Changing the status quo requires evidence and persistence – and partnership with a client also seeking a better way.
The incredible journey to rebuild Tiaho Mai, the 76-bed acute mental health unit at Middlemore Hospital, was the outcome of two strands of research that converged in 2014 to deliver a landmark project for New Zealand. Our research into new architectural models started in 2011 and found expression in two preceding projects. Meanwhile, Wanda Condell, Tess Ahern and Shona Rattrie of Counties Manukau Health’s (CM Health) acute mental health team were consulting extensively with their stakeholders to redesign their acute pathway and rebuild Tiaho Mai.
Listening to their community
Service users and staff were struggling with an outdated 1990s building that was too small for purpose, leaked, and had an outdated hub-and-spoke plan. The facility was preventing implementation of a better model of care and restricting more positive outcomes for service users.
As part of a wider overhaul of the acute pathway, the CM Health project team consulted extensively with tangata whaiora / service users and their whānau / family, clinical staff and other key stakeholders to begin the co-design of a new building. They held workshops and interviews, and invited email and postal submissions. They stayed in touch with these groups throughout the design and documentation process to ensure design propositions reflected needs and aspirations.
Through budget and design review rounds, the client team focused on the details that truly mattered. ‘I read an article about how architecture can change human behaviour,’ says Wanda, service manager for acute and hospital services. ‘I was dubious, but I have seen it with my own eyes at Tiaho Mai.’
New models in mental health architecture
For Klein, the journey began with a decision to expand our deep healthcare knowledge with a focus on mental health. We researched international papers and attended the 2011 Mental Health Facility Design Conference in Melbourne. We studied the academic work of Dr Jan Golembiewski and the therapeutic benefits of salutogenic design – spaces that are supportive of psychological, social and spiritual dimensions, placing patient recovery at the centre of the design. Traditional approaches in New Zealand mental health units (including the old Tiaho Mai building) have employed panoptic models, such as the ‘hub-and-spoke’ plan. They prioritise staff control over client recovery and as a consequence fail many service users.
The new mental health units we toured in Melbourne – Dandenong Hospital by Bates Smart and Coral Balmoral by Hassel Architects – were based on a courtyard model. With more space and light, greater choice, better passive surveillance, and the positive effects of a more domestic (less institutional) design, these new buildings and models of care were transforming service user outcomes.
The courtyard model was clearly a step-change. Single-loaded corridors felt safer, more open and less institutional. Courtyards offered fresh air, natural light and access to nature. The higher-quality environment enabled people to heal sooner and better prepared. It was a turning point for us and reinforced Klein’s focus on evidence-based design research for better health outcomes.
Courtyard buildings for mental health
Our first opportunity to design courtyards in a mental health setting was in the Psychiatric Services for the Elderly wards at Burwood Hospital in Christchurch and Te Aka, a 15-bed secure unit at the Mason Clinic. At Burwood, there is a quiet ambience in the wards now and, noticeably, service users sleep better than they did at the old facility.
Then in 2014, we were privileged to win the design commission for Tiaho Mai. At the start of our collaboration, Middlemore and Klein project leads visited other modern courtyard facilities in Australia, including Canberra Hospital’s acute unit by PTW Architects. A second visit to Dandenong with the CM Health team focused on operational aspects, so the model of care worked hand-in-hand with the planning.
A step-change for New Zealand
The design of Tiaho Mai is new for New Zealand. With stage one open for two years at the time of writing, and stage two opening this month, future quantitative and qualitive assessment will help us assess the true impact of the new design on service user experiences and clinical outcomes.
The reward at the end of this journey was seeing users experience the new building first-hand – with doors opening onto courtyards, fresh air flowing through, benches occupied, people sitting in the sun. The new Tiaho Mai has humanised the in-patient experience, bringing greater dignity to both service users and staff. Together, we have achieved something extraordinary, and we truly hope this project inspires other units to embark on their own transformational change.
To find out more about designing for acute mental health in New Zealand, please contact our team on +64 9 377 7005 or info@klein.co.nz.
