In my 15 years of designing psychiatric spaces, I have learned two important things that are frequently missed in the larger discussion around designing these spaces: Patients are ambulatory–they do not stay in their rooms–and therapy happens when they are actively engaged with staff and other patients in social and recreational spaces; and second, patients are real people with lives, loved ones, and a desire to contribute to society. Nobody would look at a patient with a broken leg and assume that they had never been able to walk, but a psychiatric patient in crisis is often treated as if that is who they have always been and will always be. Nothing could be further from the truth.
These two important facts drive me to create spaces that are defined by one word: Dignity. Too often I see both clients and designers create spaces driven solely by security features, as if a high-security prison is the best place to recover from an acute mental health crisis. They have forgotten that these are suffering people–mothers, fathers, siblings, friends, and neighbors–and efforts should be made to create a therapeutic environment for them.
Many a client has reminded me that their priorities are safety, durability, and maintenance. I agree with those priorities, but we have to do the extra work to hit high marks in those areas while also creating an environment in which patients are free to feel a sense of self-direction, empowerment, and that their recovery matters, because it does.
Here is a simple example. We can design a wall in a psychiatric facility that is strong enough not to break if a patient hits it with their head. But the purpose of the hospital is not to protect the wall, but to protect the patient’s head. Our design philosophy is centered on protecting the head. Protecting the wall is easy. Our job as designers extends to the patient impacted the most by the spaces we help create.
One of my pet peeves is the ubiquitous “group room” with 18 chairs in a U-shape around a TV. There are only four people in my house (and I love them all dearly), but we struggle to pick a movie without fighting. If I had to go through that with 17 people I may not even know on a first-name basis, I would become very agitated very quickly, even in a perfect mental health scenario. Why do we expect patients in crisis to handle this better than we would? Spaces should be designed around the principles of social dynamics with well-thought-out seating, circadian-inspired lighting, and appropriate acoustics. These considerations don’t require more money for a project, they just require commitment.