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r e : habitat A new mental health approach for urban communities awarded the Byera Hadley Travelling Scholarship 2017 for research + proposal

Explanatory Document Supervisors: Prof. David Sanderson, Mark Szczerbicki, Sue Wittenoom

Hayden Co’burn 3377204 A research project submitted in partial fulfilment of the requirements for the degree of Master of Architecture, University of New South Wales, 2017.

© Copyright by Hayden Co’burn, 2017. All rights reserved. The author hereby grants University of New South Wales permission to reproduce and to distribute publicly paper and electronic copies of this document in whole or in part in any medium now known or hereafter created.


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re:habitat a new mental health approach for urban communities


Authenticity This Explanatory Document has been prepared by myself, Hayden Co’burn as partial fulfillment of the requirements of the University of New South Wales Master of Architecture program. I declare that all work included in this document is my own, unless stated otherwise in accordance with Chicago Manual of Style (16th edition).

re:habitat a new mental health approach for urban communities

Hayden Co’burn 3377204 November 2017

iii


iv

re:habitat a new mental health approach for urban communities


Background and Personal Interest

The second reason is, as I pursue architecture, I wonder what is it that I can do for the field of mental health. On the surface, mental health and architecture can seem at opposite ends of the spectrum. Architecture is the ultimate realisation of the physical form and a very precise science, while psychology/psychiatry is possibly the least understood and most intangible element of human existence and heavily immeasurable. My graduation studio research has stirred a determination within me to explore the relationship between the built environment and mental health, reduce the stigma of mental illness and to improve access to mental healthcare. With the unprecedented global population growth and stresses of urbanisation, I feel that the existing systems need to be contemporised to serve the world more effectively as it evolves or many will suffer. I fear that mental health is not discussed nearly enough and as an ambassador of the built environment I know that architecture has a role to play in promoting mental wellness and social change.

re:habitat a new mental health approach for urban communities

I am heavily engaged in this topic for two main reasons. The first reason is that I have been surrounded by family and friends that have suffered from mental illness my whole life. My mother was diagnosed with severe paranoid schizophrenia before I was born and I have grown up with the truths that become apparent living through this experience. I have seen my mother pass through various forms of mental health care (both formal and informal), and have almost faced losing her many times through some of her more severe episodes. I have seen the harrowing impact of mental illness on her and my family. Since her divorce in 2010, my role as a son transitioned into primary carer for her. Although in better periods of her life she can maintain a level of independence, when she suffers from psychotic episodes, she now needs to be admitted into a mental health clinic. I am very fortunate that she has the appropriate medical insurance that can cover her stays in this place, and I have been there many times to understand the structure of the facilities and the positive effects it has on its patients. I hold its value in high regard; the clinic allows people to stay for weeks and is situated in an urban centre near public transport nodes that allows its patients to maintain a level of independence upon the discretion of the psychiatrists and case workers. Its organisation gifted my mum a much more informal and relaxed relationship with her psychiatrists and my involvement in her recovery was highly encouraged - before and after class I was able to visit and stay for meals, keep her company in the lounges and provided support in therapeutic consultation rooms. I know this was not the case for her and for many others in the past as the traditional model of mental healthcare was and still is heavily institutional, and my mum has accounted for that.

v


Abstract Mental illness strips people of their independence, wellbeing and dignity. There are a variety of mental illnesses that effect one’s capacity to function in society comfortably and carries with it heavy stigma. In 2010, almost 4 million people or 16.8% of the population of Australia experienced some form of mental illness, and it is expected that almost half of people will experience mental illness at some point in their lifetime. Mental illness reduces a person’s ability to live with comfort and purpose, which causes over 2,400 Australians to commit suicide each year, and it is estimated that there are 20 times the amount of attempted suicides.2 Suicide rates within those effected by mental illness are seven times higher than the general population.3 Furthermore, between 20-30% of suicides in the mental health population involve patients that were not admitted to care upon presentation or following a discharge from acute care.

re:habitat a new mental health approach for urban communities

Mental illness is perceived as a chronic stress on society, and is responsible for nearly a quarter of all disability, more than any other cause. People with mental illness also have higher rates of comorbidities, meaning that they also have higher rates of high blood pressure, cancers, diabetes, obesity, respiratory and musculoskeletal diseases.

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A great concern is the 23% of the population (1.7m) of New South Wales believed to have an underlying or undiagnosed mental health problem.6 This can be due to the fear of discrimination (from workplaces, communities, families and friends), lack of sufficient awareness of mental health or unable to navigate the current mental health system. In either scenario, these figures are alarming and will bellow out to larger problems for the health system, the economy, communities and individuals in the near future if not addressed. The World Health Organisation identified that mental illnesses accounts for nearly 12% of the global burden for disease, and by 2020 will account for nearly 15% of disability-adjusted life years (DALY’s) lost to illness. DALY’s are calculated by adding ‘years lived with a disability, injury or illness’ (YLD) and ‘years of life lost’ (YLL) from the life expectancy of the general population. Currently, mental illness accounts for 14% of the impact of all illness in New South Wales, however mental health expenditure accounts for only 8% of the New South Wales Health budget. There is a lack of economic commitment from the government and what is currently being spent is being done so inefficiently. New South Wales has the lowest rate of community care in Australia and has the highest expenditure on hospitals.


This research proposal intends to investigate new models of healthcare (and their architectural manifestations) that establish mental wellness by re-conceptualising traditional systems and reorienting the community based services at the front line and encouraging a more cohesive network of various interventions that can empower an individual to dictate their own path of recovery and diminish stigma around mental health. These models each have unique approaches that have been derived from the individual character and impact of mental health in their communities and can provide insight into the process of place-based approach which is reflective of urban community based health care as opposed to a large formal institution such as a hospital that provides a ‘one case fits all’ approach.

re:habitat a new mental health approach for urban communities

As we look towards an urbanising 2050, Sydney is expected to face an unprecedented population growth of 70% - from 5 million to 8.5 million - due to childbirth and migration. The densification of people in cities has direct links to mental health concerns; doubling the risk of schizophrenia, and increasing the risk of anxiety and mood disorders by 21% and 39% respectively. Crowding, violence, lack of infrastructure and lack of access to sufficient social support accounts for a proportion of this. However, while the traditional model of mental healthcare in NSW still focuses heavily on acute institutionalisation, and is unable to decentralize their provision of mental healthcare services, we will struggle to look after our people adequately. New mental healthcare models around the world prove that the shift away from acute hospitalisation and towards a network of community-based healthcare centres can more efficiently assign resources (such as staff, beds, recovery time and funding) and can promote one’s own mental wellness. The ultimate goal is to move away from ‘treatment’ at the end of a patient’s healthcare journey and towards prevention and intervention – to develop an individual’s resilience by empowering them to be more mindful of their mental health which reduces stigma and is a much more addressable topic in communities.

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We seem divided between an urge to override our senses and numb ourselves to our settings, and a contradictory impulse to acknowledge the extent to which our identities are indelibly connected to, and will shift along with, our locations. Bad architecture is in the end as much a failure of psychology as of design. Alain de Botton The Architecture of Happiness


CONTENTS


01 02 03

SITE ANALYSIS

14

LOCATION ORIGIN DEMOGRAPHY (2016 CENSUS) HOUSING TRANSPORT AMENITY AND DENSITY SUBTERRANEAN CONDITIONS CLIMATE MAPPING SITE OCCUPATION HISTORY CITY OF SYDNEY LEP 2012 REDFERN STREET SPATIAL AWARENESS

16 16 18 20 22 24 26 26 28 30 32 34

INTRODUCTION MICRO - BUS SHELTER BY SEAN GODSELL MESO - THE COMMONS BY BREATHE ARCHITECTURE MACRO - SEATTLE LIBRARY BY OMA PROCESS - BUTARO HOSPITAL BY MASS DESIGN GROUP PRECEDENT SUMMARY

38 40 42 44 46 48

PRECEDENT STUDIES

PROJECT INTRODUCTION & RESEARCH RESILIENCE 100 RESILIENT CITIES MENTAL HEALTH AND RESILIENCE WHAT IS MENTAL HEALTH? IMPACT OF MENTAL ILLNESS WHY REDFERN? DETERMINANTS OF MENTAL HEALTH URBANISATION AND MENTAL HEALTH THE BUILT ENVIRONMENT AND MENTAL HEALTH TRADITIONAL MODEL OF MENTAL HEALTH SYSTEM CENTRAL EASTERN SYDNEY PRIMARY HEALTH NETWORK THE SHIFT IN NEEDS CASE STUDIES THE SYSTEM NEEDS REFORM NEW MODEL OF MENTAL HEALTH SYSTEM OLD VS. NEW RECOVERY HOUSING MODELS RECOVERY ORIENTED SYSTEM OF CARE POPULATION HEALTH APPROACH 7 CONCEPTUAL SHIFTS FOR COMMUNITY MENTAL HEALTH LIVING WELL: A STRATEGIC PLAN HIERARCHY OF NEEDS

36

50 52 52 54 54 55 56 58 61 62 64 66 68 70 72 74 75 76 78 79 80 82 84


REDUCING STIGMA SOCIAL INCLUSION EXPENDITURE ON MENTAL HEALTH SYSTEM MENTAL HEALTH RECOVERY AND SOCIAL HOUSING COMMUNITY MENTAL HEALTH CENTRE CONSIDERING DESIGN FOR MENTAL HEALTH PATIENTS FINDING MEANING IN PLACE THE ABORIGINAL REDFERN THE HUMAN SCALE BIOPHILIA THERASERIALISATION INCLUSIONARY ZONING THE ROLE OF ARCHITECTURE ARCHITECTURAL QUESTION

04

05

CONCEPT MASTERPLAN OF REDFERN STREET THE WALKING CITY WALKABILITY RETRACING THE TRAM BENEFITS OF LIGHT RAIL SITE ANALYSIS: CONNECTIVITY METRO WESTCONNEX LIGHT RAIL COLOCATION: ACCESS, STREETSCAPE AND PERIPHERAL SERVICES SURRY HILLS HIGH SCHOOL AUSTRALIAN TECHNOLOGY PARK (ATP) RENAISSANCE RENAISSANCE OF REDFERN REDFERN STREET URBAN DESIGN GREEN LANEWAY THE CAR YARD THE EXCHANGE THE HOSPITAL THE COURT HOUSE THE CHURCH THE POST OFFICE

FURTHER INVESTIGATION

RACHEL FORSTER HOSPITAL COMMUNITY OBJECTIONS DIGITAL SUPPORT NETWORK RECOVERY COLLEGE CITY EAST BONDI COMMUNITY COLLEGE

CONTENTS

86 87 89 90 92 94 94 96 98 100 102 104 106 108

110 112 113 114 115 116 116 117 117 118 119 119 120 122 124 126 128 130 132 134 136 138

140 142 144 146 148 150


06 07

08

PRELIMINARY MASTERPLAN

158

MASTERPLAN MASTERPLAN: EXISTING MASTERPLAN: DEVELOPMENT MASTERPLAN: PROPOSAL SITE FEATURES RACHEL FORSTER HOSPITAL

160 162 164 166 168 170

FINAL DEVELOPMENT

172

TYPES OF CARE A NEW SYSTEM OF CARE CONTEXT PLANNING A COMPLETE SYSTEM OF CARE GROUND PLANE AXONOMETRIC TYPICAL FLOOR AXONOMETRIC RACHEL FORSTER HOSPITAL GROUND FLOOR RACHEL FORSTER HOSPITAL AXONOMETRIC INPATIENT UNIT TYPICAL FLOOR RACHEL FORTER HOPSITAL INPATIENT UNIT WING AXONOMETRIC RECOVERY COLLEGE PASSIVE DESIGN RECOVERY COLLEGE AXONOMETRIC SHARED HOUSING SHARED HOUSING GROUND FLOOR AXONOMETRIC SHARED HOUSING GROUND FLOOR REAR AXONOMETRIC SHARED HOUSING TYPICAL (FIRST/SECOND) FLOOR AXO. SHARED HOUSING ROOFTOP AXONOMETRIC RETAIL TENANCIES COMMUNITY VOICE RENDERSSSS

BYERA HADLEY TRAVELLING SCHOLARSHIP PROPOSAL RESEARCH METHODOLOGY PRECEDENT SELECTION OVERARCHING QUESTIONS INTERNATIONAL ITINERARY AUSTRALIAN ITINERARY AUSTRALIAN PRECEDENTS INTERNATIONAL PRECEDENTS

BIBLIOGRAPHY

174 174 176 178 180 182 184 186 188 190 192 193 194 198 200 202 206 208 210 212 214 220 222

242 244 246 247 248 249 250 252

256


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SITE ANALYSIS

14

1


murals depicting Redfern’s roots and Sydney’s “ Restored Indigenous inhabitants stand alongside boot repair

re:habitat a new mental health approach for urban communities

shops, barbershops, and burgeoning coffee shops. A tender mix of crumbling walls and creative community preservation ... Redfern’s evolution is in the everyday.

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re:habitat a new mental health approach for urban communities

33° 53’ 36.02’ S 151° 12’ 16.6’ E

16


Redfern is an inner-city suburb located 3 km south of the Sydney CBD. Residing within the Local Government Area of the City of Sydney, Redfern covers approximately 1.2km2 and shares its borders with suburbs that have recently experienced moderate gentrification as well as projected regions of high expected

residential, industrial and commercial growth. Redfern is proximal to various heavy infrastructural links and was established through history as an essential foundation for the development of Sydney railways through the Eveleigh Workshops.

ORIGIN

It is estimated that Redfern was occupied by the Gadigal people of the Eora Nation from around 40,000BC.

The suburb was named after William Redfern, a surgeon who was granted 100 acres of land by governor Lachlan Macquarie in 1817 1. 1

re:habitat a new mental health approach for urban communities

LOCATION

“Redfern, New South Wales�.

17


UK 655

CHINA 446

(5.4%)

NZ 433

(3.7%) (3.6%)

56.2%

43.8% TOTAL 4,411

re:habitat a new mental health approach for urban communities

(36.7%)

18

11,350

12,039

13,213

(2006)

(2011)

(2016)

POPULATION

GENDER

BORN OVERSEAS

10%

(2006)

36.2% 4.3%

SINGLE PARENT FAMILIES

DAILY CARE FOR DISABILITY

(2011)

TERTIARY EDUCATION


The 2011 Census indicated 12,039 residents in Redfern, however the 2016 Census calculated a population of 13,213 – a growth of 9.8%% in just 5 years. This is a substantial rate of growth considering a 6% growth in the 5 years prior between 2006 and 2011.

non-religious, followed by Catholicism at 18.9%.

There is a strong younger population presence in Redfern, with the young workforce bracket (25 to 34) accounting for 27.7% of the overall population. This correlates with a large proportion of the population renting (60.1%) as opposed to purchasing or owning property. Furthermore, the dominant dwelling type in Redfern are a flats, units or apartments (58.3%) as opposed to semi-detached or separate housing. The average household size is 1.92.

The majority of residents in Redfern have a family composition ‘Couple Family, No Children’. There are a considerable amount of one parent families, with a heavy bias towards female single guardians compared to male.

There is a considerable gender bias towards males at 56.2% with only a 43.8% female population. 57% of the population of Redfern were born in Australia, however recent years has seen an increase in population of those born overseas due to the proximity to commercial and educational hubs and increasing medium/ high density residential developments on the fringes of heavy gentrification. 34.5% of the population deemed themselves

In 2011, 36.2% of Redfern had acquired a qualification level of Bachelor or Higher degree, up 10% from 2006.

The predominant marital status of residents is that of ‘Never Married’. There is a full time employment rate of 68.8%, followed by a part time employment of 24.1% of the total labour force, accounting for an unemployment rate of 6.2%. 4.3% of the population of Redfern reported needing help in their day to day lives due to disability. The largest age group needing this assistance is the 20 to 59 year bracket at 34%.

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DEMOGRAPHY 2011 CENSUS

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APARTMENT 3,537

SINGLE DETACHED 401

SEMI DETACHED

OTHER

re:habitat a new mental health approach for urban communities

1,393

20

24

OWNED 3 BEDROOMS

13.7%

20.4% 2 BEDROOMS

MORTGAGE RENTED 58.3%

24.5%

OWNERSHIP

1 BEDROOM 22.3%

NUMBER OF BEDROOMS

45.4%


Occupied private dwellings - 6,579 Average people per household - 1.9 Median weekly household income - $1,447 Median monthly mortgage payments - $2,522 Median weekly rent - $380 Average motor vehicles per dwelling - 0.8 Per the 2011 Census, the greatest growth in housing tenure type was a 6.5% increase in renting – mainly private stock. A substantial 18.7% of housing tenure in Redfern is social housing, due to the various developments throughout the years such as the Waterloo towers and walk-up apartments that are scattered throughout the streets.

92.2% of Redfern’s dwellings are medium or high density. There is also a shift in household type from 2006 to 2011, with a growth in group households (up 4%), lone person households (up 3.7%) and couples without children (up 3.1%). Redfern has a large social housing population which is under threat from the government with plans to redevelop areas such as the Waterloo towers which will displace entire communities that have been established over decades.

re:habitat a new mental health approach for urban communities

HOUSING

21


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CAR 1,616 24.8%

TRAIN 1,375 21.1%

WALK 1,267 19.4%

BUS 846 13%

CYCLE 415 6.4%

TRAM 6 0.1%


Per the 2011 Census, the number of people that drive to work is fairly similar to those who catch the train, most likely due to the proximity of a highly serviceable Redfern Station.

cycleways for commuters. Tram users are a negligible statistic currently, mainly because only one tram line in Sydney is currently in operation and services beyond Redfern’s reach.

Walking is still a very prominent mode of transport to work as most residents may find employment within the suburb. Buses as a means of transport to work are more than double the amount of cyclists, and this could be due to the lack of dedicated

With the emphasis on light rail and improvements of public health through cycling and walking to work, these statistics are expected to reorient and favour walking, cycling and trams in the future.

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TRANSPORT

23


Maslow’s Hierarchy 1

Physiological

Existing Health

Mental

Redfern Health Service

Physical

Redfern Medical Centre

Emotional Food

2

Safety

Spirit

Martian Embassy, St Vincent Catholic Church

Supermarket

Woolworths, Coles, SPAR

Cafe

Yellow Fever, Breadfern Bakery, Three Williams

Restaurant

Pitt Street Diner, Redfern Continental

Fast Food

Dominos, Thai Square, Redfern Night Markets

Free Food

AMS

Community Garden

107 Projects

Sleep

Adequate housing

Yes

Shelter

Single Detached House

401

Semi-Detached House

1 393

Apartment

3 537

Other

24

Homeless Student

Urbanest Cleveland Street Student Accommodation

Airbnb

306

Hostel Hotel

Regent Redfern Hotel, Tudor Hotel Redfern

Emergency Aged

Wyanga Aboriginal Aged Care, Annie Green Court

Disabled Removal from Danger

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3

24

4

5

Belonging

Esteem

Self-Actualisation

Police

Redfern Police Start (Aboriginal Unit)

Ambulance

Redfern Ambulance Station

Fire Station

Redfern Fire Station

Dining / Bars

The Tudor, The Woolpack, Bearded Tit, Norfolk

Free Amenity

107 Projects, Tudor Comedy

Community Interaction

107 Projects, NCIE

Affection

Relationships Encouraged

Yes

Community

Library

Social

Respect

Community Centre

Redfern Oval Community Hall

Men’s/Women’s Groups

Babana Men’s Group, Mudgin-gal Women’s Group

Indoor Recreation

NCIE, Redfern Community Centre

Outdoor Recreation

NCIE, Redfern Park,

Religious

St Vincent Catholic Church

Entertainment

Actors Pulse, Tudor Comedy, 107 Projects

Arts

Aboriginal Dance Theatre, 107 Projects

Memorial

Redfern Park World War I, Mum Shirl

Help

Department of Human Services

Discrimination Free

Redfern Legal Centre

Confidence

Neighbourhood Service

Redfern Neighbourhood Service Centre,

Individual Potential

Preschool

SDN Redfern Children’s Education & Care Centre

Primary School

Jarjum College

Training Facilities

NCIE

Sport

NCIE, Redfern Park, Souths League Club

Necessities

Comm. Bank, Western Union, Convenience Stores

Other

Australian Copyright Council

Table used with permission from authors. Georgette-Crick et al., Site Analysis & Precedent Studies: Redfern Resilient Neighbourhood M.Arch Social Agency Studio.

Absent


Community Facility

Population Threshold

Fulfilled

Local Shops/Corner Store

800 - 1,000 dwellings

Small Neighbourhood Activity Centre

1,200 - 4,000 dwellings

N/A

Large Neighbourhood Activity Centre

4,000 - 10,000 dwellings

Community Health Centre

8,000 - 12,000 dwellings

Primary School

1,200 - 5,000 dwellings

Secondary School

8,000 - 10, 000 dwellings

Train Station

10,000 - 12,000 dwellings

Civic Centre

12,000 - 48,000 dwellings

N/A

• N/A

AMENITY & DENSITY STUDY

Analysis of existing services in Redfern through the lens of Maslow’s hierarchy of needs paints a picture into the values and priorities that the community holds. It can inform future investigations into the built and social environments that make Redfern unique as well as what are its weaknesses. Table used with permission from authors. Georgette-Crick et al., Site Analysis & Precedent Studies: Redfern Resilient Neighbourhood M.Arch Social Agency Studio.

re:habitat a new mental health approach for urban communities

According to the ‘Shall We Dense’ document as produced by SJB Architects, Redfern has provided adequate amenity for a suburb of 579 dwellings.

25


1.2 - 3.0 METRES

GROUNDWATER

2.5 - 4.9 METRES

SHALE/LAMINITE

7.9 - 14.0 METRES

SANDSTONE

11.7 - 17.3 METRES

114 ra Mean

22

Mean m a

infall

98

x. temp .

82

p. in. tem

66

18 m Mean

14

50 10 34 6 18 2 2

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Graphics used with permission from authors. Georgette-Crick et al., Site Analysis & Precedent Studies: Redfern Resilient Neighbourhood M.Arch Social Agency Studio.

Sep

Oct

Nov

Dec

Rainfall (mm)

26

Temperature (oC)

re:habitat a new mental health approach for urban communities

0.3 - 1.2 METRES

SILTY CLAYS

130

CLIMATE ZONE 56 / SYDNEY EAST 26

TOPSOIL AND FILL


The soil conditions in Redfern provide insight into the potential of suitable construction details and possible future subterranean design opportunities.

CLIMATE

Future climate change predictions for the south east coast of Australia: • Average temperatures will continue to increase in all seasons (very high confidence). • More hot days and warm spells are projected with very high confidence. Fewer frosts are projected with high confidence. • Decreases in winter rainfall are projected with medium confidence. Other changes are possible but unclear.

• Increased intensity of extreme rainfall events is projected, with high confidence. • Mean sea level will continue to rise and height of extreme sea-level events will also increase (very high confidence). • A harsher fire-weather climate in the future (high confidence).

re:habitat a new mental health approach for urban communities

SUBTERRANEAN CONDITIONS

27


1AM

2AM

3AM

4AM

5AM

RETAIL/BUSINESS DINING / BARS RESIDENTIAL PUBLIC 107 PROJECTS COMMUNITY TRANSPORT

Graphics used with permission from authors. Georgette-Crick et al., Site Analysis & Precedent Studies: Redfern Resilient Neighbourhood M.Arch Social Agency Studio.

6AM

7AM

8AM

9AM

10AM

11AM

12PM


1PM

2PM

3PM

MAPPING SITE OCCUPATION

4PM

5PM

6PM

7PM

8PM

Redfern Street is lined with various food/ drink places and small scale retail tenancies which establish a strong street presence during normal work hours. In the evening

9PM

10PM

11PM

12AM

however, the character dulls and is dependent on the livelihoods of the Tudor Hotel and 107 Projects to inject life and culture into the streetscape which is otherwise


re:habitat a new mental health approach for urban communities 30

40 000BC

REDFERN OCCUPIED BY CADIGAL PEOPLE OF EORA NATION

1788

BRITISH ARRIVED - SMALLPOX EPIDEMIC

1825

REDFERN LAND GRANT ISSUED TO WILLIAM REDFERN

1840’S

EVELEIGH HOUSE BUILT, REDFERN ESTABLISHED AS INDUSTRIAL SUBURB

1878

EVELEIGH TRAIN STATION BUILT (NOW REDFERN TRAIN STATION)

1906

EVELEIGH TRAIN STATION RENAMED REDFERN

1920’S

LARGE INFLUX OF INDIGENOUS AUSTRALIANS TO REDFERN

1940’S

PROTEST OF WORKING CONDITIONS IN REDFERN

1942

REDFERN ALL BLACKS FORMED

1967

NATIONAL REFERENDUM PROVIDING RIGHTS FOR INDIGENOUS

1970

ESTABLISHMENT OF ABORIGINAL LEGAL SERVICE

1971

FRED HOLLOWS AND MUM SHIRL RUN ABORIGINAL MEDICAL CENTRE

1971

FATHER TED KENNEDY WELCOMES INDIGENOUS TO ST VINCENT CHURCH

1972

ABORIGINAL HOUSING COMPANY STARTS ACQUIRING LAND - THE ‘BLOCK’

1982

NSW ABORIGINAL-POLICE LIASON UNIT SET UP IN REDFERN

1984

EORA ARTS CENTRE ESTABLISHED IN REDFERN

1992

PM PAUL KEATING MAKES REDFERN SPEECH ADRESSING INJUSTICE

2004

REDFERN RIOT DUE TO DEATH OF TJ HICKEY

2008

‘SYDNEY 2030’ VISION FOR EORA JOURNEY

2011

107 PROJECTS MOVES INTO DECOMMISSIONED CAR GARAGE

2013

JARJUM COLLEGE OPENS

2014

SOUTH SYDNEY RABBITOHS WIN NRL GRAND FINAL

2014

TENT EMBASSY RESISTING ‘THE BLOCK’ REDEVELOPMENT


The history of Redfern can be described as turbulent and full of tension throughout stages of its growth. Counter to this, there have been excellent examples of times where individuals or entire communities have banded together to stand for justice

and for the betterment of their society. The Indigenous community has been negatively typecast in the media through its history but it is essential to understand their needs as the original custodians of the land, and become responsive to their beliefs.

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HISTORY

31


Lane

3

4 2

3 Ea t

2

Redfern

2

2

Street

2

2

2

2

Boronia

2

Boronia

2

Street

2

3

Telopea

Lane

Street

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Street

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Denha m

3 3

Little

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Place

Ridge

3 2

Thurlow

Street Stanley

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Burdekin

Place

3

3

3

3

2

Street

2

2

Lane

2

Lane

Street

Street

Place

Alexandria

Lane

2

Street

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Street

2

2

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Street

Redfern

Charles

Street

2

Cleveland

3

2

Charles

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3

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Parkham

Street

Lane

Ridge

Victoria

3

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Austin

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Chapman Lane

Lane Kendall

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5

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Street

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Str

Mary

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Street

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Austin

Street

Little Stanley

Street e

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Richards

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Chalmer

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R

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Sheas Lane

Bucking ha

Terr Lan y

Street

Street

Street

Edgely

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on Nicks

Collins Alexandr ia LaneLane

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Lane

Elizabeth

Great

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Lane Austin

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CITY C Street

n Street

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en

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Baptist

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n

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Clevela nd Street

Edgely

ee

ee

Cleveland

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4

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2

3

2

t

Str

s

Mort Lane

2

The allowable height for the site is 3 - 4 storeys.

ee

ne

2

2

Lane

3

Hannam

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Nobbs

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et

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2

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Prospect

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t

Place

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2

2

BUILDING HEIGHT

Lane

Street

Street

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2

Cleveland

4

Young Lane

3

Lane

2

Ridge

Nobbs Lane

2

3 2

Car t more

5

2

Str

Redfern

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r

2

5

2

Be

2

t

3

Street

4

1

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M

4Street

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3

2

Street

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2

4

6

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3

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Pla ce

Matterson Lane

n

3

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Street

2

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Little

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Str eet

Street

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4

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Dawson

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3

2

4

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1

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4

3

Hastings Lane

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3

2

Ma

es

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2

Clevelan d

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4

Str eet

3

2

ristie

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Ch

8 2

3

Street

Avenue evAve elanue nd Street

4

6

ce

4

Street

Benne tt

Boronia

Street

Esthe

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Street

Pla

Ph

et

es

Lane

aux

B

Street

Brumby

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Street

3

t

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4

Wilsh ire

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odlet

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Street

et Str e Sheas Lane

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RichardCl s

rs

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de

Collins

2

2

3

3

2

3

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Str

t

Morehead

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Burnett Lane

Reservoir

4

3 2

or

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Street

Street Str e

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Withers Place

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2

2

2

es

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Ea t

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5

elp s

Stre et

Street

4 Mil

ne

s

3 2

4 et

eet

Street

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Street

6

6

Str

do w

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ys

4

2

Street

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Stre

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Street

Thurlow

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Redfern Lane

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Hill

Mar

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Str

6

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Short

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9

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2

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info

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ford

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4

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Street

Alexande r Lane

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Church Ln

Boronia

Place

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3

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3

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1

Albion

Street

3

Street

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2 Lane

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Street

Young Street

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Lane

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Arthur

Street

4

2

Crown

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2

Little

William

3

3 Str eet

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2

Wells

Pla

Street

Street

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2

es

Street

6

2 2

2

3

Young Lane

Street

Victoria

Str eet

3

2

t

4

Collins

Riley

Street

Short

2

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Str eet

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3

2

7M

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Bea

more

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8

nd

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Str

Street

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Street

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ton

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Lane

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Street

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4

La ce y

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er

6

Street

Hart

lt Ho

Street

Cope Stre et

Street

3

Sophia Lane

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Street

Pla ela ide Ad

William

Young Little

Place Wade

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Ma rlbo ro

Street

Wa terl oo

Street

Street

Street George

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S Street treet

Uth

Centre

Elizabe th et

Stre Street

Lane Elizabeth

Str eet

2

3

ee t

Str

le nd

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Jesson

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Street

Str

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Place

y Street

Chalme

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Street

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t

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Little

He

Lee

Street

ton

Wil

Street Victoria Batman Lane

Street

Street Renwick

Beauchamp Lane

mon Com

Street Renw Str Perry ick Street eet

Be

ne

Morehead

Street

Regent

Mar y La

Street

Woodburn

Clevelan d 2

2

4

3

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Crown

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St

Bel

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levu

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ee

t

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ce rd Pla Crawfo

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t

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Str

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AvRil eney ue Clevela nd

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Pla

ce

Street

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mon Com

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rs

ugh

ela ide

Ad

Ste el

William

Riley

Str ee t Batman Lane

Ma rlbo ro

Street

Wa terl oo

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Hart

Street

Young Little

e

Sq u

t

Str ee

t

St ree

nt

ge

lt Ho

Stre

et

Street Centre

Stre Lane

ee t

Chippen

Str

Cope Str eet M

Little

Street

Street

Street

Street Perry Street

Lane Elizabeth

East zro

Street Tud

e Str

et

Mary Street

S Street tre Street ne

Mar y La

Morehead

Clisdell

Terry

Str eet

les rcu He

ton

Wil

Street lt

Ho

Street

t

Victoria

Str ee

Ma ry Street

Street

Street nwick

George

ar

Street

t

Perry

ge n

AY

Re Street

Centre

Lane

RegentRe Street

Chippen

Street

Street Str Streeet et

Renwick Perry

Street

3

6 5

6

Ra

Street Rutland

2

St r ee

e

Lane

Matterson Lane

Jesmo

3

Fit

Arthur

5

4

>15

Street

3

5

2

5

7

Dalley Lane

Pitt

Redfern

2

3

Turner

Street

7

Withers

Tudor

Stanley

Jones

2

2

La Turnner sd ow n

Street

4

2

ne

2

3

2

4

el La

Lane

t

Collins

4

2 Stree t

Boronia

Lane

4

2

Street

2

6

3

3

4

4

Str2eet

Lane

3

Redfern

Ste

3

Street

2

t

Lane

et

Esther Lane

Lane

Str eet

Ann

8

Redfern

2

t

Jones

odle

Co

reet

3

Street

4

Street

2

Street

2

Macke y

10

2

3

2 4

Turner

3

Centre

Elizabe

Street Bucking ham

rs

h Lane

Chalme

3 4

5

et

3 2

4

2

ne

Lane

5

3 3

Goo dl

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ide

Street

Little Smith Street

Jones

2

Redfern St

3

3

3

Str ee

Chr istie

t

Stre

Redfern

Str ee

Street

es S

es

d

Alb Stre et ion Str ee t

ford

nu e

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Street

Telopea

The site is deemed as ‘detracting’ to the City of Sydney.

2 Go

3

3

Go

Be

Ad ela

Wells

Street

4

4

Street 4

ee

3

3 3

Buckingh am

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Short

4

2

3

2

4

Street

5

Street

t

2

Redfern

4

6

2

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Go

Street

4

3 3

4

Mary

Street

Buckingh Chiam ppen

e nt

Street

R eg

ary

Street

3

2

Mil

Street

ne

Lane

BUILDING CONTRIBUTIONS

Great

William

2

8

6

3

2

eet

Str eet

2

5

2

r

Gla Wells St dsto ne Str

2

Street

m

7

Little

Pembro ke

6

2 3

6

2

et

Street

3 2

Wells

George

Street Renwick

2

3 2

Street

4

Turner

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Castlereag

3

Street

Burnett

2

3

Str

eet

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Av e

Jesmon

Bedford R ain

Davi

Lane

Street

Str eet Street

East

Lane

2

Street

5

ee

Little Albion Street

3

Belvoir

2

4

4

7

6

3

Street

3

Street

2

4

8

2

3

2

Street

Stirling

Wells St

6

Buckingha

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Str

RedfBrumb ern Laney

Str

4

Wa y

6

2

tt

Dawso Projection: MGA Zone 56 n Street 7 GDA94 Datum: Paper Size: A3 Prepared By: SPUD 6 Date: August 18, 2015 Printing File: SDCP2012_BC.mxd 4

6

6

Bu

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200 m

per

Street

6

Street

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6

4

6

4 2 Ann

7

8

6

6

Street

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6

Str

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The site is deemed as a ‘Local Centre Area’. So phia

8

7

4 8

10

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6

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Street

4

3

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4

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Redfern St

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R IRCLE

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8

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Scale: 1: 5,000 at A3

Street

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are

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Street

Chalmers

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‘New vehicle access is not preferred’ along Redfern Street. ge n

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3

6

Clevelan d

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Albert

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Street

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PEDESTRIAN PRIORITY

Woodburn

rs

Chalme

Street William

Street

Street

Regent

Jones

4

8

t ee

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3

023

Lane

Street

011

Street

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3

017

Copyright ©2015 City of Sydney Council, All Rights Reserved Copyright ©2015 Land and Property Information, All Rights8 Reserved. This map has been compiled from various sources and the publisher and/or contributors accept no responsibility for any injury, loss or damage arising from the use, error or omissions therein. While all care is taken to ensure a high degree of accuracy, users are invited to notify Council’s GIS nerdiscrepancies. No part of this map may be Group of anyTur map reproduced without written permission. Street

Street

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re:habitat a new mental health approach for urban communities

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Queen St

2 Re dfern St

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Street

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Gla

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Street

Street

O'loughlin

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Street

Street We llington

2

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9

Wells St

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Burnett Street

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Street

12

14

Pitt

e

ar Sq u

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Street

Woodburn

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12

4

Street

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De Outram Street vo n shirArth e u

2 ioeet Stre n Set tre Redf et ern StDaws 2 on Street

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Chippen Street Street

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Street

Bucking ha

m

e Pembrok

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Street

William

Regent

14

Street

ent

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8

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Street

Redfern Lane

Av e

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2

St r ee

Street

e

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ur

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15

Reg

3

7

Street

Woodburn

Street

Street

St r ee

et

Stre

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Renwick

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Street

Chippen

Street

Chippen

R eg

Street

e

r

ent Reg

Dwye

Redfern

Lane

Square

Redfern Alb Str

00 m

A continuous awning is required of the site.

Lawson

Re

ge

Re

et Stre Street

Pl Regent

Avenue

Chippen Cope Str eet

Dale

e nt

6

Lane

lanc

Av en u

Art h

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Street

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t

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Bu

n

Lawson

Street

e

Street Am bu

Lane

Albert

Matterson Lane

Street Ph elp s

Chisholm

Ave nu

Str eet Be

Street

Street Ed

Lane

Street

Street

e

Ed dy

Turner e

ne

Cleveland

Street

ay

Albert

y

Stree

t

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La ne

Street

Clare

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Street Street

so n

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Ambu

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Ra FOOTPATH AWNINGS AND COLONNADES

3

et

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Ra w

Alexande r Lane

Rutland

Car t Street

Tudor

ie

Street

Maiden

Av en u

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Jones

dw a

Goo dl

Stree

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Str eet

Wa y

Ann Arthur

att

Chisholm

dy

ion

ion

Lane

Street Flinders

Bijo

t

Stree

Withers

Be

Arthur Lane

Ed

Alb

Albion

Street

O'loughlin

La ne

ide

Street

Maiden Ln

Street

Broa

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Street

Redfern

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ap

ie

Street

Bedford

ne La

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Stre

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Street

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Collins

Little Smith Street

Street

Street

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Redfern St

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Street

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Conservation Area - General (for information) Land excluded from this DCP

Street

Wells St

Str eet Ann

ne La

Bijo

So phia

Stree

Square

Lane

Street

e

Str ee

Street

Redfern

aux

Chr istie

The street frontage height of the site is 2 storeys. Be

Neutral

Queen St

Short

eet

eet

Str eet

t

Redfern

Street

Lawson

Meagher

Street

Street

Fov e

pax

Goold

Henrietta

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S

et tre

dle SRtarne et

Street

Lane

Boronia

Detracting

Short

Queen

BelvoirKip

ee

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BUILDING STREET FRONTAGE HEIGHT y dw a

Contributing

Stirling

Street We llington

Street

per

Wells Valent in

e

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Turner

Street

ington

Street

Wellington

t

Redfern St

Dawson

Kens

Outram

StreCITY CIRC et LE RA ILW

Lane

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Chalmer

s

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gh Lane Castlerea

Great

St Street Burnett

ua Sq

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Elizabeth

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t

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The LEP 2012 deems Redfern Street as anLegend active frontage. Street

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ope r

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Street

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ee

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Redfern Lane

Str eet

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Str

nd

eet

Little

Str eet

et

Albert

nd

Street

Str dsto eet ne

e O'loughlin Str

et Stre

Clevela

Street

Building contributions map Sheet 016

Lane

e

Square

eJeam t es Gla

Street

rris

Street

Lawson

St r

DeStreet vo n shir A e rthur

Ha

Turner

et

Street Woodburn

Bedford

Av Queen en u

ion

Street We llington

dy

Henrietta

Street

Stre

Goold

Jones

ACTIVE FRONTAGES

e

Street

Ed

ent

et

Re g

Stre

r

Meagher

Sydney Development Control Plan 2012

Ave nu

y

Little

Dwye

Ambu lanc e

R Redfern

ent Re g

R eg

t

Cope Str eet

ee

d

d Broa

Street

wa ai l

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ington Kens

.

Turner

Str

ap

Redfern St

Street

C Reservoir oope r Street Outram

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Str

ne La

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Wells

Wellington

et

Uth er

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Chippen

Wells St

Square

e

t

Arthur Lane

Redfern

William

ou Bij

Av en u

Rutland

ne La

Queen St

Street

as

Street

rris

Regent

Street

Ed dy

rs

Street

et

ee t

Street

Lawson

Meagher

Short

Ha

Str

Henrietta

Street

Lane

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Street

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Land excluded from this DCP

Street

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eet Street

Local Centre Areas

Outram

020 No Information

Late Night Management Areas

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The 2012 LEP indicates certain expectations of the current and future uses of the site. Of main interest is the preference for no new vehicle access along Redfern Street due to a desire to maintain a certain amenity for its pedestrians and maximise active frontages rather than roller doors and ramps to basements. The site is deemed a Local Centre Area which entails a large focus on community gathering and participation in this region.

re:habitat a new mental health approach for urban communities

CITY OF SYDNEY LOCAL ENVIRONMENT PLAN 2012

33


REDFERN PARK

ENTERTAINMENT AND TURNER LANE DAY MEDIA ARTS ALLIANCE GP02 GP03

GP01

REDFERN STREET TERRACES GP04

HARDWARE STORE GP05

PITT STREET TERRACES GP06

THE A

GP07

SITE

NIGHT

DAY

DAY

ACCESS/INCLUSION SCHEMATIC NIGHT

SPATIAL OBSERVATIONS

ACCESS

INCLUSION

NIGHT

ACCESS REDFERN PARK IS ACCESSIBLE 24 HOURS PER DAY. DURING THE DAY THE PARKS ACCESS AND INCLUSIVITY ARE CLOSELY POSITIONED. HOWEVER, AT NIGHT THE PARK IS SIGNIFICANTLY LESS INVITING AND SAFE; DESPITE THE FACT THAT THE ACCESS REMAINS THE SAME.

THE MEDIA ENTERTAINMENT AND ARTS ALLIANCE IS LOCATED ON THE CORNER OF CHALMERS AND REDFERN STREET. THE BLOCK IS INSULAR WITH WHITE WALLS AND SECURITY WINDOWS BUTTING UP AGAINST BOTH STREETS. THERE IS VIRTUALLY NO RELATIONSHIP BETWEEN THE BUILDING IN STREET APART FROM A SMALL BALCONY OVERLOOKING REDFERN.

INCLUSION THE TERRACES ON REDFERN STREET BETWEEN CHALMERS AND PITT STREET HAVE A CONSISTENT BUILT FORM AND STREETSCAPE. THE GENEROUS FRONT YARDS WITH SUBSTANTIAL PLANTING CONTRIBUTE TO THE ENGAGING STREETSCAPE AND PROVIDE FOR INTERACTION BETWEEN RESIDENTS AND PEOPLE ON THE STREET.

TURNER LANE IS A NARROW ONE WAY LANE THAT RUNS PARALLEL TO REDFERN STREET. THE STREET IS FLANKED BY SMALL SIDEWALKS WITH IMMEDIATE FRONT BOUNDARIES MEETING THE PUBLIC SIDEWALKS.

THE HARDWARE STORE ON REDFERN STREET HAS HAD THE SAME OWNER FOR OVER 48 YEARS. THE WEATHERED BUILDING FACADE ILLUSTRATES THE HISTORY OF THE BUILDING AND STORE. THE STORES FACADE AND LAYOUT ARE DISARMING, THE APPROPRIATENESS OF THE BUILDING IN ITS CONTEXT ENCOURAGES THE PUBLIC TO ENTER AND INTERACT.

THE PITT STREET TERRACES ARE 50 METERS FROM THE JUNCTION OF REDFERN AND PITT STREET. DESPITE THE PROXIMITY THE PITT STREET TERRACES ARE REMARKABLY DIFFERENT TO THE TERRACES ON REDFERN STREET. RATHER THAN A GENEROUS FRONT YARD WITH PLANTING THE PITT STREET TERRACES ARE ELEVATED FROM STREET LEVEL. A LACK OF LIGHTING AND FOOT TRAFFIC AT NIGHT CONTRIBUTE TO THE RELATIVE UNWELCOMING ATMOSPHERE.

SPATIAL CONFIGURATIONS

GP09

GP06

GP03

GP07

GP05

GP04 GP01 GP02

THE ALCHE ON A HIGH TO THE T THAT THE PEDESTRIA


0 METERS ERN AND IMITY THE MARKABLY REDFERN US FRONT T STREET M STREET ND FOOT TO THE HERE.

THE ALCHEMY

THE TUDOR

GP07

GP08

THE ALCHEMY DEVELOPMENT IS WELL LIT AND ON A HIGH TRAFFIC STREET. THE PROXIMITY TO THE TUDOR AND 107 PROJECTS MEANS THAT THERE IS TYPICALLY A NOTICEABLE PEDESTRIAN PRESENCE AT NIGHT.

THE TUDORS OPERATING HOURS, LOCATION AND LACK OF COMPARABLE VENUES WITHIN EYE SIGHT MAKE IT ONE OF THE ONLY SITES WITH A HIGHER EVENING ACCESSIBILITY. THE TUDOR IS LESS INCLUSIVE THAN IT IS ACCESSIBLE AS THERE IN AN EXPECTATION THAT YOU WILL PURCHASE DRINKS OR FOOD. FUTHERMORE THE LACK OF DIVERSE ACTIVITY CREATES A MONOCULTURE.

REDFERN HEALTH SERVICES GP09

THE OLD COURT HOUSE IS A VISUALLY STRIKING BUILDING THAT IS PROMINENT ON REDFERN STREET. THE GRAND ENTRANCE IS INSET INTO A FOYER AND FORMS A SPATIAL DISCONNECT BETWEEN THE STREET AND THE HEALTH SERVICE. ONCE THE PUBLIC HAS ENTERED INTO THE FOYER THE RELATIONSHIP IS BROKEN DOWN AND THE STAIRS BECOME AN INFORMAL SITTING PLACE .

107 PROJECTS

AMS JUNCTION

POST OFFICE

CENTRELINK

GP10

GP11

GP12

GP13

107 PROJECTS IS THE MOST ACCESSIBLE BUILDING IN REDFERN. THE BUILDING IS SET BACK FROM THE STREET AND DOES NOT ADVERTISE A PUBLIC PRESENCE. PEOPLE HAVE REMARKED THAT THEY HAVE OVERLOOKED 107 PROJECTS DESPITE LIVING IN THE AREA FOR YEARS.

DESPITE THE COMMUNITY FUNCTIONS OF THE ABORIGINAL MEDICAL CENTRE, THE JARJUM SCHOOL AND THE ST VINCENT DE PAUL CATHOLIC CHURCH THE OBVIOUS PUBLIC ACCESSWAY THAT CONNECTS THE THREE BUILDINGS IS NOT NATURALLY ACCESSIBLE TO PUBLIC ON THE STREET. THE SMALL GATED ENTRANCE IS SET BACK AND ALLOWS FOR A SEMI PUBLIC TRANSITIONAL SPACE BEFORE ENTERING THE AMS.

HERITAGE BUILDING IS ENGAGING WITH STREETSCAPE AND OFFERS A SMALL PORCH FOR SHELTER. DKO ARCHITECTS OFFICE DOES NOT ENGAGE WITH THE GENERAL PUBLIC.

CENTRELINK IS BY NATURE ACCESSIBLE. THE BUILDING AND ITS PROGRAM DO NOT WELCOME OR ENGAGE CLIENTS BEYOND THE PROVISION OF SERVICES.

GP12

GP11

GP10

GP13

GP08

SITE ANALYSIS - REDFERN STREET SPATIAL AWARENESS


36

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PRECEDENT STUDIES

2


re:habitat a new mental health approach for urban communities

“

“ Architecture can be a transformative engine for change.

37


38

PRECEDENTS

re:habitat a new mental health approach for urban communities


The Commons

Seattle Library

Micro (1:20)

Meso (1:200)

Macro (1:500)

Program

Urban

Residential

Public

Resilience Methodologies Compact City

Self Reliant Green City

Smart-Networked City

Focus

Dignity, Adaptive Re-Purpose, Social Caring, Creates Worth

Community, Interdependence, Self Reliance, Affordability, Transparency, Sustainability

Cultural, Accessible, Programmatic, Adaptable

Description

Dense urban form, variety and concentration of land use, infrastructure, buildings and services.

Integrated bio-region, residents live in City utilising lastest technology, hub harmony with nature with food and energy of highly connected IT systems and are supplied locally. globally networked society.

Cost

AUD $3 000

AUD $20 million

AUD $220 million

Key Points

• Utilises existing infrastructure that is under utilised. • Provides basic shelter for rough sleepers • Re-defines public infrastructure as an inclusive piece of public domain • Free • Retains the market values and optimisation of the bus shelter • Cheap and micro • Empowers users and promotes ownership • Gives a public face to hardship • Creates a 24 hour infrastructure

• Pedestrian oriented city • Hierarchy of materials that promote environmental and thermal outcomes in the building • Community consultation and input across the entire project • Community centric design with an emphasis on shared gardens and communal facilities to promote interaction • Numbers limited to encourage creation of relationships within the project • Proximity to public transport to allow development to be positioned in inner suburbs

• Last free space in Seattle during the rain • Form dictated by program. The architect is not subject to form, rather work develops through program and understanding of brief • Studied existing use and practice and reimagined the library model • Added a public element to the ground floor • Accessibility for users • Promotes culture and community

re:habitat a new mental health approach for urban communities

Bus Shelter House Scale

Table used with permission from author. Georgette-Crick et al., Site Analysis & Precedent Studies: Redfern Resilient Neighbourhood M.Arch Social Agency Studio.

39


40

MICRO

re:habitat a new mental health approach for urban communities


8AM

12PM

4PM

8PM

12AM

RETROFITS EXISTING INFRASTRUCTURE The bus shelter house uses a pre-existing bus shelter design that can provide shelter for a rough sleeper during un-utilised hours. Shelter is a basic human need, providing basic emergency accommodation within existing infrastructure frameworks could seek to ensure that the most needs of individuals who are experiencing sudden homelessness or displacement are met.

BUS SHELTER SEAN GODSELL

TRADITIONAL FUNCTION RETAINED The bus shelter house model is designed to allow the pre-existing operational and advertising functions to continue unimpeded. The privacy screen is embedded within the bench and emergency packs are stored in the advertising hoarding. Revenue from advertising is preserved and transport services operate as usual. The ability to retain existing services and financial production is essential as it will encourage business and government to invest in dual development proposals.

REDEFINES THE USERS OF PUBLIC SPACES The emergence of ‘defensive architecture’ and ‘anti-architecture’ in public transport hubs is as ubiquitous as the public infrastructure. The bus shelter house reinstates the homeless as a welcome user. The shelter promotes a sense of dignity and communal resilience against the negative outcomes of homelessness. The project also puts the issue of homelessness front and centre. The issue cannot be detached from the public which leads to greater awareness of and public interaction with the homeless.

The bus shelter house is part of a series of prototypical housing, developed by Sean Godsell. The housing prototypes were developed as a response to homelessness and displacement. The bus shelter house argues for a compassionate adaptive re-purposing of existing infrastructure. As the name suggests, the bus shelter house operates as a bus shelter during the hour’s public transport is active and converts into an emergency overnight accommodation during the hours in which the bus stop would otherwise be underutilized. Graphics used with permission from author. Georgette-Crick et al., Site Analysis & Precedent Studies: Redfern Resilient Neighbourhood M.Arch Social Agency Studio.

DEVELOPS ON ESTABLISHED PATTERNS OF USE Bus shelters provide a source of refuge from the elements, a place to rest and a landmark at which to meet. The bus shelter house looks to build upon and expand the notion of shelter as refuge.

The advertising hoarding is retained and again given a dual function; emergency packs can be stored for those in need. The bus shelter house was selected as our micro precedent because it re-imagined an existing infrastructure as an opportunity for promoting resilience and care. The precedent has encouraged us to look for the microopportunities on the site that present an opportunity to be adapted or reinterpreted to meet the community’s needs.

re:habitat a new mental health approach for urban communities

4AM

41


42

MESO

re:habitat a new mental health approach for urban communities


SHARED GARDENS Shared gardens with each unit having its own productive garden plot. SHARED LAUNDRY A shared laundry helps to eliminate cost as well as creating an additional communal space for residents to interact. STREET ENGAGEMENT Car spaces have been eliminated, replaced with a bike garage. This allows a commercial space to engage with the street instead of a garage entrance. BIKE PARKING 70 bike parking spaces have been provided to residents as an alternative to car parking.

LIGHT WELLS The inclusions of light wells and stepped facade allows every unit to have cross ventilation, this combined with passive solar design elements such as rain chains and exposed thermal mass eliminates the need for air conditioning. PEDESTRIAN FOCUS Proximity to public transport links enables the elimination of car parking – this helps drive a pedestrian focused design

COMMUNITY CONSULTATION Community consultation and input across the entire project to understand what the residents really want to deliver an end product that best serves the community.

AFFORDABILITY

THE COMMONS - BREATHE ARCHITECTURE

TRANSPARENCY

SUSTAINABILITY

The Commons was designed to be a moderated response to the two speed housing economy; with high rise towers being constructed within 1km of the city and single dwellings 30km or more from the city causing rapid urban sprawl. The Commons was seen as a median between these two less than ideal development models. The building was conceived as having a triple bottom line, that of sustainability, liability Graphics used with permission from author. Georgette-Crick et al., Site Analysis & Precedent Studies: Redfern Resilient Neighbourhood M.Arch Social Agency Studio.

DELIBERATIVE DESIGN

COMMUNITY CONTRIBUTION

and affordability. This was seen as a deviation from the typical developer lead project with a sole focus on profitability. The triple bottom line was achieved though the removal of elements the architects deemed unnecessary such as basement car parking, tiles, chrome fixtures. It also emphasised strong passive solar design elements such as rain chains, large thermal mass and cross ventilation in all apartments.

re:habitat a new mental health approach for urban communities

ACOUSTIC SHIELDING Acoustic shielding and double glazing along the rail corridor helps insulate the building from noise.

43


44

MACRO

re:habitat a new mental health approach for urban communities


COMPARTMENTAL FLEXIBILITY By a thorough assessment of the existing program and designing for an unknown future, the book spiral allows for the expansion and contraction of media in relation to the Dewey decimal system. The gradient of the book spiral is determined by the need to provide universal access for disabled and abled alike.

MASSING Orient massing to establish contextual relationships. The mixing room and meeting spaces canter towards Elliott Bay to provide a connection to the landscape beyond urban Seattle. PLAZA The volumetric massing of the Seattle library program provided opportunity to improve public outdoor amenity in the form of a plaza which absorbs the slope of the site.

COMMUNALLY RATIONAL DESIGN The design process was extracted through the collaboration of various parties and was counter to the idea that architecture must have an ‘author’ with a distinct signature. The form was derived purely by the programs’ desires and contextual cues.

PUBLIC AMENITY The understanding of the public library as the last vestige of public free space prompted the consideration of the ‘living room’ , an extension of the city and a safe haven in the Seattle rain.

HQ READING ROOM SPIRAL MIXING CHAMBER MEETING

PARKING

SEATTLE LIBRARY - OMA

Seattle library challenges the high modernist idea of flexibility that occurs by designing a space so generic and open to house a future use, the space itself becomes defunct and cannot fully provide for its users and programs. The concept of compartmental flexibility considers the unknown future use and segments the program to allow for the growth and decline of elements in response to a rapidly changing social and media environment.

LIVING ROOM KIDS

storage and service of media, whilst two thirds were provided to the greater community for social functions. This understanding of a buildings functions and interactions with its users enabled a hyper-rational response to the brief by visualising volumetric masses to serve Seattle. These volumes were largely carried through as first principles to derive a form that is detached from the traditional role of an architect as an author with a distinct signature.

As a contribution back to the urban landscape Through precise analysis of the existing use of of Seattle, the ‘living room’ at the ground the library, it was directly evident that only floor becomes the last vestige for citizens and one third of the library was dedicated to the provides a truly free public space. Graphics used with permission from author. Georgette-Crick et al., Site Analysis & Precedent Studies: Redfern Resilient Neighbourhood M.Arch Social Agency Studio.

re:habitat a new mental health approach for urban communities

STAFF

45


46

PROCESS

re:habitat a new mental health approach for urban communities


RESTORING DIGNITY All participants and end users in the design process should be treated with dignity. The respect given to the users is proven to improve the psychological wellbeing and improve general health. In the hospital, the current model of a sick bay with patients facing inwards towards each other in an enclosed room created an undesirable environment for rest and recovery. By flipping the model with patients looking out to a view, patients are reinstated with their dignity to rest in peace.

UNDERSTANDING THE PROBLEM Architecture often delivers a product that only parlty solves the problem. A logical solution can be extracted from the correct framing of the entire issues and usually includes observation and community interaction. The existing model fo the Butaro Hospital was actually getting people sicker. The root of the problem was identified that the stale enclosed corridors collected the unhygenic and often infected air and spread disease. By putting the corridor on the outside, the circluation of air provides healthier amenities.

USING THE PROCESS OF BUILDING TO HEAL Involving the community in the process often presents unique opportunities for development of relationships and can introduce patterns of thought beyond our own. Problem solving skills and resources are a collaborative commodity.

BUTARO HOSPITAL MASS DESIGN

The process of MASS Design Group in the design of Butaro Hospital is nothing less of highly responsive to context, culture and community and translating the issues that arose with the existing conditions. Rwanda had experienced a turbulent history with a 4-year genocide that ended only 23 years ago and estimated death toll reaching 1 million people. The process of designing and constructing this building was a transformative engine for change and was

used to heal the people. The Rwandan’s belief of ‘Ubadeyhei’ meaning ‘community works for the community’ encouraged everyone to help and contribute where they could towards providing such a pivotal building for improving the health of their community. The people were called to excavate the site which cost half as much money and took half as long as if a machine was rented to do the job. Local craftsmen were called to build the furniture and taught others in the process.

re:habitat a new mental health approach for urban communities

Locally sourcing materials draws context from the environment and is a more sustainable behaviour.

47


DRAWING LITERAL CONTEXTUAL RELATIONSHIPS TO THE PROGRAM CAN PRODUCE A RESULT THAT RESONATES WITH THE COMMUNITY. A TRULY VALUABLE BUILDING TO THE COMMUNITY CAN IMPROVE PHYSICAL ASSETS AND PROMOTE URBAN RESILIENCE. DESIGN SHOULD BE UNIVERSALLY ACCESSIBLE IN ORDER TO STRENGTHEN SOCIAL ASSETS AND INCREASES RESILIENCE IN AN URBAN CONTEXT.

+ MESO

re:habitat a new mental health approach for urban communities

UNDERSTANDING THE TRUE NEEDS OF THE STAKEHOLDER/S, AND CHALLENGING TRADITIONAL DESIGN PROCESSES TO PRODUCE A RESULT THAT ANSWERS THE BRIEF.

48

SEATTLE LIBRARY

PROCESS

BUTARO HOSPITAL

+ HIRE LOCALLY, SOURCE REGIONALLY, TRAIN WHERE YOU CAN AND INVEST IN DIGNITY. ARCHITECTURE CAN BE A TRANSFORMATIVE ENGINE FOR CHANGE; USING THE PROCESS OF ARCHITECTURE TO HEAL. IDENTIFY WHAT THE HUMAN HANDPRINT IS THAT HAS MADE THE ARCHITECTURE, TO INSTILL EMPOWERMENT.


+ MESO

THE COMMONS

UTILISING EXISTING PUBLIC TRANSPORT LINKS CAN ELIMINATE THE NEED FOR CAR PARKING AND HELP TO PROMOTE A PEDESTRIAN FOCUSED CITY. REMOVAL OF UNECESSARY ELEMENTS OF THE BUILDING ALLOWS MODERATED RESPONSE. AIM TO DESIGN AN URBAN STRUCTURE THAT ADHERES TO THE TRIPLE BOTTOM LINE OF SUSTAINABILITY, AFFORDABILITY AND LIVEABILITY.

BUS SHELTER

+

MAINTAINS SERVICE OPERABILITY AND MARKET OPPORTUNITIES FOR EXISTING INFRASTRUCTURE. REINSTATES THE BUS SHELTER AS A PUBLIC DOMAIN FOR DISADVANTAGED AND HOMELESS. REPURPOSING EXISTING INFRASTRUCTURE TO ADDRESS COMMUNITY ISSUES.

PRECEDENTS CONCLUSION

The selection of these precedents responds to various scales of interventions and three visions for the city; A smart-networked city which is a hub of highly-connected IT systems, a compact city with a good concentration and variety of land use, infrastructure, buildings and services, and a self-reliant green city where residents live in harmony with nature and resources such

as food and energy supply are local. The precedents respond by approaching their brief in different yet equally potent ways and can be drawn on in future to ensure that design problems are being resolved sensitively to context, culture, community and environment.

re:habitat a new mental health approach for urban communities

MICRO

49


50

re:habitat a new mental health approach for urban communities

PROJECT INTRODUCTION & RESEARCH

3


birth to death, life enmeshes individuals within a “ From dynamic culture consisting of the natural environment

“

(light, heat, air, land, water, minerals, flora, fauna), the human-made environment (material objects, buildings, roads, machinery, appliances, technology), social arrangements (families, social networks, associations, institutions, economies), and human consciousness (knowledge, beliefs, understandings, skills, traditions). Well-being depends on all the factors that interact within this culture and can be seen as a state of health or sufficiency in all aspects of life.

re:habitat a new mental health approach for urban communities

Australian Bureau of Statistics 2001

51


REFLECTIVE using past experience to inform future decisions

FLEXIBLE willingness and ability to adopt alternative strategies in response to changing circumstances

INCLUSIVE

RESOURCEFUL

re:habitat a new mental health approach for urban communities

prioritize broad consultation to create a sense of shared ownership in decision making

52

recognizing alternative ways to use resources

INTEGRATED bring together a range of distinct systems and institutions

ROBUST well-conceived, constructed, and managed systems

REDUNDANT spare capacity purposively created to accommodate disruption

RESILIENCE


CAPACITY TO SURVIVE AND THRIVE REGARDLESS OF

ACUTE SHOCKS

RESILIENCE

Resilience is the capacity to survive and thrive regardless of chronic stresses and acute shocks. As populations are becoming highly urbanized with an estimated 2/3rds of the worlds 9 billion people living in cities by 2050, it is important that these dense urban

centres are prepared to face known and unknown threats that could lead to extreme circumstances such as health epidemics, economic instability, natural disaster and death whilst acknowledging the movement of society and the built environment.

100 RESILIENT CITIES

Initiated by the Rockerfeller Foundation, the selection of Sydney as one of the 100 Resilient Cities empowers organisations, corporations, political parties, urban designers and residents to develop and implement strategies that strengthen the physical and social assets that

can allow it to endure stresses and shocks. As Sydney moves towards the middle of the century, it is expected that it will experience unprecedented urbanisation with rising house prices, coupled with congestion proximal to the CBD and Inner West suburbs.

re:habitat a new mental health approach for urban communities

CHRONIC STRESSES

53


health and well-being are fundamental to our “ Mental collective and individual ability as humans to think, emote,

interact with each other, earn a living and enjoy life. On this basis, the promotion, protection and restoration of mental health can be regarded as a vital concern of individuals, communities and societies throughout the world.

re:habitat a new mental health approach for urban communities

World Health Organisation

54

Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community 1. Resilience depends on individuals and

communities to exhibit mental wellness to cope with the acute shocks and chronic stresses and to enable them to make the best decisions on ways to evolve and adapt to the growth of the future.

Mental illness includes a wide range of conditions, either short-lasting or chronic, that can significantly affect the mood, thoughts, interactions and behaviours of a person. Mental health problems are similar but to a lesser extent and may develop into an illness if not effectively addressed2.

• Schizophrenia • Obsessive compulsive disorder • Autism • Post traumatic stress disorder (PTSD)

There are more then 200 classified forms of mental illness. Some more common and widespread mental illnesses include; • Depression • Anxiety • Bipolar disorder • Dementia • Attention Deficit/Hyperactivity Disorder 1

“WHO | Mental Health: A State Of Well-Being”.

2

What Is Mental Illness?.

3

What Is Mental Illness?.

Confronting the negative attitudes and stigma of mental illness is one of the biggest obstacles for people recovering from mental illness3 and can seriously aggravate a person’s condition purely from the feeling of isolation and discrimination. This report may not address a specific mental illness but rather the collective trends and behaviours as a result of various mental illnesses that are identified through evidence.

MENTAL HEALTH AND RESILIENCE

WHAT IS MENTAL ILLNESS


24%

16.8% CURRENTLY

+

50% IN THEIR LIFETIME

BURDEN OF DISABILITY

2,400 24% + IMPACT OF

MENTAL BURDEN OF ILLNESS DISABILITY

SUICIDES ANNUALLY

50%

CURRENTLY

IN THEIR LIFETIME

BURDEN OF DISABILITY

CURRENTLY BURDEN OF IN THEIR DISABILITY LIFETIME IMPACT

24% +

H B

24%

16.8% 24% + 50% 14%

IMPACT

2,400 8% SUICIDES ANNUALLY

NSW HEALTH BUDGET

2,400

+ 48,000 ATTEMPTING BURDEN OF TO TAKE LIFE DISABILITY

48,000

7x HIGHER SUICIDE RATE

5

“Suicidal Behaviour”.

4 Living Well: A Strategic Plan For Mental Health In NSW 2014-2024.

7

IMPACT

H B

7x

Mental illness strips people of their and will bellow out to larger problems for the 48,000 7x independence, wellbeing health system,ATTEMPTING the economy, communities and BURDEN OFand dignity. SUICIDES HIGHER SUICIDE DISABILITY ANNUALLY TO TAKE LIFE RATE There are a variety of mental illnesses that individuals in the near future if not addressed. ATTEMPTING HIGHER SUICIDE effect one’s to function in society TO TAKE LIFE capacityRATE comfortably and carries with it heavy stigma. The World Health Organisation identified In 2010, almost 4 million people or 16.8% of that mental illnesses accounted for nearly the population of Australia experienced some 12% of the global burden for disease, and form of mental illness, and it is expected that by 2020 will account for nearly 15% of almost half of people will experience mental disability-adjusted life years (DALY’s) lost illness at some point in their lifetime.4 Mental to illness.7 DALY’s are calculated by adding illness reduces a person’s ability to live with ‘years lived with a disability, injury or illness’ comfort and purpose, which causes over 2,400 (YLD) and ‘years of life lost’ (YLL) from the Australians to commit suicide each year with life expectancy of the general population. around 50,000 attempts to take one’s life. Suicide rates within those effected by mental Mental illness in most cases is not permanent illness are seven times higher than the general and with the correct treatment, support population.5 20-30% of suicides in the mental and care can make a recovery to re-establish health population involve patients that were themselves in the community. not admitted to care upon presentation or following a discharge from acute care. Increasingly, mental illness is becoming a chronic stress that effects the occupants Mental illness is responsible for nearly a of a city and has detrimental effects to quarter of all disability, more than any other their happiness and enjoyment levels, and cause. People with mental illness also have demands large resources from governments higher rates of co-morbidities, meaning that and organisations to address these issues. The they also have higher rates of high blood model of the mental health system in NSW pressure, cancers, diabetes, obesity, respiratory is outdated and does not reflect the globally and musculoskeletal diseases. recognised contemporary beliefs of treatment that are required to assist a person with A great concern is the 23% of the population mental illness to recover. Institutionalisation (1.7m) of New South Wales believed to is still the core treatment of mental illness have an underlying or undiagnosed mental as a means of cure, but community based health problem. 6 This can be due to the implementations that approach the fear of discrimination (from workplaces, prevention and intervention of mental communities, families and friends), lack of illness is now becoming a more prominently sufficient awareness of mental health or unable acknowledged treatment and demands less to navigate the current mental health system. resources and cost to do so. In either scenario, these figures are alarming 4 Living Well: A Strategic Plan For Mental Health In NSW 2014-2024.

14%

re:habitat a new mental health approach for urban communities

24%

14%

+

16.8%

“Mental Health: Strengthening Our Response.”

55


URBAN ENVIRONMENT

ALCOHOL AND SUBSTANCE ABUSE

YOUTH

MOTHERS INDIGENOUS

REDFERN

LGBTQI

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PROFESSIONALS

56

HOMELESS

REFUGEES

CULTURALLY AND LINGUISTICALLY DIVERSE


Redfern exhibits many of the determinants and key demographics that largely influence an increased proportion of mental illness. Indigenous Indigenous people make up 2.4% of the Redfern population, above the City of Sydney average of 1.9%. Redfern is a highly significant area to the Indigenous community, as they re-established a strong presence throughout the neighbourhood in search of employment in the 1920’s and have ever since found that the suburb is a part of their far-stretching history. Already carrying the burden of a tumultuous history of oppression, injustice, dispossession of land, imprisonment and the removal of children, about 20% of the Indigenous population experience psychological distress (including depression and anxiety) at twice the rates of their nonIndigenous counterparts.8 Suicide amongst the Indigenous communities is 1.4 times higher than for non-Indigenous people. 9 There has been an attempt to address these unacceptable statistics through the Closing the Gap initiative by the Commonwealth Government, but has failed to meet progressive targets for many their goals.

rejection, abuse and withdrawn behaviour that culminates in mental illness such as depression and anxiety. Redfern has the 5th largest LGBTQI population (indicated by same-sex couples data) in Australia,10 behind Darlinghurst, Potts Point, Surry Hills and Elizabeth Bay. Around 10-15% of all couples in Redfern are same-sex. Culturally and linguistically diverse (CALD) and refugees The psychosocial factors such as a turbulent pasts and language/cultural barriers that define this population are what prompts an increase in psychological distress. Children are far more likely to thrive when they have a positive sense of belonging to both cultures and when their new school and community environments support this.11 Furthermore, their lack of access to vital community services as well as their financial hardship compound this issue.

LGBTQI Community Global and local research has found that lesbian, gay, bisexual, transgender, and intersex people suffer from psychological distress at a much higher rate than the rest of the population, mainly caused by discrimination,

Counter to this, there are two large health network presences of the Aboriginal Medical Service and the Redfern Mental Health Centre which are invaluable in the solution to improving mental wellness. Redfern also has organisations, physical and social infrastructure that currently lacks integration but has the potential to create a strong community support network, such as 107 Projects, the National Centre for Indigenous Excellence, Department of Health Services and Jarjum College.

8 Living Well: A Strategic Plan For Mental Health In NSW 2014-2024.

11 Living Well: A Strategic Plan For Mental Health In NSW 2014-2024.

9 Living Well: A Strategic Plan For Mental Health In NSW 2014-2024. 10 Davies, “Where Do Same-Sex Couples In Australia Live? - The Urbanist”.

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WHY REDFERN?

57


MEANINGFUL ACTIVITY EMPLOYMENT MEANINGFUL VOLUNTEERING ACTIVITY SPIRITUALITY EMPLOYMENT

ENVIRONMENT PUBLIC SPACE GREEN SPACE ENVIRONMENT SAFE PLAY SPACE PUBLIC SPACE

ACCESSIBLE SUSTAINABLE

DIS

LIT

Y

ABI

CONTROL

AGE

LIT

Y

AGE

CULTURE SPORTS

SEX

ABI

HEALTHY ACCESSIBLE

LEISURE ARTS & CREATIVITY CULTURE LEISURE SPORTS ARTS & CREATIVITY

CONTROL

DIS

S UA EXUA LIT LIT Y Y

INCLUSION INCLUSION

DER ENDER G

HOME HOME

RESILIENCE/ COMMUNITY ASSETS

GOOD QUALITY FOOD AFFORDABLE GOOD QUALITY HEALTHY FOOD ACCESSIBLE AFFORDABLE COMMUNITY COMMUNITY

MENTAL HEALTH & WELLBEING MENTAL HEALTH & WELLBEING

GEN

TRANSPORT AFFORDABLE ACCESSIBLE TRANSPORT SUSTAINABLE AFFORDABLE

CLASS RESILIENCE/ COMMUNITY ASSETS

PARTICIPATION PARTICIPATION

SAFE IN NEIGHBOURHOOD

CLASS

LY MI Y A F IT IC N H ET ITY IC N H ET

NE VOLUNTEERING IGH SPIRITUALITY BO UR HO NE OD IGH BO UR HO OD

L L ICA ICA YS H YS H PH EALTPH EALT H H

PHYSICAL SECURITY HOUSING SAFETY AT SECURITY HOME PHYSICAL SAFE IN HOUSING NEIGHBOURHOOD SAFETY AT HOME

GREEN SPACE SAFE PLAY SPACE LY MI FA

CIVIL SOCIETY

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FINANCIAL SECURITY INCOME CREDIT FINANCIAL SECURITY WEALTH INCOME

EQUITY AND SOCIAL JUSTICE

WIDER DETERMINANTS

EQUITY AND SOCIAL JUSTICE

WIDER DETERMINANTS

EDUCATION LIFELONG LEARNING EDUCATION LIFELONG LEARNING

CREDIT WEALTH

SOCIAL RELATIONSHIPS AND CORE SOCIAL ECONOMY RELATIONSHIPS AND CORE ECONOMY

FIGURE 1: DETERMINANTS OF MENTAL HEALTH Figure redrawn from Freidli, Mental Wellbeing Assessment Toolkit.

58

CIVIL SOCIETY

POPULATION CHARACTERISTICS POPULATION CHARACTERISTICS

FOUR PROTECTIVE FACTORS FOUR PROTECTIVE FACTORS


To understand the approach to improving the mental health of a community it is crucial to accept that it goes beyond merely psychological concerns. Especially within a built environment and dense urban population there are many factors beyond our control that have heavily influence our mental wellness and can affect our risk of experiencing psychological distress or not.

Within this sphere of intense and broad determinants of mental health are the four protective factors that are the main purpose of establishing higher levels of wider determinants. Participation, Inclusion, Community assets and Control within an urban context are ways in which a person becomes comfortable with their external environment and how they feel purpose within an urban context.

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DETERMINANTS OF MENTAL HEALTH

59


60

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As the world approaches 9 billion people by 2050, the structure of population demographics is expected to shift rapidly to accommodate this unprecedented growth. Increasingly, there is a migration towards large urban centres to reap the benefits of larger infrastructural systems, access to resources and better employment opportunities. Cities generate 85% of global GDP, and cities around the world are growing by 1.5 million people every week through childbirth and migration.12 Sydney is on track to expect a large rate of urban population growth by 2050, swelling from 5 million in 2016 to 8.5million which is an increase of 70% in just 34 years,13 or about 1 million people per decade.

The primary purpose for this migration is greater access to facilities and infrastructure, but is never in alignment with the population. There is a constant need for the infrastructure to catch up to the population and this results in poverty and exposure to environmental adversity such as congestion, overcrowding, lack of adequate access through the city and lack of services to provide for the people, resulting in greater risk of mental health issues.

Urbanisation is not only a demographic movement but also includes social, economic and psychological changes that constitute the demographic movement and is identified as one of the most important global health issues of the 21st century.14 It brings with it a unique set of advantages and disadvantages and is accompanied by economic growth, industrialisation and the profound changes in social organisation and in the pattern of family life.15 Urbanisation has very definite links with increased mental health concerns as it introduces an increase in stressors and factors such as overcrowding , violence, reduced social support and undersupply of infrastructure. 16

Research evidence finds that living in a city roughly doubles the risk of schizophrenia, whilst raising the risk of anxiety and mood disorders by 21% and 39% respectively.18 A theory for this is the paradoxical nature of existence within urban environments of the loneliness in crowds. If social density and social isolation came at the same time and hit high risk individuals, then city stress related mental illness can be the consequence.

12

“Rapid Urbanisation - Sydney Business Insights”.

13 Evidence”. 14

Colebatch, “Australia’s Urban Boom: The Latest

15 ibid. 16 ibid.

Srivastava, “Urbanization And Mental Health”.

Moreover, the cultural transformation that takes place in moving from a rural to an urban area can cause high levels of stress,17 with new environments, social structures, higher levels of stimulation and loss of identity.

As Sydney moves towards 2050, it is essential that the project addresses the large proportion of the population that is unfamiliar to the urban context and are perceived as a higher risk of psychological distress.

17 Benedictus, “Sick Cities: Why Urban Living Can Be Bad For Your Mental Health”. 18 ibid.

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URBANISATION AND MENTAL HEALTH

61


TABLE 1:DIRECT MENTAL HEALTH EFFECTS OF THE PHYSICAL ENVIRONMENT Environmental characteristics

Mental health impacts

High-rise housing

Elevated psychological distress, especially among low-income mothers.

Residential floor level

Adults living on higher floors have more psychological distress.

Housing quality (structural defets, hazards, poor maintenance, climatic problems e.g. heat, humidity)

Greater psychological distress in housing of poorer quality.

Neighbourhood quality (aggregate bundle of social and physical attributes)

Greater psychological distress and poorer cognitive development in children.

Furniture placement (at social distances, around tables)

Increased social interaction and reduced passive, isolated behaviours in psychiatric patients.

Privacy (architecture, single rooms)

Severely retarded adults and psychiatric patients reveal better functioning with more ability to regulate social interaction.

Alzheimers facilities (smaller scale units, more homelike, less noise, accomodation of wandering)

Improved functioning, including less disorientation, fewer behavioural problems.

Residential density (people/room)

More negative effect, greater psychological distress. Psychiatric disorder not related to crowding. Areal indices such as people per census tract unrelated to mental health.

Noise (aircraft)

Unrelated psychiatric disorder. Elevated psychological distress in children.

Indoor air quality

Malodorous pollutants linked to negative affect. Behavioural toxins related to acting out, aggression. Community contamination reliably related to trauma.

Light

No reliable impacts of colour. Levels of illumination but not spectrum effect depression.

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TABLE 2: INDIRECT MENTAL HEALTH EFFECTS OF THE PHYSICAL ENVIRONMENT

62

Indirect Pathway

Environmental characteristic

Assessment of the evidence

Personal Control

Noise

Labratory and field show uncontrollable noise can induce helplessness.

Crowding

Children living in higher density homes (people/room) have greater learned helplessness. Similar findings among crowded adults in the labratory.

Suite vs. Corridor

Students in long corridors dormitories show greater learned helplessness than those living in suite designs.

Spatial heirarchy

Providing a range of social interaction spaces (i.e. solitude to small group) fosters better ability to regulate social interaction.

Territoriality

Multifamily residences that are tall, large and have few semi-private spaces (i.e. group territory), lead to feelings of lack of control and are associated with crime.

Distance

Physical proximity increases unplanned social interaction. Functional opportunities for interaction (e.g. doorway opening, proximity to pedestrian pathway) also afford greater social interaction.

Crowding

Higher density causes social withdrawal and the deterioration of socially supportive relationships.

Housing

High-rise housing and residence on high-traffic volume streets is associated with less interaction with neighbours.

Natural Elements

Nature reducing stress and diminishing cognitive fatigue.

Architecture

Design elements other than nature may have similar capabilities. Salient qualities include fascination, quiet and solitude, and coherent, tranuil stimuli.

Social Support

Restoration and recovery from cognitive fatigue and stress

Tables redrawn from Evans, “The Built Environment And Mental Health�.


Humans spend 90% of their life indoors but know more bout ambient environmental conditions and health than we do about the built environment and health. It is generally accepted that there is a strong link between the quality of the built environment that surrounds us and our levels of psychological wellbeing. 19 Long before research had established and quantified these links, we were somewhat able to intuitively detect what has a positive effect on our mental health and what has negative consequences. We have always been able to acknowledge the effect of scale, light, nature and proportion, which have been recalled time and again through architectural delights. Some of these intrinsic 19

understandings have been confirmed through critical investigation of people interacting with the built environment, while others, such as findings on the effect of colour on our psychological wellbeing, have not been substantiated. The tables opposite identify direct and indirect mental health effects on the physical environment and were formulated through various research methods and lab studies. Ultimately, they draw evidence-based links between various factors of the built environment and the psychological wellbeing of occupants and should be drawn on in future design proposals.

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THE BUILT ENVIRONMENT AND MENTAL HEALTH

Evans, “The Built Environment And Mental Health�.

63


14%

8%

IMPACT

7x

NSW HEALTH BUDGET

WELL

UNWELL

TREATMENT

COMMUNITY

GHER SUICIDE RATE

FIGURE 2: TRADITIONAL MODEL OF MENTAL HEALTH CARE JUSTICE

JUSTICE PRIVATE HOSPITALS

SCHIZOPHRENIA RESEARCH INSTITUTE

NEURA

POSTVENTION SERVICES

SELF-HELP GROUPS

EPPIC

BLACK DOG INSTITUTE

CHARITIES

HEADSPACE

MINDMATTERS

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BLACK DOG INSTITUTE

3DN

HEADSPACE

COMMUNITY MENTAL HEALTH

CENTRES OF RESEARCH EXCELLENCE

EDUCATION

ALLIED PSYCHOLOGICAL SERVICES

HOUSING

HUNTER INSTITUTE OF MENTAL HEALTH

KIDSMATTER

BUTTERFLY FOUNDATION

ABORIGINAL COUNSELLING MEDICAL SERVICES SERVICES

EDUCATION

COMMUNITY MENTAL HEALTH

POLICE

EPPIC

CHARITIES

HUNTER INSTITUTE OF MENTAL HEALTH

KIDSMATTER

PRIVATE PSYCHIATRY

NDIS

BEYONDBLUE

PRIVATE PSYCHIATRY

NDIS

AMBULANCE

PHAMS COMMONWEALTH SERVICES AND PROGRAMS

STATE SERVICES & PROGRAMS

PRIVATE SECTOR

COMMONWEALTH SERVICES AND PROGRAMS

STATE SERVICES & PROGRAMS

PRIVATE SECTOR

PHAMS

COUNSELLING SERVICES

COMMUNITY MENTAL HEALTH

LOCAL GP

DISABILITY SERVICES

COMMUNITY MANAGED ORGANISATIONS

LOCAL GP

AMBULANCE

BUTTERFLY FOUNDATION

CENTRE FOR RURAL AND REMOTE HEALTH

DISABILITY SERVICES

COMMUNITY MANAGED ORGANISATIONS

ALLIED PSYCHOLOGICAL SERVICES

BRAIN AND MIND RESEARCH INSTITUTE

MBS BETTER ACCESS

BEYONDBLUE

COMMUNITY MENTAL HEALTH

HOUSING

FIGURE 3: MAPPING OF OF MENTAL HEALTH SERVICE PROVISIONS 64

SELF-HELP GROUPS

CENTRES OF RESEARCH EXCELLENCE

3DN

CENTRE FOR RURAL AND REMOTE HEALTH

BRAIN AND MIND RESEARCH INSTITUTE

MBS BETTER ACCESS

POSTVENTION SERVICES

LOCAL HEALTH DISTRICTS

POLICE

ADVOCACY SERVICES

MINDMATTERS LOCAL HEALTH DISTRICTS

ABORIGINAL MEDICAL SERVICES

PARTNERS IN RECOVERY

PUBLIC HOSPITALS

PARTNERS IN RECOVERY

PUBLIC HOSPITALS

NEURA

ADVOCACY SERVICES

PRIVATE HOSPITALS

SCHIZOPHRENIA RESEARCH INSTITUTE


The traditional model of the mental health system emphasises the use of institutionalised care as the primary form of treatment. The person experiencing mental anguish or psychological burden would address a psychiatrist, usually after a prolonged period of time suffering with the illness, and depending on severity, would be treated with any combination of current pharmacological methods in conjunction with an isolation of the patient into a facility that is intended to remove them from their environment causing these stresses. Addressing a patients distress once it has already culminated in an illness is a basic approach to mental wellness and by doing so, enables a more chronic link between a person and their mental health concerns. People feel there are barriers to presenting themselves in mild cases of mental distress and feel they must endure or ‘suck it up’ to get through hardships which only compound the problems. Once a person has undergone sufficient treatment and are assessed to be mentally fit to leave institutional care they are pushed back into a society that has become foreign to them. The facilities are normally unwelcoming and can cause trauma itself, and the increased stigma surrounding mental illness can tempt patients to imitate a higher sense of mental wellness to clinicians than they are truly experiencing, and leave treatment prematurely. They then find themselves back in the exact same situation and may have feelings of remission, an effect known as the ‘revolving door’. Patients can become overwhelmed by the sudden change in environment and are thrown right back into a chaotic life, right where they left off. Many people suffering from mental illness commit suicide due to these reasons of cyclical behaviours and lack of coping with the constant change which wears down their energy, endurance an self-esteem. 20 Living Well: A Strategic Plan For Mental Health In NSW 2014-2024. 21 ibid.

Currently, mental illness accounts for 14% of the impacts of all illness in New South Wales, however mental health expenditure accounts for only 8% of the New South Wales Health budget.20 There is a lack of economic commitment from the government and what is currently being spent is being done so inefficiently. From a resourcing perspective, it is an enormous strain on institutions to accommodate for cases of mental illness as they differ from physical ailments in their treatment, approach and duration. A hospital that addresses too many health issues stretches the limitations of staff and available rooms/ beds and can have significant drawbacks on the effectiveness of the hospitals organisation. Furthermore, the demand placed upon psychiatrists and mental health workers in addressing a community with increasing concerns of mental wellness is immense and will soon outnumber the available staff hours required to adequately tend to these patients. There are several mental health services across Commonwealth and state governments, as well as various private sector organisations that are aimed at research and peripheral services for mental health. However, many of their services either overlap or don’t cross over enough and can result in a lot of services that are addressing the wrong mental health concerns for the wrong demographics. Greater integration of services is needed with stronger communicational links that allow these services to share resources, facilities and staff to provide a unified national mental health network which is more transparent for organisations, but more importantly, patients. New South Wales has the lowest rate of community care in Australia and has the highest expenditure on hospitals.21

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TRADITIONAL MODEL OF MENTAL HEALTH CARE

65


HIGH RATES OF HOSPITALISATION FOR MENTAL HEALTH RELATED ADMISSIONS

LOW NUMBER OF GP’S WHO HAVE COMPLETED LEVEL 2 MENTAL HEALTH SKILLS TRAINING

PSYCHOSOCIAL RISK FACTORS; BULLYING, HOUSING ETC

HIGHER RATES OF SMOKING AMONG MENTAL ILLNESS

LOW NUMBER OF LACK OF SCREENING MENTAL HEALTH LACK OF AVAILABLE NURSES FOR PHYSICAL HEALTH COMMUNITY-BASE CONDITIONS IN MENTAL SERVICES HEALTH SPECIFIC HEALTH LITERACY; LACK SERVICES OF PROVISION OR UNEVEN DISTRIBUTION ACCESS TO RESOURCES OF MENTAL HEALTH LIMITED ACCESS TO PROFESSIONALS LONG-TERM SELF HARM/ PSYCHOLOGICAL SUICIDE INTERVENTIONS FOR MANAGEMENT OF LOW INCOME CO-MORBID CONDITIONS COMPOUNDING OF INSUFFICIENT LOW LEVELS OF SOCIOECONOMIC FRONTLINE RESPONSES SEEKING BEHAVIOUR DISADVANTAGE TO PSYCHOLOGICAL FOR VULNERABLE DISTRESS, MENTAL GROUPS HIGH RATES OF ILLNESS AND SUICIDE

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PSYCHOLOGICAL DISTRESS

LIMITED ACCESS TO UNRESOLVED TRAUMA AFFORDABLE CURRENT PROGRAMS PSYCHIATRY OUTSIDE CATER FOR SINGLE PUBLIC SYSTEM CONDITIONS - PROVIDED LACK OF INFORMATION BY CLINICIANS WORKING IN ISOLATION SHARING CAPABILITIES INADEQUATE RESPONSE IN PRIMARY CARE ENVIRONMENT

SERVICE NEED

HEALTH NEED

FIGURE 4: SERVICE AND HEALTH NEEDS IDENTIFIED IN CESPHN 66

Graphic drawn based on Table 1, Table 2 ‘Outcomes of health and services needs analysis in mental health and suicide prevention’ from Central and Eastern Sydney PHN, Mental Health And Suicide Prevention Needs Assessment.


The Mental Health and Suicide Prevention Needs Assessment is the culmination of investigations conducted by the Central Eastern Sydney Primary Health Network (CESPHN) in partnership with local health districts (LHD), St Vincent’s Health network and Sydney Children Hospital Networks (LHN). which identify target demographics, key issues and future opportunities in

relation to the mental health network that are contextual to the region that Redfern falls within. As a result, the findings can inform more relevant design responses to the community of Redfern than a state-wide or national health report, although they still do have their importance.

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CENTRAL EASTERN SYDNEY PRIMARY HEALTH NETWORK

67


MENTAL HEALTH PATTERN OF CARE. AVAILABILITY OF MTC’S PER 100,000 RESIDENTS CESPHN RESIDENTIAL CARE HOSPITAL ACUTE (acute ward) 3.50

HIGH INTENSITY (hostel)

NON-ACUTE (subacute ward)

3.00

OTHER (supported accomodation, group homes)

ACUTE (crisis home)

2.50

Accessibility (employment)

NON-ACUTE (non acute crisis home)

2.00

ACCESSIBILITY

1.50

Accessibility (housing)

HEALTH ACUTE (day hospital)

1.00

0.50

HEALTH NON-ACUTE (day health centre)

Accessibility (care coordination)

DAY CARE ACUTE MOBILE (crisis mobile teams re: social needs)

WORK RELATED (social firm)

ACUTE NON-MOBILE (social emergency room)

OTHER (social club)

NON-ACUTE MOBILE (PHaMS program)

ACUTE MOBILE (crisis home teams)

NON-ACUTE NON-MOBILE (social counselling)

ACUTE NON-MOBILE (emergency rooms) NON-ACUTE MOBILE (assertive community treatment)

NON-ACUTE NON-MOBILE (community mental health centre)

OUTPATIENT CARE (SOCIAL)

MENTAL HEALTH PATTERN OF CARE. AVAILABILITY OF MTC’S PER 100,000 RESIDENTS CESPHN

SWS

WS

RESIDENTIAL CARE HOSPITAL ACUTE (acute ward)

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HIGH INTENSITY (hostel)

68

OTHER (supported accomodation, group homes)

3.50

NON-ACUTE (subacute ward)

3.00

ACUTE (crisis home)

2.50

Accessibility (employment)

NON-ACUTE (non acute crisis home)

2.00

ACCESSIBILITY

1.50

Accessibility (housing)

HEALTH ACUTE (day hospital)

1.00

0.50

HEALTH NON-ACUTE (day health centre)

Accessibility (care coordination)

DAY CARE ACUTE MOBILE (crisis mobile teams re: social needs)

WORK RELATED (social firm)

ACUTE NON-MOBILE (social emergency room)

OTHER (social club)

NON-ACUTE MOBILE (PHaMS program)

ACUTE MOBILE (crisis home teams)

NON-ACUTE NON-MOBILE (social counselling) NON-ACUTE NON-MOBILE (community mental health centre)

ACUTE NON-MOBILE (emergency rooms) NON-ACUTE MOBILE (assertive community treatment)

OUTPATIENT CARE (SOCIAL) Graphics redrawn from Central and Eastern Sydney PHN, Mental Health And Suicide Prevention Needs Assessment.


NUMBER OF BEDS PER 100,000 RESIDENTS CESPHN

SWS

WS

26.04 20.59 18.50

16.83 10.16 6.31

5.16 0.82 1.21

ACUTE (acute ward) NON-ACUTE (sub-acute OTHER (supported ward) accomodation group homes)

THE SHIFT IN NEEDS

From the findings in the Central Eastern Sydney Primary Health Network Integrated Mental Health Atlas, three main gaps were identified in the provision of services. Non-hospital acute and sub-acute care There is an absence of services with staffed mental health professionals who provide treatment and care for patients with lived experience of mental illness whom are in psychological distress. They provide the same type of care as the inpatient unit of a hospital but are embedded into the community. 22 These are small units, with a strong focus on recovery such as crisis homes. Lack of medium or long term accommodation for people with mental illness As outlined earlier in the report, the need for people living with mental illness to have access to support through various forms of accommodation is essential as they suffer many barriers to stable housing. Acute and non-acute health care dayrelated Acute day care relates to the services that provides an alternative to hospitalisation, through treatment in a community.23 They can stay in the facility during the day but will return home after hours and does not cater for sleeping arrangements. Non-acute day care facilities are usually staffed with more than 20% of highly skilled mental professionals.24 People experiencing psychological distress can spend the day 22 Central and Eastern Sydney PHN, Mental Health And Suicide Prevention Needs Assessment. 23 24

ibid. ibid.

5.66 1.19

NUMBER OF BEDS PER 100,000 RESIDENTS

HIGH INTENSITY (Hostel)

CESPHN

SWS

WS

26.04

socialising and participating in structured 20.59 activities 18.50related to mental health such as 16.83 cognitive training. 10.16 7.67

There is also a lack 5.16 of cultural and6.31 leisure 5.66 25 activities within the day care environments, 1.19 0.82 1.21 which be NON-ACUTE addressed. ACUTEcould (acute ward) (sub-acute OTHER (supported HIGH INTENSITY ward)

accomodation group homes)

Further understanding The bar graph above identifies the focus of beds allocated per 100,000 residents in the CESPHN, the South Western Sydney (SWS) PHN and the Western Sydney (WS) PHN. Although CESPHN has a higher proportion of beds in acute care, they fall behind in other decentralised forms of short to medium term accommodation. This could indicate that the services a) do not reflect the shift towards community mental healthcare services, and b) that those who do require these services must travel beyond the CESPHN to receive this type of care. This becomes an issue of inefficient resourcing and does not capitalise on the value of locality and community-based provision of service. The two radial line charts on the opposite page identify the patterns of mental health care. The top one identifies the CESPHN, noting a spike in Residential Acute care, but no services that are embedded within the community. In comparison, the graph below overlays the patterns of care of the WS and SWS PHN’s, which again convey the redistribution of residential care away from the hospital sector and into more communitybased environments.

25

(Hostel)

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7.67

ibid.

69


CASE STUDY 2

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CASE STUDY 1

70

Age: 60 Ha s suffere d from se vere p arano id schizophrenia, anxiety and depression for 30 years, and has had approximately 8 acute institutionalisations. Has left care prematurely in the past and found themselves readmitting a short time after as they weren’t given the right supports and didn’t feel environment was helping recovery. Has been suicidal and has moved into retirement villages since divorce. First village was remote and distant from all facilities needed for daily living such as shops and medical facilities. No car or frequent bus service, depended on shuttle bus for daily errands. Felt isolated and aggravated illness. Moved closer to an urban hub with greater access to support and frequent bus services. Feels much more stable and surrounded by care. Key Issues • Isolation • Felt uncomfortable in mental health clinics and requested to leave prematurely • Lack of access/mobility • No community support • Family carer never had training/education

Age: 26 Experienced depression as a teenager but not had active mental illness for years. Recently had an episode of suicidal thought and called Lifeline. Was consulted for 40 minutes over the phone before requesting someone visit. The support that arrived were the police and weren’t empathetic towards their feelings, and raised neighbour’s awareness to the situation through indiscreet actions. Was told either the ambulance come or must visit hospital. Arrived at ED on Sunday, then talked to triage before being put in a low category and waiting for 40 minutes. GP came to do some blood tests and check heart rate and blood pressure before asking for a psychiatrist or equivalent. Was then referred to psychologist but waited another hour in waiting room before consultation. Key Issues • No mental health first aid • Fear of stigma of mental illness in community • Ineffective process for admission in institutional environment before seeing psychologist


CASE STUDY 4

CASE STUDY 3 Age: 45 Been battling mental illness and drug abuse for years. Various admissions to mental health clinic but remained homeless due to feelings of insecurity and refused to take certain medication. When they sleep on the street they are insecure about their belongings getting stolen. Hasn’t seen their child for years as they don’t want to be involved while they’re institutionalised. Can’t contact child because they have no belongings/access to phone/ internet and doesn’t know child’s last name due to recent marriage. Key Issues • Resisted consultation due to stigma • Family counselling wasn’t presented as option • Institutional care not sympathetic to persons vulnerabilities/insecurities • Homelessness aggravated problem • Doesn’t own mobile phone - can’t access or get in touch with family through phone or internet.

Age: 26 Struggled with accepting parents’ divorce since childhood and brothers slip into schizophrenia. Over years, developed drug and alcohol problems which then turned into gambling and financial debt. With fears of bipolar disorder and depression, distanced themselves from any family support network and was suicidal. Was admitted into rehabilitation twice, the first time was a 3-week admission which was not enough time before being exposed to the same risk factors and triggers. Second time, was moved into a lifestyle rehabilitation program which addressed a holistic approach to health and has since been steadily improving. Key Issues • No family counselling to educate • Financial instability • Fear of consultation due to stigma of mental illness • Short term rehabilitation not successful

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PERSONAL CASE STUDIES OF MENTAL ILLNESS

71


Ian Hickey from the New South Wales Mental “ Professor Health Commission likened the mental health sector to a malfunctioning shower; “You keep pumping more water in at the top, you have lots of little holes where the water goes out. The danger is, a whole lot of people don’t get wet.

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There are more gaps between the services than there are integrated service pathways. And our response is to put more in.”


Funding The current system continues to prioritise funding into institutional settings, feefor-service, solo-practitioner or singleprofessional services when evidence shows the effective impact of community-based stepped-care psychosocial, primary and community health services.26 Although there is a need for more funding for mental health services nationwide, until the current system is reformed and can de-fund ineffective programs, there will be inefficient allocation of resources. There needs to be more attention towards providing independent and national evaluation of programs and mental health services to ensure that funding is being allocated effectively and to continue or increase funding to those that have substantial positive effect on a community. Community Many parts of the system continue to prioritise practitioners and policy makers when a more effective solution is to put patients and their families at the heart of not just care, but of the wider decision making process.27 The delivery of higher-quality mental health care through multidisciplinary teams has been proven both in Australia and internationally,25 but the system is struggling to catch up with the dissolution of clinical hierarchies into wider modes of care. More focus needs to go into encouraging families and support networks of those effected to become involved. Attempts such as Carers Allowance provides financial support have had limited success and should continue with further revision. Those with lived experience of mental illness should 26

Hickie, “Mental Health System Needs Reform”.

27 Hickie, “Putting Mental Health Services And Suicide Prevention Reform Into Practice”.

also be encouraged to participate in the continuum of community treatment as they have invaluable knowledge regarding recovery that mental health professionals may not be able to provide. Disability, Support & Employment Those that are diagnosed with a mental illness are eligible to apply for the Disability Support Pension (DSP) and may receive a lifetime of support, which does little to empower the individual to participate in daily activities such as employment. As acknowledged, mental illness can be episodic in nature and with the right treatment, a person may return to work down the track. Those with a permanent impairment and no capacity to work should still be eligible, however for the vast majority of those living with mental illness, it will promote a path to recovery. Initiatives such as the Individual Placement Support (IPS) worked with youth to make a study or work plan that had a 90% success rate in their return to study or work after a psychotic episode. Employment Those living with mental illness have better life outcomes if they maintain some workforce participation and most people who experience mental illness still have the desire to work28 but are discouraged because of the enormous barriers such as discrimination and stigma that surrounds it. The issue is that workplaces and health systems do little to embrace the return of their staff or community members after mental illness. The episodic nature of mental illness means that a person is unable to plan for their future and there is a fear they may lose income support and associated benefits.

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THE SYSTEM NEEDS REFORM

28 Ireland, “Mental Illness Does Not Mean A Lifetime On Welfare, Says Jeff Kennett”.

73


WELL

UNWELL

TREATMENT

COMMUNITY

RECOVERY

WELL

COMMUNITY

UNWELL SELF-DIAGNOSIS/ ADMISSION

TREATMENT FIGURE 5: COMPARISONS BETWEEN TRADITIONAL AND NEW MODELS OF MENTAL HEALTH CARE

re:habitat a new mental health approach for urban communities

INSTITUTIONALISED CARE

HEALTHY

DIAGNOSIS

HEALTHY / ILL

HEALTHY

DIAGNOSIS

ILL WITH HEALTHY

COMMUNITY CARE

FIGURE 6: COMPARISONS BETWEEN INSTITUTIONAL CARE VS. COMMUNITY CARE 74


Essentially, the new model of mental health places higher importance upon the value of community interaction in the holistic treatment of mental illness. It aims at decentralising the structure of the mental health system from the acute institutionalisation of patients that need psychological treatment by ‘getting in earlier’ – meaning rather than addressing an illness when it has come to a breaking point for the

patient, the model seeks higher attention towards prevention and inter vention. Community services become the buffer for people who experience psychological unrest and the intention is through a more open system that addresses all the facets of one’s lifestyle, they are able to work through their issues while they are still teething and are much more likely to dissolve them through soft interventions.

OLD VS. NEW

Whereas the old system placed high importance on the value of formal institutions and acute mental healthcare facilities, the new system seeks to utilise existing services already established within the urban fabric. This frees up demand assigned to psychiatrists whom will remain in close connection to community services and patients but in a more informal context, reducing the resources required. This frees up the hospitals for more severe cases and mental health funding can

shift from treatment to prevention-based activities which are much cheaper and more widespread. From the patients view, instead of being isolated for a certain amount of time while seeking treatment for their illness, they are able to exist within a community that is familiar with them and do not experience a shock when attempting to reacclimatise to their surroundings upon release.

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NEW MODEL OF MENTAL HEALTH SYSTEM

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Elysian House United Kingdom An initiative set up in the United Kingdom by organisation ‘Rethink Mental Illness’, recovery houses like the one in Barnet called Elysian House provides short-term support for people suffering from mental health problems by providing a therapeutic and person-centered approach to support recovery. # A home treatment team of mental health professionals carry out an assessment of a person experiencing psychological distress and will provide intensive support for a limited support within the person’s home#. They work closely with care co-ordinators to ensure that care is provided within the least restrictive environment. # If, through clinical assessment, the person seems to suffer from more severe psychological distress, they are admitted to the inpatient beds at Elysian House and a clear treatment plan is established with which is influenced by them.# Elysian house acts as a stepping stone for those ‘not actively suicidal’ and no longer need to be in psychiatric wards but are not considered ready to return to their homes.#

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The registered manager witnessed a 18-year old female who was initially discharge from hospital after faking wellness to get out, but before long ended up back in because she wasn’t ready. The recovery house structure is essential in the transition from severe mental illness to the everyday life. Details • Accommodation for 12 people experiencing a mental illness • Registered mental health manager • Staff work with community mental health team to ensure support is co-ordinated and appropriate to people’s needs • Recovery house encourages independence and provide a home away from home environment, with communal kitchens and lounges as well as ‘quiet rooms’ and small gardens. • Average length of stay is 14 days however longer periods are available • Staff help patients find housing when they are ready to be discharged from the service. • During daytime, there are 3 staff and a registered mental health manager. • 2 staff available on overnight duty. Pros • Round the clock support • Independence • Located within existing urban community fabric • Access to Train Station • Proximal to larger healthcare services • Overall, the people admitted felt like the service was effective, safe, caring, responsive and well led with capable mental health professionals. Cons • Must be over 16 • People felt like there weren’t enough activities to keep themselves busy

Excerpt taken from “Home Treatment Team - Barnet”.

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Tupu Ake

New Zealand

Similar to the Elysan House, Tupu Ake is a mental health and wellness service in Papatoetoe, New Zealand that provides real alternatives to hospital admission. It is a place for people living within the region (some of which are indigenous peoples) and is a method of prevention rather than postvention for those struggling with their household environment.


• Access to Train Station • Proximal to larger healthcare services • Overall, the people admitted felt like the service was effective, safe, caring, responsive and well led with capable mental health professionals. Cons • Must be over 16 • People felt like there weren’t enough activities to keep themselves busy

Tupu Ake

New Zealand

Similar to the Elysan House, Tupu Ake is a mental health and wellness service in Papatoetoe, New Zealand that provides real alternatives to hospital admission. It is a place for people living within the region (some of which are indigenous peoples) and is a method of prevention rather than postvention for those struggling with their household environment. The staff include registered nurses, peer support specialists and counsellors. Peer support specialists are vital in establishing common ground and a strong relationship with patients as they have experienced mental illness and are able to understand what others are going through. They have also had the appropriate mental health training to address these issues professionally. Details • 10 overnight beds • 5 additional daytime admissions (8am-8pm) Pros • Separated from stressful environment, able to unwind • Therapeutic programs such as painting, reading or excercising in the gym can improve psychological wellbeing and keep patients busy

RECOVERY HOUSING MODELS

The two examples of recovery housing provide the missing link in the prevention, intervention and treatment of mental illness. They are not in place of acute institutionalised care, but are the community-based support networks that give people better chances of recovering on their own terms for a more sustained treatment. Excerpt taken from Silver, “The Halfway Houses Keeping Mental Health Patients Out Of Hospital”.

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Cons • Separated from environment and can cause stress upon reassimilation

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SPIRITUALITY TREATMENT & REHAB

WORK/SCHOOL

SOCIAL SUPPORT

PEER SUPPORT

NUTRITION EXERCISE

HOUSING FAMILY

RECOVERY ORIENTED SYSTEM OF CARE

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FIGURE 7: RECOVERY ORIENTED SYSTEM OF CARE

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T h e n e w m o d e l o f m e nt a l h e a l th understands that mental wellbeing (and illness) are influenced by greater factors than the traditional model recognised. In the past, the main treatment was through pharmacology and isolation with limited psychiatric assessments. The new model aims at empowering individuals to become responsible for their own path of recovery as they are most likely to know their own mind and their habits/behaviours. It places people at the centre of an interconnected network of services where institutional care is only one of the inputs. It understands that mental illness is attributed by more than just stress or internal disorientation, but rather through nutrition, exercise, stable housing and work or school. This model aims at strengthening communities and their assets through recovery. There is a greater importance placed on family and friends, and those with lived experience of mental illness as they have learned much and are valuable resources to those that surround them.

Graphic redrawn from Evans, “Declaration A Decade Of Pioneering System Information”.

The recovery oriented system of care can also reduce the stigma that surrounds mental illness, as more members of the community are involved in the process and is much more addressable with help from psychiatrists, psychologists and other mental health professionals. The concept of recovery in this system of care is not that recovery means a cure, but it means hope, healing, empowerment and connection. New understandings dictate that achieving mental health is a continuous journey rather than an short, finite periods of time and as such attempt to establish a positive culture of healing. There are 6 focuses of recovery-oriented systems of care which can form metrics or deliverables for the success of its implementation; • Uniqueness of Individual • Real choices • Attitudes and rights • Dignity and respect • Partnership and communication • Evaluating recovery

RECOVERY ORIENTED SYSTEM OF CARE


GOAL

PEOPLE

EFFECTIVE AND EFFICIENT CARE

DIAGNOSED

MITIGATE RISK AND EARLY INTERVENTION

AT RISK

KEEPING PEOPLE HEALTHY

HEALTHY

FIGURE 8: POPULATION HEALTH APPROACH

POPULATION HEALTH APPROACH

With the expected increase of burden of mental illness upon communities, a more efficient system is needed to ensure that the whole population can receive the right care. The population health approach continues from the findings from the recovery oriented system of care by placing value upon the community to make general improvements and increase the resilience of people before experiencing severe psychological distress. Utilising the breath of the community, many people can be sufficiently addressed with lower injection of funding. Keeping people

Graphic redrawn from Evans, “Declaration A Decade Of Pioneering System Information”.

healthy early in the process is much more effective than allowing those same people to experience psychological distress and having to treat them within an institutional environment, which expends much more of the limited resources. By paying for a performance system, it becomes cheaper to intervene. The goal is to implement financing mechanisms that incentivise people to get better quicker and keeping people better.

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POPULATION HEALTH APPROACH

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WORKING AT THE COMMUNITY LEVEL OF ANALYSIS

WORKING UPSTREAM (INTERVENING EARLIER)

HEALTH ACTIVATION APPROACHES AND EMPOWERING OTHERS

BROAD SET OF STRATEGIES

WORKING WITH AT RISK & HEALTHY POPULATIONS WORKING IN NON-TREATMENT SETTINGS DELIVER HEALTH PROMOTION INTERVENTIONS

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FIGURE 9: 7 CONCEPTUAL SHIFTS FOR COMMUNITY HEALTH

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Graphic redrawn from Evans, “Declaration A Decade Of Pioneering System Information”.


There are 7 conceptual shifts in community health needed to fully engage with a new model of healthcare.

1. Working Upstream (intervening earlier) The earlier that mental health treatment can begin within a community means that there is less chance of short term psychological distress transforming into a chronic illness which demands much more time and resources in more acute, specialised services.

2. Broad set of strategies Looking beyond the traditional treatments of psychotherapy and pharmacology to a wider approach such as mental health first aid, something that should be as common as normal first aid.

3. Working with at risk and healthy populations Addressing cultural groups beyond standard methods. Cultural groups tend to have their own social structures and values of healthcare and some cross-cultural translation may be needed to provide parity and solve specific issues more effectively.

4. Deliver Health Promotion Interventions Resources that can be accessed in non-formal settings and by anyone at any moment of the day promotes the idea of a continuous system of care. Implementations such as websites and apps or community screening sessions brings the culture of self-diagnosis to the everyday and mainstream.

5. Working in non-treatment settings Looking at the determinants of mental health and how they align with the demography of a community can bring light to trends that can influence the impact of mental health. An example is the understanding that stable housing can promote mental wellness, which then prompts mechanisms for allowing those that are socio-economically disadvantaged with financial support for housing. It is also a more efficient use of funds and promotes cross-industry collaboration for greater results and coverage whilst providing ongoing support rather than a temporary solution.

6. Health activation approaches and empowering others Community gatherings and workshops held within formal and informal settings can raise awareness about mental wellness and can strengthen community links through a similar desire for health.

7. Working at the community level of analysis Understanding that mental wellness is ingrained into the social interactions we have and the spaces we exist within can become the catalyst of powerful movements. Cultural events and activities that bring people together from all backgrounds become idea generators and invaluable indicators of how people feel about their community and the world around them.

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7 CONCEPTUAL SHIFTS FOR COMMUNITY MENTAL HEALTH

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MENTAL HEALTH, WELLBEING AND RESILIENCE Maximised through social and economic participation, education, employment and stable housing

PEOPLE-TO-PEOPLE SUPPORT Sits on a continuum from family and friends to structured peer and group support

SELF-AGENCY Everyone can access a spectrum of tools to support self-agency, including e-health services

FREQUENCY OF NEED

PRIMARY AND COMMUNITY SERVICES These are close to home, accessible, personalised, evidence based and focused on recovery SPECIALIST SERVICES Community-based, recovery-focused acute treatment responses are available if needed RESIDENTIAL SPECIALIST SERVICES Intensive and short to medium duration services are available if needed

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CARE FOR SERVICE AND ENDURING NEEDS Available if needed

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QUANTITY NEEDED

FIGURE 10: DELIVERING MENTAL HEALTH AND WELLBEING TO NSW

Graphic redrawn from Living Well: A Strategic Plan For Mental Health In NSW 2014-2024.

COST


The New South Wales Mental Health Commission was formed in 2014 to construct a strategic plan for the next decade of mental health in NSW. It has become a tool for which they can test the implementation of its proposals and is a beacon of change in the perceptions towards mental healthcare for organisations, mental health professionals and consumers.

The figure overleaf summarises the various services that are provided in the mental healthcare system and the associated frequency, quantity and cost. It explains the importance of community participation and soft interventions at the top of the chart, which is accessed frequently, reaches the most people and is low cost proportional to the entire budget.

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LIVING WELL: A STRATEGIC PLAN FOR MENTAL HEALTH 20142024

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SELF-ACTUALISATION personal growth and fulfillment AESTHETIC NEEDS beauty, balance, form COGNITIVE NEEDS knowledge, meaning, self-awareness ESTEEM NEEDS achievement, status, responsibility, reputation BELONGING/LOVE NEEDS family, affection, relationship, workgroup SAFETY NEEDS protection, security, order, law, limits, stability BIOLOGICAL/PHYSIOLOGICAL NEEDS air, shelter, food, water, warmth, sex, sleep

FIGURE 11: UPDATED HEIRARCHY OF NEEDS DIAGRAM BASED ON MASLOW’S THEORY (CHAPMAN, 2001-2007).

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AESTHETIC NEEDS beauty, balance, form

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ESTEEM NEEDS achievement, status, responsibility, reputation BELONGING/LOVE NEEDS family, affection, relationship, workgroup COGNITIVE NEEDS knowledge, meaning, self-awareness SELF-ACTUALISATION personal growth and fulfillment BIOLOGICAL/PHYSIOLOGICAL NEEDS air, shelter, food, water, warmth, sex, sleep SAFETY NEEDS protection, security, order, law, limits, stability

FIGURE 12: EXAMPLE OF THE RESTRUCTURING OF HEIRARCHY OF NEEDS FOR A PERSON SUFFERING FROM MENTAL ILLNESS


The concept of Maslow’s hierarchy of needs is well recognized among psychologists and other disciplines in current studies of human behaviour. When a person experiences psychological distress or mental illness, they can sometimes forgo certain aspects of what is considered a structured lifestyle and can impact their perceived priority of things. The example overleaf is not an exact depiction but rather a notion of reshuffling priorities, if even temporarily and can disturb the methods of addressing mental health accurately.

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HIERARCHY OF NEEDS

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TABLE 3: PUBLIC STIGMA Stereotype

Negative belief about a group (e.g. dangerousness, incompetence, character weakness)

Prejudice

Agreement with belief and/or negative emotional reaction (e.g. anger, fear)

Discrimination

Behaviour response to prejudicve (e.g. avoidance, withhold employment and housing opportunities, withhold help)

TABLE 4 : SELF-STIGMA Stereotype

Negative belief about the self (e.g. character weakness, incompetence)

Prejudice

Agreement with belief, negative emotional reaction (e.g. low self-esteem, low self-efficacy)

Discrimination

Behaviour response to prejudicve (e.g. fails to pursue work and housing opportunities)

STIGMA OF MENTAL ILLNESS STIGMA OF ILLNESS PERSON LIVING WITH STIGMA OF MENTAL MENTAL ILLNESS MENTAL ILLNESS PERSON LIVING PERSON LIVING WITH WITH MENTAL MENTAL ILLNESS ILLNESS

NO OPPORTUNITIES TO CONTACT AND RELATE. SEPARATION BECOMES STIGMATISING. NO TO NO OPPORTUNITIES OPPORTUNITIES TO CONTACT CONTACT AND AND RELATE. RELATE. SEPARATION SEPARATION BECOMES STIGMATISING. BECOMES STIGMATISING. WIDER COMMUNITY WIDER WIDER COMMUNITY COMMUNITY

REDUCTION OF STIGMA THROUGH CONTACT REDUCTION OF REDUCTION OF STIGMA STIGMA THROUGH THROUGH CONTACT CONTACT PERSON LIVING WITH MENTAL ILLNESS PERSON LIVING PERSON LIVING WITH WITH MENTAL ILLNESS MENTAL ILLNESS

WIDER COMMUNITY WIDER WIDER COMMUNITY COMMUNITY

OPPORTUNITIES IN TIME AND SPACE FOR BOTH TO INTERACT AND MAKE CONTACT. DESENSITISES ALLOWS RELATABILITY. OPPORTUNITIES IN AND SPACE FOR OPPORTUNITIESAND IN TIME TIME ANDFOR SPACE FOR BOTH BOTH TO TO INTERACT INTERACT AND AND MAKE MAKE CONTACT. CONTACT. DESENSITISES AND ALLOWS FOR RELATABILITY. DESENSITISES AND ALLOWS FOR RELATABILITY.

REDUCTION OF STIGMA THROUGH EDUCATION

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REDUCTION REDUCTION OF OF STIGMA STIGMA THROUGH THROUGH EDUCATION EDUCATION

86

REDUCTION OF STIGMA THROUGH PROTEST REDUCTION REDUCTION OF OF STIGMA STIGMA THROUGH THROUGH PROTEST PROTEST

29 Corrigan and Watson, “Understanding The Impact Of Stigma On People With Mental Illness”.

POINT OF PARITY. PARALLEL AND COMMON LIVES. BOTH SHARE SAME GOALS. POINT OF PARALLEL POINT OF PARITY. PARITY. PARALLEL AND AND COMMON COMMON LIVES. LIVES. BOTH BOTH SHARE SAME GOALS. SHARE SAME GOALS.


The effect of stigma in mental illness can be as influential as the illness itself, and can exacerbate the feelings of isolation and seclusion that one can already experience from their psychological distress, as well as deterring potential workforce participation from mental health professionals or peer support workers wishing to put the experience behind them after recovery. It can leave people lacking opportunities that define a quality life such as good jobs, safe housing, satisfactory health care and an affiliation with a diverse range of people.29 Understanding the impact of stigma on people suffering from mental illness can be hard to evaluate but has become more widely recognised as a major determinant on feelings of inclusion in a community. Stigma surrounding mental illness can be divided into two components; public stigma, which is the negative beliefs of the community towards people living with mental illness, and self-stigma, which is the negative beliefs that a person living with mental illness places upon themselves. Both are important to address in decreasing the impact of mental health and increasing the resilience of a society. Strategies for reducing Stigma There are three generally accepted methods of reducing stigma towards persons living with mental illness; protest, education and contact. • Protest; the actions refusing to accept preconceived notions about mental illness

SOCIAL INCLUSION

that have been perpetuated through media, exposure to certain opinions or personal assumptions. The risk of this method is that it may increase stigma through instructing individuals to ignore or suppress negative thoughts and attitudes which can cause resistance and unwanted pressures. • Education; there is evidence to support that individuals who possess more information about mental illness are less stigmatising than individuals misinformed about mental illness.30 • Contact; there is convincing evidence that increased contact with persons living with severe mental illness is associated with lower stigma.31 This is due to the dissolution of segregative labels of ‘they’ and ‘us’ to a more collective understanding of a community. Attribution Theory Attributions are explanations that an individual makes about another individual’s behaviour. Mental illnesses are perceived as more controllable than medical disorders and hence, more stigmatizing . 32 This results in assumptions that the person living with mental illness is responsible for their condition, which can culminate in feelings of disassociation by the wider community. Sustained interpersonal contact with a person living with mental illness can shift the attribution from controllable to uncontrollable, which corresponds to a shift in feelings, such as sympathy.33

People suffering from psychological distress living independently sometimes experience independent living itself as a daily task or even as ‘survival’ rather than ‘living’.34 They may therefore be less inclined to participate in social and vocational activities. Those living with mental illness in independent configurations does little to promote higher levels of participation in more competitive activities such as paid employment. 35 Due to the inherent challenges of mental illness, people are also less able to achieve

higher academic accreditation through secondary and tertiary institutions and are pushed further from fulfilling employment opportunities.

29 Corrigan and Watson, “Understanding The Impact Of Stigma On People With Mental Illness”. 30 Penn and Couture, “Strategies For Reducing Stigma Toward Persons With Mental Illness”. 31 ibid. 32 ibid. 33 ibid.

34 “De Heer-Wunderink et al., “Social Inclusion Of People With Severe Mental Illness Living In Community Housing Programs”.

Contrary to this, the belief that independent living is linked to less social activity is false. Because persons living with mental illness in independent living is isolated and has lower satisfaction with daily life, they are more willing to visit and be visited by family, friends and support networks.36

35 ibid. 36 ibid.

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REDUCING STIGMA

87


88

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In the newest 2014-15 figures on expenditure, $8.5 billion was spent on mental health services nationally. This equates to $361 per person, which is an increase from $341 per person in 2010-2011. There was more funding focused on public hospital services ($2.2 billion) for patients admitted for diagnosed with mental illness than community mental health services ($1.9 billion). This does not reflect the value placed on community based services and further funding should be allocated to the latter for more effective allocation of resources, as acute specialised mental health care services are more expensive than those for non-acute services.37 The average national cost of a patient in acute care is $1,029 per patient day, however the average national cost of a patient in residential mental health care is only $400 per patient day. Of the $304million spent on residential mental health services during 2014-2015, 86.6% was spent on 24-hour staffed services ($263 million).

37 AIHW 2016. Health expenditure Australia 2014–15. Health and welfare expenditure series no. 57. Cat. no. HWE 67. Canberra: AIHW

There were 7,750 episodes of residential care recorded for approximately 5,800 residents in 2014-15. This equates to an average of 1.3 episodes of care per person, and resulted in an average of 39 residential care days per episode. 60% of completed residential care stays were between 0-2 weeks. The 5 most commonly reported principle diagnoses were of involuntar y status; schizophrenia , personality disorders, depressive disorders, schizo -affective disorders and bipolar affective disorders.

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EXPENDITURE ON MENTAL HEALTH SERVICES

89


with mental illness have a right to live in safety and “ People with stability, and to choose where they want to live, with

“

whom, and the amount of support they require.

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Sowerswine and Schetzer, Skating On Thin Ice: Difficulties Faced By People Living With Mental Illness Accessing And Maintaining Social Housing.

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A secure, stable and safe home is an essential component of mental wellness. Social housing is an important part of the housing spectrum and many suffering from illness or disability depend on it as they often also experience economic disadvantage; it can often be the determining factor whether a person is on a path to recovery or being unwell.38 However, of the 19% of people in NSW living in social housing with severe mental illness,39 many feel there are difficulties obtaining entry into social housing due to the lengthy waiting lists and burden to continually prove their needs and advocate their case.40 Social housing is sometimes a long-term need for those with mental disabilities or illnesses, however most low-income earners living with mental illnesses report living in

38 Mental Health Commission of New South Wales, Mental Health Recovery And Social Housing: A Response To Social Housing In NSW Discussion Paper - NSW Family And Community Services. 39 ibid.

unstable or marginalised housing such as boarding houses, crisis accommodation and other forms of temporary housing.41 The low incomes of people who experience mental illness can often be linked to the cyclical nature of illness, which impacts on the ability to access employment and education.42 Within the new models of mental health care, the intention is to replace long-stay psychiatric hospitals with a system of integrated community based networks, backed up by specialist hospital or other services as required.43 This may lead to a shift in funding focused on more opportunities for those living with mental illness with greater provision of stable, consistent social housing with less barriers to access.

40 ibid. 41 ibid. 42 ibid. 43 ibid.

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MENTAL HEALTH RECOVERY AND SOCIAL HOUSING

“

“ Housing is the first step to health.

91


·are Themedical, Community Health Patients Center must itself social Mental and economic. learnaddress to rely on the to the moraleofand of the people, to poverty, to permanence theself-respect physical structure. discrimination andMental to segregation. · The Community Health Center must address itself to the morale and self-respect of the people, to poverty, to discrimination and to segregation. A R. Foley Psychiatrist

David McKinley Jr. Architect · Architecture should shape environment to create David McKinley Jr. Architect behaviour. · Architecture should shape environment to create behaviour.

·AMany troubledPsychiatrist people initially consult a clergyman, physician, R. Foley or school teacher – the program must provide help for these workers to enablepeople them to handleconsult such programs effectively. · Many troubled initially a clergyman, physician, The ‘community must be able to extend histhese or school teacherpsychiatrist’ – the program must provide help for capacity forenable identifying the single to identifying workers to themwith to handle suchpatient programs effectively. with The ‘cgroups. ommunity psychiatrist’ must be able to extend his Comprehensive mental with health include capacity for identifying theprogramming single patientmust to identifying service, training and research. Research evaluation is essential with groups. to reshape the program to meet the changing needs. Comprehensive mental health programming must include The emphasis must on program, not evaluation centre. is essential service, training andbe research. Research to reshape the program to meet the changing needs. The emphasis must be on program, not centre.

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Jean Paul Carlhian Architect

92

· Each building should have a distinctive design which Jean Paul Architect indicates itsCarlhian function without the need for an applied sign. ·A highbuilding rise building a community Each shouldforhave a distinctiveservice designcenter whichis not desirable. Low income,without culturally are sign. indicates its function thedeprived need for people an applied afraid of rise a large office for building and are not likelycenter to is not · A high building a community service Kiyoshi approach itLow evenincome, toArchitect obtain help. Elderly people alsoare may desirable. Izumi culturally deprived people fear a large building because it usually means elevators, afraid of a large office building and are not likely to · Parking and other intrusions that tend to consume space escalators stairs.to obtain approach help. Elderly also may and furtheritoreven separate the units should bepeople discouraged, if not ·fear Patients should be educated use public transportation. a large building because ittousually means elevators, eliminated The of the CMHC symbolises its role on in escalators orlocation stairs. · Thecentral success of the architectural solution is dependent the community. ·the Patients should beofeducated use public transportation. understanding the basictosocial interaction, the The central location of the CMHC symbolises its role in face-to-face relationship the community. · You may end up with an informed public, a large psychiatric school with many students, a vast research center, but with iller patients. · Avoidance of institutional space is more important than achieving home or motel-like space. W. W. Caudill Architect

Humphrey Osmond Psychiatrist Robijn Hornstra Psychiatrist

· The individual is the most important person. W. Architect It is W. just Caudill as bad to build walls between agencies as it is to build walls between Center and theperson. community. · The individual is thethe most important ·ItWe want to come even if they are notassick. is just as people bad to build wallsinbetween agencies it is to ·build The overlap of services like the seashore – like land and walls between the isCenter and the community. Wilmont Vickrey Architect water – eternal change. It can be a wonderful thing. · We want people to come in even if they are not sick. ·· How much will this center cost to build? Less than if we The overlap of services like thenot seashore land and centre should blendis in and impose.– Itlike should be don’ t . water eternalformal, change.flexible, It can beinvite a wonderful thing. open, –inviting, casual entrance, ·exploration How muchbywill thischildren, center cost to build?loafers, Less than we sun, neighbours, andifstray don’ dogs.t. · Commercial enterprises are situated on the busiest corner of the site so the community residents can see the familiar, safe, and much needed resources.

Alfred Paul Bay

Tocommunity do the sick no harm.health To maintain patienta as a person. ·Robijn A mental center isthe basically program and Hornstra Psychiatrist surroundings which minimise it· Sick maypeople or mayrequire not reside within a particular structure.rather The than exaggerate theirmental surroundings. building depends on thehealth program, andis the program responds · A community center basically a program and It becomes difficult to isolate what is the result of distressing to the needs of the community. it may or may not reside within a particular structure. The and what is play the result illness. ·living Care conditions of patients not second to organised building dependsshould on the program, and of thefiddle program responds ·medicine, A The mentally ill person requires an environment which power politics or technology. to the needs of the community. prevents dehumanisation and encourages social ·both The in programs clearly shifting from the Careemphasis of patients should notisplay second fiddle to organised interaction to thein limits of,orbut their exclusive interest treatment ofnot thebeyond, mentally ill totolerance. the medicine, power politics technology. A new building the wellbeing the the mentally ill prevention of mental illness.for · The emphasis indesigned programs is clearly shiftingoffrom inWhen whichprofessionals great attention paidother their needs isinillathe better form ·exclusive seeiseach regularly elevator, interest in treatment oftothe mentally to the of public education than any amount of propaganda. eat and ride home together, they are more likely to work prevention of mental illness. together to help individuals rather to fall in back agency · When professionals see each otherthan regularly theon elevator, rules. eat and ride home together, they are more likely to work together to help individuals rather than to fall back on agency rules. Psychiatrist

·Alfred Unlike Paul organic disease,Psychiatrist mental illness never completely Bay resides within the individual. Joseph J Downing Psychiatrist · Unlike organic disease, mental illness never completely resides within the individual. · Aesthetics is extremely important, not an afterthought… but a planned adjunct to therapy for the distraught mind. · For the long term mentally ill patient, the Community Mental Health Centre may come to occupy somewhat the position of the church in pre-industrial America or medieval Europe, not as a religious center but as a center of interest for help in the present and security and hope for the future. · An exclusively medical approach to alleviate only symptoms shunts patient to other services thereby complicating an already complex situation. The psychiatric patient’s problems are medical, social and economic. Patients learn to rely on the permanence of the physical structure. · The Community Mental Health Center must address itself to the morale and self-respect of the people, to poverty, to discrimination and to segregation.

A R. Foley Psychiatrist · Many troubled people initially consult a clergyman, physician, or school teacher – the program must provide help for these workers to enable them to handle such programs effectively. The ‘community psychiatrist’ must be able to extend his capacity for identifying with the single patient to identifying


Wilmont Vickrey Architect

· Aesthetics is extremely important, not an afterthought… but a planned adjunct to therapy for the distraught mind. · The centre should blend in and not impose. It should be · For the long term mentally ill patient, the Community open, inviting, formal, flexible, invite casual entrance, Mental Health Centre may come to occupy somewhat the exploration by sun, children, neighbours, loafers, and stray position of the church in pre-industrial America or medieval dogs. Europe, not as a religious center but as a center of interest for · Commercial enterprises are situated on the busiest corner help in the present and security and hope for the future. of the site so the community residents can see the familiar, · An exclusively medical approach to alleviate only symptoms safe, and much needed resources. shunts patient to other services thereby complicating an already complex situation. The psychiatric patient’s problems are medical, social and economic. Patients learn to rely on the In 1965, Rice University held an intensive Although permanencedistress. of the physical structure.the culmination of these The Community Center address research-oriented desig n fete ·which teams’Mental ideasHealth are over 50must years old,itself many of to the morale and self-respect of the people, to poverty, to prompted the collaboration of teams of their beliefs on the importance and structure discrimination and to segregation.

psychiatrists, architects, mental health of a community mental health centre stand and built environment specialists with the strong and hold even more value in today’s intention of design experimentation and urban context than ever before. Summaries of formulation of new models of Community the team collaboration between the architect A R. Foley Psychiatrist Mental Health Centres to address the new and psychiatrist follow. era in treatment of those in psychological · Many troubled people initially consult a clergyman, physician,

David McKinley Jr. Architect · Architecture should shape environment to create behaviour.

Kiyoshi Architect Jean PaulIzumi Carlhian Architect Parking and other intrusions that tend todesign consume space ·· Each building should have a distinctive which and further separate the units should be discouraged, not indicates its function without the need for an applied ifsign. eliminated · A high rise building for a community service center is not ·desirable. The success the architectural dependent Lowofincome, culturallysolution deprivedispeople are on the understanding of the basic social interaction, the afraid of a large office building and are not likely to face-to-face relationship approach it even to obtain help. Elderly people also may ·fear Youa may end up with an informed public, large building because it usually meansa large elevators, psychiatric school with many students, a vast research escalators or stairs. center, butshould with iller patients. to use public transportation. · Patients be educated · Avoidance of institutional space is more important than The central location of the CMHC symbolises its role in achieving home or motel-like space. the community.

Wilmont Vickrey Architect W. W. Caudill Architect ·· The should blend and not impose. The centre individual is the mostinimportant person.It should be open, inviting, formal, flexible, invite casual entrance, It is just as bad to build walls between agencies as it is to exploration by sun, children, neighbours, loafers, and stray build walls between the Center and the community. dogs. · We want people to come in even if they are not sick. ·· Commercial on the–busiest corner The overlap ofenterprises services isare likesituated the seashore like land and of the site so the community residents can see the familiar, water – eternal change. It can be a wonderful thing. safe, and much resources. · How much willneeded this center cost to build? Less than if we don’t.

Excerpts from LaRue Jones, Architecture For The Community Mental Health Center.

or school teacher – the program must provide help for these workers to enable them to handle such programs effectively. The ‘community psychiatrist’ must be able to extend his capacity for identifying with the single patient to identifying with groups. Comprehensive mental health programming must include service, training and research. Research evaluation is essential Humphrey to reshape theOsmond program to Psychiatrist meet the changing needs. The emphasis must be on program, not centre. · To do the sick no harm. To maintain the patient as a person. · Sick people require surroundings which minimise rather than exaggerate their surroundings. It becomes difficult to isolate what is the result of distressing living conditions and what is the result of illness. Robijn Hornstra Psychiatrist · A The mentally ill person requires an environment which both prevents dehumanisation and encourages social · A community mental health center is basically a program and interaction to the limits of, but not beyond, their tolerance. it may or may not reside within a particular structure. The · A new building designed for the wellbeing of the mentally ill building depends on the program, and the program responds in which great attention is paid to their needs is a better form to the needs of the community. of public education than any amount of propaganda. · Care of patients should not play second fiddle to organised medicine, power politics or technology. · The emphasis in programs is clearly shifting from the exclusive interest in treatment of the mentally ill to the prevention of mental illness. · When professionals see each other regularly in the elevator, eat and ride home together, they are more likely to work together to help individuals rather than to fall back on agency rules. Joseph J Downing Psychiatrist · Aesthetics is extremely important, not an afterthought… but a planned adjunct to therapy for the distraught mind. Psychiatrist Alfred Paul Bay · For the long term mentally ill patient, the Community comeillness to occupy ·Mental UnlikeHealth organicCentre disease,may mental never somewhat completelythe positionwithin of thethe church in pre-industrial America or medieval resides individual. Europe, not as a religious center but as a center of interest for help in the present and security and hope for the future. · An exclusively medical approach to alleviate only symptoms shunts patient to other services thereby complicating an already complex situation. The psychiatric patient’s problems are medical, social and economic. Patients learn to rely on the permanence of the physical structure. · The Community Mental Health Center must address itself to the morale and self-respect of the people, to poverty, to discrimination and to segregation.

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COMMUNITY MENTAL HEALTH CENTRE

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TABLE 5: USER CONSIDERATIONS IN A MENTAL HEALTH UNIT Concerns

Consumers;

Staff;

Space

... feel caged in. ... feel their unit is too small. ... don’t value artificial courtyards. ... don’t like locked doors.

... feel caged in at nurse stations which is where they spend most of the time doing work.

Control

... feel controlled and coerced.

... feel they need control.

Time

... feel bored. ... don’t appreciate they can’t smoke. ... feel they have too much time.

... feel too busy. ... feel there is not enough time.

Feeling of presence

... feel observed.

... feel monitored.

Staff contact

... feel there is not enough time with staff.

... feel they don’t have enough time with patients as they are doing too much paperwork.

More Space

... want more space.

... don’t want to have to manage and monitor a larger area.

Object

... feel like objects, being counted and tallied.

... must keep count.

Meetings

... hate meetings and want to be left alone.

... hate staff meetings and want more tome to provide clinical care.

Interaction

... interact only with other consumers.

... interact only with other staff.

Perception

... feel bullied.

... feel they are taken advantage of.

Freedom

... don’t know when they will get out.

... can’t wait to leave.

Rules

... feel confined and restricted by rules.

... feel the rules are there for a reason, otherwise becomes tough to manage so many people.

... want more trust.

... can’t trust patients. ... taught not to trust patients.

Treatment Trust

THIS IS NOT A HOME, ITS A HOSPITAL

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MAKING SENSE

94

I should not be here

Waiting for a different place

DIFFERENTIATING SPACE

FINDING ORDINARY LIFE

Negotiating my space with others

Being and doing something different

Living with people with different problems

My ideal place

Managing routines Privacy Getting away; isolation and seclusion

Table drawn from information in Arya, Dinesh. “So, You Want To Design An Acute Mental Health Inpatient Unit: Physical Issues For Consideration”

Missing family and friends

I’M STILL HERE

Its been a long stay Where or when to go.


Beyond the built environment, there are further factors that influence the relationship between patients, staff and their surroundings and should be ingrained into the design process. Although framed by more acute mental health care facilities, the table on the opposite page is a collection of observations made from both the patient and staff perspective and its lessons on relationships can be extracted. It is interesting that most observations between the two parties are conflicting which can create separation, exclusion, dehumanisation or a lack of respect. 44 Among the findings was a suggestion for a well-designed area for community health services staff to acclimatise consumers and their families to the inpatient unit.

FINDING MEANING IN PLACE

In a study in 2012, observations were made about patients in a psychiatric facility over the course of a year.44 The findings offer a unique insight into mental healthcare beyond built form but can significantly influence design. The common themes that arose from the study paint a picture of a place that the patient can never truly connect with, and will cast a negative perception of the facility which usually remains for the length of their admission. It is important to understand that

44 Amoroso, Finding Meaning In Place: The Perspectives Of People With Severe Mental Illness Living Long Term In A Psychiatric Hospital.

Understanding the consumers and carers through process mapping and value streaming drew to the surface the view of minimising non-value activities; what would they be doing yesterday or tomorrow and how can we facilitate these daily functions? Access to facilities for self-management are usually lacking and could serve as important keys to a self-oriented system of recovery. How can design compliment clinical practice change? We acknowledge but don’t design for; • a decrease in length of stay • a changing model of care • the management of co-morbidities, and •changing expectations of health care delivery.

the first impression of the space is crucial in forming that positive first impression. It enables them to trust the spaces and faces they are surrounded by and are therefore more willing to contribute to their own path to recovery. A place that gives a patient purpose can detach them from their low self-esteem issues and can improve wellbeing dramatically and increases the rate of recovery.

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CONSIDERING DESIGN FOR MENTAL HEALTH PATIENTS

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In a discussion with an intern at the Aboriginal Medical Services in Redfern, some important concerns were raised about the integration of community services with added complexity to cultural preservation.

• There is a lack of integration between the surrounding aboriginal services as they are all funded by government and essentially are competing for the same funding. This causes competition and lack of collaboration (such as between Jarjum and NCIE).

• Physicians may use the reputation of the AMS as a stepping stone towards larger roles because it looks good on an academic transcript. Thus, they may fail to engage with patients fully.

• Nurses and physicians sometimes conflict because they see different ways of managing things. This may be because of culture or familiarity with patients.

• When indigenous doctors are working, patients feel much more welcome and can discuss some of their problems much easier, and are also understood due to cultural similarities.

• Usually visits are a welcome and familiar experience with a chance to catch up with close relatives as the patients bring their whole family along and meet other families in waiting rooms.

• There are no appointments necessary which means it is accessible to all, however this does mean potential for long waiting times which can cause patients to become restless and agitated.

• People travel from as far as Dubbo to Redfern to receive the service that is believed to be excellent and familiar.

• There are fleets of cars and drivers that are free to pick up and drop off patients to appointments and back to their residence or public transport nodes if they are unable to make their own way there (such as disability or lack of transport options).

• There have been cases where Indigenous patients have left their appointments or selfdischarged their admissions at hospitals and come to AMS because they felt that they were not being understood, respected or treated effectively in the public system.

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THE ABORIGINAL REDFERN

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16

15

14

13

12

11 31m 10

9

8

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7

98

6 13.5m 5

4 6.5m 3

2

1

Image Credit: Gehl, Life, Spaces, Buildings.


We see with our eyes and walk with our feet, but in modern society we have derived our urban scale from the car, not ourselves. Prioritising the scale and proportion of us as humans is the basis of all responsive design. Jan Gehl’s studies of public spaces over the last 40 years has provided comprehensive reports to the largest cities in the world outlining improvements that enhance the health, character and sustainable behaviours of its people. Regulation of vehicular passageways and careful consideration of pedestrian movement, as well as the provision of amenity to these public spaces all stem from the larger notion that relates the human scale in the built environment and its physiological and psychological effects on people. With the advent of the car and the move into modernism, buildings and spaces were formed by the speed and scale of the car, whilst nature and the built forms that were a response to the human scale were lost. Improving public space increases the opportunity for night time activation and interaction, therefore providing safer neighbourhoods through presence. Allowing for a variation of interactions from low intensity/passive contact to higher intensity/close engages the community, and understanding that activity itself can become an attraction will draw people to well designed spaces. When the activity between buildings becomes sparse, the boundary between low intensity and high intensity interactions becomes much sharper and uncomfortable. Gehl’s response is to reclaim the design process in a way that prioritises the activity that can occur between people, which can be drawn from a thorough site analysis. through consideration of scale, circulation and a balance of intimacy and privacy, a spatial hierarchy emerges that can intuitively distinguish the progression of public, semipublic, semi-private and private spaces. Gehl mentions that one should design a 45 Mehotra, “Kinetic City: Learning From Urbanism In South Asia”.

space smaller than one thinks; the notion of occupation and interaction in a space enhances the value of public spaces and this in turn creates a level of respect and social monitoring for the built environment. Heights of buildings should acknowledge factors of the natural environment such as light and air to enter spaces, whilst reflecting the use of the space at ground relative to human proportions. Placing importance on pedestrian movement, followed by public transport and finally cars, reinforces notions of a healthy, sustainable city. Keeping cars as the key driver of urban design doesn’t reflect the residents desire to walk or cycle as shown in demographic studies. Life is mapped through a site that reflects the needs of the program. This can be refined through a careful and responsive site analysis which can include natural features i.e. vegetation or terrain. Spaces then inform the movement of people and public transport networks throughout the site. Consideration of pedestrian-friendly circulation through gentle gradients ensures site permeability. Buildings then frame these public spaces and provide a sense of spatial order through their individual yet collective response to built conditions such as setback and height, or if there is street front interaction. The value of the ground plane is emphasised as the canvas for which city life is painted on, and should not be disturbed where possible. Public Infrastructure such as streets, laneways, and public open spaces are the primary areas in which we all relate to one another and can become intimate on a community level.45 As soon as one leaves the confines of their house, they enter a public realm where socioeconomic status and other determinants of lifestyle become less relevant and they can assume any agenda.

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THE HUMAN SCALE

99


and give strength to the body and soul.

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John Muir

100

“

needs beauty as well as bread, places to “ Everybody pray in and play in where nature may heal and cheer


The research on the theory of biophilia revolves around the concept that people possess an inherent inclination to affiliate with natural processes and diversity, and this affinity continues to be instrumental in humans’ physical and mental development.46 Studies identify the benefits of human interaction with nature in terms of 9 values of nature; • Aesthetic value (physical attraction and beauty of nature): adaptability, heightened awareness, harmony, balance, curiosity, exploration, creativity and an antidote to the pressures of modern living. • Dominionistic value (mastery and control of nature): coping and mastering adversity, capacity to resolve unexpected problems, leading to self-esteem. • Humanistic value (affection and emotional attachment to nature): fondness and attachment, connection and relationship, trust and kinship, co-operation, sociability and ability to develop allegiances. • Moralistic value (spiritual and ethical importance of nature): understanding of the relationship between human wholeness and the integrity of the natural world, leading to a sense of harmony and logic. • Naturalistic value (immersion and direct involvement in nature): immersion in the sense of authenticity of the natural rhythms and systems, leading to mental acuity and physical fitness. 46 Beyond Blue Limited, Beyond Blue To Green: The Benefits Of Contact With Nature For Mental Wellbeing.

• Negativistic value (fear and aversion of nature): developing a healthy respect for the risks, power and dangers inherent in nature with an equivalent sense of awe, reverence and wonder, leading to learning to deal with fears and apprehensions in a constructive way. • S cientific va lue ( knowle dg e and understanding of nature): developing a cognitive capacity for critical thinking , analytical abilities, problem-solving skills leading to competence. • Symbolic value (metaphorical and figurative significance of nature): being able to access the limitless opportunities offered by the process in the natural world to develop understanding of one’s own circumstances, leading to cognitive growth and adaptability. • Utilitarian value (material and practical importance of nature): emphasising the practical and material importance of the natural world on which we rely for survival. The benefits if an interaction with nature are; • Relaxation, Restoration and Stress Reduction. • The decrease in depression, anxiety, aggression, anger. • Encouragement of physical activity. • Increased social connectedness and interactions. • Encouragement of sustainable behaviours and conservation of the natural environment.

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BIOPHILIA

101


ROOM

ROOM

CITY

CITY

“ Most healthcare facilities are freestanding, and therefore

autonomous. Too often they are isolated, and, at worst, cut off from their surroundings. The outer walls of a hospital slam to the street like a guillotine. This unfortunate guillotine syndrome can occur either by design or by default. It is, by any measure, an unfortunate condition that precludes any genuine connection with the exterior world, and vice versa. The term theraserialisation is a hybrid assemblage of the words ‘therapeutic’ and ‘serialise’. It is a very promising alternative to the status quo. It is defined as a continuum of indoor to outdoor space consciously designed in support of biophilic environmental design principles. It entails the interpretation of space as being serialised, as layered, collaged, superimposed, transparent and fluid. It is about the creation of serialised space from the public, to semi-public, to semi-private, to private. It is about the spaces in-between and about illusion. Theraserialisation is applicable to a single continuum or multiple continua on the same site. It is horizontal and it is vertical, it can reach upward from subterranean spaces to the ground plane, ascending to the sky.47


Theraserialisation focuses on the strategy of providing a progression of spaces that are all linked through their connection to nature and various forms of interaction with it. The continuous, permeable and fluid public space encourages reconciliation of the historical hospital and new built form and can develop a dialogue for the people moving through the space.

NATURE AS...

an address an entrance a circulation route wayfinding a topographical resolution a landmark common ground shade a privacy screen a gathering space therapy food 47

Verderber, Innovations In Hospital Architecture.

seclusion/de-escalation a spectacle an historical marker a connect a disconnect nature carpet floor wall exposure a life force a companion

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THERASERIALISATION

103


104

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Inclusionary zoning is a form of strategic regulations that tackles the issue of housing affordability and traffic congestion which are both rife in the growing urban Sydney. It depends on new developments having strong access to community facilities and transit-oriented centres as a justification for providing a certain proportion of permanently affordable housing.48 Currently, car-dependent households in Sydney spend on average $22,000 per year on transport, whereas it is estimated that public transport costs are around $10,000 for an equivalent Sydneysider. The move to limit the provision of housing in urban centres to only transitoriented households will reinforce lower land costs through reduction of capital costs of housing and the increased ability of residents to pay for it through cost savings. Developers would also benefit from increased densities and removal of stamp duties.

48 Payne, “Make Housing Affordable And Cut Road Congestion All At Once? Here’s A Way”.

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INCLUSIONARY ZONING

105


WHAT DOES AN URBANISING, GENTRIFYING, DENSIFYING REDFERN LOOK LIKE AS IT APPROACHES 2050 AND BEYOND?

HOW CAN COMMUNITIES AND THE BUILT ENVIRONMENT BECOME THE PRIMARY TREATMENT FOR MENTAL HEALTH?

ARCHITECTS BECOMING A MORE ADDRESSABLE ENTITY TO THE COMMUNITY: AMOUNT OF ARCHITECTS IS INVERSELY PROPORTIONAL TO NUMBER OF LARGER DEVELOPMENTS HOW CAN WE ENGAGE WITH THE INSTRUMENTS THAT HAVE BEEN ESTABLISHED? LOOK AT CONSTRUCTING AND ADVOCATING A NEW SIGNIFICANCE

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WHAT DOES THE RESTUCTURING OF THE MENTAL HEALTH SYSTEM CHANGE, AND WHAT ARE THE PERCEPTIONS OF IT BY THE WIDER COMMUNITY?

106

HOW CAN DESIGN COMPLIMENT CLINICAL PRACTICE CHANGE?

UNCOVERING AND INVERTING THE HISTORICAL FUNCTIONS OF THE BUILDINGS TO PROJECT THE SOCIETAL SHIFT IN BELIEFS

GREATER CROSS-INDUSTRY COLLABORATIONS AND REFORM ON GOVERNANCE OF LAND, DEVELOPMENT AND HEALTH POLICIES

REDFERN ITSELF BECOMES A STORY OF CHANGE WHILST RESPECTING ITS HISTORY WHICH IS ITS GREATEST ASSET AND MOST LIKELY MECHANISM TO ALLOW IT TO PRESERVE ITS CULTURE

HOW DO WE DESIGN FOR SERENDIPITY AND INFORMALITY?


We as architects have the ability and responsibility to identify the problems that society are facing, and construct significance of our place through acting as facilitators of various parties and organisations, in the hope that we may provide a better equipped community and environment for those shocks and stresses. re:habitat a new mental health approach for urban communities

THE ROLE OF ARCHITECTURE

107


Architectural Question;


How can we facilitate new relationships between the urban environment and its communities to improve mental health?


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CONCEPT MASTERPLAN

110

4


the future.

“

faster the future becomes the new, the unknown, “ the the more continuity and past we must take with us into

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Odo Maquard

111


5% +

0%

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THE STUDY OF WALKABILITY ON THE MAIN STREETS OF REDFERN, WITH A MAXIMUM ACCEPTABLE GRADE FOR WALKING AT 5%.

The automobile which was once the instrument of freedom has now demanded such a presence in the urban landscape that it forms the structure, proportions and orientation of our cities. The car has become a machine of consumption; of space (on the street and in basements), of natural resources, of money and its necessity in dense urban environments is fast weaning. More preferable methods of travel are through public transport, walking and cycling. The latter two encourage physical activity which has been proven to not only reduce chronic diseases and illnesses of the body, but also 5% improve psychological wellbeing. Providing urban planning that accommodates for future densification through strong public network links encourages mixed-modes of 49

112

“Looking For A Walkable Neighborhood?�.

0%

commuting such as walking or cycling to a tram stop, catching a tram to a heavy rail node and then catching a train into the city. These mixed-modes of transport are much more environmentally friendly, take up less public space and are more economical than owning a car. Furthermore, walking encourages stronger interaction with neighbours, locals and businesses along a walking route. For every 10 minutes a person spends in a daily car commute, time spent in community activities falls by 10%.49

+

THE WALKING CITY


The walkability of a city is measured differently by various entities but there are general factors that determine the ability and motivations for residents and visitors to traverse the neighbourhood. Providing a walk as good if not better than driving a vehicle is the most important factor and the following points are all determinants of this. There needs to be reasons to walk such as to a public transport node to greater access, motivation to stay healthy or getting to points of interest like shops or cafĂŠs. Ensuring a safe walk through community surveillance and having a visual connection to the end of a walk to be aware of your surroundings. The more popular a walk

becomes, the more likely it is to become safe through constant presence of people. Providing street lighting for night time walks is important. Designing a comfortable walk through optimising gradients, using sensible groundcover materials, shading devices/trees in harsh sunlight, shelter/awnings in rain, establishing orientation through landmarks and signage and correct footpath width. Making a walk interesting by creating routes through a variety of scales in public spaces, connection with nature and greenery, controllable levels of interaction with others and sources of constant stimulation to keep walkers engaged and feeling like they’re getting something out of the walk.

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WALKABILITY

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FIGURE 13: LOOKING EAST UP REDFERN STREET WITH TRAM IN FOREGROUND AND POST OFFICE IN BACKGROUND

114

Delving into Redfern’s past reveals the use of a tram line throughout the main streets in Redfern from the early 1900’s. Initially horsedrawn, they were converted to electric lines by 1910 and were largely successful in Sydney. They were removed throughout Sydney by 1963 due to their overwhelming success and overcrowding, along with the growing competition of car use and the hazards associated with exposed aboveground tracks that caused bicycle and car crashes leading in many fatalities. The prominent corners in Redfern were softened to respect the turning radius of the trams and have informed the historical urban

50 O’Sullivan, “Light Rail Link To Green Square Among Nation’s ‘Top Priorities’”.

character of the community which should be revived through the resurrection of existing land uses. As Redfern moves into the age of high densification and vehicular congestion, it is wise to explore other alternatives to the car to improve amenity on the ground plane and to improve access for residents through and beyond the suburb. This network will provide much needed public transport infrastructure to areas of high-density development such as Green Square which missed the opportunity in the current light rail planning but was regarded as one of the nations “top priorities.”50

RETRACING THE TRAM


REDFERN

STREET

SITE

BENEFITS OF LIGHT RAIL

The reinstating and contemporising of the light rail line for the future of Redfern does not attempt to serve all streets and residents of the community, but rather create an access spine through its most popular street with many central essential community services. The service should run in conjunction with existing bus networks but reduce the dependency of personal motor vehicles. There is an ongoing debate whether the Light rail currently being installed throughout CBD towards South Eastern Sydney will be a viable transport solution. Although it is a grand idea, the reality of a tram that services Circular Quay to Randwick has too many stops in such a small area with dense population at on-peak times which will cause a massive strain on the 51

system. In contrast, Redfern is a suburb still managing low levels of vehicular traffic along Redfern Street and is capable of installation with wider carriageways in the present to establish a sustainable behaviour long before the population swells. General benefits of light rail are the added image of the street being improved with sleek and well-designed, sustainable light rail cars with a dedicated track,51 providing frequent services to prominent cultural hubs in Redfern. They are quiet, smooth and comfortable for users and residents in the community and has a flexible network capable of expansion in response to growing populations.

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FIGURE 14 LOOKING WEST DOWN REDFERN STREET WITH TRAM TRACKS IN FOREGROUND AND POST OFFICE IN BACKGROUND

“Light Rail - Pros And Cons�.

115


Redfern’s relationship in South Central Sydney is poised for greater connections both towards the CBD and to newly developed suburbs. Identifying the existing and proposed infrastructural links shapes the character and amenity of the streets in Redfern and impact its residents now and into the future. Greater access within and beyond Redfern is key in improving mental health outcomes for its residents.

SITE ANALYSIS: CONNECTIVITY

The Metro Line swings south from Central Station and has a selected station site in Waterloo which will create greater urban and suburban connections for its residents beyond the existing rail corridor.

METRO

CENTRAL STATION

N

REDFERN STATION

MACDONALDTOWN STATION AUSTRALIAN TECHNOLOGY PARK

ERSKINEVILLE STATION

ST PETERS STATION

GREEN SQUARE

LEGEND

ROSEBERY

SITE SUBURB BOUNDARY RAILWAY LINE

CENTRAL STATION CENTRAL STATION CENTRAL STATION

RAILWAY STATION CBD SOUTH EAST LIGHT RAIL METRO RAIL LINE METRO STATION WESTCONNEX OFF-RAMP WESTCONNEX THOROUGHFARE SUGGESTED FURTHER LIGHT RAIL ROUTES SEVERS OF REDFERN MACDONALDTOWN STATION MACDONALDTOWN STATION STREET BY WESTCONNEX MACDONALDTOWN STATION

WESTCONNEX OFF RAMP

N N REDFERN STATION REDFERN STATION REDFERN STATION

RE N REDF DFER ERN RE DF ER N TO RANDWICK TO RANDWICK TO RANDWICK

AUSTRALIAN TECHNOLOGY PARK AUSTRALIAN TECHNOLOGY PARK AUSTRALIAN TECHNOLOGY PARK

CONNECTIVITY ERSKINEVILLE STATION ERSKINEVILLE STATION ERSKINEVILLE STATION

ST PETERS STATION ST PETERS STATION ST PETERS STATION

GREEN SQUARE GREEN SQUARE GREEN SQUARE

VICTORIA PARK VICTORIA PARK VICTORIA PARK

ROSEBERY ROSEBERY ROSEBERY

WESTCONNEX OFF RAMP WESTCONNEX OFF RAMP WESTCONNEX OFF RAMP


REDFERN

TO RANDWICK

LIGHT RAIL

VICTORIA PARK

The single largest threat to Redfern streets is the injection of the M5 WestConnex (currently under construction) that exits at Alexandria and feeds directly into McEvoy Street. Users of the M5 are intending to move through Alexandria, Waterloo and northbound towards the city (through the first roads possible) which creates an extremely large volume of traffic running along Botany Road, Elizabeth Street and South Dowling Street. This has adverse effects on the amenity of these streets in Redfern, as currently there is only local traffic and small, manageable amounts of traffic for pedestrians to traverse. Feeding such high volumes of traffic will mean a steady flow of traffic (with more priority to traffic lights for cars, not pedestrians) as well as less street activation and empowerment of residents to interact with the ground plane. To Redfern Street, this also means a severing of its free longitudinal movement and isolation of blocks (such as the 107 Projects block) from the greater community. A current proposed Lig ht R ail runs from Circular Quay to Randwick and is controversial in its claims of success in handling the volume of daily commuters due to its route with constant stops through a dense urban centre. However, a suggestion of two additional light rails that distribute the population along over-trafficked roads and into newer suburbs with high rates of population growth and no proposed public transport in sight may provide relief and improve the amenity and exposure of Redfern Street and its services. The lines retrace original tram routes that were removed in 1963 due to the importance of the car and the above-ground tracks causing hazards, which are today buried underground. It will prompt the removal of vehicular carriageways along the length of Redfern Street and become a catalyst for a revival of street character of its retail and service frontages to residents now encouraged to meander and gather on the safe street that is returned to their community.

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EBERY

WESTCONNEX

117


T

ARE

TO

SQU GREEN

A RIIA DR ND AN ALLEEX XA TTO A O USING

REE QU AR S UA N Q E S E R N E G TTO O GRE

OCIAL

ISE S IGH R

ING H EXISINTG

HO

LIAN STRA ALIAN AU AUSTR

HOUSING OCIALL HOUS ISEE S SOCIA HR IG IS H R H ING EXISTING HIG EXIST

LENCE EXCEELLLENCE US NO EN S EXC L IG U A D O IT IN P S FOR DIGE L ER HO PITAL ENTREE FOR IN HUNT R HOS SPITA NALL C CHEL HUNTE CENTR TIO RA NA ER HO T MEER ACHEL TIONA N R A U R N FOR H FORM CHEL

K PARK RIIA A PAR TTO R C I O V C O I TTO VRK

ER RA

FORM

A PA I R O T IC

TO V

RTHS OLWO ORTHS WO WOOLW

HS WORT WOOL

ING HOUSING OCIALL HOUS ES RIS SOCIA E IGH IS H R G IGH ISTIN EX ING H EXIST

S VICES N SER RVICE UMA FH AN SE TO EN F HUM M O T T R N A E P TM IC DEEP CLINIC NS D AR MEN S CLIN WO WOME

N DFER RN R REEDFE

EN

TM DEPAR

ENTREE AL C CENTR LEG LEGAL

USING

IAL HO

SOC H RISE

IG

ING H

EXIST

IN EAFL OPORLLICICEE CFEERRNNNCCTEERNNTTRRAL PO L D A E R N NATIO REDFE

OLL HO SC OOL HA IGH SCG LS H HE HIL HIGL Y S R L R IL U YH SU S RR

S BS RB UR S BU N UB SU EER T N S R A T E TTO O EAS

E

CENTR

ALL RA CENTTR TTO O CEN LEGEND POINTS OF INTEREST

IGH S

ILLS H

YH SURR

SUGGESTED BONDI TO GREEN SQUARE LIGHT RAIL SUGGESTED BONDI TO ERSKINEVILLE TO CLOVELLY LIGHT RAIL

TO

RN EASTE

RBS SUBU

SUGGESTED PEDESTRIAN LINKS (FOOTPATHS/CYCLEWAYS) SUGGESTED PEDESTRIAN AND LIGHT RAIL ONLY (NO VEHICLES)

N

TO CE

ACCESS, STREETSCAPE AND PERIPHERAL SERVICES Greater access through a city and to vital community services improves the mental health of its residents. The suggested light rails reduce congestion in neighbouring suburbs (Green Square and Victoria Park), improve links between social housing developments and the AMS and other health services, as well as freeing up Redfern Street to improve ground plane interaction. More established pedestrian walkways and cycle corridors

will improve the physical health of visitors while connection to the National Centre for Indigenous Excellence provides parks, gyms and personal fitness services. Strengthening simple, explicit and direct links between social housing and greater community and health services is vital in improving the welfare of these residents as access can be the biggest challenge they face.

COLOCATION


DRIA

XAN O ALE

T

ALIA

AUSTR

ENCE

XCELL

US E IGENO

D

FOR IN

MAN OF HU

N

CES

N TATIO S N R EDFE

SERVI

INIC

NS CL

WOME

ATION ICE ST

POL TRAL

RN CE

REDFE

T TMEN DEPAR

PARK

R

LWUY

PEMU

SITY

IVER EY UN

DN

TO SY

HIGH

N

HILLS

OL

SCHO

AL

AL

NTR TO CE

NTR TO CE

SURRY HILLS HIGH SCHOOL AUSTRALIAN TECHNOLOGY PARK (ATP) By 2020, a $6m 14 storey high rise high school will house 1200 students only minutes walk from the site.52 This creates a great opportunity for connection between the students and the services such as mental healthcare and cultural events, which will empower youth to develop and orient their own model of care.

T h e m a s t e r p l a n o f AT P w i l l s e e Commonwealth Bank along with other large tech industries inject more than 10,000 jobs with $100k+ salaries. This spells greater employment opportunities for residents with scope that the various industries will connect to residents to provide corporate. business and essential community services and leisure/ public spaces, in a term coined ‘bleisure’ by CBA.53

52 Singhal, “New Inner Sydney High-Rise School For 1200 Students Revealed”.

53

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ENTRE

LOGY

HNO N TEC

Mercedes, “CBA’s Plan To Bring ‘Bleisure’ To Redfern”.

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re¡nais¡sance (n): a renewal of life, vigor, interest; rebirth; revival.


renaissance of Redfern; reinvigorating the community through subversion of obsolete operations and repurposing the historical built forms to reflect the contemporary beliefs of culture, technology, health and space.


the future.

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Odo Maquard

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“

faster the future becomes the new, the unknown, “ the the more continuity and past we must take with us into


To construct a significance of place in the face of new understandings of the relationship between the built environment and mental wellbeing, the buildings and urban landscape which retain outdated notions must be interpreted and appropriated through a contemporary lens. The very permanence of buildings makes them predestined for use as bearers and points of orientation in individual and collective memory,54 and importance of architectural continuity and the orientation it provides becomes particularly apparent where urban structures undergo rapid transformations. 55 Where the pressure on land and property is high, such as the centres of modern cities, the rapid flux of appearance and disappearance of buildings produces a nervous insecurity, which we compensate for with a stronger interest in historic processes.56 In establishing a new attitude towards the mental wellbeing of urban occupants such as in Redfern, stability through assurance of a recognisable built environment can have beneficial outcomes. Residents may find reverie in the buildings that hold so much historical significance, and as the suburb becomes densified and new cultures propagate, it is imperative that landmarks provide wayfinding dialogue for occupants that use the area. From economic and marketing perspectives, older buildings have the advantage that they often ooze a character which new buildings 54 Cramer and Breitling, Architecture In Existing Fabric. 55 Ibid. 56 Ibid. 57 Engel, Santifaller and Zimmermann, Transform.

can’t match.57 Planning and heritage controls also favour the preservation of historically significant buildings and is therefore wise to acknowledge these upheld beliefs in communities to ensure a responsive outcome. Conservation promotes sustainable attitudes and encourages its occupants to understand the resources that are spent in realising a project, and how small efforts in maintaining acceptable standards can be much more efficient and economical in both the short term and long term; this is until a building is by all accounts beyond repair and is unsafe to inhabit. A selection of buildings on the site have already undergone a revitalisation or are in a transitional stage; 107 Projects has subverted the purpose of a car yard which housed high-consumption automobiles into a place for collaborative creation and sustainable behaviours. The Court House is arguably the most iconic building along its length and has metaphorically reinterpreted the attitudes towards those marginalised in society (many with unrecognised mental health issues) and were incarcerated, but are now welcomed to address their mental health concerns. It is with this value placed upon the critical analysis of purpose and revival of the existing buildings on the site that the following proposals can serve as a sensitive response to the challenges that face the community.

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RENAISSANCE OF REDFERN

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CYCLEWAY A two way cycleway encourages physical health in an urban context for commuting and general sustainable access.

GREEN LA NEWAY A free and de along Redfe mocratic public spa c rn Street w hich can pro e opportunity vide for markets , spill-outs cafes or ju from st walking or relaxing .

REDFERN STREE


EET

LIGHT RAIL STOPS Light rail stops are frequent enough to to provide a suitable walkability . all services within Redfern

LIGHT RAIL LINE Reinstating light rail removes th e need for cars and improves the abili ty to traverse the streetscape witho ut kerbs, cars, conge stion or traffic ligh ts.


STREET FURNITURE

SEATING, BUBBLERS, SHADES AND INTERVENTIONS FOR ROUGH SLEEPERS AT NIGHT

BICYCLE PARKING

INTEGRATION WITH THE ACTIVE CYCLEWAY AND PEDESTRIAN LINKS

PICNICS

SPRAWL OUT ON THE LAWN AND RELAX

SOCIAL GATHERINGS

ENJOY A BARBECUE AND RELAX IN THE SUN WITH FRIENDS AND NEIGHBOURS AND ENCOURAGE INTERACTION WITH PEOPLE WALKING BY

SPORTS/LEISURE

RUN ALONG THE GREENWAY OR PLAY WITH OTHER COMMUNITY MEMBERS

COMMUNITY GARDENING

PLACES TO SHARE SUSTAINABLE EXPERIENCES WITH THE NEIGHBOURHOOD AND KEEP HEALTHY


MARKETS

MARKETS CAN LINE THE GREENWAY PERIODICALLY FOR STREET FESTIVALS

CAFE/RESTAURANT

GREEN LANEWAY

The greenway is a contribution back to the community as a result of removing the carriageways that served cars and severed the ground plane. The opportunities for the greenway aim to allow informal interaction to take place between the residents and visitors to Redfern.

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RETAIL AND HOSPITALITY CAN OPEN THEIR FRONTAGES TO ENGAGE WITH THE STREETSCAPE

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THE CAR YARD

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A CAR YARD PART OF A 20TH CENTURY CONCEPT CAUSING POLLUTION AND UNFAVOURABLE STREET CONDITIONS

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RETAIN ENTRY The historical use of the 107 Projects was a car yard and although the site has been repurposed, the gesture of the entry still allows large volumes of pedestrian traffic to encourage visitors.

ASSIGNING FUNCTIONS Storage should be located at the rear with access to the roller door for heavy goods delivery. Collaborative and resident artist spaces are various width bays along a galley for maximum possible cross-pollination of ideas.

107 PROJECTS

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05

PROPOSED

A GREEN COMMUNITY HUB THAT CELEBRATES HEALTHY AND SOCIAL BEHAVIOURS AND IDEAS TO SHAPE THE FUTURE

FLOWTHROUGH CONNECTIVITY Reconnecting the two large opposing roller doors at the front and the rear of the site encourages further use of the development and potential for interaction with Turner Lane for various events.

LARGE PLANTING Introducing large vegetation has beneficial outcomes for health of visitors and residents.

The mass-production of cars in the 20th century completely reshaped the urban landscape, as streets become the driver for city planning and the amenity of the street became less favourable for pedestrians. As we move through the 21st century however, due to the concerns of quality of public space, increasing carbon emissions leading to global warming, diminishing fossil fuels, fuel prices and the congestion of roads, the car is losing its prominence amongst the urban form. This is further reinforced by stronger pedestrian and public transport links encouraging public health, and the concept of collaborative

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FACADE REPRESENTING PROGRAM The front of 107 Projects should communicate to the greater community the three elements that perpetuate the 107 story; the admin and staff in green, the artists and resident spaces in blue and the red in the centre for visitors and the community.

TOP FLOOR PROGRAMS Multi-purpose spaces on the top floor have views to either the street or among the large planting. A communal garden on the roof is used for promoting healthy and sustainable habits.

consumption (such as Uber) provided by the technology supported systems such as the smartphone. 107 Projects has reflected the shift in understanding that community is the foundation of transformation and resilience. The social economy is rampant in the densifying inner-city suburbs and replaces the needs of 20th century consumption habits. Housing cultural events and providing collaborative workspaces for artists and creatives forms a space for sustainable ideas to propagate.

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EXISTING

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THE EXCHANGE

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A TELEPHONE EXCHANGE TO HOUSE INFRASTRUCTURE THAT CONNECTS PEOPLE INTANGIBLY

COLLABORATE AND INNOVATE EXCHANGE

PROPOSED

A COLLABORATIVE LEASABLE WORKSPACE THAT ENCOURAGES PHYSICAL INTERACTION BETWEEN VARIOUS INDUSTRIES

Historically, telephone exchanges were designed with multiple levels of large floor plates and aisles upon aisles of digital systems infrastructure to connect lines between subscribers which was once done manually but is now automated. With the nationwide rollout of the National Broadband Network (NBN) by 2020, the telecommunication infrastructure that is housed in telephone exchanges will become obsolete or downsize and be moved to dedicated NBN hubs which are under construction across Sydney to house the next generation of compact digital infrastructure.58 Telephone calls will no longer transition through a telephone exchange as this service will now be carried out entirely through NBN via VoIP (Voice over Internet Provider). It Is expected that as Telstra downsizes and moves their obsolescent infrastructure offsite, they will retain ownership of the parcels of land 58

“Future Of Telephone Exchanges”.

59

“What Happens To Old Telephone Exchanges?”.

and possibly lease portions of their buildings to public and private enterprises.59 A building that would historically serve only as a technological intersection between people within the community may be reclaimed as a largely leasable building with the potential of collaborative workspaces for small tech businesses and start-up companies as we head into the digital and social age. It could serve as a great opportunity for community interaction between a large telecommunications company and its residents, with workshops giving advice on how to move into a technological landscape and how to utilise it for personal and business use. An example is ‘The Exchange’, a refurbished Telstra building in Southport, Brisbane that was developed in conjunction with Co SPACES to provide collaborative working spaces for entrepreneurs.60

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EXISTING

60 Network”.

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“41 Nerang Street, Southport - Cospaces - Shared Office


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THE HOSPITAL

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A HOSPITAL THAT PROVIDED TRADITIONAL METHODS OF HEALTHCARE IN STATIC SPACES

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ACKNOWLEDGE EXISTING STREETS The Rachel Forster Site has two streets and a rear laneway that serve as access inputs into the site.

GREEN SPACES The green space fronting the Rachel Forster Hospital provides places for residents to gather and relax as well as keep physically active.

COMMUNITY HOUSING

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05

PROPOSED

A NEW MODEL OF MENTAL HEALTH RESILIENCE THROUGH COMMUNITY AND SOCIAL HOUSING

SITE THOROUGHFARE Connection of these streets and laneways through the site can greatly improve the ability of Redfern Residents to move through their neighbourhood.

NATURAL THERAPY The planting of large trees and large amounts of vegetation has been proven to improve the psychological wellbeing of residnets that are able to see and physically interact with the environment.

The Rachel Forster Hospital for Women and Children has a significant role in the progress of health in Australia. It was built in 1922 and was the first facility to allow female doctors to train and practice medicine within its corridors. It housed various specialised clinics, such as a breast cancer research centre and a psychiatry ward. The current masterplan for the site calls for generic medium-rise residential flat buildings that cater for investors hoping to purchase into the character of Redfern. The risk is a site that endangers the values of the community and being a perfect example of the surrounding gentrification that threatens the core values which the residents fight for. The proposal barely acknowledges the historical influence of the Rachel Forster

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MASSING ENCOURAGING MOVEMENT Direct sightline pathways improve the legibility of pedestrian travel and therefore increase the perceived safety of this movement.

MASSING AND FORM RESPONDING TO CONTEXT Folding and raising the buildings to encourage foot traffic to interact with the site will improve the cross-pollination of people so the residents don’t feel stigmatised or isolated from the community.

Hospital and in its attempt to retain the ‘heritage’ of the building will only keep the façade to Pitt Street and gut the entire building, a far stretch from adaptive reuse. The developers have resubmitted Development Applications several times since 2013 with increased yields, and keep getting knocked back. Speculation has risen that the developer has been deliberately delaying the process so that during the negotiations with council, the existing structure is exposed and is more susceptible to the deterioration by the harsh environment. Once this occurs, the structure will be deemed structurally unsafe and the developers will have permission to demolish and rebuild without any acknowledgement of the heritage, which was termed ‘demolition by neglect’ by City of Sydney councillor Irene Doutrey.

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EXISTING

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THE COURT HOUSE

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E

A COURT HOUSE THAT JUDGED AND CONDEMNED

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04

CURRENT COURTYARDS There are currently two tight couryards open to the sky which lack any natural vegetation and are confined, serving little benefit to its users.

NATURAL THERAPY Providing a space for staff, patients and visitors to come and gather amongst large trees and green areas can benefit their psychological wellbeing.

REDFERN MENTAL HEALTH SERVICES

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05

PROPOSED

A HOLISTIC MENTAL HEALTH SERVICE FREE OF STIGMA GIVING PEOPLE GREATER OUTLOOK AND PROSPECTS FOR THE FUTURE

REINSTATE THE COURT The large volume lent by the court room is largely unused currently, and could become a space for contemplation, rest and waiting.

OPEN CORRIDORS Open and glazed corridors that wrap the perimeter of the courtyard provide constant visual connection to the natural green environment throughout the building.

The heritage listed Court House built in 1897 was a significant service that shaped the character of Redfern for over a century. It ceased operation in 2008 as its purpose was diminishing and shifting to reflect the gentrification of Redfern. What was once a building that would draw in the marginalised, unrecognised and misunderstood, became a place of welcome for those suffering from mental illness. The front building retained its existing internal layout and its meeting rooms serve as walk-ins and case management consultation with psychologists and case workers. The extension in the rear of the building houses palliative end-stage cancer patients, as well as HIV/AIDS and drug/ alcohol related rehabilitation. As the perception of mental health shifts

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LINKING THE COURTYARDS By connecting the couryards, there is an understandin that mental health should be addressed as a whole rather than compartmentalising.

SPATIAL STRUCTURE The rooms are laid out in a ring and feed off the corridors to improve potential for cross-disciplinary consultation of a patients recovery.

towards an integrated service model of care, the various factors that influence ones’ recovery must be considered as a whole. Currently, there is very little connection between the old Court House and the new building, which suggests that the approach to recovery is still segmented and compartmentalised. By opening up the building and connecting the various uses by an open courtyard, not only does this improve the spatial amenity (through increased circulation, light, nature and visual connectivity) but also encourages cross-discipline care for those in need of a holistic path of recovery. As an example, now a patient can address their psychological needs in relation to their drug problem concurrently through the cross-pollination of various consultants and carers in the one facility.

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EXISTING

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THE CHURCH

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A CHURCH THAT SERVED ONE MOVEMENT OF BELIEFS

01

CURRENT CONDITIONS There is no interaction between these three prominent community services despite intimate laneways to foster relationships. A car park to the rear of Jarjum College leaves little space for the children to enjoy the natural environment.

CULTURAL EXCHANGE

02

PROPOSED

A CULTURAL EXCHANGE THAT ENCOURAGES INTERACTION ACROSS VARIOUS ESSENTIAL ORGANISATIONS

OPENING UP SPACE The old parish at the rear of the church restricts the movement across the site and leaves very little space for gathering. Removing the main mass of this dilapidated and ill-used building and replacing the car park with a garden gives the children more space to become physically active.

Serving the Catholic Redfern community from its construction in 1920, it wasn’t until Father Ted Kennedy oversaw the St. Vincent de Paul Catholic Church in 1971 that it became a space of welcoming to the Indigenous community. Father Ted Kennedy identified many social problems and challenges and his church became a place of refuge. With Father Teds’ passing, the new Father Mendes has become criticised for lack of assistance to those marginalised and disadvantaged groups within the community. The Aboriginal Medical Service provides culturally responsive health care to Indigenous populations and their families in the region. People feel welcome and are much more likely to share their health concerns in this facility than a standard hospital as the nurses and GP’s understand their individual needs. However, it has not deeply connected with its neighbouring church in recent years since the new Father of the church has instilled fear in the Indigenous community.

03

FORUM An open air forum provides informal seating for daily use of these three services with comingling of agendas. It can also serve as an amphitheatre for talks, movie nights and events regarding healthcare and culture.

Jarjum College has been a place for refuge and learning assistance for the local Indigenous disadvantaged children since 2013. Up until his death in 2004, Father Ted, along with Mum Shirl, a prominent Indigenous woman, began establishing vital community services for those at risk of poverty, homelessness and police brutality. A great concern between the AMS and Jarjum College is their lack of interaction as they both compete for the same federal funding for Indigenous community services, and no real connection can propagate. By providing a park for the college of children, they will have a small parcel of natural green space which is an essential element in their psychological development. By repurposing the old parish at the rear of the site into an open air forum, this encourages interaction between these three prominent community services with hope of a greater understanding of a holistic approach to healthcare.

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EXISTING

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THE POST OFFICE

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E

A POST OFFICE THAT SERVED AS A PROXY TO TRANSMIT CORRESPONDENCE WITHOUT CO-ORDINATING THOUGHTS

01

ISOLATED WORKSPACE The main office space of the architecture firm is set back from the facade.

DKO ARCHITECTS

02

PROPOSED

AN ARCHITECTURE FIRM THAT BECOMES THE EPICENTRE OF DEVELOPMENT AND COMMUNITY PARTICIPATION

GALLERY CURRENTLY A BUFFER The gallery that flanks the main office space isolates the community from the architects.

The Redfern Post Office was built in 1882 and served Redfern’s postal needs at a time that the suburb was experiencing large population growth. It was repurposed in 2016 to an architecture firm and is positioned well on the corner of the block with a clock spire as a prominent landmark. As the transition of media from physical to digital continues, a greater emphasis must be placed on the custodians of the built environment to uphold the communities’ wishes for the future. Suitably, an architecture firm can lend its services to the community in co-ordination and facilitation of various organisations, councils, developers and residents to ensure that the outspoken and marginalised are always heard.

03

GALLERY BECOMES A SPACE FOR COMMUNITY INTERACTION The gallery can now become a public space shared by the architects and the community for sharing ideas about the built environment, as well as upcoming proposals in the area which can be discussed with others.

Currently, the spatial arrangement of the Post Office as an architecture firm is insular and isolates from the community it serves. This is due to the main office spaces being offset to the central spaces and disconnected by two flanking galleries that provide entry and circulation along the façades. This gallery is underutilised and could become a space where the community and the architects meet in discussing upcoming projects as well as a space much like a discussion board for residents to view current issues with health and the environment (both built and natural) at their own leisure. By introducing a visual connection between the residents and the architects, they become aware of each other’s desires and roles in the community and are held accountable for their actions.

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EXISTING

139


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FURTHER INVESTIGATION

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5


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“

“ Housing is the first step to health.

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FIGURE 15: PROPOSED SITE PLAN OF DEVELOPMENT

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FIGURE 16: ARTISTS IMPRESSION OF DEVELOPMENT


The use of the Rachel Forster Hospital Site has caused conflict ever since its closure in 2000. It is a significant heritage item in the Sydney Local Environment Plan and its Interwar functionalist style hospital building has become somewhat of an icon to the Redfern locals. It has strong sociocultural associations due to its role in changing the perceptions of healthcare in Australia. The hospital was one of the first facilities in Australia to train and employ women in doctor roles,61 was the first hospital in Australia to be recognised as a school for the clinical instruction of medical undergraduates, and its programs reflected the nations newfounded aspirations of healthcare in a time of social and technological advancements. Beyond its general disease wards, it also housed a paediatrics clinic, an arthritis clinic, a breast cancer research centre, venereal clinic and a psychiatric wing. After its operations were scaled down and migration of most of the staff to Prince Alfred Hospital in Camperdown, the site still functioned as a community health centre until its permanent closure in 2000.

61

McNab, “Hospital Site Remains Empty”.

62 South Sydney Herald, “Rachel Forster Site Sold To Highest Bidder”.

Proposed Development The site wa s purcha se d by Kaymet Constructions in 2007 for $8.5million with all the net profit of the sale going towards the construction of the Harm Minimisation Clinic adjoining the current Redfern Mental Health Service running in the Court House (which opened in 2009).62 A $44 million masterplan proposal was first submitted to council in 2013 with a residential flat development of 150 apartments. Although the site is heritage listed, only a small portion of the existing built form was expected to remain, being the main 5 storey brick surgery wing on the south of the site. Also among the proposal from Kaymet was the provision of a publicly accessible open space on Pitt Street. Over the years, Kaymet has resubmitted proposals, each with ‘scope creep’ aiming to increase the yield of the development. What was already a development that was seen by the locals as a high-density development that didn’t recognise the unique culture of Redfern and existing built form of the surrounding streets, was becoming a threat to their community and a beacon of gentrification. The latest proposal seeks an extra 68 apartments from its original development, reaching 218 units across 4 generically-designed buildings adding almost 5 metres to the existing structure to make 7 floors from the lowest point on the site.

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RACHEL FORSTER HOSPITAL

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FIGURE 17: ARTISTS IMPRESSION OF DEVELOPMENT (WITH KEY CONCERNS HIGHLIGHTED)

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Community objections Greens Councillor Irene Doutney among many other residents have voiced very strong objections to the development in experiencing a continual loss of social stability63 though losses of Redfern Primary School and other essential community resources. Although not against urban consolidation and sustainable redevelopment, she felt that it could be of great concern to the public housing community as there will be a large influx of people with a lot of different expectations to the residents. The development which will become privately owned apartments for the rich looking to buy into Redfern would a be much better assignment of government land towards public housing which is so desperately needed. Ms Doutrey felt that the development is a far cry from the proposed ‘adaptive re-use’ and notes the ‘demolition by neglect’ of Kaymet Constructions through their continual scope creep that deliberately delays the process in turn threatening the structural integrity of the only existing building on the site.64

Local communit y g roup REDWatch also voiced their concern that the sale of government land may create a backlash by permanently alienating publicly owned land. “When you’re talking about increasing the population density in the area, you have to make sure that you set aside what’s going to be needed for the public domain in the future.” Mr Turnbull said the sale of the Rachel Forster site demonstrates a lack of long term planning.65 “On the one hand, you’ve got the City of Sydney looking at what it needs to buy back to be able to increase the amount of green space in the inner city as part of its 2030 Strategy. But on the other hand, you’ve now got currently-owned government land going into the private sector.”

63 Altmedia, “Rachel Forster Hosital In Redfern To Be Redeveloped”. 64 McNab, “Hospital Site Remains Empty”.

65 South Sydney Herald, “Rachel Forster Site Sold To Highest Bidder”.

COMMUNITY OBJECTIONS


becoming grossly unacceptable. • 10 people Identified the concerns raised with the overall effect of the development on the existing urban fabric, loss of existing character of Redfern and the fear that this is a development that encourages the gentrification which will eventually push out existing residents. • 5 people felt that there was no real attempt to preserve the heritage of the site and the heritage of the street. • 3 people were concerned about the removal of significant trees being the Frangipani on the corner of Pitt Street and Albert Street, and the large Jacaranda tree that became synonymous with the Rachel Forster Hospital. • 4 people identified the false claims in the proposal of a ‘suitable mix of apartments’ which included nine 3 bedroom apartments. These 3 bedroom apartments were later corrected to “2 bedroom plus sunroom”. This raised concerns that the developer is marketing for the wrong demographic and will lose the family environment of Redfern through outside investors. • 1 person identified the lack of ecologically sustainable materials and technologies in the proposal. They feel that the proposal was a missed opportunity and lacks any innovative materials or design which could improve the aesthetic of the building as well as contribute towards energy efficiency or reduction in consumption of resources.

One of the nation’s first female psychiatrists Nanette ‘Nan’ Stacey Waddy became an honorary visiting psychiatrist to the Rachel Forster Hospital in 1957 and was a strong advocator for community based mental health services, the mental health needs of the disadvantaged and homeless, and the impact of drugs and alcohol in psychiatry. She fought especially hard for the rights and fair and just treatment of people living with mental illness.

Considering the atmosphere surrounding the proposed ‘development’ of Rachel Forster Hospital, and the importance that Nan Waddy had on promoting the shift to communitybased mental health support, it only seemed appropriate that the hospital would become the embodiment of contemporary mental healthcare approaches.

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SITE SELECTION

Summary of community objections As well as recurring community meetings, which were held for the purposes of discussion (between the community, developers and council), 14 objection letters were received by council to reinforce, collect and distil the thoughts of Redfern residents. Of these; • 9 people identified traffic and congestion as a major issue with the development. They are concerned that the steep localised increase in density will cause high volumes of traffic on Pitt Street and make street parking much more difficult than it already is. They feel there is a lack of consideration for the on-site parking, and the traffic and congestion will reduce the quiet and peaceful environment of Pitt Street. • 5 people felt that the community was not involved in the process, with some even saying they felt like they were deliberately left out. Their opinions were not acknowledged and feel that the resulting development will not respect the current land users. • 9 people felt that the development of Building 3 does not respond to the adjacent terrace housing in either its scale, height, setback or design for visual privacy or noise pollution. They feel that Albert Street will lose its character though the compression of horizontal proportion and scale. • 9 people Identified the scope creep as a violation of the approved development and that the FSR, allowable building height and built forms that were already unfavourable are

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At a time where increasing accessibility to the ‘internet of things’ has sprouted collaborative consumption that connects people beyond physical domains, the use of these digital infrastructures to compliment a strong variety of community assets and innovative healthcare approaches, there is bound to be opportunity to improve the health and mental wellbeing of a city’s residents.

services do come to fruition, they may not receive the exposure that is required to work effectively in the community. In China, the rise of the ‘super app’ has changed the way in which not only individuals but whole societies can use digital infrastructure to improve their lifestyle. The concept of the ‘super app’ (such as WeChat) is that it becomes a facilitator for other apps or services and thus can provide a more integrated system of delivery through a seamless provision and interface. Beyond interwoven social media streams, the app has access to services such as entire hospital appointment systems and complex data such as urban heat maps which can inform of heavy pollution.

With the massive growth in apps and information systems daily, there are many that provide unique and invaluable services for their clients and customers. However, since these apps come and go often and there is a competitive market even when spanning beyond an apps native industry, there is a lack of integration between sectors that could prove beneficial to the end user.

What this means is access to a whole range of services that are determinants of mental health that are either lacking or unrecognised.

In regards to mental health in an urban community, the increase in population density also means the decreasing access to availability to services. And when new

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LEISURE ARTS & CREATIVITY CULTURE SPORTS

CIVIL SOCIETY FINANCIAL SECURITY INCOME CREDIT WEALTH

- budgeting app - provides local connections with employees in the finanical industry willing to help manage funds - connect with Clothing Exhange for economical clothes swapping - identify cheapest place to eat/drink at

- connect with MamaBake to cook locally with neighbours - ozharvest updates

COMMUNITY

INCLUSION

RESILIENCE/ COMMUNITY ASSETS PARTICIPATION

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TRANSPORT AFFORDABLE ACCESSIBLE SUSTAINABLE

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MEANINGFUL ACTIVITY EMPLOYMENT VOLUNTEERING SPIRITUALITY

ILY

PHYSICAL SECURITY HOUSING SAFETY AT HOME SAFE IN NEIGHBOURHOOD

- connect with Sydney Transport for integrated transit - able to ask for car pool, rent a car, Uber

- connect with career websites - connect with volunteering programs within community

ENVIRONMENT PUBLIC SPACE GREEN SPACE SAFE PLAY SPACE

- connect with Rooms and flatmate finder for safe checks on roommatees - reporting directly to councils for social housing that is in disrepute

GEN

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- identify parks nearby - data on quality of environmental assets - tips on environmentally frendly habits

EDUCATION LIFELONG LEARNING

- connection with Jarjum College, new Surry Hills High School to provide greater collaboration

- 107 Projects, NCIE provide their event calendar and access to booking sysem for spaces/events - eXpertLocal provides reviews of events on around

DIGITAL SUPPORT NETWORK


Nabo is a website/app that requests a suburb upon registration. It is similar to Facebook in its interface but its starkly different in its method of information retrieval through proximity-oriented results. The Facebook ‘newsfeed’ is replaced with the ‘Redfern hub’ and residents can communicate freely here for any purpose; from raising awareness about the removal of trees in a park due to the light rail installment, to crime and safety or traffic and transport news that is a) relevant to the local population, b) current and updated extremely frequently, and c) strengthening communities through sharing of ideas. People can suggest good medical practitioners or ask for a hand moving furniture on the weekend. Within the app is the expected commercial agendas that are selling goods/services but are encouraged to register their account as a business rather than a resident and are therefore able to be filtered out by users.

Nabo could serve as the backbone of the system and is already in place throughout Australia with established suburb networks, especially in dense urban fabric which can utilise the accessibility. To further leverage the infrastructure to improve the mental health of the community, there could be integration of other apps such as connecting to Uber when a resident needs to get to a medical appointment immediately or e-health apps formed by government to improve one’s access to their own health records. The app could connect people with a mental support network within a certain distance, such as primary mental health services, but also a carer or a mental health worker maybe around the corner at a café and are willing to help relax someone who is experiencing anxiety. Importantly, the app would integrate the systems of cultural organisations (such as 107 Projects or NCIE) to inform residents when a certain event is coming up. The issue with Facebook is you are usually required to subscribe to an organisations page to receive updates and may be right under a person’s nose but unless they are able to see it, is redundant without the correct audience.

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General Structure The app can recognise your place in various levels of organisations; family, friends, community, suburb, city, state and country and will be able to filter the results to provide the best response to your request. Local and proximal delivery of services is essential in informing sustainable behaviours in urban environments. The City of Sydney Sharing Guide outlines the opportunities present when utilising a shared economy.

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REDFERN BONDI RECOVERY COLLEGE

KOGARAH RECOVERY COLLEGE


*Courses are Free OF CHarGe for:

The majority of our staff have a lived experience of mental health issues

c People with a mental health condition

Our team is keen to provide you with support and guidance to ensure enrolment and attendance at courses is as easy as possible.

c Their families, carers and support people

Recovery from mental health conditions is a diverse, personal and social experience. Our approach encourages proactive and purposeful engagement to build trusting relationships between staff and consumers. We believe the quality of this collaborative relationship is central to supporting personal recovery and promoting wellbeing.

who live in the South Eastern Sydney catchment area

c Staff and volunteers working for South Eastern Sydney Local Health District

c Staff from our Community College partners. We reserve places in our courses and offer in-house, specialist courses for paying organisations or individuals who do not meet the above criteria.

HOW dO i enrOl?#

c c c c

integrity c respect c Hope Collaboration c self-determination Opportunity c inclusion enjoyment

COnTaCT deTails

2. Complete the enrolment form and return to the Recovery College via email or post

P: (02) 9113 2981 e: seslHd-recoverycollege@health.nsw.gov.au

3. A Recovery College Peer Learning Advisor will contact you and arrange to meet to discuss your learning needs and goals

Course Guides and further information is available on our website: www.seslhd.health.nsw.gov.au/recovery_College

THe sOuTH easTern sYdneY reCOVerY COlleGe PrOmOTes HealinG, WellbeinG and reCOVerY bY PrOVidinG learninG OPPOrTuniTies FOr PeOPle TO beCOme exPerTs in THeir menTal HealTH selF - Care and aCHieVe THeir GOals and asPiraTiOns.

I learnt a lot and really enjoyed hearing other people sharing their experiences. Loved the activities. life beyond depression

I felt very valued. I was made to feel like what I do is very important and also how important it is to look after myself. self-Care for Carers

“Learning and Growth for Mental Health”

Principal Supporters

Also supported by

WHO are We? South Eastern Sydney Recovery College is a pioneering educational initiative in Australia which encourages learning and growth for better mental health. all COurses are jOinTlY deVelOPed and FaCiliTaTed bY a Peer eduCaTOr WiTH liVed exPerienCe OF a menTal HealTH COndiTiOn and a CliniCal eduCaTOr.

WHaT dO We OFFer? Our courses are Free* and unique. We offer comprehensive education and training programs which have been developed and are delivered collaboratively by people with lived experience of mental health concerns and health professionals. We also offer support to students through development of learning plans. Courses are offered in four ‘Streams’ and vary each term. Courses also vary in duration. Some are also offered in community languages. Full details of courses offered are available on: www.seslhd.health.nsw.gov.au/recovery_College

WHere are THe COurses Held? Courses are mostly run in partnership with the City East and St George and Sutherland Community Colleges and at other locations in:

c St George Area c Sutherland Shire c Eastern Suburbs

Recovery Colleges like the ones that service the South-Eastern Sydney region are a vital element in the new approach in maintaining mental wellbeing within the community. There are a range of services that are free to those wishing to attend within the catchment area, and is extended to families, friends, carers, volunteers and support people who can continue to aid recovery beyond the scheduled sessions. There is also the option

The South Eastern Sydney Recovery College is a program of South Eastern Sydney Local Health District

04/2016

Please note a different enrolment process applies to staff attending courses. Please contact the Recovery College for details.

#

An introduction to South Eastern Sydney Recovery College

Our Values

1. See the Course Guide and enrolment form on the college website if you don’t already have a copy: www.seslhd.health.nsw.gov.au /recovery_College

4. You will be enrolled in your chosen courses (pending availability) and a confirmation letter/email providing course information and location will be sent to you.

RECOVERY COLLEGE

Our Team

Our COurses We run courses which help people in:

understanding mental Health Conditions & Treatment Options e.g.

c Introduction to Recovery c Understanding Anxiety/ Psychosis/ Depression

c Understanding the Mental Health Act c Navigating the Mental Health System, etc. rebuilding Your life – developing Knowledge & skills e.g.

c c c c c c

Nutrition Resilience Introduction to Mindfulness Getting into Volunteer Work Making and Keeping Connections Life Beyond Depression/ Psychosis, etc.

Getting involved in mental Health services & making a difference e.g.

c c c c

Systemic Advocacy in Mental Health Committee Work Challenging Stigma Courses for Educators, etc.

recovery supporting Practices for mental Health Workers e.g.

c The Strengths Model in Practice c Introduction to Trauma Informed Care c Journeys in Gender, Sex and Sexuality, etc.

South Eastern Sydney

reCOVerY COlleGe Learning and Growth for Mental Health

to pay if the individual or an organisation does not fall within the catchment or above categories. These free services should be within every community, however there is no recovery college suitable for the Redfern area as people wishing to attend the courses are required to travel between Kogarah (St George and Sutherland) and Bondi (City East) community colleges as the curriculum is split between these facilities.

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WHaT dOes iT COsT TO aTTend?

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Welcome

Who can attend Enrolling is the easyRecovery with theCollege? option to enrol online Whether you experience mental distress, use drug and alcohol

ecovery College –

y College for 2017.

ourney people with mental

ecovery d and live aCollege meaningful–life.

education that promotes e aim for people to become y wellbeing College for 2017. and achieve their

ourney people with mental d-written and live a co-facilitated meaningful life. and by education promotes tors. One is athat person with a econcerns aim for people become and ortodrug and wellbeing andprofessional. achieve their a health care _____________________

-written and co-facilitated by tors. One is a person with a concerns and or drug and ng the Drug and Alcohol a health care professional. ollaboration with the South _____________________ strict (SESLHD) Drug and ded until June 2018 and will le who use drug and alcohol ourses in the coming terms. ng the Drug erstanding Drugand and Alcohol ollaboration South Wellbeing” with at thetheLangton strict (SESLHD) Drug and ded until June 2018 and will lecourses who useindrug and Term 4;alcohol Men’s ourses inand the Mental comingHealth: terms. Disability erstanding and Alcohol tanding theDrug Experience of Wellbeing” at theAll Langton into Exercise. these whether consumers, staff or wledge about the particular courses in Term 4; Men’s Disability and Mental Health: _____________________ tanding the Experience of into Exercise. All these milies and other whether consumers, staff or wledge about the particular

suitable for carers, families _____________________ a number of carer educators es. Each term we develop a milies and other or carers. If you would like

nsw.gov.au suitable for carers, families a number of carer educators _____________________ es. Each term we develop a or carers. If you would like

services, you support someone who does or you work with South Mental health consumers, people who use drug and alcohol Eastern Sydney Local Health District we offer you the opportunity services, carers and support people who are new to the to learn about recovery, wellbeing and inspire people to lead Recovery College hopefulcan and meaningful lives. All the courses are friendly and Who attend Recovery Enrolling is the easy with theCollege? option to enrol welcoming.  Option 1: complete online enrolment form online Whether you experience mental distress, use drug and alcohol https://recoverycollege.knack.com/sies#recovery-collegeservices, you support someone who does or you withfree South The South Eastern Sydney Recovery College is work currently of enrolment-request/ Mental health consumers, people who use drug and alcohol Easternand Sydney charge openLocal to: Health District we offer you the opportunity newlead to the services, carers and support people who areform  Option 2: complete and return enrolment page to learn about recovery, wellbeing andthe inspire people to on Recovery College 20 18 ofmeaningful the course guide. and lives. thewho courses friendly and hopeful People years of age andAll over have are a mental health welcoming. concern and1:live in the South Sydney  Option complete onlineEastern enrolment form Local Health

District catchment (aqua blue section of map https://recoverycollege.knack.com/sies#recovery-collegeStaff, students and volunteers The http://www.health.nsw.gov.au/lhd/Pages/lhd-maps.aspx South Eastern Sydney Recovery College is currently free or of enrolment-request/ charge and open to: contact the Recovery College for further clarification). current students of the Recovery Collegeform on page For Option 2: complete and return the enrolment   Due to the new project for the period of June 2017 to June There isofno need to guide. complete another enrolment form, simply 20 the course  People years of age and who have a mental health 2018 we18 will be extending ourover eligibility to include people 18 phone or email us with your course preferences. concern the South Eastern Sydney Localservices Health years of and age live andinover who use drug and alcohol District catchment (aqua blue section of map and live in the South Eastern Sydney Local Health District Staff, students and volunteers  Option 1: enrol online via the mental health intranet site http://www.health.nsw.gov.au/lhd/Pages/lhd-maps.aspx or catchment (non-mandatory training): contact the Recovery College for further  Their families, carers and people.clarification). students of support the Recovery College For current http://seslhnweb/Mental_Health/Training/Clinical.asp  Due to the new project for the period of June 2017 to June Staff, and to volunteers the South Eastern form, Sydney Therestudents is no need completeofanother enrolment simply 2018 we will be extending our eligibility to include people 18 Local Health District. phone or email us with your course preferences.  Option 2: complete the enrolment form yearsofofthe age and overCollege who use drug organisations. and alcohol services  Staff Recovery partner   https://recoverycollege.knack.com/sies#recovery-collegeand live in the South Eastern Sydney Local Health District  Option 1: enrol online via the mental health intranet site enrolment-request/ catchment do(non-mandatory not meet the training): eligibility criteria and would like to If you  Their families, carers andphone: support people. For any queries, please 9113 2981 form on page attend for a fee, complete the enrolment   courses http://seslhnweb/Mental_Health/Training/Clinical.asp  Staff, students and volunteers of the South Eastern Sydney Email: SESLHD-RecoveryCollege@health.nsw.gov.au 20 and tick box as indicated in the ‘connection with the Recovery Local Health District. _________________________________________________ College’ section.  Option 2: complete the enrolment form  Staff of the Recovery College partner organisations. _________________________________________________   https://recoverycollege.knack.com/sies#recovery-collegeenrolment-request/ What our students say… If you do not meet the eligibility criteria and would like to Forcourses any queries, please phone:the 9113 2981course attend for a fee, complete form on “People can just listen inenrolment the – page the Email: SESLHD-RecoveryCollege@health.nsw.gov.au 20 and tick box as indicated in the ‘connection with the Recovery lack of pressure to talk is really important. _________________________________________________ College’ section. People feel safe.” _________________________________________________

What our students say…

“I am encouraged because now I am getting “People can just listen in the course – the to know people who feel the way I do even lack of pressure to talk is really important. though they suffer from something People feel safe.” different.” _________________________________________________ “I am encouraged because now I am getting to know people who feel the way I do even though they suffer from something different.” _________________________________________________

nsw.gov.au

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_____________________

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Recovery College | Course Guide Term 4,Guide 2017 Term 4, 2017 Recovery College | Course

Recovery College | Course Guide Term 4,Guide 2017 Term 4, 2017 Recovery College | Course

Courses There are four categories of existing courses which address different consumers at different stages of the mental wellbeing journey. Some are introductory courses to mental health for an individual wishing to learn more or has not ever been exposed to psychological distress. They go further into explain specific illnesses and how to navigate the mental health system, an important skill that can save time, money and stress from an already

Recovery College Course Streams

Welcome

Stream 1: Understanding Mental Health, Drug & Alcohol Experiences, & Treatment Options

These introductory courses are designed to provide information and generate discussion different mental health, drug and Recovery Collegeabout Course Streams alcohol experiences and common treatment options. The Stream 1: Understanding Mental Health, Drug & courses incorporate different ways of understanding mental Alcohol Experiences, & Treatment Options distress. Courses about rights, current mental health legislation and the mental health system are also offered. These introductory courses are designed to provide information and generate about Your differentLife mental–health, drug and Stream 2: discussion Rebuilding Developing alcohol experiences and common treatment options. The Knowledge & Skills courses incorporate different ways of understanding mental distress. Courses about rights, current mental health legislation In these courses students will share knowledge and ideas about and the mental health system are also offered. what helps in recovery. Courses explore strategies to develop skills and knowledge to maintain health and wellbeing. The Stream 2:to assist Rebuilding – mental Developing courses aim people to Your manageLife their own health Knowledge Skills and direct their&own mental health care. In these courses students will share knowledge ideas about Stream 3: Recovery Supporting Practiceand & Getting what helpsin in Mental recovery. Courses explore strategies to develop involved Health Services skills and knowledge to maintain health and wellbeing. The courses aim to assist people to manage own mental health These courses provide information abouttheir the different ways that and direct own mental health people withtheir lived experience, theircare. families and carers can get

involved in the mental health system as employees, volunteers Stream 3: Recovery Practice & Getting or committee members.Supporting Courses also aim to educate mental involved in Mental Healththat Services health workers in approaches support personal recovery and how to effectively work alongside and support people in These courses about the different ways that consumer, carerprovide or peerinformation worker roles. people with lived experience, their families and carers can get involved in the mental health system as employees, volunteers Staff of SESLHD Mental Health must gain approval from or committee members. Courses also aim to educate mental your manager prior to enrolling in any of courses. health workers in approaches that support personal recovery and ___________________________________________________ how to effectively work alongside and support people in consumer, carer or peer What happens if Iworker can’troles. attend the course? We understand that there may be genuine reasons why on Staff of SESLHD Mental Health must gain approval from occasion people find it difficult to attend a course. The team is your manager prior to enrolling in any of courses. available to talk to you about any barriers to attending you might ___________________________________________________ have and can suggest strategies to support you. We expect you to contact the Collegeifif Iyou are unable to attend. What happens can’t attend the course? ___________________________________________________ We understand that there may be genuine reasons why on We acknowledge the traditional owners of the land on which we occasion people find it difficult to attend a course. The team is meet: the Gadigal people of the Eora nation in the Eastern available to talk to you about any barriers to attending you might Suburbs, the Biddegal people of the Eora nation in St George have and can suggest strategies to support you. We expect you and the Gweagal people of the Dharawal nation in Sutherland. to contact the College if you are unable to attend. We pay respect to their elders past and present. ___________________________________________________ ___________________________________________________ We acknowledge the traditional owners of the land on which we meet: the Gadigal people of the Eora nation in the Eastern Suburbs, the Biddegal people of the Eora nation in St George and the Gweagal people of the Dharawal nation in Sutherland. We pay respect to their elders past and present. ___________________________________________________

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debilitating experience. Some courses delve into the holistic approach to mental health such as nutrition and exercise. Opportunities to learn how to volunteer and what our role can be in society to reduce stigma can serve a greater purpose than just the individual. Life beyond illness is sometimes hard to picture, however one course encourages people living with severe mental illness to visualise their life in the future, which can motivate the path to recovery.


The closest recovery college to Redfern is currently the City East Community college in Bondi and runs out of a refurbished terrace. Due to the heritage controls and strict constraints of the existing built fabric, the spaces within the community college are restrictive and does not lend itself to the required programs.

Organisation The courses are created and maintained by staff and volunteers of the Recovery college, and are run by those with lived experience of mental illness in conjunction with any number of mental health professionals (psychologists, psychiatrists, social workers, nurses or volunteers) with usually 2 staff per class.

on its ability to integrate with existing community college services, providing a range of classes that develop individual and communal resilience without having to specify which programs improve mental wellness. These classes in the recovery college operate in evenings and contain around 15 students per classroom currently with goals to expand.

The efficacy of the recovery college depends

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CITY EAST BONDI COMMUNITY COLLEGE

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Address The community college does not have adequate signage or a distinctive architectural language that expresses the programs within, therefore limiting any informal visitors that may wander by. Part of the idea of a recovery college is breaking down any barriers between the services and community so that one feels comfortable with visiting these facilities.

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The installation of security barred doors at entrances to rooms furthers the feelings of unease, reminiscent of highly institutional spaces. Attendees may become disoriented in the hallways and rooms as there is no distinct wayfinding system or visual landmarks, therefore disconnecting them from the external environment.

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Circulation and access Unfortunately, due to the narrow existing corridor, entrance into the college is quite claustrophobic, dark, artificially lit, unwelcoming and does not have a progression of spaces or a sense of arrival. Chairs lining the corridor make the space even less fluid and don’t encourage free circulation through the entire building. Disability access is limited to the first floor as there is no lift access and the staircase retains its original design. Limited consideration of disabled circulation exists, with inadequate turning circles at the end of corridors and the distance beyond door handle does not meet AS1428.1 - 2009.

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The two multipurpose learning spaces run out of one room but are separated by a whiteboard, a very improvised and impractical approach to real spatial demands. Windows are barred and glass is frosted, creating a disorienting and disconnecting feel within the space. Although claimed as a multi-purpose space, the furniture feels quite static and due to the restricting proportions of the space, not many configurations can be arranged. Tables are not on wheels and do not have adjustable legs for movement, storage or a variety of activities, nor do chairs have adjustable controls for maximum comfort. Carpet is not a suitable floor cover for multipurpose activity as spillages from materials require cleaning and maintenance. There seems to be no adequate storage for classroom or personal equipment.

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Computer Labs and Multipurpose spaces Arguably the most important spaces in the community college are the learning spaces themselves, which seem to fall short of any real desire to inspire the occupants of the space. The rooms are essentially just repurposed bedrooms, with no real adaptation to their new functions. The organisation of the computer lab stations is quite counterintuitive to group learning environments as they are forced to turn their backs on the teacher of the class. There is no suitable circulation path through the space. In some cases, the only climate control comes from a split-cycle air-conditioning unit or ceiling fan as windows are blocked by whiteboards due to disability glare on the computer screens. Current equipment is adequate (screen, keyboard, mouse) but does not provide learning experience for future uses, such as touchscreens, tablets, VR, smartboards or mixed media. Almost all light comes from artificial light sources.

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Administration/staffroom The administration room operates on the second level, an issue of access. The space is just like any other room, and its doorway restricts the view of attendees wishing to visit. There is no architectural language or spatial distinction that explains that it is administration space. The space should be open and transparent, easily accessible and welcome for visitors that are interested in the courses provided.


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Outside/Leisure The only suitable outdoor space for gatherings before, during and after sessions is in the terrace to the side of the site. It has limited natural vegetation and receives little to no sunlight throughout the day. The long, narrow space limits informal interactions and discourages movement through the space. Limited seating isolates users from the vegetation in an awkwardly proportioned space. Blank, blandly-painted walls with barred windows and electrical conduits continue the discomfort this very sterile and uninviting area.

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PRELIMINARY MASTERPLAN

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LAND FORM

THE EXISTING FALL OF THE SITE IS FROM NORTH EAST TO SOUTH WEST, HOWEVER THE DESIGN FOR THE RACHEL FORSTER HOSPITAL REFORMS THE LAND WITH A HEAVY EXCAVATION ALONG THE WESTERN WALL. THIS CAUSES A LARGE DROP ALONG ALBERT STREET WHICH WAS FILLED WITH SUNKEN TERRACE WARDS.

HOSPITAL

MOVEMENT

THE CENTRAL WING WAS USED FOR INTRODUCTIONS, WAITING ROOM AND ADMINISTRATION. PATIENTS WOULD WAIT HERE AND AWAIT FURTHER INSTRUCTION.

EXISTING

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THE HOSPITAL IS COMPOSED OF 4 WINGS. THE CENTRAL WING IS THE ADDRESS POINT FOR THE HOSPITAL WITH A SEMI-CIIRCULAR DRIVEWAY THAT APPROACHES A PORT-COCHERE WITH COLONNADES. THE DESIGN BOXED OFF SMALL COURTYARDS THAT WERE RARELY USED AND NOT ACCESSIBLE TO THE PUBLIC.

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PRESERVATION

DUE TO ITS HERITAGE LISTING, DEVELOPERS MUST RECOGNISE THE MAIN HOSPITAL WING AND THE COLONNADES FOR FUTURE DESIGN.

CURRENT DEVELOPMENT

LAND FORM

THE ISSUE IS THE REUSE OF THE LANDFORM THAT DOES NOT RESPOND TO ITS CONTEXT. IT BURIES APARTMENTS UNDERGROUND AND THE FALL AWAY BECOMES A PIT WHICH DOESN’T RECEIVE SUFFICIENT SUNLIGHT. IT ALSO CREATES VERY PRIVATE OPEN SPACES WHILST IT CLAIMS TO BE CONTRIBUTING TOWARDS THE PUBLIC OPEN SPACE.

DEVELOPMENT

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THE CURRENT DEVELOPMENT DOES LITTLE TO CHANGE THE ARRANGEMENT OF MASSES. IT STILL CUTS OFF THE SPACE TO THE REAR OF THE SITE, AND ALTHOUGH THE DRIVEWAY IS NOW CONVERTED TO A FOOTPATH, THE PARK WILL STILL BE RARELY USED DUE TO ITS PLACEMENT IN PROXIMITY TO APARTMENTS.

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AGAINST INSTINCT

THE INITIAL INSTINCT TO PLACE THE BULK OF THE MASS ALONG THE WESTERN EDGE AND PROVIDE A LARGE PARK FOR THE COMMUNITY SHOULD NOT BE FOLLOWED. THE PARK BECOMES A BUFFER FOR RESIDENTS AND BECAUSE THE RESIDENTS WITHIN THE SITE AND ALSO BEYOND HAVE CONFLICTING SIGHT PATHS, THIS INTRODUCES A SEPARATION AND CAN PROMOTE STIGMA OF MENTAL HEALTH DESIGN.

RESPONSE TO COMMUNITY

SUBVERTING THE FORMAL ENTRY

THE AREA WHICH WAS ONCE THE CENTRAL WING OF THE EXISTING HOSPITAL AND WOULD FORMALLY INVITE PATIENTS, HAS NOW BECOME THE REINTERPRETATION OF THE PROCESS FLOW. USERS ARE WELCOME TO ENTER THE SITE AS THEY PLEASE, AND MAY FOCUS ON THE PUBLIC SPACE RATHER THAN THE HOUSING FOR VARIOUS MENTAL ILLNESSES.

PROPOSAL

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THE APPROPRIATE RESPONSE IS TO OBSERVE AND INTERPRET THE EXISTING STREETSCAPE. PUSHING THE MASSES TO THE PERIMETER RESPECTS THE FRONTAGES OF EXISTING TERRACE HOUSING, AND THE PROPORTIONS OF LOT WIDTHS DETERMINE THE REPETITION AND AESTHETIC OF THE BUILDINGS.

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PROGRAM

THE SITE CONTAINS THE ADAPTIVE REUSE OF THE HOSPITAL INTO A COWORKING SPACE, A SUBACUTE WARD, ACUTE AND NON-ACUTE DAY CARE, LONG TERM ACCOMMODATION, A COMMUNITY RECOVERY COLLEGE , CAFE FRONTAGE AND A THERAPEUTIC GARDEN.

CIRCULATION

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MOVEMENT THROUGH OUT THE SITE WAS DICTATED BY THE 4 POINTS OF ENTRY AT EACH CORNER. TRAVERSING THE 3M DROP ACROSS THE SITE IS MANAGED WITH STAIRS AND RAMPS THAT UNFOLD INTO LESS PUBLIC SPACES.

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LEVEL OF CARE

THE WING CONNECTED TO THE HOSPITAL HAS DIRECT ACCESS FROM THE MENTAL HEALTH PROFESSIONALS AND MONITORS THE MORE ACUTE DIAGNOSES. THE TERRACE HOUSES SEPARATION FROM THE MAIN BUILDING IS AN ACT OF INDIVIDUAL LIVING. THE LOW RISE HOUSING ACCOMMODATES FOR LESS ABLED AND NEED A LEVEL OF CONNECTION WITH THE STAFF.


COMMUNITY CENTRE

A MULTI-USE SPACE IN THE CENTRE OF THE PROGRAM IS USED FOR RECOVERY COLLEGE SESSIONS AND IS AN OPEN BUILDING FOR ALL TO VIEW.

SERVICE CORE

GARDEN

THE GARDEN CAN BE VIEWED FROM ALL BUILDINGS WITHIN THE MAIN PORTION OF THE SITE TO IMPROVE THE PATIENTS AND OCCUPANTS RELATIONSHIP WITH NATURE, WHICH IS PROVEN TO INCREASE THEIR MENTAL WELL-BEING.

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THE ACUTE AND SUB-ACUTE WARDS ARE SERVICED INDEPENDENTLY FROM THE HOSPITAL AND HOUSE NURSES AND MENTAL HEALTH WORKERS FOR QUICK ACCESS TO INPATIENTS.

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RACHEL FORSTER CO-LAB

The Rachel Forster hospital has undergone refitting to address the demand for collaborative spaces that tackle mental illness and the wider determinants of wellbeing. On the same floor, cross-disciplinary teams are encouraged to interact. A student doing their thesis on mental health could be working next to a start up finance company, whilst a developer could work next to them. Together, these collaborations could inspire the next great idea to address social housing or mental health.

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E ANG AR R O SF LOW IDOR L A UT CORR ETO N S FF THE M U O COL EED THE HAT F F O T SELEXIBILIUTRYATIONS AND S U OUT ACROS D F Y G I A E T F L PLE MN MEIXINHERPEANCE CON OLU TE PEO C S E H T RK TH TRIBU OF WO S RS OF ION TO DI T C RKE WO RUN FUN ILDING S A E U IS NS VIC CES SER TERRA NDITIO ORORRIDOROF THE B A D E I O R IDE C WIDTH AR OOR ER C GE D H W COE R OUN S. OUT WEAT L 2M ES THE / Y E N B L H O I B H T S O AB ETC S MUNALUAL L COLPLI IN SUIT STR E ALL C U UGH PAS, A COMOR CAS OPEN O R S TH . L T F AN T ION UNOFATHE RLITFUNITIDESE AND C LAT JACEN U M C D R I A A O M C ED T COMING OUIDTES OPPERN FAC CAL RTI E LOCA E V ENT CO PROV NORTH E R D A I EM V E G D E T O N N T H A A T PR ENE NG ARR H TAIR ALO THE E S D KITC R H I G A F S AN ROU ND E S A HROOM S TH MNS T R Y F A COIFT SHAHE WAS 0 B COLU O1 E C INT CRET BLI 2 L RS. T D I-PU TE CON O A O M R L E D F A S HE SEP RCE TO T E IS REINFO N R I U S S RUCT TION EED T MN U AT F L S E SEC D H L A T N N R U OR COE INTER0 SQUA GRHOALF FSLO TH HE 45 R E A T OF OWREVEALRSESIDENT L E ARE SIT ANTD HE GED C D N F A U PING O THE P OR GRE O STE LEY F TH N AL E GRE

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FINAL DEVELOPMENT

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“ It is as important to bring the community

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“

to the centre as bringing the centre to the community.

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Established in ‘The Shift of Needs’ (pg. 69) were three types of care that were underrepresented in the evolving urban landscape of mental healthcare. They attempt to supplement existing acute institutional care in hospitals with non-acute services within the community, as a bridge for a person’s recovery and also to prevent more severe types of mental illness through earlier intervention. Ultimately this is a more efficient allocation of resources.

A NEW SYSTEM OF CARE

When these types of care are superimposed with a daily routine and the spatial demands such as proximity to mental healthcare professionals, the outcome is a holistic relationship that can begin to form the basis of the programs within the site. Non-acute Day related healthcare Day clinics provide therapeutic sessions to those with mental illness but can return home in the evenings and therefore do not require beds or units. They attend a variety of group and individual sessions with mental healthcare professionals throughout the course of a day. Non-hospital sub-acute care Inpatient un its provide shor t term accommodation (up to 6 weeks) for those effected by mental illness and require a level of supervision by mental healthcare professionals and staff to encourage one’s recovery.

Medium-long term accommodation Shared housing aims to provide those with lived experience or those currently suffering from less severe mental illness with opportunities to live within close proximity to mental healthcare services to encourage a sustained path of recovery, whilst reestablishing positive lifestyle habits that can be lost with independence.

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TYPES OF CARE

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Redfern street The suitability of the proposal and the relationship of the site to the greater community is heavily dependent on its proximity to Redfern Street. As per the masterplan of Redfern Street, light rail will distribute passengers along its length from Redfern station to peripheral landmarks and suburbs. There will be a light rail stop on the corner of Pitt Street and Redfern Street, outside the Court House/107 Projects and only a short 200m walk (2-3 minutes) to the site. Redfern street will become much more pedestrian oriented and will encourage walking and cycling to/from Redfern Station. Most access to the site will be down Pitt Street from Redfern Street, with local foot traffic coming up Pitt Street from Waterloo. Locals are encouraged to cross through the site on their daily walk or commutes, thereby increasing the frequency of unplanned and informal contact with the facilities and occupants– a method of reducing stigma around mental health. A rear laneway to the southwest of the site will reconnect and create further access nodes and increasing the permeability of the site.

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Pitt Street and Albert Street The differentiated streetscape characters of Pitt Street and Albert Street can be drawn on to provide an architecturally responsive design. Pitt Street is a dual carriageway with 4 lanes and a speed limit of 50 km/h and the two storey terraces to the east are set back significantly, with front yards creating even further distance from the site. The resulting separation invites larger massing along the Pitt Street boundary – at 5 storeys (the current height of the remaining wing of the Rachel Forster Hospital), the afternoon winter sun barely casts a shadow on the terraces and into their front yards. The trafficability of Pitt Street beckons more public programs at ground level, possibly hospitality and retail tenancies to resonate with the active interaction at street. Albert Street is a narrow one-way laneway only managing 20km/h with opportunities for tight parking. 2 storey terraces across the street to the north are tight up against the footpath with barely any yard – only enough to park a bike. The much more private, compact relationship along Albert street requires a more subtle, private response that doesn’t aim to disturb the existing scale and proportions. Hence, the massing on the northern boundary to Albert Street can reach 3 storeys, and due to the existing terraces to the north casting a shadow throughout the year, it is advisable to set back the mass to permit maximum solar access. The program of the northern boundary calls for housing, which perpetuates the character of Albert Street and the privacy that the existing terraces wish to retain.

CONTEXT


With the refurbishment of a 1930’s art deco brick warehouse to become a luxury residential development, The George retains its existing brick exterior and frames the western boundary of the Rachel Forster site. The pitched roofline profile creates an authentic, rustic texture that speaks of Redfern’s industrial history and will be important to incorporate into new design approaches.

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Existing built form Retaining the main wing of the Rachel Forster Hospital provides vehicular access off Pitt Street to the south for staff and loading zones, whilst keeping the main portion of the site unencumbered by vehicles, lanes and parking. This in turn keeps the site highly pedestrian-oriented.

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NATURAL

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Grid Whilst retaining the main wing of the Rachel Forster Hospital, the rest of site was razed to make way for the new residential development. The remaining land is approximately 80m x 80m, and needed a masterplan approach that would acknowledge the existing site constraints such as access to larger public nodes, road networks and attempting to return the landscape to its existing form (prior to the former Rachel Forster Hospital). By overlaying a basic square 3x3 grid on the site, the site began to exhibit some principles of architectural design which could be drawn on for planning. The site progresses from public to private, from high point to low point, and from prospect to refuge. These dichotomies intrinsically develop a progression through the site and create a natural response to the greater site context. Program Allocation It was important to use green space as an entry to the site and permeability of site is crucial in allowing cross-pollination of lifestyles and hence a central open courtyard was implemented as both a wayfinding mechanism and a social gathering space. The retail program fit along Pitt Street and

the sharehousing placement responds to the Albert Street streetscape. The Recovery College needed a direct connection to the Rachel Forster Hospital as it shared its services with the general medical operations and was suitably placed along the rear of the site to feed off the brick wall from the warehouse. Proximity to existing programs It was essential when working the programs of the site to ensure there was no overlap with existing functions elsewhere – this would cause the site to become insular and discourage people from leaving and integrating with society where possible. The National Centre for Indigenous Excellence is within 200m walk of the site and provides dedicated spaces for physical activity, such as fields, gym and swimming pool. Therefore, specialist sports spaces were refrained from being included in the site – the multifunction spaces in the recovery college lend themselves to small introductory yoga classes for visitors and attendees but more advanced classes were not to be pursued on the site but rather referenced to surrounding facilities.

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PLANNING

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When the full configuration of programs are mapped on their hours of accessibility and their provision of mental health care, a much more comprehensive system is displayed. Physical links (shown as grey bars) can be drawn between the programs through their shared communal areas and circulation spaces therefore encouraging a cross-pollination of people and operations. The variety of

programs on the site offer different levels of mental health care provision/supervision and allows the occupants of the site to determine their own levels of interaction and intimacy throughout the day. Ideally the program begins to desegregate users of the site in an attempt to reduce stigma and improve wellness through community participation.

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A COMPLETE SYSTEM OF CARE

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GROUND PLANE

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Mental First Aid Unit International models of mental healthcare have begun to address the concept of ‘mental first aid’. Mental first aid is an essential service that should be provided alongside other existing services and aims to be the first point of call for people in emergency crises due to mental distress. Nationally there exists LifeLine which is available for anyone to call when they are concerned about their mental wellbeing, however from experience, there is insufficient resourcing that can assist this phoneline. If a caller expresses great concern for their safety and are unable to make it to a hospital, the only choice that the operator has is to call the police. This has proven to escalate a situation rather than calm the caller, and can increase the stigma of mental illness within the environment. Police and paramedics are not currently trained in mental first aid, which can prove vital in critical situations where a person may not be coping with their direct environment. These specialists operate out of a dedicated space and have mobile units that can reach people in distress within minutes 24 hours a day, can assess acute psychiatric and crisis conditions and assure the person will be safe, preventing hospitalisation. The emergency mental first aid unit will operate out of the lower ground western wing of the Rachel Forster Hospital with dedicated consultation spaces. The selection of this space for the unit is due to its direct vehicular access from the rear carpark, and to allow a high level of anonymity of the patients who are in a highly-agitated state. The consultation rooms are open to a secluded relaxation garden which the person can immerse themselves in whilst coming to a more relaxed state under the instructions of the mental first aid staff.

General Medical Services The hospital was to house a small amount of general practitioner consultation rooms to encourage a mixed-use site and to ensure

that mental illness was not sequestered from all illness. The ground floor and first floor feed off the double height lobby and patients can visit these spaces for private checkups. Although initially considering a more flexible consultation room design, in discussion with a GP it was identified that they require a traditional set room configuration that is consistent through the building as they need to have prior knowledge of equipment and are often needed to ‘hot desk’ consultation rooms for visiting physicians. Central circulation core and communal areas The central zone of the Rachel Forster Hospital became a space for distributing patients, staff and workers alike - a way of desegregation. There are dedicated communal kitchens and generous communal eating areas to encourage people from all walks of life to share meals and stories, a crucial element in dissolving stigma around mental health. Lounges invite people to gather after a meal for a chat or a place to wait for a meeting with an employee in the collaborative workspaces. Collaborative workspaces The collaborative workspaces on the western wing on levels 2 through 4 encourage a variety of industries - ideally there would be students, researchers, mental healthcare professionals and other people that contribute towards a greater understanding of mental wellness all under one roof. The workspaces are transparent and visible from the circulation spaces to invite observation from patients, an indirect way of exposing them to a healthy and productive lifestyle. Nursing stations The nursing stations provide consultation rooms for visiting psychiatrists, as well as lounges for patients and informal surveillance of the inpatient units in case of crisis. Patients visit nurses to update on their wellbeing, to receive their medicine or simply chat.

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RACHEL FORSTER HOSPITAL

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GROUND FLOOR RACHEL FORSTER HOSPITAL LEGEND 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17.

RECEPTION DESK BOOK LOUNGES STAIRS TO LEVEL 1 BOOKCASES LOUNGES ACCESSIBLE TOILETS LIFTS FIRE STAIR CONSULTATION ROOM ADMINISTRATION/STORAGE CLEANERS STORAGE LARGE CONFERENCE ROOM SMALL CONFERENCE ROOM COMMUNAL KITCHEN COMMUNAL EATING HALL RECOVERY COLLEGE OFFICES STAIRS TO RECOVERY COLLEGE FLEXIBLE LEARNING SPACE 7 8

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The inpatient wings on levels 2 through to 4 extend from the eastern end of the Rachel Forster Hospital and provide fully staffed sub-acute non-hospital units. These units are aimed at providing a safe environment within the community for those suffering from a mental illness but have been assessed as not critical. The inpatient wings are raised above the ground plane to give the patients a level of privacy yet still have extensive visual connections to nature and the community beyond. These units run along an open-air courtyard to provide a variety of private and semi-private spaces integrated with natural elements. Staffed areas are positioned at the beginning of each courtyard to provide indirect support for patients and allows the daily operations such as medication distribution. The patients occupying these units may stay for up to 6 weeks, however research has identified that most inpatient admissions last around 2 weeks. This model may decrease admission time even further due to its provision of therapeutic environments. The initial design of the inpatient unit was informed by a few critical design factors; • Staff should be able to easily scan the room to ensure that the patient is safe • Patient should have a generous view of outside • Patient should have a variety of connections with nature

• Each unit should have a bathroom that is adaptable for disability • Each unit should have a small amount of storage for personal belongings • Each unit should have the ability for an extra bed to fold out so that family or friends may visit for company or support (as pictured in the plan opposite) Through analysis of successful existing inpatient unit designs, the result is a derivative of the Inpatient unit at Miami Valley Hospital. Further modifications were made to improve the amenities of each unit, including the alteration of the bathroom and living spaces configuration to comply with AS1428.1 (2009) which outlines the design requirements to comply with mobility of disabled occupants. The initial unit design lacked any private outdoor space or any access to vegetation, hence a small accessible balcony with a planter was included to allow patients to tend to their own plants. The resulting space made for a small study nook to allow patients a comfortable space for activities that they may find therapeutic, such as writing, sketching, or reading.

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INPATIENT UNIT

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TYPICAL FLOOR RACHEL FORSTER HOSPITAL LEGEND 1. LIFTS 2. FIRE STAIR 3. ACCESSIBLE TOILETS 4. COMMUNAL KITCHEN 5. COMMUNAL EATING HALL 6. LOUNGES 7. COLLABORATIVE WORKSPACES 8. INPATIENT LOUNGES 9. NURSES STATION 10. MEDICINE STORAGE/ADMINISTRATION 11. NURSES OFFICE/SECLUSION ROOM 12. CONSULTATION ROOM 13. CONFERENCE ROOM 14. PATIENT COMMON ROOM 15. OPEN CORRIDOR 16. INPATIENT UNIT 17. STAIRS TO OTHER LEVELS OF UNITS


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INPATIENT UNIT WING LEGEND ACCESSIBLE BATHROOM STORAGE/ROBE COUCH/BENCH BALCONY STUDY NOOK MULTIMEDIA WALL

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The recovery college that feeds off the Rachel Forster Hospital creates a variety of flexible spaces that encourage a constantly shifting configuration of programs, with underlying orientation towards mental wellness and community participation. The single most effective method of dissolving stigma around mental illness is contact - the more you genuinely interact and surround yourself with others, the sooner that labels of “us” and “them” disintegrate. The spaces in and around the recovery college blur boundaries of physical, personal and psychosocial space and encourage the intimacy that’s often lost in urban conditions. Flexible Gallery The flexible gallery is an airy, light filled space that opens up to the central courtyard. The large glazed façade aims to maintain visual connections with those outside to establish a level of informal interaction with others

outside. The gallery is a double height space that spans 3 bays, where each bay is 8m wide and 3m deep. The dendriform vaulted ceiling pays homage to the open collaborative workspaces of the early 19th century, such as the Stamp Office in the Somerset House. The dual axis parabolic concrete vaulted arches are reminiscent of a canopy, which draws the eye up and outwards towards the courtyard; its engagement with the columns frame each bay but at the same time unify the space whilst allowing light to dance through its branches. Each bay can be used independently, partitioned by operable wall storage systems and can house programs such as classrooms, workshops, yoga/exercise sessions or art classes. Alternatively, the space can be used as one continuous space that draws the attention from all peripheral spaces, and can house exhibitions, plays or school functions as tiered seating is provided for an audience.

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RECOVERY COLLEGE

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Fixed Learning Spaces For more intimate learning environments or when more sensitive themes are being addressed, the fixed learning spaces allow for small classrooms of 12 attendees. There are limited perforations in the joinery wall for visual access through to the recovery college but large operable glazing encourages a close connection with nature. They are suitable for group therapy sessions, wellness workshops and for school/university students for studying after school and on weekends. Consultation rooms Consultation rooms line the top floor of the recovery college and provide a middle ground for patients, families, friends, medical professionals, counsellors and social workers. These consultation rooms are suitable for informal consultations where a patient may want to discuss their pharmacological treatment – having these spaces detached from any specific medical program can dissolve the stigma around mental health by developing a level of anonymity. Outdoor terrace Furthermore, informal discussions can take place outside during pleasant weather. Nature has a profoundly therapeutic effect on people’s psychological wellbeing and Sydney’s climate should be taken advantage

of. This outdoor terrace is tucked behind the consultation rooms and is accessible along the top floor, creating a level of privacy in an otherwise open space. It is nestled among the canopy of the courtyard and is framed by the brick warehouse roofline. Free Use Corridor The free use corridor is a mezzanine that opens to the peripheral courtyard, with indirect diffuse lighting pouring down from skylighting for task based lighting such as computer/screen use. It has free table arrangement with sliding opaque glass panels to further diffuse lighting for presentations or discussions. The corridor is lined with workbenches and stools along the balcony, which overlooks the flexible gallery. The configuration encourages the notion of passive learning – one can study here individually or in a group, and having audible connection to the classes below has a subconscious effect on people. It can be difficult to take that first step to seek help or attend classes, but this free-use corridor allows for the ultimate anonymity whilst people can become curious about mental wellness.

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Classroom configurations We cannot always accurately predict the future of classrooms and learning spaces – the spatial requirements are quickly shifting and we are seeing a move into the digital realm, blurring the boundaries and substituting cumbersome furniture for less prescribed peripherals. Hence, the flexible gallery space does not restrict the projection of classroom design but in fact encourage it. Wall panel systems can be quickly moved to enclose the space for a variety of classroom sizes and configurations, and these wall panels are in themselves a template for development.

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PSYCHROMETRIC CHART including Sydney bioclimatic data

COMFORT ZONE

HEATING BY PASSIVE SOLAR

COOLING BY THERMAL MASS

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PASSIVE DESIGN

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Comfort Comfort of people within a building and its spaces indicates a successful occupancy. Thermal comfort is a condition of mind that expresses satisfaction with the thermal environment, and due to its subjectivity, can differ from person to person. Identifying a thermal comfort zone relative to a bioclimatic region is essential in understanding the appropriate passive design response. Sydney requires cooling by thermal mass for only around 4 months of the year, but requires heating by passive solar for the remaining 8 months. Passive Solar Heating The principles of passive solar heating are to maximise the potential of the sun’s radiant heat throughout the winter months where mechanical heating may be required. This is achieved through strategic placing of thermal massing to receive the suns radiant heat through the day, store the energy in connected thermal mass and then discharge the heat in the cooler hours of the evening. Concrete has a much higher thermal capacity than wood or steel and is therefore selected as a suitable material for columns and slabs. Natural Cooling by Thermal Mass In the warmer months of Sydney, overheating inside the buildings is due to the excessive solar heating and internally generated heat

reaching internal spaces. Therefore it is practical to maintain comfortable conditions with appropriate control of heat gains . The basic strategies are; • Reducing solar gains by correctly designed shading, • Minimising internal gains through exhausting heat, • Designing night ventilation openings to assist in cooling the thermal mass of the building , • Enabling appropriate air movement to raise the threshold of the occupants comfort ; and, • Designing for minimum air infiltration during the day when external air is 3°C greater than the upper comfort limit . Ventilation louvres at outdoor terrace level extract excess heat through thermal stack effect and permit thermal comfort throughout the warmer months. Lightweight materials on the top floor (such as timber frame/plywood) have a much lower thermal capacity and are used to dissipate the heat that builds up on higher levels. User Control Studies have shown that the operability of a space to regulate light, privacy and air has beneficial impacts on psychological wellbeing and creates a much stronger connection between humans and their built environment.

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COMMUNAL KITCHEN COMMUNAL EATING HALL RECOVERY COLLEGE OFFICES STAIRS UP TO LEVEL 1 STAIRS DOWN TO FELXIBLE GALLERY ENTRY TO LOWER GROUND/FLEXIBLE GALLERY ENTRY TO NORTHERN STAIRWELL FLEXIBLE GALLERY FIXED LEARNING SPACES UNDERNEATH FREE USE CORRIDOR TIERED LEARNING SPACE SECLUSION GARDEN PERIPHERAL COURTYARD CONSULTATION ROOMS OUTDOOR TERRACE STAIRS DOWN TO GROUND FLOOR LOBBY WAITING LOUNGES GENERAL MEDICAL CONSULTATION ROOMS ACCESS TO MENTAL FIRST AID UNIT

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Existing inner-city terraces The terraces have been a fairly successful model of inner-city living for Sydney residents over the last century but hold with it some outdated views on living arrangements. Some observations were made about the traditional design of the terraces in the area; • Living and communal spaces at ground level • Built on narrow but deep plots which draw inhabitants away from an active streetscape and is more difficult to draw light through deeper spaces • Private quarters upstairs

• Fairly defined spaces are enclosed by walls which reduce connections between spaces and restricts views/transparency through building • Front façade is ornate but is quite static and doesn’t create an interactive dialogue with the street or its neighbours • Disability access to bedrooms upstairs is difficult and may require chairlift installed


The inclusion of share houses along Albert Street begins to perpetuate the more intimate character that the streetscape affords. The built form was required not to challenge opposing terrace presences but compliment them, hence reference to surrounding heights of 3 storeys. Its design philosophy stems from a study and reinterpretation of the existing terraces that populate the streets of Sydney, with key focus on increasing density, communal living arrangements that supports those at various stages along their path to recovery, whilst improving access, natural lighting, amenities and connections with nature.

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SHARED HOUSING

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ALBERT STREET BOUNDARY

GROUND FLOOR PLAN

FIRST FLOOR PLAN

SECOND FLOOR PLAN


Modern Sharehouse interpretation Whereas the existing terraces had a vertical division between living areas and private quarters, a division of private quarters to the rear of the building responds to contemporary living arrangements. It reduces the concentration of private quarters, and for the purpose of a share house, more equally distributes living areas to bedrooms. The intention of living spaces along the streetfront also encourages a more active relationship with the streetscape. The largest living area at ground provides a generous communal kitchen area facing a large dining table and lounge to encourage communal living in a suitable environment. The openable kitchen window and sliding warehouse door invites neighbours and passers-by to come and join in communal meals. These architectural concepts reinforce new ideas on community based mental healthcare which de-institutionalises existing frameworks of living and giving way to more open living and greater opportunities for social interaction. The entire ground floor and its two bedrooms are disability accessible for two residents, which aims to reduce the stigma of disability within mental illness that special considerations must be made. Secure bedrooms are generous in size and come with a large robe/storage wall, a small balcony and study nook to also give occupants their own space if they need to de-escalate or are more comfortable in quieter environments and provides a time and space for reflection. These four share houses provide a variety of living arrangements within the community and is not exclusive to those effected by mental illness. The share house model aims to reduce stigma of mental illness through contact between occupants from various backgrounds and provide a level of proximity to mental healthcare services for its occupants. They can be perceived as a type of halfway

housing ; however, these share houses aim to provide a proportion of private housing bedrooms to improve connections with the greater community. The ideal types of residencies in the share houses would consist of a combination of; • Those whom have recently felt they are ready to leave an inpatient unit after approximately 3 weeks • Those waiting for a place in one of the inpatient units • Those whom find it hard to access the recovery college from home and would like to be based in the share house temporarily • Those in need of social/subsidised housing medium to long term • Those on the waiting list for social housing • Those working within the mental healthcare system or with lived experience of mental illness and feel that they can contribute to one’s path of recovery within their household • Family or friends wishing to live and provide transitional support with those whom are on their path to recovery • Members of the inner-city cadre project • Those whom are doing a rotation within the site and live far from Redfern • Those working in the collaborative workspace offices • Students wishing to live in shared accommodation • Any other type of private residence. This mix of residents blurs the distinction between various members of the community, and is a great opportunity for unplanned social interactions, with potential for development of professional and life skills between residents. Their disconnection but proximity to the staffed areas of the site provides a safety net for any resident that may experience some mental distress on their path to recovery, whilst still giving them a totally controllable level of independence.

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SHARED HOUSING

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COMMUNAL DINING TABLE LIVING ROOM KITCHEN ACCESSIBLE BATHROOM BEDROOM W/ STUDY OUTDOOR LIVING AREA SHARED FRONT YARD

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SHAREHOUSE GROUND FLOOR LEGEND 1. 2. 3. 4. 5. 6. 7.

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SHAREHOUSE TYPICAL (FIRST/SECOND) FLOOR LEGEND 1. 2. 3. 4. 5.

KITCHEN OR DINING DEPENDING ON LEVEL VOID TO LIVING ROOM MASTER BEDROOM ACCESSIBLE BATHROOM BEDROOM W/ STUDY

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RETAIL TENANCIES LEGEND

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PHARMACY 1. POINT OF SALE 2. DISPENSARY 3. BREAK ROOM/OFFICE 4. STORAGE 5. BATHROOM

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BICYCLE WORKSHOP 6. POINT OF SALE 7. WORKBENCHES 8. BATHROOM CAFE/CAFETERIA 9. SERVICE CORRIDOR 10. FIRE STAIR 11. OFFICE 12. COLD ROOM 13. PANTRY 14. CAFE 15. AL FRESCO SEATING 16. BATHROOMS 17. KITCHEN 18. DINING HALL

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The three different retail tenancies at ground level open to both Pitt street and to the internal courtyard of the plan to encourage cross-circulation of transitory customers, and to improve the transparency of the sites inner programs which include varied levels of interaction with nature. The curation of these tenancies is an attempt to reduce stigma of the

sites mixed programs and occupants, and to provide occupants of the site and the wider community with some of the tools required to commit to a physically healthy lifestyle and therefore improve their overall wellbeing. The pharmacy, bicycle shop and cafeteria respond to the new holistic model of mental healthcare and the wider determinants that can contribute to one’s resilience and recovery.

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The café opens in the early morning to serve commuters, which develops a level of community interaction and initiates the beginning of site activity for the day. The café is part of the cafeteria/restaurant but is at grade to Pitt Street for ease of access and service. It provides a few tables for customers to enjoy café menu items prepared in the café or more substantial breakfast/lunch items which are prepared in the restaurants kitchen. The cafeteria/restaurant kitchen operates from the early morning and cooks a healthy selection of meals for the inpatients and visitors throughout the day. Mealtimes

are always great opportunities for other occupants to meet outside the confines of their room, in common areas. Lunchtime and evenings are also the most ideal times for patient’s families/friends to visit, so the café and cafeteria/restaurant provide a nurturing environment. Furthermore, studies find that correct nutrition, cooking and eating together (not only with friends and family, but neighbours, others in the community) has great impact on improving mental wellness. It strengthens relationships, opens a platform for safe informal discussion, develops life skills and dissolves labels or titles of people from ‘us’ and ‘them’ to just ‘us’. Therefore, the cafeteria encourages communal participation in cooking. The kitchen bench extends beyond the chefs bounds and welcomes interaction and free lessons on cooking meals. The kitchens transparency is further enhanced by openings to the courtyard for passers-by to experience passive learning. An upstairs steel frame supports more seating upstairs to celebrate the double height space of the retail tenancies.

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Café/Cafeteria/Restaurant The space that is dedicated to the café, cafeteria and restaurant is positioned at the most prominent zone in the site, and as such, also has views across the entire promenade along Pitt Street, towards the entry, and looks inwards to the courtyard. This was a deliberate attempt to make visitors and users of the site to feel comfortable and accustomed with a staple retail frontage. The space also provides a level of informal surveillance throughout the day and into the evening, as there are large public spaces that the program lends to the community and should be respected.

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‘The Nunnery’ bicycle recycle workshop Analysis of Redfern and surroundings identified a deficiency in bicycle shops within accessible distance (less than 10-minute walk) to the site. Aligning with the masterplan, it is imperative to encourage the use of cycling to access public transport nodes and to supplement other modes of transport. After further investigation, an organisation called ‘The Nunnery’ was found to be working out on the lawn of the Waterloo towers every Saturday morning. They provide free classes to visitors on how to repair bicycles, and depend on donations (of money and bicycle parts) to continue this service. Due to their volunteer nature, the provision of their services is understandably patchy and operating out of a basement storage space is extremely limiting. Their tools and equipment are spread thin and are also mainly donated, with occasional thefts. To align with the principles of the proposed site and programs, it is suitable to encourage the relocation of ‘The Nunnery’ just up the road to a fixed retail tenancy in between the pharmacy and cafe. There will be adequate facilities to operate a functioning bicycle workshop that continues the organisations

original goals of repairing community member’s bicycles, thus encouraging cycling. Furthermore, the classes could now become an optional part of the curriculum of the recovery college where students can learn how to fix and maintain their bicycles. Classes on repairing broken bicycles may provide people with real skills and improve their wellbeing through following a therapeutic process and seeing a positive outcome. By establishing a fixed tenancy within the site, the reputation of the workshop will improve and more people will be encouraged to donate their bicycle parts. The bicycle recycle workshop will fix broken bikes, sell some repaired bicycles to receive profit and provide some working cycles as rentals, to both occupants of the site and members of the community. By allowing rentals for patients of the site, they will be encouraged to leave the site for short periods of time throughout the day to explore Redfern and surrounding suburbs. This will also provide them with greater opportunities to access public transport nodes and are much more likely to maintain a level of connection with their regular lifestyle (either family, work or social) if access is sustained.


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Pharmacy Placing a pharmac y on-site is highly encouraged as a close relationship with pharmacists aligns with new models of international mental health care. Rather than a traditional one-sided relationship between the pharmacologist and patient where the patient only receives products, new models dictate a more open relationship which creates a two-way dialogue and allows the patient to ask questions more freely, ultimately being able to greater understand their medications and are more involved in their own recovery. Establishing trust with a pharmacologist has been proven to increase the response of the medications on patients, with less chance that the patient will feel apprehensive towards or refuse medications that are vital to their condition.

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Through numerous letters to the council and visiting the City of Sydney website, it was clear that the Jacaranda on the corner of Albert and Pitt St was a significant tree, both throughout Redfern’s history and in unifying the community. Threatening its removal with the proposed residential development created an uproar from numerous individuals and groups, with some claiming the tree served as a cultural marker of the existing hospital site. Since this address of the site is the most prominent and most accessible to the greater community and public transport nodes, adopting typical developer mindset would be to reinforce the corner with a strong architectural element and create an ‘iconic’ landmark, which would inevitably remove the tree in the process. However, I feel that the entire essence of the project is to fully engage and listen to the community, respect existing cultural ties and to truly provide a response that speaks of the social mechanisms it wishes to reinforce. The corner will therefore become a pocket park that proudly boasts the significance of the jacaranda, a beacon in itself, visible from streets away. The park dissolves the hard corner and encourages cross-flow of foot traffic, providing informal seating around the edges of bushes and lush native vegetation. The corner park blurs the boundary of the site, drawing on the theory of theraserialisation as a spatial arrangement to draw people in and make their own way through the site using nature as thresholds, allowing the progression from the city scale to private spaces.

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COMMUNITY VOICE

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ENTRANCE


UNITS


COFFEE SHOP BICYCLE WORKSHOP


CAFETERIA DOWNSTAIRS CAFETERIA UPSTAIRS


INPATIENT OPEN CORRIDOR CORRIDOR GARDEN


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LIVING AREA BEDROOM + STUDY NOOK


ROOFTOP TERRACE VIEW INTO SKYLIGHT


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TIERED LEARNING SPACE RECOVERY COLLEGE FACADE


FLEXIBLE GALLERY WALKWAY


OUTDOOR TERRACE FREE USE CORRIDOR


LOOKING DOWN TO FLEXIBLE GALLERY WALKWAY TO CONSULTATION ROOMS


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BYERA HADLEY TRAVELLING SCHOLARSHIP PROPOSAL

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For each of the case studies I wish to examine, I intend to investigate various aspects of the facilities such as its success, impact on the community, the overall mental health of its occupants and the perception of mental health or stigma. The findings from this research can highlight the attitudes and trends of contemporary mental health care and the relationship between the built environment and mental health, with focus on urban contexts. Understanding the context and people a. Health/Mental status of population - What is the impact of mental health in this community/region and what are the attitudes of the people, organisations and governing bodies that have influenced the projects fruition? b. Built Environment – understanding the character of the built environment through streetscape, urban design, density. c. Characteristics of the people – understanding not only the baseline demographics but also the holistic factors such as community cohesion and beliefs on healthcare and political influence? Are there any cultural or religious values associated with mental health in this community? d. Amenities and surrounding context – what local factors can contribute to the project’s success? Are there schools, religious facilities, urban centres, sports teams, community-led organisations nearby and what role to they play in the integration of this project in the built fabric. re:habitat a new mental health approach for urban communities

1.

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2.

Type of Action/Project a. Is this project a built form, soft implementation or some combination? b. Is this project a formal or informal structure – is it organised outside the influence of larger governing bodies or is it an institution formed by regulation-driven organisations? c. What is the level of community interaction – does the project extend beyond its site and create a dialogue with the people to establish a repertoire or is it a more covert implementation? d. What is the organisational structure of the people in this project? Are there mental healthcare professionals staffed permanently/temporarily here? What type of interactions occur? Do the professionals work independently of the users or is there a more open relationship? e. What type of care does this project offer, if any? f. If a type of care is offered, what is the intended timeframes of these types of cares? Short, medium, long term? Permanent or overnight emergency? g. What is the character of the users – age, gender, background, ethnicity and any common illnesses?

RESEARCH METHODOLOGY


3.

Physical/Architectural Qualities a. What are the site details of this project (if any)? This can include location, climate, building regulations, site restrictions, site opportunities. b. What is the built form of this project (if any)? This should include general concepts of the design as intended by the architect that informed the process. c. What are the architectural qualities found in this project (if any)? This could include aspects of light, scale, form, mass, materiality, nature etc. d. What are the spatial arrangements/hierarchies of this project (if any)? Process/Social Qualities a. What was the reception of the project on the community – both within and beyond the site? b. What was the design process? Who, beyond architects, were involved in the implementation of this project? Were any mental health professionals, patients, end users involved in any collaborative capacity? c. What issues arose through the process of this project? Were there any objections? Were there any expected resistances that surprisingly dissipated or encouraged this project? Why was this? d. What systems or incentives are put in place to ensure that this relationship/impact continues? e. Are there any failings of the project or missed opportunities with the power of hindsight? f. Interviews with; i. Architect ii. Users/consumers iii. Staff/professionals (if any) iv. Public/community

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The selection of the precedents has come from vigorous research into the most successful and current evidence-based mental healthcare design. These internationally recognised projects have won various awards not only for their architectural qualities, but their ability to respond to the needs of their community and redefine the relationship that a patient has with their mental healthcare providers. My intention for selecting local and international precedents is to compare our standards and beliefs of mental healthcare to some of the most forward-thinking countries in the world, in terms of quality of life, provision of healthcare and architectural design. I hope that my learnings can ultimately contribute and benefit the fields of mental health and the built environment.

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More detail and literature on each precedent can be found in the Appendix.

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International Precedents

Australian Precedents

Humanitas Intergenerational Housing, Netherlands Humanitas

Youth Mental Health Building, Brain and Mind Research Institute, Australia BVN Donovan Hill Architecture

42nd Street Young People Mental Health, United Kingdom Maurice Shapero

Nepean Mental Health Centre, Australia Woods Bagot

Helsingor Psychiatric Hospital, Denmark Bjarke Ingels Group, Julien De Smedt Barnet Elysian House, United Kingdom Rethink Mental Illness Kronstad Psychiatric Hospital, Norway Origo Arkitektgruppe De Hogewey k Dement ia V il l age, Netherlands Vivium House of Psychiatry, Sweden Tengbom Architects

Dandenong Mental Health Facility, Australia Whitefield McQueen Irvin Alsop and Batesmart Young Adult Mental Health Clinic at St Vincents Hospital, Australia Woods Bagot Persons of Interest (for Interview/ Correspondence) Alain De Botton Author, Architect, Philosopher Professor Ian Hickie NSW Mental Health Commission Former CEO BeyondBlue Psychiatrist

PRECEDENT SELECTION


1. The design of most mental health facilities are orchestrated by larger architecture firms. Why is this? Is the resourcing, networking and regulatory navigation required mean too great a leap and too much responsibility for small firms to take on health-related projects? Is there any way that smaller, less-formal responses could complement or supplement some of these larger formal institutions, which could be undertaken by local architects to produce smaller yet more locally responsive outcomes to the character of the people and urban fabric in each specific place, especially within an urban context? 2. How can the lessons that are learnt from less urban examples in this investigation be applied to urban contexts? Can mental healthcare infiltrate the urban fabric successfully? From an urban problem, can an urban solution stem? 3. Can architecture can elevate the status of mental illness and increase awareness in society thus reducing stigma? 4. Many potential sites for urban development of mental health facilities may have more complex forces to react to compared with an expansive suburban or rural plot that can be cleared – existing built form/ heritage controls, awkward site form, height restrictions etc. – how can these be manipulated to our advantage in mental health design? Does the model and regulatory structure and governance of mental healthcare need to become more flexible to adapt with higher density programs and more mixed-use developments? 5. Does the design process require the input of mental health professionals, clients/users and the community in collaboration? If so, when, and how much? 6. Are there opportunities to house on-site research spaces adjoining or within mental healthcare facilities? What systems can encourage more instantaneous implementation of learnings into the treatment of patients? Are there any issues with this close relationship? 7. How can the architectural field learn from the current and developing relationship of mental health and the built environment? How can we situate ourselves to be most useful to our communities? 8. Can the barrier between housing and mental healthcare dissipate? Are there successful models of housing which encourage or promote mental wellness? Are there examples of mental healthcare facilities that provide a component of housing (as opposed to hospital beds/recovery rooms)? What stance should we take on the tendency of long-term patients desires to live within or close to mental healthcare facilities? Is this sustainable?

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OVERARCHING QUESTIONS

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INTERNATIONAL ITINERARY

1. June 28 - Sydney to Uppsala Flight to Stockholm: AU$800 – Thai Airways & Emirates (skyscanner.com.au) Train from Stockholm to Uppsala: return ticket SEK200 (AU$20) (tripsavvy.com) Accommodation: AU$80 per night x 2 nights = AU$160 (airbnb.com.au) Daily transport: SEK100 (AU$10) x 3 days = AU$30 Daily food: AU$40 = AU$120 Sub-total: $1,130 2. July 1 - Uppsala to Helsingor Flight from Stockholm to Copenhagen: AU$110 – Norwegian Air (skyscanner.com.au) Train from Copenhagen to Helsingor: return ticket DKK216 (AU$44) (copenhagen-travel.tips) Accommodation Helsingor: AU$70 per night x 2 nights = AU$140 (airbnb.com.au) Daily transport: DKK50 (AU$10) x 3 days = AU$30 Daily food: AU$40 = AU$120 Sub-total: $444

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3. July 3 – Helsingor to Bergen Flight from Copenhagen to Oslo: AU$208 - SAS (skyscanner.com.au) Flight from Oslo to Bergen: AU$225 (skyscanner.com.au) Accommodation Bergen: AU$75 per night x 2 nights = AU$150 (airbnb.com.au) Daily transport: NOK60 (AU$10) x 3 days = AU$30 Daily food: AU$40 = AU$120 Sub-total: $733

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4. July 8 – Bergen to Amsterdam Flight from Bergen to Amsterdam: AU$130 – SAS (skyscanner.com.au) Accommodation Amsterdam: AU$80 per night x 2 nights = $160 (airbnb.com.au) Train from Amsterdam to Deventer: return ticket EUR€37.2 (AU$55) (onlytrain.com) Accommodation Deventer: AU$75 per night x 1 night = AU$75 (airbnb.com.au) Experiential tour of De Hogeweyk Village: EUR€225 + VAT = ~AU$370 Daily transport: EUR€7 (AU$10) x 4 days = $40 Daily food: AU$40 = $160 Sub-total: $620 5. July 13 - Amsterdam to Manchester Flight from Amsterdam to Manchester: $140 – Transportugal (skyscanner.com.au) Accommodation Manchester: $80 per night x 3 nights = $240 (airbnb.com.au) Daily transport: GBP£6 (AU$10) x 3 days = $30 Daily food: AU$40 = $120 Sub-total: $530 July 21 - Manchester to Sydney Flight from Manchester to Sydney (via London): $870 - Etihad Airways (skyscanner.com.au) Total International Cost = AU$4,697


AUSTRALIAN ITINERARY

July 25 De Hogeweyk Dementia Village Care concept interview in Sydney July 25 Flight Sydney to Melbourne: Return $120 – Jetstar (skyscanner.com.au) Accommodation Dandenong: $60 per night x 1 night = AU$60 (airbnb.com.au) Daily transport: AU$10 x 2 days = AU$20 Daily food: AU$20 = AU$40 July 28 Self-drive to Nepean, Petrol = AU$5 Self-drive to Camperdown/Darlinghurst, Petrol = AU$5 Self-drive to Kensington, Petrol = AU$5 Sub-total = $255

Total cost of travels = AU$=4,963

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AUSTRALIAN PRECEDENTS - LITERATURE, REVIEWS & DETAILS

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Youth Mental Health Building, Brain and Mind Research Institute 100 Mallett Street, Camperdown 2050 NSW Australia BVN Donovan Hill Architecture “This is breaking down barriers. We have patients come in and think they must be in the wrong place” - Professor Ian Hickie, Executive Director BMRI Integrating clinical research and treatment in a respectful, welcoming environment, translating to better treatment in mental health. Heralding real change in mental health treatment and research, the YMHB represents both internationally awardwinning architectural design and world class treatment and research in mental health. The YMHB consists of two floors for patient treatment, and two floors of research laboratories above. An upper level bridge connects to further research laboratories in two adjoining buildings. This configuration allows the retention of the two-storey heritage listed façade and places the labs in a ‘sliding glass box’ on top of the old façade. The ground floor spaces are designed to be welcoming and unintimidating for patients. Internally the floors are linked by an open stair and small atrium containing the social space of the centre. Meeting rooms and all facilities are accessible from this central space. At the street edge, the building’s materials reflect the light industrial context of the neighbourhood. The ‘sliding box’ is clad with translucent glass planks ensuring diffuse natural light to the laboratories, resulting in very low energy consumption. Nepean Mental Health Centre Derby St, Penrith NSW 2750 Australia Woods Bagot The Nepean Mental Health Centre is an example of how mental health care is shifting towards creating regenerative, healing environments for recovery. The design of the unit provides a restorative health care unit, integrated into the local community and linked to the adjoining health precinct. The hard steel and glazed exterior relates to the adjacent hospital buildings, and is contrasted with the non-institutional feel of the internal spaces and internal courtyard, where the focus is on healing by design and creating a sense of humanity and ownership.


Young Adult Mental Health Clinic at St Vincents Hospital 390 Victoria St, Darlinghurst NSW 2010 Australia Woods Bagot The new young adult mental health facility at St Vincent’s Private Hospital was designed as the antithesis of a stereotypical psychiatric ward, said Kate Harel, nurse unit manager of the 20-bed facility. The unit accepts people 16 to 30 for stays that average two to three weeks, has won the healthcare category of the 2012 World Architecture News Awards. The competition’s judges praised it for providing a ‘’healing environment with limited boundaries and flexible spaces … a refuge for young people at a time in their lives when mental health issues can arise for the first time’’. There are beanbags and reading nooks, communal spaces and an outdoor courtyard - in line with research that shows group therapy and peer support are particularly important for young people in crisis. And everywhere there is natural light and views across the rooftops of Darlinghurst down towards the harbour. ‘’You have this wonderful sense of the world happening,’’ said Ms Harel, who emphasises the need for patients to maintain their external lives through social and family connections; nobody wears a hospital bracelet. ‘’We don’t label patients,’’ she said. ‘’We don’t encourage them to take the sick role.’’ The unit cannot take public patients and Ms Harel called on the federal and state governments to fund similar facilities for young in-patients in the public hospital system. Prompt mental health treatment during an early episode of mental distress could prevent illnesses that are often lifelong and prevented people from working or functioning socially, she said. ‘’Put your hands in your pockets and build another half dozen of these,’’ said Ms Harel.

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Dandenong Mental Health Facility 135 David Street, Dandenong, VIC 3175 Australia Whitefield McQueen Irvin Alsop and Batesmart The overriding principle for this hospital development was to create a modern, purpose-built facility for the community. The design responds closely to the new Model of Care, with particular reference to: - Innovative design - 100% single rooms with ensuite co-located clinical streams - Bedroom clustering within a stream - Non-institutional design - Outdoor and activity areas to encourage social interaction - A calm, safe and therapeutic environment - Supervision and observation without unnecessary intervention - A sense of place and identity for each zone - Flexibility for sharing spaces - Blended interior and exterior environments - Avoiding stand alone courtyard walls.

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INTERNATIONAL PRECEDENTS - LITERATURE, REVIEWS & DETAILS Humanitas Intergenerational Housing Radboudlaan 1, 7415 VA Deventer, Netherlands Humanitas A nursing home in the Netherlands allows university students to live rent-free alongside the elderly residents, as part of a project aimed at warding off the negative effects of aging.

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In exchange for small, rent-free apartments, the Humanitas retirement home in Deventer, Netherlands, requires students to spend at least 30 hours per month acting as “good neighbors,” Humanitas head Gea Sijpkes said in an email to PBS NewsHour. Officials at the nursing home say students do a variety of activities with the older residents, including watching sports, celebrating birthdays and, perhaps most importantly, offering company when seniors fall ill, which helps stave off feelings of disconnectedness.

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42nd Street Young People Mental Health 87-91 Great Ancoats St, Manchester M4 5AG United Kingdom Maurice Shapero Starting with the idea of two cubes, i.e. the two main buildings, Shapero divided them with a sharply-angled series of windows, slicing a space to let the light through. Think Leonard Cohen, he told me, and quoted: “There’s a crack in everything. That’s how the light gets in.” The cubes symbolise the duality of needs for young people: stability and control in the world, contrasted with the ability to break out, to be different, original and a bit unpredictable. Windows are scattered to give a collage of different views from the inside, and 3mm brushed aluminium sheets covering the outside give it a science fiction aesthetic. Details like wardrobe doors leading to counseling rooms a la CS Lewis and stairwells with leaning walls give a sense that the building is unique, uncanny, inexplicable, safe – a space that’s different from the outside world, but mirrors it. “It’s amazing. Our young people absolutely love it,” said 42nd Street director Vera Martins. “They wanted something that was different, something out of Dr Who or Alice and Wonderland.” The charity offers counseling services and support to young people aged 13 to 25 who live in Manchester, Salford or Trafford who are stressed, depressed, having problems with relationships or with their families, having image issues or are self-harming. 42nd Street reach people primarily through referral, and are counting on the new building to raise their profile in the community. They have already seen a 25% increase in interest in their services and are anticipating a surge of new young people this year. They expect the heightened interest to test their capacity, but they are determined to grow with the challenges and use their new space to meet the demand. The purchase of the site included ownership of a small Victorian shop on the corner. In future, the charity hopes to convert the interior into an art space for fun and for therapy, and to convert the upstairs area into a co-op for burgeoning artists.


Helsingor Psychiatric Hospital Esrumvej 145, 3000 Helsingør, Denmark Bjarke Ingels Group, Julien De Smedt In our research for Ellsinore Psychiatric Clinic, not only did we make intensive analysis of the program and need of the client. We also interviewed the daily users of the clinic: Staff, patients and relatives. The different input from this research did not give any clear answers as to what the clinic should be like. Rather they pointed out several conflicting qualities and ambiguities that we brought into the project by transforming them into a Hamlet-like paradox of the program, and we have designed a project that simultaneously strives “to be AND not to be” a psychiatric hospital. Grounding Ellsinore Psychiatric Clinic on 2 different levels makes the building literally grow into the green and hilly landscape. Half hidden in nature the clinic thus avoids spoiling the view from the existing somatic hospital and at the same time provides its users with a multitude of experiences of the lake and woods.

De Hogeweyk Dementia Village Heemraadweg 1, 1382 GV Weesp Netherlands Vivium The Hogeweyk (part of Hogewey care centre. A weyk or wijk being a group of houses, similar to a village) is a specially designed village with 23 houses for 152 dementiasuffering seniors. The elderly all need nursing home facilities and live in houses differentiated by lifestyle. Hogeweyk offers 7 different lifestyles: Goois (upper class), homey, Christian, artisan, Indonesian and cultural. The residents manage their own households together with a constant team of staff members. Washing, cooking and so on is done every day in all of the houses. Daily groceries are done in the Hogeweyk supermarket . Hogeweyk offers its dementia-suffering inhabitants maximum privacy and autonomy. The village has streets, squares, gardens and a park where the residents can safely roam free. Just like any other village Hogeweyk offers a selection of facilities, like a restaurant, a bar and a theatre. These facilities can be used by Hogeweyk residents AND residents of the surrounding neighbourhoods.

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Kronstad Psychiatric Hospital Fjøsangerveien 36, 5054 Bergen, Norway Origo Arkitektgruppe The design of the hospital has a strong emphasis on ‘openness and transparency’ towards the public whilst at the same time forming a protective shelter for the patients. The addition of public spaces, nature and new visual qualities to a challenging city environment has been central in the process. The 12 500 square meter building includes in-patient departments on the upper floors, day care and policlinics on lower floors and underground parking. Services within the building include mobile teams, adult policlinics, day care clinics and several wards for short stays.

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House of Psychiatry Sjukhusvägen 10, 751 85 Uppsala, Sweden Tengbom Architects The House of Psychiatry in Uppsala, Sweden, was designed by Tengbom Architects and was recently named the ninth-most architecturally impressive hospital building in the world by US Online Masters in Public Health. Tengbom won the pre-qualification for designing a new house for psychiatry psychiatric care and research in central Uppsala in 2007. The new building was created to improve care, and create a clear connection between somatic care, research and teaching. The vision for the project was to put the patient at the centre and to demystify mental illness. To do so, Tengbom designed a striking building with a bright and positive environment that encourages spontaneous interaction. Each floor integrates departments for research, education, and patient care, instead of the traditional division of different disciplines in different buildings. This way, the architecture helps develop new forms of cooperation. The House of Psychiatry encapsules a large covered courtyard and two small atriums that transport light into the building. Outpatient departments have windows facing the city and the vibrant environments, while the special care departments have their windows facing the park to provide a sense of closeness to nature and a beautiful view. The hospital also has a rooftop terrace for relaxation.

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The House of Psychiatry has also been nominated for the World Architecture Festival Award in 2013 and was recently awarded second place in a competition for Uppsala’s finest new build.

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Barnet Elysian House Charcot Road off Colindale Avenue, Barnet, NW9 5DH United Kingdom Rethink Mental Illness Home for Amina and Hannah right now is Elysian House, a type of mental health facility known as a “recovery house”, where they, and ten others recovering from periods of being severely mentally unwell, have their own private rooms. Amina was referred to the recovery house four weeks earlier after being treated for extreme anxiety in nearby Barnet Hospital’s psychiatric ward. “I wasn’t scared of going outside,” she says, “but in my flat I didn’t feel safe and would have horrible panic attacks and palpitations. It was terrifying.”

For former Elysian House resident Matthew, spending time there last summer (after a short spell on a psychiatric ward where he’d been admitted for depression) gave him that chance. “Just spending a few days in hospital wouldn’t have changed the reasons for me being there,” he says. “Having the opportunity to take some more time at a recovery house to sort more things out and understand more about how I could recover helped me a lot in my process.” During his time there, Matthew met David, who was referred to Elysian House when a difficult period coming off long-term medication for bipolar disorder and suicidal thoughts led him to hospital. He too found the house’s environment far more conducive to recovery than hospital. “In hospital there’s a tremendous amount of stress because of the fact that it’s housing anybody with a severe mental health need,” David says. While David and Matthew give huge credit to the staff at Elysian House for the role they played in their recovery, both feel that a greater connection between hospitals and community care afterwards is needed, allowing patients to be treated by the same doctors throughout their illness and recovery, for example. “You need someone to be able to see you through your entire journey to recovery so that you don’t have to keep recounting your story again and again at each stage of treatment,” David says. “By the time I arrived at the recovery house it was probably the fourth time I had had to go through it, and that was very stressful.” He and Matthew agree that having the opportunity to support each other at Elysian House was key to their successful recoveries. But they count themselves lucky to have ended up together in a house with the kind of communal environment that allowed them to do that. “We could have easily slipped through the net, as a lot of people do,” David warns. “A lot of people become lost souls.”

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A recovery house acts a stepping stone for “not actively suicidal” mental health patients who no longer need to be on a hospital’s psychiatric ward but are not considered ready to return to their homes. Round-the-clock access to therapeutic support and psychiatric services is available, but residents live independently – cooking their own food, maintaining their own rooms, and, most important, coming and going as they please. Social workers are also on hand to provide assistance to the many residents who find themselves homeless or unemployed as a result of being unwell. It is hoped that spending time in this halfway house will allow a more meaningful recovery that will prevent a patient from relapsing and returning to hospital later on. “I saw an 18-year-old girl who’d originally been sent straight home from hospital after faking wellness just to get out, but before long she ended up back there because she wasn’t ready,” the service manager at Elysian House tells us. “Without somewhere like this, you end up with a revolving door to the hospital.”

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Hickie, Ian. “Putting Mental Health Services And Suicide Prevention Reform Into Practice”. Public Health Research & Practice 27, no. 2 (2017). doi:10.17061/phrp2721710. “Home Treatment Team - Barnet”. Beh-Mht.Nhs.Uk, 2017. http://www.beh-mht.nhs.uk/mental-health-service/mhservices/home-treatment-team---barnet.htm. Ireland, Judith. “Mental Illness Does Not Mean A Lifetime On Welfare, Says Jeff Kennett”. The Sydney Morning Herald, 2017. http://www.smh.com.au/federal-politics/political-news/mental-illness-does-not-mean-a-lifetime-on-welfare-saysjeff-kennett-20140701-3b6lj.html. LaRue Jones, Coryl. Architecture For The Community Mental Health Center. 1st ed. N.Y.: Books for Libraries Press, 1967. Life, Spaces, Buildings. Image, 2015. http://lorettabosence.tumblr.com/post/104237270129/designcityla-fabriciomoragehl-methodology. “Light Rail - Pros And Cons”. Aptnsw.Org.Au, 2017. http://www.aptnsw.org.au/documents/lrtprocon.html. “Looking For A Walkable Neighborhood?”. Living In Portland, 2017. http://portlandmyway.com/looking-for-a-walkableneighborhood/.

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re:habitat a new mental health approach for urban communities

re:habitat  

A new mental health approach for urban communities. Graduation project/thesis in the Masters of Architecture Social Agency Studio. Awarded...

re:habitat  

A new mental health approach for urban communities. Graduation project/thesis in the Masters of Architecture Social Agency Studio. Awarded...

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