Apr 5, 2021

Mental Health Act reform: will it renew the focus on inclusive design?

Mental Health Act reform: will it renew the focus on inclusive design?

Anyone who has been sectioned or admitted to a mental health inpatient unit will understand how disorienting and disempowering a process it can be. We were therefore encouraged earlier this year, when Health Secretary Matt Hancock outlined a major overhaul of the 40-year-old Mental Health Act. This review of the act is long overdue and the focus on tackling disparities faced by people from Black and minority ethnic backgrounds is a welcome step forward, alongside other important changes.

This news will support shifts in the planning and design of new mental health settings which have been happening for many years. Historically, these settings had been located out-of-town in psychiatric hospitals or asylums – the term “round the bend” being derived from mental health treatment being literally out-of-sight. We have long believed that the first step in building culturally appropriate facilities is to plan and embed them in the local communities and the cultures they serve, carefully woven in amongst housing, shops and workplaces; designed to be local, familiar, and non-stigmatising.

In our larger cities, more diverse populations offer an opportunity for service planners and designers to focus on places that cater for the more specific needs of different groups. Each of these may require settings with different features and characteristics.

The inpatient unit we designed for Small Heath in Birmingham focused on the needs of South Asian women with a high prevalence of depression. Here, a modest urban infill scheme was designed with a kabaddi pitch and double height display wall for art, ceramic and fabrics. Located opposite a mosque, the project was carefully tailored to attract a group of people who may be uncomfortable accessing institutional health systems.

In South London, a creative partnership between a housing association and the Maudsley Hospital led to the development of a hostel carefully designed to provide a non-institutional home for younger Afro-Caribbean men; a small and successful intervention conceived to divert young adults from a cycle of dependency. A pair of large derelict town houses in a residential street were repurposed to provide safe, short-stay accommodation with concierge support. This was designed as a non-stigmatising setting for the residents to build their lives from a stable platform.

Most recently we have completed Blossom Court in Tottenham, North London. A remodelling of a hospital embedded in its local community. Where there were enclosing fences and walls, we have taken them down, opening the building to the park opposite. This has created a facility which is local, visible, and familiar.

Critical to breaking down the stigma that remains around mental health facilities is community involvement from the very earliest stages. Extensive community engagement provides valuable local insight and ensures that the people that will use the service, and other local stakeholders, can influence emerging designs.

This outward-facing approach can be a catalyst for local community regeneration with health at its heart. Clock View Hospital in Walton, Liverpool is an excellent example of a facility with an open and visible public presence that has had a positive impact on surrounding development. Arranged as a series of pavilions in a generously landscaped setting, each pavilion is accessed through a shared ‘front garden’ clearly visible from its surroundings.

Of course, the ambition to make facilities more local does not come without its challenges. The low availability and high cost of land in the most accessible locations can restrict the type of scale needed for a facility to be safe and purposeful. It is possible however, that with the changing dynamic of our town and city centres—with retail making way for other uses—that there will be new opportunities to rethink our priorities. This will be particularly important with the significant increase in demand for mental health inpatient services.

Christopher Shaw
Founder of Medical Architecture


[First published in Building Design on 22 March 2021]

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