Psychiatric Institutions and the Physical Environment: Combining Medical Architecture Methodologies and Architectural Morphology to Increase Our Understanding.

Evangelia Chrysikou

doi:10.1155/2019/4076259

Abstract

The pluralism that characterized the development of psychiatric services around the world created a variety of policies, care models and building types, and fostered experimental approaches. Increased complexities of care, institutional remnants, stigma, and the limited diagnostic and interventional accuracy of psychiatric treatments resulted in institutional behaviors surviving, even in newly built facilities. This was raised by research on awarded psychiatric buildings. The locus of the research comprised two acute psychiatric wards in London. Each was evaluated using the SCP model, a tool specifically developed for the evaluation of mental health facilities, identifying the relation between policy, care regime, and patient-focused environment. Data were derived from plans, visits, and staff and patient interviews. Findings were juxtaposed to those of an earlier study using the same methodology. Also, a syntactic analysis was conducted, to identify the social logic of ward layouts. There were potential connections between regimes, spatial configuration, and the social fabric. Methodologies of architectural morphologies indicated areas that would attract people because of the layout rather than function. However, insights into medical architecture outlined institutional undercurrents and provided alternative interpretation to spatial analysis. Comprehending the social fabric of psychiatric facilities could challenge the current surveillance-led model, as psychosocial rehabilitation uses could be encouraged at points of higher integration.

Highlights

Mental health provision has historically been determined by perceived risks as those have been defined by each social context, rather than patients’ needs [1]
The research produced a significant volume of data, deriving from the checklist, the architectural auditing, the spatial morphology analysis, and the interviews. ese generated a comprehensive series of findings regarding the architectural features of the buildings, the therapeutic regimes, the layouts, the relationship to care models, and to users’ preferences, plus their relationship to the data of the early 2000s UK research [11, 46, 50] that used the SCP model and generated a comparable amount of data that could not be presented in a single paper
Is is the case despite the optimism that surrounded psychiatric rehabilitation movements. e paper presented findings highlighting potential connections between policies, care-regimes, spatial configuration, and the social fabric in psychiatric institutions. e research combined the SCP model, a tool developed for the evaluation of mental health facilities to Space Syntax, a generic methodology that identifies the potential for socialization that spaces generate. ese methodologies of architectural morphologies indicated areas that would attract people because of the layout rather than the function (Figure 6)

Summary

Introduction

Mental health provision has historically been determined by perceived risks as those have been defined by each social context, rather than patients’ needs [1]. It all started from the incarceration of the mentally ill people in a sequence of coercive institutions throughout western history as described by Fouqault [1]. E judges were still powerful in responding to the inability of society to contain that risk, but gradually, mentally ill people left the mainly punitive “popper houses” and hid behind the visual impermeability of the newly established psychiatric hospitals. Provision varied according to stages of illness, from crisis centers to vocational rehabilitation services and protected apartments, or personal needs providing from accommodation to socialization and peer support [7]

Methods

Results

Discussion

Conclusion