AR - Manalo, Krishna Joy G.-Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital PDF

Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital
MANALO, KRISHNA JOY G.

2002103121 12/18/2012
MAPUA INSTITUTE OF TECHNOLOGY

School of Architecture, Industrial Design, and Built Environment
Proposed Sustainable
Redevelopment and Expansion
of Mariveles Mental Hospital
AR 200 - Thesis Research Writing
BY
Manalo, Krishna Joy G.

2002103121
12/18/2012
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ACKNOWLEDGEMENT
This dissertation would not have been possible without the guidance and the help of
several individuals who in one way or another contributed and extended their valuable
assistance in the preparation and completion of this study.
First and foremost, my utmost gratitude to Arch. Christina G. Ealdama for her exemplary
guidance, monitoring and constant encouragement throughout the course of this thesis;
The Administrators of the Faculty of Architecture Mapua Institute of Technology, for

their untiring effort in encouraging the teaching staff to pursue professional growth;
For the unwavering moral, emotional and financial support of my family, friends and
colleagues;
Above all, the omnipresent God, for answering my prayers and giving me the strength to
plod on despite mu constitution of wanting to give up and throw in the towel, thank you so
much Dear Lord.
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Abstract
This research studied how environment both built and natural effects can be used as a tool to
create a comfortable and therapeutic setting that can promote better recovery and
psychological growth for the mentally ill.
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TABLE OF CONTENTS
Abstract4
CHAPTER I ..................................................................................................................................... 8
1.1 Introduction ......................................................................................................................... 8
1.2 Background of the Study ....................................................................................................... 8
Table 1. .......................................................................................................................... 9
1.3 Statement of the Problem .................................................................................................. 10
1.4 Project Goals, Objectives and Strategies ............................................................................. 10
1.5 Significance of the Research ............................................................................................... 11
1.6 Review of Related Literature and Studies ............................................................................ 11
1.6.1 Different Types of Mental Illnesses and their Treatment Process .................. 11
Table 2. Types of Mental Illness and their treatment according to Comprehensive
Reviewer for Nursing Licensure Examination by Leonora N. Reyes, RN and Ma. Estella
M. Layug, RN, 2009 ...................................................................................................... 15
1.6.2 The Effect of the Built and Natural Environment in Mental Health Units on
Patients, Staff and Visitors ................................................................................... 18
Table 3. ........................................................................................................................ 19
1.6.3 Psychiatric Rehabilitation .............................................................................. 21
1.6.4 Healing Environment in Psychiatric Hospital Design ...................................... 25
1.7 Theoretical Framework ....................................................................................................... 28
Fig. 1 ............................................................................................................................ 28
1.8 Research Methodology ....................................................................................................... 29
1.8.1 Oral Investigation .......................................................................................... 30
Fig. 2 ............................................................................................................................ 30
Table 4. ........................................................................................................................ 34
Table 5. ........................................................................................................................ 35
1.8.2 Case Study of Mariveles Mental Hospital ...................................................... 35
Fig. 3 ............................................................................................................................ 36
Fig. 4 ............................................................................................................................ 36
Fig. 5 ............................................................................................................................ 37
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Fig. 6 ............................................................................................................................ 37
Fig. 7 ............................................................................................................................ 38
Fig. 8 ............................................................................................................................ 38
Fig. 9 ............................................................................................................................ 39
Fig. 10........................................................................................................................... 39
Fig. 11........................................................................................................................... 40
Fig. 12........................................................................................................................... 41
Table 6. ........................................................................................................................ 41
Fig. 13........................................................................................................................... 42
Table 7. ........................................................................................................................ 42
Fig. 14........................................................................................................................... 43
Fig. 15........................................................................................................................... 43
Fig. 16........................................................................................................................... 47
Fig. 17........................................................................................................................... 48
1.8.3 Case Study of Yuli Veterans Hospital ............................................................. 49
Fig. 18........................................................................................................................... 50
Fig. 19........................................................................................................................... 52
Fig. 20........................................................................................................................... 53
1.8.4 Case Study of Metro Psych Facility ................................................................ 54
Fig. 21........................................................................................................................... 56
1.9 Scope and Limitations of the Study ..................................................................................... 57
1.10 Definition of Terms ............................................................................................................. 57
CHAPTER II .................................................................................................................................. 58
2.1 Rationale ............................................................................................................................ 58
2.2 Summary of Findings .......................................................................................................... 58
2.3 Recommendations for Application ...................................................................................... 58
CHAPTER III ................................................................................................................................. 60
3.1 Site Profile and Analysis ...................................................................................................... 60
3.1.1 Setting the Criteria.............................................................................................................. 60
3.1.2 Description of Site Options .......................................................................... 60
Fig. 22 Map of Bataan .................................................................................................. 60
3.1.3 Site Selection and Justification ............................................................................................ 61
Fig. 23........................................................................................................................... 62
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Fig. 24........................................................................................................................... 62
Fig. 25........................................................................................................................... 63
Fig. 26........................................................................................................................... 63
Fig. 27........................................................................................................................... 64
3.1.5 Rules and Regulations Governing Health Facilities in the Philippines ................................... 64
Table 8. ........................................................................................................................ 69
CHAPTER IV ................................................................................................................................. 74
4.1 Users Analysis .................................................................................................................... 74
Table 9. Definition of Users .......................................................................................... 74
Fig. 28........................................................................................................................... 74
Fig. 29........................................................................................................................... 75
Fig. 30 Space Zoning ..................................................................................................... 76
Fig. 31........................................................................................................................... 76
4.2 Space Programming ............................................................................................................ 77
Table 10. Space Programming Index ............................................................................ 78
4.4 Concept .............................................................................................................................. 86
4.5 Architectural Drawings ....................................................................................................... 86
Bibliography.............................................................................................................................. 102
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CHAPTER I
1.1 Introduction
Mental illness is the third most common type of disability in the Philippines according to
National Statistics Office disability survey in 2000. This is highly prevalent among people living in
poverty, people with HIV/AIDS, drug addiction or substance abuse and prisoners. Many people
with mental health conditions experience severe stigma, discrimination and abuse; they
encounter barriers to exercising their civil and political rights; they have limited access to
educational program and healthcare facilities; and they are excluded from income-generating
and employment opportunities. Since they are highly vulnerable it is crucial that people with
mental health conditions are recognized and targeted for development interventions.
A psychiatric hospital specializes in the treatment of serious mental disorders. One of
the psychiatric facilities in the Philippines is the Mariveles Mental Hospital that was established
in 1955. The Bureau of Quarantine donated the 3.8 hectares land and buildings of the old
Quarantine Station. It has a 500-bed capacity in Central Luzon located at the seaside town of
Mariveles, province of Bataan, about 170 kilometers from Manila. Most of the buildings are
scattered around the area. Nursing students are conducting their therapy sessions with the
patients seated on mono block chairs under the trees and inside the ruins of the Quarantine
Station. The appearance of the wards replicates a prison cell. According to Luz A. Velasco, MD,
one of the medical officers in Mariveles Mental Hospital, each ward has 50-70 patients cramped
inside and just lay mats during the night to accommodate all.
1.2 Background of the Study

Mental illness is any disease or condition that influences the way a person thinks, feels,
behaves, and/or relates to others and to his or her surroundings. The exact cause of most
mental illnesses is not known, it is becoming clear through research that many of these
conditions are caused by a combination of genetic, biological, psychological, and environmental
factors.
The prevalence of mental illness in the Philippines is at the average of 11% - 44% (27.5%)
or approximately 22, 745,162 from a general population of 84, 241, 341(NSO 2005 estimate)
according to DOH records of published studies. However included in the figure are substance
related disorders which constitute 18% of 27.5%. If substance related disorder is excluded, the
prevalence rate is at 9% or 7.5 million Filipinos are suffering from some form of mental disorder.
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Correlating the latter study with an earlier World Health Organization study by Shinfuku
(1993) which states:
About 1% of population suffers from severe mental & neurologic disorders = 842,413
Filipinos* are suffering from severe mental & neurologic disorder
of which 1/3 is estimated to be suffering from psychosis or 280,804 Filipinos
About 5% of population suffers from moderate to mild forms of mental & neurologic
disorder or 4,212,067 Filipinos* (*based on 84, 241, 341 population estimate in 2005)
The current DOH bed capacity for mental disorder is 5,465. Of these, 4,200 beds are in
the NCR (at the National Center for Mental Health). The rest of the country shares the remaining
1,265 beds (CAR-40 beds, Region II-200 beds, Region III-500 beds, Region XI-200 beds). Regions I,
IV, X, XII, CARAGA and ARMM do not have inpatient psychiatric facilities. Only twenty-seven (27)
DOH medical centers and regional hospitals have mental health services.
Mariveles Mental Hospital caters to seven (7) provinces in Region III and a few outside
the region. The statistics shown below were based from the records in Center for Health
Development III.
Table 1. Statistics showing number of patients in Mariveles Mental Hospital from January-
December 2011 based from records in Center for Health Development III
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1.3 Statement of the Problem

The common notion for mental hospitals is a prison for psychotics. Furthermost, there is
a least chance of eventual recovery and discharge in most of the patients who are treated longer
in a mental hospital thus the reason of overcrowding the facility. The place for the mentally ill
needs to be more humane in order for them to recuperate.
The design of a psychiatric hospital and its environment is very crucial to the extent that
what might be considered irrelevant can have traumatic effects on patients. It is important to
study the different cases of mental disorders treated in a mental hospital, the spaces they
require, the everyday routine of the patients and staff in order to easily manage the facility, the
effects of fundamental factors such as light, noise, color, equipment, facilities and other physical
items present in the environment.
This research aims to identify:
What are the activities and processes inside the mental hospital that should be analyzed
in order to design a more effective and easy to manage facility?
What are the strategies and undertakings that can help the patients to be more
productive while inside the facility?
How to maximize the potential of the area in terms of bringing extra income to the
facility for additional funds without interfering with the safety of the patients and staff
inside the facility?
1.4 Project Goals, Objectives and Strategies
Project Goal:
To increase awareness about the effect of the built environment on mental health
To maximize the potential of the vast land of the psychiatric facility by researching
on different activities that can be allowed to improve the well-being of the patients
that may help them adjust to the community.
o Reintegration of patients with mental illness into society.
Research / Thesis Goal:
To study how to create a comfortable and therapeutic setting that can promote
better recovery and psychological growth for the mentally ill.
o To identify the critical factors needed to be considered when planning a
mental hospital.
o To study cases that is relevant to the project.
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1.5 Significance of the Research

The physical environment of a mental hospital where treatment occurs has an impact on both
the treatment process and its result. Built and natural environments have emotional impact to
all those who use it. In the present day, environmental psychologists study how environments
affect people and architects who design the facility need to consider how it will affect the users.
This study will help not only the patients but also the staff working in the facility. The vast land
where the hospital stood can be maximized to its full potential where patients can be trained to
their interests that can be used to help them become more productive in the community.
Architecture as a tool in the therapeutic process, the design and execution of a
psychiatric hospital has a potential to enhance their experience of space, increase their sense of
power, build social bonds, & reintegrate them into society.
1.6 Review of Related Literature and Studies

1.6.1 Different Types of Mental Illnesses and their Treatment Process
Mental Illnesses
Treatment
Depressive Disorders
Mental disorders characterized by There are clear guidelines for the
either depressed mood or markedly treatment of depressive disorders.
diminished interest or pleasure in These include both antidepressant
most activities of the day. medications and psychological
Associated with any significant weight interventions like cognitive therapy,
loss or weight gain, difficulty in behavior therapy, interpersonal
sleeping or oversleeping, fatigue or therapy and family therapy.
loss of energy, psychomotor agitation Individual: This therapy involves only
and slowness, excessive guilt or feeling the patient and the therapist.
of worthlessness, diminished ability to Group: 2 or more patients may
think or concentrate or indecisiveness, participate in therapy at the same
recurrent thoughts of deaths, time. Patients are able to share
recurrent suicidal ideations. experiences and learn that others feel
If they alternate with exaggerated the same way, and have had the same
elation or irritability, they are known experiences.
as bipolar disorder (one pole Marital/couples: This type of therapy
depression, the other pole, elation or helps spouses and partners understand
mania). why their loved one has depression,
The severity of the symptoms that what changes in communication and
often accompany the depressed mood behaviors can help, and what they can
and the duration of the disorder cause do to cope.
significant distress or impairment in Family: Because family is a key part of
social, occupational or other areas of the team that helps people with
functioning. depression get better, it is sometimes
helpful for family members to
understand what their loved one is
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going through, how they themselves

can cope, and what they can do to
help.
Bipolar Disorder
Bipolar disorder, sometimes called Medications are key in helping people
manic depression, is a disorienting with bipolar disorder live stable,
condition that causes extreme shifts in productive lives. Mood stabilizers can
mood. The length of each high and low smooth out the cycle of ups and
varies greatly from person to person. downs. Patients may also be
During a manic phase, patients tend to prescribed antipsychotic drugs and
feel euphoric and may believe they anticonvulsant drugs. Between acute
can accomplish anything. This can states of mania or depression, patients
result in inflated self-esteem, typically stay on maintenance
agitation, reduced need for sleep, medication to avoid a relapse.
being more talkative, being easily Talk therapy can help patients stay on
distracted, and a sense of racing medication and cope with their
thoughts. Reckless behaviors, disorder's impact on work and family
including spending sprees, sexual life. Cognitive behavioral therapy
indiscretions, fast driving, and focuses on changing thoughts and
substance abuse, are common. behaviors that accompany mood
swings. Interpersonal therapy aims to
ease the strain bipolar disorder may
place on personal relationships. Social
rhythm therapy helps patients develop
and maintain daily routines.
Friends and family may not understand
bipolar disorder at first. They may
become frustrated with the depressive
episodes and frightened by the manic
states. If patients make the effort to
explain the illness and how it affects
them, loved ones may become more
compassionate. Having a solid support
system can help people with bipolar
disorder feel less isolated and more
motivated to manage their condition.
Mental Retardation
A condition of incomplete or halted In general, people with mild and
development of the mind, which is moderate mental retardation held the
characterized by the impairment of most flexibility to adapt to
skills as manifested during the environmental conditions.
developmental period that contributes In most cases, the underlying
to the overall level of intelligence intellectual impairment does not
(WHO). improve, yet the affected persons
Significantly below average intellectual level of adaptation can be positively
functioning (IQ<70) with influenced by an enriched and
accompanying impairment in the supportive environment.
persons effectiveness in meeting The best treatment of mental
standards expected of ones age, as is retardation is primary, secondary and
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expected by social and cultural tertiary prevention.

influences in the following areas:
communication, self-care, home living,
social-interpersonal skills, use of
community resources, self-direction,
functional academic skills, work,
leisure, health and safety.
Mental retardation is classified by the
degree of intellectual functioning as
mild, moderate, severe and profound.
Schizophrenia
Mental disorder characterized by Antipsychotic medications reduce the
profound disruption in thinking and symptoms of schizophrenia.
feeling, that affects behavior, as Many are effective in reducing
shown as abnormality in language, hallucinations and delusions.
thought, perception and sense of self. Some are effective in reducing
This includes psychotic experience like symptoms like apathy, withdrawal and
hallucinations, illusions, delusions and lack of motivation or drive.
disordered thinking. Many reduce the likelihood of relapse in
Additional symptoms are social continued use.
withdrawal, extreme apathy, lack of Some have mild side effects like dryness
drive or initiative and emotional of mouth, drowsiness, dizziness and
unresponsiveness. Social dysfunction serious side effects as trouble with
as shown in self-neglect, poor muscle control, restlessness, tremors
grooming, poor interpersonal and facial tics.
interaction and being nonproductive Psychotherapy
occupationally. Psychosocial Treatments
Duration of the signs and symptoms are Family Education
at least 6 months. Self-help Groups
It is not a split personality, rather it is
shattered personality.
Schizoaffective disorder - is a mental
illness that shares the psychotic
symptoms of schizophrenia and the
mood disturbances of depression or
bipolar disorder.
Alcohol Dependence
Mental disorder recognizable through Treatment can be done in community
the following symptoms: settings
a. Strong and persistent desire to drink Prognosis is good even if a person is
alcohol despite harmful consequences pressured into treatment
b. Inability to control drinking Patients who come for voluntary
c. Higher priority given to alcohol treatment have the best prognosis
consumption than other obligations Voluntary mutual help organizations
d. Tolerance to alcohol and physical play a large role in the treatment
withdrawal reaction when alcohol is Effective alcohol control policies are
abruptly discontinued also needed
Many problem drinkers have health
problems including accidents and
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injuries, heart disease, cancer, liver

disease and alcohol psychosis.
Alcohol drinking is related to social
problems like crime and violence,
marital breakdown, poor school
performance, work absenteeism,
suicide and financial debt.
Alcohol drinking is responsible for 1.5%
of all deaths in the world.
Alzheimers Disease
Is a form of dementia that is Currently no cure for Alzheimers
characterized by the progressive Disease
degenerative brain syndrome that General treatment approach to patient
affects memory, thinking, behavior is to provide supportive medical care,
and emotion. pharmacological treatment for specific
Constitutes 50-60% of all cases of symptoms, including disruptive
dementia. behavior and emotional support for
Symptoms include the following: patients and their families.
-Loss of memory characterized by the
inability to recall pass as well as new
persons, events, situations and
information
-Difficulty in performing previously
routine tasks
-Personality and mood change
There is significant impairment in
personal care for social interaction and
occupation productivity.
At the late stage, the individual can no
longer care for themselves, do not
recognize friends, relatives and
familiar objects.
The course of the disorder is
characterized by gradual deterioration
over 5-10 years leading eventually to
death.
Colloquially described as ulianin.
Anxiety Disorder
Anxiety can range from the constructive There are a variety of treatments
kind that elevates performance as with available for controlling anxiety,
performance anxiety, to disorders of including several effective medications
anxiety, in that the individual suffers and specific forms of psychotherapy.
from a level of fear, angst, or dread The psychotherapy component of
that interferes with his or her ability to treatment for anxiety disorders is at
function. The most common anxiety least as important as the medication
disorders are specific phobias. Other treatment. The most common type of
anxiety disorders include social anxiety therapy used to treat anxiety is
disorder, panic disorder, generalized cognitive behavioral therapy (CBT).
anxiety disorder, obsessive compulsive Behavioral techniques that are often
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disorder, and posttraumatic stress used to decrease anxiety include

disorder. relaxation techniques and gradually
increasing exposure to situations that
may have previously precipitated
anxiety in the individual.
Table 2. Types of Mental Illness and their treatment according to Comprehensive Reviewer for
Nursing Licensure Examination by Leonora N. Reyes, RN and Ma. Estella M. Layug, RN, 2009
Types of Therapy
Medication - The administration of a drug or medicine. (Note that "medication" does not
have the dangerous double meaning of "drug.")
Psychotherapy - Psychotherapy is often the first form of treatment recommended for
depression. Called "therapy" for short, the word psychotherapy actually involves a variety
of treatment techniques. During psychotherapy, a person with depression talks to a
licensed and trained mental health care professional who helps him or her identify and
work through the factors that may be causing their depression. Sometimes these factors
work in combination with heredity or chemical imbalances in the brain to trigger
depression. Taking care of the psychological and psychosocial aspects of depression is
important. Psychotherapy helps people with depression:
o Understand the behaviors, emotions, and ideas that contribute to his or her
depression.
o Understand and identify the life problems or events -- like a major illness, a
death in the family, a loss of a job or a divorce -- that contribute to their
depression and help them understand, which aspects of those problems they
may be able to solve or improve.
o Help to restructure ways of thinking, negative attributes and attitudes someone
has about himself, and ways in which faulty thinking may perpetuate
depression.
o Regain a sense of control and pleasure in life.
o Learn coping techniques and problem-solving skills.
Group Therapy - A type of psychiatric care in which several patients meet with one or more
therapists at the same time. The patients form a support group for each other as well as
receiving expert care and advice. The group therapy model is particularly appropriate for
psychiatric illnesses that are support-intensive, such as anxiety disorders, but is not well
suited for treatment of some other psychiatric disorders.
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Day treatment or partial hospital treatment - also known as PHP (from Partial
Hospitalization Program), is a type of program used to treat mental illness and substance
abuse. In partial hospitalization, the patient continues to reside at home, but commutes to
a treatment center up to seven days a week. Since partial hospitalization focuses on overall
treatment of the individual, rather than purely safety, the program is not used for acutely
suicidal people. Treatment during a typical day may include group therapy, individual
therapy, and psychopharmacological assessments and check-ins. Programs are available for
the treatment of alcoholism and substance abuse problems, Alzheimers disease,
anorexia and bulimia, depression, bipolar disorder, anxiety disorders, schizophrenia, and
other mental illnesses. Programs geared specifically toward geriatric patients, adult
patients, adolescents, or young children also exist. Programs for adolescents and children
usually include an academic program, to either take the place of or to work with the child's
local school.
Specific therapies, such as cognitive-behavior therapy (abbreviated CBT) - A therapeutic
practice that helps patients recognize and remedy dysfunctional thought patterns. One
characteristic technique is exposure and response prevention, in which a patient with a
phobia deliberately exposes himself or herself to the feared situation, gradually decreasing
the panic response. Cognitive behavior therapy is used to treat obsessive-compulsive
disorder, panic disorder, and other biologically based psychiatric illnesses, often in
combination with medication. Evidence gathered from brain scans indicates that over time
this therapy can sometimes create actual changes in brain and neurotransmitter function.
Behavior modification - rewarding appropriate or positive behavior and ignoring
inappropriate behavior - also may help control unacceptable or dangerous behaviors.
Alternative therapies, such as water therapy, massage, and biofeedback.
Biofeedback - A method of treatment that uses a monitor to measure patients'
physiologic information of which they are normally unaware. By watching a monitor,
patients can learn by trial and error to adjust their thinking and other mental processes
in order to control 'involuntary' bodily processes such as blood pressure, temperature,
gastrointestinal functioning, and brain wave activity. Biofeedback is now used to treat a
wide variety of conditions and diseases, including stress, alcohol and other
addictions, sleep disorders, epilepsy, respiratory problems, fecal and urinary
incontinence, muscle spasms, partial paralysis, muscle dysfunction caused by
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injury, migraine headaches, hypertension, and a variety of blood vessel conditions,
including Raynaud's phenomenon.
Creative therapies, such as art therapy, music therapy, or play therapy.
Hypnotherapy - is entering the mainstream as a means of behavior and pain control.
According to the American Psychological Association's official position on the subject,
hypnosis is a procedure in which a health professional or researcher suggests that a client,
patient, or subject experience changes in sensations, perceptions, thoughts, or behavior.
Subjects are "induced" in many ways, usually by concentrating on an object or point and
then by hearing suggestions that they are calm, focused. In time, the therapist can teach
you to induce your own trance state and give yourself helpful suggestions when necessary.
Electroconvulsive therapy (ECT) - During the ECT procedure, an electric current is passed
through the brain to produce controlled convulsions (seizures). ECT is useful for certain
patients with significant depression, particularly for those who cannot take or are not
responding to antidepressants, have severe depression, or are at a high risk for suicide. ECT
often is effective in cases where antidepressant medications do not provide sufficient relief
of symptoms.
This procedure probably works by a massive neurochemical release in the brain due
to the controlled seizure. Highly effective, ECT relieves depression within 1 to 2 weeks after
beginning treatments. After ECT, some patients will continue to have maintenance ECT,
while others will return to antidepressant medications.
In recent years, the technique of ECT has been much improved. The treatment is
given in the hospital under anesthesia so that people receiving ECT do not feel pain. Most
patients undergo 6 to 10 treatments. An electrical current is passed through the brain to
cause a controlled seizure, which typically lasts for 20 to 90 seconds. The patient is awake
in 5 to 10 minutes. The most common side effect is short-term memory loss, which resolves
quickly. After the initial course of treatment, ECT can be safely done as an outpatient
procedure.
Vagus nerve stimulation (VNS) - surgically implanted device sends electrical pulses to the
brain through the vagus nerve in the neck. These pulses are believed to ease depression by
affecting mood areas of the brain.
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Transcranial magnetic stimulation (TMS) is a newer therapy. A non-invasive technique that

consists of a magnetic field emanating from a wire coil held outside the head. It appears as a
promising treatment for some neuropsychiatric conditions, particularly major depression.
1.6.2 The Effect of the Built and Natural Environment in Mental Health Units on Patients,
Staff and Visitors
Mental illnesses are medical conditions characterized by altered thinking, mood, or
behavior that causes distress or impaired functioning. People with mental illness have
heightened sensitivity to sensory stimuli and their lessened ability to adjust to the effects of such
stimuli, they are much more likely to be affected by their surroundings than healthier people,
and their social relationships are correspondingly affected. It is essential to maintain the
collaboration between architecture and psychiatry as an attempt to provide an optimum
psychological fit between people and their surrounding (Sime, 1986, p.49).
According to Dr. Ulrich, a Professor of Architecture at the Center for Healthcare Building
Research at Chalmers University of Technology in Sweden and adjunct professor of architecture
at Aalborg University in Denmark, consideration to the design of the physical environment of a
psychiatric hospital can provide major support for patients and their treatment programs, as
well as for their families and for the staff. A well-designed psychiatric facility has good health
outcomes for the users especially related to stress reduction and greater job satisfaction. By
reducing stress within the environment there is improved job satisfaction for employees
enabling fewer staff absentee rates and a lower staff turnover. The patients are also affected by
having a decrease in hospital stay and even a decrease in the amount of medication taken.
Overall it appears that patients feel that physical changes in ward environments help them to
feel better, whilst staffs are able to generate a more positive work attitude.
On his proposed Theory of Supportive Design, he stated that the basic principle
underlining his theory is that the potential for environments to promote improved outcomes is
linked to their effectiveness in facilitating stress coping and restoration (quoting his own
research Ulrich 1991, 1997, 1999). He stated that the great majority of patients experience
stress and many suffer from acute stress, which is a significant health outcome in itself and
which can directly and negatively affect many other outcomes such as numerous psychological,
emotional, physiological, biochemical and behavioral changes. He also stated that good design
can reduce stress, anxiety, lower blood pressure and lessen pain. He offered the following list to
answer the question, What advantages can health care administrators, designers, medical
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professionals (and the public) reasonably expect to achieve by including psychosocially
supportive design criteria in the objectives for a new facility?
Table 3. Dr. Ulrich compilation of the advantages in terms of improved outcomes that seem
realistically attainable in a well-designed facility
Anecdotal evidence related to design impacts on behavior was quoted by the National
Academy of Sciences discussed during a Neuroscience and Health Care Facilities Workshop
where Siegels (2002) architectural firm was called in by a hospital to change a newly
constructed psychiatric unit designed by another firm. The emergency (seclusion) room had tile
walls, bars on the window and a drain in the floor, where disturbed patients did what was
expected of them, for example they threw feces on the walls etc., but it was very easy to clean
up. However, a new director put carpet on the floor and drapes on the walls, together with
some pictures. When they moved violent patients in, they no longer acted destructively.
According to Siegel, as a result of this, the layout of the entire unit was modified, which in turn
changed the involvement of patients with their environment.
The effect of noise, lighting, sun, temperature and color are additional features that
contribute to the overall ambiance of the mental health unit. Each feature has to minimize the
stress it places on the individual using the environment. Noise is often considered as a
widespread source of stress that can affect patient comfort and work performance by staff. By
simply minimizing noise levels from identified sources can reduce stress, in both patients and
staff. Lighting has different impacts on different user groups. Patients, visitors, support staff and
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practitioners each require different lighting. Patients may benefit from increased levels of
lighting during the awake period and decreased levels of lighting during the sleep period, which
may enhance sleep quality and thus speed recovery. Exposure to sun in ward rooms in a
psychiatric ward has significantly reduced the average number of days spent in the ward. Room
temperature was shown to have physiological impacts and different impacts on males and
females. The impacts included hot rooms producing more aggression in both genders, but more
so for males, to raised blood pressure in hot rooms and conversely, lowered blood pressure in
colder rooms. Color does influence behavior and that it can be harnessed to influence
productive function and improve the quality of life. Such issues as way finding, highlighting and
camouflaging particular areas and mood enhancement can all be influenced by the use of color.
A study was conducted at the Chaim Sheba Medical Centre at Tel-Hashomer, Israel by multi-
disciplinary team of architects, mental health professionals and administrators to examine the
effects of design in mental health facility. They had concluded a set of guidelines for ward design
that include:
Patients should not be overcrowded or over concentrated.
A variety of spaces that support social interaction should be provided a large day room,
a well-lit and ventilated dining room, spacious lobby and corridors.
Design that resembles a living room with residential furniture.
Building that is well kept and maintained.
Safety aspects include observation by staff, lighting, exits and smoke detectors.
Staff work and rest areas are well segregated and provided with separate entrances.
The effects of the design process, based on daily clinical observations by the staff:
Patients will enjoy their physical environment, if it offers them a safe, comfortable,
nonthreatening and readily comprehensible set of surroundings.
The physical environment sends clear messages to patients about the level of respect for
the patient and concern for his or her physiological and psychological wellbeing. A well-
designed and maintained environment sends strong positive messages while the
opposite sends strong negative messages.
Physical environments also contribute to the quality of life and sense of professional
dignity of the staff.
A psycho-environmental approach to psychiatric design can provide an important and
effective tool in the pursuit of a humane, efficient containment and reduction of severe
psychopathy.
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The study supports a prediction that a well-planned environment may favorably affect
both patients and staff.
1.6.3 Psychiatric Rehabilitation

Psychiatric Rehabilitation or also known as psychosocial rehabilitation is a part of
rehabilitation that is focused on helping an individual improve or restore functions that will help
them to interact in a community and with their environment. The main concept of psychiatric
rehabilitation is focused on problems for an individual dealing with interpersonal situation and
how to interact in society more so than focusing on mental illness.
All patients suffering from severe and persistent mental illness require rehabilitation.
The goal of psychiatric rehabilitation is to help disabled individuals to develop the emotional,
social and intellectual skills needed to live, learn and work in the community with the least
amount of professional support (Anthony W. Cohen M. Farkas M, 2002). Although psychiatric
rehabilitation does not deny the existence or the impact of mental illness, rehabilitation practice
has changed the perception of this illness. Enabling persons with persistent and serious mental
illness to live a normal life in the community causes a shift away from a focus on an illness model
towards a model of functional disability (B., 1994). Social role functioning becomes relevant -
including social relationships, work and leisure as well as quality of life and family burden - is of
major interest for the mentally disabled individuals living in the community.
The revised International Classification of Functioning, Disability and Health (ICF) (WHO, 2001)
includes a change from negative descriptions of impairments, disabilities and handicaps to
neutral descriptions of body structure and function, activities and participation. It is a useful tool
to comprehend chronically mentally ill in all their dimensions, including impairments at the
structural or functional level of the body, at the person level with respect to activity limitations,
and at the societal level with respect to restrictions of participation. Each level encompasses a
theoretical foundation on which a rehabilitative intervention can be formulated. Interventions
can be classified as rehabilitative in the case that they are mainly directed towards a functional
improvement of the affected individual.
The two intervention strategies of psychiatric rehabilitation are the individual- centered that
aims to develop the patients skills in interacting with a stressful environment and the ecological
strategy that is directed towards developing environmental resources to reduce potential
stressors. To sufficiently understand rehabilitation the starting point should be concerned with
the individual person in the situation of his or her specific environment. Psychiatric rehabilitation
is frequently carried out under real life conditions thus; rehabilitation practitioners must take
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into consideration the realistic life circumstances that the affected person is likely to encounter
in his or her daily life (Bachrach, 2000). The second step is helping disabled persons to identify
their personal goals through motivational interviews that can provide a more sophisticated
approach to identify the individuals' personal costs and benefits associated with the needs listed.
This makes it also necessary to assess the individuals' readiness for change.
The rehabilitative planning process focuses on the patient's strengths (Bachrach, 2000).
Regardless of the degree of psychopathology of a given patient, the practitioner must work with
the "well part of the ego" as "there is always an intact portion of the ego to which treatment and
rehabilitation efforts can be directed". This leads to a closely related concept: the aim of
restoring hope to people who suffered major setbacks in self-esteem because of their illness. As
Bachrach (Bachrach, 2000) states, "it is the kind of hope that comes with learning to accept the
fact of one's illness and one's limitations and proceeding from there".
Psychiatric rehabilitation cannot be imposed. Quite the contrary, psychiatric
rehabilitation concentrates on the individual's rights as a respected partner and endorses his or
her involvement and self-determination concerning all aspects of the treatment and
rehabilitation process. These rehabilitation values are also incorporated in the concept of
recovery (Gagne, 2005). Within the concept of recovery, the therapeutic alliance plays a crucial
role in engaging the patient in his or her own care planning. It is essential that the patient can
rely on his or her therapist's understanding and trust, as most of the chronically mentally ill and
disabled persons lose close, intimate and stable relationships in the course of the disease
(Monzani, 2004). Recent research has suggested that social support is associated with recovery
from chronic diseases, greater life satisfaction and enhanced ability to cope with life stressors
(A., 2004). Corrigan et al (PW., 2005) have found that the most important factor facilitating
recovery is the support of peers. Therefore, psychiatric rehabilitation is also an exercise in
network building.
Finally, people with mental disorders and their caregivers prefer to see themselves as
consumers of mental health services with an active interest in learning about mental disorders
and in selecting the respective treatment approaches. Consumerism allows the taking of the
affected persons' perspective and seriously considering courses of action relevant for them
(Liberman, 2002). In this context, physicians should also acknowledge that disagreement about
the illness between themselves and the patient is not always the result of the illness process
(Bebbington, 1995).
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Life aspirations of people with psychiatric disabilities are not far different from ordinary
people in the society. They want to be respected as independent individuals and lead a life as
normal as possible. As such they mostly desire: a) their own housing, b) an adequate education
and a meaningful work career, c) satisfying social and intimate relationships, and d) participation
in community life with full rights.
The objective of psychiatric reforms since the mid-1950s has been to resettle chronically
mentally ill persons from large custodial institutions to community settings. Providing sheltered
housing in the community for the long-term patients of the old asylums was one of the first
steps in the process of deinstitutionalization. Most long-stay patients can successfully leave
psychiatric hospitals and live in community settings (G, 2004).
Ideally, a residential continuum (RC) with different housing options should be provided.
RC ranges from round-the clock staffed sheltered homes to more independent and less staffed
sheltered apartments which eventually allow individuals moving to independent housing in the
community. Critics of RC contended that: a) up to date RC is rarely available in communities, b)
RC does not meet the varying and fluctuating needs of persons with serious mental illnesses, and
c) RC does not account for individuals' preferences and choices. Supported housing, i.e.
independent housing coupled with the provision of support services (Carling, 1992), emerged in
the 1980s as an alternative to RC. Supported housing offers flexible and individualized services
depending on the individual's demands. In the meantime, rehabilitation research could
demonstrate that supported housing is a realistic goal for the majority of people with psychiatric
disabilities. Once in supported housing, the majority stay in housing and are less likely to
become hospitalized. Other outcomes do not yield consistent results (Rog, 2004).
Vocational rehabilitation originated in psychiatric institutions, where the lack of activity
and stimulation led to apathy and withdrawal of inpatients. Long before the introduction of
medication, occupational and work therapy contributed to sustainable improvements in long-
stay inpatients. Today occupational and work therapy are not any longer hospital-based, but
represent the starting point for a wide variety of rehabilitative techniques teaching vocational
skills.
Today, the most promising vocational rehabilitation model is supported employment
(SE). The work of Robert Drake and Deborah Becker decisively influenced the conceptualization
of SE. In their "individual placement model", disabled persons are placed in competitive
employment according to their choices as soon as possible and receive all support needed to
maintain their position. The support provided is continued indefinitely. Participation in SE
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programs is followed by an increase in the ability to find and keep employment. Links were also
found between job tenure and non-vocational outcomes, such as improved self-esteem, social
integration, relationships and control of substance abuse. It was also demonstrated that those
who had found long-term employment through SE had improved cognition and quality of life,
and better symptom control (Bond, 2004).
Although findings regarding SE are encouraging, some critical issues remain to be
answered. Many individuals in SE obtain unskilled part-time jobs. Since most studies only
evaluated short (12-18 months) follow-up periods, the long-term impact remains unclear.
Currently we do not know which individuals benefit from SE and which do not. After all, we have
to realize that the integration into the labor market does by no means only depend on the ability
of the persons affected to fulfill a work role and on the provision of sophisticated vocational
training and support techniques, but also on the willingness of society to integrate its most
disabled members.
In recent years, social skills training in psychiatric rehabilitation has become very popular
and has been widely promulgated. The most prominent proponent of skills training is Robert
Liberman, who has designed systematic and structured skills training since the mid-1970s.
Liberman and his colleagues packaged the skills training in the form of modules with different
topics. The modules focus on medication management, symptom management, substance
abuse management, basic conversational skills, interpersonal problem solving, friendship and
intimacy, recreation and leisure, workplace fundamentals, community (re-) entry and family
involvement. Each module is composed of skills areas. The skills areas are taught in exercises
with demonstration videos, role-play and problem solving exercises and in vivo and homework
assignments (Liberman, 2002).
As a consequence of deinstitutionalization, the burden of care has increasingly fallen on
the relatives of the mentally ill. Informal caregiving significantly contributes to health care and
rehabilitation. Fifty to ninety per cent of disabled persons live with their relatives following acute
psychiatric treatment. This is a task many families do not choose voluntarily. Caregiving imposes
a significant burden on families. Those providing informal care face considerable adverse health
effects, including higher levels of stress and depression, and lower levels of subjective well-being,
physical health and self-efficacy. Additionally, not all families are equally capable of giving full
support for their disabled member and willing to replace insufficient health care systems.
Caregivers regularly experience higher levels of burden when they have poor coping resources
and reduced social support. But families also represent support systems, which provide natural
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settings for context-dependent learning important for recovery of functioning. Therefore, there
has been a growing interest in helping affected families since the beginning of care reforms
(Carer, 2005).
As practitioners, we are often confronted with the deleterious effects of stigma and
discrimination in the lives of people with serious mental illnesses. Numerous studies have
examined stigmatizing attitudes toward people with mental illness. In recent years, the scientific
interest in the perspective of the labeled individual has increased too. There is extensive
empirical evidence of the negative consequences of labeling and perceived stigmatization. These
include demoralization, low quality of life, unemployment and reduced social network. Once
assigned the label "mental illness" and having become aware of the related negative
stereotypes, the affected individuals expect to be rejected, devaluated or discriminated. This
vicious cycle decreases the chance of recovery and normal life. (Nordt, 2004)
On the other hand, well-integrated people with mental illness exhibit better outcomes
regarding psychopathology and quality of life. The importance of social integration is underlined
even more when considering the subjective availability of support: perceived social support
predicts outcome in terms of recovery from acute episodes of mental illness, community
integration, and quality of life.
1.6.4 Healing Environment in Psychiatric Hospital Design

Psychiatric facilities are public buildings that may have a significant impact on the
environment and economy of the surrounding community. As facilities built for "caring", it is
appropriate that this caring approach extend to the larger world as well, and that they be built
and operated "sustainably". It is critically important to ensure the safety of the patients, visitors
and staff.
The American Psychiatric Association report on patient safety primary concerns are
suicide, aggression, falls, elopement, medical comorbidity, and drug/medication errorsall but
one can be directly or indirectly influenced through environmental design. While it is not
possible to design a space that prevents every potential event, the safety options for the built
environment should be addressed from the beginning of any psychiatric hospital project. The
primary safety focus of the designer should focus on prevention of events from the use of the
built environment. By incorporating strategies suggested by the research literature, physicians
can help to ensure they are providing a facility that is both functional and secure.
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Suicide The process of purposely ending ones own life. Building features such as grab
bars, doorknobs, ceiling-mounted fixtures, glass within windows, shower curtains, clothes bars,
plumbing fixtures, exposed mechanical systems and outlets are a few items that should be
addressed for safety concerns. All of these items should be designed to resist the ability to be
manipulated by the patient for self-harm or reduce the potential of the patient tying elements to
the item. Examples include doorknobs that rotate up and down (pictured below), grab bars with
bottom plates, break-away shower curtain rods and laminated safety glass.
Aggression an intention to cause harm or an act intended to increase relative social
dominance. A review published in the Journal of Urban Health cited research supporting the
notion that noise can potentiate the expression of aggression, and people exposed to noise are
significantly less likely to help others in need of assistance. Noise mitigation techniques such as
high STC ratings between rooms, quiet zones, and other techniques can help foster a more
calm, relaxing environment for patients.
Falls The impact of the built environment on patient falls can be significant, enough so
that the Center for Health Design released a report dedicated to the subject. According to a
similar report in a guide designed to help nurses improve patient safety, patient falls in acute
care settings can result from slippery floors, poor placement of handrails, inappropriate door
openings, furniture heights, and inadequate nurse staffing.
Elopement This means to leave a locked or secured psychiatric institution without
notice or permission. Hospitals can borrow from lessons learned in the development of Crime
Prevention through Environmental Design (CPTED) techniques, specifically the notion of natural
surveillance. Staff work areas and group spaces can be strategically located to allow for
supervision over entrances and exits.
Drug/Medication Errors Multiple environmental factors can contribute to reductions in
medication errors. A 1991 study determined that a higher illumination levels where medicine is
dispensed resulted in a significantly lower error rate when compared with dispensing
medications in lower lighting level conditions. Additionally, a 2003 literature review examining
the impact of single patient rooms found multiple studies supporting the concept that in
comparison to multiple-occupancy rooms, medication errors and patient transfers are reduced.
The character of the immediate surroundings can have a profound effect on the psyche
of a psychiatric patient. The New York Psychiatric Institute reports a dramatic drop in the
number of patients who need to be restrained since occupying their new facility with its bright
open spaces. Every effort should be made to create a therapeutic environment by:
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Using familiar and non-institutional materials with cheerful and varied colors and
textures, keeping in mind that some colors and patterns are inappropriate and can
disorient older impaired patients, or agitate patients and staff. See also VA Interior
Design Manual.
Admitting ample natural light wherever possible.
Providing a window for every patient bed, and views of the outdoors from other spaces
wherever possible. Views of nature can be restorative.
Providing inpatients with direct and easy access to controlled outdoor areas
Providing adequate separation and sound insulation to prevent confidential but loud
conversation from traveling beyond consulting offices and group therapy rooms.
Giving each patient as much acoustic privacy as possiblefrom noises of other patients,
toilet noises, mechanical noises, etc.
Giving each patient as much visual privacy, and control over it, as is consistent with the
need for supervision.
Giving each inpatient the ability to control his immediate environment as much as
possible, i.e. lighting, radio, TV, etc.
Providing computer stations for patient use when patient profile and treatment program
allow.
Designing features to assist patient orientation, such as direct and obvious travel paths,
key locations for clocks and calendars, avoidance of glare, and avoidance of unusual
configurations and excessive corridor lengths.
Designing a "way-finding" process into every project. A patient's sense of competence is
encouraged by making spaces easy to find, identify, and use without asking for help.
Color, texture, and pattern, as well as artwork and signage, can all give cues
Providing exercise equipment for patient use where appropriate for the program of care.
Providing access to kitchen facilities, preferably on the unit, where snacks or meals can
be prepared by patients, when patient profile allows.
Psychiatric facilities should be easy to clean and maintain.
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1.7 Theoretical Framework

This research intends to design a suitable environment both built and natural to Mariveles
Mental Hospital. Information gathered will be used as a tool in determining possible design
solutions to the existing problems in the said facility.
Mariveles Mental
Hospital
Mentally Ill Staff Working in Family and

Patients the Mental Facility Caregiver of the
Patients
Different Methods of Acceptance

Mental Illness Treatment
Statistics Factors of Reintegration

Stress to Society
Questionnaires & Review of Related

Data Gathering
Surveys Literature &
Studies
Design Conclusion
Data Analysis
&
Recommendation
for Mental Hospital
Redeveloped
Mariveles Mental
Facility
Fig. 1 Theoretical Framework
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1.8 Research Methodology

This aims to gather the information and findings needed for the study. The research will
use descriptive method. Interviews and surveys of key persons and observation of related
facilities will be conducted to support this research.
This research intends to study on how to design a therapeutic environment both built
and natural for the mentally ill and its staff. The proponent will use interviews to know the
processes that are conducted in the mental hospital; to know the factors that help in the
recovery of the patients; to know other rehabilitative activity that can be used by the patients to
help them be integrated in the society. The proponent will consider the information in other
books and related studies in order to design a more manageable and therapeutic facility for the
mentally ill.
The research study will depend on the interview as the proponent prepares
questionnaires that will be used in the study. The data gathered will be analyzed and be used in
designing a therapeutic environment for the mentally ill patients as well as its staff. The
proponent will prepare a set of questions for the key person in managing the facility and for the
specialists handling the treatment of the mentally ill patients.
The objective of these prepared questionnaires is to know the managements
perception through answering the questions and to be able to measure the level of
environmental rehabilitation needed for the mental hospital.
In order to arrive at the results of this research, the following questions will be asked:
1. What are your plans for the mental hospital when it comes to its facilities?
2. What are the factors that contribute to patients and staffs stress while in the hospital?
3. What are the therapies that you conduct for the patients?
4. What other facilities you needed to add for the wellness of the patients/staff?
5. What are the common problems you encounter in the hospital in terms of the structure
itself?
6. How many patients are currently under the care of the hospital?
7. What are the different wards for the patients? How are they segregated?
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1.8.1 Oral Investigation

The informal interviews were conducted inside the facility of the Mariveles Mental Hospital
(MMH) during the spare time of the key persons working at the hospital. The key persons that
were interviewed are the following:
Emelita R. Maca (L-R (OJT) AG Jamine;

Nursing Attendant II, Health & Information Lea-Jean M. Payong, Administrative
Management Service Aide VI; Rolly Caraig)
Human Resource Development Service
Maria Jessica C. Alcanzaren Albert Perez

RN Security Guard
Fig. 2 Employees interviewed who work in

Mariveles Mental Hospital.
Luz A. Velasco, MD
Medical Officer III
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Dra. Luz Velasco, a medical officer, explained the process of the admission of patients in
the mental hospital. The patients taken to MMH undergo the Acute Crisis Intervention Service
(ACIS). A patient is observed for three to five days. He is given medications such as rapid
tranquilization and electro-convulsion therapy to control violent, suicidal tendencies. During this
period, a family member sees for himself the reaction of the mentally ill. After the treatment,
the patient is sent home and then given a weekly, bi-weekly and finally a monthly check-up.
However, if after 3-5 days, the patient still manifest unusual behavior, he is admitted to the
hospital. The average length for hospital stay is seven months. If a patient is hospital-dependent
for medical care, he stays.
They have three (3) different types of wards: the Charity, Isolation and Pay ward.
Patients in each ward are segregated by gender. The female section in the Charity ward is
divided into four (4) categories according to the severity of their illness. The first being the most
critical and the fourth being the most functional. Some of the patients that manifest well
behavior were asked to do simple errands like buying something in the canteen. Other non-
violent patients especially those who were used to roam can wander freely around the facility.
All patients wear hospital uniforms. Pink is designated for female patients and blue for the males.
The male section is also divided into four (4) categories. The first two in the Male Ward were for
levels A and B. Male Ward A as the receiving ward being the most critical and B for those who
got better from the critical stage. The other two were called the subunits of the Male Ward
located at the opposite side. These were for old and stable patients. Mats were being used
during the night to accommodate all the patients in the wards.
Dra. Velasco admitted that the current condition inside the wards were not suitable for
the patients. She highly recommended that patients should be segregated not just in terms of
severity of the mental illness they have but also based on other contagious diseases like
tuberculosis, pneumonia, skin disease etc. Expansion of the wards is needed for better service.
She also suggested putting a partition wall that can serve as an individual room for each patient
maintaining privacy in multi-bed ward while keeping social interaction between patients
when they desired to. This can be easily managed through the help of CCTV cameras.
She emphasized that the design has to mimic natural environment so the patients will
not feel secluded. Since they are only accepting adult patients, she advised to add childrens
and adolescents ward so they can also be accommodated.
According to her there have been a lot of patients that recovers from the mental hospital.
Most patients that are discharged were already manageable at home and needs only little
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supervision but the challenge for the family was to maintain the supply of medication that costs
almost P1, 500 a week depending on the mental disorder of the patient. There will be an
expected relapse once the patient missed his medicines and the result will be much worse
condition for the patient. She mentioned that some of the patients that return to the mental
hospital with worse state were due to failure of maintaining their medicines. The recovery will
then be much difficult to achieve. The integration of patients into society is very challenging due
to social stigma and discrimination. The therapies in the mental hospital are not enough for
them to be prepared to face the community again. A livelihood program within the facility can
be a useful tool in practicing patients on how to mingle again in the society.
She stated that the approach of the mental institution should be preventive. Community-
based mental health facility can be of help to determine the early state of depression that can
lead to severe mental illness. They can give proper medication and counseling to the patient and
his family to avoid further mental damage. Unfortunately, here in the Philippines we lack
awareness about mental health. According to DOH their long term goal is the
deinstitutionalization of mental hospitals and redirect patients to community-based mental
health facilities but this remained undeveloped.
According to Human Resource (HR) manager, Lea-Jean M. Payong, if they will have a
budget for the new construction of the entire facility they would definitely grab that opportunity
since most of the structures are old and dilapidated. She gave her complaints about the design
of their administration building where they are having a hard time working inside the office. First
thing was the receiving area where there are only two (2) mono-block chairs in front of her desk
to accommodate visitors. She said that there was no privacy due to the fact that when you enter
their office, everything can be seen at one glance including documents that are important. They
lack storage room for their files. She suggested that partitions can be of help for private
conversations. They needed a small conference room for meetings and coaching sessions with
an employee that is confidential. There is only one comfort room inside the office so they used it
only for female staff and the males need to go outside the office where there is a small rest
room.
The Officer In-Charge (OIC) of Medical Section in the hospital provided the statistics of
patients admitted and discharged in the hospital. For the year 2012 it has not exceeded their
capacity yet but she mentioned that whenever the number of patients go up to more than 500,
they just tend to cope with it since they dont have any choice but to accept the patients. The
chronic mental illnesses that are being handled in Mariveles Mental Hospital are schizophrenia,
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bipolar affective disorder, acute and transient psychotic disorder, mental and behavioral
disorder due to brain disease damage and dysfunction, depressive disorder, schizoaffective
disorder, mental and behavioral disorder due to use of alcohol and anxiety disorder.
2011 Classification of Mental Disorders diagnosed in Mariveles Mental Hospital.
F00-F99 Mental and Behavioral # of Patients Diagnosed from Jan-Dec
Disorders 2011
F20 - FF20.8 Schizophrenia
F20.0 Paranoid schizophrenia 460
F20.1 Hebephrenic schizophrenia
(Disorganized schizophrenia) 29
F20.3 Undifferentiated schizophrenia 642
F20.5 Residual schizophrenia 79
F20.6 Simple schizophrenia 58
F20.8 Other schizophrenia
Cenesthopathic
schizophrenia
Schizophreniform disorder
28
NOS
Schizophreniform psychosis
NOS
TOTAL 1296
F31 F31.6 Bipolar Affective Disorder
F31.1 Bipolar affective disorder, current
episode manic without psychotic 315
symptoms
438
episode manic with psychotic symptoms
1
episode mild or moderate depression
episode severe depression without 80
psychotic symptoms
episode severe depression with psychotic 71
symptoms
F31.6 w/o Bipolar affective disorder,
24
current episode mixed
F31.6 w/ Bipolar affective disorder,
97
current episode mixed
TOTAL 1026
F23 F23.81 Acute and Transient
Psychotic Disorder
F23.2 Acute schizophrenia-like psychotic
3
disorder
F23.3 Other acute predominantly
1
delusional psychotic disorders
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F23.8 Other acute and transient psychotic

30
disorders
F23.80 29
F23.81 276
TOTAL 339
Mental and Behavioral Disorder due to
Brain Disease, Damage and Dysfunction
F06.3 Organic mood (affective) disorders 19
F06.8 Other specified mental
disorders due to brain damage and 282
dysfunction and to physical disease
F06.9 Unspecified mental disorder due to
brain damage and dysfunction and to 3
physical disease
TOTAL 304
Depressive Disorder
F32.0 Mild depressive episode 38
F32.1 Moderate depressive episode 8
F32.2 Severe depressive episode without
10
psychotic symptoms
F32.3 Severe depressive episode with
40
psychotic symptoms
F32.9 Depressive episode, unspecified 69
TOTAL 165
Schizoaffective Disorder
F25 Schizoaffective disorders 164
Mental and Behavioral Disorder due to
use of Alcohol
F10.1 Harmful use of alcohol 1
F10.2 Alcohol dependence syndrome 2
F10.5 Alcoholic hallucinosis 63
F10.51 9
F10.52 27
F10.55 13
TOTAL 115
Anxiety Disorder
F41 Other anxiety disorders 5
F41.0 Panic
5
disorder (episodic paroxysmal anxiety)
F41.1 Generalized anxiety disorder 68
F41.9 21
TOTAL 99
Table 4. Statistics of different mental and behavioral disorders diagnosed in Mariveles Mental
Hospital based from their records from Jan-Dec 2011
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They have prepared a proposal for the repair and renovation various structures inside the facility.
I. Repair/Rehabilitation of Administrative Building P15,000,000.00
II. Repair of Linen and Laundry Building 2,000,000.00
III. Repair of Occupational Therapy Building 5,000,000.00
IV. Repair and Painting of Various Buildings 6,000,000.00
1. Patients Dormitory Building
2. New & Old ACIS Building
3. Procurement, Property & Supply Building
4. Completion of COA Building
5. Out-patient Building
V. Land Development 5,000,000.00
VI. Repair of Old Guesthouse 4,000,000.00
VII. Provision for Ramps at Admin & OPD 1,500,000.00
VIII. Installation of Sewage Treatment Plan 10,000,000.00
IX. Installation of Hydrant System 10,000,000.00
SUB-TOTAL P58,500,000.00
Table 5. Proposed budget of Mariveles Mental Hospital for their infrastructure
Based from this proposed budget, the proponent can use this as a basis on the estimate
cost of the redevelopment and expansion of Mariveles Mental Hospital. It will be an advantage if
the estimated cost will only exceed the above total figure for a minimal amount.
1.8.2 Case Study of Mariveles Mental Hospital

The Mariveles Mental Hospital has strict policy on taking pictures inside its premises.
The pictures on this case study were limited but descriptions on other buildings will be provided
to have an overview of the physical condition of the structures.
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Old Quarantine Station
Fig. 3 Mini- library within the ruins

The HR manager, Lea-Jean M. Payong, shared that the only place inside the facility
where one can be allowed to take pictures on was the Old Quarantine Station. Tourists can
actually enter the facility but with strict supervision. She even said that some old action movies
were taken at the ruins. The library is situated at the back of the ruins. It has high ceiling and
electric fans are used for ventilation.
Fig. 4 Therapy and interview sessions with the patients conducted at the ruins.
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There have been a lot of nursing and psychology students from different schools
who were taking their practicum in Mariveles Mental Hospital. The therapy and
interview sessions are being held around the garden including in the ruins. Some were
under the trees seated on mono block chairs and others at the back of the new Isolation
Building where small huts were built. The patients that were interviewed were carefully
selected to ensure the safety of the students. All of them do not have any history of
violent relapses.
Acute Crisis Intervention Service (ACIS)
Fig. 5 Main entrance of the ACIS Building
Fig. 6 Exterior of ACIS Building
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The entrance door is being manually locked when someone is entering or leaving the
building. Bleachers were positioned outside where visitors can wait before being allowed to visit
their family member which is under observation. Through the left side windows at the entrance,
one can see the patients admitted. Windows have metal bars and are open. Electric fans are
used for ventilation inside
.
Administration Building
Fig. 7 Exterior of ADMIN Building
Fig. 8 Interior of the ADMIN Office

The faade of the administration building is the same as the ACIS and the OPD building.
This building has air-conditioning units. The left image above shows the budget and accounting
area. The room of the supervisor is at the center where the interior window can be seen in the
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right photo above. It also shows the desk of the HR manager. The billing, cashier, pantry and
restroom occupy the other side of the room.
Fig. 9 Hallway inside the ADMIN Building
The hallway uses natural ventilation. The administration office is at the left side
of the hallway and at the right are two offices for the chief of the hospital and a doctor.
The window at the far left corner is for payments of bills.
Parking Area
Parking Area
Guard House
Fig. 10 The parking area for the ambulance and service van near the guard house
The small shed where the van was parked can accommodate at least five (5) vehicles
and the rest can park under the trees.
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Fig. 11 Mariveles Mental Hospital Master Site Development Plan with Floor Plan
The female section in the Charity ward is divided into four (4) quarters according to the
severity of their illness. The first being the most critical and the fourth being the most functional.
The male section is also divided into four (4) categories. The two were located at the opposite
side of the Male Ward called subunits Male Ward A and Male Ward B where each has one (1)
restroom at the middle. The area of the male and female ward is 432m2 excluding the restrooms.
There were three (3) water closets for each division with a total of twelve (12) in the female
ward and ten (10) water closets in the male ward. All restrooms inside the wards dont have
doors for supervision of the patients. The nurse station and observation building is in between
the male and female ward.
The Pay ward or what they call the CCU building (Custodial Care Unit) has a total area of
395m2. The male ward has an area of 127.5m2 with a restroom of 3.5m x 5m. The area of the
female ward is 85m2 with the same size of restroom as the male ward. The isolation room with
an area of 42.5m2 is beside the female ward. The nurse station is in front of the wards at the
center.
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2
The 112m area of the isolation building has 12 rooms for individual patients that need
to be separated from others due to violent reactions or contagious disease. It is located adjacent
the occupational therapy building.
The Old Isolation Building that is already dilapidated is still being used for violent
patients and with communicable diseases like chickenpox, etc. male patients. It can
accommodate 10 male patients.
The current situation in the wards was no longer therapeutic to patients according to Dr.
Luz Velasco. All patients were cramped inside the wards that really replicates a prison cell, thus
redevelopment can help in careful planning and design of these wards to give the patients
comfort while recuperating.
Total Number of In-Patients
2500
2000
1500
2005
2006
1000
2007
500 2008
2009
0
Fig. 12 Graph showing the total number of in-patients in MMH for 5 years
Province 2005 2006 2007 2008 2009
Pampanga 1592 1711 1666 1966 1728
Bataan 1281 1283 1357 1613 1385
Nueva Ecija 718 847 874 879 1010
Zambales 679 698 697 724 996
Tarlac 527 624 676 762 597
Bulacan 307 374 237 246 414
Aurora 47 49 73 91 104
Outside Region 716 767 822 808 793
Table 6. 2005-2009 In-patient statistics according to province
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2500
15 YEAR IN-PATIENT STATISTICS IN MMH 1995
1996
2000 1997
1998
1999
1500 2000
No. of Patients
2001
2002
1000 2003
2004
2005
500 2006
2007
2008
0 2009
Pampanga Bataan Nueva Ecija Zambales
Fig. 13 Graph showing the total number of in-patients in MMH for 15 years
TOP 4 PROVINCES W/ THE HIGHEST IN-PATIENT
YEAR STATISTICS
Pampanga Bataan Nueva Ecija Zambales
1995 791 730 153 541
1996 1086 1075 186 621
1997 1181 1181 253 614
1998 1229 1141 336 637
1999 1281 1191 407 740
2000 1287 1191 536 815
2001 1392 1238 558 883
2002 1633 1316 499 932
2003 1780 1372 541 928
2004 1693 1255 711 805
2005 1592 1281 718 679
2006 1711 1283 847 698
2007 1666 1357 874 697
2008 1966 1613 879 724
2009 1728 1385 1010 996
TOTAL 22016 18609 8508 11310
Table 7. Top 4 Provinces w/ the Highest In-Patient Statistics
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700010 YEAR DISCHARGE & 10 YEAR IN-PATIENT STATISTICS MMH
6201
6000 5891 5963
5220 5306
5000 4740 4923
4478
4177
No. of Patients
4000
3369
3000
2000 1685 1631 1556

1338 1298 1387
939 1046 1171
1000 827
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Fig. 14 Graph showing the 10 year discharge and in-patient statistics in MMH
10 YEAR OUT-PATIENT STATISTICS MMH

7000
6478 6522
6258
6000 5658
5500 5586
5000 4965
No. of Patients
4527
4000 3869
3000 2711
2000
1000
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Fig. 15 Graph showing the 10 year out-patient statistics in MMH
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Fig. 16 Facilities inside Mariveles Mental Hospital
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ACIS Building 115m to the male ward.
OPD Building
Male Ward
Female Ward 156.5m from

the ACIS bldg.
Fig. 17 Master Site Development Plan
Long walks are required to transfer patients

from ACIS bldg. to the psychiatric wards. A service van
or an ambulance is sometimes used to transfer them.
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1.8.3 Case Study of Yuli Veterans Hospital

Yuli Veterans Hospital (YVH), which is located at the midpoint of Taiwan's East Rift Valley
in the town of Yuli, has been the largest mental hospital for the patients with chronic and severe
mental illness in Taiwan for the past 50 years. It has aimed to help extended stay in-patients
with severe mental illness to integrate into the local community of Yuli. Life in the hospital is
made as similar as possible to life in the community. First, the one-size-fits-all custodial wards
were diversified into units with different structures, as well as a continuum of treatment and
rehabilitation modalities appropriate to patients' clinical reality. There are acute inpatient, long-
term rehabilitation and day care units, community rehabilitation and residential programs, and
nursing homes. Patients may go through each of these stages during their stay in the hospital.
The acute inpatient ward hallway. The acute inpatient ward dining room.
The lobby of the inpatient rehabilitation ward. Yuli Day Care Center
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Community rehabilitation center: Joint Nursing homes for long-term care.

program with local church.
Fig. 18 Facilities in Yuli Veterans Hospital
Considerable resources have been put toward enriching the environment of the hospital
campus, such as convenience stores, a post office, bakeries, a caf, a recreational center, a
restaurant, and a garden. Patients can move about the campus, interact freely with other
patients and staff, and engage in therapeutic, recreational, or casual activities on the campus
and in Yuli town. During these activities, they may develop close relationships with fellow
patients and hospital workers. Together, patients and staff have created a common life style and
cultural identity in this hospital-community. To help the most dysfunctional and treatment-
resistant patients live in a more open and free space administrative support is crucial. At the
management level it is necessary to have persistent efforts to achieve consensus concerning the
goals and values of the hospital, and communicate that message to all levels of personnel. The
goal of the hospital is not only to diversify and enrich the services it provides, but also to create a
better future for patients, whether they continue to live in the hospital or are discharged to the
community. The value of this hospital is that it offers patients a community in which it is possible
to enjoy a meaningful life. This is what the reforms at Yuli Veterans Hospital have tried to
achieve, even though families and society may continue to be pessimistic about the future of
patients.
There are four main components of the Yuli model: holistic medical support, vocational
rehabilitation, case management, and the residential program. The four components help
patients recover two essential features of their lives: vocational life and ordinary daily routines.
As the process of recovery evolves, patients gradually regain inner stability, dignity, self-
confidence, and a sense of control. The four components are critical to rebuild the structure and
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order of life of the patients and are indispensable and interdependent parts of one service
package. They operate simultaneously to benefit the patients to the greatest degree possible.
Intensive and continuous treatment and rehabilitation are offered to those patients in
YVH who suffer from schizophrenia which is manifested in positive, negative and disorganized
symptoms and, to a great degree, negative effects on neurocognitive, social and vocational
functioning. Psychiatrists work closely with colleagues such as case managers, psychiatric nurses,
social workers, psychologists, occupational therapists, and non-professional mental health
technicians who are trained to monitor and support patients on a daily basis. As patients live and
work in the open campus and Yuli town they often face interpersonal stress and work pressures,
which may influence their inner stability and result in relapse and crises such as instances of self-
harm or aggression. Thus, a major challenge is keeping alert and sensitive in order to detect
subtle changes of patients' emotions, behaviors, perceptions and thoughts. In addition to
psychiatric services, patients can rely on various departments (e.g., general medicine, surgery,
gynecology, and dentistry) in the hospital, which is also the biggest general hospital in the area,
to address their medical needs. Thus, continuous psychiatric and medical care is provided under
one administrative roof, which minimizes problems with referral as well as the barriers
associated with distance and transportation.
The main goals of case management are to mobilize all available resources to help
patients remain clinically stable, get and keep jobs, and enjoy a satisfying life in the community.
Therefore, assertive outreach, on-going, round-the-clock services are offered no matter where
patients are (e.g., sheltered workplaces, community workplaces, markets, and the residential
program houses) to ensure a continuity of care across time and functional domains (e.g.,
working, living, learning and leisure activities). Multidisciplinary teams, consisting of psychiatrists,
nurses, social workers, clinical psychologists, occupational therapists, and mental health
technicians in charge of vocational training and life coaching, are responsible for case
management while also attending to a range of patients' needs concerning working, living, and
learning in the community. The caseload is shared and is designed so that members of the team
do not work alone, and there are supervisors and coordinators who help team members solve
problems, boost morale, and secure on-going and consistent administrative support.
Vocational rehabilitation aimed at gainful employment not only enhances patients'
economic autonomy but also their place in the community and their dignity. Patients who are
clinically stable, possess basic social and work skills, and are motivated to work according to
functional level are assigned to one of three groups in the vocational rehabilitation program:
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hospital work training, community work training, and supported employment. Patients in the
first two categories typically work part-time, entry-level jobs in hospital and community settings
with minimal or subsidized pay. Currently, 213 patients are in hospital work training programs at
24 worksites, such as making bread in a sheltered bakery, doing daily chores at convenience
stores, working in a horticulture garden, or washing clothes in a laundry. These work training
activities combine the functions of traditional occupational therapy, prevocational training, and
sheltered workshop. Community work training is intended for those patients who can work at
least 20 hours per week, but whose productivity falls below the requirements of competitive
employment. There are now 29 patients at 8 community work training sites, e.g., housekeeping
at community hostels, doing daily chores at City Hall, and helping in a bakery. Patients in
supported employment work at least 20 hours per week in community settings, and receive
wages that are commensurate with those of a competitive job. At present, 52 patients work
part-time at 25 sites, e.g., gas stations, supermarkets, restaurants, a hotel, and food stalls.
Eleven patients work full-time (maximum of 48 hours per week) at 4 sites, e.g., doing daily
chores at restaurants, bakeries, or in horticultural enterprises. In vocational rehabilitation
patients are required to have good manners, dress appropriately, be well-groomed, and follow
the advice and guidance of vocational counselors and employers. Vocational rehabilitation
programs help patients internalize the structure and order of daily life, which, in turn, helps
them to regain a sense of reality and control over their lives.
Work training in hospital bakery. Work training in community bakery.
Fig. 19 Vocational Rehabilitation
Community employment in horticulture

industry.
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The residential program on the YVH campus is located in a pleasant and attractive two-
storey building that has a spacious lobby, sunny rooms, a variety of recreational facilities, and an
open garden. Each room can accommodate four persons, is furnished with four sets of closets
and desks, and has a separate bathroom. In contrast to the wards, the residential facility has no
locked doors or bolted windows. There are 203 patients in the program.
The residential program. Yuli Mental Health Research Center

Fig. 20 Residential program in YVH and its Health Research Center
YVH is close to the center of life in Yuli town; it is only a 15-minute walk to downtown.
After 50 years of interaction, a mutually dependent relationship has developed between the
hospital and the town. Patients are seen as ordinary people as they mingle in the crowds, shop
in stores, eat in restaurants or food booths, and join folk or religious activities. For example,
patients usually more than 100 at a time may be seen in the Yuli traditional market, or in the
Friday night market where they have frequent social exchanges with local inhabitants.
This case study reveals the possibility of transforming a custodial mental hospital into a
hospital providing high quality care. Hospital and community are not in opposition. They are part
of a continuum of care for the patients. The reinterpretation and refinement of the boundary
and function of hospital and community, and thereby create a new service model, the Yuli
Model, to help patients to reintegrate into the community. The Yuli model, which particularly
focuses on the needs of people with long-standing illness and prolonged hospital stay, illustrates
one approach to linking hospital and community in a creative and constructive manner. This can
be adapted in Mariveles Mental Hospital especially the vocational therapies that can help the
patients adjust into community life.
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1.8.4 Case Study of Metro Psych Facility

Metro Psych Facility is a private psychiatric hospital owned and operated by Metro
Psychiatry Incorporated. It is the actualization of a dream of a group of psychiatrists to be able to
provide alternative care for individuals needing psychiatric treatment and rehabilitation. Even
before Metro Psychiatry Inc. was formally registered with the Securities and Exchange
Commission in February 24, 1999, majority of its Board of Directors, being experts in the field of
psychiatry, have been involved in advocacy and provision of mental health services as a group
and as individuals. Most of the members of the Board of Directors worked and some are still
connected with the National Center for Mental Health in Mandaluyong. They have seen how
psychiatric patients are treated in the said government facility and rejected by their own families
and the society. The said patients are regarded as nuisance; burden and some families even
wished them dead. This maybe because psychiatric patients at the height of their symptoms are
distressing and some of them becomes physically violent. When Metro Psych Facility was
created, it ensures that the practices that are not likeable in the government psychiatric hospital
will not happen in their facility. The physical set up of the facility was designed attractively and
spaciously so that patients will not feel that they are being punished and imprisoned.
The work forces were screened carefully on their views on mental illness and made sure
that all of them had no history of working in any psychiatric hospital. They were patiently trained
so that what they envisioned was followed strictly. They wanted the patients to feel secure and
made their facility a refuge where they can stay in times of crises brought about by pressures
from work and family. They instill to their staff the values of honesty, loyalty, respect and love
for their family. They want their patients to be treated properly and view their admission at the
facility as a positive experience where they can feel relief of their symptoms. They believe that
psychiatric patients are still capable of leading a normal life only if their psychiatric symptoms
are controlled. They envision a facility that provides activities to slowly integrate them back to
their family and society in general. They also involve their families in the treatment process for
them to fully understand their patient. Families should be educated on the nature of the
psychiatric illness of their loved ones so that they are ready to identify and deal with future
relapses, as this is inevitable.
They initially catered to both psychiatric and substance abuse patients, but the set-up
was not helping either type of patients. The substance abusers made-fun of the psychiatric
patients and at the same time they were so bored as the program being implemented is for the
psychiatric patients only.
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A review of some epidemiological studies from the US revealed that 25 to 50 percent of
newly admitted psychiatric patients have concomitant drug and/or alcohol abuse problems
(Simon et al). Similarly, in New York State, the Commission on Quality Care for the Mentally
Disabled found that 50 percent of the patients admitted for psychiatric care had alcohol or drug
abuse that required treatment. In another review of 100 clients in a psychiatric out-patient
services in New York State who have received extensive psychiatric care, and who were known
substance abusers revealed that 61 of the clients had never received substance abuse
treatment. Many of these clients accepted the lack of availability of substance abuse services,
and kept their substance abuse problems to themselves.
Initial assessment showed that statistics at Metro Psych Facility would corroborate such
findings. A review of 270 admissions from May 1999 to December 2000, 78 (29%) had
concomitant drug and/or alcohol abuse problems. Many of them have been discharged
improved of psychiatric symptoms but without the benefit of intervention for their drug and
alcohol problems.
Encouraged by this response and inspired by an apparent need for a diversification of
the services it provides, a sister company was established to put up a drug rehabilitation center
in its second floor Roads and Bridges to Recovery. A vision for both companies was
established.
The Facility
Metro Psych Facility Family Cottage
Pharmacy Reception
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Acute In-patient Hallway Psychiatric Patient Ward
Substance Abuse Ward Swimming Pool
Library Basketball Court
Multi-purpose Hall
Fig. 21 Amenities in Metro Psych Facility

The attractive and spacious facility can be a model in redeveloping the Custodial Care
Unit (Pay Ward) in Mariveles Mental Hospital since the patients are paying for the services. It is
just rightful to provide them with a comfortable room /ward in return.
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1.9 Scope and Limitations of the Study

The primary scope of this study is to redevelop the built and natural environment inside
the Mariveles Mental Hospital on how with architecture can create an environment which is
psychologically and spiritually rehabilitative. The physical condition of the facility will be
examined through case studies. Since the focus of the study is the environment for the mentally
ill, related works on psychiatric hospitals and clinical studies on environmental factors that
greatly affect them will be reviewed as well. The proponent will conduct interviews with the key
persons in the said facility to know the possibility of integrating patients with mental illness into
society through vocational rehabilitation. This will only be discussing the current situation of the
said facility and the problems that needed to be dealt with in order to come up with the
appropriate solution.
1.10 Definition of Terms

Mental hospital A hospital that specializes in the treatment of serious mental disorders.
Mental disorder Health conditions that are characterized by alterations in thinking, mood and
behavior (or some combination thereof). Associated with distress and/or impaired functioning
and spawn a host of human problems that may include disability, pain or death.
Mental illness A term that refers collectively to all diagnosable mental disorders. Although the
symptoms of mental illness can range from mild to severe and are different depending on the
type of mental illness, a person with an untreated mental illness often is unable to cope with
life's daily routines and demands.
Redevelopment means the act of improving by renewing and restoring.
It is any new construction on a site that has pre-existing uses.
Rehabilitation produces measurable positive effects on patients clinical outcomes and staff
effectiveness.
Sustainable This can be used as an energy and ecologically conscious approach to the design of
the built environment.
Expansion increase in size and effect to accommodate the additional users of the space
WHO World Health Organization
DOH Department of Health
MMH Mariveles Mental Hospital
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CHAPTER II
2.1 Rationale
This project aims to redevelop the Mariveles Mental Hospital for better service, sustainability
and execute vocational rehabilitation to help the patients with mental illness integrate into
society.
2.2 Summary of Findings

Based from the thorough case study of Mariveles Mental Hospital, the proponent came
upon the conclusion of redeveloping the different psychiatric wards, the Occupational Therapy
Building for better service and recovery of patients.
It has been proved that most of the buildings need redevelopment. The distances
travelled by the staff and the patient can be minimized through careful spatial planning. The
critical factors such as noise, lighting, sun, temperature and color should be considered in
designing the building. Segregation of the patients will be Focus on the safety of the patients as
well as the staff will be at utmost priority.
2.3 Recommendations for Application

Psychiatric Wards will be segregated according to severity level with sublevels based on
the type of illness and age bracket. The ACIS, OPD and ADMIN building will be re-
planned for better circulation of staff and patients.
Building orientation will be considered for natural ventilation in the structures. To be
more sustainable, all materials that can still be used will be recycled.
Vocational rehabilitation as part of the Occupational Therapy will be enhanced through
horticulture activity, creating crafts and other products like candles or soap which can be
sold for extra income.
The project will consider the safety of all the users specially the patients through the
help of the researched design guidelines.
The design of the structures will be based from Administrative order No. 70-A s.2002,
Revised rules and regulations governing the registration, licensure and operation of
hospitals and other health facilities in the Philippines.
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Key design concepts for designing inpatient mental health units:
Create a non-institutional, home-like environment through careful attention to external
and internal architectural features and interior design elements.
Layout should incorporate an open and bright design.
Unit configuration should be based on a pod-like design and should be absent of long
corridors in order to promote social engagement and interaction with staff and provide
for a more domestic and less institutional feel.
Layout should be free of blind corners. Portions of the unit, such as the office suite,
should be designed to be closed off after hours to reduce the amount of area within the
unit required to be supervised by staff.
Provide ample visual and physical access to nature, which promotes healing. Provide
attractive, secure outdoor spaces directly off the unit. In addition to ample courtyard
space for patient activities, consideration should be given to incorporating healing
gardens. Indoor patient activity areas should have access to natural light and views, as
well as appropriate acoustic control.
Incorporate wall color, trim, accent colors, and securely-anchored artwork in common
areas and patient rooms.
Minimize the potential for furnishings, fixtures, and equipment within the unit to be
used as a weapon or anchor point for hanging.
Develop multiple patient room clusters within the unit to allow for separation of
different patient sub-groups.
The nursing station should blend in both in scope and design with the therapeutic
environment. The nursing station should have direct visibility of all patient wings and
activity areas. The station itself should be designed to allow for informal interaction with
patients without compromising the confidentiality of patient records.
Include an identifiable reception area for greeting patients and their families in a lobby
area just outside the unit. In addition to functional benefits, a reception area sends a
welcoming message to users. Sufficient signage should be placed to direct patients and
families to this area.
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CHAPTER III
3.1 Site Profile and Analysis
3.1.1 Setting the Criteria
According to Administrative order No. 70-A s.2002, Revised rules and regulations
governing the registration, licensure and operation of hospitals and other health facilities in the
Philippines, the environment for a hospital and other health facilities shall be so located that it is
readily accessible to the community and reasonably free from undue noise, smoke, dust, foul
odor, flood and shall not be located adjacent to railroads, freight yards, childrens playgrounds,
airports, industrial plants, disposal plants. The location of Mariveles Mental Hospital complies
with the said regulation.
The view of the mountains and the beach adds to the therapeutic setting of the site. These
criteria will make the patients feel that they are not being punished or secluded.
3.1.2 Description of Site Options
Fig. 22 Map of Bataan
Mariveles is located in a cove at the southernmost tip of Bataan Peninsula, and

approximately 173 kilometers overland from Manila. It is bounded in the east by the Manila Bay
and North Channel, which separates the town from the island of Corregidor, in the south and in
the west, by South China Sea while at the northwest by the town of Bagac and Limay at the
north.
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3.1.2.1 Accessibility
The overland road accessing Mariveles Urban center will pass through the 4 kilometers
of Zigzag Road or through the By Pass Road, which have 45 degrees steep inclination. Two major
Bus Lines are plying the Manila and Mariveles route. Provincial Mini Buses are also available for
Balanga-Mariveles route.
Private watercrafts can also access Mariveles using either the Mariveles Pier or the BEZ wharves.
Passenger Ferry boats are also making a daily trip from Manila to Orion which is just 25 minutes
away from Mariveles. Private helicopter can also access Mariveles through BEZ Helipad.
3.1.2.2 Transportation
All national highways leading to the town are all concrete, provincial highways are also
concrete except in some portion between the boundary of Mariveles and Bagac. Municipal and
barangay roads are also made of concrete except in some area mostly in some newly established
community.
Two major Bus lines are operating in Mariveles ferrying passengers from Mariveles to Manila,
Baguio, and Nueva Ecija.
3.1.3 Site Selection and Justification

Based from the statistics gathered, even if Pampanga has the most number of in-
patients in Mariveles Mental Hospital for the past 15 years, it is still not advisable to locate the
proposed additional 500-bed capacity by the hospital to serve its catchment area. The reason is
because the Local Government Unit Mental Health Teams (LGUMHT) primarily enacts necessary
legislative issuances and promotes and advocates the implementation of Community-based
Mental Health Program among their respective localities and constituents. MMH was proposed
to be redirected and transformed into a center for comprehensive mental health care catering
for the seven provinces in the region. The aim of this development is to shift mental health care
out of the hospitals to a variety of community-based services ranging from acute psychiatric
units and outpatient clinics in the provincial hospitals, home treatment care, mental health care
and psychosocial rehabilitation in primary health care. The implementation of this project
started in the latter months of 2003 according to WHO.
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3.1.4 Site Analysis
Fig. 23 Mariveles Mental Hospital is under the Institutional Zone according to the Land Use
Map of the Municipality of Mariveles
LOWER MARIVELES ROAD MAP
Fig. 24 It can be reached by land transportation through the Olongapo-Gapan road or Subic-
Clark Tarlac Expressway and Bataan Provincial Highway in approximately 3 hours.
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Fig. 25 Sun Path Diagram in Mariveles Bataan.
Fig. 26 Wind Diagram
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Fig. 27 Noise Diagram
3.1.5 Rules and Regulations Governing Health Facilities in the Philippines

Administrative order No. 70-A s.2002
Revised rules and regulations governing the registration, licensure and operation of hospitals
and other health facilities in the Philippines
1 Environment: A hospital and other health facilities shall be so located that it is readily
accessible to the community and reasonably free from undue noise, smoke, dust, foul odor,
flood and shall not be located adjacent to railroads, freight yards, childrens playgrounds,
airports, industrial plants, disposal plants.
2 Occupancy: A building designed for other purpose shall not be converted into a hospital. The
location of a hospital shall comply with all local zoning ordinances.
3 Safety: A hospital and other health facilities shall provide and maintain a safe environment for
patients, personnel and public. The building shall be of such construction so that no hazards to
the life and safety of patients, personnel and public exist. It shall be capable of withstanding
weight and elements to which they may be subjected.
3.1 Exits shall be restricted to the following types: door leading directly outside the
building, interior stair, ramp and exterior stair.
3.2 A minimum of two (2) exits, remote from each other, shall be provided for each floor
of the building.
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3.3 Exits shall terminate directly at an open space to the outside of the building.
4 Security: A hospital and other health facilities shall ensure the security of person and property
within the facility.
5 Patient Movement: Spaces shall be wide enough for free movement of patients, whether they
are on beds, stretchers, or wheelchairs. Circulation routes for transferring patients from one
area to another shall be available and free at all times.
5.1 Corridors for access by patient and equipment shall have a minimum width of 2.44
meters.
5.2 Corridors in areas not commonly used for bed, stretcher and equipment transport
may be reduced in width to 1.83 meters.
5.3 A ramp or elevator shall be provided for ancillary, clinical and nursing areas located
on the upper floor.
5.4 A ramp shall be provided as access to the entrance of the hospital not on the same
level of the site.
6 Lighting: All areas in a hospital and other health facilities shall be provided with sufficient
illumination to promote comfort, healing and recovery of patients and to enable personnel in
the performance of work.
7 Ventilation: Adequate ventilation shall be provided to ensure comfort of patients, personnel
and public.
8 Auditory and Visual Privacy: A hospital and other health facilities shall observe acceptable
sound level and adequate visual seclusion to achieve the acoustical and privacy requirements in
designated areas allowing the unhampered conduct of activities.
9 Water Supply: A hospital and other health facilities shall use an approved public water supply
system whenever available. The water supply shall be potable, safe for drinking and adequate,
and shall be brought into the building free of cross connections.
10 Waste Disposal: Liquid waste shall be discharged into an approved public sewerage system
whenever available, and solid waste shall be collected, treated and disposed of in accordance
with applicable codes, laws or ordinances.
11 Sanitation: Utilities for the maintenance of sanitary system, including approved water supply
and sewerage system, shall be provided through the buildings and premises to ensure a clean
and healthy environment.
12 Housekeeping: A hospital and other health facilities shall provide and maintain a healthy and
aesthetic environment for patients, personnel and public.
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13 Maintenance: There shall be an effective building maintenance program in place. The
buildings and equipment shall be kept in a state of good repair. Proper maintenance shall be
provided to prevent untimely breakdown of buildings and equipment.
14 Material Specification: Floors, walls and ceilings shall be of sturdy materials that shall allow
durability, ease of cleaning and fire resistance.
15 Segregation: Wards shall observe segregation of sexes. Separate toilet shall be maintained for
patients and personnel, male and female, with a ratio of one (1) toilet for every eight (8) patients
or personnel.
16 Fire Protection: There shall be measures for detecting fire such as fire alarms in walls,
peepholes in doors or smoke detectors in ceilings. There shall be devices for quenching fire such
as fire extinguishers or fire hoses that are easily visible and accessible in strategic areas.
17 Signage: There shall be an effective graphic system composed of a number of individual visual
aids and devices arranged to provide information, orientation, direction, identification,
prohibition, warning and official notice considered essential to the optimum operation of a
hospital and other health facilities.
18 Parking: A hospital and other health facilities shall provide a minimum of one (1) parking
space for every twenty-five (25) beds.
19 Zoning: The different areas of a hospital shall be grouped according to zones as follows:
19.1 Outer Zone areas that are immediately accessible to the public: emergency
service, outpatients service, and administrative service. They shall be located near the
entrance of the hospital.
19.2 Second Zone areas that receive workload from the outer zone: laboratory,
pharmacy, and radiology. They shall be located near the outer zone.
19.3 Inner Zone areas that provide nursing care and management of patients: nursing
service. They shall be located in private areas but accessible to guests.
19.4 Deep Zone areas that require asepsis to perform the prescribed services: surgical
service, delivery service, nursery, and intensive care. They shall be segregated from the
public areas but accessible to the outer, second and inner zones.
19.5 Service Zone areas that provide support to hospital activities: dietary service,
housekeeping service, maintenance and motor pool service, and mortuary. They shall be
located in areas away from normal traffic.
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2002103121 12/18/2012
20 Function: The different areas of a hospital shall be functionally related with each other.
20.1 The emergency service shall be located in the ground floor to ensure immediate
access. A separate entrance to the emergency room shall be provided.
20.2 The administrative service, particularly admitting office and business office, shall be
located near the main entrance of the hospital. Offices for hospital management can be
located in private areas.
20.3 The surgical service shall be located and arranged to prevent non-related traffic.
The operating room shall be as remote as practicable from the entrance to provide
asepsis. The dressing room shall be located to avoid exposure to dirty areas after
changing to surgical garments. The nurse station shall be located to permit visual
observation of patient movement.
20.4 The delivery service shall be located and arranged to prevent non-related traffic.
The delivery room shall be as remote as practicable from the entrance to provide asepsis.
The dressing room shall be located to avoid exposure to dirty areas after changing to
surgical garments. The nurse station shall be located to permit visual observation of
patient movement. The nursery shall be separate but immediately accessible from the
delivery room.
20.5 The nursing service shall be segregated from public areas. The nurse station shall be
located to permit visual observation of patients. Nurse stations shall be provided in all
inpatient units of the hospital with a ratio of at least one (1) nurse station for every
thirty-five (35) beds. Rooms and wards shall be of sufficient size to allow for work flow
and patient movement. Toilets shall be immediately accessible from rooms and wards.
21 Space: Adequate area shall be provided for the people, activity, furniture, equipment and
utility.
Space Area in Square Meters
Administrative Service
Lobby
Waiting Area 0.65/person
Information and Receiving 5.02/staff
Toilet 1.67
Business Office 5.02/staff
Medical Records
Work Area 5.02/staff
Storage Area 4.65
Emergency Room
Toilet 1.67
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2002103121 12/18/2012
Nurse Station 5.02/staff

Examination and Treatment Area w/ Lavatory/Sink 7.43/bed
Observation Area 7.43/bed
Equipment and Supply Storage Area 4.65
Wheeled Stretcher Area 1.08/stretcher
Outpatient Department
Toilet 1.67
Admitting and Records Area 5.02/staff
Consultation Area 5.02/staff
Examination and Treatment Area with Lavatory/Sink 7.43/bed
Dental Clinic 8.36/dental chair
Surgical and Obstetrical Service
Major Operating Room 33.45
Recovery Room 9.29
Delivery Room 33.45
Labor Room w/ Toilet 9.29
Sub-sterilizing Room 4.65
Sterile Instrument, Supply and Storage Area 4.65
Office of the Hospital Administrator 5.02/staff
Office of the Chief of Hospital 5.02/staff
Conference Room 1.40/person
Staff Toilet 1.67
Housekeeping Area 5.02/staff
Laundry and Linen Area 5.02/staff
Maintenance Area 5.02/staff
Garage Area 9.29
Supply Room 5.02/staff
Waste Holding Room 4.65
Pharmacy 15.00
Dietary
Dietitian Area 5.02/staff
Supply Receiving Area 4.65
Cold and Dry Storage Area 4.65
Food Preparation Area 4.65
Cooking and Baking Area 4.65
Serving and Food Assembly Area 4.65
Washing Area 4.65
Garbage Disposal Area 1.67
Dining Room 1.40/person
Staff Locker Room and Toilet 2.32
Social Service Area 5.02/staff
Cadaver Holding Room 7.43/bed
Clinical Service
Anesthesia Storage Area 4.65
Scrub-up Area 4.65
Clean-up Area 4.65
Male Dressing Room and Toilet 2.32
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2002103121 12/18/2012
Female Dressing Room and Toilet 2.32

Nurse Station 5.02/staff
Wheeled Stretcher Area 1.08/stretcher
Janitors Closet 3.90
Nursery
Pathologic Room 3.72/bassinet
Premature Room 3.72/bassinet
Work Area w/ Sink 4.65
Viewing Area 3.90
Breastfeeding Area 3.72/bassinet
Nursing Unit
Private Room w/ Toilet 9.29
Semi-Private Room w/ Toilet 7.43/bed
Female Ward w/ Toilet 7.43/bed
Male Ward w/ Toilet 7.43/bed
Isolation Room w/ Toilet 9.29
Nurse Station w/ Work Area and Lavatory/Sink 5.02/staff
Treatment Room w/ Lavatory/Sink 7.43/bed
Central Sterilizing and Supply Room
Receiving and Releasing Area 5.02/staff
Work Area 5.02/staff
Sterilizing Room 4.65
Sterile Supply Storage Area 4.65
Nursing Service
Office of the Chief Nurse 5.02/staff
Staff Locker Room and Toilet 2.32
Ancillary Service
Laboratory
Toilet 1.67
Clinical Work Area w/ Sink 10.00
Pathologist Area 5.02/staff
Radiology
Dressing Area 1.67
Toilet 1.67
X-ray Room w/ Control Booth 14.00
Dark Room 4.65
Film File and Storage Area 4.65
Radiologist Area 5.02/staff
Pharmacy 15.00
Table 8. Adequate area for spaces in mental health facility
Notes:
1. 0.65/person Unit area per person occupying the space at one time
2. 5.02/staff Work area per staff that includes space for one (1) desk and one (1) chair,
space for occasional visitor, and space for aisle
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2002103121 12/18/2012
3. 1.40/person Unit area per person occupying the space at one time
4. 7.43/bed Clear floor area per bed that includes space for one (1) bed, space for
occasional visitor, and space for passage of equipment
5. 1.08/stretcher Clear floor area per stretcher that includes space for one (1) stretcher
6. 8.36/dental chair Clear floor area per dental chair that includes space for one (1)
dental chair, space for movement of person, and space for passage of equipment
7. 3.72/bassinet Clear floor area per bassinet that includes space for one (1) bassinet,
space for movement of person, and space for passage of equipment
LICENSING REQUIREMENTS FOR ACUTE-CHRONIC PSYCHIATRIC CARE FACILITY

1 SERVICE CAPABILITY
1.1 General Administrative Service
1.2 Clinical Service
1.2.1 Psychiatric Service
1.3 Nursing Service
1.3.1 Psychiatric Nursing Care
1.3.2 Crisis Intervention
1.4 Ancillary Service
1.4.1 Psychological Service
1.4.2 Recreational Therapy
2 PERSONNEL Number of Personnel
2.1.1 Administrator 1
2.1.2 Clerk 1
2.1.3 Laundry Worker 1
2.1.4 Utility Worker 1
2.1.5 Security Aide 1
2.1.6 Driver 1
2.1.7 Cook 1
2.1.8 Food Service Worker 1
2.1.9 Medical Social Worker 1:100
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2.2.1 Psychiatrist 1
2.2.2 Physician (full time) 1
2.3 Nursing Service
2.3.1 Nurse 1:20 beds/shift
2.3.2 Nursing Attendant 1:10 beds/shift
2.4.1 Psychologist (part time) 1
2.4.2 Recreational Therapist (part time) 1
3 EQUIPMENT / INSTRUMENT Number of Equipment
3.1.1 Bench 1
3.1.2 Cabinet 1
3.1.3 Calculator 1
3.1.4 Chair 1/staff
3.1.5 Desk 1/staff
3.1.6 Fire Extinguisher 1
3.1.7 Open Shelf 1
3.1.8 Standby Generator 1
3.1.9 Transport Vehicle 1
3.1.10 Typewriter 1
3.1.11 Conveyor 1
3.1.12 Dish Storage 1
3.1.13 Electric Fan 1
3.1.14 Exhaust Fan 1
3.1.15 Food Scale 1
3.1.16 Osterizer/Blender 1
3.1.17 Refrigerator/Freezer 1
3.1.18 Storage Rack/Shelf 1
3.1.19 Stove 1
3.1.20 Utility Cart 1
3.1.21 Work Table 1
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3.2.1 Ambu Bag 1
3.2.2 Bed w/ Straps depending on ABC*
3.2.3 Clinical Weighing Scale 1
3.2.4 Laryngoscope w/ Blades 1
3.2.5 Oxygen Unit 1
3.2.6 Sphygmomanometer 1
3.2.7 Stethoscope 1
3.2.8 Suction Apparatus 1
3.3.1 Recreational Therapy
3.3.1.1 Basketball
3.3.1.2 Guitar
3.3.1.3 Karaoke
3.3.1.4 Table Tennis
3.3.1.5 Television
3.3.1.6 VHS/VCD
4 PHYSICAL PLANT
4.1.1 Waiting Area
4.1.2 Information and Receiving Area
4.1.3 Business Office
4.1.4 Office of the Administrator
4.1.5 Staff Toilet
4.1.6 Laundry and Linen Area
4.1.7 Garage Area
4.1.8 Supply Room
4.1.9 Waste Holding Room
4.1.10 Dietary
4.1.10.1 Dietitian Area
4.1.10.2 Supply Receiving Area
4.1.10.3 Cold and Dry Storage Area
4.1.10.4 Food Preparation Area
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4.1.10.5 Cooking and Baking Area
4.1.10.6 Serving and Food Assembly Area
4.1.10.7 Washing Area
4.1.10.8 Garbage Disposal Area
4.1.10.9 Dining Room
4.1.10.10 Staff Locker Room and Toilet
4.2.1 Admission, Discharge and Follow-up Unit
4.2.1.1 Admitting and Records Area
4.2.1.2 Nurse Station
4.2.1.3 Consultation Area
4.2.1.4 Examination and Treatment Area
4.2.1.5 Equipment and Supply Storage Area
4.2.1.6 Toilet
4.2.2 Nursing Unit
4.2.2.1 Private Room w/ Toilet
4.2.2.2 Semi-Private Room w/ Toilet
4.2.2.3 Female Ward w/ Toilet
4.2.2.4 Male Ward w/ Toilet
4.2.2.5 Female Observation Room w/ Toilet
4.2.2.6 Male Observation Room w/ Toilet
4.2.2.7 Female Strap Room w/ Toilet
4.2.2.8 Male Strap Room w/ Toilet
4.2.2.9 Isolation Room w/ Toilet
4.2.2.10 Nurse Station w/ Work Area and Lavatory/Sink
4.3.1 Recreational Therapy Unit
4.3.1.1 Indoor Activity Area
4.3.1.2 Outdoor Activity Area
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CHAPTER IV
4.1 Users Analysis
Primary Users Secondary Users Tertiary Users
Patients Family / Relatives Visitors
All patients that go to Any family member or Any visitors/tourists that
the mental hospital with relative of the patient want to look or take a
mental illness. admitted visiting in the picture in the Ruins.
In-patient and out- mental hospital.
patient
Medical Staff Maintenance Staff
All doctors, nurses and All janitorial staff /
medical specialists that cleaning aides that fix
work in the mental equipment/maintain the
hospital. facility.
Administrative Staff Security
All administrative All security personnel
officers that work in the that work in the mental
mental hospital hospital.
Table 9. Definition of Users
Office of the CHIEF OF HOSPITAL

CHD 3 REGIONAL DIRECTOR
Medical & Ancillary Administrative Service

Service Nursing Service
Headed by Supervising
Headed by Headed by Nurse V
Medical Specialist III
Administrative Officer
Out-Patient Human Resource

Medical Office Development Budget Service
Department
Service
Accounting and
Acute Crisis Cash Service
Psychology Unit Billing Service
Intervention Service
Procurement,
Property Pharmacy Service
& Supply Service
Dental Unit Custodial Care Unit
Health & Information Admission &

Management Service Information Service
Occupational Male & Female
Therapy Ward
Unit Nutrition and Medical Social
Dietetics Service Service
Maintenance Linen & Laundry

Service Service
Fig. 28 Organizational Chart
Security Service
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Fig. 29 User Diagram
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Fig. 30 Space Zoning
Fig. 31 Circulation Diagram
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Fig. 32 Behavioral Diagram
4.2 Space Programming
Main Users of the Wards
PATIENTS
- 500 IN-PATIENTS
- 8 PATIENTS PER ROOM (RECOMMENDED) (6mx7m RECOMMENDED)
- 30 PATIENTS PER WARD (RECOMMENDED)
- 1 TOILET PER 8 PATIENTS
NURSES
- 2 NURSES PER 8 PATIENTS
- 1 TOILET PER 8 NURSES
DOCTOR/PSYCHIATRIST
- 1 DOCTOR PER 30 PATIENTS
* Recommended according to WHO Expert Committee on Mental Health
77
SPACES NO. OF FURNITURE/
ACTIVITIES PRINCIPLE/ CONCEPTS SPACE FACTOR AREA
USERS APPLIANCES
2002103121
PUBLIC AREAS
A hospital and other health

Building Security and facilities shall ensure the
Security Office 6 Desk, Chair 5.02/staff 30.12m2
Inspection security of person and

property within the facility.
Reception area sends a

welcoming message to
Reception/ Reception Desk, users. Sufficient signage
20 Providing Information 5.02/staff 100.4m2
Main Lobby Chairs and Cabinets should be placed to direct
patients and families to this
area.
78
Located near the entrance
to the unit and nurse
Visitor's Area for patient's Chairs, 2-3 Seater
10 station allowing visual and 0.65/person 6.5m2
Lounge visitors Sofa
conversational level with
acoustical privacy.
Table 10. Space Programming Index

Separate toilet shall be

maintained for public,
patients and personnel, male
Body waste disposal Water Closet, Must be easily accessible
Toilet 20 and female, with a ratio of 33.4m2
and hand washing Lavatory from rooms and wards.
one (1) toilet for every eight
(8) patients or personnel.
1.67
Public Dining Tables and Must be located away from

50 Dining 1.40/person 70m2
12/18/2012
Cafeteria Chairs private areas

EMERGENCY NO. OF FURNITURE/
ACTIVITIES PRINCIPLE/CONCEPTS SPACE FACTOR AREA
DEPARTMENT USERS APPLIANCES
2002103121
A small waiting area in sight of the

receptionist should be provided for the
Area for Chairs, 2-3 chaperon of the patient. Waiting area
Waiting Area 20 0.65/person 13m2
waiting Seater Sofa should allow view of mainstream of
activity but is located in well-defined

area out of main traffic pattern.
Nurse stations shall be provided in

Desk, chairs, The nurse station shall be located to all inpatient units of the hospital
Station for
Nurse Station 8 cabinets/drawer permit visual observation of patient with a ratio of at least one (1) 40.16m2
nurses on duty
s movement. nurse station for every thirty-five
(35) beds. 5.02/staff
79
First aid ward
Holding Area 4 area for Beds Not Applicable 7.43/bed 29.72m2
patients
Examination Rooms for
Bed and Medical
and Treatment 3 treatment of Not Applicable 7.43/bed 22.29m2
Equipment
Area patients
Preparation Cabinets,
Pantry 5 and serving of Kitchen Sink and Not Applicable 1.40/person 7m2
food Dining Table
Separate toilet shall be maintained
for public, patients and personnel,
Body waste
Water Closet Must be easily accessible to nurse male and female, with a ratio of
Staff Toilet 2 disposal and 3.34m2
and Lavatory station and staff lounge. one (1) toilet for every eight (8)
hand washing
12/18/2012
patients or personnel.
1.67
OUT-PATIENT NO. OF FURNITURE/
ACTIVITIES PRITNCIPLE/CONCEPS SPACE FACTOR AREA
DEPARTMENT USERS APPLIANCES
Waiting area should be small groups in sight

of the receptionist. Waiting area should
2002103121
Chairs, 2-3 Seater 2

Waiting Area 15 Area for waiting allow view of mainstream of activity but is 0.65/person 9.75m
Sofa
located in well-defined area out of main
traffic pattern.
Nurse stations shall be provided in all

inpatient units of the hospital with a
Station for Desk, chairs, The nurse station shall be located to permit
Nurse Station 8 ratio of at least one (1) nurse station 40.16m2
nurses on duty cabinets/drawers visual observation of patient movement.
for every thirty-five (35) beds.
5.02/staff
First aid ward

Holding Area 4 Beds Not Applicable 7.43/bed 29.72m2
area for patients
80
Rooms for
Examination and Bed and Medical
3 treatment of Not Applicable 7.43/bed 22.29m2
Treatment Area Equipment
patients
Cabinets, Kitchen
Preparation and
Pantry 5 Sink and Dining Not Applicable 1.40/person 7m2
serving of food
Table
Separate toilet shall be maintained for

public, patients and personnel, male
Body waste
Water Closet and Must be easily accessible to nurse station and female, with a ratio of one (1)
Staff Toilet 2 disposal and 3.34m2
Lavatory and staff lounge. toilet for every eight (8) patients or
hand washing
personnel.
1.67
Office furniture,
Store for
12/18/2012
Pharmacy 1 cabinets and Not Applicable 5.02/staff 5.02m2

medicines
display rack
ADMINISTRATIVE NO. OF FURNITURE/
OFFICES USERS APPLIANCES
2002103121
Administrative Human Resource, billing Admitting office and business

and Business 5 and collecting of Office furniture office shall be located near the 5.02/staff 25.1m2
Office payments main entrance of the hospital.
Cashier and
10 Bill payment Office furniture Not Applicable 5.02/staff 50.2m2
Queuing Area
Engineering and
Maintenance 4 Building maintenance Office furniture Not Applicable 5.02/staff 20.08m2
Office
81
Nursing Services Offices for Chief and The nursing service shall be
10 Office furniture 5.02/staff 50.2m2
Office Head Nurses segregated from public areas.
Must be near the billing,

Medical Records Storage of patients' information and out-patient

2 Office furniture 5.02/staff 10.04m2
Office records department where patients
usually fill-out their information.
Office of the Office for the

3 Office furniture Not Applicable 5.02/staff 15.06m2
Administrator Administrator
Office of the Office for the Building

3 Office furniture Not Applicable 5.02/staff 15.06m2
Building Chief Chief
12/18/2012
NURSING NO. OF FURNITURE/
2002103121

UNITS USERS APPLIANCES
A hospital and other health

Security and
Building security and Desk, Chair and facilities shall ensure the
Monitoring 2 5.02/staff 10.04m2

monitoring of patients monitoring screens. security of person and property
Rooms
within the facility.
Located near the entrance to

the unit and nurse station
Reception and Area for visiting family
20 Chairs, 2-3 Seater Sofa allowing visual and 0.65/person 13m2
Visiting Areas members of the patient
conversational level with
acoustical privacy.
Living areas/day spaces are
82
desirable to allow noisy and
Area for group and Long table, chairs and quiet activities to occur
Activity Areas 30 5.02/person 150.6m2
individual activities cabinets simultaneously. Quiet activity
space could be used for group
therapies.
Conversational areas for A small conversational area for a

Socialization Area 30 Chairs 1.40/person 42m2
chatting and discussions group of 2-4 persons
Showers and bench for

Shower Stalls 4 Taking a bath Not Applicable 1.67 6.68m2
dressing
Psychiatrist's Private offices for doctors 8 psychiatrists for every 100 beds 2
2 Desk, chair and cabinets 5.02/staff 10.04m
Office with Toilet on duty and their staff and 1 additional for 50 more beds.
12/18/2012
NURSING NO. OF FURNITURE/
ACTIVITIES PRINCIPLE/ CONCEPTS SPACE FACTOR AREA
2002103121
UNITS USERS APPLIANCES
6-8 patients per room in a 30-patient

ward. Wards shall observe segregation of
Develop multiple patient sexes. Separate toilet shall be
Patient's Room Sleeping, personal

8 Patients' bed room clusters within the unit maintained for patients and personnel, 36m2
with Toilet and private needs
to allow for male and female with a ratio of one (1)
toilet for every eight (8) patients or
personnel.
Nurse stations shall be provided in all

Stations for nurses' Desk, chairs, Separation of different inpatient units of the hospital with a
Nurse Station 8 40.16m2
on duty cabinets/drawers patient sub-groups. ratio of at least one (1) nurse station for
every thirty-five (35) beds. 5.02/staff
83
The nurse station shall be
Cabinets, Kitchen
Preparation and located to permit visual
Pantry 32 Sink and Dining 1.40/person 44.8m2
serving of food observation of patient
Table
movement.
Separate toilet shall be maintained for

Must be easily accessible to public, patients and personnel, male and
Body waste disposal Water Closet and
Staff Toilet 2 nurse station and staff female, with a ratio of one (1) toilet for 3.34m2
and hand washing Lavatory
lounge. every eight (8) patients or personnel.
1.67
Storage of
Supply Room 6 medicines and other Storage cabinets Not Applicable 4.65 27.9m2
supplies
12/18/2012
2002103121
NO. OF FURNITURE/
INFIRMARY ACTIVITIES PRINCIPLE/CONCEPTS SPACE FACTOR AREA
USERS APPLIANCES
Waiting area should be small

groups in sight of the
receptionist. Waiting area
Chairs, 2-3 Seater
Waiting Area 15 Area for waiting should allow view of 0.65/person 9.75m2
Sofa
mainstream of activity but is
located in well-defined area
out of main traffic pattern.
84
The nurse station shall be Nurse stations shall be provided in all
Station for nurses Desk, chairs, located to permit visual inpatient units of the hospital with a ratio
Nurse Station 8 40.16m2
'on duty cabinets/drawers observation of patient of at least one (1) nurse station for every
movement. thirty-five (35) beds. 5.02/staff
The medical service shall

Ward area for Beds and Medical be located and arranged

Medical Ward 10 7.43/bed 74.3m2
patients Equipment to prevent non-related
traffic.
12/18/2012
2002103121
NO. OF
INFIRMARY ACTIVITIES FURNITURE/APPLIANCES PRINCIPLE/CONCEPTS SPACE FACTOR AREA
USERS
Testing and Physical

Laboratory 10 Counter and Equipment Not Applicable 5.02/staff 50.2m2
Examination
General Dental and General Medical Equipment and

5 Not Applicable 5.02/staff 25.1m2
Medicine Area Medical Treatment Office Furniture
Preparation and Cabinets, Kitchen Sink and

Pantry 10 Not Applicable 1.40/person 14m2
85
serving of food Dining Table
Separate toilet shall

be maintained for
public, patients and
Must be easily personnel, male and
Body waste disposal

Staff Toilet 2 Water Closet and Lavatory accessible to nurse female, with a ratio of 3.34m2
and hand washing
station and staff lounge. one (1) toilet for
every eight (8)
patients or personnel.
1.67
12/18/2012
2002103121 12/18/2012
4.4 Concept
The concept was derived from a different kind of Rubiks Cube where it is made up of
triangles instead of cubes but can still create a lot of forms. Despite its complexities, it can still
end up with a regular shape like a rectangle. Simplicity in designing psychiatric wards is suitable
to mentally ill patients to avoid confusion and disorientation.
4.5 Architectural Drawings
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88
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89
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90
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BIBLIOGRAPHY
(S.G.V, 2012, Jacobsen, 2003; Robinson, 2005b, Jerry Travers, 2009, Elizabeth kitchen, 2011).
(n.d.).
Merriam Webster's Online Dictionary. (2011). Retrieved October 30, 2011, from
http://www.merriam-webster.com/
A., R. E. (2004). Community Mental Health Journal.
Anthony W. Cohen M. Farkas M, e. a. (2002). Psychiatric rehabilitation. 2nd ed. Boston: Center
for Psychiatric Rehabilitation, Boston University.
B., G. (1994). Br J Psychiatry.
Bachrach, L. (2000). Psychosocial rehabilitation and psychiatry in the treatment of schizophrenia
- what are the boundaries? Acta Psychiatr Scand.
Bebbington, P. (1995). Int Clin Psychopharmacol.
Bond, G. (2004). Supported Employment.
Carer, H. M. (2005). Social Science Medicine
Carling, P. (1992). Housing, community support, and homelessness: emerging policy in mental
health systems.
G, B. A. (2004). Psychiatric Service
Gagne, F. M. (2005). Community Mental Health Journal
Liberman, R. K. (2002). Psychiatric Service
Monzani, B. A. (2004). Quality of Life Research
Nordt, L. C. (2004). Community Mental Health Journal
PW., C. (2005). Community Mental Health Journal
Leonora N. Reyes, 2009 Comprehensive Reviewer for Nursing Licensure Examination
102

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Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital

MANALO, KRISHNA JOY G.

MAPUA INSTITUTE OF TECHNOLOGY

AR 200 - Thesis Research Writing

Manalo, Krishna Joy G.

The Administrators of the Faculty of Architecture Mapua Institute of Technology, for

1.2 Background of the Study

1.3 Statement of the Problem

1.5 Significance of the Research

1.6 Review of Related Literature and Studies

going through, how they themselves

expected by social and cultural tertiary prevention.

injuries, heart disease, cancer, liver

disorder, and posttraumatic stress used to decrease anxiety include

Transcranial magnetic stimulation (TMS) is a newer therapy. A non-invasive technique that

1.6.3 Psychiatric Rehabilitation

1.6.4 Healing Environment in Psychiatric Hospital Design

1.7 Theoretical Framework

Mentally Ill Staff Working in Family and

Different Methods of Acceptance

Statistics Factors of Reintegration

Questionnaires & Review of Related

Fig. 1 Theoretical Framework

1.8 Research Methodology

1.8.1 Oral Investigation

Emelita R. Maca (L-R (OJT) AG Jamine;

Maria Jessica C. Alcanzaren Albert Perez

Fig. 2 Employees interviewed who work in

F23.8 Other acute and transient psychotic

1.8.2 Case Study of Mariveles Mental Hospital

Old Quarantine Station

Fig. 3 Mini- library within the ruins

Fig. 5 Main entrance of the ACIS Building

Fig. 6 Exterior of ACIS Building

Fig. 7 Exterior of ADMIN Building

Fig. 8 Interior of the ADMIN Office

Fig. 9 Hallway inside the ADMIN Building

Total Number of In-Patients

Table 7. Top 4 Provinces w/ the Highest In-Patient Statistics

700010 YEAR DISCHARGE & 10 YEAR IN-PATIENT STATISTICS MMH

2000 1685 1631 1556

10 YEAR OUT-PATIENT STATISTICS MMH

Fig. 15 Graph showing the 10 year out-patient statistics in MMH

Fig. 16 Facilities inside Mariveles Mental Hospital

ACIS Building 115m to the male ward.

Female Ward 156.5m from

Fig. 17 Master Site Development Plan

Long walks are required to transfer patients

1.8.3 Case Study of Yuli Veterans Hospital

Community rehabilitation center: Joint Nursing homes for long-term care.

Work training in hospital bakery. Work training in community bakery.

Fig. 19 Vocational Rehabilitation

Community employment in horticulture

The residential program. Yuli Mental Health Research Center

1.8.4 Case Study of Metro Psych Facility

Metro Psych Facility Family Cottage

Acute In-patient Hallway Psychiatric Patient Ward

Substance Abuse Ward Swimming Pool

Library Basketball Court

Fig. 21 Amenities in Metro Psych Facility

1.9 Scope and Limitations of the Study

1.10 Definition of Terms

2.2 Summary of Findings