A new vision for mental health facilities

A critically timed Royal Commission into Victoria’s Mental Health System is driving significant changes to how mental health care is delivered in Victoria, Australia. Human-centred design puts people at the heart of the design process and is seeing consumer and carer experiences guide the creation of new and refurbished facilities, driving safer outcomes and higher quality care, says Rebecca Eyers, Technical Director.

The 2019 Royal Commission into Victoria’s Mental Health System final report called for an ambitious reform agenda with more than 65 recommendations to improve the state’s mental health and well-being system. The expansion of flexible mental health infrastructure is the centrepiece of significant investment commitments from the Victorian State Government and is shining a light on the need for modern facilities that support recovery-focused treatment and provide consumers with an appropriate level of autonomy over their environment. 

Over the last two years, the Victorian state budget has committed more than $AUD 5 billion (US$3.4 billion) to support better mental health outcomes. AECOM is currently engaged on several mental health projects, including the secure forensic mental health facility, Thomas Embling Hospital. The 136-bed facility is undergoing expansion and refurbishment, providing an additional 82 beds by the end of 2024. The hospital provides treatment and care for people living with a serious mental illness who are in, or at risk of entering, the justice system. The $AUD474 million expansion will address critical bed shortages, providing 82 new secure mental health beds, including a new dedicated women’s precinct, a medium security men’s facility and a new entry complex. AECOM is providing multidisciplinary engineering services for the project, working closely with Guymer Bailey Architects and MAAP Architects.  

In this article, we share learnings from the design and delivery of mental health facilities in Victoria and explore the key considerations that make these facilities unique from any other health facility.  

Co-designing a better future 

As design professionals, we are responsible for interpreting and responding to community insights to provide better spaces that support recovery. 

Modern-day mental health facilities are an important part of our community, and their design is evolving with greater recognition of recovery-focused outcomes. Learning from those with lived experiences through the ongoing co-design of facilities is integral to the evolution of mental health care and ensuring the needs of consumers are met. For example, during the co-design process, consumers can share aspects of a facility where design solutions could improve their experience, or they could share their personal experiences, such as feelings of fear and confusion when arriving at a facility and the key design elements that could improve the experience. 

Through co-design, we gather their unique insights – what were the pressure points, what was good and how could it be better? Their perspective is essential to ensuring our facilities are fit for purpose.  

The design of mental health facilities is critical in providing a safe and rehabilitative environment for consumers, and while from the outside, facilities may appear to be similar to other buildings, they are highly bespoke with every aspect, from design to material selection and audio-visual solutions, considered. 

Six key considerations  

1. Safety is the core design principle: safety is at the heart of the design process to ensure the wellbeing of consumers and staff. Safety is prioritised across every design element and impacts everything from electrical solutions and fire safety interventions to ceiling heights to reduce risks of self-harm. For example, a higher level of acoustic treatment is required in mental health facilities to minimise stress incurred from noise in adjacent spaces. When considering security design, it’s important to take a mitigative approach using passive systems, which are unobtrusive and respectful of privacy while prioritising consumer and staff safety.  
2. Designing for flexibility: it’s critical to design facilities to be flexible and adaptable to cater to changing models of care and to reduce the impact on facility operations and unnecessary disturbances to consumers. For example, floor-to-floor heights will need to be coordinated with building services to make it easier to adapt spaces in the future. This requires a highly integrated design between engineering disciplines and architects.
3. Sustainability and access to nature: the environment has an important role in enabling a salutogenic approach to health and wellbeing. A healthy and comfortable indoor environment is widely accepted to support positive health outcomes for consumers and staff. Access to daylight and improved indoor air quality is vital to achieving this and can be supported using anti-ligature operable windows to help consumers control their environment. Providing consumers with a connection to nature through biophilic design solutions that use natural materials and providing courtyard areas and visual access to the landscape through views of water and green spaces can also support recovery. The use of temperature control can also be beneficial to help reduce aggressive behaviours and encourage good sleep hygiene, while the use of circadian lighting can be used to support health and wellbeing by mimicking natural lighting to align with our biological clock. 
4. Technology: plays an important role in recovery. Internet connection and web-based communication platforms can provide consumers with a sense of connection to friends, family, and support networks beyond the mental health facility and access to training and development programmes. These connections form part of an integrated approach to treatment and support their reintegration into society and ability to lead a meaningful and contributory life. Audio-visual technology solutions, such as sensory rooms with fibre-optic star ceilings and wall projections create immersive experiences for consumers and are designed to aid rehabilitation.  
5. Designing for infectious disease: the coronavirus pandemic has fundamentally changed how we design buildings. We are now acutely aware of the need to control the spread of infectious diseases, and how this will inform design outcomes in future. In practice, this could be designing specific wards that can operate safely in pandemic mode or be more easily adapted to suit pandemic operational requirements. This is particularly critical for mental health facilities where consumers cannot be easily transferred to other facilities due to specific safety and security requirements or where disruption to one’s environment may impact recovery outcomes. 
6. Embed your costing in the process: mental health facilities are inherently complex. What appears as a regular building component is rarely as it seems, for example, plywood backing behind walls for reinforcement, anti-pick caulking around fittings, and tamperproof and anti-ligature fixtures and fittings all add a premium cost. Every aspect requires more or special materials or time to achieve the level of robustness needed. This means there are significant cost risk factors across every design element, and they must be tracked throughout the project to reduce the risk of going over budget.

A solution for all 

Mental health projects require meticulous planning and delivery experience. New technology and models of care are driving better outcomes for consumer recovery, and how our buildings transform over time requires both an agile mindset and a considered approach. Innovative ideas are important to push the industry forward and drive better care, but to be successful in a mental health setting, a thorough understanding of the unique sensitivities and pressure points is vital to creating a built solution that meets the needs of consumers, their families, and staff alike.