Close to Home - Design Manual

Design Manual

設計手冊

Neighbourhood strategies for Beijing’s urban psychiatric care.

生活中的都市策略 Cameron Clarke Student Number: 170175 Urbanism and Societal Change

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Cameron Clarke 170175

Unit Urbanism and Societal Change Institute IBBL Tutor Christine Bjerke Unit Directors Charles Bessard & Deane Simpson Spring 2019

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Institute of Mental Health Law of the People’s Republic of China

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contents

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global context project synopsis china’s mental health law a prototype project a prototype site desheng subdistrict design principles therapeutic cabinet therapeutic matrix urban acupuncture urban clinic digital layer program journey urban acupuncture pocket garden community kitchen garden rooftop kitchen garden community exercise space car-park roof garden meditative walking routes silent meditation spaces tower group therapy space street-side talking space mental wellness and recovery clinic emotional support line group meeting space professional consultation psychotherapy innovative therapy spaces communal kitchen and dining

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global context

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UN Sustainable Development Goals

The project will address the following UN Sustainable Development Goals: Good Health and Well-being Goal 3.4 “By 2030, reduce by one third premature mortality from noncommunicable diseases through provention & treatment & promote mental health and wellbeing.”

(United Nations, 2015)

Reduced Inequalities Goal 10.2 “By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.”

(United Nations, 2015)

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project synopsis

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Today, almost 180 million Chinese citizens suffer from a mental health illness, almost 1 in 5 of the population.

Of these 180 million people living with a mental illness, 160 Million have not had any psychological treatment or care.

This lack of treatment is a crisis in-waiting, and the economic and social consequences are yet to be fully comprehended.

Can answers to China’s urban mental health crisis be found close to home?

In this project I argue that answers may be found within existing community and neighbourhood structures.

This is achieved by proposing a preventative & rehabilitational focused psychiatric care model based upon a urban acupuncture of care facilities across the city fabric, rather than the current model of reactive centralised institutions.

Architectural spaces and interventions are networked together by a digital layer of communication technology, bringing mental healthcare physically, and virtually, closer to each of the city’s citizens, and in doing so increasing communal and neighbourly interaction and reducing stigma and fear of illness, which is integral for good mental health.

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china’s mental health law

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2012 Mental Health Law

2015 - 2020 Mental Health Working Plan

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2012 Mental Health Law

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2015 - 2020 Mental Health Working Plan

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a prototype project Internet Enabled Social Networks Diagnostic & Treatment Apps

Community Support Groups

Urban Community Networks

Technological Innovation Intelligent patient monitoring, security & space utilisation

Educational Spaces

Community Treatment & Care Facilities

Architectural Spatial Intervention

VR Spaces created for Diagnostics & Treatment

Remote access to hospital consultations & specialists

Rehabilitation Facities

National Strategy & Policy

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The publication of the National Mental Health Work Plan of China (2015 - 2020) expanded upon the 2012 National Mental Health Law and set out a series of goals to be achieved by 2020 to deliver on the overall agenda, which aims to create a comprehensive and holistic mental healthcare system:

The policy aims to maximise integration with local communities, simultaneously enabling care to take place closer to patients existing social networks, while improving the wider public’s understanding of mental healthcare. The policy states that local governments:

“[To] build a social milieu of understanding, acceptance, and caring for individuals with mental illnesses; raise community awareness of the importance of mental health; promote the psychological well-being of the public; and enhance the harmonious development of the society”

“...should vigorously promote a comprehensive, community-based, open model of rehabilitation for individuals with mental illnesses that effectively links medical rehabilitation and social rehabilitation and that strengthens the technical support provided from specialised mental health institutions to community-based rehabilitation facilities”

The Work Plan also seeks to spread the responsibility of mental healthcare into the private sector, away from solely being provided by state funded primary health services. As part of wider reforms being brought to healthcare more generally, the policy encourages private commercial and community organisations to develop services, products and treatmenta which can contribute to the overall mental health policy goals. There is a clear encouragement on the adoption of new technologies and in learning from new practices in the international community so that “successful experiences from international sources… should be rapidly applied in the practice of mental health work.”

Thus, it is possible to assess the strategies outlined in both the 2012 National Mental Health Law and the National Mental Health Work Plan of China (2015 - 2020) through the lense of three interconnected thematics: Firstly, the role of existing urban community and neighbourhood networks play in both increasing understanding, controlling stigma, opening access to diagnosis, treatment and rehabilitation.

Secondly, how rapid technological innovations are changing the methods of treatment for mental healthcare across the globe, and are enabling a move away from institutionalised care, to treatment in local neighbourhoods and in the home.

Finally, there is a particular emphasis on strengthening community care, treatment and rehabilitation facilities which“involves the collaborative participation of specialised mental health facilities, community rehabilitation centres, social organisations, and families.” .

One way that this policy is to be achieved is by the opening of a new type of architectural intervention:“public community-based rehabilitation facilities.”

And lastly, there is an oppportunity for a new unique series of spatial, achitectural and planning strategies to be proposed as prototype projects at local neighbourhood scales, which can then be networked together to form the built landscape of a new mentalhealthcare infrastructure

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A Prototype Site

This project proposes a series of interventions which form the basis of a Design Manual for a Prototype Project, speculating on a possible alternative trajectory for Chinese urban mental healthcare.

The project focuses on a prototype site for proposals, offering programs which are largely absent from the current mental healthcare system. These interventions will support community awareness, early diagnosis and also recovery support and community reintegration for patients. I will be basing my investigations at the edge of the central Beijing’s oldest district: Xicheng.

Xicheng contains the broadest spectrum of urban typologies in the city and is home to central Beijing’s last remaining psychiatric hospital. The population of the district is 1.3 Million , over twice that of Copenhagen. Xicheng is further subdivided into 15 neighbourhoods, these proposals will focus on the Desheng Subdistrict. Desheng is a 4.14 km2 neighbourhood, with a residential population of 116,199 and an additional transient population of 25,50 0.

This site has been selected for investigation as it crosses the 2nd ring-road boundary which de-marks the typological change from traditional hutong neighbourhoods, danwei work unit housing to the ultra high density gated community housing schemes which has begun to dominate the Beijing sk yline.

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Desheng Subdistrict

Typical Megablock Plan, Beijing

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Tectonic massing of typical Megablock

Tectonic massing of typical Danwei Typical Danwei Plan, Beijing

Typical Hutong Plan, Beijing

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Tectonic massing of typical Hutong

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Three Neighbourhood Sites within Desheng Subdistrict, Xicheng, Beijing Source: Baidu, 2019

See photos in Site Journey, overleaf

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Desheng Subdistrict Hutong 花 园

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Desheng Subdistrict, Beijing 1 : 2000 22

150m

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听 花 园

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Desheng mental wellness & recovery clinic

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listening pavilion

和 平

peaceful space

花 园

reflective garden

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meditative route

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Desheng subdistrict hospital

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design principles

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Light

It is well documented that daylight, artificial light and sunlight can all provide significant health benefits for the general population, as well as mental health patients in particular.

There is research to suggest that bright light—natural or artificial— can improve health outcomes such as depression, agitation, sleep, circadian rest-activity rhythms, and length of stay in dementia and bipolar seasonal affective disorder (SAD) patients.

Further to this, studies show that exposure to morning light is more effective than exposure to evening light in reducing depression.

Using light to reduce depression is a relatively inexpensive intervention that has been shown to yield consistently positive results. While artificial lighting can be manipulated throughout the design process, the initial layout of rooms to face east, allowing natural daylight in patient rooms in the morning, can make a significant contribution to patient wellbeing.

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Elimination of Environmental Stressors

In the pursuit of recovery, mental health patients must first be comfortable. Noise, glare, and air quality are among the many environmental variables that must be considered in the design of healthcare facilities. Noise is a major cause of sleep disturbance, and there is evidence to suggest that noise increases stress in patients, inducing high blood pressure and increased heart rates. Design interventions that minimise or eliminate noise throughout the facility are important.

While natural light has been identified as crucial in maximising recovery potential, flooding rooms with too much light in inappropriate locations is likely to cause discomfort, as is poor indoor air quality.

Way finding is also a critical element in the elimination of stress for both patients and their visitors, who may be unfamiliar with the facility.

Way finding systems should use external cues, local information and graphical clarity.

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Safety & Security

Safety specifically addresses the need to keep staff and patients out of harm’s way through physical elements in design, while security allows the freedom of movement for patients within the facility without compromising treatment and the safety of the patients, staff, and the community.

Good security design allows the freedom of movement for patients within the limits of their condition.

The more serious the illness, the more overt will be measures to ensure patients do not harm themselves.

Design must also consider the protection of staff, other patients, visitors and members of the public.

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Observation

Closely related to security is the issue of observation, which is ideally achieved through passive surveillance. Innovative ways to increase the potential for staff to check on patients can be seen in a number of new facilities.

Providing secure courtyards is succesful approach, but there are other ways of maximising observation without intruding the patients.

Wide corridors with regular gathering spaces enable a low key approach to observation, and single loaded corridors with uninterrupted views to external spaces also allow staff to continue with their work while keeping an eye on activities throughout the facility.

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Avoidance of visual disturbance

Visual disturbance can take many forms, but mental health facility planners generally strive to provide a calm environment with ample space and minimal clutter – through colour, light, furniture and art.

Evidence indicates that a calm environment free of technological distractions allows patients time and space to reflect.

Art selection can contribute to a calm atmosphere: studies on art in hospitals suggest that, in addition to benefits from access to nature, patients respond positively to art depicting nature and negatively to chaotic abstract art. There is also evidence that inappropriate art styles can increase stress and worsen other conditions.

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Colour

The colour most beneficial in making people feel calm is blue. Studies have shown that brighter colours: (whites, light grey, and lighter colours) are found to be less arousing, and less dominant than darker colours, grey and black.

However, the calming effect is not the only benefit of astute colour selection– colour coding the environment can greatly assist in orientation and can be used as part of the way finding strategy.

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Group Interaction

The value of social interaction for psychiatric patients is well researched, and varies according to the type of illness and the demographic of the patients.

There are two aspects to socialisation – with other patients, and with visitors.

Culture has a large bearing on how people behave in mental health settings - privacy with and for family are critical. Social interaction with family and friends is an important element in many treatment programs, and research indicates that single rooms are significantly better than multi-bed rooms for accommodating visitors. Multi-bed rooms may even deter family presence because they greatly reduce privacy and restrict visiting hours.

While some patients sharing the same bedroom provide each other with social support, research shows that the presence of a roommate is more likely to be a source of stress rather than support.

There is also strong evidence that where single bed rooms are provided, patient to patient interaction can be increased, and stress levels lowered, by providing lounges with comfortable furniture arranged in small flexible groupings.

Access to outdoor spaces that are large enough for different social and cultural groups to inhabit is also important.

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Access to Nature

Many recently designed mental health facilities focus strongly on links to nature, through both views and physical interaction. A significant body of research consistently finds that viewing nature induces positive emotional and physiological changes and diminishes negative emotions through changes in blood pressure and heart activity.

Post-occupancy evaluation where the mental health facility is based on the courtyard model, is indicating that patient stay has been reduced significantly as well as the incidence of violence. Other studies indicate that patients and family who use hospital gardens report positive mood change and reduced stress.

As an added bonus, staff in facilities with gardens can benefit from nature.

Gardens in the workplace can reduce stress and improve outcomes through fostering social connection and providing opportunities for positive escape from stressful clinical settings.

The impact of smell on well-being is also identified in research relating to design in mental healthcare settings in which commonalities across the literature suggest that ‘pleasing aromas may reduce blood pressure, slow respiration, and lower pain perception levels; unpleasant odours stimulate anxiety, fear and stress.

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therapeutic cabinet

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therapeutic matrix Mental Wellness

Theraputic Goal

Prevention

Awar

Self Awareness Privacy Social Interaction Physical Activity Stress Reduction Diet Unpolluted Environment Access to Nature Community Connection Social Purpose Self Help Mindfulness Listening Support Talking Therapy Peer Support Groups Clinical Assessment Observation Psychotherapy Pharmacotherapy Family & Carer Support Supported Housing

Urban Acupunctural Elements

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Tower Group Therapy Space

Silent Meditation Space

Medative Walking Routes

Community Carpark Roof

Community Exercise Space

Rooftop Kitchen Garden

Community Kitchen Garden

Pocket Garden

Inpatient Care

Digital Layer

Mental Wellness and Recovery Clinic

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Infrastructure for Awareness, Diagnosis & Treatment

Urban Acupunctural Elements

Pocket Garden

Treatment

Community Kitchen Garden

Rooftop Kitchen Garden

Community Exercise Space

Community Carpark Roof

Medative Walking Routes

Silent Meditation Space

Tower Group Therapy Space

Diagnosis

Streetside Talking Space

Inpatient Care

Communial kitchen & dining

Innovative therapy spaces

Psychothrerapy

Professional Consultation

reness

Group Meeting Space

Emotional Support Line

Streetside Talking Space

Mental Illness Recovery

Remission

digital layer

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digital layer

the intervention the clinic institution

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1.

Computerised Cognitive Behavioural Therapy (CCBT) Utilizing patients familiarity with smartphone devices and applications to deliver programmes of self directed talking therapy in their home environment.

2. Telepsychiatry Enabling therapists to connect and communicate remotely with patients, to operate over large distances and provide cheaper therapeutic treatment that traditional face to face consultations.

3. Healthcare Provider Tools Creating tools and software which enables healthcare providers to communicate with each other, and maximise efficiency and to create flexible, contextual and responsive treatment programmes.

4. Patient Mobile Tools Building mobile tools which allow patients to track their treatments, or to communicate with other patients in their local or wider network, enabling and facilitating self run support groups 5. Hardware Using connected hardware such as VR headsets and motion trackers to deliver immersive virtual treatments, change perceived spatial conditions or utilise virtual environments to test and diagnose patients.

6. Applied Artificial Intelligence Connecting patient data with artificially intelligent machine learning to analyse patient conditions, treatment efficacy & to assist with diagnosis or prevention.

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program journey A Community Mental Health System based upon the recovery approach which resonates strongly with traditional Chinese culture and is consistant with the government’s 686 Project, paying more attention to the patient’s level of functioning and their strengths, rather than their disabilities and psychopathology.

The recovery approach emphasises self-confidence 自信, self-help 自助 & self-sufficiency 自給自足.

The programme will address the treatment gap found between diagnosis and hospital inpatient acute care or medication and will open up awareness of mental illness and wellness for those undiagnosed in the commununity 42 62

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the proposals

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pocket garden Mental Mental Wellness Wellness

Theraputic Theraputic Goal Goal

Mental Mental Illness Illness

Prevention Prevention

Awareness Awareness Diagnosis Diagnosis

Treatme Tre

Self Awareness Self Awareness PrivacyPrivacy Social Interaction Social Interaction Physical Physical ActivityActivity Stress Stress Reduction Reduction Diet

Diet

Unpolluted Unpolluted Environment Environment AccessAccess to Nature to Nature Community Community Connection Connection Social Purpose Social Purpose Self Help Self Help Mindfulness Mindfulness Listening Listening SupportSupport TalkingTalking Therapy Therapy Peer Support Peer Support GroupsGroups ClinicalClinical Assessment Assessment Observation Observation Psychotherapy Psychotherapy Pharmacotherapy Pharmacotherapy Carer Support Family Family & Carer&Support Supported Housing Supported Housing

de Talking Space

t Care

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editation Space

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e Walking Routes

Schematic Neighbourhood Plan

ity Carpark Roof e Walking Routes

ity Exercise Space ity Carpark Roof

Kitchen Garden ity Exercise Space

ity Kitchen Garden Kitchen Garden

Garden

Therapeutic Matrix

Garden ity Kitchen Garden

Inpatient Inpatient Care Care

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community kitchen garden Mental Wellness

Theraputic Goal

Mental Illness

Prevention

Awareness

Diagnosis

Treatme

Self Awareness Privacy Social Interaction Physical Activity Stress Reduction Diet Unpolluted Environment Access to Nature Community Connection Social Purpose Self Help Mindfulness Listening Support Talking Therapy Peer Support Groups Clinical Assessment Observation Psychotherapy Pharmacotherapy Family & Carer Support Supported Housing

de Talking Space

t Care

ve therapy spaces

hrerapy

ional Consultation

eeting Space

al Support Line

ial kitchen & dining

roup Therapy Space

de Talking Space

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editation Space

Schematic Neighbourhood Plan

e Walking Routes

ity Carpark Roof

ity Exercise Space

Kitchen Garden

Garden

Therapeutic Matrix

ity Kitchen Garden

Inpatient Care

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retractable ETFE roofing insulates the garden, allowing for the creation of various different microclimates, giving the potential for crops from all over china to be successfully grown.

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garden an be opened to the hutong street to allow passersby to visit, but can be secured at night when no in use

Gardening takes place within existing building structure

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carpark roof garden Mental Wellness Mental Wellness

heraputic Goal

Awareness

Theraputic Goal

Prevention

Mental Illness

Prevention Awareness

Diagnosis Awareness

Mental Illness

Diagnosis

Treatment

Treatme

Self Awareness

acy

Privacy

al Interaction

Social Interaction

sical Activity

Physical Activity

ss Reduction

Stress Reduction Diet

olluted Environment

Unpolluted Environment

ess to Nature

Access to Nature

mmunity Connection

Community Connection

al Purpose

Social Purpose

Help

Self Help

dfulness

Mindfulness

ening Support

Listening Support

ing Therapy

Talking Therapy

r Support Groups

Peer Support Groups

cal Assessment

Clinical Assessment

ervation

Observation

chotherapy

Psychotherapy Pharmacotherapy

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al ve Support therapy Line spaces

hrerapy

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ional Consultation ial kitchen & dining

roup Consultation Therapy Space ional

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Schematic Neighbourhood Plan al Support Line

de Talking Space

Kitchen Garden

ity Kitchen Garden

Garden

Therapeutic Matrix

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Inpatient Care

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Supported Housing

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Garden eKitchen Walking Routes

ported Housing

ity Kitchen Carpark Garden Roof ity

Family & Carer Support

ity Exercise Space Garden

rmacotherapy

mily & Carer Support

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rooftop kitchen garden Mental Mental Wellness Wellness

Theraputic Theraputic Goal Goal

Mental Mental Illness Illness

Prevention Prevention

Awareness Awareness Diagnosis Diagnosis

Treatment Treatme

Self Awareness Self Awareness Privacy Privacy Social Interaction Social Interaction PhysicalPhysical Activity Activity Stress Reduction Stress Reduction Diet

Diet

Unpolluted Unpolluted Environment Environment Access Access to Nature to Nature Community Community Connection Connection Social Purpose Social Purpose Self Help Self Help Mindfulness Mindfulness Listening Listening SupportSupport Talking Therapy Talking Therapy Peer Support Peer Support Groups Groups Clinical Assessment Clinical Assessment Observation Observation Psychotherapy Psychotherapy Pharmacotherapy Pharmacotherapy Family &Family Carer & Support Carer Support Supported HousingHousing Supported

roup Therapy Space de Talking Space

de Talking Space

t Care

t Care

ve therapy spaces

ve therapy spaces hrerapy

ional Consultation hrerapy

ional Consultation eeting Space

eeting Space al Support Line

de Talking Space al Support Line

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ial kitchen & dining

ial kitchen & dining

roup Therapy Space editation Space

de Talking Space roup Therapy Space

Schematic Neighbourhood Plan

e Walking Routes editation Space

ity Carpark Roof e Walking Routes

ity Exercise Space ity Carpark Roof

Kitchen Garden ity Exercise Space

Kitchen Garden ity Kitchen Garden

Garden

Therapeutic Matrix

ity Kitchen Garden Garden

InpatientInpatient Care Care

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located against the existing lift overun, a lean-to roof creates an idea suntrap for the planting of seeds and saplings, before they are potted untill they are ready to be replanted outside

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Entrance from lift core directly into rooftop ‘potting shed’

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rooftop planting benefits from being free from overshadowing by other buildings, escape from the worst of the street level pollution

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while allowing a reconnection to nature, gardening can be a very sociable activity, so space is provided for groups and individuals to share knowledge and hold group gardening therapy meetings

Simple light weight folded structures shelter the garden from adverse weather

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community exercise space Mental Wellness Mental Wellness

Theraputic Goal Theraputic Goal

Prevention

Mental Illness Mental Illness

Prevention

Awareness

Awareness Diagnosis

Diagnosis

Treatment

Treatme

Self Awareness Self Awareness Privacy

Privacy

Social Interaction Social Interaction Physical Activity Physical Activity Stress Reduction Stress Reduction Diet

Diet

Unpolluted Environment Unpolluted Environment Access to Nature Access to Nature Community Connection Community Connection Social Purpose

Social Purpose

Self Help

Self Help

Mindfulness

Mindfulness

Listening Support Listening Support Talking Therapy

Talking Therapy

Peer Support Groups Peer Support Groups Clinical Assessment Clinical Assessment Observation

Observation

Psychotherapy

Psychotherapy

Pharmacotherapy Pharmacotherapy Family & Carer Support Family & Carer Support Supported Housing Supported Housing

editation Space

de Talking Space

t Care roup Therapy Space

ve therapy spaces

ve therapy spaces ional Consultation

al Support Line

hrerapy eeting Space

ional Consultation

eeting Space de Talking Space

editation Space

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de Talking Space

Schematic Neighbourhood Plan

de Talking Space

t Care ial kitchen & dining

hrerapy ial kitchen & dining

al Support Line roup Therapy Space

Therapy Space eroup Walking Routes

ity Carpark Roof editation Space

Exercise Space eityWalking Routes

Kitchen Garden ity Carpark Roof

ity Kitchen ExerciseGarden Space ity

ity Kitchen Garden

Garden

Therapeutic Matrix

Kitchen Garden

Inpatient Care

Garden

Inpatient Care

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meditative walking routes Mental Wellness

tic Goal

ss

Mental Wellness

Theraputic GoalPrevention

Mental Illness

PreAwareness vention

Diagnosis Awareness

Mental Illness

Diagnosis

Treatment

Treatme

Self Awareness Privacy

ction

Social Interaction

vity

Physical Activity

tion

Stress Reduction Diet

nvironment

Unpolluted Environment

ture

Access to Nature

Connection

Community Connection

se

Social Purpose Self Help Mindfulness

pport

Listening Support

py

Talking Therapy

Clinical Assessment Observation

de Talking Space

ity Carpark Roof

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al Support Line ial kitchen & dining eeting Space

roup Therapy Space hrerapy

alking Space de ve Ttherapy spaces

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ity Carpark Roof

Schematic Neighbourhood Plan

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Inpatient Care

Kitchen Garden editation Space

Supported Housing

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Kitchen Garden

ousing

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Pharmacotherapy Family & Carer Support

Garden

rapy

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Psychotherapy

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Peer Support Groups

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Groups

ssment

和 平 听

和 平

花 园

和 平

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花 园

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meditative route

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App user is guided through a route with accompanying medative audio

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Therapeutic Matrix

ional Consultation e Walking Routes

ity Carpark Roof eeting Space

al Support Line

ity Exercise Space

de Talking Space

roup Therapy Space Kitchen Garden

Schematic Neighbourhood Plan

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roup Therapy Space

de Talking Space

DiagnosisTreatment

ity Exercise Space

ity Carpark Roof t Care

e Walking Routes

ial kitchen & dining

editation Space

ve therapy spaces roup Therapy Space

Mental Illness

hrerapy de Talking Space

ional Consultation

Awareness

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de Talking Space ial kitchen & dining

Awareness Prevention Diagnosis

editation Space ve therapy spaces

Mental Wellness

hrerapy

Theraputic Prevention Goal

editation Space ity Kitchen Garden

Mental Wellness

Garden

e Walking Routes

ity Carpark Roof

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Kitchen Garden

t

ity Kitchen Garden

Garden

silent meditation spaces Mental Illness

Treatme

Self Awareness

Privacy

Social Interaction

Physical Activity

Stress Reduction

Diet

Unpolluted Environment

Access to Nature

Community Connection

Social Purpose

Self Help

Mindfulness

Listening Support

Talking Therapy

Peer Support Groups

Clinical Assessment

Observation

Psychotherapy

Family & Carer Support

Pharmacotherapy

Supported Housing

Inpatient Care

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Simple curved seating creates a private moment where thoughts can be heard

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Therapeutic Matrix

ity Carpark Roof ional Consultation

eeting Space

al Support Line ity Exercise Space

de Talking Space Kitchen Garden

Schematic Neighbourhood Plan

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de Talking Space

Diagnosis Treatment

Kitchen Garden

Exercise Space tity Care

ity Carpark Roof

e Walking Routes ial kitchen & dining

Mental Illness

ve therapy spaces editation Space

hrerapy roup Therapy Space

ional Consultation de Talking Space

eeting Space

Awareness

al Support Line t Care

de Talking Space

Awareness Prevention Diagnosis

roup Therapy Space ial kitchen & dining

editation Space

ve therapy spaces

Mental Wellness

e Walking Routes hrerapy

Theraputic Prevention Goal

roup Therapy Space ity Kitchen Garden

Mental Wellness

Garden editation Space

e Walking Routes

ity Carpark Roof

ity Exercise Space

Kitchen Garden

ity Kitchen Garden

Garden

tower group therapy space Mental Illness

Treatme

Self Awareness

Privacy

Social Interaction

Physical Activity

Stress Reduction

Diet

Unpolluted Environment

Access to Nature

Community Connection

Social Purpose

Self Help

Mindfulness

Listening Support

Talking Therapy

Peer Support Groups

Clinical Assessment

Observation

Psychotherapy

Family & Carer Support

Pharmacotherapy

Supported Housing

Inpatient Care

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By interconnecting 4 apartments, enough space is created for a range of activities

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ity Kitchen Garden

Garden

Therapeutic Matrix

Schematic Neighbourhood Plan

74 Mental Illness

Diagnosis Treatment

ity Kitchen Garden de Talking Space

t Care Kitchen Garden

ity Exercise Space

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Mental Illness

hrerapy editation Space ve therapy spaces

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de Talking Space ional Consultation

Awareness

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t Care al Support Line

de Talking Space

PreDiagnosis vention

editation Space ial kitchen & dining roup Therapy Space

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Mental Wellness

hrerapy

ity Carpark Roof

ional Consultation

eeting Space ity Exercise Space

Awareness

Kitchen Garden al Support Line

Prevention Theraputic Goal

alking Space de ityTKitchen Garden

Mental Wellness

Garden roup Therapy Space

editation Space

e Walking Routes

ity Carpark Roof

ity Exercise Space

Kitchen Garden

street-side talking space Rec

Treatme Rem

Self Awareness

Privacy

Social Interaction

Physical Activity

Stress Reduction

Diet

Unpolluted Environment

Access to Nature

Community Connection

Social Purpose

Self Help

Mindfulness

Listening Support

Talking Therapy

Peer Support Groups

Clinical Assessment

Observation

Psychotherapy

Family & Carer Support

Pharmacotherapy

Supported Housing

Inpatient Care

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Passers-by can share a moment of stillness on the busy street

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Lightweight timber and fabric construction can be easily folded up and relocated

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Open to the sky, the space helps take the mind off the surrounding chaotic city

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ity Carpark Roof

ity Exercise Space

Therapeutic Matrix

ity Carpark Roof

ial kitchen & dining

ity Exercise Space

Schematic Neighbourhood Plan

80 Remission

de Talking Space

t Care

Diagnosis

Garden

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Mental Mental Wellness Illness

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Treatment Awareness

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Prevention

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Diagnosis

Kitchen Garden ve therapy spaces

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Garden ional Consultation

Theraputic Awareness Goal

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ention

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Self Awareness

mental welless and recovery clinic Mental Illness Recovery

Treatme

Privacy

Social Interaction

Physical Activity

Stress Reduction

Diet

Unpolluted Environment

Access to Nature

Community Connection

Social Purpose

Self Help

Mindfulness

Listening Support

Talking Therapy

Peer Support Groups

Clinical Assessment

Observation

Psychotherapy

Family & Carer Support

Pharmacotherapy

Supported Housing

Inpatient Care

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Roof Plan 1:100

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Existing Building

Existing

30m

Building

Existing Building 25m

Site

Programme Strategy

Programme Sequence

82

Layers of Privacy

Thresholds

Vertical Circulation

83

ground floor

84

botanical lab

pharmacy staff & inpatient entrance

consultation

consultation

medicinal garden

activity space

community activity space

kitchen

nurse station

community living room

fruit and vegetable garden

dining

vr classroom

covered market space

entrance

streetside respite & phone line

85

first floor

86

acupuncture clinic

bedroom

consultation room

bedroom

consultation room

consultation room

consultation room

bedroom

bedroom

waiting room

group room emotional support line

First Floor Plan 1:100

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roof plan

88

A

A

Roof Plan 1:100

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structural plan

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structural section 3 group room

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Sect 1

1.

Existing structure foundations underpinned to form pad support for steel / timber structure insert to take new structure 2.

Painted steel ring-beam, bolted through existing brickwork to support during removal of roof and new sitting of CLT first floor structure 3.

Reglit glazing system between primary timber structure, with internal curtains and acoustic plasterboard ceiling.

2.

emotional support line

2 entrance

1

tion AA 1:50

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section detail 1.

Primary crosslaminated timber structure, secured with bolted connections for expedient assembly and disassembly.

2

3

2.

Corrugated galvanised steel facade panel, in-filled with woodfibre insulation on a Met-sec framing system, between primary and secondary timber structure

1.

3.

Large format, ALU. framed triple glazed window system, with inward opening side vent and concealed internal blinds 4.

Crosslaminated timber panel flooring system spanning between primary structure, with rigid thermal insulation and acoustic plasterboard internally 5.

Openable rooflights, with internal remotely operated blinds

2.

6.

Acoustic plasterboard internally between primary timber roof structure, below 200mm acoustic plenum

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4

5

1

6

group room

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wayfinding 1.

The clinic is graphically identified by use of the Chinese character 天 ‘tian’ meaning ‘sky’, ‘above the head’ and refering to ‘nature’

oof Plan

2.

Entrance to the clinic is subtly suggested by floor painted patterns which guide patients into the clinic and towards treatment, inspired by the green line which leads patients from the Old Street tube station in London to the nearby eye hospital

96

97

entrance

botanical lab

pharmacy staff & inpatient entrance

consultation

consultation

medicinal garden

activity space

community activity space

kitchen

nurse station

community living room

fruit and vegetable garden

dining

vr classroom

covered market space

entrance

streetside respite & phone line

Ground Floor

98

Ground Floor Plan 1:100

kitchen

fruit and vegetable garden

dining

covered market space

entrance

stre

99

facade of corrugated aluminium panels subtly reflects the sky down into the hutong. the panel system is easily replaceable and modifiable throughout the building’s life

staff and patients have control over visibility from street level into the building as good levels of natural lighting are ensured via large roof-lights above all first floor spaces

sheltered space at street level can be used by patients and locals for social events, markets and community engagement and awareness

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View showing clinic’s interaction with street-life and existing architecture

101

entrance is identified by simple neon light for chinese character ‘tian’ meaning ‘sky’, 天

always open entrance to street-side respite space, where visitors can rest from the noise and bustle of the street, or make a direct call to the emotional support line above.

points of entry to the building are indicated by textures pained onto the street surface

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Clinic entrance and respite space located within existing hutong building fabric

103

on entry there is a direct sight-line into the centre of the clinic, its courtyard garden from which all ground floor programmes can be directly accessed

communal spaces such as dining room, activity rooms are located on the ground floor patients who have appointments with a consultant arrive and proceed to the first floor

appointments are notified via the app for each patient, removing the need for stressful queue systems that are commonly found in larger hospitals

104

Entrance subtly shown by blue floor painting leading through to courtyard garden

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emotional support line acupuncture clinic acupuncture clinic

bedroom bedroom

consultation room consultation room

bedroom bedroom

consultation room consultation room

consultation room consultation room

consultation room consultation room

bedroom bedroom

bedroom bedroom

waiting room waiting room

group room group room emotional support line emotional support line

First Floor Plan First Floor Plan 1:100 1:100

First Floor

106

consultation room

community living room

fruit and vegetable garden

st Floor Plan

waiting room

emotional support line

entrance

streetside respite & phone line

107

workers in the emotional support line have passive surveillance over the external respite space below and circulation up to the consultation rooms

the confidentiality of a support-line depends upon anonymity of both caller and volunteer, and so the volunteer desks are situated on first floor behind a reglit glazing system. their presence can be felt from street level, but cannot be individually identified the welfare of volunteers is vital, and so space is provided to rest and drink tea between taking calls

108

Behind frosted glass the anonymous emotional support line takes calls from locals

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respite space in the form of an enclave between the existing building structure and the new insertion of the clinic

a pocket garden fills the space, creating a calm atmosphere by mitigating the stressful environmental conditions of the city. noise, visual chaos and the smell of fumes are replaced by natural stimuli and a moment of peace

within the respite space is seating and a direct phone connection to the emotional support line which is located above.

110

A direct line exists from the respite space at street level, free from surveillance

111

group meeting space acupuncture clinic

bedroom

consultation room

bedroom

consultation room

consultation room

consultation room

bedroom

bedroom

waiting room

group room emotional support line

First Floor Plan 1:100

First Floor

112

bedroom

bedroom

group room

emotio

113

First Floor Plan

roof-lights in all first floor spaces give good qualities of soft natural light, which can be controlled via internal blinds. all first floor circulation routed are located under the highest section of the ceiling, directly under views of the sky above

the buildings timber structure is clearly expressed through the building, brining with it its positive spatial, visual and acoustic qualities to each space.

larger flexible spaces are simply divided by curtains which are hung just above the finished floor level, so as to maintain the consistency of being within one larger volume, while being appropriately divided for specific function

throughout the building furniture is integrated into the construction as much as possible. this allows for specifically customised spaces to be created at a low cost, makes spaces easier to maintain and safer for staff and patients.

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Local support groups make use of flexible space located above the hutong street-life

115

professional consultation acupuncture clinic

bedroom

consultation room

bedroom

consultation room

consultation room

consultation room

bedroom

bedroom

waiting room

group room emotional support line

First Floor Plan 1:100

First Floor

116

consultation room

consultation room

consultation room

waiting room

117

generous yet simple built-in furniture provides ample space for patients and their families to wait for consultations while enjoying the peaceful views over the courtyard garden or out above the roof level of the surrounding hutong

textured floor surface guides patients through the waiting room and towards individual consultation rooms

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A patient checks in via the App., connecting directly to her consultant

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soft natural light is filtered into the consultation room from the roof-lights to the east and dappled light through the courtyard trees in the afternoon and evening intensity of light can be controlled via external timber louvres and internal fabric blinds

inbuilt furniture provides the consultant with a generous desk-space and patient sofa where they can sit or lay down during the consultation minimised use of moveable furniture reduces cost and improves the safety for patient and consultant

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Consultation room, with dual aspect lighting at a level with courtyard trees

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psychotherapy clinic botanical lab

pharmacy staff & inpatient entrance

consultation

consultation

medicinal garden

activity space

community activity space

kitchen

nurse station

community living room

fruit and vegetable garden

dining

vr classroom

covered market space

entrance

streetside respite & phone line

Ground Floor

122

Ground Floor Plan 1:100

botanical lab

staff & inpatient entrance

consultation

consultation

medicinal garden

kitchen

123

psychiatrist offices are located on ground floor, adjacent to the botanical therapeutic garden where many traditional chinese medicines are grown a calm backdrop to the space is created, where patients can watch their treatments being grown and developed while also providing ‘western’ medicine in combination with traditional herbal techniques, the direct relationship to the garden allows patients and therapists to walk around the garden while discussing treatment plans

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Consultation with Psychiatrist against a backdrop of therapeutic botanical garden

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traditional therapy spaces acupuncture clinic clinic acupuncture

bedroom bedroom

consultation consultation room room

bedroom bedroom

consultation room room consultation

consultation room room consultation

consultation room room consultation

bedroom bedroom

bedroom bedroom

waiting room room waiting

group group room room emotional emotional support support line line

First Floor Plan First Floor Plan 1:100 1:100

First Floor

126

acupuncture clinic

bedroom

bedroom

127

innovative therapy spaces botanical lab

pharmacy staff & inpatient entrance

consultation

consultation

medicinal garden

activity space

community activity space

kitchen

nurse station

community living room

fruit and vegetable garden

dining

vr classroom

covered market space

entrance

streetside respite & phone line

Ground Floor

128

Ground Floor Plan 1:100

kitchen

nurse station

dining

vr classroom

covered market space

129

the nurse station provides a space for staff to monitor patients as they move between residential facilities on the first floor, communal spaces such as the kitchen, garden and dining room, and the treatment spaces a centralised location reduces distance travelled by the nurses, and thus reduces staff fatigue

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View from Nurse’s Station at the heart of the treatment & social spaces

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the adjoining existing building fabric is retained, supported by a simple steel ring-beam and timber internal wall structure allows for the space to be opened up for maximum flexibility and future adaptability

generous activity spaces either side of the nurse station are equipt with facilities to allow use of the latest VR therapeutic techniques, as well as staff training and community events

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Patients undergo VR assessment & treatment within renovated hutong building

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communal kitchen & dining botanical lab

pharmacy staff & inpatient entrance

consultation

consultation

medicinal garden

activity space

community activity space

kitchen

nurse station

community living room

fruit and vegetable garden

dining

vr classroom

covered market space

entrance

streetside respite & phone line

Ground Floor

134

Ground Floor Plan 1:100

kitchen

fruit and vegetable garden

dining

covered market space

entrance

135

the centre of any hutong home, the kitchen also forms the heart of the clinic diet plays a critical role in mental health, and also in the wide diversity of chinese culture here patients and staff can learn to cook together beijing’s citizens come from all over china and often this relocation disassociates them from their specific traditional cuisine here they can re-engage with growing and cooking of familiar dishes in a communal shared environment

the sense of smell is vital to the stimulation of appetite, which is often lost during mental illness and treatment an open double height space above the kitchen allows the smell of cooking to travel through the communal circulation, helping patients to build their daily routines around the simple tasks of cooking and eating

direct access to the garden where many of the ingredients can be cultivated in a range of micro-climates, reflecting the diversity of chinese produce

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Patients and staff cook together, using food grown in the courtyard garden

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in the warmer months all the windows of the dining space can be fully opened, allowing for a sheltered but highly open space to be created the dining room is located alongside the vegetable produce area of the courtyard garden

dining is traditionally a highly social activity, but due the increased time burden on many chinese citizens it is now often a more solitary activity this can have a profoundly negative impact on mental well-being, and is particularly the case for those suffering or recovering from a mental illness thus, the kitchen is directly adjoined by a generous dining space, comprising of one large communal table which is shared by staff, patients and their families

it is common in hutong streets for dining and cooking spaces to have a direct relationship with the street, and here that possibility is maintained with access and visual connection to the sheltered external space and adjacent to the entrance to the facility from here events can spill out onto the street-side, for example a produce market or community dining or food sale

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Communal dining room adjoins kitchen, garden and connection to the street

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Institute of Mental Health Law of the People’s Republic of China 144