THE PLANNING AND DESIGN OF

PSYCHIATRIC FACILITIES
by
Archt. PROSPERIDAD C. LUIS, fuap, apec
architect

Strategic and Development Planning Workshop

National Center for Mental Health
Ciudad Christhia Resort, San Mateo, MM
February 13, 2012
The Manual

Defines what a SAFE HOSPITAL is

during an emergency or disaster

Describes the ESSENTIALS in

supporting safe hospitals

Lists the structural, non-structural

and functional INDICATORS to be
considered as standards to be
ACHIEVED
PLANNING AND DESIGN OF
PSYCHIATRIC FACILITIES
According to the World Health Organization and the
National Institute of Mental Health, one in four
people will suffer from mental illness at some point
in their lives.

However, despite the widespread nature of mental

illness and the proven effectiveness of modern
treatments, the majority of behavioral health
facilities are outdated and inadequate to
support today’s care regimens.

Sensitively designed facilities positively

impact patient outcomes.
PHYSICAL INVENTORY OF BUILDINGS
(As of 2007)

Oldest building built in 1928

“Youngest” building built in 1970
(Altho in 2009, there were new
buildings under construction)

Mostly one and two-storey buildings

Mostly for repair and improvement

35 pavilions/cottages and 52 wards

No. of functional buildings = 68

No. of condemned buildings = 7
 CURRENT TRENDS IN
PLANNING AND DESIGN OF
PSYCHIATRIC CARE FACILITIES
 Current Trends in Planning and Design of
Psychiatric Care Facilities
• “Normalizing Environment”
• Transparent Security
• Single vs. Multi-bed Patient Rooms
• The Dining Experience
• Outdoor Recreation
• Designing for Flexibility
• Community-based
• Leveraging Land Value

NATIONAL CENTER for MENTAL HEALTH

Strategic and Development Planning Workshop
February 13, 2012
OLD MODEL:
PATIENT IS INCURABLE,
WILL BE CONFINED FOR LIFE
CURRENT MODEL:
PATIENT SHOULD BE
REHABILITATED AND RETURNED
TO THE COMMUNITY WITHIN A
REASONABLE TIME
 CREATE A
“NORMALIZING ENVIRONMENT”

INTEGRATION OF PRIVATE AND PUBLIC SPACES

TO SUPPORT A CONTINUUM OF SOCIALIZATION
WITHIN A SAFE AND SECURE CAMPUS

- Kent Muirhead,
David Treece
TRANSPARENT SECURITY
CREATE AN ENVIRONMENT THAT FEELS OPEN AND VISUALLY
CONNECTED TO ITS SURROUNDING LANDSCAPE

USE ALTERNATIVES TO TRADITIONAL FORTRESS-LIKE SECURITY

WALLS AND FENCES

Fortress-like security
Example of transparent security
walls and fences
design solution
Example of Castle Peak Psychiatric Hospital, HongKong
A central garden integrates the ground floor facilities of the different buildings to
form a “village within the hospital” to facilitate rehabilitation of patients and their
integration into the community.

Building

Building
Building

Campus/Village

Building

TRANSPARENT SECURITY
LIMITED, CONTROLLED ACCESS: 1-for staff and visitors, 1-for patient
admission, and 1-supplies and other materials
MONITORED BY CLOSED-CIRCUIT TELEVISION at strategic points

Staff and Visitors

Building

Building
Building

Campus/Village
Patient Admission

Supplies,
other materials
Building

TRANSPARENT SECURITY
PRIVATE vs. SEMI-PRIVATE
WHICH FACILITY MODEL BETTER SUPPORTS REHABILITATION?

2-bed
patient room
1-bed
patient room

T
Offers opportunities
for solitude as well as
interaction Discourages isolation

Single vs. Multi-bed Patient Rooms

THE DINING EXPERIENCE TREND REFLECTS TREATMENT
APPROACH:
TREND #1 (for unitized facilities)
Living units of 6 patients each
to maintain the small community
environment and associated
relationships

Continuity of staff supervision

Patients eat within their units

Leave unit for treatment and activity

programs

Meals prepared in central kitchen,

distributed to each unit in trays

Patients engaged in setting tables

and cleaning up
THE DINING EXPERIENCE TREND PROVIDES FOR
THE DINING EXPERIENCE
TREND #2 (for large facilities) MOST APPROPRIATE TO
THE PATIENT’S
CONDITION AND
TREATMENT:

Variety of centralized dining

facilities designed around a
type of food service –
example: cafeteria, grill/café
that offer meal choices,
buffet, etc.

Patients will be assigned to

the type of food service that
is appropriate to their
capabilities and mode and
phase of treatment.
OUTDOOR RECREATION
OUTDOOR RECREATIONAL SPACES SHOULD BE DESIGNED TO
COMPLEMENT SPACES FOR INDOOR RECREATIONAL AND
OCCUPATIONAL THERAPY SPACES TO PROVIDE A CONTINUITY
OF INDIVIDUAL AND GROUP ACTIVITIES

Outdoor activity
spaces – walking
Indoor activity spaces –
and jogging paths,
crafts tables, card and
basketball courts,
games tables, music
outdoor teaching
areas, television areas
areas
DESIGNING FOR FLEXIBILITY

DESIGN IS FLEXIBLE ENOUGH TO SUPPORT CHANGES IN:

• NUMBER OF PATIENTS
• THERAPEUTIC PROGRAMS

EXAMPLES OF FLEXIBILITY
• CONVERTIBILITY OF PATIENT ROOMS FROM PRIVATE TO SEMI-
PRIVATE IF NUMBER OF PATIENTS INCREASE
• COLUMN-FREE ROOMS TO ALLOW FOR EASY PARTITIONING AND
RE-PARTITIONING
50 YEAR AGO: INDIVIDUALS RECEIVING CARE FOR MENTAL
DISORDERS OBTAINED TREATMENT FROM A SPECIALTY
PROVIDER IN AN IN-PATIENT SETTING.

In 1955, 77% of or patients were in 24-hour hospital services

TODAY, MOST INDIVIDUALS RECEIVE MENTAL HEALTH CARE ON

AN OUT-PATIENT BASIS AND LIVE IN A COMMUNITY SETTING.

In the USA, accounts show that less than 15% of the total
spending for delivered services is spent for psychiatric hospitals

There is a broader array of treatment options in general hospitals

and nursing homes.

There are primary care services provided by clinicians,

psychologists, and social workers that are mostly community-
based.

COMMUNITY-BASED SERVICES
 In many older mental health facilities,
operational costs have risen and surpassed
the buildings’ capital value.

Yet, these buildings are sitting on large

parcels of increasingly valuable land.

The existing land value can be used to

finance all or part of a new facility’s cost

Examples:

The bases’ conversion strategies in the

past.

The plan for Veterans Memorial Medical

Center in relation to bases’ and military
land conversion.

Area = 46.7 hectares

LEVERAGING LAND VALUE

 CURRENT WORLD TRENDS
IN HOSPITAL PLANNING AND DESIGN
CURRENT WORLD TRENDS IN
HOSPITAL PLANNING AND DESIGN

 Non-institutional environment
 Facilities as tool and healer
 People-centered, humanized hospital
 Film-less and paperless hospital
 Robotics
 Green hospital
 The Patient as an Ally in His Own Healing
 Centers for Excellence: the Specialty Hospitals
Current World Trends
Non-institutional environment

Exterior Architectural Character

Current World Trends
Non-institutional environment

Interior design
& atmosphere
Current World Trends
Facilities as Tool and Healer

Sensual stimulation
 World Trends
Facilities as tool and healer

Positive distractions
 Current World Trends
People-centered hospitals

The Home Model

Current World Trends
People-centered hospitals

The Mall Model

Current World Trends
People-centered hospitals

The Hotel Model

Current World Trends
Film-less and paperless hospital

 Film-based to digitalized processes

 Reduction of storage spaces
 More dispersed spaces for work stations
 Networking of computers within hospital and
community
 Paper files to electronic files
Current World Trends
Robotics

Robot food and supplies trolley

 Current World Trends
Green hospital

Energy conservation

Symbiosis: nature and man

Use of local materials

 Current World Trends
The patient as an ally in his own healing

Patients’ Library

Patients’ Dining Room Patients’ Lounge

Current World Trends
Centers of excellence: specialty hospitals

Hospitals for Children

Current World Trends
Centers of excellence: specialty hospitals

Women’s Center
 PRINCIPLES OF
HOSPITAL PLANNING AND DESIGN
HOSPITAL SHAPE AND FORM
THE VILLAGE CONCEPT

Like a village
Buildings of different forms
connected by “streets”

Easy to phase
Easy to expand
Nature-permeated
ambience

Requires a large site

Corridor system lengthy
HOSPITAL SHAPE AND FORM
MODIFIED VILLAGE CONCEPT

Like a village
Buildings with pre-determined forms

Easy to modularize
Fast construction

Forced planning
HOSPITAL SHAPE AND FORM

THE BLOCK

A high-rise form
Hospital developed vertically
Ideal for sites that are tight
Requires a very small site
Visibility of a tall building

Can be difficult to design

Difficult to expand
HOSPITAL SHAPE AND FORM

THE TOWER AND PODIUM

Fast-growing departments in Podium

Slow-growing departments in Tower
Replicable departments in Tower

Easy to design and construct Tower

Fast-growing departments are at
lower floors
HOSPITAL SHAPE AND FORM

Veterans Memorial Medical Center

Circa 1950

Developed from the train corridor Single-loaded corridor – natural light

Spine corridor linking various fingers and ventilation

Might be difficult for staff if corridors

are too long
HOSPITAL SHAPE AND FORM
Philippine Children’s Medical Center

Natural ventilation an lighting from

Form closes on itself exterior and from the court
With an open court at center Nature into inner spaces
Court is a spill-over area
Easier to secure

Open court used as expansion area

HOSPITAL SHAPE AND FORM
Like a box
A solid, deep plan
Relies on engineering for
internal environment
Ideal for cold countries

Compact spaces
Less building footprint

Consumes a lot of energy

Artificial ventilation and light
in inner spaces
HIERARCHY

WHOLE
Hierarchy of Elements in a Hospital
HOSPITAL

ZONES

DEPARTMENTS

ROOMS

SPACES
ZONING PRINCIPLES
OUTER ZONE: most public oriented
OPD, Emergency, Business Office, Physical Rehab, etc.
SECOND ZONE: workload from Outer Zone
Ancillaries, Diagnostic/Therapeutic Departments
Administration: non-public sections
INNER ZONE: need quiet environment, accessible to public
Nursing Wards
Staff Quarters

DEEP ZONE: aseptic areas, off-limits to public

Operating, ICU, Delivery, Nursery

SERVICE ZONE: “dirty and busy”, grouped around

service yard for supplies and removal
Dietary, Laundry, CSSD, Maintenance, Motorpool, etc.
SPECIAL SERVICE ZONE
Morgue
GRAPHICS OF ZONING PRINCIPLES

Entry
Problematic Zoning

Entry
 FIRST THOUGHTS ON THE
PLANNING AND DESIGN OF THE
NEW NCMH FACILITIES
CATEGORY OF NCMH
Special Research Training Center and Hospital under the DOH

HOSPITAL SERVICES
Render comprehensive (preventive, promotive, curative and
rehabilitative) range of quality mental health services nationwide

Give and create venues for quality mental health education, training
and research geared towards hospital and community mental
health services nationwide

NCMH SERVICES INCLUDE:

 Community Service
 Hospital Service
 Training and Research
 Other Major Services i.e. DOH Programs
 REDEVELOPMENT

Many structural and building service items

are already at the end of their life
expectancy – in fact, BEYOND their life
expectancey.

It would be more cost-effective to

redevelop NCMH rather than do massive
refurbishment and continuous upgrading
of the old facilities.

The nature of the pre-disposition of

buildings on the site allow for phasing of
project components. Temporary transfer
areas for functions in buildings under
construction is easy to identify.

AREA OF SITE = 46.7 hectares

WHAT IS REDEVELOPMENT?

Any construction on a site that has pre-existing uses.

Urban infill on vacant parcels that have no existing activity

Ex: redevelopment of an industrial site into a mixed-use
development

Constructing with a denser land usage

Ex: redevelopment of a block of townhouses into a large
condominium building

Adaptive reuse, where structures that have outlived their uses are
converted into new ones.
Ex: industrial warehouses into housing lofts

REDEVELOPMENT is the best strategy for physical development of

NCMH
 SITE ATTRIBUTES

VIEWS

VIEWS

NATURAL
ECOLOGY

SIZE: Area = 46.7 hectares

SITE ATTRIBUTES EXISTING ROAD SYSTEM

It will be economical to retain as much of

the existing road system as possible.
They consider the rolling geography of
the site
The road system is a combination of
circumferential and radial routes that
follow the contour of the site
SITE ATTRIBUTES

SITE ZONING

COMMUNITY SETTING

STAFF FACILITIES

MAIN HOSPITAL BUILDING

(administrative, curative)

SERVICES AND SUPPORT

“NORMALIZING ENVIRONMENTS”
(rehabilitative)
Current Trends in Planning & Design of Psychiatric Care Facilities

SO, WHAT ARE YOUR FIRST THOUGHTS ON THE

APPLICABILITY OF THESE TRENDS IN PLANNING AND DESIGN?
• “Normalizing Environment”
• Transparent Security
• Single vs. Multi-bed Patient Rooms
• The Dining Experience
• Outdoor Recreation
• Designing for Flexibility
• Community-based
• Leveraging Land Value

NATIONAL CENTER for MENTAL HEALTH

Strategic and Development Planning Workshop
February 13, 2012
 CURRENT WORLD TRENDS IN
HOSPITAL PLANNING AND DESIGN

SO, WHAT ARE YOUR FIRST THOUGHTS ON THE

APPLICABILITY OF THESE TRENDS IN PLANNING AND DESIGN?

 Non-institutional environment
 Facilities as tool and healer
 People-centered, humanized hospital
 Film-less and paperless hospital
 Robotics
 Green hospital
 The Patient as an Ally in His Own Healing
 Centers for Excellence: the Specialty Hospitals
 THANK YOU!
40 SQ.M ./PATIENTS TO INCLUDE ALL SPACE REQUIREMENT TO INCLUDE
NURSES STATION AND RECREATIONAL AREAS PEGGED AT PhP
35,000.00/SQ.M. AS OF 2012.