1000/1000
Hot
Most Recent
Healing environments have been defined as therapeutic landscapes (TL), where the physical and built environments, social conditions and human perceptions combine to produce an atmosphere which is conducive to healing. The environment in mental-healthcare facilities can influence health and recovery of service users and furthermore contribute to healthy workplaces for staff. The physical (built and natural), social, and symbolic dimensions of the therapeutic landscape can have positive and negative impacts. Therefore, the needs and characteristics of the different stakeholders have to be considered.
Within the physical dimension, design features and their perception are included. A unanimous opinion was the need for a caring, homelike, and pleasant environment. In this regard, a balance between a pleasant and useful environment, evenly offering privacy and safety for SUs and staff, is necessary. Moreover, a facility should enable possibilities for reflection without disturbance but also positive distraction by the TL. Hackett et al. [36] found similar results regarding the physical environment for youth SUs in different healthcare settings. Service providers and youth SUs mentioned a welcoming environment, i.e., being bright, decorated, and youth-friendly, to be important for high quality care. Moreover, youth SUs asked for privacy and autonomy in decorating their own rooms. An open view and access to nature were mentioned as important aspects of the physical environment by some of the referred studies. Visual and physical access to nature have been found to be important for healthcare facilities in general, as being not only beneficial for the physical and mental health of SUs, but also that of staff [37]. In the same way, the provision of daylight within the facility enhances SUs’ and staff’s physical and mental health [37]. In the study by Shepley et al. [38], there was an awareness for the need for daylight, but no idea of realisation. According to Sherif et al. [39], daylight and the view from a window can be influenced and regulated by the shape of the slats on blinds. In this regard, the possibility of personal control of the individual’s environment can benefit MH additionally [37][40]. Moreover, special designs/furniture for certain SUs, e.g., geriatric or forensic SUs, are needed. According to Karlin and Zeiss [41], an issue that must be considered is the design of the interior in such a way that goals of stimulation are addressing the right SU, while fostering an optimistic sense about hospitalisation at the same time. It is desirable to design psychiatric facilities that align with different SU demands, but this may be not completely feasible in every case [33][41].
The provision of rooms for social connection and activities with other SUs, carers, and staff, and to practice religion, is important and directly connected to a conducive social environment. This is in line with results from Jovanović et al. [42], who found that family rooms off ward were associated with psychiatric SUs’ treatment satisfaction. Most of the investigated wards in this study were part of general hospitals; hence, it may be easier to provide social places off-ward than at solely psychiatric facilities. Nonetheless, it is likely that the availability of specific places to meet family and friends, apart from communal rooms, enhances SU treatment satisfaction and thus well-being. In this regard, informal carers’ demands, such as accessibility to the facility and places to connect with their cared-for relatives, are essential and enhance social interactions [37]. Moreover, multiple-occupancy rooms can provide the opportunity for social interaction between SUs [43][44]. In addition, Ulrich et al. [45] mentions the stress-reducing effects of communal areas with movable seating and ample space, which allows the regulation of relationships. Providing unlocked outdoor gardens and rooms with a view of nature can foster stress reduction by offering pleasant places to seek privacy or socialise [45]. Karlin and Zeiss [41] recommend designing social places so that SUs can control their level of social contact, retreat, or form new relationships. The need for areas and (sportive) activities, where the mental illness is not present for SUs or visible for others, allowing them to adapt to roles apart from being a SU, was also outlined by McGrath and Reavey [46]. Regarding (meaningful) activities or areas, it is important to take SUs’ preferences into account. As shown by Parkinson et al. [47], activities, i.e., horticulture, are not meaningful per se. SUs perceived horticulture only as beneficial when related to the individual’s interest [47].
A relevant aspect of the social dimension is a balance between sense of safety, privacy, autonomy, and freedom, e.g., to allow everyday choices and prevent the feeling of being locked up. Similar to the results of this qualitative meta-analysis, SUs in several studies repeatedly expressed feeling locked-up and described the environment as prison-like [36][44][46]. Clear boundaries and options on how to use private and common places, e.g., no formal SU–staff interaction in private rooms, can be supportive for treatment, but need to fit SUs’ demands. Although in the present qualitative meta-analysis SUs expressed a desire for (great) leeway, Maloret and Scott [48] showed that specific SU-groups (SU with autism spectrum disorder and an acute panic disorder) need daily routines and structure. Single-SU rooms are associated with privacy [37] and autonomy through the sense of control of the SUs’ own environment [37][44]. A review of MH aspects of the built environment affirms the importance of indirect control of the built environment through social interactions, in a variety of settings [40]. In one included study, women felt less safe in communal spaces [49]. In contrast, Jovanović et al. [42] found that SU treatment satisfaction is associated with mixed-sex wards. Consequently, further research is needed as previous research stated both advantages and disadvantages of mixed-sex wards [50][51]. Regarding safe spaces, staff have to be considered [52][53], because about 24–80% of MH care staff experience violence at least once in their career [54].