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09 September 2020

Tiaho Mai acute mental health inpatient unit, Middlemore Hospital

Klein Tiaho Mai Exterior Evening

Tiaho Mai is the first courtyard building of scale for acute mental healthcare in New Zealand and heralds a new era in facilities design based on salutogenic design.

Serving the communities of Counties Manukau Health (CM Health) in South Auckland, stage one of the new Tiaho Mai opened in 2018, with stage two officially opened in September 2020. Translated, Tiaho Mai means ‘shining light’, and the rebuild marks a step-change in designing for mental health in New Zealand – from its co-design approach to salutogenic design principles to its cultural capability.

After extensive consultation with stakeholders, CM Health managed the co-design process to ensure the best possible outcome for their service users, whānau / family and clinical staff. The result is a 76-bed facility that offers greater privacy, peace and safety for users, allows staff to offer an improved model of care, and reflects the cultures of its community. The service has been transformed into more of a partnership model between tangata whaiora / service users and the Tiaho Mai team, supporting people on their path to wellness.

Co-design: capturing what is most important for building users

The co-design process unearthed a wide range of stories and experiences of the previous building and desires for a better future. From this engagement, CM Health wrote a detailed qualitative brief to guide our design process. Overarching themes included greater service user choice and agency, greater personal safety, a more dignified experience, more light and fresh air, connection with nature, and a more culturally capable building.

Salutogenic design: a holistic response

Since 2011, we had been on an R&D journey of our own in mental health facility design , and we saw Australia forging ahead. We visited some incredible facilities in Melbourne designed around courtyards, and heard Dr Jan Golembiewski speak about salutogenic design in mental health. He discussed the impact of enriched, democratic environments that focus on users’ psychological, social and spiritual needs, with an emphasis on nature, natural light and fresh air.

There were going to be budgetary challenges in a sector that relies on maximising space and efficiency, but comparison planning at sketch design stage found that a single-loaded corridor, courtyard arrangement could be managed within the budget. So with a watching brief from Dr John Crawshaw, Director of Mental Health and Addictions at the Ministry of Health, the project team pushed on.

Klein Tiaho Mai Communal Area


Courtyard buildings: creating sanctuary

Courtyard buildings deliver light and air right into the heart of a large building. They are the inverse to the hub-and-spoke plan, with its dark corridors and dead ends – the old Tiaho Mai building couldn’t support a contemporary model of care. By extending the building perimeter out towards the boundaries, space is created in the centre for a campus, rather than institutional, experience.

With abundant natural light and fresh air, courtyards naturally deliver on salutogenic principles. Their openness enables staff to be more integrated across the floor plan for passive surveillance and participation in natural interactions with service users. The model also offers far greater choice in how services users occupy the building – from the most private rooms through to ‘in-between’ spaces or shared communal areas. The courtyard model feels insulated from the outside world, creating a peaceful sanctuary inside.

What was critical, says service manager Wanda Condell, was ‘a sense of space. With acute mental health episodes, physical boundaries become blurred and confused, so wide corridors help to reduce anxiety. It is noticeably calm in the new unit and that has a lot to do with the space and openness, and because service users have greater choice in the space they choose to occupy.’

Less institutional, more home-like

At every level, the project team selected home-like details for a more domestic, less institutional experience. Residential wings now have single-loaded corridors full of light, overlooking one of seven courtyards. Each corridor contains window seats, allowing tangata whaiora to survey the scene safely before making their own way to communal areas. They can take different routes, and even these seemingly small, daily choices provide people with more agency in their own health management as they gradually adjust to the world following a period of being unwell.

Klein Tiaho Mai Basketball


Invisible layers of security

A high-security environment poses many challenges when designing a softer, more home-like interior. The solution was found in a combination of zoned planning and flexible spaces, all activated by invisible electronic locking systems. Staff can run the facility in different modes, subtly changing zoning to suit the different needs of service users on any given day. Access to certain spaces is easily controlled for each individual, so as a person moves from high to low dependency, their security access can be progressively opened up.

Many female service users said they felt scared in the old building, where some bedrooms and bathrooms were shared, and bedrooms were open and unlocked during the day. Single bedrooms with an ensuite became a non-negotiable feature for the rebuild. These are locked at all times for safety and can be opened only by the service user and their support staff with an electronic proximity card. Each bedroom is fitted with a daybed / settee, so family members have a place to sit during visits and a bed to sleep overnight.

Klein_Tiaho-Mai_Marai


A culturally capable building

It was important to have a building where Māori tikanga could flourish, and so wide consultation with previous tangata whaiora and their whānau, mana whenua and community-based mental health providers informed both the new building and the new model of care. Principles such as actively engaging and supporting whānau in their role, treating tangata whaiora in a culturally appropriate and sensitive manner, and taking into account a tikanga Māori approach to recovery are all supported by the new physical setting.

‘The very first experiences in a mental health facility can set the tone for the rest of the stay,’ says Tess Ahern, general manager for Integrated Mental Health & Addiction Services, ‘and have a major impact on the quality and speed of recovery.‘

CM Health has redesigned their whole admissions process. Instead of arriving in a narrow corridor and being bundled through locked doors and dark spaces – like in the old facility – the admission experience at Tiaho Mai is light, spacious and welcoming. Architectural and cultural spaces that support the new approach include the new whare, Nga Whetu Marama (‘the bright stars’), which provides an alternative, calm place to welcome tangata whaiora on admission and for use throughout their care.

‘The whare is a substantial entrance, it’s very important. It holds the mauri of the building and it is the one thing that is connected in an intrinsic way to the community mental health centres,’ says Mahaki Albert, senior advisor Māori for Strategy and Service Development at CM Health. ‘It’s a place tangata whaiora can say, “I am part of this whare, it’s my own.”’

It was also important to humanise the secure entrances. There would be no more garages and roller doors for police vans. Instead, we created a new kind of secure entry with a whare-style veranda, and a place inside where people could be offered a cup of tea. One of these secure entrances can access the whare for admission.

Nga Whetu Marama provides a familiar and calm space. The design specifically considers the state that someone may be in when they are admitted, and the role that different spaces can have in helping to make what can be a traumatic experience as positive and as peaceful as it can be. There is a sense of safety in the familiar, and it was important for the community that we integrate cultural artefacts and design throughout the building – in the form of artwork, a central pou, form, pattern and colour – for both Māori and Pasifika people.

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Tiaho Mai marks a new chapter in mental healthcare design in New Zealand and would not have been possible without the dedication and passion of our clients at Counties Manukau Health. Their excellent and extensive community engagement and co-design process gave us incredible insight into their needs and aspirations, and inspired a range of innovative architectural solutions.

To find out more about designing for acute mental health in New Zealand, please contact our team on +64 9 377 005 or info@klein.co.nz.

Klein Tiaho Mai Po Area Klein Tiaho Mai Entrance2
Klein Tiaho Mai Courtyard Portrait
Klein Tiaho Mai Entrance Evening
Klein Tiaho Mai Courtyard Oval
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