This article is part of a series on the future of architecture and how it can guide innovation in healthcare environments. We hope to inspire conversations about creating a better world for tomorrow, together.
Stigma surrounding mental health has always tainted the relationships between healthcare institutions, their patients, and communities. As urban densification is accelerating, social inequalities are intensifying, and access to care remains problematic at best, mental health persists as a major social issue: It is estimated that nearly 20% of the Canadian population personally experiences a mental health problem or illness in any given year.
These conditions have catalyzed a paradigm shift where people being cared for are being placed at the heart of clinical concerns, and where approaches to care facility design are taking on more sensitive, sustainable, and inclusive angles as a result.
Integrative architecture is set to play a key systemic role in this new approach. By establishing a balanced relationship between care practitioners and those they care for, and by making space less a thing patients are subjected to and instead spaces patients can inhabit and grow from, care environments can be transformed into qualitative places that contribute directly to the recovery process—particularly in mental health facilities.
From constraint to appropriation
With a focus on improving both individual and collective well-being, integrative architecture invites us to rethink the design of care spaces in a more holistic light, one that takes all the components and stakeholders of medical environments into account.
It relies on transdisciplinary collaboration to spark reflection on a multitude of fundamental healthcare issues, from access to services to the patient-caregiver experience, to make room for hospitality, inclusion and empathy in an already fragile context. This nudges healthcare systems away from asymmetrical models and towards integrated and humanistic structures, opening up new perspectives for architects.
“Once we adopt integrative approaches in the broadest sense, design is totally enriched and no longer belongs to architects and designers alone. It becomes a real collective effort that pushes designers out of their comfort zone,” emphasizes Antoine Buisseret, design director and Lemay’s Director of Market Intelligence in Healthcare.
By freeing itself from clinical standards, the design process becomes an act of care: It turns the hospital into a ‘second envelope’ for the body, a place that is more soothing and benevolent than restrictive and imposed—a place that can be appropriated by patients. This appropriation softens the containing factor of hospitalization, giving patients a degree of control over their space and supporting their recovery.
This can be encouraged in many different ways:
- Integrating living elements such as plants, natural materials and light, and unobstructed views of the outside world;
- Secure access to gardens, works of art, and reception areas for visitors;
- Pleasant, enveloping forms;
- Diversified spaces in terms of seating, ergonomics, textures, and so forth that are flexible and adaptable;
- A judicious opening and distribution of space to limit the “corridor” effect;
- Smooth transitions between social or high-stimulus zones and intimate/relaxation zones;
- Influencing the environment through lighting, furniture layouts, comforting features, and more.
Promoting overall health and well-being, these biophilic and sustainable strategies also enable patients to rediscover their bearings whether they’re temporal, visual, or sensory. Hospitalization is often perceived as a shock for those who experience it; beyond the constraints of movement and intimacy, hospital environments often create rifts between patients and their daily habits or landmarks they use to orient themselves.
By restoring a more domestic scale and freedom of movement within care environments, patients’ perception of those spaces can be radically changed—they’re no longer subjected to space, but grow from it instead.
“In psychiatry, hospitals create spaces based on a preoccupation with safety. This inevitably creates an aesthetic that we’re all familiar with, one that’s relatively inhuman and inhospitable. We need to completely reverse the scale of values in the production of spaces, and really start from the impact they mentally have on us,” asserts Carine Delanoë-Vieux, designer and co-founder of the Laboratoire de l’accueil et de l’hospitalité (lab-ah) at GHU Paris.
Her colleague Marie Coirié, with whom she runs lab-ah, agrees: Design must go beyond what’s functional and become an act of compassion. To achieve this, designers and nursing staff alike need to free themselves from a longstanding culture of surveillance and isolation in favor of soothing spaces of free expression.
“To be able to come and go, to have control in a space by modulating sound and light, to choose how to posture one’s body… This is all a big step away from the culture of permanent patient supervision in intensive care units,” she explains.
Designed to support, and listen to, the patient
Integrative architecture requires architects to take the vulnerabilities of the people affected by their designs into account by involving them in decision-making. The “Montreal model” from Quebec is regarded as a pioneering way to recognize patients’ experiential knowledge and form what’s called ‘patient partnerships’. It’s a collaborative practice that relies on dialogue, complementary knowledge, and patient experience to improve the effectiveness of care at all levels with reciprocal relationships. Patient partners bring a personal perspective to the realities of hospitalization, and can guide designers of care environments so they are better adapted to patients’ needs. For Stéphanie Fontaine, patient partner and manager in charge of developing innovative mental health projects for the CIUSS du Centre-Ouest-de-l’Île-de-Montréal, this is a major step forward in care as it gives patients an active role in their recovery.”We include not only the person being cared for, but also what they are experiencing, their present reality, and their loved ones. Caregivers aren’t the only ones focused on me; I’m a stakeholder in my own recovery.”
This partnership is particularly beneficial in psychiatry as it establishes—as Michel Foucault described in his book Madness and Civilization—a common language where “suffering and knowledge adjust to each other in the unity of concrete experience” between the patient and the various professionals.This is how professionals and patients can develop more balanced relationships to one another in spaces that can be appropriated and adapted to promote recovery, and built environments both support care teams in their intervention strategies while helping patients adapt to new environments.
“These soothing spaces, as we have imagined them, are 80% about the design. The remaining portion is designed by the care team which writes the care plan. How else can they invest themselves in a space and make it their own, according to their needs? We have to resist the urge to make a finished product, ‘ready to order and install’, in order to stimulate genuine therapeutic alliances between caregivers and patients,” explains Marie Coirié.
When spaces are neither imposed nor restrictive, care teams observe a reduction in crisis episodes, a high level of patient acceptance, and virtually no deterioration of the premises, Coirié adds. “We often talk about the patient-caregiver relationship, but the designer-user relationship is also conventionally a little asymmetrical. It requires a great deal of humility and openness,” Antoine Buisseret emphasizes. “We need to question the very heart of the care system, but also the way in which its chain of values works to better understand the reality of hospitalization and translate this into more inclusive, empathetic and restorative physical and social environments.”
A care relationship at the human scale
With nearly 20,000 Quebecers waiting for mental health services, we need to think about how to design these facilities so that they can better support current social issues, their needs and, ultimately, the recovery of those requiring care.
“The real role of hospitality in a public institution, and even more so in a psychiatric hospital, is to accommodate people, restore their confidence, reconnect them with themselves, and provide them with resources so that they can get on with their lives and return as little as possible. It’s about ensuring that they no longer need hospital services. That’s the whole philosophy of recovery,” adds Carine Delanoë-Vieux.
By making appropriation, sensitivity, and experiential knowledge cornerstones of the design process, integrative architecture gives patients and their loved ones a seat at the decision-making table. It empowers them to play an active role in their own recovery, enabling them to influence the space in which they live, and regain their autonomy.
Above all, it brings care back to the very essence of hospitality: Welcoming others with kindness and generosity.
Interested in this topic? Learn more by reading our article on the impact of architecture on our health.