Clinical Seminars

We will present research on the significance of the physical environment for health and well-being in various closed settings such as forensic psychiatry, youth homes (SiS), and prisons.
Moreover, we will propose design suggestions that may have the potential to improve people’s wellbeing and health in these settings.

The healthcare environment serves as an active agent in the rehabilitation and habilitation of patients in psychiatric closed care. The design of the physical environment in psychiatric settings has been compared to the need for high-tech equipment in somatic healthcare. The physical environment itself becomes both a tool and support for patients and staff, primarily through its stress-reducing function, as highlighted by the field of Evidence Based Design (EBD). Our research shows that the environment can support the therapeutic alliance between patient/client and staff, especially by conveying a sense of trust, security, and autonomy. It is also reasonable to assume that the environment itself can reinforce or "redirect" and change the identity we carry.

The staff constitutes the essence of the care provided, and therefore, their need for a safe and secure working environment should be an integral part of the environment's design. Only then can the conditions for good care and interpersonal encounters be established.

In any closed facility the feeling of confinement is at the forefront, accompanied by many losses. The question is whether the environment can compensate for these losses, or at least not exacerbate them. Despite the limited living conditions within institutional care, there are ample opportunities through environmental design to promote well-being. We see that physical and mental health could be positively influenced by designs that encourage e.g. physical movement both indoors and outdoors, a better designed sleep environment, and not least a sense of belonging.

It is well recognised that in secure mental health inpatient units, boredom leads to challenging behaviours and poor physical health. This presentation will explore how considered planning and design can ensure ‘a meaningful day’ for all patients, promoting recovery through activity. The newly completed Sycamore at Northgate Hospital will be used as a case study to demonstrate this principle, with insight on the building design from Paul Yeomans (Medical Architecture).

In collaboration with a large NHS Foundation Trust based in the North of England, this research project aims to understand the psychological dimensions of acute inpatient ward social spaces and explore the interplay of inhabitants and in both existing and newly developed acute environments. Acute wards are collective spaces of care, monitored and supported by clinical staff. Such spaces include inhabitants with individual and shared identities embracing diverse backgrounds and support needs. Social spaces on these wards constitute vital sources of social interaction offering core benefits related to recovery. However, they are complex spaces involving boredom, noise, social conflict and other challenges. There is currently a lack of research relating to experiences of social spaces, for those living and working in inpatient environments despite their importance in hospital life.

An interdisciplinary team of academics specialising in mental health and cognitive neuroscience research aim to capture emerging feelings, thoughts, and perceptions of inhabitant experiences and their bodily senses as they interact with old and new contemporary environments. Two studies will be outlined from this overall project, undertaken in acute mental health wards with staff and inpatients. The first adopts a well-established visual qualitative, photo-production methodological approach (Reavey, 2011; 2020) in a current hospital and the second uses a 3D visualisation approach using virtual reality with integrated eye-tracking to simulate a new hospital environment not yet built. The aim is to ascertain how patients and staff experience existing social spaces in acute environments in the first study and to then explore their experiences of social spaces in new (albeit virtual) ones as a means of comparison.

Through an ecological approach, a better understanding of these unique and complex spaces in acute mental health wards will be developed, furthering knowledge on the design and management of these vital social spaces.

Eating disorders are responsible for more loss of life than any other mental health condition and are becoming increasingly common. Treatment can be challenging, with patients often reluctant to receive effective care. This can lead to covert interference behaviours, ‘sabotaging’ treatment.

This presentation will explore how considered planning and design can create specialist facilities that enable patients to re-establish a positive relationship with food and exercise. The newly completed Kimmeridge Court Eating Disorders Unit at St. Ann’s Hospital, Dorset, will be used as a case study to demonstrate this principle, with insight on the clinical model from Dr Carla Figueiredo (Dorset HealthCare) and the building design from Laura Delgado (Medical Architecture).

Kimmeridge Court is not a typical NHS mental health facility. Located in a protected wooded site, the building has been designed to preserve the quality of its natural setting and to create a uniquely private and therapeutic environment for the treatment of patients with eating disorders; many of whom have limited mobility. The size, positioning and detailing of the building have been carefully crafted to minimise its impact on the surrounding mature trees, enabling their retention remarkably close to the new building and offering spectacular views out to gardens, the surrounding woodland, and tree canopy to maximise their therapeutic benefit.

Service users were consulted on all aspects of the design including effective therapy, safety and privacy, and the interior design. Integrated art, seating and rooflights create informal places for therapy and contemplation. Observation is integrated to be effective and discrete. Therapy and activity spaces are designed to be flexible, using sliding screens, to be either social or private.

This new facility treats patients with dignity and respect; a tangible demonstration that the service, staff and patients are valued.

Trust: Sussex Partnership NHS Foundation Trust
Architects & Interior Designers: Gilling Dod
PSCP: Kier

The design journey for RIS:ES has been one of co-production and collaboration which has been embraced by all stakeholders. The building brings together a variety of healthcare specialisms, including working age adult and older adult inpatient wards, with medical education and neuromodulation departments.

RIS:ES is to replace the existing Department of Psychiatry facilities in Eastbourne which has dormitory accommodation, restricted access to garden spaces, and is set in the clinical setting of Eastbourne District General Hospital.

Experts by experience have been at the core of the RIS:ES story, sharing their expertise and insights every step of the way with positivity and care. Their input has informed all aspects of the building design from the little details such as having tables with rounded corner in meeting rooms, to the big picture principles around room adjacencies and garden spaces.

The co-production approach has developed an innovated X-shaped ward typology which provides two gardens spaces per ward, en-suite bedrooms clustered into 3 groups of 6, single sided bedroom corridors, and connectivity to adjacent wards.

Trauma-informed, dementia-friendly, and neurodiversity-friendly design principles have been implemented and tested with trust specialists in those fields.

Co-production with staff has helped implement a diverse provision for staff welfare with localised staff rest room, lockers, changing rooms, and showers to each department.

Applying lessons learned also informed design, not least in the bedrooms. The P22 repeatable room bed position most preferred by service users was adopted. Half bay windows were added to provide a view out to landscaped grounds directly from the bed position.

This co-production approach has extended into the construction phase, with the PSCP Kier turning the collaborative working into the reality of a physical building.

RIS:ES is due to open in 2025.

Patients with mental health disorders could find themselves in the emergency department in their most vulnerable state. However, CQC research has identified that these patients have a poorer perceived experience than other patient groups.

Increasingly, the physical needs for patients with mental health disorder in the emergency pathway have been addressed and dedicated places of safety are provided in the department. However, what have we put in place to safeguard a patient's psychological well-being in these environments?

As an architect and a service user, I would like to share personal experience of using these spaces in the emergency departments and the subsequent design project I undertook to redesign a mental health patient assessment room. This research project included testimonies from service users, families and ward staff.

This talk will highlight the benefits of broad collaboration, the importance of a strong relationship with stakeholders and securing post-occupancy feedback. It reflects on the rewards and difficulties of applying a Grounded Theory research methodology as opposed to a conventional building process.

Cambridge Children’s Hospital (CCH) is the first children’s hospital in the UK to integrate physical and mental healthcare, bringing young people, their families, clinicians, and researchers into the same space to foster collaboration and innovation within the emerging Cambridge Biomedical Campus (CBC), the centre of Europe’s leading life sciences cluster.
The spatial organisation supports a new model of integration, where the hospital’s multiple departments are organised to share resources, create greater operational efficiency, and encourage collaboration to form a knowledge exchange between clinicians, and foster empathy between patients. This integration is most obvious at the ward levels, where mental and physical health units are co-located on each level to bring together patients of similar ages and establish correlations between mental and physical health conditions.
Clinically, this integration brings team members together to create an efficiency of space and service, consolidating hospital staff who are currently dispersed across several sites. More importantly, this provides opportunities to exchange novel insight and knowledge around the care of young people.

This new model is the first of its kind in the world and aims to treat the whole child, not just their underlying symptoms, by taking into account the mental health implications of long-term hospital stays and the physical health complications faced by patients with mental health conditions.
I will be joined by one of the clinical leads working on the CCH and our presentation will set out the following:
- The client’s vision for the CCH.
- How the design has responded to the client’s vision and brief.
- How the spatial organisation supports their model of integration and provides future flexibility.
- How we are designing with empathy and providing spaces that supports healing and responds to the needs of all involved: clinicians, parents, and children of all ages.