Tactile materials, user involvement and natural greenery are helping create safe but friendly facilities for vulnerable young people
Mental health facilities for children and young people might be described as Goldilocks buildings. Their brief demands that they keep vulnerable service users safe and secure, but they also need to be welcoming and friendly. And in an environment where one user’s comfort can be another’s trigger for distress, elements like space, colour and temperature must be just right.
Architects and their clients are working to reconcile these and other factors with a new generation of mental health facilities. These desperately needed facilities are helping young people get their lives back on track through their function and design. They are allowing diverse mental health services to be brought together in one building, meaning children and young people can more easily receive the care they need – often for multiple conditions – while minimising disruption to schooling and family life. Architects are also adopting biophilic principles, using nature inside and out to help calm and heal troubled minds.
During design development, the architect spoke to staff and former service users, with the latter even drawing their own ‘ideal’ facility
Challenging conventions
Achieving all this within the strict parameters and practices of the NHS is far from easy. Roddy Langmuir, practice leader at Cullinan Studio, talks of the challenges of navigating ‘the conventional wisdom of the NHS, [which has] so many systems in place designed for safety and to protect the children’. He continues: ‘They can often, if they’re not dealt with in an innovative way, work against the objective we all have, which is to create a therapeutic environment for children to get better’.
That innovation is evident in the twin buildings at Liverpool’s Alder Hey Children’s Hospital, designed by Cullinan Studio and delivered by Manchester-based 10architect. Catkin Centre and Sunflower House have different purposes, the former providing various outpatient services; the latter is an inpatient unit accommodating 12 children aged 5-13.
Hygiene requirements have made exposed timber surfaces a relative rarity in clinical settings, but that ‘conventional wisdom’ has been successfully challenged to allow the use of hybrid timber structures here. Catkin Centre combines glulam with cross-laminated timber (CLT) slabs while Sunflower House has CLT walls and slabs. ‘We used CLT as a way of giving warmth and a natural feel to the environment and we knew it would be robust,’ says Langmuir.
The building contains a variety of spaces, not only for clinical functions but also to create comfortable environments for users. During design development, the architect spoke to staff and former service users, with the latter even drawing their own ‘ideal’ facility. ‘What we really learned was that these children are pretty amazing’, says Langmuir. ‘You’d imagine that having a serious condition might make children self-concerned, but not at all; they were worried about having the right conditions for others.’ He remembers one former user pointing out that although they couldn’t cope with bright colours, others might like them, and so arguing for choice.
Consulting rooms incorporate seating areas in bay windows while cosy seats are embedded into walls. These provide a sense of refuge for those who need it, says Langmuir, ‘creating spaces where children can see what is going on but be cocooned’. This non-institutional feel continues in Catkin Centre’s reception area, a circular timber structure rising through the two-storey building and incorporating bench seating. With its organic form, exposed timber and crowning skylight, the reception’s biophilic-influenced design creates a warm welcome.
But at the same time, there was a safeguarding requirement for anti-ligature design, which can often lead to an environment that is unnatural and unnerving. The architect worked with clinicians and managers to again challenge conventional wisdom and focus on spaces children would occupy alone. ‘Then you go in and try and work with the details to try and normalise them as much as you can,’ explains Langmuir.
While the building appears light and airy, windows deliberately limit views in, with Sunflower House’s inpatient bedrooms having bay windows resembling horse blinkers and cloisters looking into a courtyard garden. ‘It has got some qualities of a prison in terms of the briefing, in that people inside can’t be seen from outside,’ explains Langmuir, ‘So our reaction was to adopt a kind of hard shell, like a tortoise, but break it open to give private views out and make a soft centre that was fully open.’ Sunflower House has a completely private courtyard, while The Catkin Centre courtyard looks onto a new park.
The ‘hard shell’ is made from earth-coloured Corten steel, which contrasts with surrounding landscaping. Originally designed as two separate buildings, the pair were joined with a single entrance and staircase, one of a number of changes resulting from value engineering under the project’s design and build procurement. The building sits above a car park and second entrance, which allows patients to enter in privacy.
With the project completed last year, Cullinan’s focus has shifted to south London where its design for the new Beormund School is under construction. The school’s timber structure, skylights and views onto landscaped playgrounds will help create a similarly calming environment for pupils with social, emotional and mental health needs.
Co-location, co-design and the city
Demand for mental health services can be particularly acute in cities, where space for facilities is most scarce. The Pears Maudsley Centre for Children and Young People nearing completion at south London’s Maudsley Hospital demonstrates how facilities can be incorporated into the constrained urban context.
The centre has been developed by South London and Maudsley NHS Foundation Trust, King’s College London and the Maudsley Charity and brings together clinical services and translational research, with the aim of improving collaborations and ultimately care. This meant the building had to meet the needs of researchers and clinicians, groups who are, says Graham Harris, principal at architect Arcadis (formerly IBI Group), ‘at opposite ends on the aspiration scale’. He explains: ‘One is dealing with issues that need solving today and the other is looking into the future and what we can improve’.
Co-design workshops were organised with service users and parents and carers to ensure their aspirations were reflected in the design, often revealing differing perceptions. ‘One [parent] said one of the worst things was when a place of care felt like it wasn’t welcoming, whereas the children wanted somewhere lively or where they could feel more in control,’ says Harris. Importantly, he says, ‘We did all those workshops before we drew a single line on paper.’
One clear ‘want’ from workshop participants was access to nature. ‘They needed to be able to get to outside space and wanted natural plants, and said they didn’t want fake things,’ says Harris. That chimed with the architect’s thinking on biophilic design.
The resulting building meets these needs over eight storeys. It has research-based facilities on the lower ground floor containing spaces for tests, such as scans. Above are four floors of outpatient services and office space for clinicians and researchers, while inpatient space sits above that. The seventh floor houses a school – essential to allow users to continue their studies – topped by the school’s exercise terrace. Outpatient services also cater for a third user group: those following an intensive treatment programme for eating disorders who attend the centre daily. The three groups must be kept separate, which required the circulation to be designed to allow each to be moved safely to and from the school.
One clear ‘want’ from workshop participants was access to nature. ‘They needed to be able to get to outside space and wanted natural plants’
The building form has been shaped by practical parameters, including requirements to avoid overshadowing neighbouring hospital buildings, to link to the landscape, admit daylight to all plans and provide the diverse spaces all users needed. This also enabled the design to incorporate a series of staggered terraces, allowing every group access to precious outside space and nature. For safety, the terraces have high screens but with their lush planting and raised beds they form high-level gardens where studies in horticulture are planned.
This project was funded by the NHS, clients and fundraising efforts. ‘You’ve got to have something that looks appealing for fundraising, so a lot of our effort went into assisting the charities with video and media material to help sell the experience,’ explains Harris. ‘We also had to have the practicalities sorted out. We needed to be able to show the building was going to solve problems that existed within the existing buildings and services.’
Fitting a building of this scale onto a site in a live hospital environment, while avoiding negative impacts for neighbouring buildings, has been a design puzzle. In its co-location of research and clinical services and its urban response, this project is a model, Harris believes. ‘If you look at bigger cities in Australia or Canada, they have examples of taller mental health units in city centres and I think we’ve done something similar here because we just don’t have the space,’ he says. ‘It is very much addressing the issues we have with inner city locations.’