Healing Architecture: Designing for the mentally ill

Ayman H. Makki Architect Architecture & Design (A&D)

Beirut, Lebanon

Challenges youth with mental illness face in the MENA region

Discrimination, abuse, & neglect Lack of adequate healthcare facilities & educational programs Lack of funding & awareness Marginalized from productive community

Objectives
Recognize the magnitude of the issue Increase awareness about the effect of the built environment on mental health
an attempt to create a therapeutic environment

Create innovative design solutions Reintegrate youth with mental illness into society

Hypothesis
Architecture is one of the elements that can play a role to improve youths status in urban areas: Architecture has the potential to enhance their experience of space, increase their sense of power, build social bonds, & reintegrate them into society.

How is reintegration possible?

S pecial needs recognized (extra care, specific design) S ocial integration opportunities (participate in & be a healthy part of the community) Focus on youth empowerment & independence Institution linked to the local area & not isolated from urban life

Architecture & Psychology

A link between architecture & psychology is needed as an attempt to provide an optimum psychological fit between people and their surrounding (S ime, 1986, p.49).
S ubjective experience of space Effect of physical context on mental health Psychological needs ? architectural components

Psychology of space

Methodology
Autism & S chizophrenia as case studies Observed their particular ways of perceiving & using space & elements in space S tudied architectural dimensions & relationships between spaces in order to highlight how design is different for different users

Architectural dimensions to consider

A stimulating environment: S timulation is the amount of information in a setting that affects the user, with regard to colors, light, noise, and patterns.

Lack of stimulation ? boredom & weak connection to space

High level of st im ulat ion ( com plex scenes) ? overload the senses & distraction Moderate level of stimulation? optimum functioning

Exam ple
Autistics use visual coding / signage system, such as floor patterns, colors, materials & other sensory cues to discover spaces. Schizophrenics might find such elements frustrating & chaotic.

Architectural dimensions
A legible space: Spaces need to be clear to avoid confusion.
Clear architectural cues Navigational aids (ex: picture coding) ? convey the function of space

Architectural dimensions
Coherence: Space needs to be predictable with appropriate boundaries.
Visual & functional order Clearly distinguished spaces & their uses with the aid of simple elements such as partitions, big rugs, steps,

Architectural dimensions
Control: Patients should feel able to alter & interact with space.
Hierarchy of spaces (size & layout) ? private / public, noisy / quiet ? choice of where they want to be Flexible & dynamic spaces ? feeling of empowerment & independence

Architectural dimensions
Restorative qualities of space: Design elements have the potential to function therapeutically.
Comfortable furniture Soothing colors Homelike ambiance Retreat areas Exposure to views of nature

Relationships between spaces to consider

Design & location of spaces helps:
Encourage the activity intended for that space Associate different spaces with different functions
[Classroom VS kitchens]

Relationships between spaces

Visibility & proximity of spaces help:
Decrease anxiety & motivate transition from space to space Encourage exploration of the environment [Classroom VS therapy room]

Relationships between spaces

T ransparency between spaces helps:
Avoid segregation Encourage social interaction Create a friendly atmosphere [Offices VS dayrooms] VS [staff resting area]

Relationships between spaces

Size of spaces affects:
Social interaction Comfort [Rooms VS hallways]

Design implications of a therapeutic environment

Specific kinds of work:
The mental health system needs to help patients develop work skills which allow them to be active, independent, & empowered in the institution & later in the wider community. Examples:
Woodwork Sewing Manufacturing tasks Office work Cooking Horticulture

Design implications of a therapeutic environment

Public spaces encourage:
Social interaction Recreational activities Self-expression Practice of social skills Reintegration process
Communal spaces / dayrooms Visiting areas Multipurpose activity rooms Etc

Design implications of a therapeutic environment

Private spaces encourage:
Empowerment Independence Personal identity Privatization of space through display of personal effects
Bedrooms Praying areas Bathrooms Etc

Percentages of disability in the MENA region

Estimates include physical & mental health impairments Estimate calculated to be between 9 to 27 million people in the MENA region in 2002 (The World Bank, 2005) Detailed estimates difficult to attain due to: Differences in definitions of mental illness Lack of adequate diagnosing measures & unrecorded cases of mental illness Ongoing wars & political violence in parts of the MENA region such as Lebanon, Iraq, West Bank & Gaza Wide discrepancy between local & international statistics & percentages (around 10% difference)

Lebanon as a case study

Challenges Lack of adequate facilities Expensive cost of treatment S ocietys low tolerance of mental illness Lack of awareness campaigns about available facilities such as: Dar-Al-Ajaza, Al-Zawrak, ArcEn-Ciel, Classe Orange.

Lebanon as a case study

Role of the government
Increase awareness & spread knowledge about the mentally ill (through media, advertisement, campaigns & education)
Helps change societys attitude towards them Encourages community participation in their healing Leads to increase in contribution & funding Avoids losing a part of our youth who can be very resourceful if given the right reintegration opportunities

Increase funding for specialized facilities (fundraising & donations)

Improves the quality of care & the status of youth with mental illness Organizations become more available to families who cannot afford them Organizations become more capable of meeting different needs Allows designers to contribute in creating more appropriate environments for them

Continued efforts should be made to aid & maintain the success of such organizations Moral support (ex: enforcing employment laws that enhance youths economic prospects)

Lebanon as a case study

Role of municipal authorities Assess & re-assess local needs through statistical surveys Coordinate with the government to better intervene
This connection between government & municipal authorities helps in meeting the needs of more areas & de-centralizing available care & facilities.

Conclusion
For reintegration to be possible, the institution needs to mimic society & create a replication of the dynamic outside world & society through: Work experiences Interpersonal relationships Identity Designers & architects have an obligation to pay attention to design features that affect the quality of life of patients in order to maximize the healing benefits of the environment & foster their participation in the community.