Healing Empowerment · Kalmar county, and forensic as well as child and youth psychiatry for the...

Team 9 Project Booklet 181221ARK263 - Healthcare Architecture Autumn 2018Examiner - Peter FröstSupervisors - Christine Hammarling, Elke Miedema

Healing Empowerment

Team 9

Elin NilssonToivo Säwén

Yunfan Zhang

Team 9 - Elin Nilsson, Toivo Säwén, Yunfan ZhangARK263 - Project Booklet

ANALYSIS VÄSTERVIK

PSYCHIATRIC CARE IN SWEDEN

Psychiatric care in Sweden is provided through public welfare financed largely through taxes. Most patients are treated in primary care provided by the municipality. Care for patients with severe issues is provided by the county.

One fifth of Swedish citizens receive treatment for mental health issues regularly. The majority are treated as outpatients. All patients in inpatient care are treated individually based on their needs. The treatment methods include psychotherapy, CBT and medications.

VÄSTERVIK HOSPITAL

Västervik is a coastal town in the east of Sweden, founded in the 13th century. The economy was historically focussed on shipbuilding, an industry which declined in the 20th century, replaced by other small industries. Presently the economy is largely driven by tourism. Some demographic trends is an increased migration as well as an aging population due to senior citizens moving in. Another important goal for the region is realigning to a sustainable economy and building stock.

The current hospital in the town centre first opened in 1860 and has gradually expanded. The town’s old psychiatric hospital at Gertrudsvik opened in 1912, and has since been replaced. The current psychiatric facilities built in 1972 are in need of replacement. To meet this demand a new psychiatric building is to be constructed, housing adult psychiatry for the northern region of Kalmar county, and forensic as well as child and youth psychiatry for the entire county. The entire hospital area is intended to gradually be replaced over the course of the 21st century.

Psychiatric hospital sites

SITE CHOICE

Two sites are proposed for the new psychiatric hospital:

Urban site: An infill location on the existing hospital site.Rural site: A new location in the farmland next to the lake Kvännaren.

A SWOT analysis was performed to evaluate the two sites:

Urban site:+ Excellent connection to the somatic care+ Economical to reuse existing facilities+ Good access using existing infrastructure- High density would be required- The site would not fulfill Evidence Based Design (EBD)requirements of access to nature and physical activity

Rural site:+ Excellent healing environment based on EBD principles+ Potential to create a new hospital site with sustainable technologies- Existing buildings would need to be demolished- Recreation area is affected

In addition, the project is a comment on the relationship between psychiatric and other healthcare. Some want to destigmatise psychiatry by colocating it with somatic care, acknowledging that there is no difference between mental and physical health. Others argue that psychiatry should be separated to reduce the sense of being “ill”.

Views are split and each patient has different needs. By providing view over and access to greenery in combination with a lot of daylight have according to EBD provided great healing results. The less dense site also gives the possibility to provide privacy for the patients. Therefore, providing a good healing environment was the deciding factor in our choice of working with the rural site.

VÄSTERVIK

VÄSTERVIK OLD TOWN VÄSTERVIK HOSPITAL

KALMAR COUNTYSWEDEN

Existing hospital site

Proposed project site VÄSTERVIK OLD TOWN


VISION

CARE VISIONDESIGN VISION FUTURE VISION

HEALING ENVIRONMENT

Access to greeneryAccess to daylight

Promote physical activityContact with staffFeeling of a home

Choice of spaceChoice of interaction

Low social densitySafety and privacyPractice for society

Self-sustainingLow impact

ResilientExpandableAdaptable

The design project is guided by our three main visions: a care vision of an autonomous patient in control of their situation; a design vision of a healing environment providing access to greenery, daylight, physical activity and a feeling of being at a home rather than an institution; a

future vision of a building with a low environmental impact and a concern for possible future scenarios.

HEALING EMPOWERMENT HEALING THE ENVIRONMENT


STRATEGY

HEALING

All patient rooms and workplaces have access to daylight and view of greenery.

The rooms are designed so that patient surveillance can be achieved with minimal intrusion into the patients personal space.

The unit can be divided into smaller clusters which provides a calmer environment and reduces stress.

The large garden for inpatients provides opportunities for walks and other physical activity. The garden is protected from outside view of the patients.

ROOM

UNIT

BUILDING

URBAN

EMPOWERING SUSTAINING

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The broken up scale of the buildings reduces the institutional feeling and has a familiar look.

A low social density and a variety of spaces means the patient can choose their level of social interaction.

The building represents a gradient of support, where each space is designed to provide a different amount of autonomy for the patient.

There are multiple ways of approaching the building. It is easier to reach the public parts of the building, the housing wards are placed more privately.

The rooms are designed to be adapted to multiple future uses.There are multiple ways of furnish the rooms and the celing hight provides future installations for somatic care.

The floor plan system allows for future expansion of the ward units.

The building provides large areas of soft ground and green roofs to handle water treatment on the facility grounds.

A new hospital development means the possibility of implementing sustainable systems for energy and water.


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To realise our vision in an architectural project, we considered how each aim can be met in the different scales of the building. From the private room of the patient, to the ward unit where they spend most of their days, to the connections between the building units and the urban context, we make sure that our visions are fulfilled. This is a valuable tool both to guide the design, and to evaluate the result.


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ASSEMBLY


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The design process and building logic start at the patients and their individual needs with the patient room providing the basic component of the building. The patient room is the most important healing environment, and EBD inspired design values like access to greenery and good daylight conditions must be achieved at all costs. The ward unit appears as the rooms are assembled,

with each unit adapted to its specific needs. Finally, the building is assembled in embracing the large central garden. The most public functions are oriented toward the town centre and infrastructural access, while the more private rooms are facing the nature. This is our process of assembly, and the presentation of the project in this booklet will follow the same logic.


PATIENT ROOMGSEducationalVersion

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The patient room is the atomic component of the building. It needs to be a calm space providing privacy, sleep and individual activity. It is a firm point for a turbulent mind. A place were the patient can feel like they belong and is in control of their situation. The scale of the room is chosen to provide enclosure. The windows provide daylight and views of greenery without compromising the patient privacy. A highly placed window in the toilet wall privides indirect daylight into the bathroom.


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SOLAR PANELS

GREEN ROOF


PATIENT ROOM

The room shape allows for different zones where the patient can choose their level of activity and move freely through the space. The undulating corridor creates small entrance zones, breaking the monotonity of the corridor without creating hidden corners. Also, it provides a small zone outside the room which becomes the porch of the patient room.

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ROOM SEQUENCE AND FURNISHINGZONES VISIBILITY

SIGHTLINES DAYLIGHT

PATIENT ROOM PERSPECTIVE

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The high visibility means staff can survey the room without entering, improving the patient integrity. The sunscreen serves both to reduce strong sunlighti in the space and improves the privacy by blocking sightlines from other rooms.

A slit facing the entrance as well as a larger window near the “activity space” provide views of greenery.

Daylight enters the space and penetrates into the bathroom through a high window.

The rooms are designed so that they can be furnished in multiple ways. The middle one is the standard furnishing, with loose furniture so that the patient can refurnish according to their preference. To the left the room is furnished for more somatic care with easier access for the staff around the bed. The room to the right shows that there is a possibility for patients that wish to share room to do so in a regular room.


BUILDING STRATEGY

EXPANDABLE - REDUCEABLE

The building consists of two bodies that are pushed in and out to expand or reduce space for different needs in the program and in the future.

LIGHT - VIEW - CLUSTERS

The rows of rooms are placed towards the light and split to get light into the ward. This provides a view of the nature and creates smaller social units, clusters.

ROTATE - SPACES

A garden is put in the middle to provide the possibility to walk around it, promoting movement. The garden is twisted to avoid long corridors and to create spaces.

SPLIT GARDEN - SUBDIVIDE

The garden is split to provide two choices for the patient. This also gives the possibility to subdivide the wards into smaller units if needed.

INPATIENT WARD - MIRROR

The structure is mirrored to create the inpatient buildings. The staff spaces are concentrated in the division of the two wings for good overview of the whole ward. The same system is used in all inpatient wards.

MENTAL HEALTH CENTER - SUNFEATHER SHAPE

The structure is formed like a sunfeather to create the mental health center. Two wings are twisted away from each other. Then the same shape is mirrored. This way there is a lot of facade area for rooms that need light, e.g. consulting rooms. GSEducationalVersionGSEducationalVersion



FORENSIC WARD

SECTION B-B SCALE 1:200

INPATIENT WARD PERSPECTIVEThe ward serves as an important social space for most of the inpatients. To create a healing environment, the most important factor is reducing stress. This is achieved through the following means: smaller clusters of rooms reducing the institutional feeling and the social density, a choice of two large gardens which bring greenery inside and provide opportunities for physical activity, a good overview for staff and patients which means a good contact and support for patients in need. The placement of the gardens also provides the possibility to subdivide the ward and cut of parts if needed.

Many patients involuntarily spend years in the ward unit, and thus they need to be able to control their social interaction. The good overview means the patient can easily choose where to situate themselves according to their current wishes.

PLAN FORENSIC 22 SCALE 1:200


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TRAINING KITCHEN TRAINING KITCHEN

GARDENING

GREEN HOUSE

MULTI SPORT AREA

CONTEMPLATION GARDEN


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE

The inpatient buildings are organised around a large central garden which invites to physical and social activities. Inpatients gain more free access to the garden as their mental state improves, which constitutes part of the care vision of practicing for society in a controlled way. To reach therapy spaces, the patient sports hall and rooms for visitors, the patient must take on their clothes and cross the public space in a first step in their reintegration into society.The buildings provide good access for vehicles to the emergency unit, while offering the forensic patients who stay the longest the best nature view as well as the most private direction.

Emergency 21

Forensic 22/23

Inpatient 24

Administrative courtTherapy roomsVisitor rooms


FORENSIC WARD

FACADE NORTH

FACADE WEST

To allow close access to nature and gardens with lots of daylight, the inpatient buildings has only one floor. This also creates a small scale impression of the building, which when further broken up create a less institutional character.

The facade material is wood, which is a traditional material used in the old town of Västervik. The windows are carefully placed not to allow views between patient rooms, and the sun screens reduce the amount of direct sunlight in the rooms.


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE

FACADE SOUTH

VÄSTERVIK OLD TOWN


MENTAL HEALTH CENTERGSEducationalVersion

OFFICE OFFICE OFFICE

OFFICE

OFFICE

OFFICE

OFFICE EXTRAST.

OFFICE

CONSULTING

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ITY

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HWCSHOWER

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SHOWERCHANGING

HWC

SHOWER

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HWCSHOWER

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HWCSHOWER

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CLEANING

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STA

FF ROOM

STORAGE

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HW

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WAITING ROOM

CONF. PAUSE

RECEPTION

WAITING ROOM

TOUCH DOWN SPOTS

TOUCH DOWN SPOTS

WAITING ROOM

WARM UP / CARDIO

YOGA

CONF. PAUSE

The building containing the Outpatient psychiatry spaces, administrative offices as well as the shared facilities of the hospital, has been redefined as a “Mental Health Centre”. It is a place where no difference is made between different people in society, and everybody is invited to be made aware and take care of their mental health.

The mental health center is designed as a gradient. The visitors enter into the atrium, that is the most public part. It provides a café, gym and yoga studio, reception, conference and other spaces where exhibitions about mental health awareness can be displayed. There are pool tables and pingpong for a bit of social and physical activity, seatings for conversations or for rest. The atrium also contains small islands of greenery to create spaces of privacy and a organic flowing through.

In this space there is also peer support persons working to interact with persons who dont have access to therapy or inbetween therapy sessions. As an everyday supporting proffessional friend.

This is to become the societys livingroom, were you can come and socialize, activate yourself, whichever health state your mind is in.It is a place to educate people before, during or after mental illnes, a prevention center.

The further into the building you get, the more private you become. Like a gradient of support and social density.


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE

M H CFLOOR 2

M H C FLOOR 1


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE

Adult outpatient

Child outpatient

AdministrationStaff spacesVisitor rooms

ATRIUM


MENTAL HEALTH CENTREMENTAL HEALTH CENTER SCALE 1:200

PERSPECTIVE MENTAL HEALTH CENTER

c

c

SECTION C-C SCALE 1:200


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE

For consulting the patients enter into the more calm and private parts of the gradient. The patient and staff is always provided with a variation of spaces and gardens to fit their individual need. This is created with the same techniques of clustering and broken up corridors as the inpatient buildings.

There are consulting rooms with different character, including consulting gardens which can be used to allow patients different ways of interacting with therapists, and encourage creativity and physical activity as healing methods. The staff do not have their own personal workspaces but rather meet the patient in a neutral space to enter the consulting room together, balancing the power relation between carer and caretaker.

To provide close access the staff have “touchdown spots” close to the consulting rooms as well as a larger, activity based offices more separated to ensure the confidentiality of patients. This way of working creates a healthy natural move for the staff, not sitting at the same place all day.


19 2

00

11 430

13 100

15 0

00

CO

NS

UL

TIN

G

11,5

m2

EX

AM

INA

TIO

N

13,9

m2

ST

OR

AG

E

9,0

m2

ST

OR

AG

E

9,0

m2

CONSULTIN

G

11,5 m2

CONSULTIN

G

11,5 m2

CONSULTIN

G

11,5 m2

SAM

PLE

11,5 m2

CONSULTIN

G

13,9 m2

GROUP ROOM

24,2 m2 CONSULTING

11,5 m2

CONSULTING

11,5 m2

OFFICE

55,1 m2

CONSULTING

13,4 m2

CONSULTING

13,4 m2

CONSULTIN

G

28,9 m2

ST.5,5 m2

PHONE B

OOTH

S

5,5 m2

CONSULTING

11,5 m2

CONSULT

ING

11,9

m2

OFFIC

E11,5 m

2

TREATM

ENT

18,9 m2

HWC

5,0 m2

WC

1,8 m2

WC

1,8 m2

HW

C5,0 m2

RECEPTION

24,8 m2

HW

C5,0 m2

CAFÉ

KIT

CHEN

18,6

m2

STO

RAGE

13,8

m2

WC

2,0 m2

WC

1,9 m2

WC

2,0 m2

WC/C

L2,7 m

2

ENTRANCE

WAITING ROOM

CONSULTIN

G

17,8 m2

LIVING ROOM

CONSULTING

11,5 m2

STO

RAGE

12,0 m2

CAFÉ/SHOP

CONSULTING

31,7 m2

ST

OR

AG

E

7,8

m2

WC

2,8 m2

RECEPTIO

N

8,0

m2

HW

C

5,0

m2

SHOW

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5,6

m2

CHANGIN

G

15,5

m2

HW

C

5,0

m2

SHOW

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5,6

m2

CHANGIN

G

15,5

m2

CONSULTING

11,1 m2

CONFERENCE

31,6 m2

STAFF ROOM

19,5 m2

COPY

15,6 m2

HWC

5,4 m2

SHOWER

5,6 m2

CHANGING

13,3 m2

HWC

5,0 m2

SHOWER

5,7 m2

CHANGING

17,9 m2

HWC

5,0 m2

SHOWER

6,1 m2

CHANGING

18,7 m2

EL.C

3,7 m2

WAITING ROOM

TOUCH DOWN SPOTS

TOUCH DOWN SPOTS

WAITING ROOM

WARM UP / CARDIO

YOGA

TOUCH DOWN SPOTS

TOUCH DOWN SPOTS


11 8

40



BUILDING

EmergencyForensicAdult InpatientVisitorYouth OutpatientAdult Outpatient

ConferenceCourt staffGym visitorPsychiatry staffGoodsTechnical staff

CustodyEm

ergency W

21

ABC

BUP

Emergencyentrance

Goods entrance

Adult outpatient unit

Emergency W21

CourtStaff area

Gym/Yoga studio

Adult outpatient

Addiction unit

Main entrance

Main entrance

OTHER FLOWS

PATIENT FLOWS

Garden

Inpatient W24

Visitor space

Forensic

W22

Therapy

Inpatient W24Forensic W23

Court

Forensic

W23

Conference

ABC

BUP

Forensic W22

Technical spaces

PLAN SCALE 1:1000


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE

Adult outpatient

Child outpatient

AdministrationStaff spaces

Emergency 21

Forensic 22/23

Inpatient 24

TOTAL BUILDING SIZE = 20 200 M2


MENTAL HEALTH CENTRE

The scale of the Mental Health Centre building with the traditional gabled roofs have a familiar character avoiding an institutional feeling. The atrium serves as a clear yet undramatic entrance point, with the adjacent building volumes embracing a small entrance square in front of the building. Facing the inpatient part of the building, the windows are placed to avoid a feeling of being surveyed by staff from above, considering the patient integrity.

The facade materials are chosen to give a different character to each volume, mimicking the style of the Västervik town centre. Wood is the main structural and surface material, with a low environmental footprint and careful finishing to improve durability.


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE

FACADE SCALE 1:200

PERSPECTIVE ENTRANCE

FACADE NORTH EAST

FACADE EAST

FACADE SOUTH

FACADE SOUTH WEST


SITE ANALYSIS

NN

EMERGENCY/GOODS ENTRANCE

NATURE VIEWS

ACCESSIBLE PARKING

TRAIN STOP

PEDESTRIAN ACCESS

ENTRANCE

POTENTIAL PARKING GARAGE

The site is a farmland with some existing buildings which would need to be demolished to make room for the new hospital development. It is a fiew one storey residentials that is not marked with cultural heritage. The site has excellent access to nature with the forest and the lake nearby. The access to the site is good with some infrastructural improvements. A new train station adn bus stop would allow good public transport. The development can become a new urban hub serving the existing residential area to the north.

SITE SECTION SCALE 1:2000


SITE PLAN

The building is oriented to provide southeast-southwest facing windows for all inpatient rooms, with priority for the longer staying forensic patients. Public transport is available at a new train stop and bus stop, and bikes can be parked near the entrance. Accessible parkings are provided close to the entrance. Car parking and the main emergency access are placed to the side to reduce their impact on the hospital activities. The gentle slope of the site creates slight natural elevation of the inpatient units, bringing them about a metre from the surrounding nature which improves the patient privacy.

South facing roofs have solar panels to use as much renewable energy from the site as possible. North facing roofs are green to provide a cooling efffect, collecting storm water and increasing the biodiversity of the site.


156 8

40

170 900

SITE PLAN SCALE 1:2000


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE


SKALA 1:50

0 1 2 5

METER

SKALA 1:200

0 1 2 5 10 15 20

METER

SKALA 1:500

0 5 10 20 50

METER

SKALA 1:1000

0 5 10 20 50 100

METER

SKALA 1:2000

0 1020 50 100 150 200

METER

N

N

SCALE

SCALE

SCALE

SCALE

SCALE

BT


TECHNICAL CONCEPT

System boundary

Locally provided &

recycled materialLocal waste reuseLocal fo

od provision

Goods and services

Waste

Municipal

water supply

Municipal

water treatment

BlackwaterGreywater Lake water

Constructed wetland

Filter

Filter

Green roof for water

management

Consideration of existing biosystem

System boundary

District

heating/cooling

Redundancy provided

by hospital system

Electricity

Heat exchange

Locally produced energy Heat pump

The technical systems are intended to create a building which is a self-sustaining as possible. The lake can be used as a freshwater source as well as provide the energy for a heat pump regulating the building temperature. Modern FTX systems and well dimensioned thermal insulation ensure a high thermal efficiency and the appropriate air quality for a hospital building.

Water can be treated in a constructed wetland on the site, and hard ground is generally avoided as much as possible.

GSPublisherVersion 0.99.100.100


SKALA 1:100

0 1 2 5 10

METERA1 = 1:500

A3 = 1:200

CLEANING STORAGE

44.0 m2

RECYCLE

57.6 m2

12.8 m2

GATE

EL.C

EL.C

EL.CE

L.C

EL.C

EL.C

CULVERT SYSTEM + TECHNICAL SPACES


PHYSICAL MODEL


Process

Team 9Elin Nilsson

Toivo SäwénYunfan Zhang


CONCEPT

Being in the group unsure of which site to work on we made a pros and cons list of the sites. We discussed a lot and sketched our ideas.

We came to the conclusion that we want to work with healing architecture with access to nature.We chose the rural site because we think that we have the best possibility to create a healing environment here. We see a possibility to move the hospital to the rural site and spare the existing hospital for other purposes. We are also more free in the shape of the buildning.

The main outcome before the concept critique was the idea of the Sheltered Society. We wanted to create a shelter space where the patient can practice for their every day life. Our different concept models were combined to show different aspects such as transparency, height differences, and being able to choose how to interact with the spaces. Later in the process this became the inspiration for our “gradient of support” which represents how the building offers different amount of autonomy to patients with different severity of mental health problems.


INSPIRATION

Printing the model photos from our continuous work with Björn Gross workshop, though not opposite, and analysing what the concept and caracteristics of the model is.

In the beginning we didnt like the models we made and felt a bit lost, but after analyzing them like this we actually found interesting and positive aspects in all of them, though we dont like the shape as a whole. Afterwards we feel like this was a really effective and good method to put down into words what we think about the models and not only discuss it and most of the thoughts get lost.

Final page of the concept critique. Our next step was to combine the flows, unit layout diagrams, volume studies and program interpretation into one design.

Empowerment - giving choice.Try to disrupt the symetry in the wards. Clusters of rooms create choice. Centralized or decentralized TS?Think about “universal design” or “inclusive design”.Possibilities to practice on privacy...

Legend:Patient roomsPatient social areaStaff areaGardenStaff support area

ARK263 - Healthcare ArchitectureSheltered Society - Concept Crit 181030Elin Nilsson, Toivo Säwén, Yunfan Zhang

Next step

Teamstation

Staff support

Garden

Garden

Entrance

Cluster of patient rooms

Common spaces

Patient room

Buildning volume

Room layout/plan

Flow of people in the hospital


INNOVATION

Ward sketch Connection diagram

Patient room sketchWard sectionIdea of how to create gardens protected from overview when making a two storey patient ward. After several tries to make a plan in two levels we killed this darling by choosing to have only one storey of the inpatient wards. It created to much trouble with visability for the staff by putting dark spaces around the gardens. When we have the nature site with all the space we can afford to have one storey of the ward units.

Creating zones within the patient room. Possibility to put the bed against the wall but also sematic style.

A: First attempt. Long wards surrounding courtyardPros:* Large garden surrounded entirely by inpatient units* Small footprint* Good connection between inpatient unitsCons:* Long wards create corridor feeling* Creates monotonous spaces in public space outside building

A building atrium for scale

B: Attempt to implement “winged” unit layoutPros:* South and east facing windows for majority of patient rooms* Large atrium for wayfinding when entering buildingCons:* Entrance retracted into building* Odd connection between outpatient and shared facilities* Very large footprint/sprawl* Opening in large garden needed

C: Next iteration of winged layoutPros:* More rational and open solution for inpatient part* Protected area near BUP unit* Good connection Outpatient - SharedCons:* Small jagged garden* Still large footprint/inefficient* Long distance between inpatient units

D: More rational solution with wall to wall unitsPros:* Good connection between inpatient units* Enclosed garden* Large atriumCons:* Outpatient unit facing interior garden* Very long dark wall in all inpatient units* Symmetry may limit design options

E: Slight shift of inpatient wardsPros:* Creates possibility for windows in 3 directions* Very large garden possible* Small footprint* Protected but still open space outside BUP unitCons:* Still unnecessary connection between garden and outpatient* Very narrow entrance atrium for visitors and outpatients

F: E with courtyards

G: E with test of stacked inpatient wardsPros:* Possibility for nature view from inside garden (maybe an issue as well)* Larger entrance atrium* Separated staff entrance possibleCons:* Stacked inpatient unit causes several issues: * Courtyards * Vertical transportation * Patients should feel access to nature

A

B

C

D

E

F

G

Building volume study


214,4 m2

77,5 m2

108,7 m2

214,

4 m

2

77,5

m2

108,

7 m

2

LAUNDRY

15,0 m2

DAYROOM

20,0 m2

ACTIVITY

35,0 m2

ACTIVITY

20,0 m2

DINING

30,0 m2

KITCHEN

15,0 m2

DISHES

9,0 m2

RWC/

SHOWER

6,0 m2

GROUP ROOM

20,0 m2

STAFF ROOM

20,0 m2

T.S.

OFFICE

25,0 m2

COPY

12,0 m2

WC STAFF

2,0 m2

DOCTOR/JOUR

12,0 m2

STORAGE

9,0 m2

DESINF

12,0 m2

CONSULTING

14,0 m2

CONSULTING

14,0 m2

CONSULTING

14,0 m2

MED.

15,0 m2

MED.

EXTRA

6,0 m2

SAMPLE

EXTRA

12,0 m2

SAMPLE TAKING

12,0 m2

SAMPLE

RWC

5,0 m2

EXAMINATION

16,0 m2

LAUNDRY

15,0 m2

DAYROOM

20,0 m2

ACTIVITY

35,0 m2

ACTIVITY

20,0 m2

DINING

30,0 m2

KITCHEN

15,0 m2

DISHES

9,0 m2

RWC/

SHOWER

6,0 m2

GROUP ROOM

20,0 m2

STAFF ROOM

20,0 m2

T.S.

OFFICE

25,0 m2

COPY

12,0 m2

WC STAFF

2,0 m2

DOCTOR/JOUR

12,0 m2

STORAGE

9,0 m2

DESINF

12,0 m2

CONSULTING

14,0 m2

CONSULTING

14,0 m2

CONSULTING

14,0 m2

MED.

15,0 m2

MED.

EXTRA

6,0 m2

SAMPLE

EXTRA

12,0 m2

SAMPLE TAKING

12,0 m2

SAMPLE

RWC

5,0 m2

EXAMINATION

16,0 m2

MO

VIN

G T

O S

HAR

ED

AC

TIV

ITY/T

HER

APY H

OU

SE??

CO

NN

EC

TIO

N T

O H

OSPIT

AL

MO

VIN

G T

O S

HAR

ED

AC

TIV

ITY/T

HER

APY H

OU

SE??

CO

NN

EC

TIO

N T

O H

OSPIT

AL


72,2 m2

33,4 m2

30,6 m2

30,6

m2

30,6

m2

30,6

m2

30,6

m2

30,6

m2

33,4

m2

33,4

m2

30,6

m2

30,6

m2

30,6 m2

30,6 m2

30,6 m2

33,4

m2 213,9 m2

63,8 m2

72,2 m2

33,4 m2

30,6 m2

30,6

m2

30,6

m2

30,6

m2

30,6

m2

30,6

m2

33,4

m2

33,4

m2

30,6

m2

30,6

m2

30,6 m2

30,6 m2

30,6 m2

33,4

m2

213,9 m2

63,8 m2

KITCHEN

15,0 m2

DISHES

9,0 m2LAUNDRY

15,0 m2

DAY ROOM

20,0 m2

DAY ROOM

15,0 m2

DINING ROOM

30,0 m2

ACTIVITY ROOM

25,0 m2

OBSERVATION

EXTRA

12,0 m2EXTRA

20,0 m2

OBSERVATION

EXTRA

12,0 m2

VISITOR

10,0 m2

DESINF.

12,0 m2

CONSULTING

15,0 m2

MED.

15,0 m2

EXTRA

12,0 m2

TO SAMPLE TAKING

MED.

EXTRA

6,0 m2

SAMPLE

RWC

5,0 m2

SAMPLE TAKING

12,0 m2

EXAMINATION

16,0 m2

WC

2,0 m2

RWC CHANGING TABLE

6,0 m2

WARDROBE

10,0 m2

VISITOR

14,0 m2

CONFERENCE

34,0 m2

T.S.

OFFICE

25,0 m2

PSY

SHARE 23

OFFICE

10,0 m2

PSY

SHARE 23

OFFICE

10,0 m2

PSY

SHARE 23

OFFICE

10,0 m2

PSY

SHARE 23

OFFICE

10,0 m2

PSY

SHARE 23

OFFICE

10,0 m2

HEAD

SHARE 23

OFFICE

16,0 m2

STAFF

20,0 m2

GROUP

20,0 m2

COPY

12,0 m2

WC

2,0 m2

WC

2,0 m2

RWC/SHOWER

6,0 m2

KITCHEN

15,0 m2

DISHES

9,0 m2

LAUNDRY

15,0 m2

DAY ROOM

20,0 m2

DAY ROOM

15,0 m2

DINING ROOM

30,0 m2

ACTIVITY ROOM

25,0 m2

OBSERVATION

EXTRA

12,0 m2

EXTRA

20,0 m2

OBSERVATION

EXTRA

12,0 m2

VISITOR

10,0 m2

DESINF.

12,0 m2

CONSULTING

15,0 m2

MED.

15,0 m2

EXTRA

12,0 m2

TO SAMPLE TAKING

MED.

EXTRA

6,0 m2

SAMPLE

RWC

5,0 m2

SAMPLE TAKING

12,0 m2

EXAMINATION

16,0 m2

CONFERENCE

34,0 m2

T.S.

OFFICE

25,0 m2

STAFF

20,0 m2

GROUP

20,0 m2

COPY

12,0 m2

WC

2,0 m2

WC

2,0 m2

RWC/SHOWER

6,0 m2

10 degrees

Ward unit sketches


1 998,1 m 2

1 998,1 m 21 9

98,1 m

2

1 998,1

m2

1 9

98,1

m2

1 9

98,1

m2

1 9

98,1

m2

1 9

98,1

m2

1 998,1 m2

1 998,1 m2

821,7 m2

2 220,4 m2

1 998,1 m 2

1 998,1 m 21 9

98,1 m

2

1 998,1

m2

1 9

98,1

m2

1 9

98,1

m2

1 9

98,1

m2

1 9

98,1

m2

1 998,1 m2

1 998,1 m2

821,7 m2

2 220,4 m2

1 998,1 m 2

1 998,1 m 2

1 998,1

m2

1 9

98,1

m2

1 9

98,1

m2

1 9

98,1

m2

1 998,1 m2

1 998,1 m2

821,7 m2

2 220,4 m2

1 998,1 m 2

1 998,1 m 21 9

98,1 m

2

1 998,1

m2

1 9

98,1

m2

1 9

98,1

m2

1 9

98,1

m2

1 9

98,1

m2

1 998,1 m2

1 998,1 m2

821,7 m2

2 220,4 m2

1 998,1 m 2

1 998,1 m 21 9

98,1 m

2

1 998,1

m2

1 998,1 m 2

1 998,1 m 2

1 949,9 m 2

1 9

98,1

m2

1 9

98,1

m2

50,9 m2

50,9

m2


H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

H

MED. EXTRA

MED.

SAMPLE. EXTRA

SAMPLE

EXAMINATION

DESINF.

LAUNDRY

CONSULTING

HWC SAMPLE

TEAM STATION

KITC

HEN

DISHESSTAFF PAUSE

COPY

HWC

WC

WC

VISITORS

GATEHWC

GARDEN

GARDEN

STAFF GARDEN

GROUP ROOM CONFERENCE

PATIENT ROOM

PATIENT ROOM

PATIE

NT R

OOM

PATIE

NT R

OOM

PATIE

NT R

OOM

PATIE

NT R

OOM

PATIE

NT R

OOM

PATIE

NT R

OOM

PATIE

NT R

OOM

DAY ROOM

OBSERVATION

HW

C

HW

C

HW

C

HW

C

HW

C

HW

C

HW

C

HWC

HWC

HWC

STO

RAGE

STO

RAGE

STO

RAGE

STO

RAGE

STO

RAGE

STO

RAGE

STO

RAGE

STORAGE

STORAGE

MED. EXTRA

MED.

SAMPLE. EXTRA

SAMPLE

EXAMINATION

DESINF.

LAUNDRY

CONSULTING

HWC SAMPLE

TEAM STATION

KITCHEN

DISHESSTAFF PAUSE

COPY

HWC

WC

WC

VISITORS

GATE HWC

GARDEN

GARDEN

GROUP ROOMCONFERENCE

PATIENT ROOM

PATIENT ROOM

PATIENT ROOM

PATIENT ROOM

PATIENT ROOM

PATIENT ROOM

PATIENT ROOM

PATIENT ROOM

PATIENT ROOM

PATIENT ROOM

PATIENT ROOM

DAY ROOM

HWC

HWC

HWC

HWC

HWC

HWC

HWC

HWC

HWC

HWC

HWC

STORAGE

STORAGE

STORAGE

STORAGE

STORAGE

STORAGE

STORAGE

STORAGE

STORAGE

STORAGE

STORAGE

ACTIVITY ROOM

PATIENT ROOM

HWC

STORAGEHWC

OBSERVATION

HWC

HWC

CUSTODY

CUSTODY

CUSTODY

CUSTODY

DINING ROOM

DAY ROOM

DAY ROOM

Simultaniously continuing the sketches on the building volume we tried a variation of options. The colourful one to the right was the final idea for the composition of the buildings because it created a nice entrance angle from the outpatient building and provided the inpatients with a large garden and the outpatients with a smaller garden.

We found it hard to decide on a exact shape before we knew exaclty how the inpatient ward looked. We realized that the inpatient shape would decide the shape and not the opposite.

Sketches of the inpatient ward, trying to find the optimal shape for maximum overview from the teamstation and cluster the rooms. We also wanted to have a rational way of creating the staff spaces for the staff in the different forensic wings to collaborate and share knowledge and spaces.

This plan solution gives a good overview from the teamstation, creates good qualities to the staff space (green) and separates living spaces for patients (yellow) from medical spaces (grey).After finalizing the inpatient ward shape above we experimented with he composition.


IMPLEMENTATION


24,8 m2 24,8 m2

24,8 m224,8 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

LIVINGROOM

17,3 m2

CONFERENCE

ROOM

34,0 m2

CONFERENCE

ROOM

34,0 m2

STORAGE

10,0 m2

STORAGE

10,0 m2

STORAGE

10,0 m2

STORAGE

10,0 m2

STORAGE

9,8 m2

STAFF ROOM

20,0 m2

GROUP ROOM

16,0 m2

GROUP ROOM

20,0 m2

GROUP ROOM

16,2 m2

GROUP ROOM

16,3 m2

EXAMINATION

16,4 m2

EXAMINATION

16,0 m2

EXAMINATION

16,0 m2

WAITING

WC

2,0 m2

WAITING

WC

2,0 m2

STAFF/

WC

2,0 m2

WC

2,0 m2

WC

2,0 m2

CHANGING

ROOM

15,0 m2

PHARMACEUTICAL

ROOM

35,0 m2

COPY

ROOM

20,0 m2

KITCHENETTE

4,0 m2

EXTRA

5,5 m2

EXTRA

6,0 m2

EXTRA

6,0 m2

ENTRANCE

7,0 m2

ENTRANCE

7,0 m2

SAMPLE

TAKING

12,2 m2

HWC

5,0 m2TREATMENT

ROOM

18,3 m2

CONSULTING

ROOM

12,0 m2

OFFICE

12,1 m2

WAITING

ROOK

14,0 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

OFFICE

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

CONSULTING

ROOM

13,2 m2

OFFICE

11,0 m2

GROUP ROOM

17,4 m2

GROUP ROOM

17,4 m2

EXAMINATION

16,0 m2

EXAMINATION

16,0 m2

ACTIVITY

25,0 m2 ACTIVITY

20,0 m2

STORAGE

9,0 m2

STORAGE

9,0 m2

STORAGE

9,0 m2

STORAGE

9,0 m2

STORAGE

9,0 m2

COPY ROOM

16,0 m2

WAITING ROOM

25,0 m2

WAITING ROOM

24,6 m2

HWC

6,0 m2

RECYCLE ROOM

25,0 m2

RECEPTION

10,0 m2

HWC STAFF

5,0 m2

CHANGING ROOM

25,0 m2

STAFF ROOM

25,7 m2

CLEANING

3,0 m2

CONFERENCE

50,0 m2

CONFERENCE

25,0 m2

CONFERENCE

25,0 m2

WARDROBE

20,0 m2

WC

2,0 m2

WC

2,0 m2

WC

2,0 m2

WC

2,0 m2

WC

2,0 m2

WC

2,0 m2

WC

2,0 m2

WC

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DAY ROOM

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DARK SPACESDARK SPACES

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We decided to sketch for a new shape of the outpatient building. Elke challenged us to be visionary and create a different concept for outpatient care than the normal corridor of rooms that is both the therapists office and consulting room. We wanted to create a neutral space were the therapist and the patient enters on the same premisses.

This picture shows our own brainstorm/workshop were we came up with the idea of using the health promotive idea and create a Mental health center, were therapy and meaningful social activity is combined like a gradient from the entry into the consulting rooms. This should be a building were “mentally healthy“ persons from society can come before they get sick and are in need of therapy. A place that could use the lecture halls to inform about mental health e.g. how to cope with stress. Have social and physical activities like a café, pingpong and a gym to attract persons that normally wouldnt come to the hospital.

Tried to fit the outpatient program into the same shape as the inpatient building. After the sketch crit we After discussions with Elke the conclusion was that the inpatient building shape is so specialized and good for inpatient care but using it on another place with another function actually can make tha inpatient concept weeker. If we were to use the inpatient shape for outpatient care aswell, it wouldn be optimal for outpatient and then it weekens the project that inpatient is the main focus when outpatient care is as important as inpatient care.

We detected four important design qualities that we wanted to bring from inpatient into the mental health center. With them in mind we created one diagram each with was the base for upcomming work with the plans.

We wanted to keep the pushing in and out method from inpatient structure to have a coherence with the rest of the buildings and tried different ways of making clusters with circulations and create an atrium for the entrance.

In the outpatient building in two floors the old idea about gardens in different levels came to life again, what didnt fit the inpatient building actually created our consulting gardens.

One important thing was to find the right angle of the buildings for the entrance through the atrium. A welcoming angle that leads the visitor into the building. We wanted it to look something like the perspective above.

Comming really far with the plans in this shape we felt that something wasnt right, the building had a low coherence with the rest of the hospital and we came up with the shape on the right, which is based on the inpatient wing but creating an sunfeather shape and use it in a different setting but with the same shape. This idea felt very coherent and created the feeling of everything being one hospital.


Themes

Team 9Elin Nilsson

Toivo SäwénYunfan Zhang


RESEARCH INFORMEDRESEARCH INFORMED

Research informed design principles are key to the realisation of a hospital project. As the environment is a key part in the healing process, the same principles that are guiding the evaluation of healing methods can be applied to the evaluation and design of hospital spaces.

The key notion that pervades our project is bringing greenery into the building through the numerous garden, as well as allowing both patient rooms and workplaces views of greenery. This has been shown to improve the healing process of surgery patients [1]. However, the definition of greenery is something that we could have explored further. It is clear that a nature view is good, but does an internal garden have the same effect? Would images of nature be sufficient to have a healing effect? What is the effect of being in nature, with the smell and other sensory experiences? Are there some mental ailments which

reduces the stress caused by other patients. However, some patients may feel isolated in such a situation, so we provide the opportunity to place two beds in one room if necessary.

In general, the concept of social density has been applied throughout the building [3]. This means a number of smaller spaces are created as opposed to a big one, which means a user of the space can choose how to locate themselves in relation to other users, and move between spaces if a stressful situation arises.

The outpatient building also follows the principle of reducing stress in several ways. The broken up volume creates a familiar appearance as opposed to institutional. As the patient enters the building, they are greeted by staff to support wayfinding. The waiting rooms are separated into multiple spaces, following the low social density principle.

are more influenced by nature views, possible some to which it is detrimental? Further investigation is needed to find the answer to this question.

We have also worked with daylight, and giving the longest staying patient the best lighting conditions in their rooms. For instance, east-facing windows have been shown to reduce the length of stay for inpatients compared to other directions [2]. This, however, has to be achieved with the privacy in mind, as windows facing other buildings may cause patients to choose to pull down the blinds, thus removing the healing effect. We have chosen to have a moderate amount of windows in each room, adding screens which remove the strongest daylight and reduce views, and to orient the patient rooms away from each other.

We have chosen to work with single patient rooms guided by EBD [2], which

Sources:

[1] Ulrich, R., View Through a Window May Influence Recovery from Surgery, Science, 224(4647):420-1, 1984, http://doi.org/10.1126/science.6143402

[2] Ulrich, R., Essay: Evidence based healthcare architecture, Lancet, Vol 368, 2006, https://doi.org/10.1016/S0140-6736(06)69921-2

[3] Ulrich, R. et al., Psychiatric ward design can reduce aggressive behavior, Journal of Environmental Psychology, Vol. 57, 2018, https://doi.org/10.1016/j.jenvp.2018.05.002

Inpatient ward with different choice of space and activity


HEALTH PROMOTIONHEALTH PROMOTION

Our approach to health promotion ties into the Evidence Based fact that physical activity greatly improves mental health [1]. It is important for us to provide the opportunity for all patients, independent of their state of mental health, to physical activity including walks, table tennis, spinning bikes etc. based on their own preferences.

As many patients with mental illness suffer from somatic diseases associated with sedentary behaviour [2], providing even the smallest opportunity for physical activity may greatly improve both their mental and physical health. From a building design perspective this means providing multiple spaces where such activity is possible, which also dosn’t force the patient to experience an unsolicited social situation. The design of our inpatient wards means the patient

for staff, giving them a space where they can breathe out after a hopefully not so stressful day.

We have redefined the outpatient part of the program to be a Mental Health Centre. This means a place where anybody can receive information and inspiration in taking care of their mental health. The idea is for the building to be welcoming not only to those who are admitted to psychiatric care, but provide a space where the focus is upon reflection on mental wellbeing. This includes a gym space and a yoga studio for quite literal mental wellness, but also exhibition spaces and activity spaces where people from all parts of society can meet and discuss and be made aware of their state of mental health.

always has overview over who is using a certain space. If they want to take a walk around the courtyard they can do so when nobody else is there. There are also always multiple ways of going outside, to ensure that there is always a way of getting fresh air and a quick stretcher.

The large internal garden is another important health promoting factor. The concept of “getting your jacket on and going into society” when moving between living and therapy/court spaces includes an important aspect of physical activity. In the act of moving between the home and the activity space, there is an element of inspiring to every day physical activity. The programmed activity spaces have also been extended with a gym for the patients as well as a gym and relax area

Sources:

[1] Stephens, T., Physical activity and mental health in the United States and Canada: Evidence from four population surveys, Preventive Medicine, Volume 17, Issue 1, 1988, https://doi.org/10.1016/0091-7435(88)90070-9.

[2] Richardson, C. R., Integrating Physical Activity Into Mental Health Services for Persons With Serious Mental Illness, https://doi.org/10.1176/appi.ps.56.3.324

Section showing access to gardens and physical activity


FUTURE PROOFING FUTURE PROOFING


Our main approach to future proofing has been considering the future of psychiatry in Sweden, and what this would mean for the development of Västervik hospital. The current trend is of a declining mental health among the general population, especially how youth estimate their own well-being and how often they experience anxiety [1]. If this trend continues, it would mean an increased need for psychiatric facilities, and the need for expansion may be great.

However, an opposing trend of replacing traditional psychotherapy sessions with pharmacotherapy [2], meaning shorter patient visits and less focus upon the therapy space as a healing environment. Considering these two trends in parallel it is clear that the future needs for psychiatric buildings are uncertain.

To respond to these changing needs, we have developed a rational building system where any given part of the building can be expanded and remodelled to support a different use.The choice of an activity-based office environment means the potential for a changing organisation in the outpatient care based on current needs, not lockedi nto traditional divisions into ward units. The inpatient units also follow a rational scheme which can easily be subdivided should the requirements change.

Another important trend in psychiatry is an increasing awareness and destigmatisation of mental health issues [3]. This has been shown to improve the attitudes towards people with mental health issues, and may also cause an increased demand for psychiatric services. To face this demand, we have redefined the Outpatient portion of the building as a Mental Health Centre, where not only admitted patients but the general public can be educated about mental health.

In a wider perspective, the future will include large changes, both environmental and societal. We have responded this through a sustainable design, where for instance hard ground is avoided to be able to handle heavier rainfalls as a result of climate change. From a societal perspective, migration streams are likely to increase, which would mean psychiatry would need to provide spaces for people with different backgrounds and social needs. Our project follows a rational concept to meet demands based in Evidence Based Design, providing single patient rooms with views of daylight and greenery. An improvement to the project would be to consider even more potential users, and provide an array of different rooms suitable to differing needs both from a cultural perspective and one of mental health.

Sources:[1] Hagquist, C., Ökar den psykiska ohälsan bland ungdomar I Sverige?, Socialmedicinsk tidskrift, Volume 88, Issue 6, 2011, http://socialmedicinsktidskrift.se/smt/index.php/smt/article/view/837/657

[2] Mojtabai R, Olfson M., National Trends in Psychotherapy by Office-Based Psychiatrists. Arch Gen Psychiatry. 2008;65(8):962–970. doi:10.1001/archpsyc.65.8.962

[3] Pinfold, V. et al., Working with young people: the impact of mental health awareness programs in schools in the UK and Canada, World Psychiatry, Volume 4, https://pdfs.semanticscholar.org/3543/56181bab0a323d490ac500ae8d9b66aaabf2.pdf

GSPublisherVersion 0.99.100.100GSEducationalVersion

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Array of patient rooms with different uses and organisation

Potential to extend or reduce the shape based on demands


SUSTAINABILITY

System boundary

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recycled material

Local waste reuseLocal fo

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For an architectural project designed in 2018, achieving sustainability is a baseline requirement. It is commonly related to the definition of sustainable development: “Sustainable development is development that meets the needs of the present without compromising the ability of future generations to meet their own needs” [1]. This means achieving a design which fulfils requirements of social, ecological and economical sustainability. However, in today’s rapidly changing climate it is likely that a sustainable solution is not enough.

Today researchers are talking about resilience and other terms to describe the effect of a proposed project [2]. For instance, it is no longer enough to keep the environmental impact as low as possible - it is required to have a net positive effect on the global environment.

Hospital buildings typically have a large environmental impact due to advanced equipment, continuous operation and high redundancy needed to support e.g. life supporting systems [3]. However, psychiatric buildings have the advantage of not needing that much equipment, instead relying on the environment as treating the patient.

As the psychiatric hospital constitutes a large complex, the possibility to integrate sustainable technology in the building is great. In addition, our choice of relocating the hospital to a greenfield site means the necessary infrastructure can be constructed from the ground up in a sustainable way. The roofs are

oriented to achieve maximum solar panel efficiency, the heating/cooling system uses the nearby lake for a heat pump system, and the farmland can keep its use to provide food and treat waste locally.

From a thermal perspective, the correct insulation system must be chosen to ensure a good performance. However, the choice of a one floor solution with multiple penetrating gardens will inevitably be less efficient than a more compact volume. However, in this instance the healing effect of greenery had the highest priority.

For social sustainability it could be argued that a large hospital complex is detrimental to the urban development of the area near the lake Kvännaren. The hospital is also further from the city than its current location, which may reduce access. However, it may give back to the area as the Mental Health Centre becomes a community centre, and may also become a gateway to the nature site near the lake.

From an economical perspective we have worked with a rational plan, which will allow a rapid construction process and the use of local materials. While we have mostly stayed true to the program, we have introduced some functions which will serve both to tie the hospital site closer to the site, but also may provide income for the hospital through conference visitors etc. Working with EBD design principles is also clearly sustainable, as better working conditions for staff reduce the number of sick days and improves staff retention.

Sources:[1] United Nations General Assembly (1987) Report of the World Commission on Environment and Development: Our Common Future. http://www.un-documents.net/wced-ocf.htm

[2] Passer, A., Habert, G., Kromp-Kolb, H. et al. Int J Life Cycle Assess (2018). https://doi.org/10.1007/s11367-018-1550-9

[3] Castro, M.., Mateus, R. & Bragança, L. Environ Dev Sustain (2015) 17: 1381. https://doi.org/10.1007/s10668-014-9611-03

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Healing Empowerment · Kalmar county, and forensic as well as child and youth psychiatry for the...

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