This article first appeared in the Private Practice.
In each year, approximately one in every five Australians will experience a mental illness(1) while globally, an estimated 300 million people are currently affected by depression, 47.5 million people have dementia and close to 800 000 people die due to suicide every year, with suicide rated the second leading cause of death among 15–29-year-old as recently as 2015.(11)
At first glance these statistics are appalling; almost repellent. We may even ask ourselves if the human race is on a rapidly accelerating downhill slide. However, although these figures are staggering, there is a kernel of hope within them, being that the pervasive stigma belonging to mental illnesses is lifting, and with it, more and more silent sufferers are choosing to speak out and access a healthcare service which is rising to the challenge.
What Are Mental Health Disorders?
Mental health disorders are as broadly categorised as the people who suffer their effects, however, they are generally characterised by some combination of abnormal thoughts, emotions, behaviours and relationships with others. Importantly, mental health illnesses are far more substantial in their effect than flippantly labelled ‘negative thoughts’, with research collating a growing body of data supporting the presence of a tangible effect on the sufferer’s physical person.
Excitingly, as mental health disorders have come to be accepted as legitimate health issues, physicians, nursing staff, counsellors, clinicians and medical researchers are increasingly equipped to prescribe effective combinations of pharmaceutical and behavioural treatments which are seeing significant results. This increased access to health care and social services capable of providing treatment and social support is key in improving outcomes for those suffering from mental illnesses.
In addition to the growing social acceptance of mental health disorders, so to has the design aspect of treatment facilities evolved away from the antiquated notion of bedlams, ‘loony bins’ and asylums, spaces developed to segregate ‘healthy folk’ from the ‘crazy people’ who were often pegged as being cursed, sub-human or otherwise undeserving of a place in pleasant society.
In addition, a more discerning, digitally connected, and informed consumer base has exercised their right to choose treatment facilities and options more aligned to their personal needs and wants, causing relevant operators to sit up and take notice.
Whilst we have thankfully matured from our former Dickensian perspective of mental health, with sufferers generally reporting more experiences of being treated positively than of being avoided or discriminated against – particularly from friends, loved ones and family member(4) – still, as at 2007 only 35% of people with a mental disorder had accessed a health service according to the Australian National Survey of Mental Health and Well-being(1). and a 2016 qualitative analysis into discrimination experiences reported that people with a mental illness commonly report feeling devalued, dismissed, and dehumanised by many of the health professionals with whom they come into contact(6).
In a classic chicken and egg argument, does the mindset inform design or vice versa?
Whatever the correct answer to that age-old dilemma, the practical truth is that significant changes can be effected on both the human and architectural interfaces to dramatically improve the most important objective; generating positive patient outcomes.
Whilst more obvious examples of outdated mental health design include huge plexiglass safety screens, grills, security cameras, and restraints such as spartan internal rooms – which by nature restrict natural light and fresh air – other, more subtle considerations such as poorly signed access to buildings, shared emergency waiting rooms and exposure to excessive sensory stimuli are considerations which need to be considered from the unique perspective of those suffering with mental health disorders.
Although architects, builders and practitioners are embracing a more holistic view to designing for mental health, optimal guidelines are as yet few and far between, despite the titillating promise of what University of Melbourne PhD student, Stephanie Liddicoat has recently submitted via her thesis Architecture and the Design of Therapeutic Environment. This thesis, long anticipated, is set to make huge and healthy waves in the industry by creating a series of therapeutic guidelines for the field of mental health design, from furniture through to fixtures.
Despite the lack of formal guidelines, a general consensus surrounds the particular importance integrating plentiful daylight, external views, interaction with nature and the facilitation of physical activity. Additionally, making sensory spaces accessible to patients needing to regain control or calm down, including anything from aromatherapy, music, mood lighting, blankets, and soft furniture allows patients with a degree of control within the space as they adjust the settings to meet their specific need.
Further championing individual patient controls, facilities are rethinking the standard requirement for patients to simply surrender control of their devices upon entry into a mental health facility, a practise which is severely off-putting to patients and can further aggravate current symptoms through increasing stressors. Whilst safeguarding the privacy and safety of the facility and all users, designers are also beginning to integrate technology spaces to accommodate the basic need for connection amongst patients.
Increasingly, designers and architects are drawing on and employing hospitality-inspired aesthetics such as artwork, soft furnishings and daylighting which are resulting in new, innovative, and ultimately effective, approaches to layout. The constant challenge for designers, architects, and operators in the face of this new design outlook is to find cost-effective solutions that meet the high safety and security needs of the mental health industry while still providing a comfortable and welcoming environment where a patient can stabilise and receive treatment.
Mental illness knows no bounds, is defined by no singular cultural or geographical demograhic. It is not constrained by sexual orientation, relationship status or financial affluency, nor does it discriminate on age.
To illustrate the enormity of the mental health impact on society today are the following statistics:
• The number of deaths by suicide in young Australians is the highest it has been in 10 years In 2015, 391 (12.5 per 100,000) young Australians aged 15-24 died by suicide compared with 290 (10.4 per 100,000) young Australians in 2005.(8)
• Between 10 and 15 %of older people experience depression with 10 % experiencing anxiety, with rates of depression among people living in residential aged-care are believed to be much higher, at around 35 per cent.(7)
• Approximately 5% of Australians will experience substance abuse disorders in any 12-month period, with men more than twice as likely as women to have substance abuse disorders.(1)
• Fourteen per cent of Australian children and adolescents aged 4-17 have mental health or behavioural problems. (1)
In the face of these dubious figures, designers and healthcare practitioners have committed to partnering in utilising and integrating holistic design elements to provide a new way forward in the effective treatment of mental health disorders.
Disclaimer: Views, information or opinions expressed within this article are solely those of the individuals involved and do not necessarily represent the official policy or position of any other agency, organisation, employer or company. These views are subject to change and revision and the author is not to be held responsible for misuse, reuse, recycled and cited and/or uncited content within this article.
 Australian Bureau of Statistics. (2007). National Survey of Mental Health and Well-being: Summary of results. Catalogue No. 4326.0. Canberra, ACT: Australian Bureau of Statistics
(2)3303.0 ABS Causes of Death, Australia, 2014 (2016). Underlying causes of death (Australia) Tables 11.1 and 11.3
(3)3303.0 ABS Causes of Death, Australia, 2012 (2014). Underlying causes of death (Australia) Table 1.3
(4)Nicola J Reavley, Anthony F Jorm. 2015. Experiences of discrimination and positive treatment in people with mental health problems: Findings from an Australian national survey. Australian & New Zealand Journal of Psychiatry. 49(10) 906–913. Available from: http://journals.sagepub.com
(5)Mission Australia’s 2016 Youth Survey
(6)Qualitative analysis of mental health service users’ reported experiences of discrimination.
Hamilton S, Pinfold V, Cotney J, Couperthwaite L, Matthews J, Barret K, Warren S, Corker E, Rose D, Thornicroft G, Henderson C Acta Psychiatr Scand. 2016 Aug; 134 Suppl 446():14-22.
(7) National Ageing Research Institute. (2009). Depression in older age: a scoping study. Final Report. Melbourne: beyondblue.
(8) McGorry PD, Tanti C, Stokes R, et al. Headspace: Australia’s National Youth Mental Health Foundation – where young minds come first. Med J Aust. 2007;187(7 Suppl):S68–S70
(9) National Institute for Health and Clinical Excellence, 2006
(10)Malkin, J. 1992. Hospital Interior Architecture: Creating Healing Environments for Special Patient Populations, New York, John Wiley.
(11) WHO – World Health Organisation