eMerge

eMerge

A T R A U M A - I N F O R M E D M E N T A L H E A LT H H U B F O R Y O U N G P E O P L E .

“eMerge - a trauma-informed mental health hub for young people” provides a vision for a transformative change in the way healthcare buildings can be designed to support individualised care, respond to social and cultural factors, and reduce the burden of mental illness in the community.

NBRS supports the design of patient-centred mental health services in NSW. We use creative design processes to provide therapeutic health services which support physical and mental wellbeing. Central to our approach is practice-based research that improves our ability to design for diverse communities and respond to social and cultural change.

The Envision Student Partnership by NBRSARCHITECTURE is a three-month research and design program, with a focus on developing sector-based knowledge leadership in architectural design.

In early 2021, Michelle Lee and Daniel Calvetti joined our Wellness Studio with the objective to explore the needs of young people accessing health services. This culminated in a vision for a more integrated, accessible and simplified approach to youth mental health.

Upon completion of their NBRS internship, Michelle and Daniel presented eMerge at the 2021 European Healthcare Design Congress and supported the preparation of this paper.

Calvetti, D., Gibson, I., Huynh, A., and Lee, M. (2021) EMerge: A trauma-informed mental health hub for young people. Sydney, NBRS.

eMerge: A trauma-informed mental health hub for young people is a publication by NBRS ISSN 2653-1879 ©2021 NBRS No part of this publication may be reproduced, stored in a retrieval system or transmitted without the prior written permission of the publisher.

Nominated Architect Andrew Duffin NSW reg. 5602 ABN 16 002 247 565 SYDNEY 4 Glen Street, Milsons Point Nsw 2061 +61 2 9922 2344 MELBOURNE Suite 704 / 575 Bourke St Melbourne VIC 3000 www.nbrs.com.au

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e M e r g e A trauma-informed mental health hub for young people.

Chapter 1: Framework

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Chapter 2: Research

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Chapter 3: Opportunities for change

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Chapter 4: Brief

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Chapter 5: eMerge

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Chapter 6: Conclusion

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CHAPTER 5: eMerge

Foreword This volume has been conceived by expert students taking part in the groundbreaking Envision Student Partnership. Their expertise in youth mental health arises from having experienced and witnessed many similar challenges in their lives. Most importantly, their deep immersion in and understanding of the mental health issues confronting youth today has contributed to the formation of a model physical environment supporting trauma-informed care.

This document is bound to be procreative as it challenges the established approach to addressing the mental health needs of young people by conceiving a highly accessible new community, a new multi-faceted environment which embraces and meets both the physical and psychological needs of these young Australians. This model, eMerge, is a beacon of light in a dark world, a plea from youth for youth to challenge and change the accepted model of mental health care.

James Ward Chairman, Director of Strategy and Finance, NBRS

Envision student partnership The Envision Student Partnership by NBRSARCHITECTURE is a three-month research and design program, with a focus on developing sector-based knowledge leadership in architectural design.

This unique program, led by NBRS since 2010, encourages students to investigate collaboratively and provides them with an opportunity to experiment through an interplay of research and design. Previous programs have investigated: • residential care for younger people • future transformational health environments • the adaptation of existing school buildings to provide 21st Century Learning Environments • ways to reinvigorate the university environment to facilitate the creation and development of ideas • holistic frameworks for the design of positive, low-cost residential development • positive influence on childhood development through architecture • changing urban landscape In February 2021, Michelle Lee and Daniel Calvetti joined our Wellness Studio with the objective to explore the needs of young people accessing health services. This culminated in a vision for a more integrated, accessible and simplified approach to youth mental health.

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Research team Daniel Calvetti | B Des Arch | M Arch (in progress) As part of the ENVISION Student Partnership Program at NBRS ARCHITECTURE, Daniel has extensively researched trauma and youth experience in mental health to form an understanding of the impacts of complex trauma in the redesign of health services. Currently studying a Master of Architecture at the University of Sydney, Daniel has graduated with

a Bachelor of Design in Architecture in 2020, with a semester studying abroad at VIA University College in Denmark.

His previous experiences have grown his passion for creating spaces for the community that can enhance overall well-being. Moving forward, Daniel would like to complete his postgraduate studies and further explore different fields of architecture.

Michelle Lee | B Des Arch | M Arch (in progress) Michelle is a current postgraduate student at the University of Sydney, pursuing a Master of Architecture. With previous experience in architectural research projects, she approaches design with a curiosity and drive to learn. As a motivated student of architecture, she has graduated from the University of Sydney with a Bachelor in Design Architecture in 2019, and has studied overseas at the University of California, Berkeley. This year, as part

of the ENVISION Student Partnership Program at NBRS ARCHITECTURE, she has played an active role in conducting a practice-based research project focusing on the formation of a conceptual design for integrated youth mental health services with a traumainformed approach to care. In the future, she hopes to pursue her interest in person-focused design and complete her postgraduate studies.

Ian Gibson | B Des Arch | M Arch | NSW 9181 As the Studio Principal for the NBRS Wellness Studio, Ian seeks to deliver person-centred and adaptable health and aged care environments. The studio’s approach is underpinned by a commitment to research and a belief that every project requires a fresh approach. He is a passionate advocate for the role of high-quality design in providing spaces for healing and

improved patient outcomes. Ian has extensive experience running health and aged care projects across Australia, including managing stakeholder engagement and design coordination.

Ian is registered with the NSW Architects Registration Board, with a Master’s Degree in Architecture from The University of Sydney, and is a member of the Australian Health Design Council.

Alison Huynh | B Des Arch | M Arch | NSW 10680 Alison approaches architecture through listening and understanding staff and consumers needs. She is passionate about creating simple, seamless buildings that balance the clinical and operational requirements with a person and family-centred experience. Alison has been involved in the development of hospital and mental health precinct masterplans in Australia and overseas and is familiar with contemporary models of cares and trends in service 5

delivery. Evidence-based research forms a core part of her approach, providing up-to-date knowledge and expertise for clients. She is experienced in the interpretation of complex clinical briefs and is passionate about understanding the patient journey in health services.

Alison actively engages in professional development through the Australian Health Design Council and the Salus Global Knowledge Exchange.

CHAPTER 1: FRAMEWORK

1.1 Introduction 1.2 Trauma-informed care model 1.3 Trauma-informed care principles

1 in 4 young people are at risk of “ serious mental illness, with that risk increasing as they age. There is a need for a greater focus on high risk groups, such as Indigenous youth and young women. We need a tailored approach to mental health care that can respond to a range of cultural and social experiences.”

Black Dog Institute and Mission Australia. (2017). Youth mental health report. Randwick: Black Dog Institute and Mission Australia

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1.1

Introduction How can an understanding of trauma inform a new youth mental health care model?

The 2017 Youth Mental Health Report published

by Black Dog Institute and Mission Australia was used as a platform for the Envision research. It is an insightful and compelling report which compiles 5 years of mental health data collected from young people across Australia. Mental illness is identified as one of the biggest challenges for the future of young people, and one that needs to be tackled by the community, health services, and families.

This research question approaches the issue of youth mental illness through a trauma-informed care lens. As a care model focused on patient experiences, it is hoped that a trauma-informed approach can provide a tailored response to mental illness for high-risk youth in Australia.

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CHAPTER 1: FRAMEWORK

humans we need to feel and be “ Assafe, be able to trust the people, situation, space we’re in, we need to have choices and to be able to know what our options are, not to be told and directed and painted into a little box, not have things imposed on us” Cathy Kelzman AM – President, Blue Knot Foundation

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1.2

Trauma-informed care model Trauma-informed care is a contemporary lens of mental health care. In this context, trauma refers to one’s exposure to multiple emotionally painful or distressing events and the wide-ranging, long-term effects of this exposure. A trauma-informed approach to care is developed from the principle of understanding complex trauma in consumers and working together as a health community to support recovery. While there is no single definition of trauma-informed care, it can be understood through the four key themes outlined below.

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A significant number of people living with mental health conditions have experienced trauma in their lives. This may affect approaches to treatment and management of their conditions.

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Trauma may be a factor for people in distress.

Trauma survivors are unique individuals doing the best they can to manage traumatic reactions in their own way.

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The impact of trauma may be lifelong. It is based on the impact that an experience has had on an individual, rather than the event itself.

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Trauma can impact the person, their emotions, and relationships with others. Trauma-informed services seek to ensure that victims are not blamed for their reactions, or re-traumatised when seeking treatment or support.

Currently, models of care are moving away from strictly medical and psychiatric care to also consider that trauma can impede a wide range of functioning activities and coping mechanisms.

This perspective is a powerful lens through which to consider the re-design of health services to avoid re-traumatisation in consumers.

Trauma-informed information and resources. Blueknot.org.au. (2021). Retrieved 13 May 2021, from https://www.blueknot.org.au/Workers-Practitioners/For-HealthProfessionals/Resources-for-Health-Professionals/Trauma-Informed-Care-andpractice.

What is trauma-informed care? - Principles for effective support. Health.nsw.gov.au.

(2021). Retrieved 13 May 2021, from https://www.health.nsw.gov.au/mentalhealth/ psychosocial/principles/Pages/trauma-informed.aspx.

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1.3

Trauma-informed care principles Trauma-informed care is established around six main principles. These are framed in such a way to encourage the individualised care of consumers and break down real and perceived barriers to accessing care and treatment.

Empowerment

Safety

TRAUMA-INFORMED CARE​ Trust

Collaboration​​

Choice

Culture

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Empowerment People living with mental illness need to feel supported in expressing themselves, ask questions, or share their experience. Being engaged in the development of treatment plans means that feelings of helplessness can be reduced.

Safety Physical and emotional safety means different things for different people. Tailoring the environment for a safe conversation allows for recovery and treatment. Welcoming spaces set the tone for a positive interaction with health services.

Collaboration​ Communicating a sense of engagement and collaboration ensures that consumers and health services are working together towards a common goal.

Culture An understanding of different perceptions of gender, ethnicity, sexual orientation, age and relative disadvantage is required of service providers to ensure that a culturally sensitive environment can be created.

Choice The provision of consumer choice recognises the individuality of preferences and experiences. This reduces negative feelings of loss of control and identity.

Trust Fear and distrust can cause misunderstanding and poor communication, leading to inappropriate care or potential re-traumatisation. Health services that are sensitive to consumer’s needs help to build confidence in healthcare.

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CHAPTER 2: RESEARCH

2.1 Research 2.2 History of care 2.3 Evolving models of care 2.4 Specific youth needs 2.5 Navigating complexities

Key findings

The model of care is changing, but buildings are not changing with it

Many existing mental health services do not address the specific needs of adolescents and young adults

Services that are available to young people are complex and difficult to access.

2.1 Research How is mental health care being delivered?

How can we remove the barriers to accessing care?

The history of mental health care in New South Wales provides significant insight into changing approaches and perceptions of mental illness in the modern era. In the late 19th century, there was a shift towards a moral and humane approach for those suffering from mental illness. This new approach to care was focused on dignity, compassion, and comfort. However, declining investment over the years led to neglect, mistreatment, and abuse, well documented in a series of reports and royal commissions.

reduction in acute lengths of stay, with a higher focus on outpatient care and improved selfmanagement of care in the community.

In recent years, a trauma-informed perspective is being integrated into care models, requiring more individualised treatment approaches. However, there is a need for the physical environment to be adapted to meet diverse populations and reduce the risk of re-traumatisation. Existing buildings which are institutional, de-humanising and impersonal are not appropriate for effective trauma-informed care. The physical environment has a part to play in the way care is delivered, and a positive therapeutic environment can have a significant impact on recovery.

Renewed investment in mental health care and social awareness led to rapidly evolving approaches to treatment. A person-centred, recovery-focused model has led to a significant

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Recent investment into mental health services has focused on counselling and emergency support, often provided in the form of a digital or telehealth method such as free hotlines or websites.

While this may be effective in supporting early diagnosis or access to treatment, the wide range of services supporting different needs may be seen as complex and confusing, leading to a delay in accurate diagnosis and a lack of personal care.

buildings which are high quality, public and accessible can help in reducing the barriers to care by minimising stigma, raising the profile of mental health treatment, reflecting the needs of a diverse community, and supporting trauma-informed approaches to care.

A trauma-informed approach to mental health care for young people presents a significant opportunity for early intervention before mental disorders can compound into adulthood. This will reduce the overall burden of disease on society into the future, as well as minimising the stigma of mental illness and delay in diagnosis and treatment in the future.

There are opportunities to provide a more streamlined and integrated approach to initial diagnosis and interventions, reducing the overall long-term impacts of mental illness on an individual, and their family and friends. Health

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2.2

History of care

The history of mental health care in Sydney reveals the cyclical nature of changing approaches to care.

Convicts, Criminals and Lunatics

Bethlem Asylum in London opened in 1247 and is one of the oldest asylums in the world. Practices there, as in similar institutions at the time, were very traumatic for patients. ‘Treatments’ included bleeding, vomiting and purging, in the hope of restoring balance to the bodily systems based on the concept of the balance of the four humors. Those with mental illness were considered to be possessed and, when they became confined to such institutions, their capacity to re-enter society was limited. Alternatively, they were locked away at home, separate from their family, or left to wander the streets.

When the First Fleet arrived in Australia in 1788, discourse surrounding mental health treatment was beginning to change. In 1793, French physician Philippe Pinel ordered that chains be removed from mental patients at the Biçetre Hospital, Paris; Pinel published the first description of schizophrenia in 1809. This described how a new understanding of mental illness as a medical condition may inform treatment practices.

However, in Sydney, convicts with mental illness were not distinguished from criminals until around 1838 when Tarban Creek Lunatic Asylum opened in Gladesville. Here, ‘lunatics’ were separated from convicts and housed in cramped, poorly ventilated buildings, many of which were not purpose-built but rather old convict factories.

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Moral Responsibility and Treatment

The Dangerous Lunatics Act of 1843 heralded a shift in the perception of mental illness in the Colony of New South Wales. It detailed a new awareness of the need for medical treatment and the acceptance of responsibility by governments for care of the mentally ill.

This marked the beginning of the moral treatment era in Australia.

Prominent moral reformers and medical practitioners such as politician Henry Parkes and Dr Francis Campbell (superintendent of the Tarban Creek Asylum) condemned the antiquated buildings that housed ‘lunatics’, and advocated for purpose-built institutions designed along the lines of the latest theories of moral therapy.

Compassion and Care

In 1884, with the help of Colonial Architect James Barnet, Dr Norton Manning opened Callan Park, the first asylum in the colony to be designed and built according to moral therapy principles.

Moral therapy was a form of psychotherapy based on the belief that a person with a mental disorder could be helped by being treated with compassion in a clean, comfortable environment that provides freedom of movement, opportunities for occupational and social activity, and care from physicians and attendants.

This approach to mental health was a stark departure from the previous concept of mental health and treatment, and a significant step forward towards humane mental health care.

Manning’s extensive travel and research into the latest treatments according to moral therapy principles led to

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significant reforms in treatment.

Views of nature and access to fresh air, sunlight and exercise were considered critical for a therapeutic environment.

Ha-ha walls provided security without reducing views, and minimised the negative feelings of restriction and control. This was further supported by thoughtful separation of cohorts,

understanding that differences in genders and patient acuity can reduce the effectiveness of treatment. A calm setting with quiet environments was believed necessary to reduce distraction, foster introspection, and support active therapy. This was balanced with active engagement and opportunities for creativity, learning, and fun.

Moral therapy spatial design elements

The architectural response to moral therapy was to create a soothing environment for patients through external views, a serene location, and a quiet atmosphere, coupled with key spatial design elements.

Exercise and airing courtyards

Separation of genders

Natural daylight

Central building with pavillions housing different patients

Quiet atmosphere

Ha-Ha walls

Serene setting

Natural ventilation

Views to nature

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Decline and Drug Therapies

The establishment of Callan Park signified a revolutionised mental health care system in NSW. At the time, asylums were well funded and political discourse was encouraging, with Henry Parkes remarking that the colony’s asylums were now ‘palaces’ under Manning’s directorship. However, moral therapy asylums should not be romanticised.

Although conditions had improved and the model of care had changed to favour medical and therapeutic approaches, asylums were overcrowded, institutional, and custodial in operation. The lack of effective treatments for chronic patients led to a build-up of patients in care, causing overcrowding. In the 1880s, there were 200 patients in Callan Park without a bed; this ballooned to 1500 patients in the 1930s. As a result of this overcrowding, the quality of care declined drastically. Funding in the interwar periods reduced resources for asylums, leading them to become mismanaged with high staff turnover.

A similar pattern of decline followed globally. Journalist and social historian Albert Deutsch noted in the 1940s that overcrowding and a build up of chronic patients shifted asylums from places of active treatment to custodial care. Callan Park had become a revolving door for patients, with readmission rates at 60% in the 1970s, rising from just 10% in 1880.

Conditions had become so bad that the public sentiment about mental health care began to change. The discovery of psychotropic drugs in the 1950s offered hope that medical therapies may enable chronic patients to live outside wards, initiating the shift to community care models. The 1983 Richmond report meant that Australia officially moved away from custodial treatment to community care. However, as early as 1989, the Burdekin report found that community mental health programs were drastically underfunded. This pattern has continued for the past 40 years to the present day.

Restoring Dignity and Reducing Stigma

There are significant overlaps between the historic principles of moral therapy and contemporary care models.

Reflecting on the physical environment provided in the original Callan Park Asylum provides inspiration for new mental health services.

Throughout 2020-2021, many young people around the world have experienced negative mental health impacts when deprived of their freedoms.

Destigmatising mental illness is critical to ensuring that they get the care and support they need. Increased investment in mental health creates opportunities for new buildings that engage the community, are a positive contribution to the built environment, and welcome young people into a supportive space.

APA Dictionary of Psychology. Dictionary.apa.org. (2021). Retrieved 13 May 2021, from https://dictionary.apa.org/ moral-therapy.

A Victorian Mental Asylum | Science Museum. Science Museum. (2021). Retrieved 13 May 2021, from https:// www.sciencemuseum.org.uk/objects-and-stories/medicine/victorian-mental-asylum#:~:text=The%20word%20 asylum%20came%20from,in%20the%20City%20of%20London.

Carron, M., & Saad, H. (2012). Treatment of the Mentally Ill in the Pre-Moral and Moral Era: A Brief Report. Jefferson Journal Of Psychiatry, 24(1). https://doi.org/10.29046/jjp.024.1.001 Greenfield, D., Eljiz, K., & Vrklevski, L. (2017). The Evolution and Devolution of Mental Health Services in Australia.

Retrieved 13 May 2021, from http://www.inquiriesjournal.com/articles/1654/the-evolution-and-devolution-ofmental-health-services-in-australia.

Garton, S. (2009). Seeking Refuge: Why Asylum Facilities Might Still Be Relevant for Mental Health Care Services Today. Health and History, 11(1), 25–45.

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CHAPTER 2: RESEARCH

2.3

Evolving models of care

“It’s human, it understands that we’re each individuals, and we each come with our own backgrounds” Cathy Kezelman on trauma-informed care

Trauma-informed Care and Practice.

Blue Knot Foundation. Retrieved 13 May 2021, from https://www.blueknot.org. au/Workers-Practitioners/For-HealthProfessionals/Resources-for-HealthProfessionals/Trauma-Informed-Careand-practice.

McClellan, P. (2014). Interim report.

Royal Commission into Institutional Responses to Child Sexual Abuse.

Department of Health. (2017). The Fifth National Mental Health and Suicide Prevention Plan (p. 31). Canberra: Commonwealth of Australia.

According to the Blue Knot Foundation, “frameworks of care and treatment are changing from purely bio-medical (medicine and psychiatry) and/or purely psychoanalytical (psychology) to include the psycho-social (trauma-informed) and a recovery focus (recovery-oriented)”. Based on recent evidence highlighting the lasting impacts of childhood trauma on a person’s mental health, the Fifth National Mental Health and Suicide Prevention Plan recommended that mental health staff in all service settings should be trained in the delivery of recovery-oriented and traumainformed care. The need for a comprehensive and consistent approach to providing care in mental health services, based on trauma-informed principles, is vital to ensure people have the greatest opportunity of recovery.

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Understanding psychological safety

Trauma often affects the way people approach potentially helpful relationships, stemming from a lack of safety and trust.

By supporting people to feel safe, both physically and psychologically, a traumainformed approach to care aids the recovery process. Previous methods of seclusion and restraint only account for the physical safety of a consumer and those around them, and disregard psychological safety.

A higher consideration of both physical and psychological safety lessens the need for physical interventions that are confronting and potentially traumatising to the consumer. Provision of safety, both physical and psychological, is fundamental in promoting a better recovery.

Institutional and impersonal buildings

Trauma affects us all, whether directly or indirectly. A trauma-informed approach to care recognises this and considers its impacts on the wellbeing of people and communities.

This shift in the model of care has become more widely recognised and implemented.

However, while models of care are evidently changing to reflect a consideration of these impacts, buildings have yet to do so. Instead of purpose-built health services designed to respond to trauma-informed care, buildings are being retrofitted to adapt. As such, they do not reflect a trauma-informed approach to care and often result in aged, cramped, and institutional spaces.

Creating safe environments for care

Safety is important to consider for a consumer’s general wellbeing and is critical to the healing and recovery process. Consumers, who may already feel unsafe in their daily lives, need to feel safe in receiving care. A move away from traditional mental health spaces such as seclusion and restraint rooms, which exacerbate feelings of unsafety in inpatient settings, can promote safety in treatment. A purpose-built healthcare environment can positively contribute to the recovery process and reduce the need to rely on outdated approaches to care.

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CHAPTER 2: RESEARCH

2.4

Specific youth needs Mental health disorders experienced in adolescence have the potential to be extremely disruptive to an individual’s wellbeing, functioning, and development, in both the short and long term.

Black Dog Institute and Mission Australia.

(2017). Youth mental health report.

Randwick: Black Dog Institute and Mission Australia.

NSW Government.

(2018). Supporting Young People During Transition to Adult Mental Health Services. Guideline: NSW Government Mental Health Branch.

Retrieved from: https://www1.health. nsw.gov.au/pds/ ActivePDSDocuments/ GL2018_022.pdf

As a natural process of growing up, adolescents are frequently exposed to new experiences. While most experiences can be positive, there may be compounding stresses or instances of trauma that are detrimental to a young person’s mental health. The potential severity of the long-lasting impacts of mental health disorders poses a significant danger to the healthy development of an individual, which can be exacerbated by the risk-taking behaviours associated with adolescence.

As such, it is critical to have effective interventions and services in place that are accessible and address the specific needs of young people, as well as those who care for and support them.

Building Healthy Relationships

Childhood trauma can be defined as “the experience of an event by a child that is emotionally painful or distressful, which often results in lasting mental and physical effects” and can occur as a result of interpersonal trauma or traumatic events. When it occurs in adolescence, interpersonal trauma can impede a young person’s ability to build healthy relationships with people, creating relational insecurity. This can be particularly detrimental when it comes to seeking help.Young people who lack relational security are less likely to seek help from adults, preventing the formation of potentially beneficial relationships. This can impose an additional barrier to care and exacerbate feelings of being unsafe.

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Discontinuity of Care

The risk of serious mental illness increases as adolescents age, becoming most prevalent in the older teen years.

This could be due to the difficulties in transitioning from child to adult service structures. Discontinuity in care at this age can lead to the disruption of crucial milestones and have adverse impacts on an individual’s health, social, educational and vocational outcomes.

Currently, there are no adolescent and young adult specific services to aid in this transition. This inevitably means that many young people fall into gaps in care, disrupting the development of mature health behaviours.

Breaking the cycle of trauma and disadvantage

75% of lifelong mental disorders are diagnosable before the age of 25. Early intervention improves knowledge around mental health and encourages the development of mature health behaviours. This prevention through early intervention could reduce or remove both the short-term negative impacts of mental health disorders, and the longer-term impacts which contribute to an ongoing cycle of disadvantage that may result from mental health disorders going untreated into adulthood.

In the current mental health environment, services are inadequate to meet the demands of youth mental health, clearly demonstrated by the high prevalence and significant disease burden within the youth demographic.

There is a significant gap in the delivery of mental health services. Youth-specific services must be prioritised.

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2.5

Navigating complexities

Young Minds Matter: Use of services by young people with mental disorders. Child Family Community Australia. (2021).

Retrieved 13 May 2021, from https://aifs.gov. au/cfca/2016/08/22/ young-minds-matteruse-services-youngpeople-mentaldisorders.

Limited independence

McCrindle Research.

(2020). The Future of Education 2020.

Norwest: McCrindle Research. Retrieved from https://mccrindle. com.au/wp-content/ uploads/reports/ Education-FutureReport-2020.pdf

Young people are often dependent on adults and caregivers in their lives to support them.

Current adolescent and young adult services do not consider the potential barriers to care that young people may face. Young people without sufficient support may have limited ability to seek help. Youth-specific design should consider that most young people are studying full-time, have little financial means or access to Medicare, and are travelling via public transport.

Young people may have difficulty navigating through health networks, and understanding the process of referrals.

There is a significant reform required to ensure that young people can easily access the help they need, regardless of their level of independence, mobility and family support.

Social Stigma

Most young people will struggle in silence when experiencing difficulty and are reluctant to seek help. This reflects the deep-rooted social stigma attached to mental health. Social stigma has long been a significant barrier in accessing care, heightened by a lack of mental health knowledge and the negative perceptions associated with seeking help. Complex systems of care reinforce the notion that mental health services should be hidden away from the public eye. As a result, while

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stigma surrounding mental health has seen significant reduction in recent years, it is still a barrier to accessing services. On top of this stigma, young people fear that their confidentiality will not be maintained when seeking help, especially from caregivers. Feeling unsafe when seeking help indicates a lack of security which adds an additional barrier to treatment and recovery.

Navigating the System

Mental health services are often difficult to navigate and access as they are often networked and disaggregated, or disjointed and independent. Specialised services may not be operating within the same networks, or may not be clearly available to the consumer.

The pathway to referral for individualised services is unclear for young people and may rely in part on some self-awareness and self-diagnosis by the consumer.

Many young people are unable to direct themselves towards relevant services and, as such, are unable to access the help that they may need. Young people under the legal care of parents/ guardians are reliant on their primary caregivers. As a result, they may not have the resources to independently seek help, which may be necessary where there is a lack of support from the household.

CHAPTER 3: CHAPTER 3: OPPORTUNITIES OPPORTUNITIESFOR FORCHANGE CHANGE

3.1 Opportunities for change 3.2 Understanding perspectives

3.1

Opportunities for change What are the barriers for young people accessing mental health care?

1.

There is a fragmentation of mental health services across a wide number of government and nongovernment services, both state-wide and national. They are not unified, and vary in the level of care and support they provide. Young people with emerging mental health concerns may not have accurate diagnoses and do not know which service can support them.

2. There is a high level of stigma associated with mental illness, amongst young people as well as parents and carers. They may feel that problems associated with growing up are just a phase and hesitate to seek help early.

3. There is a lack of in-person services that provide tailored information and face-to-face interaction. Online and telephone services can help in times of crisis, but fail to deliver on-going interaction required to build trust between young people and those who can help them.

4. Adolescents and young adults mature at various rates, but there is a lack of specific services to support transition from child to adult care. Adult mental health services may not take into account the needs of young people transitioning into adulthood. This includes continuing education, maintaining support from carers, or establishing independent living. Adolescence is a period in which mental health disorders can be compounded by the experiences of growing up, engaging in risk-taking behaviours, growing distrust for adults, peer pressure, and social media.

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How can we remove these barriers and improve youth mental health services?

1.

The Hub Model

Create a unified hub of services which acts as a Centre of Excellence for youth mental health care. The opportunity to collocate a wide range of support options encourages collaboration and integrated care delivery, as well as improving transitions between services.

2. Community Integration Normalise mental health care through community engagement, boosting awareness amongst young people, parents, teachers and others. Use architecture as an opportunity for integration and positive community activities, avoiding the stigma arising from being hidden away.

3. Ease of Access Provide visible walk-in services tailored to young people, with or without their parents or carers. A space which is youth-centric and safe can be a first point of reference for information.

4. Designed Environments Support trauma-informed care through design, working with service providers to create tailored environments that can be adapted to a wide range of needs.

5. Early Intervention Focus on prevention and early intervention by supporting recreation, exercise, and meaningful engagement with community and nature. Bring supportive functions into mental health care environments, such as sport, outdoor activity, music, and art.

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CHAPTER 3: OPPORTUNITIES FOR CHANGE

“

Co-design is important in mental health services because it challenges the status quo, addresses wellknown power imbalances that exist across many levels, and ensures the voice of people with lived experience is a co-driver of change, innovation, and leadership. The evidence shows that using co-design creates safer, higher quality and more efficient care.”

A Guide to Build Co‑design Capability - Consumers and staff coming together to improve healthcare © Agency for Clinical Innovation 2019

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3.2

Understanding perspectives As a further exploration into the key findings, this chapter presents three journeys that represent the potential stakeholders involved in accessing adolescent and young adult mental health services. Using the ACI co-design handbook as a framework, the journeys mapped are a process of co-design that places emphasis on the consumer and their experience in accessing mental health services. Journey maps aim to personify a consumer’s behaviour, feelings, thoughts, and attitudes at each stage of their experience.

This experience-based co-design is a collaborative approach that brings consumers, families, and staff together to improve existing health services. Co-design is particularly useful in a trauma-informed context as it recognises the value of the consumer in identifying their needs.

Personas, such as those of Simon, Lydia and Lydia’s parents, are a useful tool in highlighting the deeper issues and unmet needs in the context of the current mental health environment. They can be developed on the basis of a real quote, supported by research and demographic statistics to provide deeper insights into the real issues faced by young people when seeking help. A range of potential user groups have been explored through our research to identify opportunities for improvement in service design.

These experiences reflect those of a significant proportion of young people for whom mental illness has serious impacts on educational outcomes and transition into adulthood. Their journeys demonstrate that the right environment for accessing mental health support may be critical to early intervention and reduce the strain of long-term mental illness on themselves and their families.

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CHAPTER 3: OPPORTUNITIES FOR CHANGE

Simon

“I tried really hard to get some help, but I soon found that there weren’t many options or places to go in the town where I was living. It was like there was nowhere to turn.”

Simon Age: 14 Gender: Male

Simon is 14 years old and the eldest child in a single parent family. He has no clinical diagnosis but is experiencing violent outbursts of aggressive behaviours. As a member of the indigenous community, he feels like he can’t ask for help, and is scared of being pushed away from his community.

Simon’s Emotional Journey

Simon helps his single mother get his younger siblings ready for school. He walks them to the primary school on his way to high school. He arrives late to school and is told off by his teacher.

He feels singled out and has a violent outburst in the middle of class. His teacher sends him to the principal, who

sends him to the school counsellor. He tells the counsellor not to bother telling his mum, who wouldn’t even care as she is too busy. The counsellor refers him to some online services that he can look at in his own time. At home, his mum is too busy tending to his younger siblings, so Simon goes to play in the local park with his friends. Later that night, he looks up some of the services his counsellor told him about and found a service that he may be able to visit. After school, he takes the bus to the community health centre. He doesn’t tell anyone that he’s there. He speaks to staff and they refer him to some services that may be useful and ask for a Medicare card. Simon, who is under 15, does not

Helping Mum and siblings get ready for school

Late to class, getting in an argument with the teacher

My Mum relies on me

It’s not my fault I’m late

I have to take care of my little brother

The teacher is always picking on me

I feel tired and stressed

This is unfair!

In trouble for a violent outburst.

School counseller provides Simon some resources I’m too angry to talk about it right now

Burden of disease analyses show that for Indigenous people aged 10–24 the leading contributors to the disease burden were suicide and self-inflicted injuries (13%), anxiety disorders (8%) and alcohol use disorders (7%). Most of the deaths of young Indigenous people are due to potentially avoidable conditions if given timely and effective health care. It is therefore important that services are available and accessible to Indigenous youth that facilitate health and happiness and provide support in times of need.

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ENVISION 2021

have access to a Medicare card. Without a Medicare card, Simon is unable to access the support that he needs, and his violent behaviours continue. Without a clinical diagnosis, his aggression is misunderstood, and he turns to risktaking behaviours and becomes less engaged with school.

What if there was better intervention that was able to support Simon? How could a different referral pathway improve his experience?

Simon sits down with his school counsellor after his violent outburst in class. The counsellor refers him directly

Counseller refers Simon to eMerge service I’ll check it out after school

to an eMerge centre that is easily accessible to adolescents such as him.

Simon visits the centre after school. He finds it welcoming and easy to navigate, and is referred to some services that are free and scheduled outside of school hours. He visits the centre in his own time to access the services he has been referred to. In his sessions, after speaking about his ambitions to work, the team at eMerge help to direct him towards relevant vocational studies.

Outside of his appointments, he plays basketball at the centre with some friends.

eMerge staff provide free services after school hours

Simon accesses regular support and counselling

This doesn’t seem so bad

They’re understand what I’m going through

They have a skate park and sports facilities

Australian Institute of Health and Welfare (2018). Aboriginal and Torres Strait Islander adolescent and youth health and wellbeing 2018. Cat. no. IHW 202.

Canberra: AIHW.

I can focus on school now

An accessible, walk-in centre is enough to positively impact Simon’s experiences in seeking mental health services and turn his life around.

Mum is too busy to talk in the evening. Simon looks up services online Maybe I can find help online

Attempting to access health services I’m hopeful but nervous They say I need a medicare card and a referral

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Alone and unsupported, behavioural issues continue The world is unfair, it makes me angry I need to be tough and take care of myself

CHAPTER 3: OPPORTUNITIES FOR CHANGE

Lydia

“I told some of my friends that I was feeling low and they told the counsellor at school, so I started getting some counselling which kind of helped. But I still felt depressed and after a while my friends felt like I was too much for them and they stopped hanging out with me. Then things really went downhill for me.”

Lydia Age: 16 Gender: Female

Lydia is a high school student studying full-time. She feels pressure from school to perform well in her upcoming HSC and has been speaking to her school counsellor for help. Outside of school, she has no support and feels overwhelmed by suicidal thoughts and self-harming behaviours.

Lydia has been feeling especially lonely after feeling rejected from her friends at school. She is already overwhelmed with the thought of completing her HSC. During lunch, she goes to speak with her school counsellor. She’s able to talk about some of her worries until

the lunch bell goes off and she has to go back to class. At home, she tries to focus on her studies but is too overwhelmed by depressive and suicidal thoughts.

Alone, she has no one to turn to for help. When her parents come home, they discover she has self-harmed.

They want to take her to the emergency department, but Lydia is afraid and refuses to go. They call hotlines, looking for urgent care, but keep getting directed elsewhere. The next day, they visit the family GP. The GP is able to refer her to a child psychologist but, when they try to set up an appointment, they find there is a two-month waiting list. Lydia waits

Talking to school counsellor

They’re still ignoring me

I just need someone to talk to

I hate it here

There’s never enough time to explain how I’m feeling

Lydia’s Emotional Journey

Alone at school, rejection from friends

Studying at home Experiencing depressive and sucicidal thoughts Why can’t I focus?

I’m going to be a failure

Amongst female students in Years 11-12, 16% have self-harmed in the last 12 months, and 14% have a diagnosed mental disorder, with the most prevalent being anxiety disorders and major depressive disorders. 1 in 13 students aged 12-17 years have seriously considered suicide, and one-third of those had attempted suicide.

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ENVISION 2021

two months for her appointment with the psychologist. During this time, her depressive and self-harming behaviours have escalated. Even after being able to access counselling, she feels no improvement and that her needs are unmet. Her educational outcomes suffer and she is unable to complete her HSC on time.

What if there was a better intervention that was able to support Lydia? How could a youth-specific emergency service support her needs?

Lydia’s parents come home to discover that she has engaged in self-harming behaviours. They call a hotline that immediately direct them to eMerge, an accessible, urgent care centre dedicated to adolescent mental health. She is admitted into the inpatient unit and receives the care that she needs. The team there is also able to make sure she doesn’t fall behind at school. After three weeks, she is discharged from eMerge and returns every week to receive further treatment to support her transition out of inpatient care. She is able to access services when she needs to and is able to re-integrate into school.

An emergency hotline directs Lydia to an eMerge centre

eMerge team support Lydia’s recovery

Discharged and returning to school

A 24hr service that’s safe for adolescents?

I’m getting active treatment

I still have my ups and downs, but I know where to get help now

Goodsell B, Lawrence D, Ainley J, Sawyer M, Zubrick SR, Maratos J (2017) Child and Adolescent Mental health and educational outcomes. An analysis of educational outcomes from Young Minds Matter: the second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

Perth: Graduate School of Education, The University of Western Australia.

I’m feeling recharged

My recovery will take time

Having a point of urgent care dedicated to mental health problems in young people was essential in intervening in Lydia’s journey and giving her the support that she needs.

Lydia’s parents discover she has self harmed I’m scared and don’t know what to do

GP provides advice and referral to psychologist They’re going to help us There’s a two-month waiting list for an appointment

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Without support, Lydia’s health deteriorates I have no energy or motivation What’s the point of studying

CHAPTER 3: OPPORTUNITIES FOR CHANGE

Kevin and Phuong, Lydia’s parents

“School must be difficult right now - the HSC is tough.

I’m sure if she needed us, she would ask...let’s give her some space and let her figure it out.”

Kevin Age: 48 Gender: Male Phuong Age: 46 Gender: Female

Kevin and Phuong are Lydia’s parents.

Both work full-time. Lydia is their only child. They remember being stressed at Lydia’s age, but they got through it somehow and are fine now.

Her parents’ Emotional Journey

They both know that Lydia is worried about school and have noticed she is spending a lot of time alone in her room. Phuong has tried to talk to Lydia but Lydia has brushed her off and sometimes they have had fights. She and Kevin are trying to keep the peace, thinking that at least a calm home life might help Lydia deal with whatever is worrying her. But they want her to do

her best and try to keep her focused on her future. Kevin has been talking to his friends about it and they say their kids are struggling too, but he thinks Lydia seems worse than the stories they have been telling him. When they get home from work, they find Lydia crying and are devastated to see she has harmed herself. She won’t go to the hospital and Phuong calls her mother to see if she has any ideas. Phuong and Kevin call some emergency hotlines, but keep getting sent to other places. They decide to start with the family doctor and see if they can get a referral to a psychologist.

The GP is good, but the specialist has a long waiting list and they can’t get in for

Trying to stay connected to Lydia

Feeling shut out

by Lydia

She spends all her time on her phone

I’m sure if she needed us we would know

They find out she self-harmed, but don’t know what to do

Kids can be real arseholes

Let’s give her some space

Maybe it’s just a phase She’s too young for these problems

Over a quarter (26.8%) of all parents and carers reported that their child or adolescent had some need for help for emotional or behavioural problems. For those who didn’t seek help for their children, the most commonly identified reason was not being sure where to get help (39.6%).

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ENVISION 2021

two months. Lydia sees the psychologist, but it’s only a temporary fix - she is getting worse and worse, and Phuong and Kevin worry about leaving her alone at home in the afternoons. The school isn’t much help and they don’t want to get into details with their friends.

Phuong and Kevin can’t find help and can’t focus on their jobs while they are so worried about their daughter. Phuong takes time off work, but it’s not enough on the end Lydia can’t complete her HSC. She still can’t talk to them about what’s going on, and Kevin and Phuong fight constantly about what to do. They don’t know how she will ever be able to live independently.

What if there was a better intervention that was able to support Kevin and Phuong? How could a youth-specific emergency service support the family’s needs?

When Kevin and Phuong first find that Lydia has self-harmed, they call a hotline that directs them to eMerge, an accessible, urgent care centre dedicated to adolescent mental health. Lydia goes into temporary care and they visit regularly. With Lydia’s ok, they are given updates on her progress and are glad to see that she is keeping up with her schoolwork. eMerge’s transition services are offered to Kevin and Phuong, so that they know how to talk to Lydia during her transition out of care, and how to help her in the future.

An emergency hotline directs Kevin and Phuong to eMerge

eMerge keep Kevin and Phuong informed

We can get help for her straight away

Lydia has care and help more than we could give

We can visit her - she’s not locked up

The facilities and staff seem really understanding

Kevin and Phuong try to get help but Lydia is reluctant We can’t make her do anything

Ongoing support after discharge I’m so glad we know where to go now We are relieved that she can keep planning for her future

Nothing seems to be working and Lydia is not getting better

Lydia’s health and their marriage deteriorate

There must be something we can do, but I don’t know what it is

We are always fighting about what to do

I can’t work while I’m so worried about her

We are trying not to make things worse, but it’s really hard

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Lawrence D, Johnson S, Hafekost J, Boterhoven De Haan K, Sawyer M, Ainley J, Zubrick SR (2015) The Mental Health of Children and Adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

Department of Health, Canberra.

Accessible, informed care dedicated to youth mental health provided the support that Kevin, Phuong and Lydia needed, both in time of crisis and on an ongoing basis.

CHAPTER 4: BRIEF

4.1 Approach 4.2 Service centres 4.3 Adaptable approach

BRIEF 32

ENVISION 2021

4.1

Approach The research informed the development of a service brief tailored for the needs of adolescents and young adults. The proposed service is a trauma-informed mental health hub for young people. eMerge provides a vision for a transformative change in the way healthcare buildings can be designed to support individualised care, respond to social and cultural factors, and reduce the burden of mental illness in the community.

A unified hub of comprehensive mental health services that targets young people across a broad spectrum of acuities, eMerge provides a continuum of care that can service individual mental health care requirements throughout adolescence. Collocation and integration of services aims to reduce complexity for consumers. This is particularly important in context of emerging mental disorders that are experienced by young people.

The development of a well-defined care centre aims to engage the community in a dialogue about mental health, reducing social stigma, and encouraging more people to access mental health care. There is an opportunity to develop a distinct architectural typology that differentiates itself from traditional institutions and draws inspiration from contemporary public and community buildings.

The brief is transferable to a range of sites, with the opportunity to network eMerge with existing services.

New and refurbished buildings can be designed to support a trauma-informed approach to care, when considered within the eMerge framework.

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CHAPTER 4: BRIEF

4.2

Service centres eMerge is a comprehensive mental health service and centre of excellence for treatment of young people. It addresses the specific needs of adolescents and young adults who are in transition between child and adult health services, and who have specific needs relating to education and family support.

It is comprised of six service centres, collocated to enhance service continuity and simplify consumer journeys.

Tre at

Urgent care

m

t en Staff Hub

eMerge

Acute care

Pre

&

n tio en v r

v e n tio n M

ance ten ain

Ear ly

Recreational Hub

in

te Stepped-down care

Community care

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ENVISION 2021

Urgent care

Urgent care provides 24-hour accessible emergency mental health support in a safe environment for young people.

In contrast to traditional emergency departments, consumers are triaged by a multi-disciplinary mental health team following trauma-informed care principles. Consumers may be provided with advice or referrals, access a telehealth specialist directly, or be triaged and monitored for up to 24 hours as necessary. The urgent care service is

networked with acute health services including local emergency departments and inpatient services, to ensure that all presentations can be addressed.

The triage team recognises the specific needs of young people and incorporates child and family health specialists, to ensure that young people are safe and that their family are informed and involved in their care journey as appropriate.

Acute care

Acute care provides rapid intervention in a safe inpatient environment where a high level of nursing and support is required for a short period. Young people and their families will meet with the mental health team, incorporating counsellors, therapists and social workers, prior to being admitted into the facility. Parents and family will be able to visit during this time, taking an

active part in supporting recovery. The focus will be on targeted and intensive treatment to empower adolescents and young adults and get them back to education and employment. Pathways and transitions out of acute care into stepped-down care and the community will be planned in advance of discharge, to maintain continuity of care and support recovery.

Stepped-down care

Stepped-down care provides a stable longer-term environment for rehabilitation and recovery, where a managed transition period enables longterm self-management and self reliance.

Consumers will be able to continue their education while they are in steppeddown care, and can come and go as they please to access other community

services and participate in sports and social activities. Staff are present and available to help with counselling and training. Adolescents and young adults who have difficulty managing their care at home will have the time to learn life skills and develop healthy habits, to allow them to transition into independent living in the community.

Community care

Community care provides counselling, psychiatric and therapeutic services for adolescents and young adults who may be walk-in presentations or referred from other services. It is a critical touchpoint for adolescents in need, providing a reception and help-desk where consumers can have a private conversation about their mental health

35

needs. Community health services will encompass a wide range of occupational therapies, support groups and counselling. This outward-facing service will encourage community involvement through open days to raise awareness for mental illness and reduce barriers to accessing care.

CHAPTER 4: BRIEF

Recreational hub

The Recreational Hub aims to maintain the wellbeing of the broader community through outdoor activities, exercise, and events. This creates a focal point to foster a sense of community that may assist in de-stigmatising mental illness and reduce the demand on acute services through prevention and early intervention. This is a semi-

public community space which may incorporate community vegetable gardens, picnic and barbeque spaces, skate parks, and sports facilities.

Consumers can utilise these spaces for occupational therapy and walk-andtalk counselling, maintain fitness and develop new skills.

Staff Hub

Staff Hub recognises that traumainformed care must not only apply to the consumers but also to the staff. A thoughtful and positive work environment, which supports a multidisciplinary team and provides training and education, ensures that staff are able to provide the best possible care. Workplace culture and employee support is particularly important in high

4.3

stress environments such as emergency and acute care, and when dealing with complex mental health presentations.

By collocating treatment, research and staff training, a Centre of Excellence in mental health care can be established onsite, providing opportunities to share knowledge and support satellite services.

Adaptable approach The proposed design response for eMerge is based on a new facility providing a comprehensive range of health services.

In the design response, the facility envisions 6 urgent care beds, 24 acute inpatient beds, and 12 step-down care units. Community care incorporates a wide range of therapy rooms, while the Recreation Hub incorporates a skate park, gardens, café and a community veggie patch. The key to the comprehensive care model is the collocation of a number of services, within a clearly defined urban identity.

The service model is adaptable to a wide range of environments where a mix of old and new buildings can be reimagined as a single service. Public and private health care providers may work together to deliver an eMerge precinct, and even work with local councils and

36

schools to collocate education and recreation.

An eMerge zone might form a part of a large health precinct, allowing for collocation with adult and children’s hospitals, as well as other mental health services. In remote or regional environments, an eMerge centre may be a small service that provides an information hub and walk-in community care, networked with other referral services.

Regardless of the size or complexity of an eMerge service, the focus should be on access, engagement with the community and the promotion of prevention and early intervention.

The investment in the mental health of young people will reduce the longterm impact of poor mental health throughout their - and our - lives.

ENVISION 2021

eMerge is a unified hub of services which acts as a Centre of Excellence for youth mental health care. A wide range of support options encourages collaboration, integrated care delivery, and community engagement.

37

CHAPTER 5: eMerge

5.1 Design response 5.2 Callan Park: an eMerge precinct 5.3 Connected care 5.4 Community interaction

eMerge 38

ENVISION 2021

5.1

Design response The design response is an eMerge centre developed from trauma-informed design principles. The architectural form was inspired by the concept of the cove, a classic Sydney motif that is representative of tranquility and respite.

The cove is a natural shelter which provides rest and recovery.

Come and go as you like, to gain respite from the constant stream of life

39

CHAPTER 5: eMerge

5.2

Callan Park: an eMerge precinct While the design proposition can be adapted to any site, we have identified Callan Park as a test precinct, recognising its significance in the history of Sydney’s mental health care.

Callan Park’s Kirkbride building was previously an asylum, with architecture designed to suit the principles of moral therapy. Similarly, our design uses trauma-informed care, as the most contemporary care model, to inform a design that unifies key principles of architectural excellence and mental health treatment.

form of the centre, providing a sense of protection and peace. The built form embraces the site landscape, creating a large north facing public realm that puts the community at the heart of the scheme and screens the busy road to the south. The site’s heritage is recognised through the retention of signficant trees.

Our response to the brief uses a covelike mass as an initial reference for the

A new boundary is created, integrating eMerge into the surrounding parkland, while retaining its connection to neighbouring support services. The site is accessible by pedestrians and public transport, ensuring young people can visit the eMerge centre independently.

Heritage Listed Kirkbride Complex, The Original Asylum For Moral Therapy

OAD RF R

WHA

NSW Ambulance

OAD

AIN R

Vehicle Access Pedestrian Access

BALM

Wharf Road entry Orange Grove Public School

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Acute Care

Community Care

Stepped Down Care

Urgent Care

41

Recreational Hub

Staff Hub

CHAPTER 5: eMerge

TO CALLAN PARK WATERFRONT

N WAY

GARDE

E RD

GA AY NW

WHARF ROAD

GATE

BALMAIN ROAD

Acute Care

Stepped Down Care

Recreational Hub

42

Community Care

Urgent Care

Staff Hub

ENVISION 2021

5.3

Connected care A sense of protection and peace coupled with a connection to community

The mass has been broken up into a large, protective segment unit to the west and three smaller forms, carving out entries based on desire lines.

These have been further stepped down to break down the façade and create zones for smaller community spaces.

Changing levels create a variety of scale and different identities to each form. Bridges create secure pathways between masses and establish entry gateways at ground level.

The forms are zoned for programmatic use. Community Care is placed centrally and most visible to the street front, assisting in destigmatising care through its visibility. Urgent Care is set back and on the eastern drive, next to the ambulance depot. The Staff Hub is located with easy access to urgent care and provides facilities for staff respite.

The largest form, the inpatient unit, provides the western border to the site.

Each mass is connected by green atria, courtyards and skybridges. These form points of entry, respite and visual connections between each program and the central yard.

In the acute unit, corridors are intersected by irregular shaped green courtyards, creating an internal view to nature and a meandering journey through the building, rather than long, institutional hallways.

There are provisions for outdoor open space throughout the public realm, and also in activated rooftops. Recreational activity is dispersed throughout the landscaping. Recreational pavilions are created further to the north, drawing people from the street into the site.

Murcutt Mpavillion. Melbourne, AU

Hiroshi Senju Museum. Karuizawa, JP

The inpatient unit provides step up/step down facilities and acute care, with the

programs stacked vertically. Stepped down care is on the ground floor as consumers have the liberty to come and go; Acute Care spaces are on the first and second floors, with rooftop access for outdoor recreational space.

Garden pavilion for community activity integrates architecture and landscape

Maggie’s Centre. Leeds, UK

Murcutt Mpavillion. Melbourne, AU

Irregular shaped atrium allowing natural light and views to nature

Interior spaces create sense of calm through gentle, light-filled environments

43

Architecture creates a public domain that is protected by the built form

CHAPTER 5: eMerge

Welcoming spaces

1

1

Active Rooftop

Active rooftop spaces provide outdoor space for consumers, enabling zoned recreation areas for respite and fresh air.

Controlled integration with the community may be possible.

44

ENVISION 2021

3

2

2

Street Entry

3

The setback from the street creates a public forecourt, linking the centre to the wider community.

Green Atria

Green atria create open space fostering a sense of safety and connection with nature.

45

CHAPTER 5: eMerge

46

ENVISION 2021

Community interaction The landscape is designed to not only benefit the building occupants but also the community at large, through the provision of publicly accessible activity spaces. A gradation of spaces is created from the southern entry through to the north of the site which leads beyond into Callan Park and down to the foreshore. These spaces encourage the development of health and wellness within the broader community and foster interaction between consumers and the public.

to create a point of interest that may be seen from Balmain Road, drawing people off the street and further into the cove.

A primary path runs through the site creating a thoroughfare linking Balmain Road and Callan Park. Activities are located on each side of the path, offering choice to the user based on personal preference. A café and skate park are centrally positioned in the landscape

By integrating an activated public domain into the scheme we hope to create a touchpoint with the public, reducing stigma by fostering dialogue and involvement with the broader community.

Forecourts may be activated for markets and events, enabling regular connection with the community. Sensory parkland spaces with seating provide areas of respite and peace. The skate park encourages activity and interaction.

The roof tops also have active spaces for consumers and may be opened to the community.

Goods Line. Ultimo, AU

Park ‘n’ Play. Copenhagen, DK

5.4

A central spine with activities adjacent

Acre Eatery. Camperdown, AU

Nou Barris Skatepark. Barcelona, ES

Active rooftops for varied recreation

Garden café placing an emphasis on food and diet for overall wellbeing

47

Skate park targeting young people

CHAPTER 6: CONCLUSION

eMerge positively affects youth mental health outcomes through the provision of accessible, trauma-informed care

6.0

Conclusion Mental health disorders in youth can impact healthy development of individuals, leading to long-lasting impacts on people and on society.

Access to mental health care for young people has a range of challenges arising from various sources, including complex health networks and systems, lack of knowledge and awareness of available support, gaps in care between child and adult mental health services, and social stigma preventing discussion and acceptance of treatment.

A trauma-informed model of care seeks to provide individualised care that minimises the long-term impacts of trauma and reduces re-traumatisation due to difficulties in finding care.

This model has evolved from earlier approaches to treatment, and carries a number of similarities to the model therapy approach first initiated in the 1800s. eMerge offers an accessible mental health service targeted to the individual needs of young people and focused on prevention and early intervention.

Developed through the Envision research program, the adaptable design can be located in a wide range of environments and networked with other health services and precincts. It offers engagement with the wider community through open gateways and integrated

48

services, reducing the social stigma of mental health.

A blend of care levels is included which enables transition throughout the facility as mental health improves.

Urgent care offers 24 hour support with access to a multi-disciplinary mental health and triage team trained in trauma-informed care. Acute care provides targeted and intensive treatment coupled with transition plans to stepped down care and return to education and employment. Stepped down care has the flexibility to come and go as needed, with access to similar transition planning. Community care provides counselling, psychiatric and therapeutic services on both a walk-in and referred basis.

Care services are coupled with recreation hubs that can be integrated with community facilities, serving a dual purpose of access to external space for recreation and reduction in social stigma.

Staff hubs provide respite, training, education and support for the eMerge workforce, important in high stress environments such as emergency and acute care.

Investing in the mental health of young people through the creation of eMerge centres will reduce the longterm impact of poor mental health throughout their - and our - lives.

ACKNOWLEDGEMENT

Contributors Alexandra Crawford – Clinical Psychologist Sumithira Joseph – Operations Manager, Perinatal, Child & Youth Mental Health Services , WSLHD Caroline McSherry – Deputy Director of Nursing, Perinatal, Child & Youth Mental Health Services , WSLHD Bernadette Keenan – Health Facilities Planner, Bernadette Keenan Health Projects (BKHP) Dr Cathy Kezelman AM – President, Blue Knot Foundation Dr Rohan Lulham – Senior Research Fellow, Design Innovation Research Centre UTS Domenic Svejkar – Strategic Designer, Design Innovation Research Centre UTS Tracey Ronald – Associate Director, Johnstaff

Anthea Doyle – Justice Studio Principal, NBRS Craig Stephen – Associate, NBRS Mythri Vittal Boggaram – Architectural Graduate, NBRS

Mentors James Ward – Chairman, Director of Strategy and Finance, NBRS Andrew Duffin - Director of Design, NBRS Ian Gibson – Studio Principal - Wellness, NBRS Alison Huynh - Associate - Wellness, NBRS Melanie Alsop - Communications, NBRS Ko-Lo Chen - Communications, NBRS Sara Ward - Communications, NBRS

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