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Inclusive and engaging buildings that treat people in need of rehabilitation with respect and dignity are proving their value for healthcare providers, patients and the wider community. Veronica Simpson reports.

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By Veronica Simpson

'They tried to make me go to rehab, but I said no (no, no).' So sang Amy Winehouse, and many people (before her untimely end due to alcohol poisoning) would have thought her something of a hero for resisting - the party girl who refused to sober up and 'behave'.

But what did we think she meant by rehab? For most UK celebs, rehab means the Priory - a mysterious destination, tucked away behind locked gates somewhere in the Home Counties. For decades it has enjoyed an almost mythical status in the British popular imagination (and press), as the inevitable destination for every diva with depression, drug-dependency or anorexia. Now there are Priory outposts all over the UK; rehabilitation is clearly big business.

There is no shortage of potential customers: not only depression, but anxiety and food-related disorders are on the rise, alcohol-related hospital admissions up by 12 per cent (just in the UK), along with an estimated 15.5 million to 38.6 million problem drug users across the world (according to the UN's Office on Drugs and Crime).

But up until now, accommodation for the needy has been pretty bleak. If you're not one of the wealthy elite who can take themselves off to a Peter Zumthor-designed retreat in Switzerland when the struggles of maintaining your executive lifestyle gets too much, the kind of rehab facility the average civilian could expect to enter might bear more resemblance to the harsh, institutional model immortalised in One Flew Over the Cuckoo's Nest. It's clearly high time there was a reinvention. And luckily for some, it's well underway.

For example, would Amy Winehouse have been a little keener to head off for rehab if she had seen the brochure for the Qatar Treatment and Rehabilitation Centre in Dohar? This Stantec-designed scheme offers white marble clinical areas, exquisitely landscaped gardens and water features, and social spaces for every occasion (including, a 'club' house, billiards room and library), not to mention the VIP villas offering bespoke furnishings, silk rugs and every luxury an oil-rich billionaire's pampered offspring could possibly want.

There is a very good reason for this opulence. Stantec's lead interior architect on the project, Velimira Drummer, and her team were well aware that only an environment that matched the quality of affluent young Qataris' homes could even start to break down the stigma and fear that rehabilitation potentially holds. But more to the point the centre - funded by the state and intended as an exemplar project for future rehabilitation centres - is designed to help the residents find serenity and purpose again through their Islamic faith.

Part health resort and part spiritual retreat, its layout and design are inspired by Islam's '12 steps to serenity', with a mosque at its centre. The whole look and feel - atmosphere, interiors, architecture and treatment programme - says Drummer 'is designed to support their psychology and spiritual identity'.

Short-term psychiatric and rehabilitation services are now also a major opportunity in India, where the growing middle classes are increasingly acquiring middle-class problems of addictions: eating disorders and stress-induced/performance-related anxieties. Hawkins\Brown is designing a new private facility that aims to accommodate a wide range of potential patients within a low-key complex set within the lush landscape of the Punjabi region. Says lead architect Harbinder Birdi: 'The client had worked for 10 years in the NHS and saw a huge opportunity [to cater for] everything from wealthy industrialists with psychiatric needs all the way to clinically diagnosed psychiatric patients or [people who need] counselling for addiction.'

The main inspiration for Birdi with this Wellbeing Institute (see case study, right) has been the Maggie's Cancer Caring Centres. As with the Maggie's Centres, the building is primarily 'about reassurance', he says. 'Family plays a huge part in recovery, and they are paying for this treatment.' They are also, in the case of female patients, going to be staying there - young women will be accompanied by either mothers or sisters. Says Birdi: 'We are hoping to offer a facility that becomes a destination in its own right - almost like a sanctuary.'

With largely private-paying patients, such dreams are highly achievable. However, within state-funded healthcare (outside of the oil-rich Emirates) there are few opportunities to create buildings that could be equally appealing to non-patients as patients. In the straitened environment of the UK's NHS, glimmers of hope for those in need of rehabilitation tend to be found through creative organisations brimming with good intentions, rather than through architectural innovation (see Typecast case study).

However, some enlightened nations have figured out that inclusive, nonstigmatising rehabilitative environments have inherent advantages - for example, greater family and friend involvement with patients, and more rapid reintegration into 'normal' society. This usually leads to faster recovery times.

'First impressions last,' says Stefan Lundberg, White Arkitekter Associate and project architect on two exemplary Swedish psychiatric buildings. Says Lundberg: 'When you meet a person and shake their hand, that impression you have of them will colour your experience. It's the same with buildings - especially for people with mental health issues. You have to strengthen their own sense of dignity.'

White Arkitekter is part way through designing an uplifting new facility for psychiatric treatment and rehabilitation (see case study), based on their findings from another remarkable facility it completed in 2006, the Östra Hospital Building for Psychiatry. The success of this earlier scheme has led the practice to formulate an 'architecture as medicine' model, which includes: creating a welcoming atmosphere from the moment of arrival, with main entrances for all - patients, relatives and staff - and ideally sited within the main hospital complex; a separate emergency entrance for arrivals involving ambulance or police services; cosy bedrooms and professional (rather than institutional) treatment areas; access to secure but uplifting garden/ outdoor spaces within the perimeter of the building (thus avoiding fences); single bedrooms, to be grouped into small units of no more than three to _ ve patients; all social patient areas placed 'at the heart' of the building with options for a variety of social situations to maximise choice (and therefore normality).

Obviously, this model requires a more mobile, less centralised staff, and this is where such ambitious, humane schemes often fall foul of staffing 'efficiencies' and institutional conservatism. However, research on the impacts of White's Ostra unit design, lead by Professor Roger Ullrich - famous for his Eighties' experiment that proved bedroom views on to nature and landscapes accelerate healing in healthcare environments - demonstrates that the benefits outweigh the costs.

In an article in The New York Times in 2013 he summarised the findings from examining the behaviour of the same patient population before and after being relocated to Ostra: 'The drop in the use of patient restraints - a proxy for incidents of aggression - was striking. The number of patient sedations at Ostra was 21 per cent lower than at the hospital it replaced, and the use of physical restraints fell by more than twice that (44 per cent).'

He admitted: 'It's hard to know for sure that there weren't major differences in patient care and training between the old facility...and the new.' However, up to 80 per cent of the staff reported that the new buildings had impacted positively on both actual behaviour and perceived threats of violent behaviour - and a reduction in staff sick leave backed this up.

Ulrich concluded: 'It's time we put our growing understanding about stress-reducing design into architectural practice.' After all, as the publicity's for Boston's impressive Spaulding Rehabilitation Clinic (see case study) declares: 'Rehabilitation is not just about strengthening the body. It's also about strengthening the spirit.'

Psychiatric Clinic, Borås White Arkitekter

Borås clinic, outdoor courtyards are inside the building, so no need for obvious fences or walls.

Part of Sweden's Southern Älvsborg Hospital (SAS), the new Psychiatric Clinic in Borås, by White Arkitekter, aims to completely destigmatise the hospital experience for psychiatric inpatient and emergency cases. With a 76-bed adult psychiatry section, a 10-bed area for children and adolescents, and a rehabilitation unit, the scheme is designed to offer the 'dignity of a public building', but with additional qualities that should enhance wellbeing.

All rooms have private facilities

 

The four 19-bed adult wards are broken down into three smaller units of six/seven patients. All patient rooms are singles with a balcony and private shower/ toilet. Patients' rooms have access to a shared dayroom with a veranda that overlooks the complex's surrounding pine forest, and activity rooms and a large shared kitchen/dining area are clustered around a large atrium, offering daylight and views of nature. Outdoor courtyards are enclosed by the building itself and by glazed screens and with east-facing gardens (landscaped by White Arkitekter's in-house team).

Staff are integrated throughout the facility, working closely with small groups of patients in the small ward units, or moving around the complex as required. The project won the WAN Award 2013 for best future healthcare project. - Client: Västfastigheter

Architecture and landscape design: White Arkitekter
Cost: £33m
Area: 14,000 sq m
Scheduled for completion: 2017

 

Spaulding Rehabilitation hospital, Boston

Generously proportioned glazing allows plenty of natural light in and calming views of nature outside throughout the centre

Perkins + Will has designed a 132-bed state-of-the-art inpatient rehabilitation centre for physical and brain injuries on a reclaimed piece of Charlestown Navy Yard in Boston, providing spectacular views over the Boston skyline.

Inclusivity is a writ large in the programming and design, with 75 per cent of the ground-floor facilities open to the public and integrating with the Boston Harbor Walk.

The building is divided into two connected sections: one eight-storey patient tower and a three-storey element that includes a large aquatherapy pool. Facilities include an 'activities-of-daily-living' suite and 'transitional patient apartment' to help patients return to independence. An outpatient rehabilitation gym sits within the large outpatient facility, with two further satellite gyms.

Extensive use of glass curtainwalling creates transparency, with the curves and grey exterior elements intended to evoke the military battleships and aircraft carriers that used to dock here. Reclaimed timbers are used throughout the site, referencing the dock's first incarnation as a timber receiving basin.

The design team worked closely with accessibility experts to ensure that it went beyond current ADA requirements: the entry is at street level, reception desk is low and rounded; patient rooms have bespoke cabinetry and automated shades, private bathrooms and sleeping accommodation for family members.

'The vision for the new Spaulding Rehabilitation Hospital was to create a space for patients that promotes healing and addresses the needs of the widest possible audience,' says Ralph Johnson, design director at Perkins+Will.

'What resulted is a building design that is transparent and carefully researched.'

Client: Spaulding Rehabilitation Hospital

Architecture and interiors: Perkins + Will

Size: 24,000 sq m

Completed: April 2013

The Wellbeing Institute, Punjab, Hawkins\Brown

Because of the stigma of psychiatric problems discretion and privacy are of paramount importance in the scheme designed by Hawkins\Brown. Various two-storey room clusters are arranged around two garden 'squares', with one connecting, central spine, and three entrances - one for ambulances, one for VIPs, and a general one. There will be an extensive outpatient element, but for inpatients the 12-room clusters vary in security according to the patients' needs - for example, those not deemed 'at risk' may stay on the first floor, with access to upper-storey terraces and roof gardens, while others will stay on the ground floor, with access to landscaped courtyards. Gardens and landscaping are a major feature, for therapeutic reasons as well as 'place'. Says lead architect Harbinder Birdi: 'Punjab means "five rivers" and it's so fertile that 20 per cent of India gets its food from this region. We wanted patient access to the gardens.

Gardens are an essential element of the Wellbeing Institute's design, with horticulture being part of the region's DNASome will even be encouraged to grow things.' Horticulture is in the regional DNA, and spending time outside is a key element of the therapy. Great attention will be paid to providing different kinds of gardens and landscapes, to offer variety and interest. Materials and interiors will be based on what is most simple, locally available and durable - namely, concrete, for its thermal insulating properties, sandstone and timber.

Client: Private
Architecture: Hawkins\Brown
Schedule: Under construction

Rehabilitation centre, Arnham Groot Klimmendaal

Located in the heart of a Dutch forest, outside Arnhem, Architectenbureau Koen van Velsen's rehabilitation centre, clad in warm brown anodised aluminium, almost blends into the surrounding scenery. The three-storey scheme comprises offices, clinic, sports facilities, swimming pool, restaurant and theatre - it is intended to be a community asset not just for patients but for locals as well. A shallow wooden staircase connects all floors in the building. Full-height glazing on the ground floor creates a sense of transparency and permeability, filling the interior spaces with light, as do continuous glazing sections along the upper floors. Starting from a small footprint, the building fans out into the trees, with its upper cantilevered sections supported by slender stilts, minimising the massing and visual impact of this 14,000 sq m building.

A double-height ground fl oor at entrance level leads to staff offices, sports and fitness facilities, a swimming pool, restaurant and theatre. The clinical treatment area is on the first floor and accommodation on the roof. The layout and programming was planned after extensive consultation between Koen van Velsen and the building's potential users - both staff and patients. The aim is to create a building that radiates 'self-confidence and self-control', and encourages activity and engagement, within a restorative setting. Sustainable building systems and materials and low-maintenance floor, ceiling and facade treatments ensure ease of maintenance and longevity, while the use of the spaces themselves is flexible to accommodate evolutions in care and management.

Groot Klimmendaal is part of a masterplan by Koen van Velsen to transform the whole area into a public park. It was shortlisted for a Mies van der Rohe Award in 2011.

Client: RMC
Architect: Architectenbureau Koen van Velsen
Size: 14,000 sq m
Completed: 2010

 

Typecast, Stoke on Trent

Cutlery was produced in the therapy workshops, going on to be used - and displayed in a major arts event.

Typecast began life as a pilot study supported by the organisation behind Stoke-on-Trent's British Ceramics Biennial to see if working with clay could improve behaviour and outcomes for people in rehabilitation. The first trial, in 2013, offered clay workshops led by ceramicist Joe Hartley to men staying on a residential alcohol rehabilitation programme in Eastgate. Six weeks of one two-hour ceramics session a week, supported by 'mindfulness' meditations led by English lecturer and mindfulness practitioner Barry Taylor, achieved notable benefi ts - residents were reported to be calmer individually, and more supportive of each other as a group, after and beyond the sessions.

Cutlery was produced in the therapy workshops, going on to be used - and displayed in a major arts event

The scheme is now being rolled out to four European partners. Its simplicity makes it very replicable. Taylor says: 'The maker participates by doing what they do best - they don't have to be a social worker. The participants get an integrated experience transferable to everyday life.' And the synergies between mindfulness (similar to Buddhist meditation in that it encourages a restful, 'being in the moment' state) and craft practice also work to its advantage.

Hartley makes elegantly utilitarian tableware, so this is what the participants made - bowls, plates and cutlery. The end of the course was marked with a dinner for participants, who ate from their own handmade tableware, which was also exhibited at the Biennial in October-November 2013. -

Sponsor: British Ceramics Biennial
Artists/practitioners: Joe Hartley and Barry Taylor