Unsuitable or inadequate in-patient accommodation for people experiencing a mental illness will limit a service’s ability to help people recover.

Imagine being admitted to a mental health ward, already ill, and being asked to share a bay with five total strangers. Imagine having to share a toilet and bathroom down the other end of the corridor with up to 20 people. Imagine being unable to access fresh air without waiting for a staff escort or having nowhere private to talk to your family when they visit.

Service users up and down the country continue to criticise inpatient mental health services as being frightening, boring, isolating places that actually do more harm than good.

In 2008, the Mental Health Commission reported that the busy acute wards “appear to be tougher and scarier places than we saw a decade ago”.

Although the key to providing excellent inpatient services is undoubtedly the quality of the clinical and support team and the relationship they develop with service users and carers, there is strong evidence that concludes that the built environment directly affects the satisfaction and experience service users, carers and staff have.   

The crucial question is whether their views are always being taken into account when designing new buildings. 

The strategic emphasis is, correctly, on keeping people out of local in-patient accommodation.  However that doesn’t mean that there should be no focus or standards relating to the quality of in-patient accommodation. 

Even if we ignore the evidence relating to how the built environment can positively affect a person’s mood, attitude and behaviour, as human beings we cannot ignore the need to support basic human rights, and give people accommodation that provides privacy, dignity, safety and connects with the world around them.

Mersey Care Trust, in association with Liverpool, Sefton, and Knowsley primary care trusts, has embarked upon an ambitious programme to address this gap by bringing all local in-patient accommodation up to an acceptable standard, starting with two new units housing inpatient services for approximately 75 people each and eventually re-providing inpatient services for around 285 people across five sites in North Merseyside. 

The new buildings will be provided and operated by Liverpool and Sefton Health Partnership as part of the NHS LIFT programme.

The best determinants of an acceptable standard are the service users themselves and the trust has put them at the very centre of the design process. Their demands are surprisingly modest and often glaringly obvious. Basic needs like safety, sanctuary, privacy, personal space and freedom of access feature prominently, yet these are typically absent in current accommodation.

The trust has developed a “touchstone network” as a method of engaging service users, carers, clinicians and local clinical managers in the design process. In this context, touchstone is used as a metaphor, similar to an acid or litmus test, as a standard of comparison or evaluation. Members of the network work alongside architects, engineers and project managers to describe their aspirations and then assess whether the developing design achieves those aspirations.

The most important point is to genuinely involve the people who are actually going to inhabit the new units, and that the process of involvement matters just as much as the final design solution. 

This is not as straight forward as it sounds, as it sometimes challenges roles, status and timescales, and might mean that design decisions are made that the architect or a senior manager does not necessarily agree with, for example room adjacencies or a colour scheme. However, what it does mean is that the users of the new unit made the decision and are therefore more likely to own, understand and like the new unit. We have also seen this approach work on smaller trust capital schemes, such as a new low secure unit and a new psychiatric intensive care unit.

The “expert” opinion, such as, an experienced architect or an academic unit specialising in aspects of the build environment are essential elements of a design process.  However, for a trust to fulfill its role as an informed client it must be able to equally assert its expertise of delivering excellent mental health services, by putting its people in the heart of the design process.