Environments for mental

health care in Scandinavia

3 case studies

Knut Bergsland
SINTEF Health Research
Trondheim, Norway

2009-09-21
EuHealth Property Network,
2009 Woorkshop Durham

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Scandinavia the
three projects

Telemark hospital, ac. psych. unit

(28 beds) Norway
stra sjukhuset, psych dept.
(126 beds) Sweden
Helsingr psychiatric hospital
(54 beds) Denmark
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 Some basics:
Telemark
stra hospital, Helsingr Hospital, acute
psych dept hospital care section
Completed 2006 2006 2000
Location general hospital general hospital hospital area
Inpatient+
Inpatient+ outpatient+ Inpatient - no
Content outpatient amb.care offices
Inpatient beds 126 54 28
Single rooms % 86 78 100
Unit size 14 14 10
Unit shape T V L
Area 18,800 m2 5,100 m2 3,200 m2
No. of storeys 2 (4) 1(2) 1

Concept Triple courtyard Cloverleaf Double courtyard

Site 16,600 m2 10,000 m2 4,000 m2

sloping slightly rolling slightly sloping
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Physical dimensions the 5 ss
(Not just bricks and mortar, RCoPs, 1998)

Size (scale, internal distances, number and size of units)

max 5 x 15 ward units, comprehensibility,
Structure (first impression, wayfinding)
Patient spaces (own room, size, form, furnishing, common spaces,
recreation spaces)
Treatment and staff spaces (generality, room size, working
conditions)
Siting (proximity to recreation spaces and the real world,
ordinary hospital) reducing stigma
Security and safety (enough space, normality)
Staff

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Normality the ultimate goal

To appeal to normality, you have to bring it to the fore in the

design of the environment.
Sigurd Wislff, Head of psychiatric Dept., Haugesund hosptal

Design for the meet between patients and staff

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stra sjukhuset psychiatric department

126 inpatient beds 87 % single rooms

Outpatient department
18,500 m2

White Architects

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stra sjukhuset psychiatric department
Site plan
Vision:
Identifiable, small scale
buildings
Welcoming entrance
Activity grouped around
a central mall
Access to gardens

Goal: The total environment should contribute

to re-establish patients sense of reality

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Entrance: First impression counts

Welcoming entrance
Easy to find,
Easy to orientate

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Functional structure - Outpatient department

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Outpatient department

White architects
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Functional structure- the mall

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 3
Informal meeting place
Generous space
Daylight
Views to courtyards

caf education Occ. and physiother.i research

avd 4

avd 1 avd 2 avd 3

The mall
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Functional structure - courtyards

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Functional structure - education, clinical services, etc.

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Ward structure: 9 x 14 beds

2 (3) floors, administrative units connects to the mall

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Wards with link, heart and dwelling groups 3
caf education occ.+ phys.therapy research

avd 4

avd 1 avd 2 avd 3

9 x 14 = 126 beds The link

White architects

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 Interview room
adm. offices

admittance

Ward unit the link

White architects

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 No long corridors
TV Good visibility,
ease of control
Views to the outside,
plus the courtyards
Spaciousness
nursingavd station kk
kitchen
station

dining
matplats
common
vardag

aktiv

Ward unit the heart hhj jr rt taat t White architets

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Wards: The heart

Added feeling of spaciousness

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Wards the heart

Two storey central room

reduces space on the
upper floor.

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 The heart

1(isol)

1 1
Group space

Dwelling group 4- 5 beds

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Patient room non-hospital feel?

- Size
- Character
- Variation in furnishing
- Daylight
- Views to nature

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 Single patient room
15 m2 excluding toilet/ shower

Size
Character
Variation in furnishing
Daylight
Views to nature
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 5100 sq.m
The snowflake

Helsingr psychiatric hospital

- 54 beds
- day care unit, ambulatory care unit,
- outpatient unit JDS Architects
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Contradictions as the starting point

Central vs Decentral
Freedom vs control
Open vs closed
Private vs common
Sick house vs house for health
Curing vs living

User involvement vs bright, young, strong architects

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Helsingr psychiatric hospital
Ward unit structure

14 single rooms
2 double rooms

Staff base

Patient rooms
Staff/ treatment
Common rooms
Courtyards
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Helsingr psychiatric hospital
Unit structure

cloverleaf
central entrance hall
gym/ physio at the
central hall
patient areas with
views to the pond
and the fields

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Views for patients daylight for staff
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 Main entrance

Welcoming entrance
Easy to find,
Easy to orientate
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 warm end friendly
Central entrance hall. reception
people inside

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 Gym with a view
patients on parade

Courtyards bringing the

landscape into the building

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Art in psychiatric units

Helsingr psykiatriske sygehus, dgnavsnitt

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32
Team station

Staff is visible to patients

Patients are visible to staff
Team building made easier

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Patient room countering hospital feel ?

- Size
- Character
- Variation in furnishing
- Daylight
- Views to nature

Helsingr psykiatriske sygehus, PLOT 2006

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Acute psychiatric unit, Telemark Hospital

3,200 m2
28 beds
Double courtyard L-shaped inpatient units
Asplan Viak
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Basic principles

Spaciousness, flexible solutions

No hospital corridors
Homelike, domestic feeling
Short internal distances
Security without noticeable safety measures
Unstrained observation, not surveillance
Noise reduction measures, including noiseless ventilation
One level onlySite plan
slightly sloping
4,000 m2 site

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 Admittance unit

Acute

Main entrance

Treatment Common/ Staff offices

Patient zone activity
zone

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 Patient room

Perceived control of own environment

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 Addition to the ward

Therapeutic talk
Reducing agitation
Letting out steam and smoke

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Common room

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Security using technology

Corridor with automatic

partitioning at night
wide corridors
ceiling heights
space, space, space

Mobile alarm system Central temperature

control
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 Helsingr Telemark

Scale
Avoid:
acute hospital features
repetition
long corridors

homelike? stra

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 Helsingr Telemark

Space
- Sufficient space (sq.m)
- Plan for larger body zones
- Feeling of spaciousness
- Can high quality places (finishes
and furniture) counter the need
for space? stra

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Furniture
High quality

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Conclusions

Maximum 50 90 beds probably right

People at the entrance point almost a necessity
Courtyards vehicles for good solutions
Maximum two storey buildings for inpatients preferrably 1
Direct access for patients to the outside
Built-in non-visible security
Do not use ordinary hospital beds
Teach the architect, make him become emphatic

A psychiatrist without empathy may be dangerous to his

patients. An architect without empathy may be the same

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Find more on:

www.sykehusplan.no

Thank you!

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Visions
stra Helsingr Telemark
acute mostly elective + acute acute only
LOS = 20 LOS = 25 LOS = 9
Make good treatment
Appeal to normality Appeal to modernity possible
As low as possible, small
scale buildings Low buildings Low, small scale buildings
Daylight Daylight for staff Daylight
Views to nature Views for patients Views to nature
Access to outdoors Access to outdoors Access to outdoors
Places for equal
meetings Program requirements Homelike feeling
Safety and security: Safety and security: No
Normality in environment Safety and security: visual measures + use of
+ staff assistance Wards "below ground" technology
High quality materials and Modern materials and Local materials + modern
furnishing furnishing Norwegian furniture

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