The Role of Courtyards within Acute Mental Health Wards: Designing with Recovery in Mind
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Connectedness
A008 “So the patients were all sort of counselling each other really... yeah a lot of talk goes on out in the courtyards. I try and look after all the... I’m usually one of the older people there, so I try and look after the young ones that come in.”
A003 “I talk to other people usually. But quite often I just sit alone, just for the peace and quiet, to be out in the fresh air. And yet still potentially in contact with people even though they don’t make an [inaudible] to me and I don’t make an [inaudible] to them. It’s still nice to have people around even if you’re not talking to them. So you get your quiet space but with people around. So you can talk to them if you like.”
C005 “That was one of those was quiet. That one of these yeah. Pretty good. There may be there’s another one out there the tranquil gardens. Yeah, that one was mainly used for smoking people, the girls sometimes went out there having a girlie chat Let’s make sure that sometimes those young male Māori guys have had their friends around and yeah get out the here that was well which was like problems out there seemed to be fine.”
3.2. Hope and Optimism
A004 “Oh God, even if they brought some false grass in, you know, that grass, that stuff? Because it’s like concrete there and then when it’s hot there’s no shade. …there is one shade cloth, which is a waste of time having it there… there’s no shade”.
A009 “Yeah, the picnic tables. You sit on one side and the other side goes up and your drink goes flying. It’s the same ones since I was 19. They’re still the same fricking chairs”
B003 “…used to be a gazebo…but someone broke it.”
3.3. Identity
D007 “He said the space was really lovely, and um, but the thing that was lacking as he goes, ‘there’s ten of us—males, in this ward…those colouring in and mindfulness stuff, that’s what my baby does. And I’m forty. And I don’t want to be colouring in to be honest, is there any activities ‘cause the few of us and he looked at, you know at the others, [and said] “A few of us we’ve done time in prison. Yeah. We don’t want to be doing colouring in.”
A009 “Yeah. I reckon it needs a bit more nature out there. There’s nothing out there. It’s just plain. It looks like a bit of a schoolyard. You’ve got two little veggie boxes, but that’s not enough”.
B003 “It’s still nice to have people around even if you’re not talking to them. So you get your quiet space but with people around. So you can talk to them if you like.”
D004 “Like play tennis or like badminton, things like squash, like get them fit, like have a little gym…We just need a rugby ball so we can um, play rugby or a tennis ball and all that. Even like a hoop would help.”
3.4. Meaning and Purpose
A009 “Yeah it’s… I don’t know, it seems to be the only place everyone congregates and gets together and whatnot, but it’s dirty it’s gross. It’s...the chairs are shit, there’s not enough chairs actually, for everyone. And… I mean the basketball hoop’s good, you know, but maybe I don’t know they could put something else out there. I don’t really know... I’m not a big sports person”.
A007 “[Go in the courtyard] Yeah because there’s nothing else to do in here, it’s so boring, it’s depressing, it gets you down.”
A004 “I spend the time basically walking around and try to keep fit, in the courtyard even though the courtyard’s all concrete it’s somewhere. Somewhere to just walk around and try to keep fit. It can be quite boring you know.”
3.5. Empowerment
B006 “Well I was on edge all the time which is why I’m in here but this has made it completely worse. Breeze, grass, outdoor area, somewhere I can actually just walk around looking at birds, or listening to birds. There’s no access to real outside. That’s a courtyard area that’s all completely; it’s in the central, centre. So you can’t really, it’s just building all around.”
A010 “Yeah it’s actually quite a nice courtyard, it’s like being able to have a few plants out there, which is nice. It’s got very dirty though, because the story was people were occasionally feeding the pigeons. The pigeons were pooping, and then in theory possibly it was causing fly problems as well. And it was pretty dirty with cigarette butts and stuff. So I got one of the staff members and then said can I have a chance to clean that part of the courtyard. So he let me use this fire extinguisher and I gave it a complete blast to try and clean it.”
A001 “Yeah. I mean the plants were pretty much dead. And a couple of people took it into themselves to wash the court yard with a hose and scrub brush. So they did a really good job.”
3.6. Safety and Security
B004 “[on a courtyard in West Wing] it’s got a beautiful garden to look out on. Quite a substantial garden, with trees. And I think they used to have pagodas in the courtyard. And then people were trying to hang themselves, and they had to go. So they took all those away. This one’s only got a basketball court, which is enough to drive you bonkers. Like a hospital for mentally ill people, and someone’s out there bashing a basketball. I mean that’s the last thing you need”.
A002 “There’s nowhere else to sit except out in the courtyard, or stand in the courtyard basically because the tables are covered in cigarette butts and disgusting things, it’s so unsafe. So there’s courtyard and basically all the wards and all the offices and everything goes around this courtyard. That courtyard could be much better utilized. I could see probably an extra six rooms are there, you know if you got rid of the courtyard and made just a little smoking area, you know just a little smoking area away from that and make the visitors areas, so you actually had your family there”.
B004 “Initially I thought I really liked the garden- big lovely garden with trees, and chairs under it. The worst thing about- you know, that one there- the one we’ve got here, this courtyard here is not great, but at least you’re not looking at a wire cage, like being in High Care Area, like you’re being a tiger in a cage. And the motorway’s right there, and everyone’s driving right past you. Yeah, so that was a bit awful”.
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Theme | Service Implications |
---|---|
Connectedness |
|
Hope and Optimism |
|
Identity |
|
Meaning and Purpose |
|
Empowerment |
|
Safety and Security |
|
Inclusion Criteria | Exclusion Criteria |
---|---|
Peer-reviewed articles (2010–2022) Empirical research English-language literature Outdoor built environment Acute mental health | Non-peer-reviewed articles Conference proceedings Narrative reviews, lecture notes and studies published in theses Non-health-related studies |
CHIMES Themes | US Model | Scandinavian Model | Description |
---|---|---|---|
Connectedness | Nature distraction/engagement | High ratio of green landscape; rich sensory details; seasonal interest; sight and sound of water; wildlife. | |
Hope and Optimism | Emotional and physical comfort Adequate maintenance | A range/balance of experiences to address a range of mental health issues (e.g., walking on different ground surfaces to increase body awareness and provide exercise); accessibility for people with functional disorders. | Covered seating at garden entry; comfortable seating throughout the garden; mitigation of extreme weather; quiet location; regularly well-maintained garden. |
Identity | Social connection and support | Attention to geographical and historical context and initial experience; familiar feeling over abstraction; serene and spacious with richness in species and culture; restorative ‘room’(s). | Semi-private seating clusters; close proximity to nursing units, waiting rooms and staff break rooms. |
Meaningful Activity | Physical movement and exercise | Designed for horticultural therapy program; inclusion of areas that are purposefully left ‘unfinished’ to empower service users; provision for levels of involvement ranging from inward reflection to outgoing involvement. | Level, non-glare pathways with appropriate traction; destination points. |
Empowerment | Sense of control Visual and physical accessibility | Ensure ‘rooms’ where sad, distressed and upset people can calm down and be restored. | Moveable seating; variety of walking loops; places to sit in sun or in shade; ensure garden is visible from well-used indoor spaces, such as lobbies and waiting rooms; doors and thresholds to garden are easily navigable. |
Safety and Security | Safety, security and privacy | The creation of ‘rooms’ to clearly delineate parts of the courtyard from the surrounding spaces and increase the feeling of security. | Clear boundaries or sense of enclosure; places for people to retreat on their own or with others; adequate lighting. |
CHIMES Themes | Landscape Architecture Implications |
---|---|
Connectedness |
|
Hope and Optimism |
|
Identity |
|
Meaningful Activity |
|
Empowerment |
|
Safety and Security |
|
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McIntosh, J.; Marques, B.; Jenkin, G. The Role of Courtyards within Acute Mental Health Wards: Designing with Recovery in Mind. Int. J. Environ. Res. Public Health 2022, 19, 11414. https://doi.org/10.3390/ijerph191811414
McIntosh J, Marques B, Jenkin G. The Role of Courtyards within Acute Mental Health Wards: Designing with Recovery in Mind. International Journal of Environmental Research and Public Health. 2022; 19(18):11414. https://doi.org/10.3390/ijerph191811414
Chicago/Turabian StyleMcIntosh, Jacqueline, Bruno Marques, and Gabrielle Jenkin. 2022. "The Role of Courtyards within Acute Mental Health Wards: Designing with Recovery in Mind" International Journal of Environmental Research and Public Health 19, no. 18: 11414. https://doi.org/10.3390/ijerph191811414