psychiatric hospital architecture case study

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Kritsotaki D, Long V, Smith M, editors. Preventing Mental Illness: Past, Present and Future [Internet]. Cham (CH): Palgrave Macmillan; 2019. doi: 10.1007/978-3-319-98699-9_10

Preventing Mental Illness: Past, Present and Future [Internet].

Chapter 10 designing for mental health: psychiatry, psychology and the architectural study project.

Edmund Ramsden .

Affiliations

Published online: October 17, 2018.

In 1953 the American Psychiatric Association established an Architectural Study Project in collaboration with the American Institute of Architects. The project brought together a wide range of experts from psychiatry and the behavioural sciences and the planning and design professions to provide solutions to the ailing mental hospital system in North America. They began to focus attention on various aspects of the hospital environment, such as light, colour and the creation of spaces for privacy and social contact, in ways that would go on to influence theories, methods and designs far beyond the walls of the institution. This paper will explore the contribution of the mental hospital, as both laboratory and field site, to the development of the new field of environmental psychology which attended to the function and design of a range of city spaces to prevent mental illness and promote mental health in a period of urban crisis.

• Introduction

In historical reflections on the architecture of the mental hospital, there is a familiar narrative arc. 1 This runs from an optimistic era of moral treatment in the eighteenth and nineteenth centuries which informed the designs of those such as Thomas Kirkbride that the hospital should be light, spacious and connected to nature, to one of intense pessimism in the twentieth, with damning exposés and critical ethnographies of the mental hospital that used personal accounts and participant observation techniques to dramatic and disturbing effect. 2 In Albert Deutsch’s The Shame of the States , the reader is introduced to inhuman practices and conditions, and in Erving Goffman’s Asylums to the idea of the ‘total institution’ in which ‘a large number of like-situated individuals, cut off from the wider society for an appreciable period of time, together lead an enclosed, formally administered rounds of life’. 3 The mental hospital therefore becomes an intensely problematic space due, in part, to its physical features such as its geographical isolation from the world, designs for confinement and surveillance, depressing wards and crowded dormitories. It is also seen as a site of perpetual conflict between disciplines and communities, such as psychiatrists, psychoanalysts and social and behavioural scientists, the latter gaining their institutional strength and legitimacy from the university, rather than the mental hospital which was increasingly questioned as a locus of research and care. 4 Together with the emergence of new drugs and therapies, this criticism contributed to the opening-up of psychiatric services from the 1950s with the emergence of community care legislation, the growth of psychiatric units in general hospitals and the establishment of new buildings such as Community Mental Health Centres to better integrate different therapies and communities, rehabilitate patients and prevent mental illness.

This chapter will take a different tack, and, rather than seeing the mental hospital as cut off, isolated and left behind, will examine it as a physical space that served as a crucial site for cross-disciplinary communication and collaboration in the twentieth century. The architectural historian Daniel Abramson has explored how the ‘obsolescence’ of urban buildings generated innovative solutions through designs that emphasised flexibility, choice and freedom, and so too in the case of the mental hospital where architects and psychiatrists came together to provide creative solutions for a system under severe pressure. 5 We will be focusing on the short history of a collaborative project between the American Psychiatric Association (APA) and the American Institute of Architects (AIA), and the longer term influence of some of the individuals, principles and practices involved. The Architectural Study Project (ASP) began in 1953 and reflected a growing concern with the state of mental hospital facilities. Psychiatrists and architects turned their attention to various aspects of the hospital environment, such as light, colour and the creation of spaces for privacy and social contact, in ways that would go on to influence theories, methods and designs developed and applied far beyond the walls of the institution. This chapter explores the role of the mental hospital as a ‘hybrid’ place and an ‘experiment’ of nature and society that combined elements of laboratory and field. 6 As Robert Kohler argues, the adaptation of laboratory instruments and techniques to the field helped to create a ‘distinctive border culture’ or ‘zone’ which proved a richly fertile ground for modern biology. 7 Critical to its success was the reinvention of the field as a place where experiments were possible. Mary Morgan has focused on the significance of ‘Nature’s or Society’s experiments’ in which events, situations or places provide elements of isolation and control that give them value as ‘rich sites for scientists to research’. 8 Here, we will see how the mental hospital served as such a site for an emerging interdisciplinary field of environmental psychology, allowing for new methods for mapping behaviour and measuring emotional reactions and the development of concepts such as personal space to analyse the relationship between human beings and their physical environments. The work that resulted from the study of the mental hospital would play a critical role in the study, planning and designing of the wider territories of the city to prevent mental illness and promote mental health and psychosocial well-being in the United States in a period of urban crisis.

• The Architectural Study Project

In a paper read before the American Hospital Association (AHA), Daniel Blain, Medical Director of the APA, declared 1953 to have been an ‘epochal year’ for mental health. Events had demonstrated ‘that we have come to the end of one era and are at the beginning of another’. 9 Not to be overlooked among the congressional hearings and the ‘outstanding’ treatments by the World Health Organization (WHO) and National Institute of Mental Health (NIMH), was the APA’s comprehensive report on manpower and the move to standardise training. With these contributions, the mental health field was moving from ‘vague and subjective planning efforts to a more scientific quantitative approach’. It was also embracing a wider range of preventative measures and treatments that recognised the relevance of psychological, socio-economic and political conditions. Blain interpreted this reorientation through scientific planning as contributing to a shift from the ‘mere adding of hospitals’ to the ‘provision for multitudinous other services’. 10 It had not come soon enough in North America, with its ‘enormous’ hospital system of which 714,000 beds of the total 1.5 million were filled by mental patients, and another 300,000 were required. It was expensive and dangerously short staffed, with recruitment crippled by the damning revelations of ‘inhuman conditions’ in large state mental hospitals. 11 In this regard, Blain observed that 1953 was also the year that the APA had secured a large grant from the Rockefeller Foundation and the Division Fund of Chicago for a ‘first project on design, construction and equipment of mental hospitals’. 12 The ASP reflected both a determination to fix the ailing hospital system and a growing interest in designing and building for new philosophies of prevention and treatment that moved away from long-term custodial care.

The ASP grew out of a conference in April 1952 organised by the APA to develop solutions for a system suffering ‘extreme overcrowding’ in buildings ‘obsolete, deteriorated, and sometimes condemned’. 13 While new treatment strategies might reduce the hospital population of the future, they still had a ‘vast backlog’ of patients who were so damaged that they required long-term custodial care in buildings that needed to be rehabilitated or replaced. Many buildings, even new projects, failed to properly consider patient and staff needs, and, as a consequence, lacked the ‘optimism’ and ‘atmosphere of peace and comfort’ of a truly ‘therapeutic milieu’. Environment was of critical importance because mental patients were unusually sensitive, and this was compounded by the fact that their stay would last for months, even years; it could not afford to be ‘dingy, forbidding or bleak’. While the two days of discussion did not contribute any new design solutions, it did confirm an awareness of the need for the exchange of information between those who designed and constructed the buildings and those who worked in them. It was decided that the fundamental cause of the failure of hospitals was the ‘lack of mutual understanding between doctors and designers of each other’s needs and problems’. 14

To realise what the architect Isadore Rosenfield described as the ‘humanization of mental hospitals’, they needed some form of central agency where hospital planners, administrators, architects, engineers and psychiatrists could contribute ideas and access the latest information, criteria and standards. 15 Architects expressed their frustration at not having fully explained to them the function of a ward or treatment and on the absence of a comprehensive source of reliable answers to a wide range of questions. Therefore they were hindered in their attempts to realise functional design, the precepts of which are central to modern architecture. Psychiatrists, in turn, were disappointed by how poorly medical needs were met by designers. 16 Seeking to solicit funds to launch such a project, the conference proceedings were published and circulated in pamphlet form as ‘Design for Therapy’. Included was a proposal for an organisation to collect, analyse and disseminate the ‘best information’ on design, construction and equipment, and an introduction written by Blain which declared: ‘With close collaboration between architecture and psychiatry once established, mental hospital design for modern treatment can become a reality. Buildings yet to be blueprinted will help instead of hinder the task of those who will work in them for the ultimate recovery or easement of the patient.’ 17

The ASP was directed by the APA with a strong input from the AIA who helped to provide a series of architectural consultants. Alston Guttersen, an architect with experience in hospital design with the US Public Health Service, was employed full time as the Project’s Assistant Director. A wide range of experts were called upon to give evidence on various technical elements of design and equipment, such as colour and furnishings, to help humanise hospital architecture by making it ‘more home-like’. 18 Through correspondence, conferences and hospital visits, the ASP began to collect vast amounts of material relating to elements of design, such as blueprints for new buildings, wards or recreation facilities or information on materials for walls, windows or doors. This was then organised and shared as the ASP offices became a clearing house of information, inundated with requests from administrators, planners and designers seeking to build or refurbish. They established a consultancy service, organising expert interventions on request (for a small fee) and served clients across North America. They also put local architects and psychiatrists in contact with one another, establishing joint teams to aid with the collection of data regarding good and bad design practices. To help share information and generate publicity, examples of good design—consisting of descriptions, sketches and blueprints—were published in a new architectural section in the monthly magazine Mental Hospitals , which some 700 hospitals subscribed to. 19 The object, as psychiatrist and ASP Director Charles Goshen, declared, was to provide ‘little notes on various innovations’ and ‘ingenious little ideas from various people’. 20

ASP members saw their role as working to dispel the fog of ‘ignorance and prejudice’ surrounding mental hospitals in the minds of architects who, through design, ended up making ‘many of the major decisions on the subject’. 21 Patient sensitivities were described, and design implications suggested, such as countering the common tendency to withdraw by means of environmental innovations that could ‘draw and hold human interest’. 22 Colour, long associated with emotion, was explored as a means of making the hospital atmosphere seem softer, less institutional and, where needed, as an ‘attention-getting’ measure. 23 But ASP members were also concerned to influence the field of psychiatry, to encourage it to move beyond the mental hospital as the site for psychiatric care. This was an issue that emerged early in the debates regarding the Project’s direction, and with subsequent changes in leadership, it became increasingly central. With the final two directors, Lucy Ozarin and Charles Goshen, in 1956 and 1957 respectively, a greater proportion of Project work became oriented towards alternatives to large state mental hospitals such as the day hospital, clinics, community centres and psychiatric services or units in general hospitals. 24 In their correspondence, Goshen and Ozarin questioned building for the ‘sole purpose of housing more patients’ and argued that future needs for rehabilitation would be met by smaller and more flexible installations, providing ‘more personal and… a better type of psychiatric care’. 25

The travels of Guttersen in Europe, in part funded by the WHO, helped to popularise the opening-up of psychiatric units to the community. His accounts of visits to facilities abroad were published in Mental Hospitals , complete with detailed descriptions, sketches and photographs, and made the point that the US in particular was falling behind. New advances in treatment, most notably the new range of tranquilising drugs, allowed and indeed required new kinds of psychiatric spaces. For example, Goshen observed that the ‘elaborate facilities’ needed for insulin and electric shock therapies were no longer necessary, and that the ‘old-fashioned hydro-therapy units have become storage rooms’. 26 The ASP was also building on the conclusions of the Joint Commission on Mental Illness and Health which, by bringing a wide range of health and service organisations together from 1955, had sought ‘solutions outside of the traditional framework of the mental hospital’. 27 Goshen went so far as to describe the mental hospital as having a ‘built-in obsolescence’ due to the fact that all but the most difficult patients sought alternatives to the closed institution. 28 In the place of custodial isolation, the ASP promoted two alternative psychiatric spaces, the day hospital and psychiatric services in general hospitals. The latter was a means of better integrating psychiatry with general medicine, thereby connecting more successfully with the public and taking advantage of the federal funds spent on hospital construction following the Hill-Burton Act of 1946, of which psychiatric services had received little. The day hospital provided intensive treatment while allowing the patient to retain and rebuild important connections to family and community. The psychiatrist Bernard Robbins argued that with the range of activities on offer and an atmosphere that was more like a ‘school, club or workshop’, they could make a ‘clean break with the undesirable aspects of the tradition surrounding the usual psychiatric hospital’. 29 These new kinds of environments would, in turn, drive innovation in psychiatry as, by bringing together diverse groups of mental health researchers and professionals around psychiatric places, rather than theories, it would be possible to build common therapeutic practices. 30

However, there were tensions between ASP members. Some wanted a much broader focus on mental health programming and community services from child guidance centres to clinics for the treatment of addiction. Others wanted to continue restricting the attention of the ASP to hospitals, private and public. In meetings, they spoke of the need for a ‘manual’ for hospital design, with Blain hoping for ‘a sort of textbook on mental hospital architecture for the use of the people doing the building’. 31 But Guttersen was noticing a growing ‘preference for the first activity on the part of some of the Consultants’. 32 The architect Moreland Griffith Smith was forthright, declaring that as ‘pressing’ as the problems of institutional facilities may have been, the ASP was in an ‘ideal position to do more’; the promotion of psychiatric facilities in general hospitals could, he suggested, be the Project’s ‘finest contribution’. 33 The ASP was being pulled in two directions, one towards improving conditions for the huge majority of psychiatric patients still being treated in large mental hospitals, and the other, away from the total institution in an effort to keep pace with a field that was changing rapidly. It was proving difficult to reconcile these approaches and establish coherence. The psychiatrist Addison Duval expressed his concern early in the Project, that with ‘such a diversity of opinion… the Study will come up with nothing’. 34 With this continuous broadening of the Project’s base, the end goal of the ASP was also shifting. The idea of a ‘manual’ or ‘textbook’ of standards and plans was being displaced by a more flexible and universal series of ‘principles’ of design that could travel across these increasingly varied sites of psychiatric treatment and satisfy concerns with both hospital improvement and more diverse psychiatric services. As Goshen argued, ‘There is no single set of model blueprints which could be reasonably recommended as a guide to design any psychiatric unit.’ 35 To generate these principles, as well as plan more effectively for the future, the ASP needed to conduct its own studies rather than merely rely upon information and opinion offered by others.

• The Mental Hospital as an Investigative Space

When Goshen assumed the directorship of the ASP in 1957, he described the dissipation of early optimism that ‘new and progressive ideas, as well as standards, for mental hospitals might be developed’. As psychiatric care had been changing so quickly, the ‘Project never really came up with anything of value’. 36 Goshen was seeking ways to make the project ‘perform’. The ASP would move beyond its early attempts to match building types with demographics or therapies and better appreciate the environment from an architectural perspective, as one architect demanded: ‘We do not want standards, we want principles and philosophy’. 37 This meant understanding how space was experienced and used in the day-to-day life of a hospital, space being, it was argued, ‘the essence of mental hospital design’. 38 Here, Goshen was building on the direction established by his predecessor, Lucy Ozarin, who saw the development of ‘principles’ of design as dependent upon a programme of investigation. 39 Research was not new to the ASP and in late 1954, they had begun the laborious process of sifting through thousands of hospital admissions to secure ‘basic data’ to aid planning in accordance with changing patient needs. 40 But as the ASP adopted broad survey methods to mirror its widening focus, some were driven to question: ‘is this an architectural approach?’ 41 Ozarin’s work was more directly tied to architectural concerns with the use and function of space. Her studies sought to improve design through the application of observational techniques used in the social, biological and behavioural sciences, thereby complementing the quantitative approaches applied for the benefits of planning.

Aided by a clinical psychologist, Abdul Tuma, Ozarin’s studies consisted of ‘direct observation’ of patient and staff movements and activities. 42 In a study of patients in seven psychiatric wards in five general hospitals, movement was recorded for a total of 18 hours over several days. Every 15 minutes in 3-hour blocks of time, the patients were checked to see where they were and what they were doing. Observation generated specific information on space requirements and allowed Ozarin to make a series of recommendations: few patients needed to be housed in secure wards; open wards which allowed patients to use the kitchen generated an ‘active social center’; lots of small semi-private spaces were better for activities than large day rooms; the option of single bedrooms was critical for patients in need of privacy; and spaces for occupational therapy and recreation were essential. 43 Following another study, it seemed apparent that nurses stations ‘do not suit the purposes they presently serve’. Physical barriers, such as a pane of glass, isolated staff from patients. 44 More generally, Ozarin used the evidence to criticise atmospheres that were ‘rigid’, ‘bare’ and ‘typically institutional’, and celebrate open, busy, active, comfortable and colourful wards with reduced security measures and increased patient privileges. 45

In designing her studies, Ozarin drew from a variety of sources. She credited the so-called ‘Boston experiment’ for having re-established a philosophy of ‘social treatment’. 46 At the Boston Psychopathic Hospital, psychiatrists, anthropologists and social scientists had come together to explore how the environment could be used more therapeutically. To this, the ASP could contribute the important dimension of improved physical design. 47 She drew from the sociological study of a private mental hospital by Alfred Stanton and Morris Schwartz who, in their volume The Mental Hospital of 1954, privileged highly ‘acculturated’ conditions over the cold, charmless and ‘spartan’ environments so common to institutions, as critical to patient recovery. 48 By 1957 Stanton was writing to Ozarin to request help with an ‘architectural problem’ at one of the Harvard Medical School’s psychiatric hospitals. 49 Ozarin also drew from some less obvious sources, such as the work of Heini Hediger, zoo director and author of several influential books on animal behaviour in captivity. As an ethologist, Hediger argued that it was essential to design artificial environments in accordance with the biologically determined behaviour of a species. To do otherwise resulted in pathologies comparable to those of human beings in the total institution. As Ozarin surmised, the health and well-being of animals were determined by the ‘quality and quantity of space in which they live’. 50

Ozarin had learnt of Hediger’s work from a psychiatrist, Humphry Osmond, whose ideas and methods would prove increasingly central to the work of the ASP. As director of Weyburn Hospital, Saskatchewan, Osmond had been seeking design solutions for a hospital described by his research associate as ‘cavernous, poorly lit, with long corridors, institutional colors, inadequate ventilation, and little soundproofing’. 51 The flaws of Weyburn were all too common, a ‘testimony to the failure in communication which has existed between architect and psychiatrist for much of the last century’. 52 Osmond worked with Robert Sommer, a psychologist, and architect, Kiyoshi Izumi, to design an alternative therapeutic space. But they were immediately struck with the lack of information available, Sommer later complaining: ‘More was known about the design of zoo cages and chicken coops than about the design of hospital wards.’ 53 Zoo animals were expensive, he quipped, and often the subject of greater sentiment than the mentally ill, and ‘this is sufficient reason to undertake research into conditions necessary for their survival’. 54 And so, it was Hediger’s insights that helped them to develop a methodological and analytical framework for understanding the relationship between people and the physical environment. The most important requirements for the individual were spatial. Patients needed spaces in which they could interact with others, but on their own terms. They needed their own territory and privacy. Osmond argued that Hediger had ‘shown that for many wild animals incarcerated in zoos, the presence or absence of this nest or den makes the difference between the survival or death of the creature. He has also shown that the size of this place is much less important than that it should be functionally rather than structurally equivalent to the conditions found in nature’. 55

Through their own observational studies, the Saskatchewan team argued that the quality of physical space was more important than its quantity; for psychotic people, smaller rooms, even with as little as 50 square feet of floor space, were better than overly spacious, often cavernous, dormitories, whose scale was likely to confuse and overwhelm. It was critical to avoid ambiguous, muddled and complicated designs and ensure that spaces were manageable and clearly defined to avoid making demands on the patient’s impaired perceptual apparatus. Social interaction also needed to be controlled to reduce the possibility of panic and withdrawal, while maintaining healthy and suitable social relationships. Enlarged spaces meant increased frequency of unwanted social contact due to high population numbers; ‘unpleasant even for the healthy people’, such overconcentration could ‘so damage the mentally ill that they lose all hope of recovery’. The large corridors that dominated hospitals were a particular problem as they were ‘admirably suited for keeping people on the move, but ill-suited for developing interpersonal relationships’. 56 Osmond developed a set of guidelines based on the psychological and behavioural needs of patients which included privacy, choice, the reduction of uncertainty and beneficial social relationships.

With its emphasis on principles of planning and design, the ‘Saskatchewan plan’ was becoming increasingly influential in the work of the ASP. 57 In 1954, there had been a flurry of correspondence and a sharing of information with Osmond and Izumi. 58 As the programme of modernisation progressed at Weyburn, the ASP solicited the plans of Izumi’s innovative semi-circular designs for a nursing unit that tackled the problem of corridors while providing patients with freedom of movement, stimulation and meaningful interactions with staff. 59 The ASP pushed for its publication in Mental Hospitals with a complimentary article by Osmond described as a ‘think piece’, Ozarin declaring: ‘I think architects are begging for this kind of information [on] principles and philosophy’. 60 The Saskatchewan plan was the focal point of the first mental hospital design clinic in 1958, jointly sponsored by the ASP and AIA to ‘lead to a set—not of blueprints —but of principles of good psychiatric hospital design’. 61 In their joint presentation, Izumi explained how his design had fulfilled the principle of ‘sociopetality’, as developed by Osmond, in which stable interpersonal relationships were fostered through a design that encouraged small group formation and face-to-face contact. Socio-petal space, designed to bring people together and foster communication and cooperation, was contrasted with the socio-fugal, which drives people apart, and ‘prevents or discourages the formation of stable human relationships’. This was a quality that, while necessary in some urban buildings, had been become too common in the ‘monstrous’ mental hospitals of the recent past. 62

The work at Saskatchewan embodied what Goshen described as the ‘new look’ being brought to the ASP, as they sought to ‘define more clearly what the psychiatric requirements of design are, or what we hope them to become’. 63 It helped to bring much-needed conceptual and methodological advance and encouraged a functional and research-based approach. It also showed how it was possible to translate principles into plans, blueprints, bricks and mortar. Goshen edited the ASP’s final contribution, Psychiatric Architecture , published in 1959 with the last of their funds from the NIMH, a text which collected together a selection of innovative designs and processes such as furnishing and soundproofing, and highlighted the wide range of potential facilities for rehabilitation. It was a text in which the Saskatchewan plan had a prominent place, Osmond providing two of the papers focused on the relationship between psychiatry and architecture. While the ASP had struggled in its search for coherence, Goshen now declared that its ‘most important aim [was] the development of effective communication between the two main professions concerned—psychiatry and architecture’. 64 To this, Osmond added a request for ‘the help of colleagues in other disciplines’. 65 As we shall now examine, it was this much broader interdisciplinary endeavour, focused on the relationship between the physical environment and mental health, that would continue to use psychiatric spaces as critical sites for controlled investigation. In turn, the focus on the mental hospital would help establish territory, privacy and personal space as key principles for the study and design of a wide range of institutional and urban spaces.

• Principles of Privacy, Territory and Personal Space in Built Environments

Among significant changes that took place in the mental health field in the post-war era was the growing influence of the social and behavioural sciences, funded extensively through the NIMH. Andrew Scull sees sociologists and psychologists as having ‘contributed extensively to the loss of legitimacy that institutional psychiatry experienced’. Critical to this loss, Scull argues, was the pessimistic portrait of the mental hospital painted by those such as Goffman. 66 The mental hospital did, however, continue to make a more positive contribution to this very movement away from institution that gathered pace in the 1960s, with the growth of community mental health programming. It continued to serve as a site that brought different disciplines and professions together to focus on the relationship between environment and behaviour and a place where ideas, concepts and principles could be generated and tested through observation and experimentation.

The clearest realization of the connection between environmental form and human behavior is taking place in the institutional field. People… are surprised to find that decisions regarding the physical plant amounting to tens of millions of dollars are made without adequate information about user behavior. Whether it is a matter of separate or bunks beds in college dormitories, secluded or exposed nurses’ stations in hospitals, open or partitioned offices, ceilings eight or eight-and-one-half feet in apartments, it is evident that little is known as to how the alternatives affect people. 67

In this statement, Sommer moves deftly from the institution to the modern apartment building and, therefore, from the hospital to the city. While earlier attempts to humanise the mental hospital had attempted to make it more ‘homelike’ and thus more like the world outside, there was now a reversal of roles; the hospital was reinterpreted as a critical site for the development of principles that were not only relevant to all psychiatric services, but to a wide variety of urban spaces in this new era of preventative mental health.

Sommer was also identifying the demand for design information that was coming from administrators and managers of institutions which, in turn, placed pressure on architects and planners. This pressure was considerable in an era of expanding urban and suburban development, increased population density and an accelerated pace of life, and with it, growing fears of a mass society in which speed, impersonality and uniformity became the norm. Concern intensified in the 1960s with the growing fear of violence and crime in the era of ‘urban crisis’. Architects were beginning to organise in response. In the late 1950s, the AIA established a Committee on Research for Architecture to ‘contribute to the public welfare through better building in both the physical and esthetic sense’. 68 And yet, as the environmental analyst and designer Mayer Spivack noted, architecture and the design disciplines ‘offer us very little in the way of reliable and sophisticated conceptual and design tools’. 69 Advisors to the AIA such as the sociologist Robert Merton suggested a ‘clinical’ approach, in which, just like the physician, the architect drew upon a variety of sciences to solve ‘classes of recurrent problems’. 70 In order to understand the psychological impact of the environment, one AIA group declared: ‘we need the help of behavioral science skills and techniques’. 71 Psychologists reciprocated in turn, concerned to move beyond the ‘contrived settings’ of the laboratory and address social problems in the ‘real world’. 72 The result was the intensely interdisciplinary field of architectural or environmental psychology, supported largely by the NIMH, and described simply by one of its leading early figures as: ‘The psychological study of behavior as it relates to the everyday physical environment’. 73

While the field of environmental psychology emerged in the 1960s, its origins lay in the work of the 1950s. Sommer was a pioneer and Osmond’s paper published in Mental Hospitals was considered field defining. Sommer continued to work with Osmond’s concepts and apply them to a range of institutions and environments. Using naturalistic observation, experiment and interview, he examined how space was controlled by individuals and the effects on intrusions into what he defined as ‘personal space’, an area that surrounded a person’s body. These were a further advance on methods originally developed in the mental hospital, such as his studies of seating arrangements to understand user behaviour and model the right kinds of spaces on a geriatric ward. 74 The development of the invasion technique, where the researcher would sit too close to individuals and gauge their response, was made possible in the mental hospital, ‘a place where the usual sanctions of the outside world did not apply’. 75 Once refined, Sommer transferred these techniques to a wide range of spaces, from college libraries to airport terminals, and argued that the spatial principles developed had universal relevance. When he turned his attention to ‘softening’ correctional architecture, he compared, as he so often did, the ‘barren, cold, or hard’ conditions where inmates were treated ‘worse than… zoo animals’, to those of mental hospitals before their research at Saskatchewan had helped to overcome the state of inertia and neglect. 76

Sommer also drew from continuing research in the mental hospital such as the ethologically informed work of psychiatrist Aristide (Hans) Esser on a psychiatric ward in the Rockland State Hospital, New York. 77 Patients were observed according to a strict time-sample and their location, posture and interaction recorded with code on maps of the ward divided into a grid of 3 × 3 foot squares. The processed information gave them a breakdown of each patient’s movement and interactions. Esser argued that, just as in nature, ‘an ordering principle occurs’ based on territoriality and a dominance hierarchy. The way in which patients used space was related to their social rank—the more dominant moved freely around the ward, while the weaker and more withdrawn established their own restricted ‘definite territories’ which they defended aggressively. 78 The mental hospital offered a unique opportunity for understanding this very complex process of social ordering in relation to space, as the ‘chronically mentally ill… are incapable of and are not allowed to participate in most role relationships. Clearly revealed is the simplicity of their aggressive behaviour related to defence of property and rank’. 79 The mental hospital had further advantages, as not only was the territorial behaviour ‘unmasked’ or ‘undisguised’, but the ward was both a ‘closed’ setting in which variables were relatively constant and a ‘natural habitat’ unlike the artificial setting of the laboratory. 80 The ward was a hybrid space, a natural experiment that allowed them to interrogate the functions of spatial behaviour from the vantage point of the nurses’ station, Esser noting just how easy ‘systematic observation’ was in ‘our specially designed observation area’. 81 It also, of course, generated principles such as territoriality that could inform the design of environments to sustain communal living in ‘the increasingly crowded conditions in our technological world’. 82 To help achieve these aims, Esser founded and directed the Association for the Study of Man-Environment Relations in 1968 and edited the journal Man - Environment Systems , both important to the development of environmental psychology. 83

So central was research in mental hospitals that all three of the first centres for environmental psychology that emerged in the 1960s did so as a direct consequence of research in spatial behaviour and design in the psychiatric ward. The most prominent, and the first to offer graduate training, was based at the Graduate Centre of the City University New York (CUNY). It emerged through a series of NIMH grants, beginning in 1958, to a research team to study mental hospital design led by a psychologist of perception, William Ittelson, at Brooklyn College. The purpose, as one member described it, was to ‘be able to tell some architects how to build a mental hospital so the patients will get cured much faster’. 84 But of course it was not so simple. They described how ‘questionable assumptions’ were stripped away and they were forced to ‘postpone the question’ of design and turn instead to explore how the hospital environment was experienced by patients. 85 An extensive research programme was undertaken and they developed an even more sophisticated technique of ‘behavioural mapping’. This not only involved time-sampling with multiple observers recording behaviour during a predetermined period in the wards of three hospitals, but also included a more formal series of ‘behavior categories’ to establish ‘types’ such as the ‘isolated passive’, a withdrawn individual either lying in bed or sitting alone. 86 This isolation was, they suggested, a consequence of the individual’s failure to control space and establish territory and privacy and so attain ‘freedom of choice’ in behaviour. The implications for design were that single or double bedrooms were preferable, as they encouraged social interaction on the patient’s own terms and thus hastened recovery. These studies were not only relevant to the design of psychiatric facilities, but, as the researchers made clear, they also had taken a step ‘toward developing general principles applicable to a variety of settings’. 87

The CUNY research group described the mental hospital as the catalyst for the development of a field ‘born of social necessity’. 88 Lawrence Good was also funded by the NIMH to model the renovation of a ward in Topeka State Hospital, Kansas in 1962. 89 Some of the anthropologists, psychologists and sociologists brought together for the project founded the Environmental Research Foundation in 1965 which soon ‘expanded its research scope into urban problems’. 90 Finally, a doctoral programme in architectural psychology was established at the University of Utah following a series of conferences on mental hospital design. Its co-director, Roger Bailey, again emphasised how research focused on the relations between the architectural environment and patient behaviour had ‘wide application in the other fields of architecture’. 91

The wider relevance of principles of psychiatric architecture was captured by a comparative piece in the magazine Progressive Architecture in 1965. This brought together an architect and psychiatrist in an investigation of two environments—a mental hospital and a college campus. The recent appointment of architect Robert Geddes as Dean of the School of Architecture at Princeton was considered ‘significant, for it implies a new direction in architectural education, in which the study of the behavioral and social sciences will become an integral part of the curriculum’. 92 Geddes was strongly influenced by Osmond, now at Princeton, and involved him in a mental hospital study carried out by his students which included materials by the ASP. The purpose of having students design for the mentally ill, and its relevance to the hall of residence designed by Geddes, was to demonstrate how Osmond’s principles of social design were ‘in effect, applicable to all architecture that involves people, whether in office buildings, in apartment houses, or, as in their case, in a college complex’. 93 It was necessary to design spaces in ways that encouraged social interaction but also ensured that individuals were not overwhelmed by unwanted social contact, otherwise ‘friendships and social groups do not form’.

Osmond advised on many other similar projects, the majority funded by the NIMH, as the behavioural sciences became increasingly influential in architectural departments, organizations and practices in the interests of promoting mental health and social well-being. He was listed as an advisor to a project devised by Mayer Spivack and others at the Laboratory of Community Psychiatry, Harvard Medical School, which was aimed at providing evidence for improved architectural practices and design criteria ‘at a critical time’ for the NIMH and the new mental health centres. 94 But the grant application captured, once again, a much broader vision. With the acute sensitivity of the ‘emotionally disturbed individual’ to spatial factors, they could be used as ‘probes’ to explore the environment. Thus, the naturalistic studies of the ward could provide ‘optimum’ specifications for ‘architectural and urban spaces in general’ and generate a better understanding of the ‘relationship between the physical environment and its influence on the minds and movements of men’. Once again, the psychiatric facility served as an ideal, valid and intact setting for the investigation and design of functional spaces. The knowledge gained would, they anticipated, feed back into the ‘design of urban structures in general… correctly classified as preventative mental health for our increasingly urbanized population’.

In 1968 the social psychiatrist Leonard Duhl published a paper entitled ‘The shame of the cities’. 95 The title acknowledges Deutsch’s earlier exposé of the state mental hospital, now reworked by one of the leading promoters of preventative mental health to focus attention onto ‘failure’ in the ‘real world’ at the height of the urban crisis with American cities blighted by sickness, stress, violence, and poverty. 96 And yet, for an emerging group of environmental psychologists, mental hospitals had done much more than stimulate, through their obsolescence, a turn away from custodial care; they had played a critically important role in building, adapting and refining the tools needed to address many of the problems that now inflicted the wider urban environment, problems with which experts and policy-makers were struggling to deal. When Lucy Ozarin reflected on the rise of collaborative efforts between architects and psychologists to design for mental health, she made a point of beginning with the ASP’s early studies of patients and staff, its consultation and publications as central to an ‘intensive campaign to improve existing psychiatric facilities’. 97 Similarly, when William Ittelson considered a programme of research for architecture, he reflected on his own studies of the psychiatric ward and argued that they had ‘a vast laboratory of already completed structures for study. All we need to know is how to go about doing it.’ 98

The mental hospital was a particularly important ‘laboratory’ for the development of concepts and methods to explore the social and psychological aspects of the built environment. Kohler argues that the key characteristic of a laboratory is its ‘placelessness’; its ability to generate objective knowledge and generalisation stems from ‘stripped down-simplicity and invariability’. 99 The laboratory gives the experimenter close control over material and ‘when place affects laboratory experiments we know that something went wrong’. 100 The mental hospital, with its separation from the outside world and its ‘clearly delineated physical and social system’, offered an impressive degree of control. 101 The carefully regulated systems of time, space and function allowed behaviour patterns in the hospital’s uniquely sensitive population to be identified, controlled and manipulated, such as in Sommer’s experimental altering of furnishings, for example, or in the comparison between an original and refurbished ward. But, of course, at the same moment the complexity of place, of real and intact settings, was critically important, and many psychologists were dismissive of laboratory studies for their neglect of social and physical context of behaviour. While the mental hospital granted researchers a significant degree of control, it was also a natural setting representative of the ‘real world’ which so concerned environmental psychologists. The mental hospital was a ‘hybrid’ space that contained elements of both laboratory and field. Blain described the institution as ‘part laboratory, in part hospital in the traditional sense, in part convalescent home, in part rest-home, in part university, and overall, as has been said “an institution where we teach the patients how to live”’. 102 It was, as one environmental psychologist pointed out, ‘in many ways a microcosm’ of wider society that ‘reflects within its own organization many of the larger unsolved complexities of urban life as a whole’. 103

The credibility of the mental hospital as a site for generating principles for design was further reinforced by the interpretation of the world as a multitude of comparable spaces, the city now broken into a series of settings to which the methods and concepts for understanding the spatial behaviour of the psychiatric patient could be usefully transferred. ‘In fact’, environmental psychologists declared, ‘a large part of our lives is spent in institutional settings of one kind or another, and the qualities that make a setting institutional imply some common effects on behavior’. 104 The understanding of territorial behaviour and personal space that had been established on the psychiatric ward (and which had been informed by the zoo) could be applied to the general hospital, prison, classroom, dormitory and even family apartment. In public housing developments, an understanding of territoriality was deemed critical to building more cohesive communities that promoted mental health and prevented crime. 105 In this way, the study of psychiatric architecture fulfilled the broader ambitions of the ASP. The ‘immediate need’ of improving the therapeutic potential of psychiatric facilities had brought together, for the first time, a diverse group of psychiatrists, architects and behavioural scientists who had then worked to contribute a broader and more basic understanding of spatial behaviour in the context of mental health. 106 As the ASP turned to ‘principles’ of ‘functional design’ to address the problems of psychiatric treatment, ‘by the same token’, its members suggested, ‘psychiatric thinking can be related to architectural and community design in a general way’. 107 The principles established in the context of the mental hospital could be incorporated into ‘homes, schools, factories, public buildings and community projects’. The ASP had identified the very obsolescence of the mental hospital as offering a ‘tremendous field for the architect’s imagination, putting the architect in a position to make a significant contribution to both psychiatry and society’.

See, for example, Lawrence A. Osborn, “From Beauty to Despair: The Rise and Fall of the American State Mental Hospital,” Psychiatric Quarterly 80 (2009): 219–31.

On Kirkbride, see Carla Yanni, The Architecture of Madness: Insane Asylums in the United States (Minneapolis: University of Minnesota Press, 2007). See also Leslie Topp, James E. Moran, and Jonathan Andrews, eds., Madness, Architecture and the Built Environment: Psychiatric Spaces in Historical Context (New York: Routledge, 2007).

Albert Deutsch, The Shame of the States (New York: Harcourt, 1948), Erving Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (New York: Doubleday, 1961), xiii.

See Andrew Scull, “Psychiatry and the Social Sciences, 1940–2009,” History of Political Economy 42 (2010): 25–52.

Daniel M. Abramson, Obsolescence: An Architectural History (Chicago: Chicago University Press, 2016).

On the value of uniting these two elements, see Thomas F. Gieryn, “City as Truth-Spot: Laboratories and Field-Sites in Urban Studies,” Social Studies of Science 36 (2006): 5–38 (7).

Robert E. Kohler, Landscapes and Labscapes: Exploring the Lab-Field Border in Biology (Chicago: University of Chicago Press, 2002), 134.

Mary Morgan, “Nature’s Experiments and Natural Experiments in the Social Sciences,” Philosophy of the Social Sciences 43 (2013): 341–57 (354).

Daniel Blain, “Mental Health Program Planning,” read at the Institute on Hospital Planning, American Hospital Association (AHA), DC, February 16, 1954, Archives of the American Psychiatric Association, Architecture Study Project (hereafter ASP Papers), Folder 122. See also Daniel Blain and Robert L. Robinson, “A New Emphasis in Mental Health Planning,” American Journal of Psychiatry 110 (1954): 702–4.

Blain, “Mental Health Program Planning.”

Memorandum: Mental Health, July 1955, Council of State Governments, Chicago, ASP Papers, Folder 106.

Blain, “Mental Health Program Planning.” They received $140,000 from the Rockefeller Foundation and 15,000 from the Division Fund.

Daniel Blain, “Heart of the Matter,” in Design for Therapy: An Investigation into The Possibilities of Collaboration Between Psychiatrists and Architects in Developing Basic Information for Mental Hospital Design, Construction and Equipment , Conference in Washington, DC, April 6–7, 1952, p. 5, APA, ASP Papers, Folder 90.

Blain, “Heart of the Matter,” 6.

Blain quoting Rosenfield in “Heart of the Matter”, p. 7.

See “Notes from Talk by Dr. Paul Haun,” 1/10/55, Consultants’ Meeting, ASP Papers, Folder 104.

Blain, “Heart of the Matter”, 8.

“Mental Hospital Architecture,” n.a., n.d., ASP Papers, Folder 91.

“Proposed Hospital Construction and Equipment Project, to be administered by APA Mental Hospital Service,” ASP Papers, Folder 92. Mental Hospitals was published by the APA’s Mental Hospital Service, which served as a clearing house for technical information.

Charles Goshen, “Summary of Year’s Progress and Projects Now Underway in the Architecture Study Project, to APA Council,” November 1957, ASP Papers, Folder 118.

“Space—The Essence of Mental Hospital Design,” n.a., n.d., ASP Papers, Folder 91.

“Mental Hospital Design—Environmental Therapy,” n.a., n.d., ASP Papers, Folder 91.

Charles Goshen, “Guidelines for the Development of Psychiatric Services in General Hospitals,” n.d., ASP Papers, Folder 90.

Both had worked in some of the most innovative sites of psychiatric work, Charles Goshen as Executive Director of the first private day hospital, the Robbins Institute in New York, and Lucy Ozarin as Chief of Hospital Psychiatry in the Veteran’s Administration. There were numerous directors over the years which did not help the Project’s coherence, and prior to Ozarin and Goshen, John L. Smalldon served as director with the beginning of the Project on September 8, 1953, and he was replaced by Charles K. Bush in May 1954. “Report to the Rockefeller Foundation of the Activities of the Mental Hospital Architectural Study Project, from June 1, 1954 to May 31, 1955,” ASP Papers, Folder 105.

Goshen to R. E. Peek, August 28, 1958, from Goshen, ASP Papers, Folder 88; Ozarin to Samuel Whitman June 25, 1956, ASP Papers, Folder 119.

Charles Goshen, “A Re-appraisal of the Architectural Study Project,” 7/15/57, ASP Papers, Folder 104.

Arthur Noyes, President of the APA, to Edwin Crosby, Director of the AHA, February 22, 1955, ASP Papers, Folder 83.

Goshen, New Concepts of Psychiatric Care with Special Reference to the Day Hospital: A Summary of the Proceedings of the First National Day Hospital Conference held in Washington D.C., March 1952, presented at the Annual Convention of the APA, May 13, 1958, ASP Papers, Folder 76.

Bernard S. Robbins, “The Theoretical Rationale for the Day Hospital,” in Proceedings of the 1958 Day Hospital Conference, A Mental Hospital Design Clinic Conducted by The Architecture Study Project and The General Practitioner Project of the APA , Washington, DC, March 28–29, pp. 6–7, 1958, ASP Papers, Folder 76.

Charles Goshen, “Day Hospitals: Physical Facilities and Equipment,” presented at the First Day Hospital Conference, Washington, DC, March 1958, ASP Papers, Folder 76.

“Minutes—Meeting of Consultants’ Committee,” ASP, April 5, 1954, ASP Papers, Folder 120.

Alston Guttersen, “Review of Designated Activities for the Architectural Study Project,” ASP Papers, Folder 93.

Moreland Griffith Smith, “RE: Proposed National Plan for Mental Health Facilities,” ASP Papers, Folder 93.

“Minutes—Meeting of Consultants’ Committee,” ASP, March 1, 1954, ASP Papers, Folder 120. Duval was an important and influential member of the ASP as he served as Chair of the Committee on Standards for Psychiatric Hospitals and Clinics of the APA, which he combined with his role at St Elizabeth’s Hospital in Washington, DC, where Goffman had carried out his studies.

Goshen, “Guidelines for the Development of Psychiatric Services”, p. 11.

Goshen to Vincent Kling, July 24, 1957, ASP Papers, Folder 88. Goshen wanted to involve Kling as a consultant as he believed that, despite Alston Guttersen’s contribution, the project lacked ‘any real architectural orientation’.

John R. Magney, “Minutes—Advisory Committee Meeting,” December 14, 1956, ASP Papers, Folder 120.

“Space—The Essence of Mental Hospital Design.”

“Proposal for a Program of Investigation and Evaluation of Psychiatric Facilities Leading to the Derivation of Principles of General Architectural Design and Equipment,” November 30, 1956, ASP Papers, Folder 120. This shift towards investigation was also driven by the failure of the psychiatrist and architect teams, few returning the prepared questionnaire.

This survey originally encompassed 10,000 case records of patients admitted to six state hospitals and two outpatient psychiatric clinics in the calendar year of 1953 and was then extended to include other facilities in accordance with the broadening focus of the ASP. The widening survey approach did not help their case when they requested an extension to their grant, and the source of funding shifted from the Rockefeller Foundation to the NIMH.

Duval in Meeting, AHA & ASP, June 30, 1954, ASP Papers, Folder 105.

“Progress Report, ASP, APA, Study of Intensive Treatment Facilities for Psychiatric Patients, USPHS Grant W-5, 1956,” ASP Papers, Folder 105. Abdul Tuma was employed by the ASP having been recommended by the VA. Ozarin to Abdul Tuma, June 7, 1956, ASP Papers, Folder 111.

Lucy Ozarin, “Patterns of Patient Movement in General Hospital Psychiatric Wards,” ASP Papers, Folder 91. Later published in American Journal of Psychiatry 114 (1958): 977–85.

“Addendum to Progress Report”, Study of Intensive Treatment Facilities for Psychiatric Patients, USPHS Grant W-5, 1956, ASP Papers, Folder 121 and Lucy Ozarin, “Functions of Nursing Stations on Psychiatric Services in General Hospitals,” ASP Papers, Folder 90.

Ozarin, “Patterns of patient movement.” See also, A. H. Tuma and Lucy B. Ozarin, “Patient ‘Privileges’ in Mental Hospitals,” American Journal of Psychiatry 114 (1958): 1104–10.

Lucy Ozarin, “New Horizons in Psychiatry,” ASP Papers, Folder 91.

The physical environment was the thinnest section of the resulting volume—Milton Greenblatt, Richard H. York, and Esther L. Brown, From Custodial to Therapeutic Patient Care in Mental Hospitals (New York: Russell Sage Foundation, 1955).

Ozarin, “New Horizons.”

Alfred Stanton to Ozarin February 13, 1957, ASP Papers, Folder 113.

Ozarin, “Patterns of Patient Movement.”

Robert Sommer, “Studies in Personal Space – This Week’s Citation Classic,” Current Contents 24 (1983): 14.

Humphry Osmond, “Function as the Basis of Psychiatric Ward Design,” Mental Hospitals 8 (1957), 23–29 (23).

Sommer, “Studies in Personal Space.”

Robert Sommer, Personal Space: The Behavioral Basis of Design (Englewood Cliffs, NJ: Prentice-Hall, 1969), 12.

Osmond, “Function as the Basis of Psychiatric Ward Design”, 25–26.

Ibid., 25, 28.

The plan involved breaking up and dispersing psychiatric facilities and had a central architectural component. For an insightful, extensive and detailed analysis of this and the work of Osmond and Izumi more generally, see the work of Erika Dyck on which this paper draws—Erika Dyck and Alexander Deighton, Managing Madness: Weyburn Mental Hospital and the Transformation of Psychiatric Care in Canada (Winnipeg: University of Manitoba Press, 2017) and Erika Dyck, “Spaced-Out in Saskatchewan: Modernism, Anti-psychiatry, and Deinstitutionalization 1950–1968,” Bulletin of the History of Medicine 84 (2010): 640–66. Dyck notes that the rapid pace of deinstitutionalisation in Canada meant that little was built.

For example, Guttersen sent Izumi reprints of type plans and suggested useful hospitals for him to visit. Guttersen to Izumi August 9, 1954, ASP Papers, Folder 54. The following year, he provided information on dormitory spaces and nursing units and suggested the need for a ‘master plan.’ Guttersen to Osmond, January 12, 1955, ASP Papers, Folder 54. Smalldon had been advising Osmond on design issues regarding security and group sizes since late 1953. Smalldon to Osmond, October 7, 1953, ASP Papers, Folder 77.

Ozarin to Izumi, November 13, 1956, ASP Papers, Folder 54.

Ozarin to Osmond, January 24, 1957, and Ozarin to Osmond, December 19, 1956 ASP Papers, Folder 54.

“New Trends in Psychiatric Architecture—The First Mental Hospital Design Clinic”, sponsored by the ASP and AIA, Washington, DC, January 16–17, 1958, ASP Papers, Folder 91. The clinic also included three further reporting teams from Ohio, Indiana, and Delaware, but it was Saskatchewan, represented by Osmond and Izumi, and recipient of the APA’s Hospital Improvement Award, that was the focal point of the discussion.

Osmond, “Function as the Basis of Psychiatric Ward Design”, 28, 23.

Charles Goshen, “Progress Report,” October 30, 1957, ASP Papers, Folder 120.

Charles Goshen, “A Review of Psychiatric Architecture and the Principles of Design,” in Psychiatric Architecture: A Review of Contemporary Developments in the Architecture of Mental Hospitals, Schools for the Mentally Retarded and Related Facilities , ed. Charles Goshen (Washington, DC: The American Psychiatric Association, 1959), 1–6 (1).

Humphry Osmond, “The Historical and Sociological Development of Mental Hospitals,” in Psychiatric Architecture , ed. Goshen, 7–9 (9).

Scull, “Psychiatry and the Social Sciences, 1940–2009,” 37.

Sommer, Personal Space , 9.

“Special Report no. 4, A Statement on Architectural Research by the AIA Committee on Research, AIA,” May 1956, Martin Allen Pond Papers, Yale University Library, Box 12, Folder 227.

Mayer Spivack, “Some Psychological Implications of Mental Health Center Architecture,” 1966, Archives of the Environmental Research and Development Foundation (hereafter ERDF Papers), Kenneth Spencer Research Library, University of Kansas, Box 58, 2600. Spivack also drew from ethologists such as Hediger.

R. K. Merton to Walter E. Campbell, AIA, November 4, 1957, Pond Papers, Folder 227.

“Report A,” in Research for Architecture, Proceedings of the AIA-NSF Conference, Ann Arbor, Michigan, 10–12 March 1959 , ed. Eugene F. Magenau (Washington, DC: AIA, 1959), 90. Attendees expressed much support for such interaction.

William H. Ittelson, H. M. Proshansky, L. G. Rivlin, and G. Winkel, An Introduction to Environmental Psychology (Oxford: Holt, Rinehart & Winston, 1974), 71; Harold M. Proshansky, “Environmental Psychology and the Real World,” American Psychologist 31 (1976): 303–10.

Kenneth Craik, “The Prospects for an Environmental Psychology,” Draft, for Journal of Environmental Design , ERDF Papers, Box 55, 2154.

For a much more detailed analysis of Sommer’s work at Weyburn, see John A. Mills and Erika Dyck, “Trust Amply Recompensed: Psychological Research at Weyburn, Saskatchewan, 1957–1961,” Journal of the History of the Behavioral Sciences 44 (2008): 199–218.

Sommer, Personal Space , 31–32.

Robert Sommer, “Final Report: Research Priorities in Correctional Architecture,” July 1, 1970–December 30, 1970, ERDF Papers, Box 28.

This was reciprocated with Esser drawing on Sommer’s seating techniques—Richard Almond and Aristide H. Esser, “Tablemate Choices of Psychiatric Patients: A Technique for Measuring Social Contact,” Journal of Nervous and Mental Disease 141 (1965): 68–82. Esser was also influenced by Osmond and Izumi—Aristide H. Esser, “Environmental Design Needs Empathy to Combat Pollution,” to appear in Matrix , 1971, ERDF Papers, Box 47, 3669.

Aristide H. Esser et al., “Territoriality of Patients on a Research Ward,” in Biological Advances in Psychiatry , ed. Joseph Wortis (New York: Plenum, 1965), 37–44 (37).

Aristide H. Esser, “Interactional Hierarchy and Power Structure on a Psychiatric Ward: Ethological Studies of Dominance Behaviour in a Total Institution,” in Behavior Studies in Psychiatry , eds. Sidney J. Hutt and Corrine Hutt (Oxford: Pergamon Press, 1970), 25–59 (42).

Esser, “Interactional Hierarchy.”

Aristide H. Esser, “Social Contact and the Use of Space in Psychiatric Patients,” Abstract, AAAS Meeting, 1965, ERDF Papers, Box 54, S.1692.

John Zeisel, “Behavioral Research and Environmental Design: A Marriage of Necessity,” Design & Environment 1 (1970): 51–66.

Proshansky, “Environmental Psychology,” 303.

Harold M. Proshansky, William H. Ittelson, and Leanne G. Rivlin, “The Influence of the Physical Environment on Behavior: Some Basic Assumptions,” in Environmental Psychology: Man and His Physical Setting , eds. Proshansky, Ittelson, and Rivlin (New York: Holt, Rinehart and Winston, 1970), 27–37 (27).

William H. Ittelson, Harold M. Proshansky, and Leanne G. Rivlin, “Bedroom Size and Social Interaction of the Psychiatric Ward,” Environment and Behavior 2 (1970): 255–70.

William H. Ittelson, Harold M. Proshansky, and Leanne G. Rivlin, “The Environmental Psychology of the Psychiatric Ward,” in Environmental Psychology , eds. Proshansky, Ittelson, and Rivlin, 419–39 (424).

Proshansky, Ittelson, and Rivlin, “The Influence of the Physical Environment on Behavior,” 27.

“The Foundation’s Work in the Area of Mental Health Care Environments,” ERDF Papers, Box 7.

Robert B. Bechtel, Environment and Behavior: An Introduction (London: Sage, 1997), 84. See also Lawrence R. Good, Saul M. Siegel, and Alfred Paul Bay, eds., Therapy by Design: Implications of Architecture for Human Behavior (Springfield, IL: C.C. Thomas, 1965). The Environmental Research Foundation became the Environmental Research and Development Foundation (ERDF) in 1970. Of considerable importance to their philosophy was the work of Roger Barker at the Midwest Psychological Field Station in Kansas, which grew out of research into child development. Barker’s observation techniques and concepts made field studies work amenable to the production of objective data on behaviour. Also critical was the work of the anthropologist Edward Hall on proxemics which served to unite disciplines around the study of spatial behaviour and communicate ideas and methods to a broad audience—see Edward Hall, The Silent Language (Garden City: Doubleday, 1959).

Roger Bailey, “Needed: Optimum Social Design Criteria,” The Modern Hospital 106 (1966): 101–3 (103).

“The Psychological Dimension of Architectural Space,” Progressive Architecture 46 (1965): 159–67.

Ibid., 163.

“The Effects of Physical Settings on Patient Behavior,” research grant application, 1967, ERDF Papers, Box 58, 2710. Spivack was named as the proposed project’s director and the principal investigator was sociologist Harold Demone, Jr. Notably, both the application and Spivack’s work in general drew strongly from ethological ideas. For an important analysis of the architectural design and function of the Community Health Centre as a critical technology in the transition from a clinical to a public health model in psychiatry, see Joy Knoblauch, “The Permeable Institution: Community Mental Health Centers as Governmental Technology (1963 to 1974)”, in Delia Duong Ba Wendel and Fallon Samuels Aidoo, eds., Spatializing Politics: Essays on Power and Place (Cambridge: Harvard Graduate School of Design, 2015).

Leonard J. Duhl, “The Shame of the Cities,” American Journal of Psychiatry 124 (1968): 70–5.

Harold M Proshansky, “The Field of Environmental Psychology: Securing the Future,” in Handbook of Environmental Psychology , eds. Daniel Stokols and Irwin Altman, v. 2 (New York: Wiley, 1987).

Lucy Ozarin, “Notes on the Development of Collaboration Between Architects and Clinicians,” Hospital & Community Psychiatry 31 (1980): 276–77 (277).

Ittelson, Discussion in Magenau, ed., Research for Architecture , 38. To this end, the architect Walter Taylor noted, they had been working closely with the APA in their research and in their ‘clinic conferences’ for design of mental hospitals.

Kohler, Landscapes , 7.

Ittelson, Proshansky, and Rivlin, “The Environmental Psychology of the Psychiatric Ward,” 419.

Daniel Blain, “Psychiatric Facilities of the Future,” n.d., ASP Papers, Folder 98.

Roslyn Lindheim, “Factors Which Determine Hospital Design,” in Environmental Psychology , eds. Proshansky, Ittelson, and Rivlin, 573–79 (573–74).

Ittelson et al., An Introduction to Environmental Psychology , 368.

On this important application of ideas of territoriality to the design of urban spaces, see Joy Knoblauch, “The Economy of Fear: Oscar Newman Launches Crime Prevention through Urban Design (1969–197x),” Architectural Theory Review 19 (2015): 336–54.

The Psychiatric Architecture Design Contest, 1957, ASP Papers, Folder 118. This was a contest open to students of architecture to encourage interest in psychiatric architecture, and was organized around a series of ‘principles’.

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• Cite this Page Ramsden E. Designing for Mental Health: Psychiatry, Psychology and the Architectural Study Project. 2018 Oct 17. In: Kritsotaki D, Long V, Smith M, editors. Preventing Mental Illness: Past, Present and Future [Internet]. Cham (CH): Palgrave Macmillan; 2019. Chapter 10. doi: 10.1007/978-3-319-98699-9_10
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Psychiatric Hospital, Helsingør

• Typologies Health  Hospital 
• Date 2002 - 2005
• City Elsinor 
• Country Denmark 
• Photographer Dragor Luftfoto  Peter Sorensen  Esben Bruun 

The Psychiatric Hospital in Helsingør, a port city in Denmark, is halfway between the suggestive forms generated by the new digital technologies and the rigorous geometries that characterize the more functional structures. In the research prior to the project design, an exhaustive analysis of the program and the needs of the client was done, as well as interviews with the daily users of the clinic, both medical staff and patients. The different inputs did not give any clear answers regarding what the psychiatric hospital should be like. Rather, they pointed out several paradoxes and ambiguities that were brought into the program: open and closed, centralized and decentralized, freedom and control, privacy and sociability. These conflicting qualities became part of the project design, generating a building that is and is not a psychiatric hospital.

As is known, a safe and welcoming atmosphere is essential for the good development of pyschiatric treatment and the well-being of patients. Modern treatment and therapies require a new type of architecture combining a rational and efficient program with homely and private spaces that help patients feel secure and comfortable. From the beginning, the hospital design avoided clinical stereotypes: hallways without windows and rooms on both sides with artificial, easy-cleaning materials such as plastic or linoleum in cold, grey colors. In this project, all materials have their natural surfaces: wood, glass and concrete in lively colors to create spaces that are far from the typical sad and dull image of hospitals.

Functionally the program reconciles residential use and healthcare services, public and private areas, and also defines spaces for different types of users. The star-shaped hybrid building gathers communal areas in a central node and organizes the rooms of patients, the offices and medical staff areas in a snowflake structure, separated by plant-filled triangular sections. In this way, two sets of rooms face the lake and one set of rooms faces the surrounding hills, all of them with direct access to the exterior. Organized in two levels, the building blends into the hilly landscape, with courtyards resembling cuts on the terrain. One of the galleries in the treatment program stretches out like a bridge that links up with the existing hospital and becomes a flexible structure for expansion due to future development and needs.  [+] [+]

Cliente Client Frederiksborg County, Helsingør Hospital

Arquitectos Architects BIG-Bjarke Ingels Group Socios responsables Partners in charge: Bjarke Ingels, Julien De Smedt Jefe de proyecto Project leader: Jakob Eggen Jefe de obras Project architect: David Zahle Mánager de proyecto Project manager: Leif Andersen Equipo de proyecto Project team: Anders Drescher, Anna Manosa, Annette Jensen, Ask Hvas, Casper Larsen, Christian Finderup, Dennis Rasmussen, Finn Nørkjær, Hanne Halvorsen, Henrik Juel Nielsen, Ida Marie Nissen, Jakob Møller, Jamie Meunier, Jesper Bo Jensen, Jesper Wichmann, Jørn Jensen, Kasper Brøndum Larsen, Lene Nørgaard, Louise Steffensen, Nanna Gyldholm Møller, Simon Irgens-Møller, Thomas Christoffersen, Xavier Pavia Pages

Colaboradores Collaborators Moe & Brødsgaard (ingeniería engineers ); Ncc Construction Denmark (construcción construction ); JDS Architects

Fotos Photos Dragør Luftfoto; BIG; Peter Sørensen; Esben Bruun

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A Secure Unit for Psychiatric Treatment and Rehabilitation

A Secure Unit for Psychiatric Evaluation and Rehabilitation A THESIS Submitted by

Sruthi Raguraj 311213251093 In partial fulfilment of the requirements for the award of the degree of

BACHELOR OF ARCHITECTURE ANNA UNIVERSITY

MARG INSTITUTE OF DESIGN AND ARCHITECTURE SWARNABHOOMI Velur Village, Cheyyur Post Kanchipuram District Tamil Nadu - 603302 MAY 2018

DECLARATION I declare that this Thesis titled

A Secure Unit for Psychiatric Evaluation and Rehabilitation is the result of my work and prepared by me under the guidance of Prof. M. Senthil and that work reported herein does not form part of any other thesis of this or any other University. Due acknowledgement has been made wherever anything has been borrowed from other sources.

Signature of the Candidate :

Sruthi Raguraj

RollNumber:311213251093

BONAFIDE CERTIFICATE Certified that this Thesis forming part of Course work AR2452, Thesis, X semester, B.Arch, entitled

A Secure Unit for Psychiatric Evaluation and Rehabilitation Submitted by Ms. Sruthi Raguraj Roll No. 311213251093 to the Department of Architecture, MARG Institute of Design and Architecture Swarnabhoomi, Anna University, Chennai in partial fulfilment of the requirements for the award of Bachelor Degree in Architecture is a bonafide record of work carried by her under my supervision. Certified further that to the best of my knowledge the work reported herein does not form part of any other thesis. Date: Signature of the Supervisor : Name : Designation :

External Examiner 1

External Examiner 2

MIDAS Date :

MIDAS Date: 3

ABSTRACT This thesis investigates the fact that architecture can have a positive effect on the common attitude towards mentally challenged patients by providing them with an environment suitable for development and initiative. The project analyses the situation of such a forum in the process, that of a psychiatric and rehabilitation facility functioning to change mindsets on either side of the fence by taking patients through a wholesome development programme designed specially to aid them in the real world. It promotes mental health as well as sets up a new forum of public spaces where products and consumers meet. The centre provides a space full of natural atmosphere and vitality; a place that is self-contained and forms a corresponding relationship with the surroundings. It also emphasizes the need for craftsmanship in achieving the same. The project attempts to use an architectural language that is futuristic, reflecting the significance of progress and evolution in mental health for the nation. This thesis proposes the creation of a secure unit aiding rehabilitation of psychiatric patients. The centre emphasises on the importance of encouraging knowledge transfer and understanding. It enables social interactions between people from different cultures, creating valuable connections between communities while reducing social isolation and prejudices. lowering the stigma that surrounds such people. The ultimate goal of the project is to support and rehabilitate psychiatric patients through a wholesome all rounded program. The centre will be imagined as an architecture of progress; a gateway to a better future. 4

ACKNOWLEDGEMENT

Firstly, I am grateful to God for the given intellect, health and wellbeing without which this thesis would not have been brought forth. I would also like to thank my thesis guide Prof. Senthil Mani for his valuable input and timely advice. I would like to express my deepest gratitude to Prof. Ramji and Prof. C.K.Praveen for their guidance and input throughout this project. I would like to express my deepest appreciation for Dr. Bhadrinarayanan MS, NIMHANS and Prof Naveen, NIMHANS for their insight, knowledge and support. I would like to sincerely thank my parents and family for all their encouragement and support. My father for his advice and my mother for her prayers. I would also like to take the opportunity to thank a few of my friends Akshita Arunachalam, Thirumoorthy J, Kiran Raj and juniors Akshaya Prabhu, Harie Krishnan, Gautam. S and Sarah Varghese for all their assistance and advice.

TABLE OF CONTENTS CHAPTER NO.

ACKNOWLEDGMENT

LIST OF FIGURES

INTRODUCTION 1.1

INTRODUCTION

LIMITATIONS

SPECIAL STUDY

STUDY & RESEARCH 2.1

LIST OF CASE STUDIES

SITE SELECTION AND ANALYSIS

SOLUTION & CONCLUSION 3.1

ADMINISTRATION & CRISIS

STABILIZATION UNIT 3.4

FORENSIC UNITS

TREATMENT SPACES

RE-INTEGRATION VILLAGE

DESIGN STUDY

LIST OF FIGURES FIGURE NO.

FIGURE NAME

Admitting Authorities

Affecting factors

NIMHANS entrance

Views of NIMHAN

Plan, NIMHANS

News article NIMHANS

VSIMH Entrance

Zoning of VSIMH

Views of VSIMH

Planning of VSIMH

Site Plan VSIMH

Broadmoor Entrance

Isolation ward view

VSIMH houses chart

Broadmoor Plan

Location of Site

Climatic Study

Shading Devices

Functional flow

Window positioning

3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24

Main Block view Site plan Admin GF plan Admin block Admin Sections & Elevation Forensic Unit Plan & View Forensic Female Unit Forensic Male Unit Intermediate Female Block Intermediate Views Intermediate Male Block Chronic Stay Female Block Chronic Stay Views Chronic Male Block Chronic Block Views Acute Care Female ward Acute Care Sections Acute Care Male Block Rehab Centre Plan Rehab Sections 1 BHK 2 BHK VILLA Design study

39 40 42 43 44 45 46 47 48 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64

INTRODUCTION "To not have your suffering recognized is an almost unbearable form of violence" - Andrei Lankov A nation's progress is not just the physical wellbeing of its citizens, but how their psychological health is also looked after. People with behavioural problems need more help from the country. Sadly, our country is lacking in this area. In a country of 1.34 billion people nearly 22,63,821 are mentally challenged. About 80 percent of the country’s psychiatric beds are in the country’s 37 colonial-era “mental hospitals”, draughty, overcrowded, poorly managed constructions, deplorably suited to their anachronistic name. Through the 70s and 80s, these institutions earned press coverage that grew into an indigenous sub-genre of gothic horror. Among the recurring elements were patients being tied up or consigned to dank isolation cells, having little to no access to healthy food and fresh water.There is a high prevalence of psychiatric illness among prisoners lodged in Indian jails and it isn’t surprising that more than half of them had history of substance abuse. According to a study published in the latest edition of the Indian Journal of Psychiatry, the psychiatric morbidity among prisoners is substantially higher than in the general population. Most inmates have several defined problem areas, with substance use, depression and anxiety disorders most prevalent.

BACKGROUND “Nothing is an offence, which is done by a person who, at the time of doing it, by reason of unsoundness of mind, is incapable of knowing the nature of the act, or that he is doing what is either wrong or contrary to law.” - Indian Penal Code, 1860

It has been held by the Supreme Court that the law presumes every person of age of discretion to be sane and defence on ground of insanity needs to be proved. If defence is established on ground of insanity, such persons are committed to the Psychiatric Hospitals as per sec 471 (i) of the Cr.P.C., 1973. Sec 89, IPC provides protection for any action done in Fig 1.1 good faith for the benefit of a person of unsound mind by or by consent of the guardian or other person having lawful charge of that person. Sec 305, Indian Penal Code (IPC) provides for punishment of death or imprisonment of life for abetment of suicide by an insane person.

ISSUES 



There is a high prevalence of psychiatric illnesses among prisoners lodged in Indian jails. According to a study published in the Indian Journal of Psychiatry, the psychiatric morbidity among prisoner is substantially higher than in general population. Most inmates have a number of problem areas with substance abuse, depression and anxiety disorders being the most prevalent. A study conducted by the doctors of Government Medical College, Amritsar and MM College, Haryana found that 23.8% of the inmates had psychiatric problems. These figures are similar to other studies conducted in prisons across the country. The high rate of common psychiatric disorders calls for facilities within or in proximity to the prison compound to diagnose, treat and rehabilitate the inmates.

The asylums of India are modelled on those established during British rule. Their sole purpose is to hide and restrain those unfortunate souls from society, rather than treating their disorders and helping to rehabilitate them. Society always tends to lock up and forget about them. This is more so in the case of prisoners with psychiatric disorders.

MOTIVATION 

Institute of Mental health and Neurosciences have revealed that at least 13% of the Indian population are suffering from mental health conditions with 10% i.e. approximately 150 million Indians in need of immediate attention. India was one of the first countries to develop a national mental health programme in the 1980’s but no concrete measures were implemented to understand and estimate the spread of mental illnesses in the country. The Parliament passed the Mental healthcare Bill 2016 providing comprehensive legislation for state healthcare facilities, spells out rules and protects the rights of persons with mental illnesses in India. Numerous calls have been made to invoke political will, enhance advocacy, and for galvanizing community participation. With rising awareness in the Indian society, it can be expected that early recognition and access to treatment will follow, as will the adoption of preventative measures.

OBJECTIVES    

To introduce the concept of rehabilitated prisoners, cured from their diagnosed conditions as everyday citizens of society. To diagnose prisoners that have committed crimes and to treat them accordingly with safe and suitable methods as specified with stimulating infrastructure. Rehab patients will have specific treatments, categorized depending on the level of affliction and the crime committed. The facility aims to reintegrate patients into society and their families through the sale of handmade goods thereby instilling a sense of community in the prisoners and aims to lower the stigma surrounding rehabilitated patients.

A design that appropriately addresses the issues mentioned in the study. A space full of natural atmosphere and flexibility, a place that is self-contained, and forms a corresponding relation with the surroundings. Emphasis on the role of the individual in the process of rehabilitation and on the influence of good spaces. A design that provides affordable access to healthcare as funded by the concerned department of government. The design enables and empowers them to live in a community within the facility as well as the right to confidentiality of treatment.

LIMITATIONS 

Due to the limitation of time and scale of the project the scope will be restricted to certain activities immediately aiding the development of mental health leaving the rest for future development and expansion. Once again due to the limitation of time and scale of the project the proposed design is a model that will only be serving an area within its impact radius. The services such as Electrical, HVAC, Plumbing, Fire System, and Finishes will be considered while designing but not to be detailed. Being a hypothetical proposal maximum research and experimentation is done to achieve the maximum possible. Fig 1.3 14

SPECIAL STUDY To understand a process necessary for a meaningful experiential design approach for an architectural design that affects the mindset of the user. To study and integrate the concept, technology of prefabrication with vernacular materials, construction technology for a unique, easy and quicker method of construction without losing the values & essence of vernacular architecture.

STUDY & RESEARCH CASE STUDIES : NIMHANS, Bangalore VSIMH, Amritsar Broadmoor, England

SITE SELECTION Site Analysis

SPECIAL STUDY: Climate responsive Designing Work Flow 16

NIMHANS, BANGALORE: LOCATION

: Bangalore

: *various*

YEAR OF CONSTRUCTION

:13,221 sq.m

Modelled based on Morstley Hospital, London. Upgraded as per needs this hospital specializes in Neurosciences and psychiatry. It helps the patients fund themselves by providing Occupational therapy and Life Training. The National Institute of Mental Health and Neurosciences is a multidisciplinary institute for patient care and academic pursuit in the frontier area of mental health and neuro sciences. The priority gradient adopted at the Institute is service, manpower development and research. A multidisciplinary integrated approach is the mainstay of this institute, paving the way to translate the results from the bench to the bedside. Several national and international funding organisations provide resources for academic and research activities. MATERIALS USED:  Stone and concrete for the older wards. 17

Brick and lime plaster for the newer treatment blocks.

PAVILIONS: The various wards are placed around a open courtyard and connected by an open pathway. Aged bricks, concrete and stone give a unique character to each of the blocks at NIMHANS. The age old buildings all have a central courtyard and high load bearing walls and overhangs supported on columns. The lush and green climate responsive design is shown in the following examples: + Open pathways linking blocks amidst green gardens + The various centres are connected through boulevards. + Local materials used. WARDS:  Wall height - 5-6m Reducing accessibility to roof hung fixtures such as fans , lights , etc 18

Windows - 4-5m Reducing accessibility to window grill and escape routes. Switch Boards - 4-5m To reduce misuse and self-harm tendencies. Wards - Only Beds provided to prevent self-harm tendencies Bathroom fixtures -As low as possible with minimized projections to prevent self-harm tendencies.

CENTRAL COURTYARD: Easy to maintain with drainage and ventilation FORENSIC WARD: Observation Room - For Under trial patients Stay Room - For HC and DC (Currently 2 patients -staying for 6 months) VISITING ROOMS : Near Entrance and first gate DINING ROOM: Serves as a multi-purpose room for occupational therapy and dining COMMON GARDEN: Serves as a therapeutic space under supervision. 19

NURSES’ ROOM: Serves as a treatment room and stay for nurses. SECURITY GATES: It has double security gates for prevention of escape. CASES DEALT WITH: Detention and evaluation of whistle-blower: In December 2014, it was reported that a soldier from the Indian Navy was being held in NIMHANS for a month to evaluate whether he was suffering from mental illness, after acting as a whistle-blower. After the month-long evaluation, NIMHANS concluded that the Navy person was not suffering from any mental illness Negligence of hospital staff regarding mentally disabled man: An intellectually disabled man who was admitted in NIMHANS for treatment was found to have leaped from the terrace of a building. It was reported that he was under round the clock supervision, but escaped without notice. He was found lying in a pool of blood, and was taken to the Emergency Section of the Hospital. Refusal to admit youth to intensive care unit: The New Indian Express reported that the family of a 21-year-old individual who died in NIMHANS complained that their request for him being admitted to the ICU, due to his worsening condition, was declined by the staff. The youth later died, after his condition started to deteriorate.

VSIMH, AMRITSAR LOCATION

: Amritsar 21

: Sarbhjit Bhaga

Planned on a site of 45 acres, the master plan comprises primarily two zones: • the outer circle • the inner circle.

The outer circle accommodates the buildings like 1. OPD-cum-diagnostic-cum-administrative block 2. Occupational therapy/rehabilitation unit 3. Voluntary patients’ unit 4. Serai 5. Shopping / cafeteria 6. Services like kitchen, laundry, and stores 7. Staff quarters

The inner circle having wards of different types has further been divided in two sections: • The male section on the east • The female section on the west. 1. All the building blocks in the campus have been laid out on a strict cartesian pattern with symmetrical juxtaposition reminiscent of traditional indian campuses. 2. The built-up masses and the open spaces are ingeniously interwoven to create a building-in-the-garden effect. 3. The entire hospital complex has been linked by vaulted corridor running independently through open spaces with greenery on both the sides. 4. Built-up benches have been provided at certain intervals for casual sitting while walking in the corridor. 5. The intersections of two corridors have been developed as a 20 feet by 20 feet chowk with a high roof. 6. The entire inner circle has been kept strictly pedestrian so as to impart serene and tranquil environment to the inmates 7. Vehicular traffic has been restricted to the periphery.

8. The designs of all the building blocks have been evolved keeping in view the peculiar requirements of different types of patients. 9. Efforts have been made to evolve a distinctive architecture for each block so as to make them easily identifiable by the inmates. 10. However, the unity and consistency–the two important aspects of campus designing–have been taken care of by providing uniform external finishes i.e., exposed concrete and red sandstone cladding. 11. The master plan provides for ample open spaces to be developed as gardens, parks, play fields, etc. this helps in creating a lively, cheerful, and natural environment, which is a prerequisite for such hospitals.

NUMBER OF BEDS

A mental hospital is a specialty hospital, with its patients having their special needs. broadly, the

patients can be acutely disturbed and excited, or behaviourally settled. Most of the patients are mobile, and, therefore, need more open space. Average stay of patients in a mental hospital is usually much longer than their counterparts in other hospitals, and they frequently suffer from 24

social stigma and face problems in rehabilitation on discharge.

BROADMOOR, ENGLAND LOCATION

Broadmoor Hospital is the best known of the three high-security psychiatric hospitals in England. It provides a specialist service assessing and treating men from the south of England who have serious mental health or personality disorders. The highly structured environment requires lighting which reduces risk and promotes safety. The hospital opened in 1863 and was first named the Broadmoor Criminal Lunatic Asylum. However, mental health care has advanced tremendously and the Victorian architecture no longer offers fit for purpose accommodation and care appropriate for the high secure services required in the present day. 26

The act of 1863 with its innovating notion of separating criminal from non-criminal lunatics was what formed the basis for the construction of Broadmoor in Crowthorne, Berkshire. The Broadmoor “Criminal lunatic asylum” (as it was first called, was designed by Major General Joshua Jebb, a military engineer who had previously designed Pentonville Prison (Taylor, 1991, 160). According to the Commissioners in Lunacy, the institution would be: A Lunatic Asylum, A Convict Prison for criminal lunatics, and a Hospital. Broadmoor changed from institution to hospital after the1948 Criminal Justice Act. And also in 1948 the staff’s titles changed from Attendant to Nurse. The locked up regime, where the patients were locked in their rooms from evening till morning, was abolished six years ago. Now they are under what is called a “twenty-four hour therapeutic care”, which means that patients have keys to their

rooms and are free to move about in the ward. Giving more freedom to the patients implies that more staff is needed to do the controlling part. Patients spend most of their time in the common rooms within the wards and have access to toilets at all times.

Fig 2.12 27

Kent House is a three storey high building comprising 3 identical wards, one on each floor. It is an “F” shaped block where the main corridor runs across the “L” facing the terraces. The first spaces one encounters are the ward manager and offices to the left, followed by side rooms. Halfway through the corridor on the right projecting onto the terrace, one finds the staff mess room and offices followed by the patients’ common areas where they spend most of their time.

Somerset House is a three storey high building compromising three wards with an identical layout. They are constituted by an “L” shaped corridor with all spaces off to one side. The ward manager is strategically located right where the two wings pivot gaining visual control of the two corridors. Bedford House was built together with Oxford House. It is a one storey high building, east of the main entrance and rather separated from the older buildings located in the middle of the site. Both Oxford House and Bedford House are near the boundary wall. Bedford House compromises Luton ward and the psychology department. All patients at arrival to Broadmoor Hospital go to Luton ward, which is the assessment ward, the 28

most secure ward in Broadmoor. They are then transferred to a different block. The area of the Psychology department also houses treatment areas such as the dental surgery, ECT area, podiatric clinic, X-ray rooms etc. Oxford House is a two storey high building mostly assigned to living areas. There are two wards on each floor. Both wards are identical, with a corridor on each wing and side rooms off both sides. Even though Oxford House is mainly a building for living in, there are a large number of spaces assigned to clinical treatment.

SITE SELECTION Thorapadi is a part of Vellore Corporation. It is a prominent area in the city of Vellore. It is located at 12.93째N 79.13째E. It has an average elevation of 216 metres. Azad roard is the arterial road of Thorapadi. Thorapadi is 7km from Katpadi Junction Railway Station, 4km from Old Bus terminus, 5km from New Bus Terminus and 3km from Cantonment Railway Station. As of 2001 census, Thorapadi has a population of 14,292. Location

Thorapadi Vellore Tamil Nadu Prison Department Bagayam Road Vellore Tamil Nadu 632002 India 12.886429째N 79.120277째E Building Type No. of Prisoner

Central Prison 2,208

Considering the legal implications and the shared user profile of both the existing jail and the proposed design, it is logical to provide both at proximity to each other for easier access and use. The Thorapadi Jail District consists of various facilities regarding security and area for future expansion. + Located within the Jail District. + Secluded from the loud city life. + Proximity to Warden Training Centre

+ No main road access

Fig 2.14 31

BYE - LAWS OPPOSITE ROAD WIDTH SITE AREA PLOT FRONTAGE FRONT SETBACK OVERALL SETBACK OSR

SPACING BETWEEN BLOCKS CORRIDOR WIDTH DRIVEWAY

9m 35000sq.m 12 m 3m 4.5 m 10 % 3500sq.m 6m 2.4m 3.5m

Vellore is at 12.92°N 79.13°E, 220m above the mean sea level. The city has a semi-arid climate with high temperatures throughout the year and relatively low rainfall. It is in Vellore district of the South Indian state, Tamil Nadu, 135 km (84 mi) west of the state capital Chennai.

Vellore lies in the Eastern Ghats region and Palar river basin. The topography is almost plain with slopes from west to east.

There are no notable mineral resources. Black loam soil is found in parts of Vellore Taluk. The other type of soil in the city is chiefly gravelly, stony and sandy of the red variety.

Vellore experiences a tropical savanna climate (Köppen climate classification Aw). The temperature ranges from a maximum of 39.4 °C (102.9 °F) to a minimum of 18.4 °C (65.1 °F). Like the rest of the state, April to June are the hottest months and December to January are the coldest. Vellore receives 1,034.1 mm (40.71 in) of rainfall every year.

The site has an average temperature of 32 - 35°, with rains 5 months a year. Wind blows at an average of 10mph throughout the year from east to west and north - east to south - west. 32

CLIMATE RESPONSIVE STUDY LANDSCAPING

IN-MATES’ GARDENS

Trees that are provided in the open space are required to be such that it does not encourage or permit self-harm tendencies. Trees should not have lowhanging branches, thorns or poisonous sap and fruits. Palm trees must be provided with safety catch-nets to prevent harming of in-mates due to dropping palm fruit. Common Name: Ashoka Tree Plant Height : 12 Plant Spread : 2 Use : accents, street tree, informal screen, windbreak Soil Moisture : dry for extended periods to constantly moist Sunlight : hot overhead sun Origins : India-Subcontinent Seasonality : Evergreen Common Name: Indian Mahogany Plant Height : 12 Plant Spread :6 34

Use Soil Moisture Sunlight Origins Seasonality

: shade, street tree, windbreak, timber : periodical watering : hot overhead sun, partial shade : India-Subcontinent : Sheds in winter for 2 weeks

Common Name: Toddy Palm Plant Height : 30 Plant Spread : 2 Use : accents, fruit, trunks, leaf weaving. Soil Moisture : dry for extended periods to constantly moist Sunlight : hot overhead sun Origins : India-Subcontinent Seasonality : Evergreen Common Name: Coconut Palm Plant Height : 35 Plant Spread : 2 Use : accents, street tree, trunks, leaves , fruit Soil Moisture : dry for extended periods to constantly moist Sunlight : hot overhead sun Origins : India-Subcontinent Seasonality : Evergreen Common Name: Peepal Tree Plant Height : 30 Plant Spread : 15 Use : shade, informal screen, windbreak Soil Moisture : dry for extended periods to constantly moist Sunlight : hot overhead sun Origins : India-Subcontinent Seasonality : Evergreen PASSIVE COOLING Passive cooling is a building design approach that focuses on heat gain control and heat dissipation in a building in order to improve the indoor thermal comfort with low or no energy consumption. This approach works either by preventing heat from entering the interior (heat gain prevention) or by removing heat from the building (natural cooling). Natural cooling utilizes on-site energy, available from the natural 35

environment, combined with the architectural design of building components (e.g. building envelope), rather than mechanical systems to dissipate heat.Therefore, natural cooling depends not only on the architectural design of the building but on how the site's natural resources are used as heat sinks (i.e. everything that absorbs or dissipates heat). Examples of on-site heat sinks are the upper atmosphere (night sky), the outdoor air (wind), and the earth/soil. SURFACE SHADING Surface shading can be provided as an integral part of the building element also. Highly textured walls have a portion of their surface in shade as shown in Figure 5. The increased surface area of such a wall results in an increased outer surface coefficient, which permits the sunlit surface to stay cooler as well as to cool down faster at night. SUN SHADING DEVICES Well-designed sun control and shading devices, either as parts of a building or separately placed from a building facade, can dramatically reduce building peak heat gain and cooling requirements and improve the natural lighting quality of building interiors. The design of effective shading devices will depend on the solar orientation of a particular building facade. For example, simple fixed overhangs are very effective at shading south-facing windows in the summer when sun angles are high. However, the same horizontal device is ineffective at blocking low afternoon sun from entering west facing windows during peak heat gain periods in the summer ROOF SHADING A cover of deciduous plants and creepers is a better alternative. Evaporation from the leaf surfaces brings down the temperature of the roof to a level than that of the daytime air temperature. At night, it is even lower than the sky temperature

FUNCTIONAL FLOW KITCHEN

CRISIS STABILIZATION

THERAPEUTIC SPACES 39

A therapeutic environment can be defined as a patient care environment that helps make patients more receptive to the treatment provided by staff. Some who provide services to psychiatric patients feel the built environment where these patients receive services should resemble a “typical residential� atmosphere. Unfortunately, patients from different backgrounds may have entirely different views of what constitutes a home-like setting. A more realistic goal, then, should be to create a non-threatening environment in which patients can feel relaxed and comfortable. Other general hospital elements, such as medical gas outlets, bedpan washers, nurse call systems, and wrist handles on faucet valves, are simply not needed In a psychiatric unit. Windows and window coverings also require special consideration. In the past, very heavy stainless-steel screens were often installed as a safety measure. Although still used in some facilities, these screens provide a very institutional or prison-like appearance. A variety of window glazing materials that cannot be easily broken to produce sharp shards of glass and, if broken, will stay in the frame to resist egress are appropriate for use in psychiatric facilities. Tempered glass breaks into very small pieces that do not stay in the frame; laminated glass will stay in the frame but yields shards. Polycarbonate sheets satisfy both of these requirements.

SOLUTION & CONCLUSION

SVADHYAYA In Sanskrit, sva means “self;” dhyaya translates as contemplating, meditating on or reflecting upon. Svadhyaya refers to any activity wherein we quietly study ourselves and reflect upon our actions, thoughts, emotions, motivations, aspirations, desires and needs in pursuit of a deeper experience of our lives and our own selves. “Svadhyaya therefore can be translated as self-reflection, selfcontemplation or the study of oneself.” Another classical form of svadhyaya is the study of sacred scriptures. This could refer to yogic scriptures, such as the Bhagavad Gita or Yoga Sutras, but could also include any writing that is spiritually revealing and uplifting and which encourages investigation of our own divinity. When we study these works and tap into the wisdom of previous spiritual seekers and sages, we also engage in our own self-examination. These resources can be used as a mirror to reflect the sublime in our own soul. Svadhyaya refers to any activity wherein we quietly study ourselves and reflect upon our actions, thoughts, emotions, motivations, aspirations, desires and needs in pursuit of a deeper experience of our lives and our own selves.

ADMINISTRATION AND CRISIS STABILIZATION DESCRIPTION AREA : 2545 SQ.M The Admin block houses three main functions - the administration of the entire facility, security checks on entry and exit and a crisis stabilization unit that handles emergencies within the facility. The Admin block is of three floors with the crisis stabilization unit for only one floor. The entire block is air-conditioned, and the roof is provided with solar panels for additional energy requirements. The Crisis Stabilization unit has a separate entry in the back for easy access from the treatment spaces.

GROUND FLOOR 44

FIRST FLOOR

SECOND FLOOR

ELEVATION A

ELEVATION B

SECTION A-A’

SECTION B-B’

FORENSIC UNITS DESCRIPTION AREA: 800 SQ.M BEDS: 20 The forensic ward is planned to house mentally-ill offenders or criminals who are admitted to the hospital under law for observation. Separate Ward blocks were required for such patients to safeguard the interests of other patients, and to ensure adequate security provided by the police. The ward planning consists of two independently planned units of 5 beds each. The units are mirror imaged and joined together, resulting in a highly planned symmetrical structure encompassing enclosed and semi enclosed structures. FEMALE WARD

ELEVATION B MALE WARD

GROUND FLOOR

TREATMENT SPACES INTERMEDIATE STAY

DESCRIPTION

The Intermediate patient’s unit as the name denotes, is meant for the patients who have either improved after a long treatment or their or their treatment involves shorter period of hospitalisation and are likely to be relieved within a few weeks or months. Since the condition of this category of patients is comparatively better their wards are designed to be 3storeys high. Fig 3.9

FEMALE BLOCK

SECTION A-A’ Fig 3.11

CHRONIC STAY

DESCRIPTION Chronic Stay Units have been designed to house those chronically ill patients who are unable to sustain lifestyle on their own, and, therefore, need external help to perform their daily chores. Majority of these patients are unlikely to be recovered and hence need hospitalization throughout the remaining part of their life. It is required to provide the patients their exclusive open space/ court for outdoor activities. The Acute care and Chronic stay units have been juxtaposed in such a manner that they enclose adequate space in between.

FEMALE BLOCK: Fig 3.12

SECTION A-A’

SECTION B-B’

MALE BLOCK:

SECTIO N B-B’

ACUTE CARE DESCRIPTION The Acute Care Unit accommodate those mentally-ill patients who are acutely serious and need longer stay and special care in the hospitals. Since these patients are not expected or

capable of moving upstairs their wards have been designed as single- storey. The Male and Female care units are of similar planning, and form is similar to that of Chronic Stay. FEMALE BLOCK

ELEVATION B MALE BLOCK

ELEVATION B REHABILITATION CENTRE

DESCRIPTION Occupational therapy and rehabilitation is a vital component in the functioning of a mental hospital. It’s purpose is to train the patient’s in utilizing this time efficiently and productively. This unit has thus been designed to provide important supportive services for the betterment of mentally ill patients. All the training rooms draw sufficient daylight from large fenestrations from the outer periphery. In addition, ventilators have been provided on the inner courtyard side for additional ventilation. Fig 3.19

RE-INTEGRATION VILLAGE Occupational therapy and rehabilitation is a vital component in the functioning of a mental hospital. It’s

purpose is to train the patient’s in utilizing this time efficiently and productively. This unit has thus been designed to provide important supportive services for the betterment of mentally ill patients. All the training rooms draw sufficient daylight from large fenestrations from the outer periphery. 1 BHK

ELEVATION 2 BHK

DESIGN STUDY ACUTE CARE

FORENSIC UNIT

Psychiatric inpatient facilities present a unique set of challenges, and the solutions to designing safe facilities are often completely different from what is typically done for medical/surgical units in a general hospital. Decisions about design for psychiatric facilities should be thoroughly discussed with facility staff beginning during the programming phase and continuing at decision points throughout a project. As well, the decisions made should be documented, including the reasons behind them, before proceeding to subsequent phases of a project. Space does not allow detailed discussion of solutions to all of the problems mentioned in this paper and, in any case, answers are often very specific to a particular facility. In addition, a product that is perfectly acceptable for one patient population may not be acceptable for another.

REFERENCES Common Mistakes in Designing Psychiatric Hospitals May 2015 James M. Hunt, AIA, NCARB David M. Sine, DrBE, CSP, ARM, CPHRM Healing Landscapes Gardens as places for spiritual, psychological and physical healing

By Kristin Faurest, Ph. ARCHITECTURE FOR PSYCHIATRIC TREATMENT EPFL – École polytechnique féderale de Lausanne Énoncé théorique for the Master Thesis in Architecture, January 2011 Variation to the Master Plan for Vellore Local Planning Area. [G.O.Ms. No. 130, Housing and Urban Development (UD4-1), 14th June 2010.] Ernst and Peter Neufort, Architect’s data

• Vermont Psychiatric Care Hospital

Location : Berlin, VT Project Type : Healthcare Area Supplied : Corridors, Bathrooms, Lobby Products :  Mosa  Greys, Light Warm Grey | 24″ x 24″; 12″ x 12″,  Mosa  Beige & Brown, Grey Brown | 6″ x 6″,  Mosa  Murals Lines, Dark Anthracite | 6″ x 12″,  Mosa  Global Turquoise | 6″ x 6″,  Mosa  Terra Maestricht Cool Porcelain White | 2″ x 24″; 4″ x 24″ Quantity : 15,000 Square Feet (SF) Design Firms : Prime Architect: Architecture + | Associated Architect: Black River Design Tile Installer : Tri-State Flooring, Inc.

Awards Interior Design Project, Overall Winner, Design & Health International Academy Awards, 2015 Mental Health Project, Finalist, Design & Health International Academy Awards, 2015 World Architecture News (WAN) Healthcare Awards Shortlist, 2015 Merit Award, American Institute of Architects, Eastern New York Chapter, 2014

At the Vermont State Hospital in Waterbury, VT, 50 patients were displaced by the storm, and the hospital had to be closed permanently due to the resulting damage. Many viewed this as a “blessing in disguise” as the facility, originally constructed in the early 1900s, did not have air conditioning, proper fire safety, adequate treatment facilities, or access to outdoor space for the patients.

Hurricane Irene forced that solution. Most of the 54 beds available at the hospital were replaced by the new 25-bed, state-of-the-art Vermont Psychiatric Care Hospital in Berlin. The new hospital draws upon the findings of cutting-edge research in order to promote healing and reduce aggression in psychiatric facilities. The two facilities couldn’t be more drastically different.

Challenge Architecture+ was tasked with creating the design that would turn the facility around. The time had come for the hospital to be given a fresh start. Architecture+ sought an interior design concept that would pull elements from the Vermont landscape as inspiration. The finish materials and color selections needed to create a soothing and restorative environment.

When Architecture+ approached Creative Materials, the designer shared that the project needed to be fast-tracked, and the preference would be to use Mosa tile for its clean look and high quality. Mosa offers a vast array of color and finish options, and all tile is rectified to precise tolerances which allow for the achievement of tight grout joints while minimizing the risk of lippage.

Solution Creative Materials has strong knowledge of Mosa’s vast collections and recommended the options that would suit the space and desired aesthetic. The designer went with soothing browns and greys that would complement the healing design, and a turquoise and brown mosaic-look for the lobby.

The Creative Materials project team closely monitored the progress of the project and coordinated the successful production and supply of material to ensure that no circumstances would compromise the Mosa material selection originally made by the design team.

The facility now houses patients with diverse diagnoses in a secure, updated environment and provides a safe and therapeutic setting with the aesthetics of traditional Vermont design. Creative Materials is proud to have contributed to this project which won several awards including overall winner at the Design & Health International Academy Awards in 2015 and was described as a space that “commences with grace and proceeds with serenity and respect.”

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Healing Gardens: Nature as Therapy in Hospitals

• Written by Luciana Truffa | Translated by Maggie Johnson
• Published on December 13, 2021

For the Cosmos Foundation , environmental conscience, ecological conservation, and community focus form the foundations of land planning and landscape design within public infrastructure projects. We sat down with the foundation's project director, Felipe Correa, as well as foundation architects Valentina Schmidt and Consuelo Roldán, as they went in depth on the benefits, objectives, and motivations behind the Healing Gardens initiative.

Nature's Place Within Hospital Infrastructure

Throughout the conquest and colonial times, plants held a central place within hospital architecture , especially within sanatoriums specializing in the treatment of tuberculosis and mental illnesses. As time passed, however, natural spaces disappeared from medical buildings in Chile and the rest of the world, thanks in part to the Hygienist Movement of the 19th and 20th centuries. For the past few decades, however, scientific research has mounted evidence against the Hygienist methods in support of re-incorporating nature into healthcare, since, "in many cases, gardens and nature are more powerful than any medicine" (Sacks, 2019). This research could--and should--revolutionize hospital architecture through a new understanding of how the human body works and its connection with its surroundings.

Healing Gardens: A Way of Incorporating Nature into Health Centers

While nature heavily influenced early hospital architecture, it's therapeutic potential has largely been ignored within modern medical paradigms, due largely to sanitation policies and budget restrictions. Nevertheless, throughout the 80s, various studies were done that demonstrated the necessity of reincorporating natural elements into hospitals .

The wide range of scientific studies as well as the empirical evidence gathered in hospitals indicate that reincorporating natural elements into hospitals will prove to be a monumental task. Given the amount of perspectives supporting their therapeutic potential, Healing Gardens offer a solution. The initiative aims to integrate Healing Gardens into healthcare systems via public policy, setting the foundations for reconnecting humans with the environment.

The Healing Garden offers a natural space within a healthcare facility for patients, family, and hospital staff. Its design aims to bring the benefits of the outdoors into the hospital, adding to the physical, psychological, emotional, and social elements of wellbeing and maximizing patients' recovery. (Jardines Sanadores, 2019).

In the same way that medicine understands the human body as a unit that doesn't focus on a singular organ to heal the entire individual, it should also understand that the individual and their recovery process is connected to their environment. In keeping with this understanding, reestablishing nature's place within the healthcare system is essential to changing the overall paradigm and much of this transformation starts with the infrastructure and architecture of health facilities. 

Three Points to Consider in the Development of Healing Gardens

Through the ten experimental Healing Gardens placed in hospitals throughout Chile , the Cosmos Foundation has pinpointed three essential elements when planning for future spaces in other healthcare facilities.

Nature's place within spaces for healing and recovery

In Roger Ulrich's 2002 paper titled the  Health Benefits of Gardens in Hospitals , Ulrich highlights the connection between aesthetics and emotions and how garden design can create spaces that enhance a human being's connection to nature and thus optimize their recovery and overall health. 

The aforementioned study took place in the Healing Garden and Memorial of the Maritime Sanatorium of Viña del Mar , in the Valparaíso Region of Chile , and looked to study the benefits of the garden for both the patients, mainly children with severe neurological injuries, and the staff at the facility. Nestled in a gorge with sweeping ocean views, the 1.300m2 site provides an ideal space to relax and connect with the surrounding nature. Taking into consideration the conditions of the patients and the layout of the space, the project participants determined that the existing fruit trees would provide optimal sensory treatments and then designed three work spaces within the garden all connected by a walking trail, allowing visitors to experience an array of colors, smells, and textures during their time in the space.

The garden features an area with pomegranate and lavender plants with for hands-on exploration and a space for workshops and horticultural therapy, where participants can participate in the sewing and harvesting of plants and witness actively witness their lifecycle. This not only provides an educational experience for the young patients, but allows them to develop their motor and sensory skills as well. 

The last area within the garden provides a space dedicated to emotional healing, an ever-growing need for the surrounding community. The space is lined with thickets of verbena, pepper trees, and soapbark, which separate it from the main area of the garden. Birdhouses were installed to attract birds to space, allowing visitors to enjoy birdsong as a part of their experience within the garden. 

Incorporating natural spaces into hospital infrastructure will facilitate effective, sensory-based therapeutic practices proven to benefit the human mind and body. More importantly, current national trends make it more possible than ever to incorporate this spaces into the national health system.

Nature as Patrimonial, Communitarian, and Healing Infrastructure

Findings by Vidal and Pol (2005) regarding environmental psychology indicate that an important element of feeling part of a social group is feeling connected to physical spaces significant to said group. The Cosmos' Foundations builds on this concept in their research on rehabilitation within healthcare communities that highlight the importance of empowering individuals through exposure to the native ecosystem. 

A clear example of this is the Jacaranda Healing Garden at the Children's Neuro-Psychiatric Service of the San Borja Arriarán Hospital in Santiago , which treats more than 30,000 patients annually. This 1,600m2 space houses the original trees from the hospital's old garden, including six Phoenix palms that precede the building's construction. For the surrounding community, these trees became a part of the local collective subconscious, denoting not only the history and heritage of the building but of the community itself and the experiences lived by its members within the hospital. This made the palm trees a focal point for the creation and layout of the healing garden and they served as the markers for the distinct areas within the garden, such as the spaces for meditation, sensory activities, physical therapy, and workshops.

In the case of gardens within historical hospitals, plants often harbor a connection with the local community and the incorporation of local flora into landscape and architectural project should focus more on plants' place within local health customs than on their aesthetic qualities.  

Nature in Hospital Infrastructure

There is evidence that some elements of exterior design have significant impact on the clinical results of patients (Rubin, 1998).

Another such garden can be found at Pequeño Cottolengo , an institution located in the Cerrillos Commune of Santiago that specializes in the care of mentally disabled individuals. Many of its residents have limited mobility and can't independently visit the green spaces on the institute's grounds so, to give them access to a nature area, the garden was designed without divisions or barriers between spaces. The space consists of two gardens connected by a sheltered terrace that allows residents to enjoy the garden even when it's cold or raining. This also allows patients who can't go outdoors to visually enjoy garden within a space that can accommodate their needs.

A great deal of research has indicated that people who feel in control of their circumstances demonstrate higher stress management and better overall health than individuals who feel they have little power over what happens to them (Evans y Cohen, 1987). This perceived loss of control yields negative results within treatment, especially when patients perceive they have no ability to decide where they go, what they do, and are placed under constant supervision with no time to themselves to relax or pursue their own interests (Taylor, 1979; Ulrich, 1991, 1999). Healing gardens aim to alleviate this restrictive environment by breaking up the monotonous routines of the patients, giving them the freedom to move about and explore in a safe, private, and relaxing space.

Other research has shown that, in many cases, people who have greater social support experience less stress and better health than those who face isolation and fewer social connections (Shumaker y Czajkowski, 1994). At Cottolengo , this support is provided by the staff, whose needs were also considered in the project's design. These considerations led to the creation of a relaxation space, where the staff can interact with each other and build their support systems (Marcus y Barnes, 1999). The staff's space includes shaded benches surrounding a fountain, offering both scenic and auditory relaxation experiences to give them a respite from the hustle and bustle of the workday.

In this context, vegetation serves as a design element able to transform otherwise inhospitable areas into comfortable, relaxing environments that benefit everyone, including those suffering from both physical and mental ailments. 

Looking Forward: Nature within Hospital Infrastructure

Not only do plants aid in stress and pain reduction, but they also add to sleep quality and decrease the likelihood of reinfection, resulting in both decreased hospitalization times and costs (Ulrich: 1990). For these and many other reasons, nature within hospital infrastructure should become a fixture in all areas of the national health system.

Firstly, it has been demonstrated that it is necessary to bring hospitality back to hospitals; in other words, return to the origins of health-centered architecture and incorporate research-based natural elements into our health infrastructure. This starts with a cultural shift in both how we design and build hospitals and how we plan and apply therapies, implying a trans-disciplinary approach applied across both the architectural and medical field. 

Secondly, this cultural shift should be bolstered by public policies based on current scientific evidence. This means that changes are not limited to only the nation's prestigious medical institutions but are made available to any and all who desire or require them. Conversely, if government entities disagree with said evidence, this will not only result in monetary losses but the potential loss of life. Luckily, the implementation of nature into Chile's hospitals is effectively possible.

In the midst of the COVID-19 pandemic, these changes are more needed than ever. In times of epidemics and pandemics, humans have aligned with and distanced themselves from nature on a cyclical basis. The question is, where are we in the cycle currently? Will designers and healthcare professionals be able to advocate the scientific evidence and overturn existing cultural notions that hold back health and healing? Given this historic and complex time we are living in, the answer remains unclear but the opportunities are bright. In the words of Alexander von Humboldt, “in this great chain of causes and effects, no single fact can be considered in isolation” (Humboldt, 1807:43). In essence, nature is a living ensemble within which all organisms are intertwined in a network driven by dynamic change: the cosmos. (Wulf, 2015:293-308)

Now has never been a more opportune moment for hospital architecture to shift and realign itself with its naturalistic roots and incorporate nature into its design, resulting in a holistic and healing approach to modern healthcare. 

About the authors:

Felipe Correa Tagle

Architect, Pontifical Catholic University of Chile , 2005. Publications include "Planificación de la Precordillera como Plataforma para la expansión de los Parques Urbanos: el caso del Parque Natural Cantalao Precordillera" (published in From The South/Desde el Sur: Global Perspectives on Landscaping and Terrain, Sciaraffia et al, Chile, 2019). He has been a professor of Architecture at the University for Development. Since 2014 he's been the Project Director for the Cosmos Foundation in Chile.

Valentina Schmidt Escobar

Architect, University of Chile , 2011. Fullbright and CONICYT Scholar for Master in Urban Design, University of California Berkeley, USA, 2017. Her publications include San Francisco Bay: Adaptation by Design, jointly published by the University of California Berkeley and the Architecture School at Delft University of Technology, 2016-2017, She is the co-author of the book Ephemeral Urbanism: The Landscape of Temporary Cities, Harvard Graduate School of Design, 2015-in the process. She has been an assistant professor of Architecture and Urbanism at the University of Chile. Currently, she serves on the architectural team of the Cosmos Foundation.

Consuelo Roldán Diethelm 

Architect, Masters of Landscape Architecture from the Pontifical Catholic University of Chile , 2017. Masters Thesis presented at the 10th Landscaping Biennale in Barcelona, 2018. Roldán is a professor of City and Landscaping at the University for Development in Chile and has been an instructor for the Masters in Terrain and Landscaping at the Diego Portales University in Chile as well. She is part of the architectural team for the Cosmos Foundation.

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