Green Theatre Seminars

Englishcombe Lane supported housing will provide much-needed accommodation for adults with learning disabilities on an allocated site in Bath. Plans for the development, which will provide 16 units of community housing on land to the rear of 89-123 Englishcombe Lane, were approved by Bath & North East Somerset Council planning committee on 25 September.

Client and the design team set out to create the best possible internal and external environments for people with neurodiverse conditions to support their emotional wellbeing. Guided by the stakeholder team from the council who works daily with the future residents, the homes have been specifically designed to enhance the lives of adults with learning difficulties and /or autism spectrum disorder by minimising potentially distressing environmental factors whilst enabling and supporting the residents in reaching their full potential. The architects have used PAS PAS 6463:2022-Design for the mind, guidance from the Stirling University DSDC and HAPPI design principles to achieve sensitive and flexible layouts for the houses, that allow the resident and carers to control the stimuli and triggers and enable the resident to decorate and personalise their house to suit their needs and personality.

The development will provide a mixture of one-bedroom single-storey houses and two-bedroom two storey houses. There will also be a community hub for the residents. All the houses will be designed and built to ensure accessibility and adaptability for wheelchair users.

The site selected for the project was challenging: The plans needed to balance the need for community housing whilst protecting the ecology of the site and incorporate flood and drainage considerations. The houses are carefully designed around a challenging topography.
The landscape-led scheme will use a Building with Nature approach to sensitively integrate heritage and ecological conservation with high-quality design, visual amenity, and sustainable development principles.

North View is Greater Manchester Mental Health NHS Foundation Trust’s new 150 bed, £106M Adult Acute inpatient unit, at North Manchester General hospital. The scheme replaced the Trust’s inpatient dormitory accommodation - Park House, and forms part of the NHP/Healthy Neighbourhood Masterplan for the site which reimagines a multi-faceted and holistic approach to healthcare delivery at the heart of the Community.

Key topics/themes –
• Once in a lifetime opportunity to redesign a service. The clinical vision. Clinical and Operational learnings from the past.
• Funding/politics/navigating the Business case process. The ‘Economics’ of modern MH inpatient care. The need for change.
• Design brief – Continuing to push boundaries and apply innovation.
• Designing/engagement/procurement through the pandemic. Challenges and reflections.
• Co-production/Stakeholders informing design. > ‘Person-Centred-approach’, ensuring SU voice is not lost in the engineering.
• NHP context/Healthy neighbourhoods master-planning. Integrating the design/delivery within the site wide masterplan/NHP timelines/diverse stakeholder group.
• Creating/protecting a human scale on a major build. Maintaining the ‘person perspective’. Avoiding the asylum.
• Designing multi-storey inpatient environments >challenges/opportunities. ‘Gardens in the air’.
• Risk and nursing> Evolution of Ward typology design, standardisation vs pathway drivers. Safety and psychologically informed environments.
• Place making and narratives. The importance of landscape and artwork. Addressing the legacies of the past and a reset on the role of MH services in the community.
• NZC and Mental health settings. Fully electric solution. Reflections/lessons learned.
• Construction delivery through a pandemic, European War, cost-of-living crisis.
• Handover/transition planning/commissioning > use of tech and VR.
• First 6 months of occupation > reflections/early indicators around changed behaviours/ownership. Lessons learned and future legacy.

The presentation will take a multi-facetted approach with representations/insights from the Trust (GMMH – Estates and Clinical), Service users and staff, Designers (GDA/iteriad) and possibly contractors (IHP).

The new Acute Mental Health Unit at Ipswich Hospital, Queensland, Australia has been designed to fulfil an ambitious vision around delivering best-practice recovery-focused care for the community.

A foundation of healing underpins an environment that nurtures wellbeing and mindfulness. Architecture, interior design and landscape work together to establish a holistic setting of calm to restore dignity to the healing journey, normalise mental health care in the community and deliver a new benchmark for recovery-orientated care in Australia.

An overarching philosophy around ‘designing for people’ has shaped both the process and the outcomes of this project. The design focus has been on caring for people, consumers, their loved ones and those people providing the care, to create an environment that supports the network around each person and enables care for the ‘whole person’.

The community has been at the core of the co-design process and the community remains the foundation of the care model that is now being successfully delivered.

A community of stakeholders – the facility has been designed through a deep and comprehensive engagement process that welcomed the community, including First Nations representatives, to participate in the co-design journey with equal footings.

A community of care – the building as a setting to enable best practice in a rehab-focused model of care – consumers, carers and staff form a progressive community focused on healing and mindfulness.

The family community – breaking down stigma, consumers, carers and family are welcomed with pride into the healing environment and participate in the recovery journey, aiding transitioning to home and resulting in reduced relapse.

Evidence is currently being gathered which indicates that the healing environment is profoundly benefitting the community through more effective healing and a more effective workforce providing both health and cost benefits for the whole community.

The presentation will outline key project objectives, the collaborative design process and innovative design manoeuvres that have shaped the facility and are now directly benefitting the community. This will include insights around the type of care being delivered, family participation, staff satisfaction and consumer recovery rates.

A child’s ability to regulate their nervous & vestibular systems can help them stay focused, control emotions and improve attention spans and sleep. Some children process sensory input different than others—some are constantly seeking out movement while others prefer to stay still or move in a more rhythmic manner. Some kids are ‘sensory seekers’ and will be constantly jumping, bumping into things on purpose, have lack of personal space, seek out loud noises and more. Instead of admonishing these behaviors, it is important to understand the physiology and psychology behind these actions and how the built environment can help regulate these seemingly out of control behaviors that can be disruptive.

It is vital for children to have the opportunity to regulate their nervous system and emotions, whether they’re in a behavioral healthcare space or in the classroom. This presentation will share design strategies that can be easily incorporated to allow for neuroregulation (gross motor rooms, incorporating technology that promotes movement, safe access to indoor and outdoor spaces where movement is encouraged) as well as in progress or completed projects that have such strategies or spaces.

There will be a focus on neuroregulation strategies and spaces in child and adolescent behavioral health facilities and education settings, where children may have more difficulty with regulating and need more assistance and opportunities to do so. Considering everything from how a child will move through the space to furniture selection to different textures and finishes in a room can be simple ways to help therapies and outcomes.

Meadow Green is special because:

1. It’s been designed from a staff initiative to fulfil a clinical need.
The presentation will explain how the original idea came from staff initiatives and research.

2. It’s functional.
Through the design process, we concentrated on function above everything. Part of the 'functional' aspect of the project is the new facility must be easy to look after and work for staff as well as patients.

3. It’s outside and yet part of the existing Meadow Ward.
The integration of the ward was a particular concern for staff.

4. Staff have been instrumental in guiding the design at every stage.
Design Team meetings (held both online and in person at the unit) were attended and in many cases driven by staff at the New Haven Unit.

5. It’s retrofitted (not new build) to an existing hospital.
This makes the new Ward extremely cost effective and space-efficient.

6. It’s in an NHS setting (not a care home).

7. It’s been installed to a budget and NHS clinical constraints.

I have worked with DSA Environment + Design since 2007 on a range of outdoor spaces mental healthcare projects across Worcestershire. I was therefore confident that they had the ability and track record to deliver what was needed to meet the brief for this forward-looking and innovative project.

DSA knew the site well, David Singleton having been a member of the design team that delivered the original Newhaven Wards in 2012. DSA have tackled the complexities of the project competently and with their usual enthusiasm! They engaged the staff early on and were particularly responsive in working closely with them to evolve ideas and produce a new Outdoor Ward; something that is, we think, unique to NHS dementia care in the UK.

DSA continue to visit to learn how the ‘outdoor ward’ is working, so that the lessons can be taken forward into other projects.

The SouthWest London and St George’s Mental Health NHS Trust commissioned new hospital buildings, Trinity and Shaftesbury, which opened in December 2022 and September 2023 respectively.
The Estates Modernisation Programme focused on the de-stigmatization and integration of mental healthcare within a community. New secure and acute inpatient wards were placed next to ca 900 new homes, a new 13-hectare public park, retail shops and community spaces for an emerging South London neighbourhood. The design aimed to create therapeutic surroundings for staff and service-users with courtyard gardens, ample daylight and fresh air, dignified surroundings and safe layouts.
In the one-year period since the first building was handed-over to the Trust, the initial post-occupancy data shows serious incidents are down by over 36% - an exceptional and noteworthy benefit. But the intention of this presentation is to take an unvarnished look back; using both recent incident data and feedback interviews, it will examine the nuances of what has worked and what hasn’t in the design of new mental healthcare facilities.
Designers live in a bubble partially of our own making. We believe in the therapeutic benefit of well-designed environments. But when this vision meets the reality of understaffed, under-funded and risk-averse healthcare institutions, how do these ideals stand up?
The presentation will look at how the new wards have been adapted after hand-over by the Trust to address practical concerns about control and security. It will look at what specific features of the new hospital are valued (or not) by service-users, clinical staff and management. Lastly the talk will examine the way a major healthcare project is co-produced between designers and clinicians; through a multi-year process of design and delivery, how stakeholder(s) can uphold the vision of better, safer and more therapeutic mental healthcare facilities?

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).

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.

Reflections on the new £32m Aspen Wood Low Secure Learning Disabilities Unit Project, Maghull, for Mersey Care NHS Foundation Trust. Including national context re LD services, service aspirations/key drivers, Service user engagement, cross sector learnings, Sensory design, security challenges, Landscape design, the Arts, construction delivery through COVID. Lessons learned/Influence and on two subsequent GDA LD specific projects currently in design in Lancashire and the Black Country (ie Blundell Brooke LD Unit and Heath Lane LD recovery Hub). Continuity of briefing/risk approach across different Trust clients. Finally, lessons learned and impact on wider Mental Health design best practice not just LD.

The Safe Home Environment Assessment (SHEA) was developed as a pragmatic way to capture risk issues and sensory preferences that need to be considered when designing a more bespoke home for someone. It was originally focused on the transforming care agenda where suitable housing has been acknowledged to be one of the potential barriers to someone leaving hospital.

Over the last 12 months the teams at Gilling Dod, Kingsway Group and Britplas have undertaken research, development, and collaboration to explore patient centred design around next generation CAMHS bedroom environments and in particular design responses around Autism, Neurodiversity and eating disorders.  The project is a vehicle to stimulate meaningful engagement and collaboration with a broad range of Service users, Experts by Experience, Clinical practitioners, carers, and providers in the sector. To give service user voices a platform, to stimulate design innovation/insight/learning and bring in supply chain experts/innovators to respond to bespoke needs. Aim was to create an innovative, responsive, sensory bedroom concept design which could be used to promote discussion/feedback/insights/learnings via real world mock ups to be encountered/explored/evolved with stakeholders moving forward.

Key to this project was engagement and we approached this is numerous ways. POE from previous CAMHS clients, reaching out to MH charities, advocates and champions in the field, and approaching leading figures in Autism centred services. This included The Caudwell Children’s charity who we have worked with collaboratively in developing the brief and even taking part in their Family fun day event meeting/engaging with young people, families, ambassadors and clinical practitioners to understand the key issues/drivers/triggers. Same experts then helped refine the initial concepts into a working design.

Designs were then developed with an assembled group of innovative suppliers (Kingsway Group, Britplas, Pineapple, Thorlux etc) to help create actual 1 to 1 mock up located either end of the country and with a view to engaging with key stakeholders over time to help evolve the understanding/stimulate the conversation. A chance to challenge the norm, go beyond the P23 repeatable room model, and promote design aspiration and expectations on MH build projects across all pathways.

There are 14 Secure Children’s Homes throughout England and Wales providing placements for vulnerable Young People aged between 10 and 19. The homes deliver tailored care in high-quality, safe, and therapeutic environments that meet all the Young People’s social, educational, health and wellbeing needs. Children are placed in the homes directly from the Courts, either through the Youth Custody Service or through Welfare requirements.

The Lincolnshire Secure Children’s Home (Millennium Lodge) is a pathfinder scheme. The project design team informed the design development process with visits to other exemplar Secure Children’s Homes and similarly aligned establishments. They have sought to implement the learning from these visits and the best practices at the establishments studied.

The goal is to enable Young People inclusive access to healthcare and educational facilities. This is at a time when the Young People accommodated present increasingly complex and multiple needs (such as child sexual exploitation, gang-related violence, mental health issues, and substance misuse). By adopting best practices in the design of the Home we improve and enable the successful operation of the new Secure Home. The project seeks to learn from the experiences of Young People, staff and visitors to develop a nurturing rehabilitative social and educational environment that is robust yet homely.

The design aims to normalise social, mental wellbeing and healthcare education as part of each Young Person’s daily routine. There are clearly delineated zones for healthcare, education and residential accommodation that support a mix of social and supportive spaces. The project team have carefully considered the experience of the building users in order to explore movement, adjacencies and support spaces that reflect the wellbeing needs of each Young Person in a robust, safe, and secure Home.

It is proposed to present this scheme in collaboration with the Secure Children's Home End User Stakeholder and DfE Client

The Brook is a new-build inpatient facility at Langdon Hospital for adults with a learning disability and/or autism. Highly Commended in the 2024 ‘Project of the Year - Future Design’ award category, the project is due to complete construction in early 2025.

The presentation will share how the design was developed to create a therapeutic, comforting, uplifting environment for recovery for people with complex sensory needs. Designing for neurodiversity was at the forefront of this project, with the added complexity of a mixed patient cohort comprising individuals who may have greatly differing environmental requirements.

Co-production and robust engagement with clinicians and Experts by Experience informed every stage of the design process; from advising on spatial zoning and flow for individuals who struggle with wayfinding, to developing interiors that avoid sensory overwhelm while using colour, lighting and acoustic solutions creatively to create calming and homely spaces.

The benefits to patients’ wellbeing of accessing outdoor space was a key design driver. Internal spaces are arranged around a series of generous gardens to create a sense of openness and ensure a view to the outside throughout.

Patient accommodation is provided in the form of 10 ‘flats’, each containing a living/dining space, bedroom, ensuite and garden. This enhanced level of private space reflects a domestic setting and supports those for whom social interaction or excessive stimulation may be overwhelming. The presentation will explore the challenges the team faced in providing patient kitchenettes and gardens while ensuring the associated risks could be suitably managed.

Brain science has made many exciting advances in the last decade. Understanding of this complex area is improving and so are options for people with severe mental illness. This presentation will discuss current and emerging psychiatric treatments, their procedures, side effects, regulations and outcomes for modalities such as Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), Esketamine Therapy, Psychedelics and more. Close to 80% of people who receive electroconvulsive treatment (ECT) for their mental illness improve greatly, with very few suffering setbacks as a result. It is often the first time they experience real results since diagnosis. However, this effective treatment modality has a complicated history with intense stigma and little consistent regulations. In addition to ECT, there are several other emerging interventional modalities proving successful in treating acute mental illness. This presentation will look at the physical environment required for these treatment modalities and how flexibility plays a key role in evolution of care. Discussions around clinical and licensing considerations will provide a holistic view on these emerging treatments and their powerful outcomes. It will also share project examples of neuromodulating suites, including different design solutions and approaches to flexibility.

The state of Texas in the southwestern portion of the United States is one of the largest states in the union. It has a current population of 24 million and is growing compared to the 57 million in the UK. Its population is expected to surpass the UK by 2050. The state’s is about 700,000 square kilometers or 2.5 times that of the UK. If it were an independent country its GDP would rank 8th in the world just behind the UK and France.

The state has operated a public mental health system for almost 150 years. The anchor of the system is the state hospital system comprised of 11 state hospitals built at different times. Over the years, many of these hospitals have become outdated and are inefficient.

In 2014 the state government embarked on a system assessment and how to best address the needs of the day and the future needs. A strategic plan was developed with recommendations on how to rebuild the system.

State legislature accepted and implemented all the recommendations in the strategic plan and eventually provided funding to build eight new state mental health hospitals. Three of the new hospitals have been completed or are nearing completion. The other five new hospitals are currently in the design process with the expectation of being completed in 2027.

This presentation will discuss the mental health needs in Texas, the strategic planning process to fill the gaps in the needs, and its recommendations. The presentation will also explore the opportunities in creating standardized facilities within the system while still respecting the unique communities that they exist in. Finally, the presentation will depict the design of the largest of the new hospitals and its unique design features for the populations it serves.

Joining in the presentation will be Mr. Scott Schalchlin, Deputy executive Commissioner of the Texas Health and Human Services Commission who is responsible for providing mental healthcare at the state level in Texas.

Arcadis’ architectural and interior design team has worked closely with the South London & Maudsley MH Foundation Trust (SLAM) and its stakeholders to design two high quality, patient-focused facilities within a very constrained site – Pears Maudsley Centre for Children and Young People (CYP) and Douglas Bennett House for Adults (DBH).
Designing and delivering two 10,000m2 high density, multi-storey buildings only metres apart presented a number of challenges, not least fitting the required floor area onto the congested site.
The design solution for CYP was an eight-storey building which includes research and office spaces, four floors of outpatient services, inpatient rooms and a school on the seventh floor. Large landscaped roof terraces and a school exercise terrace offer space for planting and nature. At DBH the solution was a five-storey building with 143 adult inpatient beds and a PICU. Each ward is based around a triangular light well to ensure good daylight internally along with double height balconies and outdoor rooms to offer outside space to inpatients at each level. The tiered designs and approach to evidence-based biophilic design, not only enhanced levels of natural daylight into all spaces, it helped reduce the overall impact of the schemes and contributes to achieving the London Plan urban greening factor.
This talk will showcase how these two different use buildings were designed with a shared architectural language both in their form and use of contextually integrated external materials to fit within the conservation area.
The interior design of the two buildings will also show how the same materials can be used in different ways to achieve appropriate designs for the very different user groups. It was important on CYP to use a colour scheme which was age appropriate for the young people who will use the building as the majority are teenagers.

This presentation will cover how a property was designed for an individual with a Learning Disability who had been sectioned under section 3 of the Mental Health Act. The aim of the project was to enable them to be discharged from an out of county hospital safely back to the community using a person-centred approach.

The presentation focuses on who the client is; his wants, life goals and what is important to him. It will then show the different ways the client was given choices and was included in the design of the property as well as through the entire build process, discussing how the designs developed along the way to meet the needs of the individual. The presentation will also consider how his involvement led to a positive experience for the client and his family, as well ensuring the design of the property will support him appropriately long term.

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.

Ty Llidiard: 15-bed Child/Adolescent Mental Health (CAMHS) regional admission hospital unit in Bridgend.

• 2019: went into level 4 enhanced monitoring (‘special measures’ highest level) over quality, safety, leadership and culture concerns.
• Undertook intensive 4Cs work programme to change the unit’s culture and physical environment to address concerns and improve staff and young people’s (YP) mental health and wellbeing.
• 2023: de-escalated to level 0 care group monitoring.

Challenges

• Meaningful engagement with demoralised and demotivated staff, following intense scrutiny/investigation for 4 years, and Covid-19.
• Coproducing with YP aged 12-17 with wide range of behavioural/emotional/health needs.
• Very large, hexagon-shaped building with mostly white, cold-looking, segmented clinical spaces.
• Funding - no models/precedent for similar transformation programme in health board.

Ingredients for success

• Unit lead trusted by health board, able to define and communicate vision and commission specialist delivery team. Worked with Scarlet Design creating visual identity and 4Cs philosophy: Caring, Compassionate, Calm, Confident.
• Genuinely coproduced - engagement events, including on-site event with 65+ people, extensive consultation with past and present service-users, carers, staff and stakeholders, collecting 300+ survey responses.
• Unit lead understood the amount/type of physical environment change required to achieve aims.
• Building transformation plan created at start, delivered in stages to evidence impact, build trust and source funding.
• Visual identity that could extend across large unit.

Impact

4Cs identity, rainbow tree with birds logo and woodland scene applied across unit:
• Giant 4Cs scenes in connecting corridors, waiting spaces, meeting rooms
• External/internal entrances redesigned, providing welcoming environment, improving ‘first impressions’.
• Staffroom and outdoor spaces redesigned
• Ward office relocated to building centre creating a central square, improving interaction and observation for staff and YP - graffiti wall requested by YP.
• on YP door name-plates, office/lift doors, staff uniforms/lockers.

Staff feel valued, with improved retention and sickness reduction; YP feeling listened to and empowered, with improved outcomes.

- Outlining the vision to create an outstanding environment for healthcare, research, innovation, and education, achieved with true co production.

The presentation will focus on how we have started a complex journey in realising a shared vision and ambitious plans driven by a unique collaboration between an NHS Foundation Trust, the oldest university in the English speaking work, and a philanthropist.
To create a mental health hospital, offering the best therapies, care, and a therapeutic environment that provides the best opportunity for recovery, co-located with global brain health research facilities and a new post-graduate college that educates future generations of clinicians and researchers.
Demonstrate how we have worked with a number of interested parties across the partnership and how we have sought to engage and achieve true co production.
Sought to achieve leading design and innovation within the built environment of a site that will not only meld Healthcare, research and education but also span 200 years of architecture.
How we have endeavoured to do that sympathetically while also learning important lessons from the past and enhancing the knowledge base for the future. An environment that is ambitious in its aim to vastly improve patient and staff experience and one that will truly promote mental health and wellbeing.
How we are using clinically driven design based on the input from our staff and experts by experience in our plan to develop a new hospital that, if approved, will deliver world-leading care for patients in Oxfordshire and beyond.

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.

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.

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.

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.

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.

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

Informed Choices is a testing standard to reliably assess the suitability of products for use in mental health environments.

The standard has been developed by the Design in Mental Health Network in partnership with Building Research Establishment (BRE), working with experts from the field. Rather than a pass or fail test, it is a way to grade products for a range of clinical uses so that teams can make more informed choices.

Frank Ellis will examine the implications of the standard from the specifier and client perspective, whilst Laura Critien will give practical insight about the product testing and manufacture.

Working with NHFT for over 10 years - Fleet will be sharing the work on 2 retrofit projects with the Trust - the first is a relocation of CAMHS into an existing PFI operated estate including a modest extension to accommodate art and education activities. The second is a respite residential care facility for guest from 4 to 16 years old derived from an existing and very tired Local Authority run facilty.

Both projects are a result of a very productive user-architect relationship and both push the limits of retro-upgrades to existing estate with distinct complications and limitations.

A thicket of useful knowledge has grown within the fields of planning and design for people who are experiencing mental illnesses and those that care for them.  This development of new learnings, research, and best practices has certainly been helpful in our work to improve care environments for both service users and care providers.  Nonetheless, at points along this journey a thoughtful clinician or designer might have had reason to pause and reflect for a moment about some of the contradictions that are inherent in our work and wonder how we might proceed without what we have currently accepted as a necessary dissonance.

Our focus on patient safety, as an example, can easily lead to environments that, while safe, are also some combination of sterile, featureless, or containing an abundance of alien (but safe) fixtures. Similarly, the vast literature on whether nurse stations/care desks should be open or closed is replete with seemingly contradictory impulses that either favor openness for clinician patient communication or enclosed to provide staff with the comfort of an impregnable safe place.   Can we have one without the other?  Where and how do we achieve a proper balance?

Our natural tendency to see and hear care providers and service users through the prism of their roles compounded by their own natural tendencies to speak and advocate from the place of those roles in the care process inevitably adds a series of very concrete project drivers and expectations that inevitably adds additional sources of transactional dissonance.  We all compartmentalize around what we see as our role in a given situation to the disadvantage of what we might see, understand, request or provide through the essential lens of our own basic humanity.  In a very real sense, this natural focus on roles and the needs arising from roles is a basic building block of stigma.

This presentation is the outcome of an ongoing personal conversation about how to cut through this thicket of knowledge and roles by finding a way to understand what is absolutely essential to a successful care process for both the service user and a care provider.  The presenter's thesis is that by taking the time to discern the essential, and then giving the essential priority in satisfying the needs of the important, we might create better environments with far less contradiction.

Our conversation will be about an ongoing working process; one where the path is more important than the current conclusions.  While these will be shared as a catalog of the important in the context of those essentials and a catalog of design examples as a response, that sharing is only meant to be  a start of a conversation about the need to attend to the important only in the context of the consideration of the essential.  The field will be more likely to come to agreement about the essential and the place of the important within those essentials if we in initiate a conversation among care providers, service users, and designers who are considering the problem from this perspective.

Coproduction has become a buzz phrase within the NHS mental health care. What does it really mean? How can designers, clinicians and architects truly meaningfully consult with people with lived experience – and get the most out of the experience to ensure that their plans are effectively coproduced? Issues of language and accessibility, hierarchy and interpretation all have a part to play – as does the role of peers and facilitators with lived experience in bringing out the voice of the service user in the area of design.

In this panel discussion, Raf Hamaizia Lived Experience Lead for Cygnet Healthcare and Emma Sithole, CEO The Recovery Foundation talk about their experience of meaningful coproduction, what constitutes and facilitates it, and how to maximise its impact in the built environment.