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THE PLANNING AND DESIGN OFPSYCHIATRIC FACILITIESbyArcht. PROSPERIDAD C. LUIS, fuap, apec architectStrategic and Development Planning WorkshopNational Center for Mental HealthCiudad Christhia Resort, San Mateo, MMFebruary 13, 2012The Manual

Defines what a SAFE HOSPITAL is during an emergency or disaster

Describes the ESSENTIALS in supporting safe hospitals

Lists the structural, non-structural and functional INDICATORS to be considered as standards to be ACHIEVED

PLANNING AND DESIGN OFPSYCHIATRIC FACILITIESAccording to the World Health Organization and the National Institute of Mental Health, one in four people will suffer from mental illness at some point in their lives.

However, despite the widespread nature of mental illness and the proven effectiveness of modern treatments, the majority of behavioral health facilities are outdated and inadequate to support todays care regimens.

Sensitively designed facilities positively impact patient outcomes.

PHYSICAL INVENTORY OF BUILDINGS(As of 2007)

Oldest building built in 1928Youngest building built in 1970(Altho in 2009, there were new buildings under construction)

Mostly one and two-storey buildingsMostly for repair and improvement

35 pavilions/cottages and 52 wards

No. of functional buildings = 68No. of condemned buildings = 7

CURRENT TRENDS INPLANNING AND DESIGN OF PSYCHIATRIC CARE FACILITIESNATIONAL CENTER for MENTAL HEALTHStrategic and Development Planning WorkshopFebruary 13, 2012Current Trends in Planning and Design of Psychiatric Care Facilities

Normalizing EnvironmentTransparent SecuritySingle vs. Multi-bed Patient RoomsThe Dining ExperienceOutdoor RecreationDesigning for FlexibilityCommunity-basedLeveraging Land Value

OLD MODEL:PATIENT IS INCURABLE, WILL BE CONFINED FOR LIFECURRENT MODEL:PATIENT SHOULD BE REHABILITATED AND RETURNED TO THE COMMUNITY WITHIN A REASONABLE TIME

CREATE A NORMALIZING ENVIRONMENT

INTEGRATION OF PRIVATE AND PUBLIC SPACES TO SUPPORT A CONTINUUM OF SOCIALIZATION WITHIN A SAFE AND SECURE CAMPUS

- Kent Muirhead, David Treece TRANSPARENT SECURITYCREATE AN ENVIRONMENT THAT FEELS OPEN AND VISUALLY CONNECTED TO ITS SURROUNDING LANDSCAPE

USE ALTERNATIVES TO TRADITIONAL FORTRESS-LIKE SECURITY WALLS AND FENCES

Fortress-like securitywalls and fencesExample of transparent security design solutionTRANSPARENT SECURITYBuildingBuildingBuildingBuildingCampus/VillageExample of Castle Peak Psychiatric Hospital, HongKongA central garden integrates the ground floor facilities of the different buildings to form a village within the hospital to facilitate rehabilitation of patients and their integration into the community.TRANSPARENT SECURITYBuildingBuildingBuildingBuildingCampus/VillageLIMITED, CONTROLLED ACCESS: 1-for staff and visitors, 1-for patient admission, and 1-supplies and other materialsMONITORED BY CLOSED-CIRCUIT TELEVISION at strategic pointsPatient AdmissionStaff and VisitorsSupplies,other materials PRIVATE vs. SEMI-PRIVATE WHICH FACILITY MODEL BETTER SUPPORTS REHABILITATION? TTOffers opportunitiesfor solitude as well asinteractionDiscourages isolation1-bed patient room2-bed patient roomSingle vs. Multi-bed Patient RoomsTHE DINING EXPERIENCE

TREND #1 (for unitized facilities)TREND REFLECTS TREATMENT APPROACH:

Living units of 6 patients eachto maintain the small community environment and associated relationships

Continuity of staff supervision

Patients eat within their units

Leave unit for treatment and activity programs

Meals prepared in central kitchen, distributed to each unit in trays

Patients engaged in setting tables and cleaning up THE DINING EXPERIENCETREND #2 (for large facilities)TREND PROVIDES FOR THE DINING EXPERIENCE MOST APPROPRIATE TO THE PATIENTS CONDITION AND TREATMENT:

Variety of centralized dining facilities designed around a type of food service example: cafeteria, grill/caf that offer meal choices, buffet, etc.

Patients will be assigned to the type of food service that is appropriate to their capabilities and mode and phase of treatment.

OUTDOOR RECREATIONOUTDOOR RECREATIONAL SPACES SHOULD BE DESIGNED TO COMPLEMENT SPACES FOR INDOOR RECREATIONAL AND OCCUPATIONAL THERAPY SPACES TO PROVIDE A CONTINUITY OF INDIVIDUAL AND GROUP ACTIVITIESIndoor activity spaces crafts tables, card and games tables, music areas, television areasOutdoor activity spaces walking and jogging paths, basketball courts, outdoor teaching areasDESIGNING FOR FLEXIBILITYDESIGN IS FLEXIBLE ENOUGH TO SUPPORT CHANGES IN: NUMBER OF PATIENTS THERAPEUTIC PROGRAMS

EXAMPLES OF FLEXIBILITY CONVERTIBILITY OF PATIENT ROOMS FROM PRIVATE TO SEMI- PRIVATE IF NUMBER OF PATIENTS INCREASE COLUMN-FREE ROOMS TO ALLOW FOR EASY PARTITIONING AND RE-PARTITIONING

COMMUNITY-BASED SERVICES50 YEAR AGO: INDIVIDUALS RECEIVING CARE FOR MENTAL DISORDERS OBTAINED TREATMENT FROM A SPECIALTY PROVIDER IN AN IN-PATIENT SETTING.

In 1955, 77% of or patients were in 24-hour hospital services

TODAY, MOST INDIVIDUALS RECEIVE MENTAL HEALTH CARE ON AN OUT-PATIENT BASIS AND LIVE IN A COMMUNITY SETTING.

In the USA, accounts show that less than 15% of the total spending for delivered services is spent for psychiatric hospitals

There is a broader array of treatment options in general hospitals and nursing homes.

There are primary care services provided by clinicians, psychologists, and social workers that are mostly community-based.

Area = 46.7 hectaresIn many older mental health facilities, operational costs have risen and surpassed the buildings capital value.

Yet, these buildings are sitting on large parcels of increasingly valuable land.

The existing land value can be used to finance all or part of a new facilitys cost

Examples:

The bases conversion strategies in the past.

The plan for Veterans Memorial Medical Center in relation to bases and military land conversion.

LEVERAGING LAND VALUECURRENT WORLD TRENDS IN HOSPITAL PLANNING AND DESIGNCURRENT WORLD TRENDS INHOSPITAL PLANNING AND DESIGN Non-institutional environmentFacilities as tool and healerPeople-centered, humanized hospitalFilm-less and paperless hospitalRoboticsGreen hospitalThe Patient as an Ally in His Own HealingCenters for Excellence: the Specialty HospitalsCurrent World TrendsNon-institutional environment

Exterior Architectural CharacterCurrent World TrendsNon-institutional environment

Interior design & atmosphere Current World TrendsFacilities as Tool and Healer

Sensual stimulationWorld Trends Facilities as tool and healer

Positive distractions

Current World TrendsPeople-centered hospitals

The Home ModelCurrent World TrendsPeople-centered hospitals

The Mall ModelCurrent World TrendsPeople-centered hospitals

The Hotel ModelCurrent World TrendsFilm-less and paperless hospitalFilm-based to digitalized processesReduction of storage spacesMore dispersed spaces for work stationsNetworking of computers within hospital and communityPaper files to electronic files

Current World TrendsRobotics

Robot food and supplies trolleyCurrent World TrendsGreen hospital

Energy conservationUse of local materialsSymbiosis: nature and manCurrent World TrendsThe patient as an ally in his own healing

Patients LibraryPatients Dining Room Patients LoungeCurrent World TrendsCenters of excellence: specialty hospitals

Hospitals for ChildrenCurrent World TrendsCenters of excellence: specialty hospitals

Womens CenterPRINCIPLES OF HOSPITAL PLANNING AND DESIGN

Like a villageBuildings of different forms connected by streets

Requires a large siteCorridor system lengthyEasy to phaseEasy to expandNature-permeated ambienceHOSPITAL SHAPE AND FORMTHE VILLAGE CONCEPT

Like a villageBuildings with pre-determined formsEasy to modularizeFast constructionForced planningHOSPITAL SHAPE AND FORMMODIFIED VILLAGE CONCEPT

A high-rise formHospital developed verticallyIdeal for sites that are tightRequires a very small siteVisibility of a tall buildingCan be difficult to designDifficult to expandHOSPITAL SHAPE AND FORMTHE BLOCK

Fast-growing departments in PodiumSlow-growing departments in TowerReplicable departments in TowerEasy to design and construct TowerFast-growing departments are at lower floors HOSPITAL SHAPE AND FORMTHE TOWER AND PODIUM

Developed from the train corridorSpine corridor linking various fingers Single-loaded corridor natural light and ventilation Might be difficult for staff if corridors are too long

HOSPITAL SHAPE AND FORMVeterans Memorial Medical CenterCirca 1950

Form closes on itselfWith an open court at center Natural ventilation an lighting from exterior and from the courtNature into inner spacesCourt is a spill-over areaEasier to secure Open court used as expansion areaHOSPITAL SHAPE AND FORMPhilippine Childrens Medical Center

Like a boxA solid, deep planRelies on engineering for internal environmentIdeal for cold countries Compact spacesLess building footprintConsumes a lot of energyArtificial ventilation and light in inner spacesHOSPITAL SHAPE AND FORMHIERARCHY WHOLEHOSPITALZONESDEPARTMENTSROOMSSPACESHierarchy of Elements in a HospitalOUTER ZONE: most public orientedOPD, Emergency, Business Office, Physical Rehab, etc.SECOND ZONE: workload from Outer ZoneAncillaries, Diagnostic/Therapeutic Departments Administration: non-public sectionsINNER ZONE: need quiet environment, accessible to publicNursing WardsStaff QuartersDEEP ZONE: aseptic areas, off-limits to publicOperating, ICU, Delivery, NurserySERVICE ZONE: dirty and busy, grouped around service yard for supplies and removalDietary, Laundry, CSSD, Maintenance, Motorpool, etc.SPECIAL SERVICE ZONEMorgueZONING PRINCIPLESGRAPHICS OF ZONING PRINCIPLESEntryEntryProblematic ZoningFIRST THOUGHTS ON THEPLANNING AND DESIGN OF THE NEW NCMH FACILITIES CATEGORY OF NCMHSpecial Research Training Center and Hospital under the DOH

HOSPITAL SERVICESRender comprehensive (preventive, promotive, curative and rehabilitative) range of quality mental health services nationwide

Give and create venues for quality mental health education, training and research geared towards hospital and community mental health services nationwide

NCMH SERVICES INCLUDE:Community ServiceHospital ServiceTraining and ResearchOther Major Services i.e. DOH Programs

AREA OF SITE = 46.7 hectares

REDEVELOPMENT

Many structural and building service items are already at the end of their life expectancy in fact, BEYOND their life expectancey.

It would be more cost-effective to redevelop NCMH rather than do massive refurbishment and continuous upgrading of the old facilities.

The nature of the pre-disposition of buildings on the site allow for phasing of project components. Temporary transfer areas for functions in buildings under construction is easy to identify.

WHAT IS REDEVELOPMENT?

Any construction on a site that has pre-existing uses.

Urban infill on vacant parcels that have no existing activityEx: redevelopment of an industrial site into a mixed-use development

Constructing with a denser land usageEx: redevelopment of a block of townhouses into a large condominium building

Adaptive reuse, where structures that have outlived their uses are converted into new ones.Ex: industrial warehouses into housing lofts

REDEVELOPMENT is the best strategy for physical development of NCMH

SIZE: Area = 46.7 hectares

SITE ATTRIBUTESVIEWS

VIEWS

NATURAL ECOLOGY

EXISTING ROAD SYSTEM

It will be economical to retain as much of the existing road system as possible. They consider the rolling geography of the siteThe road system is a combination of circumferential and radial routes that follow the contour of the site

SITE ATTRIBUTES

SITE ATTRIBUTESSITE ZONINGMAIN HOSPITAL BUILDING(administrative, curative)SERVICES AND SUPPORTNORMALIZING ENVIRONMENTS(rehabilitative)COMMUNITY SETTINGSTAFF FACILITIESNATIONAL CENTER for MENTAL HEALTHStrategic and Development Planning WorkshopFebruary 13, 2012Normalizing EnvironmentTransparent SecuritySingle vs. Multi-bed Patient RoomsThe Dining ExperienceOutdoor RecreationDesigning for FlexibilityCommunity-basedLeveraging Land Value

SO, WHAT ARE YOUR FIRST THOUGHTS ON THE APPLICABILITY OF THESE TRENDS IN PLANNING AND DESIGN?Current Trends in Planning & Design of Psychiatric Care Facilities

CURRENT WORLD TRENDS IN HOSPITAL PLANNING AND DESIGN Non-institutional environmentFacilities as tool and healerPeople-centered, humanized hospitalFilm-less and paperless hospitalRoboticsGreen hospitalThe Patient as an Ally in His Own HealingCenters for Excellence: the Specialty HospitalsSO, WHAT ARE YOUR FIRST THOUGHTS ON THE APPLICABILITY OF THESE TRENDS IN PLANNING AND DESIGN?THANK YOU!40 SQ.M ./PATIENTS TO INCLUDE ALL SPACE REQUIREMENT TO INCLUDE NURSES STATION AND RECREATIONAL AREAS PEGGED AT PhP 35,000.00/SQ.M. AS OF 2012.