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Healing Architecture: Designing for the

mentally ill

Ayman H. Makki

Architect – Architecture & Design (A&D)Beirut, Lebanon



Challenges youth with mental illness face inthe MENA region

Discrimination, abuse, &neglect

Lack of adequatehealthcare facilities &educational programs

Lack of funding &awareness

Marginalized fromproductive community



Objectives

Recognize the magnitude ofthe issue

Increase awareness about theeffect of the built environment

on mental healthan attempt to create atherapeutic environment

Create innovative designsolutions

Reintegrate youth with mentalillness into society



Hypothesis

Architecture is one of the elements that can playa role to improve youth’s status in urban areas:

Architecture has the potential to enhance theirexperience of space, increase their sense ofpower, build social bonds, & reintegratethem into society.



How is reintegration possible?

Special needs recognized (extra care, specificdesign…)

Social integration opportunit ies (participate in

& be a healthy part of the community)

Focus on youth empowerment &independence

Institution linked to the local area & notisolated from urban life



Architecture & Psychology

A link between architecture & psychology isneeded as “an attempt to provide an optimumpsychological fit between people and their

surrounding” (Sime, 1986, p.49).

Subjective experience of space

Effect of physical context on mental health

Psychological needs ? architectural components



Psychology of space



Methodology

Autism & Schizophrenia as case studies

Observed their particular ways of perceiving &using space & elements in space

Studied architectural dimensions &relationships between spaces in order tohighlight how design is different for different

users



Architectural dimensions to consider

A stimulating environment:

Stimulation is the amount of information in asetting that affects the user, with regard to

colors, light, noise, and patterns.



Lack of stimulation ? boredom & weak connection to space

High level of stimulation (complex scenes)? overloadthe senses & distraction

Moderate level of stimulation? optimum functioning



Example

Autistics use visual coding / signage system, such asfloor patterns, colors,materials & other sensorycues to discover spaces.

Schizophrenics might findsuch elements frustrating &chaotic.



Architectural dimensions

A legible space:

Spaces need to be clear toavoid confusion.

Clear architectural cues

Navigational aids (ex:picture coding)? convey the function ofspace




Coherence:

Space needs to be

predictable with appropriateboundaries.

Visual & functional order

Clearly distinguishedspaces & their uses withthe aid of simple elementssuch as partitions, big rugs,

steps,…




Control:

Patients should feel ableto alter & interact withspace.

Hierarchy of spaces (size &layout) ? private / public,noisy / quiet ? choice ofwhere they want to be

Flexible & dynamic spaces

? feeling of empowerment& independence




Restorative qualities ofspace:

Design elements have thepotential to functiontherapeutically.

Comfortable furniture

Soothing colors

Homelike ambiance

Retreat areas

Exposure to views of nature



Relationships between spaces to consider

Design & location of spaces helps:

Encourage the activity intended for that space

Associate different spaces with different functions

[Classroom VS kitchens]



Relationships between spaces

Visibility & proximity of spaces help:

Decrease anxiety & motivate transition from space to space

Encourage exploration of the environment

[Classroom VS therapy room]




Transparency between spaces helps:

Avoid segregation

Encourage social interaction

Create a friendly atmosphere

[Offices VS dayrooms] VS [staff resting area]




Size of spaces affects:

Social interaction

Comfort

[Rooms VS hallways]



Design implications of a therapeuticenvironment

Specific kinds of work:

The mental health system needs tohelp patients develop work skillswhich allow them to be active,independent, & empowered in the

institution & later in the widercommunity. Examples:

Woodwork

SewingManufacturing tasks

Office w orkCooking

Horticulture




Public spaces encourage:

Social interaction

Recreational activities

Self-expression

Practice of social skillsReintegration process

Communal spaces / dayrooms

Visiting areas

Multipurpose activity rooms

Etc…




Private spaces encourage:

Empowerment

Independence

Personal identity

Privatization of space throughdisplay of personal effects

Bedrooms

Praying areas

Bathrooms

Etc …



Percentages of disability in the MENAregion

Estimates include physical & mental health impairments

Estimate calculated to be between 9 to 27 million peoplein the MENA region in 2002 (The World Bank, 2005)

Detailed estimates difficult to attain due to:

Differences in definitions of mental illnessLack of adequate diagnosing measures & unrecordedcases of mental illness

Ongoing wars & political violence in parts of the MENAregion such as Lebanon, Iraq, West Bank & Gaza

Wide discrepancy between local & internationalstatistics & percentages (around 10% difference)



Lebanon as a case study

Challenges

Lack of adequate facilities

Expensive cost of treatment

Society’s low tolerance of mental illness

Lack of awareness campaigns about available

facilities such as: Dar-Al-Ajaza, Al-Zawrak, Arc-

En-Ciel, Classe Orange.




Role of the government

Increase awareness & spread knowledge abou t the mentally ill (through media,advertisement, campaigns & education)

Helps change society’s attitude towards themEncourages community participation in their healingLeads to increase in contribution & funding

Avoids losing a part of our youth who can be very resourceful if given the right reintegrationopportunities

Increase funding for specialized facilities (fundraising & donations)Improves the quality of care & the status of youth with mental i l lness

Organizations become more available to families who cannot afford themOrganizations become more capable of meeting different needsAllows designers to contribute in creating more appropriate environments for them

Continued efforts should be made to aid & maintain the success of such organizations

Moral support (ex: enforcing employment laws that enhance youth’s economicprospects)




Role of municipal authorities

Assess & re-assess local needs throughstatistical surveys

Coordinate with the government to betterintervene

This connection between government & municipal

authorities helps in meeting the needs of more

areas & de-centralizing available care & facilit ies.



Conclusion

For reintegration to be possible, the institution needs to mimicsociety & create a replication of the dynamic outside world &society through:

Work experiences

Interpersonal relationships

Identity

Designers & architects have an obligation to pay attentionto design features that affect the quality of life of patientsin order to maximize the healing benefits of the

environment & foster their participation in thecommunity.

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