International Perspectives on Design with People in Mind.

The latest publication in the Design with People in Mind booklet series – ‘The International Issue’ – was launched at the annual Design in Mental Health Network conference in Coventry this June. In this booklet, we review trends and latest developments around designing mental health-care environments around the globe. As with all the booklets in the series, we are keen to identify and promote research and evidence that can inform a service-user centred approach to design practices. ‘The International Issue’ compares different perspectives to show areas of common ground and consensus. It also highlights some of the differences in design philosophies which have emerged across countries and regions and what the prospects might be for these.

The publication gives some snapshots of what is happening across a range of countries around the world. In Sweden, for example, there is a long tradition of person- centred design which has given rise to some fascinating new hospital projects. By contrast, China has only relatively recently engaged on an ambitious programme of hospital building after shifting from a long tradition of community- based care. In Brazil, a different direction of travel is taken, with the use of innovative psychosocial community centres (CAPS) aiming for social inclusion. Things are different again in South Africa, where the history of addressing HIV as a public health priority offers important lessons for rethinking integrated community mental health care.

‘The International Issue’ is organized around four overall themes, reflecting globally shared issues. All inpatient mental health care needs to balance the demands for safety with those of patient autonomy, particularly around the longstanding issue of open and locked wards. Healing or therapeutic architectural practices can be found in a great many countries and there is now a wide range of evidence for what the key elements of space are that make people feel good, including elements of biophilic design. Recovery and patient focussed approaches are also broadly acknowledged globally, although they vary considerably in terms of their scope and implementation. Finally, we look to the future of mental healthcare design to ask whether the future will see a system where hospitals remain at the centre of care, or whether more integrated community therapeutic landscapes can be realised.

As part of our research analysis, we conducted a procedure known as a Rapid Evidence Assessment (REA). This is an increasingly well- established technique for collecting, sorting and evaluating published evidence. Unlike other techniques such as Systematic Reviews, which tend to focus only on a limited range of ‘gold-standard’ evidence such as Randomised Controlled Trials, we wanted to look for a broad range of evidence. This is important because it is well known that post-occupancy evaluation is often very difficult and can be uneven in mental healthcare, due in part to limited resources. We also wanted to recognise work from service-user, professional and practitioner literatures that provide important and powerful insights.

In making international comparisons, we have inevitably revisited some topics covered in previous DWPIM publications, such as The Nature and Borders & Boundaries issues. However, for this publication we have deliberately chosen not to discuss work conducted in the UK, to shift the focus beyond national boundaries. Each section also includes a short case study – drawn from Finland, South Africa, China and Japan – intended to capture a flavour of the different ways of thinking and practice found internationally.

This booklet is also a collaborative effort between the International and the Research and Education workstreams of DIMHN.

We hope that this introduction to international perspectives may help to spur thinking about differences and similarities in design approaches. Our vision, as always, is for this evidence to be put to good and to benefit those who live and work in mental health care environments, both in services and in the wider community.

Prof. Steve Brown, Prof. Paula Reavey & Donna Ciarlo

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