Penny Coombes and Gavin Adams: Ensuring the bricks and mortar support users’ quality of life and mental health

Chair: Leonie Manns

Speakers: Penny Coombes and Gavin Adams

Attendees being seated… session will begin soon

Starting with Penny Coombes – from The People for Places and Spaces

Gavin and I share a passion to get the built environment as supportive as possible. We want to inspire you to make these environments better.

Shows a building in Townsville for children and young people and Gavin will go through that later today.

She shows venn diagram showing People Activities and Environment and how it links.

Refers to how in medical professionals often use the corridors to chat and discuss patients – they learnt this and then installed chairs in those corridors which did work very well.

Discussing importance of a literature review of the effect of the built and natural environment of Mental Health Units on mental health outcomes and the quality of life of the patients the staff and patients.

QLD govt were planning 27 new or refurbished MH unit – 146 additional mental health beds . They had a range of  needs, acute, community care, medium secure, older persons and staff experience so she worked with them

They looked at models of care, involved architects and planners, the voice of consumer, carers and staff, and evidence based design.  She reinforces the need for those involved in those spaces to have a say as they experience those spaces everyday.

QLD Health Objectives

• develop consumers clinicians and architects expertise in mental health design
• support collaboration
• interpret service models
• published evidence to inform design
• australasian health facility guidelines (AHFG)

Started with listening workshops called conversation pits, the amount of sharing was enormous and the changing of attitudes was large.  Then they had to imagine what an optimal unit would look like – the very best unit (aspirational picture) – mental health workers generally not so good at doing that. Discusses the elements of evidence based design which included case studies, literature review and expert opinion and more.

One element of the research says that Nature Matters – and therefore designing mental health units with greenery around them – is important, and how calming it is.

There is work around domestic and institutional design,  has domestic feel, calming the noise – but think domestic scale on institutions – shows photo of one place with a domestic feel.

Staffing facilities are important – discusses unsuitable staff rooms, some staff rooms are being used as active spaces with patients. It makes a difference to the staff and therefore to patient satisfaction.

The literature was sourced from a variety of areas and these are combined with the location experts (consumers, carers and staff) and then these are combined with draft designs.  Discussion of corridors and sightlines, Privacy and other individual areas that are based on literature review. The workbooks are  disseminated in the workshop for discussion. All the notes are taken back – qual research all is looked at.

Each of the design elements are critically assessed – Draft Design Considerations were then given to the architect.

Gavin Adams -now takes to the floor to discuss how the building was designed and then built.

The Building: at the very least it protects you from elements, minimum requirement the building should not have adverse outcomes for the user. If we look at what we want from the building it needs to provide therapeutic opportunities.

As architects we need to understand the great variety of users all with individual needs, we also need to understand the aspirations of those users. We need to create more than is envisaged at the beginning.

To achieve this we need a clear vision and a brief, user input is critical they should be involved in the process. The lit. review was a fantastic resource to have, we also have to comply with regulations and building codes.

Users contribute in workships, user group meetings were also called, the interactions have to be meaningful and effective.As the process unfolds the users need to buy in to the process along the way.

A good brief should contain: vision and aspirations, activities and functions to be accommodated, model of care, budget,functional reationships between spaces and ESD

The Look and Feel can often be intangible and not easy to quantify.

Now moves on to the Townsville Child and Youth MHU (not built yet), shows projected design on screen.  It was an old maternity hospital that is now admin services for the Townsville Child and Youth MHU. The setting is quite green – but it does have some flooding concerns. The building itself is relatively small but it has courtyard space.  He shows the plans in 3d.

Design Considerations

• Creating an environment that is relevant for young people
• Scale is important – domestic in style
• Natural light and ventilation
• Safety is also an issue even though it is an open unit  but duty of care means it should be safe
• Must look at variety of activities it is a very small inpatient centre
• There are designated areas for day centre, support, public and special bedroom (if you need a larger space providing flexibility)
• Use of colours in the building

There are a range of spaces in the building that are allocated to certain functions but the rooms are generic sizes. Room examples: quiet rooms, classrooms etc

Flexibility in Design: standardisation of room sixe, open plan staff pods, flex furniture, use of outside areas and operable walls. We created a large covered verandah for gym activities.

Viewing and Experiencing Nature: As mentioned above it is very critical component.

Fencing was 3 metres high due to duty of care but the fence has been broken up with colours, blackboard, – its not just a barrier and quite a lot of landscaping to reduce the impact of that fence.

Sightlines are important within the design elements – now shows all the different internal views. He discusses opportunities for families and private areas for staff use only – upper level. A number of double volume spaces – users were happy with double storey solution – acoustics are important for assessing the state of the unit .

Privacy and Confidentiality - important, some private spaces, quiet rooms, single bedrooms with ensuites, acoustic privacy

ESD – Environmentally Sust Design – orientation and shading, natural ventilation. rainwater harvesting, material selections and more

Domestic vs Institutional - a combination of factors will make it have a domestic feel.

Questions

1.

We have created a low open arrangement where staff can have easy interaction with consumers but they also have private staffing spaces – we dont want barriers between carers and consumers.

2. Ballpark figure for cost of such a lovely figure?

The total budget was $13 m – but dont get scared of the budget, we need to make the building better and staff retention and de-escalation of aggression.

3. If we don’t have the same amount of money and need to make do with our existing buildings and make better use of them??

Even some smaller changes even with furniture can make a difference, ie not even touching the main building.Discusses a case where they are going to change floorcovering and do a new paint scheme (very cost effective) there is always something you can do. You can go back tomorrow and make your space better. It is good however to have a masterplan if you can – rather than little ad-ons all the time ie work towards a longer term objective.  Even some basic throwing out of old equipment – got a large skip – so you can always do something. 

4. It is good QLD has gone down this track but as a psychiatrist worried about the second storey and safety of teenagers.

Yes self-harm /risk factors looked at very carefully and the second floor was for staff only.

5. In Patient service – under pressure in NSW putting staff in large open places – what is the optimal space for flexibility? why did we need so many airlocks and high fences? and second level of separate level for staffing? could there be a domestic pod and a day centre – doesnt look domestic scale place?

The site determined how the building was designed, the fence did cause debate clinical staff wanted that fence and their concern was around their duty of care, there is ongoing discussion regarding this issue. 

In open office space you need to look at design that works for them, in this situation only 30% of chairs are sat in because those staff are out on the floor, it is about how you make the space the amenities and facilities.

6. QLD story is wonderful but what is situation regarding the Australasian Facility Guidelines – if guidelines have been bypassed what come back do you have?  what is state govt expected to do with respect to those guidelines

The guidelines dont have to all be adhered to, certifiers will approve a building on other elements.

7. Comment from the floor about the dangers of listening to people when they are transient – the culture may for example change when people change.

8.  Comment regarding the recent Orange hospital and line of sight

9. Comment regarding the length of building process

yes has been on hold back to life, different sites were looked at, construction process will be a year long, it will allup be a three year process.

*speaker finishes*

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