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Designing better mental health wards

It might seem like common sense: mental health inpatients do better in well-designed environments. Natural light, use of colour and choice of furniture all play a part. A few projects are making a difference, but there’s still a long way to go.

Words by Emily Reynolds

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The photograph shows a flat roofed two-storey brick building with white PVC windows surrounded by a tall perimeter fence with a grassy area in the foreground. The lower storey of the building is painted with wide brightly coloured diagonal stripes in lime green, sky blue and various tones of purple separated with narrow bands of white. Under the windows on the upper storey there appears to be a safety fence.
Artist collaboration between Remi Rough and patients at the Croydon Psychiatric Intensive Care Unit, Bethlem Hospital. © Hospital Rooms. Photo: Damien Griffiths.

Mental health wards, in my experience, tend not to be particularly aesthetically pleasing places. Often shabby, they’re also clinical, unyielding and overwhelmingly beige, with stained, fraying chairs and grubby walls. Art – and particularly colour – is hard to come by, and what you do see is pretty uninspiring: a stock image of a horse or a painting of a wooded landscape hanging on a greying wall and illuminated by fluorescent strip lighting is hardly likely to give you much of a sense of joy.

Some discomfort is obviously situational: often there against your will, you’re likely to be experiencing distress, are isolated from outside support networks and may not want to adhere to the treatment plan presented to you by your clinical team. But the design of wards can have an impact too, with physical environment an often overlooked but nonetheless vital part of the healing process.

Though research in the area is still limited, there is proof that more pleasant environments have a clinically significant impact on how patients act, think and feel. One study found that thoughtfully designing wards could even result in positive behavioural changes in patients. Furniture style, floor covering and colour scheme all have an impact on their experience, as does a focus on other features, including natural light. 

Another study found that the interior design of a facility – including a simple change in how seating was arranged – helped create a “more supportive, stabilised environment” for those with schizophrenia.

Radical transformations

For an increasing number of patients, activists and artists, the current state of mental health wards is untenable – and they’re doing something about it. Along with curator Niamh White, artist Tim A Shaw runs Hospital Rooms, a project designed to inject joy into the ward environment. 

Inspiration for the project came when a close friend of Shaw’s attempted suicide nearly five years ago and was placed under section. Shaw found that visiting his friend was “quite a shock”, especially when it came to the environment she was being cared for in. “The thing I found really weird was that you might be in three different rooms for three different visits and not be able to tell between them,” he says. “We wanted to make everywhere feel different.”

Five years on, the charity now regularly commissions artists to go into locked and secure units to radically transform the environment with colour and art, believing it has the power to “provide joy and dignity and to stimulate and heal”. Shaw and White and their artists first get to know both the space and the patients and staff who occupy it; artists often conduct workshops, to either make something “totally co-created” or use the consultation to create something of their own. 

“The thing we’ve found out is that this is all about belonging,” Shaw says. “It’s a collaborative thing – it’s not just about making something for someone else, but understanding them, too.”

Designing the perfect hospital environment

James Leadbitter – otherwise known as the vacuum cleaner – is also using art to change the way we experience wards. His latest project saw him go into an inpatient mental health ward for seven to 14-year-olds at Great Ormond Street Hospital, asking them to imagine a different type of environment – where would it be, what would it look like, who would look after them? 

“One of the first things we did was go around the ward and put Post-its on everything they didn’t like,” he says. “The ward, to be fair to that hospital, is pretty good. But they didn’t like the institutional feel, they didn’t like the temperature, they didn’t like the sound of the food machine, the cheese stuck on the chairs, that the DVDs only went up to the age of 12... it’s a hospital; it’s not a playful environment. The staff were engaged, but there was no sense of wonder or magic.”

One weekend, which Leadbitter wryly describes as “a little bit chaotic”, the group were taken to John Lewis to pick their perfect bed, sampling fabrics, colours and textures; another weekend they were asked to imagine what their perfect view would be – what they’d like to see when they look out of the window. At the end of the project, they created clay models of their perfect environments, which are now part of Wellcome Collection’s ‘Being Human’  exhibition. This act of creation, Leadbitter says, gave the children agency, a feeling often lacking in psychiatric environments.

Art, light and colour

As for what a ward could look like in the future, both Shaw and Leadbitter have plenty of suggestions. Shaw notes that when units are built, it’s the “5 per cent taken off the budget at the end” that makes a difference – a skylight removed, art left out. “A skylight would make such a difference to a space – it makes it feel not like a cell,” he says. “We need to make those spaces less dehumanising.”

Leadbitter has been hospitalised several times, an experience that informs his work, and he lists things he’d like to see for his own stays in mental health wards. He wants stimulation, the ability to use and move his body, luxury; things to “lie around on and look at”.

We need to make those spaces less dehumanising.

“Being in hospital is really hard,” Leadbitter says. “The children wanted magical things because their life is really hard. Obviously you’re not going to feel joyful all the time. But creativity can really allow you to push against the boundaries a bit. It can give you autonomy.”

This is key. Being under section is, at its very core, the absolute opposite of having autonomy. Often you have little to no choice: your days are regimented, your medication routine set, your therapy sessions scheduled. You might not want to be there at all.

For this to change, far more needs to be done than making wards look nice. But, while we’re there, what’s wrong with wanting a bit of colour?

About the author

Photograph of Emily Reynolds

Emily Reynolds

emilyoliviareynolds.com

Emily Reynolds is a writer and campaigner based in London.