Rethinking the Core of Psychiatric Provision: Change of Paradigm From Surveillance-led to Psychosocially Supportive Environments

Increased complexities of care, institutional remnants, stigma and the limited diagnostic and interventional accuracy of psychiatric treatments resulted in institutional behaviours surviving, even in new facilities. This aim of the research was to further our understanding of psychiatric contexts. The locus of the research comprised two acute psychiatric wards in London. Each was evaluated using the SCP model, a tool specifically developed for the planning and evaluation of mental health facilities, identifying the relation between policy, care-regime and patient-focused environment. Data derived from plans, visits and staff and patient interviews. Findings were juxtaposed to those of an earlier study using the same methodology. A syntactic analysis linked to architectural morphology theories was conducted, to identify the social logic of ward layouts. The purpose of that was to identify potential connections between regimes, spatial configuration and social fabrics of the wards involved.

Methodologies of architectural morphologies indicated areas that would attract people, because of the layout rather than the functions of spaces. However, insights from medical architecture by applying the SCP method, outlined institutional undercurrents and provided alternative interpretation to the spatial analysis.

Comprehension of the social fabric of psychiatric facilities challenged the current surveillance-led model. This leads to the suggestion that psychosocial uses could be encouraged at points of higher integration even in settings of high acuity. It also demonstrates that we need to rethink the current surveillance led model in favour of typologies that bring psychosocially supportive and therapeutic activities to the core of the wards. Currently, these functions are perceived as second-line priorities in places of high acuity.