Applying staff experiences and expectations of an optimum environment for psychiatric care toward a holistic design of an inpatient psychiatric facility in KZN.

Abstract

This research paper consists of three key time lines within the evolution of the inpatient psychiatric facilities: the past (local and international), the present (within Kwa-Zulu Natal), and a move toward an improved design model for KwaZulu Natal which considers therapeutic milieu and the end-user needs. This approach seeks to provide valuable insight toward the development of the built form, and how it has impacted the quality of life of the healthcare users who are detained within these facilities, and those who provide their care and treatment. Throughout history, and still evident today in South Africa, the predominant style of psychiatric institutions, is the asylum style of architecture. The historical asylum model, used the built form as a measure to control, detain and confine the mentally ill who were believed to be deviant individuals who, as Markus (1993:95) describes, brought “chaos into the social order of normal society”. During the 17th and 18th centuries, various architectural models were established, based on different beliefs and ideas of how to treat and house the mentally ill. Based on these differing ideas, the design of psychiatric institutions “occupies an unstable space between prison and hospital” (Markus (1993:130). Towards the 21st century, there has been growing trends toward community based care and therapeutic environments however inpatient facilities within KwaZulu Natal still resemble highly institutional-like environments, which are not conducive to the care and recovery of patients, and the working environment of the staff. The primary research therefore focuses on creating an optimum environment for therapeutic care and patient rehabilitation, based on an understanding of care-giver experiences and expectations of inpatient psychiatric facilities. Based on the theory of salutogenesis and therapeutic environment theory, core themes including one’s functional, social, and psychological needs, have been used to assess the evolution of the built form, and how this can be used to inform future architectural design of Psychiatric Inpatient facilities for acutely mentally ill adult male and female patients.