Supportive Housing for Mental Health Recovery: a Bio-Psycho-Social Approach
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Supportive Housing for Mental Health Recovery: A Bio-Psycho-Social Approach by Heather Christine Fitzpatrick A thesis presented to the University of Waterloo in fulfilment of the thesis requirement for the degree of Master of Architecture in Architecture Waterloo, Ontario, Canada, 2007 © Heather Christine Fitzpatrick 2007 ii AUTHOR’S DECLARATION Author’s Declaration I hereby declare that I am the sole author of this thesis. Th is is a true copy of the thesis, including any required fi nal revisions, as accepted by examiners. I understand that my thesis may be electronically available to the public. iii iv ABSTRACT Abstract Th is thesis responds to the lack of psychiatric and infrastructural support during the transition from inpatient to outpatient care, and proposes a supportive housing model for patient recovery. It establishes an architecture to support a new model for mental health care using the bio-psycho-social perspective outlined in the psychological research section. Research into diff erent methods of treatment, perception, and current patient infrastructure reveal that the existing framework does not suit the needs of patients caught between the secure levels of care in forensic institutions and those recovered enough to sustain themselves. Th e psychiatric program is based on the bio-psycho-social perspective outlined in the psychology chapter of the thesis, which will be used to treat patients with schizophrenia, mood disorders and anxiety disorders. Th e architecture is designed to support this perspective, and is based on the research into perception and the architectural strategies needed in the design of a healing environment: community, security and privacy, patient control including spatial intelligibility, haptic and basic orientation, light, sound and positive distraction. Th e design is proposed for the Moss Park area in Toronto: where the actual site itself stretches from Dalhousie Street and Queen Street East to Mutual Street and Shuter Street. Its history and current amenities make it an ideal location for a design proposal, though multiple locations are envisioned across the GTA. Th e design presented in this thesis is envisaged as part of a network of varying care levels: follow-up care, supportive care and comprehensive care. Th e program for the site will consist of the supportive care programming, which is the middle level of care. v ACKNOWLEDGEMENTS Acknowledgements I would like to thank my supervisor, Th omas Seebohm, and my committee, Rick Andrighetti and John McMinn for their support in my thesis. I would like to thank my external examiner, Pamela Cluff for her participation in this process. I would like to thank Robin Snell and Lynne Wilson-Orr of Parkin Architects Ltd for their wealth of hospital information. I would also like to thank Andrew Palmer of Grand River Hospital and the tour guides of the Homewood for the tours of their mental health facilities. Finally, I would like to thank my family and friends for their continued support in the last few years. So many of you have been a mainstay of encouragement and support throughout the whole process, either because you knew what I was going through, because you let me lean on you, or because I was in your prayers. Th anks, I couldn’t have done it without you. vi DEDICATION Dedication “To all who’ve gone before us, and all who’ve gone ahead...” Robbie Seay - Faith of Our Fathers Th is topic is inspired by the lives of several people who have either gone through, or are currently working through the mental health healing process. It is dedicated to them, and to the countless others I’ve met along the way, who have asked me about my thesis, and then proceeded to share their personal stories in hopes that they could off er their support. Th ank you. vii viii TABLE OF CONTENTS Table of Contents Author’s Declaration iii Abstract v Acknowledgements vi Dedication vii Table of Contents ix List of Illustrations xiii Preface xxiii Part 1: Introduction & Overview 1 Part 2: Mental Health Background 5 1.0 Illness Background 6 1.1 Schizophrenia 7 1.2 Mood Disorders 8 1.2.1 Depressive Disorders 8 1.2.2 Bipolar Disorders 10 1.3 Anxiety Disorders 11 1.4 Illness Conclusion 15 2.0 A History of the Th erapeutic Community 16 2.1 Th e Madhouses and the Hôpital Général 16 2.2 Moral Treatment 18 2.3 Milieu Th erapy and the Th erapeutic Community 18 2.4 Th e Last 20 Years 20 3.0 Treatment Methods 23 3.1 Group Th erapy 25 3.2 Family Th erapy 25 3.3 Individual Th erapy 26 3.4 Electroconvulsive Th erapy (ECT) 27 3.5 Psychosurgery 28 3.6 Drug Th erapy 28 3.7 Nutritional and Environmental Th erapy 31 3.8 Community Involvement 34 3.9 Physical Activity and a Connection to the Outdoors 35 3.10 Spirituality 36 3.11 Th esis Treatment Focus 37 Part 3: Perception 45 1.0 Sense 45 2.0 Self-Perception 47 3.0 Perception 49 4.0 Proximity 50 5.0 Perception Conclusion 52 ix Part 4: Architectural Precedents 55 1.0 Architectural Issues 56 1.1 Community 56 1.2 Security and Privacy 58 1.3 Patient Control 59 1.4 Haptic & Basic Orientation 60 1.5 Light 61 1.6 Sound 62 1.7 Positive Distraction 63 1.8 Paradoxes 64 2.0 Hospital Precedents 65 2.1 Grand River Hospital 66 2.2 Whitby Mental Health Centre 71 2.3 Wood Green Mental Health Centre 75 2.4 Th e Homewood Health Centre 79 2.5 Seven Oaks 83 2.6 Hospitals Summary 87 3.0 Inspirational Precedents 89 3.1 Soteria House 90 3.2 UHousing Competition 94 3.3 Hotel Explora in Atacama 98 3.4 Pousada de Santa Maria in Braga 103 3.5 Four Seasons Resort at Sayan 107 3.6 Inspirational Precedents Summary 111 4.0 Architectural Conclusion 112 Part 5: Background & Precedent Conclusion 115 Part 6: Design Exploration 117 1.0 Vision 117 2.0 Supportive Housing Program 119 2.1 Comprehensive Care 120 2.2 Supportive Care 121 2.3 Follow-Up Care 122 3.0 Site Analysis: Moss Park 124 4.0 Supportive Care Building Design 133 4.1 Biological Perspective 157 4.2 Psychological Perspective 161 4.3 Social Perspective 165 4.4 Building Design Summary 169 Part 7: Conclusion 173 1.0 Envisioning the Future 173 2.0 Th e Future of Supportive Housing 177 3.0 Conclusion 179 x TABLE OF CONTENTS Appendix A: Space Syntax Analysis 183 1.0 Introduction 183 2.0 Grand River Hospital 185 3.0 Wood Green Mental Health Centre 188 4.0 Hotel Explora in Atacama 191 5.0 Pousada de Santa Maria in Braga 194 6.0 Design Exploration 196 7.0 Appendix Conclusion 202 Appendix B: 6-Bed Second Floor Plan 205 Works Cited 207 Bibliography 213 1.0 Architectural References 213 2.0 Environmental References 216 3.0 Hotel and Resort References 218 4.0 Housing References 219 5.0 Image References 222 6.0 Medical and Alternative References 226 7.0 Psychiatric References 229 8.0 Site References 233 xi xii LIST OF ILLUSTRATIONS List of Illustrations All images by author unless otherwise noted. Part 2 2.1 Normal Brain 7 Myers: Psychology, 6th Edition; 560 2.2 Schizophrenic Brain 7 Myers: Psychology, 6th Edition; 560 2.3 Model of the Brain 28 Myers: Psychology, 6th Edition; 65 2.4 Body as a Container 31 Krop: Healing the Planet; 41 Part 3 3.1 Close Distances of the Eye 46 3.2 Personal Boundaries 47 Bloomer & Moore: Body, Memory and Architecture; 20 3.3 Pantheon Measured Elevation, 48 Competition for the Capitol’s Design: Website; www.loc.gov/exhibits/ us.capitol/s2.html 3.4 Pantheon 48 3.5 Pantheon Entry 48 3.6 Tunnel 49 3.7 Colonnade 49 3.8 Personal Distances in Groups 50 Panero: Th e Human Dimension; 15 3.9 Th e Various Distances According to Edward Hall 50 Panero: Th e Human Dimension; 15 3.10 Personal Boundaries 51 Panero: Th e Human Dimension; 16 Part 4 4.1 Corridor Alcoves from WG 57 Dawson: Care in the Community; 27 4.2 Two diff erent styles of communal tables 58 4.3 Th e Fuller Hospital Dining Room 59 Parkin Architects Limited: Photograph 4.4 Th e Fuller Hospital Dining Room Window 59 Parkin Architects Limited: Photograph 4.5 Th e Fuller Hospital Dining Room Window 60 Parkin Architects Limited: Photograph xiii 4.6 Multiple Paths of Egress 61 4.7 WG Corridor 61 Dawson: Care in the Community; 37 4.8 Landscape Image 63 Smithsonian Education: Website; http://www.smithsonianeducation. org/images/educators/lesson_plan/landscape_painting/si_ci_bierst_ lg.jpg 4.9 Abstract Geometric Image 63 Author Unknown: Weblink Location Lost Grand River Hospital (GRH) 4.10 GRH Location Plan 66 Grand River Hospital: Website; http://www.grandriverhospital.on.ca/ 4.11 GRH Mental Health Unit Plan 66 Parkin Architects Limited: Floor Plan 4.12 GRH Main Entrance 67 Grand River Hospital: Website 4.13 Velcro curtain attachment 68 Parkin Architects Limited: Photograph Whitby Mental Health Centre (WMHC) 4.14 Former WMHC Before Redevelopment 71 Von Egmund: Photograph; http://svan.ca/travel/whitby/ 4.15 WMHC Location map 71 Whitby Mental Health Centre: Website; http://www. whitbymentalhealthcentre.ca/ 4.16 WMHC Catchment Area 71 Whitby Mental Health Centre: Website 4.17 WMHC Unit Organization 72 Whitby Mental Health Centre: Website 4.18 WMHC Building 5 72 Sherwoods Windows: Website; http://www.sherwoodwindows.com/ images/detention1.jpg 4.19 WMHC Entry Canopy 72 Sherwoods Windows: Website 4.20 WMHC Interior Courtyard 72 MacDougall, Jyl: Humanizing Institutional Space; article 4.21 WMHC Admissions Entrance 73 Sherwoods Windows: Website 4.22 WMHC Patient Units 73 Sherwoods Windows: Website 4.23 WMHC Central Stair Case 73 MacDougall, Jyl: Humanizing Institutional Space; article 4.24 WMHC Glass Atrium 74 Sherwoods Windows: Website 4.25 WMHC Patient Exterior Spaces 74 Sherwoods Windows: Website Wood Green Mental Health Centre (WG) 4.26 WG Street Front