Text: Sara Bandelier
Photo: Vegar Moen, CCL

the end of the Cuckoo’s nests

Rounded walls, open spaces, private gardens. Psychiatric institutions are redesigning their structure and facilities. Why? To transform a soulless place into a soothing environment.

The wind rustles the dead leaves lying along the alleyway. In the park, a man in a straightjacket is surrounded by doctors. And in the background looms the dark, sinister asylum where patients receive shock treatment. This cliché of the psychiatric hospital is definitely a thing of the past. Doctors and architects now work together to design a welcoming environment open to the outside world.

These changes are made to improve care. “The idea that architecture could heal, calm, welcome and surround the patient came about in the 19th century,” says Jean-Michel Kaision, director of the Department of Psychiatry at the Lausanne University Hospital. But it took some countries longer to integrate those principles. “Psychiatric hospitals are still often thought of as a prison, a place for punishment,” says his colleague Jacques Gasser. “We want to create an environment for treatment that is both aesthetic and organic, with colours and non-cubic shapes.” As chair of the Department of Psychiatry, Jacques Gasser is leading the project to redesign the Hospital of Cery in Lausanne. Plans are to rebuild the complex entirely between now and 2019.

Individual bedrooms, rounded structures, smaller units, shared spaces, open access to private gardens, atriums and personalised areas are now an integral part of new psychiatric treatment facilities.

Östra Hospital in Sweden has already embarked on a similar programme. Its architecture reflects the design of Scandinavian homes, with their paintings depicting nature scenes, their wooden furniture and their colourful curtains. Roger Ulrich, professor of architecture at Chalmers University of Technology in Gothenburg, Sweden, conducted a study in which he noted the benefits of these redesign projects. “The physical setting plays a key role in reducing stress and aggression in patients,” he says. “Our research shows continued increases in the use of physical restraints and sedation at traditional psychiatric facilities in Sweden, while Östra has observed a considerable drop in aggressive behaviour.”

Roger Ulrich has identified a number of factors that are believed to reduce stress and aggression. The patient’s privacy and dignity are guaranteed with individual bedrooms and WCs. Their space can be adapted to their needs for isolation. Free access to the garden offers a sense of control and calm. Silence is also important. Units are smaller in size to reduce the stress caused by crowding and noise.

“Patients are meant to start responding to the stimuli from the outside world again, through the architectural design that awakens their body and their senses and gradually bring them back into contact with others.”

In Lausanne, the Alcôves project launched by Pieter Versteegh and Catherine Versteegh-Cellier aims to transform the intensive care unit at the Hospital of Prangins (Vaud). “It’s the most problematic area, where staff work on therapeutic isolation for the most serious cases,” says architect Pieter Versteegh. Catherine Versteegh-Cellier’s objective is to “reduce the number of situations that can make the patient’s condition worse when they are taken to intensive care and during their stay in the room, while still guaranteeing their safety.” She goes on to explain, “Patients are meant to start responding to the stimuli from the outside world again, through the architectural design that awakens their body and their senses and gradually bring them back into contact with others.”

“When patients are placed in this room, they always experience it in the pain of their symptoms rather than as a treatment,” says Catherine Versteegh-Cellier, head of the Clinical Unit at the Neuchâtel Psychiatric Centre. Patients are overcome with a feeling of seclusion, exclusion and oppression. They are lonely, unable to see the rest of the unit around them and sometimes unable to open the shutters on the window… if there is one. Intensive care units have also been reinvented at Cery. The facility will feature two to three bedrooms surrounding a community area. “There are environments that affect patients with dementia differently, like a setting from their youth,” says Jean-Michel Kaision. “We’re going to try to recreate environments where they feel comfortable.”

Swedish architect Roger Ulrich believes that revamping psychiatric facilities is a step in the right direction. “Modern facilities now have individual rooms, more natural light and perhaps improvements in design,” he says. “But most of them still have long corridors and centralised desks where staff can easily observe the patients, sometimes intrusively. Progress is still needed.”