As care pathways have changed to support patient recovery, so too has the design of mental health environments. In this article we speak to architect, Alessandro Caruso, about his work with Care UK to create a new generation of community-based health and social care facilities designed to support and promote health and wellbeing
Across the country there is a shortage of facilities designed to help people with mental health problems.
But, over the past few years, Care UK has led efforts to create a new generation of psychiatric units that are a far cry from the institutional centres of the past.
“Step-down facilities for mental health patients are a relatively new concept,” said Alessandro Caruso, who runs Alessandro Caruso Architecture and Interiors (ACA+I).
“They help people to get used to being back in the community, which is a vital part of their long-term recovery.”
As an organisation we have been providing mental health services for a long time and while we have good clinical models it was a challenge managing truly recovery-focused services in some of our older buildings
Working with his previous practice, Gelder + Kitchen, Caruso was responsible for three projects in conjunction with Care UK – in Walsall, West Midlands; Horsham, West Sussex; and in Manchester.
“Every development I was involved with represented an opportunity for Care UK to review its model of care,” said Caruso.
“Each facility is designed for people with a range of mental illnesses or learning disabilities who require intermediate care in a community setting after completing inpatient treatment elsewhere.”
Steve Hubbard, business development director for mental health services at Care UK, added: “As an organisation we have been providing mental health services for a long time and while we have good clinical models it was a challenge managing truly recovery-focused services in some of our older buildings.
“We realised it was a massive step for service users to go from group living to having their own flat in the community.
“What we then did was to sit down with architects and project managers and decide how we could provide environments that would mimic what was going on in the local community, but would also manage the risks these service users present with.”
The Walsall centre comprises eight en-suite intensive rehabilitation bedrooms and 20 apartments; while Horsham has eight en-suite rehabilitation bedrooms and 16 apartments. The unit in Manchester had 34 bedrooms and 12 apartments.
“All units are adaptable, flexible and practical as well as being safe, secure and robust to meet the demands of an extensive range of patient profiles, from young to old and from able-bodied to disabled,” said Caruso.
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“But what they all have in common is that they have been designed to be supportive of service users’ needs and clinical models of care. It is vital when designing healthcare buildings that you do speak to both clinicians and service users to find out exactly what will be most successful.”
Residents of this type of facility can spend many months in these units, so they are designed to be homely.
Caruso said: “All of the facilities have been designed with modern and safe kitchens and suitable laundry facilities to support the service user training programme in the use of domestic equipment so they can regain confidence when returning to a life in the community.
Society has tended to bury its head in the sand when it comes to mental illness, but over the last few years there has been increasing awareness of mental health problems and this is affecting the approach to design
“Particular attention has been paid to the design of quiet and family rooms to provide an environment that supports patients’ privacy and dignity.”
Landscaping is equally as important as the interior for the design team. Caruso said: “At Horsham, for example, an existing tree was retained within the courtyard. Care UK balances risk in this way to provide a truly reassuring and normal environment for service users. Many features like this tree, despite considered important, have been designed out in the past.
David Nurse, an ACA+I consultant and associate manager for Humber NHS Foundation Trust, added: “Over recent years clinicians have begun to realise that the environment in which they deliver care to patients is important. Society has tended to bury its head in the sand when it comes to mental illness, but over the last few years there has been increasing awareness of mental health problems and this is affecting the approach to design.”
David sits as an independent consultant on mental health review panels where teams decide whether to release patients from full-time secure inpatient care. Step-down facilities like those provided by Care UK are, however, few and far between.
He told BBH: “At these panels I listen to the clinicians and their views and one of the biggest problems we get is when the patients should be able to recover in the community, but social services have nowhere suitable for them to go.
“A good environment is a major factor for mental health services because being able to be calm when subjected to stress and anxiety is important. You want to create spaces that are residential in character and not much different from what patients would experience at home.
“The conflict of security versus homeliness will always be there, but we have to start considering the environment more than we have done in the past.
“It seems recently that clinical teams are more open to being inspired in this way and we are working much more closely with them.”
Hubbard added: “The biggest challenge is managing regulations. At the end of the day, we are still providing hospital services, but for a group of people who have historically had some of the worst environments.
“We want to give service users their own space and we think these recent projects will start to stimulate the market and provide much-needed move-on accommodation for people with mental health problems.”
The conflict of security versus homeliness will always be there, but we have to start considering the environment more than we have done in the past
Alison Rose-Quirie, managing director of mental health services for Care UK, concluded: “In the past people suffering from mental health issues have been treated as second-class citizens and accepted sub-standard living conditions as this was the norm. With the increasing service user movement, people are being given a voice and now, quite rightly, they expect more.
“The facilities we have designed provide high-quality accommodation in urban areas that can be adapted to meet local need and facilitate integrate with existing services. At long last I can walk into a service and genuinely say I would be content for a member of my family to live here. It's been a long time coming"
During development of the Horsham unit, a tree was retained within the courtyard. This part of Care UK\'s efforts to manage risk while providing a \'normal\' and homely environment for patients. Many times features like this, despite being considered important, are designed out
