7 June 2023 Seminars

A patient will be interviewed by a psychiatrist who was his Responsible Clinician when he was detained. The interview will concentrate upon the patient experience with specific reference to the physical environments within which he has been managed as an inpatient. There will also be time to pose your own questions.

Laura will be presenting the findings from two systematic literature reviews that she has led and delivered to inform the development of the mental healthcare built environment (mHBE) Quality Assessment Tool produced by NHS Scotland Assure and the Scottish Government. The systematic literature reviews identified, critically assessed and synthetised existing research on the factors of the facility design that (1^st literature review) act as a therapeutic intervention for service users, and (2^nd literature review) impact or are important to staff. The focus of both reviews is on adult mental health inpatient settings.

In this session, Raf Hamaizia, Lived Experience Lead for Cygnet Healthcare, will explore the importance of Co-production within the built environment. Using Cygnet’s coproduction toolkit as a basis, he will give examples of how it can be used to improve environments, patient safety as well as peoples experiences and their well-being.

The audience will be left to explore different and innovative ways of working such as harnessing talents and abilities of the workforce and people with lived experience in dedicated roles such as the Co-production Artist at Cygnet Health Care.

This presentation will involve: input from a CAMHS Consultant Psychiatrist and Medical Architecture.

The theme will be the journey of developing the case for and the design of a CAMHS PICU in Poole, Dorset. The presenters will bring together the patient experience, the clinical need, the operational drivers, and the design piece.

The recognised shortage of CAMHS PICU beds nationally, makes this a live issue. The proposed new-build PICU will have a number of state-of-the art therapeutic spaces. The focus of the sessions will be about relating design, to the PICU clinical model and patient experience.

PICU Physical environment.

The Third Edition of the PICU text book published by Cambridge University Press is due for publication later this year.

Within the text book, a chapter features covering the physical environment of a PICU including relevant evidence and other published opinions.  This presentation will reflect the key characteristics of PICU design included in the book chapter as well as other advice based on experience of delivering PICU services in different environments. The presentation will include photographs and video of a PICU with the past, present and possible future design issues highlighted.

The presentation will focus upon the nuances and realities of an effective PICU physical environment.

Recognising the need for standardised product testing in the mental health built environment, DIMHN have been working for some years now on an independent testing solution in partnership with BRE – INFORMED CHOICES – a new global testing standard which gives a graded performance measure for use in mental health environments. Extensive research with the market, estates and clinician consultation have formed the backbone of this work, which is being launched formally at the conference.

To encourage adoption of the new standard, DIMHN will support education events, webinars and discussion points so that clinicians, specifiers and planners can make INFORMED CHOICES.

At the workshop INFORMED CHOICES – transparency between built environment and clinical risk management Emma Shakespeare, Senior Design Manager, Sir Robert McAlpine, Claire Iverson, suicide prevention lead at Merseycare and Vicky Taylor, interior designer at Knightsbridge Furniture and associate of the Network, will discuss the balance between managing risk through built environment, product, clinical, and service design. The Workshop will be an opportunity to share thoughts with peers on how to assess performance results and best practice using the new standard. Suitable for clinical teams, designers, manufacturers and architects.

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An audit of mental health patients carried out by Lewisham & Greenwich NHS Trust in August 2019 found that more than half of the people who went to emergency departments (EDs) for help because of their mental health waited more than four hours to get the right care. One in seven spent more than 12 hours in ED, exposing patients, NHS staff and visitors to additional stress. This figure is probably far greater now.
The project involves collaborative working between the Queen Elizabeth Hospital (QEH) and Oxleas NHS Foundation Trust, to improve the collaboration and partnership between mental health departments and ED teams. The new area will allow mental health patients to receive higher quality care by providing them with a specialised area for their specific needs, staffed by specialist nurses from Oxleas.
The new Mental Health Assessment Area (MHAA) at QEH will offer the local population a suitable and safe environment for patients who present in crisis, in which to be assessed and treated whilst awaiting next steps in their care pathway or whilst awaiting transfer into a clinically appropriate environment. This will give a better patient experience by removing patients from the overly stimulating ED environment and by allowing patients to access therapeutic intervention.
The presentation will focus on the collaboration and partnership of the MH and EDs teams and in specific on two of the biggest challenges which were:
• To find and agree on a location within the existing and busy hospital to host the new MHAA, considering the importance of the relationship with the EDs and mental health teams, and
• The consultation with all the different groups of stakeholders to build strong ERs and to deliver a mental health friendly and functional environment which can work for all the stakeholders.

This presentation will follow Jo’s journey from Architect to service user, and from service user to lived experience Advisor. It is an invitation to collaborate with evidence based, lived experience expertise, and will explore the need for, and potential of, lived experience advisors in the design of mental health spaces.

Jo will provide insights into the involvement process behind spatial planning, furniture selection and art creation in collaboration with art charity Hospital Rooms, and examining the role of lived experience advisors in the design of the new mental health hospitals in South West London.

Our mental health care spaces can hold the tension between providing ‘sense of safety’ and a ‘sense of self’. Surely then, the expertise of users should help to shape better care for the future?

1 in 4 people experience a mental health problem of some kind each year, and the biggest current concern for these people is the problem with accessing support. Shortage of providers is now critical and staff burnout prevention has become a major concern. The workshop shall aim to look at means of making mental health support more accessible. The primary focus being to improve the social connection through MH cafes & creating healthy wellbeing spaces for patients and staff. Ensuring easy access with free wifi and levelling up home access to those in need. Exploring where the journey begins, and what means can be reviewed and enhanced to create better education and prevention. Investigating ways on how we can destigmatise Mental Health so that it is easily accessible to all.

Please register for a place on site

We are all the experts on ourselves. Ideally, we need to stay within our homes and communities. However, if a facility is needed it needs to feel comfortable and the person needs the space and opportunity to learn who they are. Let’s be open to the idea that western psychiatry is not necessarily the right answer for some and maybe multi-cultural approaches can be beneficial.

The National Forensic Mental Health Hospital in County Dublin, represents a once-in-a-generation step-change in the design of facilities for mental health services in Ireland. The building was designed by Scott Tallon Walker Architects in association with Medical Architecture. Located on a 10-hectare woodland site, the 25,000m² campus replaces the existing Central Mental Hospital in Dundrum, and accommodates 170 high, medium, and low secure mental health beds. The accommodation is laid out as a series of single storey pavilion buildings around a pedestrianised ‘village green’ which contains peaceful gardens for patient amenity and therapeutic activities. Intuitive wayfinding is achieved through a site-wide narrative of colour, art, and landscaping. The project brief and subsequent design have been heavily focused around providing a safe, secure and healing environment that contributes to a patient`s recovery. The presentation will look at how this has been realised including: • Strategic masterplanning and arrangement of accommodation to optimise the existing topology, mature woodland setting and long coastal views. • Adopting a set of very clear planning principles to manage safety and security, while providing freedom of movement for patients • Addressing the competing requirements of observation with the quality of space, daylight and views • Creating high quality internal environments that will endure • High quality landscaping and space for activity to create community, and a meaningful day for patients • Accommodating differing services and future adaptability through standardisation of design. This new facility sets a new standard in mental health facility design in Ireland and provides an international benchmark from which other nations, including the UK, can use to inform future developments. The presentation will look at lessons learnt from design, delivery and the initial evaluation of performance.

Several studies departing from the experiential worlds of patients and staff have explored the links between the architectural design of forensic psychiatric buildings and the patient recovery process. Others have proposed models of how psychiatric wards may be designed to reduce stress and aggression. Nevertheless, one of the most prominent recommendations in the literature concerning psychiatric hospital design is to minimize the institutional atmosphere and instead promote a more homelike environment. Even though current literature has affirmed the importance of the physical environment in supporting better outcomes in mental health services, more rigorous research is needed to establish the link between structural surroundings and mental health outcomes.
In November 2018, the psychiatric Aarhus University Hospital (AUH), dating back to 1852, relocated to a new modern purpose-built psychiatric hospital. The relocation presents a unique opportunity to examine the effect of structural surroundings on aggression and how the physical environment may impact recovery.

Aim of study
To explore how inpatients and staff in medium secure forensic psychiatric wards experience the structural environment, focusing on homeliness and how the structural surroundings may impact recovery and aggression.

Methods
The study design is mixed-method. We perform semi-structured interviews with staff and patients, collect structural data from official blueprints and building databases on the old and new forensic wards. Interview data will be coded in Nivivo12 and analyzed using thematic analysis inspired by the literature on patient recovery. We depart from a model of how architecture may support the reduction of aggression in wards and evaluate what kind/if critical architectural features are recognized as essential to minimize the risk of aggression.

Results
Will be presented and discussed at the conference.

We are all different. What makes each of us tick and feel able and well to tackle the challenges of the world is different. How to we find comfort and wellbeing away from home?

We know that personalised and flexible spaces are the result of choice and create the opportunity for individualised care and recovery. Having choice is a fundamental requirement of freedom that is often reduced or removed in In-patient environments. But mental health inpatient settings are regularly designed around a set of core spaces and standardised repeatable rooms, with limited resources focused on how we enable truly individualised care through the building itself.

The workshop will explore key components of a typical mental health ward, striving to define what makes good design appropriate for each of us, and how this can be achieved using innovative products and technologies.

Ideal attendees will include People with Lived Experience, Clinical Staff, Estates and Facilities Teams, and Designers, and will help inform a new best practice for in-patient care environments.

Outcomes will be summarised in a paper within 6 weeks of the workshop.

Please register for a place at the workshop on site

This presentation will focus on the important role played by good landscape design in the creation of therapeutic mental health facilities. Our approach to landscape design in mental health, and a focus on good such design can enhance mental healthcare settings. We all recognise how green outdoor spaces and access to nature benefits our health and wellbeing. Most important is the provision of patient and service user accessible outdoor space. Spending time in nature has been proven to reduce stress, improve our memories, and make us kinder and more creative. Providing accessible sensory and healing garden spaces enhances the sense of wellbeing and helps to reduce stay times in mental health facilities. It is the vital role of the landscape that is the theme of this presentation. Our presentation will cover a number of key criteria as part of this placemaking process as well as covering the important clinical requirements of providing therapeutic and sensory spaces that encompass safety and security in a much more creative way to avoid places feeling institutional.

In 2020, The NHS declared its journey to net zero vision. This ambitious vision includes mile-stone targets for an 80% reduction in the carbon footprint by 2028-2032 and a 100% reduction in the carbon footprint by 2040 (net zero carbon performance). Achieving these targets demands that we collaborate, acting now, acting decisively, and acting correctly.

This is a great ambition, and it must be delivered whilst maintaining a patient first approach to health care. Based on feedback from service users given in the 2021 Designing in Mental Health Conference, the environmental condition within rooms has a pronounced effect on patient well-being, health and recovery.

Following the successful response to our presentation at last year's conference we would like to come back and present further findings over the year and how current net zero carbon thinking is affecting service user experience.

Having worked for the Trust in IT for four years I'm a person with lived experience and I also have A physical disability, I'm at the centre of the programme's day to day running. I have real responsibilities and I am involved in making key decisions. I have attended all the design engagements and design meetings across the programme. I feel listened to and able to offer feedback and advice. I've been a vessel for service users and carers across our services to be involved, giving feedback on how they'd like the buildings to look and feel.

Sussex Partnership is a mental health and learning disability NHS Foundation Trust in South East England. In 2020, a project was proposed to work with hospital staff to create 'Autism Friendly' environments on acute mental health wards, by primarily looking at the Environment; the Ward Processes; Staff Training and increasing Confidence. This was due to recognising the high number of autistic service users who had reported that the environmental and sensory aspects of their admissions had negatively impacted their wellbeing and inpatient experience.

Two pilot wards were selected: an 18-bed female acute mental health ward and a 19-bed mixed sex acute ward in Sussex. Both wards support adults aged 18-65 with mental health needs, who require inpatient care and treatment.

A sensory audit of the ward environment was completed by two Occupational Therapists (OTs) and a group of Experts by Experiences (EbEs). The EbEs all had experience of admission. Photos were also shared with another OT and further EbEs and The 'Checklist for: Autism & Mental Health-Friendly Environments' was used to help facilitate discussions around the senses and experience of each area of the wards.

The team worked to develop environmental recommendations considering the senses (visual; olfactory; auditory; proprioception/body awareness; tactile; gustatory and vestibular). These were shared with management and estates teams to implement these recommendations safely and efficiently to achieve our goal of creating 'autism friendly' environments. The project coincided with ward refurbishment projects and therefore the recommendations were able to be incorporated as part of the general refurbishments.

By collaboratively working with the group of EbEs, this kept the service user experience in the centre of the project, and challenged all involved to think differently. It is felt that the recommendations are meaningful and already having a positive impact for service users within the mental health wards.

Architecture is a discipline that helps organise environments to suit the user's requirements and needs. This is fundamental to our design philosophy, none more so than when we work on mental health projects. We believe that creating autism friendly environments is central to any scheme and that, no more, should people with autism have to fight for their rights.
In many cases we see that surrounding environments contribute to a person's disablement. The same person set in the right environment could then be seen as an able person.
The main design principles, which we apply to all our projects, have evolved through consultation and engagement with trustees, clinical staff, facility managers and, more importantly, in talking with and respecting people with autism and other learning difficulties and their families.
The presentation will focus on
• How to engage with people with Autism at the design stage
• Autism friendly colour palette research with Hilary Dalke at Kingston University
• Proxemics and sensory space perception
• Specific challenges: finding the right balance between a building that will resist challenging behaviour and the need of sensory stimulation to avoid self harming