect the situation on wards? Self Harm Incidents by Ward
  12. 12. Department of Health Guidance Health Building Notes HBN’s & Health Technical Memoranda HTN’s • Does the guidance adequately reflect the situation on wards? Ligature Incidents by Ward
  13. 13. Department of Health Guidance Health Building Notes HBN’s & Health Technical Memoranda HTN’s • Does the guidance adequately reflect the situation on wards? Barricade Incidents by Ward
  14. 14. Going Beyond the Department of Health Guidance • where/when/how do incidents occur? Self Harm Base Drawing © MAAP Architects
  15. 15. Going Beyond the Department of Health Guidance • where/when/how do incidents occur? Violence/Abuse/Harrassment Base Drawing © MAAP Architects
  16. 16. Going Beyond the Department of Health Guidance • Design Principles Acute Ward built in 1931 Acute Ward built in 2009 Base Drawing © MAAP Architects
  17. 17. Going Beyond the Department of Health Guidance • Design Principles Acute Ward built in 1931 • Visibility Acute Ward built in 2009 Base Drawing © MAAP Architects
  18. 18. Going Beyond the Department of Health Guidance • Design Principles Acute Ward built in 1931 • Visibility Acute Ward built in 2009 • Outdoor Space Base Drawing © MAAP Architects
  19. 19. Going Beyond the Department of Health Guidance • Design Principles Acute Ward built in 1931 • Visibility Acute Ward built in 2009 • Outdoor Space • Avoidability Base Drawing © MAAP Architects
  20. 20. Going Beyond the Department of Health Guidance • Design Principles Acute Ward built in 1931 • Visibility Acute Ward built in 2009 • Outdoor Space • Avoidability • Dignity/Privacy Base Drawing © MAAP Architects
  21. 21. Going Beyond the Department of Health Guidance • Design Principles Acute Ward built in 1931 • Visibility Acute Ward built in 2009 • Outdoor Space • Avoidability • Dignity/Privacy • Live/Work Zones Base Drawing © MAAP Architects
  22. 22. Going Beyond the Department of Health Guidance • Design Principles Acute Ward built in 1931 • Visibility Acute Ward built in 2009 • Outdoor Space • Avoidability • Dignity/Privacy • Live/Work Zones • Daylight • Fresh Air • Control/Choice • Acoustic Quality • Difficult Patient Base Drawing © MAAP Architects
  23. 23. Going Beyond the Department of Health Guidance • Design Principles Acute Ward • Visibility built in 1931 Acute Ward built in 2009 • Outdoor Space • Avoidability • Dignity/Privacy • Live/Work Zones • Daylight • Fresh Air • Control/Choice • Acoustic Quality • Difficult Patient 700 Incidents Base Drawing © MAAP Architects 316 Incidents
  24. 24. Going Beyond the Department of Health Guidance • Design Principles Acute Ward • Visibility built in 1931 Acute Ward built in 2009 • Outdoor Space • Avoidability • Dignity/Privacy • Live/Work Zones • Daylight • Fresh Air • Control • Acoustic Quality • Difficult Patient SUI Incidents Base Drawing © MAAP Architects SUI Incidents
  25. 25. Going Beyond the Department of Health Guidance • Design Principles Victorian Ward built in 1841 • Visibility New Ward built in 2005 Base Drawing © Nightingale Associates
  26. 26. Going Beyond the Department of Health Guidance • Design Principles Victorian Ward built in 1841 • Visibility New Ward built in 2005 • Outdoor Space Base Drawing © Nightingale Associates
  27. 27. Going Beyond the Department of Health Guidance • Design Principles Victorian Ward built in 1841 • Visibility New Ward built in 2005 • Outdoor Space • Avoidability Base Drawing © Nightingale Associates
  28. 28. Going Beyond the Department of Health Guidance • Design Principles Victorian Ward built in 1841 • Visibility New Ward built in 2005 • Outdoor Space • Avoidability • Dignity/Privacy Base Drawing © Nightingale Associates
  29. 29. Going Beyond the Department of Health Guidance • Design Principles Victorian Ward built in 1841 • Visibility New Ward built in 2005 • Outdoor Space • Avoidability • Dignity/Privacy • Live/Work Zones Base Drawing © Nightingale Associates
  30. 30. Going Beyond the Department of Health Guidance • Design Principles Victorian Ward built in 1841 • Visibility New Ward built in 2005 • Outdoor Space • Avoidability • Dignity/Privacy • Live/Work Zones • Daylight • Fresh Air • Control/Choice • Acoustic Quality • Difficult Patient Base Drawing © Nightingale Associates
  31. 31. Going Beyond the Department of Health Guidance • Design Principles Victorian Ward built in 1841 • Visibility New Ward built in 2005 • Outdoor Space • Avoidability • Dignity/Privacy • Live/Work Zones • Daylight • Fresh Air • Control/Choice • Acoustic Quality • Difficult Patient Base Drawing © Nightingale Associates 274 Incidents 2005 128 Incidents 2012 - 2013
  32. 32. Going Beyond the Department of Health Guidance • Design Principles Victorian Ward • Visibility built in 1841 New Ward built in 2005 • Outdoor Space • Avoidability • Dignity/Privacy • Live/Work Zones • Daylight • Fresh Air • Control/Choice • Acoustic Quality • Difficult Patient Base Drawing © Nightingale Associates SUI Incidents 2005 SUI Incidents 2012 - 2013
  33. 33. Going Beyond the Department of Health Guidance entrance shared areas entrance Visibility Avoidability staff: back of house quiet garden Zoning around Outdoor Spaces social and activity spaces active garden patient bedrooms
  34. 34. Going Beyond the Department of Health Guidance Entrances and Outdoor Spaces Patient Areas: Bedrooms Patient Areas: Day and Dining Patient Areas: OT and Group Rooms Staff Base and Visibility Back of House and Staff Areas Shared Areas
  35. 35. Department of Health Guidance Health Building Notes HBN’s & Health Technical Memoranda HTN’s • Does the adherance to the guidance create therapeutic environments?
  36. 36. In Summary • Potential to save costs due to Overspecification by studying where/how/why Incidents occur • Increased visibility, compact layouts and better design may make it possible to reduce demands on Staff and/or Staff numbers • A risk-based approach leads to design for the ‘worst case scenario’ and more custodial care • An evidence-based approach leads to a balanced evaluation of multiple risks and a focus on creating therapeutic, normalised environments

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