Architecture and Mental Health

by Mimi Zeiger

September 2006 Can the collision of healthcare and architecture really be analyzed? Markus Miessen and Matthew Murphy posed this question at the start of the undergraduate course they taught at the Architectural Association (AA) in London last year. Design studio briefs often cover a range of programs—housing, libraries, train stations—yet few tackle the difficult challenges of the mental health institution. The professors’ query provoked the students to go beyond a formal study and to probe all aspects of the hospital environment, including the dark, but very real, details of everyday life in a mental ward—subjects such as suicide prevention and patient restraint.

Their course of study spanned three terms and began with a trip to Russia—an immersion in the bleaker histories of mental illness. Miessen and Murphy organized an informal meeting with the nonprofit Center for Curative Pedagogics, a Moscow-based organization that provides humane treatment for children with mental and physical disorders. The group provides an alternative to the notoriously prisonlike care under the Soviet regime. Additionally, the students toured a hospital in North Moscow that was never completed and is now used as a military training ground—a structure illustrating the impoverished nadir of Russian healthcare facilities.

Once back in London, the 10-person studio spoke with a host of professionals—National Health Service psychiatrists, ward managers, staff from the Center for Forensic Mental Health at the local Homerton Hospital, architects specializing in healthcare buildings, and potential users—in order to craft their individual research and responses. Freda Yuen’s project, for example, is titled “Conflict Prevention in Mental Health Wards.” Using the staff/patient relationship as a way to mediate potential self-harm and violent conflict in the wards, she pinpointed how not only the ward manager, but also the prevalence of antisuicide fixtures, can influence the architectural environment. Her proposal advocates both policy and spatial changes, specifically recommending a variety of modifiable public and private zones.

Stephanie Edwards’s work analyzes East London’s St. Clements Hospital, a building that opened in 1849 as a Poor Law Union workhouse and was perceived, as Crabbe, a 1906 inmate wrote, “as a prison with a milder name.” Her project looks at how the architecture, designed for one purpose, affects how the hospital operates today. She created timetables that chart when and how spaces are active—the first tracks the staff’s structured agenda for the patients, another reveals the patients’ actual schedule. Via small changes like the elimination of formal uniforms, Edwards’s study challenges the existing staff, patient, and visitor relationships as influenced by the institutional environment.

Since many of the projects defied typical architectural representation, Miessen and Murphy asked the class to produce charts and drawings in order to represent the complex, and often personal, aspects of the research. “The students were encouraged to somehow visualize their immersion in their chosen environments. We pushed Freda to investigate the mechanisms of change in a particular ward, in order to fully understand the logistics of the place and people she worked with,” Miessen explains. “This, of course, requires a very particular way of drawing. If you are not talking about a drawing that reveals the structural thickness of a wall, but about a drawing that reveals the relationship of how people interact with one another or how components make up an environment, you have to invent your own visual representation.”

The year-long studio culminated in a round-table discussion at the AA, rather than the traditional jury review. Students sat down with the professionals who were consultants during the term and were joined by artists, architects, and theorists, including  Serpentine Gallery co-director, Hans Ulrich Obrist. The result was a probing dialog that proposed shifts in the mental institution paradigm and opened up that insular world to architectural possibilities.