Contested Spaces: The Problem with Modern Psychiatric Interiors

Abstract

This paper demonstrates how the interior design of many UK state psychiatric wards for adult acute patients arrived at the current status quo and why this needs to be readdressed. Acute wards within the National Health Service (NHS) are standard psychiatric inpatient wards for 18–65-year-old service-users. Drawing on historical determinants for the psychiatric ward, from both design and medical perspectives, this research shows how the interiors of these wards have often been rooted in, and reflective of, both design and psychiatric practices. Today, an investigation into the interiors of psychiatric wards is important, as we need to ascertain the extent to which the move towards service-user led care and socially responsive design is reflected in the wards themselves. These are not long-term wards like their nineteenth-century and pre-Second World War antecedents, but now in many ways are respite from the outside world: the “community,” in which patients struggle to cope. Their role is to help patients deal more ably with life as an outpatient–“community care.” That is the ideal scenario. Conversely, they can be used as an interim step to more specialist psychiatric services if required. As will be shown, what is apparent from the existing research among service-users on acute psychiatric wards, there is a strong preference for the familiar, the humane and deinstitutionalized environments. Furthermore, studies have shown environments that prioritize the familiar to be economically and medically effective. However, the importance of the “psychotherapeutic milieu” confronts the “rationality” underpinning the dominance of most medical discourse and much design practice and discourse. As a result we are too often left with stark and institutional settings. Indeed, with regards to hospital design generally, Waller and Fine wrote: “We have now reached a position where far too many hospitals succeed in making people feel worse than they did when they came through the main entrance” (2004: 5). Throughout this paper it will be demonstrated that a complex dialogue exists between the interests of the service-providers, both medical and design, who too frequently put functional efficiency before everything else, and the service-users' need for a therapeutic and healing environment. Accordingly, psychiatric wards are contested spaces–physically, academically, and methodologically.

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