Environments for mental health care in Scandinavia

Transcription

1 Environments for mental health care in Scandinavia 3 case studies Knut Bergsland SINTEF Health Research Trondheim, Norway EuHealth Property Network, 2009 Woorkshop Durham Health Research 1

2 Scandinavia the three projects Telemark hospital, ac. psych. unit (28 beds) Norway Östra sjukhuset, psych dept. (126 beds) Sweden Helsingør psychiatric hospital (54 beds) Denmark Health Research 2

3 Some basics: Östra hospital, psych dept Helsingør hospital Telemark Hospital, acute care section Completed Location general hospital general hospital hospital area Inpatient+ Content Inpatient+ outpatient outpatient+ amb.care Inpatient - no offices Inpatient beds Single rooms % Unit size Unit shape T V L Area 18,800 m2 5,100 m2 3,200 m2 No. of storeys 2 (4) 1(2) 1 Concept Triple courtyard Cloverleaf Double courtyard Site 16,600 m2 10,000 m2 4,000 m2 sloping slightly rolling slightly sloping Health Research 3

4 Physical dimensions the 5 s s ( Not just bricks and mortar, RCoPs, 1998) Size (scale, internal distances, number and size of units) max 5 x 15 ward units, comprehensibility, Structure (first impression, wayfinding) Patient spaces (own room, size, form, furnishing, common spaces, recreation spaces) Treatment and staff spaces (generality, room size, working conditions) Siting (proximity to recreation spaces and the real world, ordinary hospital) reducing stigma Security and safety (enough space, normality) Staff Health Research 4

5 Normality the ultimate goal To appeal to normality, you have to bring it to the fore in the design of the environment. Sigurd Wisløff, Head of psychiatric Dept., Haugesund hosptal Design for the meet between patients and staff Health Research 5

6 Östra sjukhuset psychiatric department 126 inpatient beds 87 % single rooms Outpatient department 18,500 m2 White Architects Health Research 6

7 Östra sjukhuset psychiatric department Site plan Vision: Identifiable, small scale buildings Welcoming entrance Activity grouped around a central mall Access to gardens Goal: The total environment should contribute to re-establish patients sense of reality Health Research 7

8 Entrance: First impression counts Welcoming entrance Easy to find, Easy to orientate Health Research 8

9 Functional structure - Outpatient department Health Research 9

10 Outpatient department White architects Health Research 10

11 Functional structure- the mall Health Research 11

12 Informal meeting place Generous space Daylight Views to courtyards 3 café education Occ. and physiother.i research avd 4 avd 1 avd 2 avd 3 The mall Health Research 12

13 Functional structure - courtyards Health Research 13

14 Functional structure - education, clinical services, etc. Health Research 14

15 Ward structure: 9 x 14 beds 2 (3) floors, administrative units connects to the mall Health Research 15

16 Wards with link, heart and dwelling groups 3 café education occ.+ phys.therapy research avd 4 avd 1 avd 2 avd 3 9 x 14 = 126 beds The link White architects Health Research 16

17 adm. offices Interview room admittance Ward unit the link White architects Health Research 17

18 nursing avd station station TV kök kitchen No long corridors Good visibility, ease of control Views to the outside, plus the courtyards Spaciousness vardag common dining matplats aktiv Ward unit the heart h j ä r t a t h j ä r t a t White architets Health Research 18

19 Wards: The heart Added feeling of spaciousness Health Research 19

20 Wards the heart Two storey central room reduces space on the upper floor. Health Research 20

21 The heart 1(isol) 2 Group space 1 1 Dwelling group 4-5 beds Health Research 21

22 Patient room non-hospital feel? - Size - Character - Variation in furnishing - Daylight - Views to nature Health Research 22

23 Single patient room 15 m2 excluding toilet/ shower Size Character Variation in furnishing Daylight Views to nature Health Research 23

24 5100 sq.m The snowflake Helsingør psychiatric hospital - 54 beds - day care unit, ambulatory care unit, - outpatient unit JDS Architects Health Research 24

25 Contradictions as the starting point Central vs Decentral Freedom vs control Open vs closed Private vs common Sick house vs house for health Curing vs living User involvement vs bright, young, strong architects Health Research 25

26 Helsingør psychiatric hospital Ward unit structure 14 single rooms 2 double rooms Staff base Patient rooms Staff/ treatment Common rooms Courtyards Health Research 26

27 Helsingør psychiatric hospital Unit structure cloverleaf central entrance hall gym/ physio at the central hall patient areas with views to the pond and the fields Health Research 27

28 Views for patients daylight for staff Health Research 28

29 Main entrance Welcoming entrance Easy to find, Easy to orientate Health Research 29

30 Central entrance hall. warm end friendly reception people inside Health Research 30

31 Gym with a view patients on parade Courtyards bringing the landscape into the building Health Research 31

32 Art in psychiatric units Helsingør psykiatriske sygehus, døgnavsnitt Health Research 32

33 Team station Staff is visible to patients Patients are visible to staff Team building made easier Health Research 33

34 Patient room countering hospital feel? - Size - Character - Variation in furnishing - Daylight - Views to nature Helsingør psykiatriske sygehus, PLOT 2006 Health Research 34

35 Acute psychiatric unit, Telemark Hospital 3,200 m2 28 beds Double courtyard L-shaped inpatient units Asplan Viak Health Research 35

36 Basic principles Spaciousness, flexible solutions No hospital corridors Homelike, domestic feeling Short internal distances Security without noticeable safety measures Unstrained observation, not surveillance Noise reduction measures, including noiseless ventilation One level onlysite plan slightly sloping 4,000 m2 site Health Research 36

37 Admittance unit Acute Main entrance Patient zone Treatment zone Common/ activity Staff offices Health Research 37

38 Patient room Perceived control of own environment Health Research 38

39 Addition to the ward Therapeutic talk Reducing agitation Letting out steam and smoke Health Research 39

40 Common room Health Research 40

41 Security using technology Corridor with automatic partitioning at night wide corridors ceiling heights space, space, space Mobile alarm system Central temperature control Health Research 41

42 Helsingør Telemark Scale Avoid: acute hospital features repetition long corridors homelike? Östra Health Research 42

43 Helsingør Telemark Space - Sufficient space (sq.m) - Plan for larger body zones - Feeling of spaciousness - Can high quality places (finishes and furniture) counter the need for space? Östra Health Research 43

44 Furniture High quality Health Research 44

45 Conclusions Maximum beds probably right People at the entrance point almost a necessity Courtyards vehicles for good solutions Maximum two storey buildings for inpatients preferrably 1 Direct access for patients to the outside Built-in non-visible security Do not use ordinary hospital beds Teach the architect, make him become emphatic A psychiatrist without empathy may be dangerous to his patients. An architect without empathy may be the same Health Research 45

46 Find more on: Thank you! Health Research 46

47 Visions Östra Helsingør Telemark acute mostly elective + acute acute only LOS = 20 LOS = 25 LOS = 9 Appeal to normality Appeal to modernity Make good treatment possible As low as possible, small scale buildings Low buildings Low, small scale buildings Daylight Daylight for staff Daylight Views to nature Views for patients Views to nature Access to outdoors Access to outdoors Access to outdoors Places for equal meetings Program requirements Homelike feeling Safety and security: Normality in environment + staff assistance Safety and security: Wards "below ground" technology High quality materials and furnishing Modern materials and furnishing Safety and security: No visual measures + use of Local materials + modern Norwegian furniture Health Research 47