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facilities are outdated and inadequate to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 todays 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
David Treece

- Kent Muirhead,

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
walls and fences

Example of transparent security

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.

Campus/Village

Building

Building

Building

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

Building

Campus/Village

Building

Patient Admission

Building

Staff and Visitors

Building

TRANSPARENT SECURITY

Supplies,
other materials

PRIVATE

vs.

SEMI-PRIVATE

WHICH FACILITY MODEL BETTER SUPPORTS REHABILITATION?

1-bed
patient room

2-bed
patient room

T
T
Offers opportunities
for solitude as well as
interaction

Discourages isolation

Single vs. Multi-bed Patient Rooms

THE DINING EXPERIENCE

TREND #1 (for unitized facilities)

TREND REFLECTS TREATMENT

APPROACH:
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 #2 (for large facilities)

TREND PROVIDES FOR

THE DINING EXPERIENCE
MOST APPROPRIATE TO
THE PATIENTS
CONDITION AND
TREATMENT:
Variety of centralized dining
facilities designed around a
type of food service
example: cafeteria, grill/caf
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

Indoor activity spaces

crafts tables, card and
games tables, music
areas, television areas

Outdoor activity
spaces walking
and jogging paths,
basketball courts,
outdoor teaching
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 SEMIPRIVATE 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 communitybased.

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 facilitys 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

Womens 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

Spine corridor linking various fingers

Single-loaded corridor natural light

and ventilation
Might be difficult for staff if corridors
are too long

HOSPITAL SHAPE AND FORM

Philippine Childrens Medical Center

Form closes on itself

With an open court at center

Natural ventilation an lighting from

exterior and from the court
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
Hierarchy of Elements in a Hospital

WHOLE
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.