Historically established on the fringes of cities and then absorbed by the urban growth of recent decades, psychiatric establishments have long been designed according to models, but these have contributed to fueling taboos and creating divides between society and people living with forms of otherness.
On the other hand, this autonomous, isolated approach has preserved undeveloped plots of land with remarkable landscape features, which today offer real opportunities for the city—the Montreal (formerly the Louis-H. Lafontaine Hospital) and Douglas Mental Health University Institutes are both good examples.
Douglas Hospital c. 1970, Ville de Montréal
Evolving practices and modes of care, increasingly oriented towards outpatient care and alternative solutions to hospitalization, are prompting us to rethink the layout of these establishments and their place in urban contexts.
To free them from their traditional, fortress-like dimensions, they need to open back up to their cities and integrate into their communities, taking into account their contexts along with the specific vulnerabilities of each individual.
Supporting new urban conditions
Living in the city has many advantages, but it’s also associated with higher rates of mental suffering than in rural areas. According to a study by the Centre for Urban Design and Mental Health (UD/MH), city dwellers are nearly 40% more likely to suffer from depression, over 20% more likely to suffer from anxiety, and double their risk of schizophrenia.
Several factors explain this weakening of mental health in urban areas, including:
- Population density
- A lack of greenspace
- Isolation and loneliness
- Pollution
- Sensory overstimulation
- Feelings of insecurity
Psychiatric care facilities in our cities are faced with two very specific problems: An increasing number of cases of mental health disorders, and the lack of scalability of their infrastructure due to their typology inherited from an outdated vision of psychiatry.
Psychiatric establishments can break free from this at times cumbersome and ostracizing compartmentalized model, however. Often equipped with landscape reserves and low density which are remarkable assets for promoting transitions and greater openness towards the outside world, they can help to restore the continuum between institutions and their cities. This approach not only counteracts stigmatization, but also has a regenerative impact on cities, their social fabric, and collective mental well-being.
According to Dr. Alexis Beauchamp-Chatel, psychiatrist, medical chief of the adult neurodevelopmental psychiatry program at Institut universitaire en santé mentale de Montréal (IUSMM) and assistant clinical professor in the Department of Psychiatry at Université de Montréal, the size of current structures is one of the main reasons why psychiatric institutions are so standardized and dehumanizing.
“We should no longer be aiming for gigantic hospitals, but rather for a more human dimension, and therefore on a different scale,” they state.
“This would stop isolating patients and facilities, bringing them closer to the community and making them more visible. This could solve a number of problems at the same time.”
Democratizing the psychiatric institution
Creating “care territories”—with amenities, public squares, gardens and neighbourhoods—rather than megastructures makes it possible to work on a domestic scale and ensure the presence of an evolving care pathway that’s adapted to the realities of patients. These establishments could then be perceived as a continuum between specialized medical space and public space.
In short, the hospital becomes part of the city, and the city becomes part of the hospital.
For Virginie LaSalle, assistant professor of interior design at the École de design de l’Université de Montréal and member of the Laboratoire d’étude de l’architecture potentielle (LEAP), this two-way reflection is necessary:
“I really like the idea of thinking of space through transitions or sequences with different uses and different zones that allow those hospitalized to gradually come into contact with the outside world and, conversely, always having the option of going back if they feel uncomfortable or the situation doesn’t lend itself to it,” she says.
“It’s a very stimulating and creative challenge for designers to think about the different interfaces we can create to foster opportunities for encounters between the community and patients.”
The emergence of a third place in healthcare
In Europe, we are already seeing this trend towards open care facilities that are intertwined with the public. Successful examples of this model include the new Maison de l’enfance et de l’adolescence (MEA) in Geneva and the Mental Health Hospital Heilige Familie in Courtrai, Belgium.
Looking at child psychiatry through the prism of continuity between care and transdisciplinarity, these establishments humanize mental health by combining treatment, nature and culture in a therapeutic setting reminiscent of home. Particular attention is paid to materials, abundant natural light and a harmonious integration with the city, with the aim of ensuring the well-being of both users and the environment. The building features a playful aesthetic, with smooth transitions between the public space and space for care, communal areas such as conference, teaching and projection rooms, a café, large outdoor terraces with gardens and play areas, and so forth. These mixed-use spaces are available to young patients and their families, but also to the general public, creating both a strong community and cultural network.
Easily adaptable to a Quebec system recognized worldwide for its innovations in healthcare, and more broadly to the rest of Canada, this concept is inspired by the principles of the “”, bringing together patients, staff and community in a setting that is harmoniously integrated into its urban environment.
By blurring boundaries with the city and hosting shared, convivial spaces, freed from their traditional functions, the hospital becomes a territorial and social player, offering added value to all members of the community whether they need care or not.
Like our Care+Design initiative, this holistic, ecological and democratic model of care focuses on decompartmentalizing activities, knowledge and disciplines to encourage dialogue between the various players in the sector—family caregivers, patient partners, scientists, care staff, local representatives, designers—and give rise to innovative, human-centered therapeutic initiatives.
However, as Lemay’s Director of Design and Market Intelligence in Healthcare Antoine Buisseret points out, this rethinking of psychiatric facilities’ layouts cannot take place without rethinking how care is programmed.
“If programs remain hospital-centric, we will continue to reproduce the asylum model. This openness must be accompanied by alternative and transitional spaces inside and outside hospital enclosures to ensure genuine porosity between uses. That’s how architecture and landscape Can become vectors of new urban conditions.”
It’s an approach supported by Dr. Alexis Beauchamp-Chatel: “How can we avoid the need for an institution? Perhaps one of the answers is to have a place in communities where you can pass through while remaining in a familiar environment. Neighbourhoods could reclaim this social mission through smaller, more flexible recovery centers that meet patients’ needs more proximately.”
Let’s work together to imagine tomorrow’s care environments through Care+Design.
