Service users and their physical environment

Yesterday I had a very interesting meeting about mental health environments and their architecture with a recent graduate from my old school, Rachel Hammond. Rachel is going up to Bath to study architecture, is particularly interested in mental health environments and their design, and wrote a great article about deconstructivist architecture in my school magazine, which is why I got in touch with her. I’m hoping that she is going to be able to contribute to a presentation I want to do to the Design in Mental Health conference, and also that she’ll be able to run some workshops there.

Her insight, as a young woman and of her generation, is an interesting one to me, nearly twenty years older. I thought I was ground breaking in my ideas 5 years ago or so when I did a presentation about the impact that buildings have on the identity of the mental health service user. It seems that either I wasn’t and my thoughts were common knowledge, or that they have gained currency among a younger generation, who is much more understanding of mental health and its prevalence among the young. We both agreed that mental health is a journey and one in which the service user should be encouraged to be playful with their identity, not see it as fixed and static, but one in which possibility and recovery are embedded within their story. In order to do this, the mental health service user needs to be in an environment which encourages them to see themselves as a work in progress, as we all are.

This is particularly pertinent in mental health units, where to gain entry one has to fit one’s identity into one of three categories, mental health service user, visitor, or staff. Like prisons, by their nature these buildings have a hard imprint on identity because they are closed environments in which one has to have a purpose for visiting. This is what gives the key to admission on a mental health unit. The imprint that mental health units create on identity needs to be softened and made more playful in order to allow for the possibility of recovery.

This is what James Leadbitter is doing brilliantly with Mad Love, the project that invites design ideas from service users up and down the country. One of the ideas that was created in the workshops that he runs is that of a staircase, with bookshelves on the side. It leads to a point in the air about 6 foot off the ground, provides a resting point or a seat there, and then goes nowhere else. The idea is to encourage playful interactivity with the space, to allow a different perspective by viewing from a height, and to present a challenge as to what to do with it. Rachel’s perspective on stairs was interesting, she said that unlike walls, or ceilings, stairs have a unique architectural quality in that you have to engage with them to use them, you climb them, you feel the hand rail under your palm, you experience them. Stairs are not passive.

Playful environments, encouraging the user to interact and buildings that are influenced by the qualities of deconstructivist architecture are surely the future. The modernist model that we have been handed down after the abandonment of the old Victorian watertower hospital, seems to me to be on the way out. They are designed as if being prescribed for the user, rather than generated by them. Modernist architecture is rational on the outside, the spaces inside dictated by the confines and requirements of its external walls. It was to be fair an appropriate response to the extraordinary gothic legacy of the asylum system, with the place on the hill being a place of stigma and isolation. In response to this legacy, architects designed flat buildings with natural light and access to the outside via a series of courtyard gardens. Progressive at the time, it now begins to feel like prison architecture. Modernist architecture is all very well for the sense of calm and order it creates. But why in the 21st century are we presenting mental health service users with a static idea of identity? Can we not offer them calm without stasis? The two are not inseparable after all. Modernism represents a rational response to a problem. One that is an intellectual response to the challenge of integrating mental health into the community. As such it has been prescribed and orchestrated by someone in power.

However, over the last twenty years, we have surely moved beyond this. Just as we no longer choose between 4 channels of television and make an intellectual choice between 4 options when we sit down in the evening anticipating our viewing pleasure at 8pm. Instead we accept now that our choices are often irrational and dictated by feelings as much as thought. We sit down when we choose – at 8.17, say – and watch what we feel like – a comedy? Whatever takes our fancy. The notion of the controller of our entertainment is removed. We self generate material, whether through YouTube, Facebook or other social media, as much as we watch a plethora of channels. We are in control, not the controllers.

Speaking about this to Rachel, the architecture student, I was struck by two things, firstly how she and her generation had never known anything different to this plethora of choice, domination of emotion, and the drive towards self authentication and empowerment. And secondly by how open she was to the integration of mental health into the mainstream of society. I wondered if the two were related. In some ways, now that service users are moving towards coproduction and partnership with mental health authority figures, a rational building is the least preferable architectural solution to someone in mental distress.

In contrast to modernism, deconstructivist architecture is a form in which the internal space dictates the outside appearance. The buildings can appear outrageous on the outside, but they are designed to be understood from the inside out. They have their own emotional rationale, which is to do with natural light and easy wayfinding, empowerment and narrative within the building. They are not concerned to fit in. They are playful spaces which encourage experimentation. And possibly they have a softer footprint on identity, allow possibility within the recovery journey, and are more sympathetic to the range of experiences within the mental health service user community. I find it an intriguing possibility that they might be the model for mental health units in the future. I certainly think that, in contrast to the modernist or indeed the Victorian models, the fact that they are designed to be understood from the inside might encourage people, rather than shunning or fearing the experience of entering a unit, might actually want to go into them, to explore their spaces, to join with others on a mental health journey, to discover their identity and to celebrate mental health, good and bad, in an experience of self authentication.

I look forward to future casting with Rachel and her generation, it might take until they are practicing architects for these kind of thoughts to emerge in practice. But they represent a growing acceptance of mental health and mental ill health in all its hues, and an ease of talking about it that integrates service users and service use within the broad stream of everyday society. So in the end, the top down model has to end. Eventually.

Power to the people. We can but dream.

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