Innovative architecture is good for mental health

When HRH Crown Princess Mary cut the red ribbon to the new psychiatric hospital in Slagelse in 2015, she was at the same time heralding in a new era in Danish psychiatry. GAPS, as the hospital is called, is a state-of-the-art example of healing architecture. Not just in Denmark, but also internationally, the project has won considerable praise and a string of awards.

Christian Karlsson is an architect and owner of Karlsson Arkitekter. Together with Vilhem Lauritzen Arkitekter, Karlsson Arkitekter designed the 44,000-square-metre GAPS complex with space for about 200 patients.

– We started by looking for the best psychiatric hospitals in Scandinavia, Europe and the USA. However, all we found were lots of things that didn’t work. So we set out to envisage for ourselves how the physical facilities can support the healing process, explains Christian Karlsson.

– Instead of taking disease as our starting point, we based our design on the opposite. We asked ourselves: What sort of architecture supports living a good life as a healthy person? We then scaled up our conclusions to the functions which are needed at a psychiatric hospital.

Smooth transition to communal areas

This scaling has been key to creating the best possible environment for mentally vulnerable patients.

– We’ve been working with hierarchies of transparency, colours and community. When you’re very ill, you can’t handle contact with other people. But from this point, you embark on a journey that re-establishes your belief in once again being able to cope with daily life. In being able to do the laundry, see your children and make a packed lunch. The architecture has to support this journey, says Christian Karlsson, and names several specific examples:

– All the patients’ rooms provide direct access to a courtyard on one side. Opposite is a double door which can be opened up completely, turning the room into a niche within the communal space. This way, you can also look out at greenery through the windows. This creates a smooth transition between being sociable and spending time on your own.

Light as therapy

GAPS has been praised, in particular, for the use of light as a therapeutic tool.

– Glass technology has come a long way in recent years, so there are many ways in which daylight can be integrated into the architecture. We’ve increased the influx of light by avoiding closed corridors, and by choosing light-reflective surfaces, explains Christian Karlsson.

– Together with the Austrian company Bartenbach, we’ve developed the world’s most advanced artificial light with colour management to tie in with the rhythms of the day. This means warm light in the evening and at night. Each luminaire has an IP address, which makes it possible to control the lighting centrally depending on the time of day and the season.

Same approach in Vejle

Glass, smooth transitions and easy access to green areas are also key features at the psychiatric hospital in Vejle, which was completed just over a year after GAPS. Arkitema designed the 17,000-square-metre new building, which was nominated for the Healthcare Building 2017 award.

– The architecture is characterised by smooth transitions between the private and the communal spheres. From the private patient’s room at one end of the spectrum to the public areas with the foyer, multi-purpose hall and training facilities at the other. In-between, several different types of rooms have been created where patients can withdraw in peace and quiet, and observe everything else that is going on around them until they feel ready to join in, explains Stence Guldager, an architect and senior creative manager at Arkitema.

All six wards overlook glass-walled, enclosed courtyards. Stence Guldager explains:

– The patients can walk out into the courtyards without being accompanied by a member of staff. This gives them a greater sense of freedom and control over their own lives. And experience shows that a sense of control helps to reduce stress. Glass facades around the courtyards also ensure good visual contact for patients and staff. This makes the patients feel safe, and it means that they can see in advance who they are likely to encounter in the courtyards.

Troldtekt ceilings exude calmness and warmth

Yet another architectural feature which is common to both Vejle and Slagelse is the use of robust and warm materials. Troldtekt acoustic panels have been chosen for many of the ceilings in both projects.

– We went for Troldtekt as a material because it guarantees good acoustics and a warm feel. Moreover, the ceiling creates a sense of continuity between the sports facilities, offices and communal areas, says Christian Karlsson.

– A pleasant acoustic environment is important for the patients, while Troldtekt’s rough finish goes well with the other materials. At the same time, it mitigates the institutional feel, which makes patients feel more comfortable, says Stence Guldager about the hospital in Vejle.

Less use of physical restraint

The idea behind the transparent architecture and the tranquil spatial layout is to minimise the use of physical restraint. The philosophy is that patients and employees need a much higher degree of visual contact.

In Vejle, the use of mechanical restraint fell from 98 cases between February and July 2016 to 45 cases between February and July 2017, after the new hospital had been inaugurated.

In Slagelse, Christian Karlsson recently visited the highly secure section ‘Sikringen’ at GAPS. He had a ‘tremendously positive impression’ of the section, where patients are admitted according to a particular ‘danger criterium’, and often stay there for much of their lives.

– We’ve gone out of our way to avoid confined spaces and bars on the windows in the secure section. The patients there are very ill and have been admitted due to their extremely violent behaviour. We also have high-intensity rooms for critical situations. These rooms are larger and built with more luxurious materials than the patient rooms, and it’s also possible to use film and music as stimuli, he says, before adding: 

– During my visit to the section, I could see that five out of ten doors to rooms were open. There wasn’t a scratch or a smashed window to be seen. The staff really feel that the enhanced transparency is a big asset, and the use of restraint has been significantly reduced.