Contributions of the built health-care environment to effective treatment and recovery : a proposed community hospital for addiction and mental health in Durban.

Abstract

This study was intended to determine the architectural characteristics of a built environment that makes a positive contribution to the effective treatment of addictions and associated mental illnesses. Buildings affect people both physically and psychologically: Architects and interior designers create retail spaces that increase sales, restaurants that stimulate appetite and offices that maximise productivity. But do they design mental health-care facilities that improve treatment and recovery? Surely, given the nature of its function, this building typology is the most deserving of attention with regard to the subject of ‘environmental psychology’. On the contrary however, mental health-care has a history of inadequacy when it comes to the buildings that have been constructed to facilitate it: During the middle of the twentieth century – particularly in Great Britain and the United States of America – state ‘mental asylums’ housed hundreds of people in oppressive, inhumane buildings, remote from their communities. Derelict asylums bear testimony to the ‘de-institutionalism’ movement that followed, favouring out-patient care in the community context. On the other hand however, homeless, destitute addicts and mentally ill individuals tell of the shortcomings of community-based care. Current medical insights have now led to a new concept of ‘balanced-care’, which calls for the integration of in-patient and out-patient treatment. This new approach provides an opportunity for architects to re-define the mental healthcare facility – to humanise the institution and create treatment environments that contribute positively to recovery. The purpose of this study was therefore to establish a sound understanding of the unique needs of this particular user group, to interpret the implications of these needs with regard to the design of the treatment environment, and to assess the appropriateness of existing facilities in terms of these findings. The research was carried out by way of consultation with local mental health-care professionals, a review of existing literature on the subject, and relevant precedent and case studies. The outcome was a set of principles and criteria to inform the design of a new addiction and mental health clinic in Durban.