The design and development of new architectural products is influenced by many factors – principally performance, cost, aesthetics, durability and maintenance requirements. But occasionally a new product is required for such a specialised application that the design brief goes well beyond normal boundaries.
Few applications are as demanding as mental healthcare, especially when mental illness makes patients a danger to themselves or to others, and where emphasis is on treatment but within a secure environment.
Detention under the Mental Health Act is aimed at providing clinical care in conditions of appropriate security but while other secure environments, such as prisons, are often purposely designed to look oppressive, in healthcare the reverse is encouraged. A pleasant healing environment is the aim, with the challenge being in providing a healthcare facility that is designed to be secure.
Just over two years ago we were approached by the main contractor with the consortium building the new £75 million Roseberry Park Mental Hospital in Middlesbrough. The contractor’s preference was to develop an aluminium framed window product that met the rigorous design criteria laid down by the client – Tees, Esk & Wear Valleys NHS Foundation Trust.
Windows are a critical element in the design of any mental health hospital, as John Ord, associate project director for the trust, explained: “In mental health projects, windows inevitably become one of the biggest issues, they generate a huge amount of debate. Clinicians, architects and other project team members all have often conflicting opinions on optimum solutions. There is only limited Department of Health guidance on the whole issue and no common standards exist.”
Windows, it transpires, have a direct impact on the risk of what the National Patient Safety Agency calls ‘Never Events’ – “serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented.” That usually means attempted suicide or escape of a restricted patient.
From the security point of view, taking robustness as a given, the best window is one that cannot be opened. But this usually is not a practical option. It is generally acknowledged that a sealed building, reliant on an expensive and wasteful air conditioning system for ventilation, is not a healthy or normal environment for any patient. It is also acknowledged that any opening window poses some risk of ligature. The design should attempt to minimise this risk.
Roseberry Park therefore needed windows which could be opened but which would meet the trust’s design criteria. These boiled down to the requirement that the window should have a limited opening range, be capable of being locked open as well as locked shut, that it should include a ‘contraband mesh’ (a steel screen to admit airflow and light into the room but prevent drugs or other prohibited items to be passed through), and that it should be capable of withstanding prolonged attack with any object a patient could obtain within the hospital.