Architecture as ‘change-agent’?

A British Medical Journal article

What follows are a series of quotes drawn from a research paper (linked above & cited below) that considers the impacts of architectural design within mental healthcare settings.

Full Title: ‘Architecture as change-agent? Looking for innovation in contemporary forensic psychiatric hospital design’

Authors:

Dr Rebecca Mclaughlan - School of Architecture and the Built Environment, The University of Newcastle, Newcastle, NSW 2308, Australia

Codey Lyon

Dagmara Jaskolska

“Researchers working within the field of architectural history also understand that patient experience is partially determined—for better or worse—by the decisions that designers make, and that models of care have been used to drive design outcomes since the establishment of the York Retreat in 1796. With their focus on moral treatment, the York Retreat influenced a shift in the way asylum design was approached, from the provision of safe custody to finding architectural solutions to support the restoration of sanity.”

— B Edginton (1997), “Moral Architecture: The Influence of the York Retreat on Asylum Design,” Health & Place 3, no. 2: 91–9; Jeremy Taylor (1991), Hospital and Asylum Architecture in England 1849–1914: Building for Health Care (London: Mansell Publishing Limited); Anne Digby (1985), Madness, Morality and Medicine: A Study of the York Retreat 1796–1914 (New York: Cambridge University Press).

---

“Choice and independence for patients, the desire for a patient’s recovery progress to be reflected in their environment, and opportunities for peer support and family involvement have been present in approaches to mental health treatment since the formal endorsement of the ‘therapeutic community’ approach to hospital construction and administration in the WHO’s report of 1953.”

— World Health Organization (1953), The Community Mental Hospital. Also refer to T.F Main (1946), “The Hospital as a Therapeutic Institution”, Bulletin of the Menninger Clinic 10, no. 3: 66–71; David Clark (1965), “The Therapeutic Community Concept, Practice and Future,” The Journal of Mental Science 111: 947–54.

---

“The physical layout of spaces has been linked to both the likelihood of developing socially supportive relationships and impeding this development, with direct implications for communication, concentration, aggression and a person’s resilience to irritation.”

— Leon Festinger et al. (1950), Social Pressures in Informal Groups: A Study of Human Factors in Housing, vol. 11 (New York: Harper Bros); David Halpern (1995), Mental Health and the Built Environment: More than Bricks and Mortar? (London: Taylor and Francis); A. Baum and G.E. Davis (1980), “Reducing the Stress of High-Density Living: An Architectural Intervention,” Journal of Personality and Social Psychology 38, no. 3: 471–81; I. Altman and M.M. Chemers (1984), Culture and Environment (Monterey, CA: Brooks & Cole Publishing); Gary W Evans (2003), “The Built Environment and Mental Health,” Journal of Urban Health: Bulletin of the New York Academy of Medicine 80 no. 4: 536–55; Ulrich et al., “Psychiatric Ward Design Can Reduce Aggressive Behavior,” 53–66.

---

‘If architecture is capable of acting as a change-agent in the delivery of mental healthcare, then it needs to show leadership, not only in the provision of a better experience for patients but more broadly in taking steps to help shift public perceptions around mental illness.’