The Role of Courtyards within Acute Mental Health Wards: Designing with Recovery in Mind.

The role of courtyards and other outdoor spaces in the recovery of acute mental healthcare users has been gaining international appreciation and recognition. However, the physical properties and conditions necessary for therapeutic and rehabilitative engagement remain to be clearly established. This paper contributes to that knowledge by triangulating evidence from the literature, exemplar case studies of good practice and first-hand accounts of the experiences of staff and service users from four acute mental health facilities. The findings are then aligned with a well-established recovery framework (CHIMES) in light of existing landscape architecture knowledge. Within the complexity of varied mental health environments, this work establishes landscape architectural design requirements and qualities essential for recovery. Rather than adopting a prescriptive quantitative approach setting out areas, numbers of elements, etc., the proposed framework recommends a performance-based model and the creation of a cohesive network of microspaces that mesh into a design of outdoor areas. In this way, design details, materials, vegetation and the variety of spaces can be modified to suit service user population demographics and site-specific needs.

There's no smoke without fire: Smoking in smoke-free acute mental health wards.

BACKGROUND: People who smoke with serious mental illness carry disproportionate costs from smoking, including poor health and premature death from tobacco-related illnesses. Hospitals in New Zealand are ostensibly smoke-free; however, some mental health wards have resisted implementing this policy. AIM: This study explored smoking in acute metal health wards using data emerging from a large sociological study on modern acute psychiatric units. METHODS: Eighty-five in-depth, semi-structured interviews were conducted with staff and service users from four units. Data were analysed using a social constructionist problem representation approach. RESULTS: Although high-level smoke-free policies were mandatory, most participants disregarded these policies and smoking occurred in internal courtyards. Staff reasoned that acute admissions were not the time to quit smoking, citing the sceptres of distress and possibly violence; further, they found smoking challenging to combat. Inconsistent enforcement of smoke-free policies was common and problematic. Many service users also rejected smoke-free policies; they considered smoking facilitated social connections, alleviated boredom, and helped them feel calm in a distressing environment - some started or increased smoking following admission. A minority viewed smoking as a problem; a fire hazard, or pollutant. No one mentioned its health risks. CONCLUSION: Psychiatric wards remain overlooked corners where hospital smoke-free policies are inconsistently applied or ignored. Well-meaning staff hold strong but anachronistic views about smoking. To neglect smoking cessation support for people with serious mental illness is discriminatory and perpetuates health and socioeconomic inequities. However, blanket applications of generic policy are unlikely to succeed. Solutions may include myth-busting education for service users and staff, local champions, and strong managerial support and leadership, with additional resourcing during transition phases. Smoke-free policies need consistent application with non-judgemental NRT and, potentially, other treatments. Smoking cessation would be supported by better designed facilities with more options for alleviating boredom, expressing autonomy, facilitating social connections, and reducing distress.

Housing design that improves the independence and safety for older adults using a walker.

Globally, the walker is one of the most common assistive technologies used by older adults with mobility impairments, which is also the case in New Zealand. However, there is a scarcity of knowledge regarding their specific requirements in housing design. Adopting an ethnographic approach, the perceptions and spatial use of 16 older adults who used a walker were investigated as part of a larger study on quality of life and housing design. Five emergent themes for walker user perception and spatial use were identified, from which design considerations were distilled and then categorised into 10 design elements. The study highlights differences between the requirements for accommodating walkers and those for accommodating wheelchair users. It provides new insights into improved housing design for older adults, which have the potential to be incorporated into existing frameworks for accessible design and universal design thereby improving the independence and safety of older adults.

Fit for What Purpose? Exploring Bicultural Frameworks for the Architectural Design of Acute Mental Health Facilities.

Acute mental health care facilities have become the modern equivalent to the old asylum, designed to provide emergency and temporary care for the acutely mentally unwell. These facilities require a model of mental health care, whether very basic or highly advanced, and an appropriately designed building facility within which to operate. Drawing on interview data from our four-year research project to examine the architectural design and social milieu of adult acute mental health wards in Aotearoa New Zealand, official documents, philosophies and models of mental health care, this paper asks what is the purpose of the adult inpatient mental health ward in a bicultural country and how can we determine the degree to which they are fit for purpose. Although we found an important lack of clarity and agreement around the purpose of the acute mental health facility, the general underpinning philosophy of mental health care in Aotearoa New Zealand was that of recovery, and the CHIME principles of recovery, with some modifications, could be translated into design principles for an architectural brief. However, further work is required to align staff, service users and official health understandings of the purpose of the acute mental health facility and the means for achieving recovery goals in a bicultural context.

Experiencing place: Younger people with dementia facing aged care.

OBJECTIVES: There are currently few facilities for people with younger onset dementia and they are placed by default into dementia care facilities designed for the elderly. There is limited understanding of how people with younger onset dementia and their care givers anticipate or experience aged residential care. This qualitative study has used semi-structured interviews to give voice to the opinions and perspectives of nine people with younger onset dementia and 11 care givers. METHOD: Interpretative Phenomenological Analysis was used for idiographic analysis, allowing examination of the lived experience of younger people with dementia and an iterative exploration of what their experiences mean. RESULTS: Themes of memory, autonomy and therapy emerged from the data. There is a need for a familiar memory of place in an intergenerational community and home-like setting. The loss of autonomy and ensuing stagnation or even institutional internment was much feared. Appropriate exercise and purposeful occupational activities as well as emotional support were valued therapies but often lacking for this group Conclusions: Emotional distress with the loss of a meaningful life can result from the placement of younger people with dementia into old age services. Development of age-appropriate services are required.