The psychiatric facility: how patients with schizophrenia respond to place

Abstract

There is strong evidence that people with psychosis are highly responsive to environmental changes. The institutional tradition has been blamed for chronic psychotic illness in the past, but there has been little evidence to identify the negative influences that it has perpetrated. This study attempts to identify hitherto unknown factors embedded in the physical design of psychiatric environments. A grounded theory method was chosen for this study. The study was undertaken from April 2013 until May 2015 in a mental health facility with 110 male patients with psychosis mostly diagnosed with chronic schizophrenia. Data were collected by covert non-participant observation and unstructured interviews with nine centre staff. The study found that there are standing patterns of behaviour around affordances – that is, around opportunities for action. When these encourage self-expression, better sensory, and bodily engagement and form meaningful experiences, they are positive and recovery-oriented. However, when they involve competition for territory and relative comfort, they are deleterious to mental health. Standing patterns of behaviour are predictable – be they good or bad. An understanding of these patterns will enable better mental health facility design in the future.