Therapeutic architecture, sometimes referred to as ‘healthcare architecture’; ‘patient centred design’; and even ‘evidence-based architecture’ is not entirely new in conception, but it is slowly entering the consciousness of mainstream thought. Born out from studies of architectural facilities designated for psychiatric care, therapeutic architecture was originally an examination of the people who lived and suffered in hospitals and institutions — and whether the confines of the environment itself exacerbated or lessened such sufferings.
It was the beginning of a new train of thought for architects: that architecture itself could play a significant role not just as a physical location, but also as a mechanism for power and control.
Kate Johnstone, one of the few architects with a PhD in the field of ‘healthcare architecture’ and the creator of the term ‘therapeutic architecture’, was first drawn to the subject when she realised almost no literature was available on the subject. She followed closely a case study in Greece, as the authorities tried rather blindly to relocate and reintegrate patients from the asylum of Leros into the community. Almost nothing was understood about what would be the best course of action for this reintegration process.
The transition from healthcare architecture to therapeutic architecture
Healthcare architecture developed on the back of medical architecture. This antecedent focused almost entirely on regulating and constraining patients, and had almost nothing to say of the environment itself. It was not until the medical community began to notice that space itself — physical space — held more value than was initially thought.
This recognition of the importance of space encouraged environmental professionals, academics, and clinicians to come together and re-evaluate the importance of architecture. Most importantly, how the design of the surrounding environment itself could support both the medical professionals and the patients contained within them.
It also encouraged medical practitioners and architects to collect patient and staff feedback, and to meet with them for consultations on what they thought about their surroundings.
One of the earliest successes that brought therapeutic architecture into the mainstream involved a project that compared and contrasted generic healthcare facilities with healthcare facilities designed to regulate mental health. In the catchment area of Camden and Islington NHS Foundation Trust, a photographic exhibition was held that contained within it hundreds of pictures of mental health facilities and compared them to other, non-mental health promoting facilities. The study found big differences not only in how the two types of buildings matched up with one another, but also in location. The mental health facilities were almost always far removed from transport networks.
The benefits of therapeutic architecture
In the medical world, designing spaces to fit with the inhabitants’ likely perceptive and physiological traits put extra focus on the role that obstacles play in an environment. For example, it is understood that any obstacle in our way requires extra energy to get around — which is usually not a problem if a person is in good health. But it can make a big difference is a person is unwell or has to draw on resources that are hard to find or unavailable.
The role of therapeutic architects is reimagine an environment so that it contains as few ‘obstacles’ as possible. This, in theory, is therapeutic to the patients, because the environment is suddenly a restorative factor that supports their health and wellbeing.
Therapeutic architecture in the commercial centre
All of this research helped to springboard therapeutic architecture from being solely the domain of medicinal facilities, into the wider context of the commercial and even residential world. It helped to bring forward the message that architecture is about space and place, and how the two of them comprise the physical context of our lives.
In the commercial and residential sectors, an inverse on what is being tested in the medical world is often preferable. More ‘obstacles’ can encourage greater physical health, which in turn can improve mental health and ward off general health problems later on in life. Obstacles like making the public toilets further away, to encourage walking. Staircases are a big one: if they are too narrow, or hidden away, or too dark, they are likely to be overlooked. Improving the lighting or design of staircases in order to encourage more employees to use them is a big factor in improving the architecture of a building.
Then there is lighting. Certain types of lighting can disrupt melatonin production in the body. Therefore, therapeutic architects prefer to take advantage of natural daylight whenever they can, to further support healthier lifestyles. In fact, it is now strongly recommended that all offices have direct or indirect access to daylight (and if you are reading this and are already familiar with the therapeutic benefits associated with natural light, congratulations, you have already been influenced by the work of therapeutic architects).
Good views of nature are also considered very important, along with clean air, and adjustable air conditioning for thermal comfort. And so too, is the space for communication. This can come in a variety of forms: from acoustics for privacy, to getting the right seating, and for having the optimal spaces for individual workstations, desks, and chairs. Together, all of these elements add up to improve employee satisfaction, and reduce turnover rates.
The future of therapeutic architecture
As Kate Johnstone has said: “Designing spaces according to people’s perception and physiology, and therapeutic best practice, is the essence of therapeutic architecture”. Put very simply, therapeutic architecture is about enabling safe movement and natural daylight to support healthier lifestyles, mentally and physically.
As our society becomes more switched on to recognising the importance of mental health at large, and in our homes, institutions and businesses, the future seems bright for therapeutic architecture. In fact, it seems set to be dominated by it and all of its influences.
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This article was written by Thomas Owens of Re-Space, an office refurbishment and fit-out company located in Kent, UK.
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