Fit for What Purpose? Exploring Bicultural Frameworks for the Architectural Design of Acute Mental Health Facilities

Acute mental health care facilities have become the modern equivalent to the old asylum, designed to provide emergency and temporary care for the acutely mentally unwell. These facilities require a model of mental health care, whether very basic or highly advanced, and an appropriately designed building facility within which to operate. Drawing on interview data from our four-year research project to examine the architectural design and social milieu of adult acute mental health wards in Aotearoa New Zealand, official documents, philosophies and models of mental health care, this paper asks what is the purpose of the adult inpatient mental health ward in a bicultural country and how can we determine the degree to which they are fit for purpose. Although we found an important lack of clarity and agreement around the purpose of the acute mental health facility, the general underpinning philosophy of mental health care in Aotearoa New Zealand was that of recovery, and the CHIME principles of recovery, with some modifications, could be translated into design principles for an architectural brief. However, further work is required to align staff, service users and official health understandings of the purpose of the acute mental health facility and the means for achieving recovery goals in a bicultural context.

The familiar stranger of mental health

Purpose This paper aims to contribute to the debate about the closure of institutional mental health-care facilities, from an experiential perspective of a former mental health inpatient, ongoing service user and campaigner for retention of such facilities. It argues that auto-ethnographic accounts of mental illness by those with multiple social identities can have a greater role in terms of future training of mental health-care professionals. Design/methodology/approach The paper offers an experiential account of the impact of mental health facility bed closures as a patient admitted to institutional mental health facilities; as a mental health campaigner, fighting for the provision of both places of safety and “safe space” within his own local community; and as an ongoing service user. The research is in the interpretivist tradition of social science in taking an auto-ethnographical methodological stance. Findings This paper is underpinned by two key theoretical notions. Firstly, Stuart Hall’s concept of the Familiar Stranger (2017) is used to explore the tensions of self-identity as the author SHIFTS uncomfortably between his three-fold statuses. Secondly, the notion of “ontological insecurity” offered by Giddens (1991) is used with the paper exploring the paradox that admission to a mental health facility so-called “place of safety” is in fact itself a disorientating experience for both patient and carer(s). Research limitations/implications No positivistic claims to reliability, representativeness or generalisability can be made. It is the authenticity of the account which the reader feels should be afforded primacy in terms of its original contribution to knowledge. Practical implications This paper should have practical use for those tasked with developing educational and training curriculums for professionals across the mental health-care sector. Social implications This paper implicitly assesses the political wisdom of the policy of mental health bed closures within the wider context of the deinstitutionalisation movement. Originality/value This paper is underpinned by original experiential accounts from the author as patient, campaigner for places of safety and onging service-user of mental health care provision.

On Happiness

The publication of Happiness in 2019 marked a near twenty-year immersion in narratives that dealt with notions of war and trauma, an inquiry that began with a memoir The Devil that Danced on the Water (2002), written at the time of the civil conflict in Sierra Leone, and continuing through four novels, culminating in Happiness. In The Memory of Love and through the character of British psychologist Adrian Lockheart, a trauma specialist who arrives in Sierra Leone in the wake of the conflict, I engaged most directly with conceptual notions of trauma. It is in this novel that Attila Asare, a Ghanaian psychiatrist who runs a mental health facility in postwar Sierra Leone, makes his first appearance. Some years later, following publication of the Croatian-set novel The Hired Man, I found myself compelled to return to the character of Asare and the subject of trauma in my most recent novel, Happiness.

“Looking Forward”: a qualitative evaluation of a physical activity program for middle-aged and older adults with serious mental illness

ABSTRACTObjectives:Older adults with serious mental illness (SMI) often have poor physical health in addition to serious mental health issues. Sustained engagement in a group physical activity program may provide necessary physical and mental health benefits. The purpose of this report is to describe participants’ feedback about a video game-based group physical activity program using the Kinect for Xbox 360 game system (Microsoft, Redmond, WA). In particular, we wanted to understand what worked about the program, what was not ideal, and how it impacted their lives.Design:Semi-structured interviews were collected and analyzed with grounded theory methodology.Setting:Mental health facility.Participants:Sixteen older adults with SMI.Measurements:Participants played an active video game for 50-minute sessions, three times a week for 10 weeks. Qualitative interviews were conducted with 16 participants upon completion of the program.Results:Participants expressed enthusiasm for the physical activity program, indicating it was an activity that they looked forward to doing. The results of the study provide insight into how the program may be implemented into practice at mental health facilities. Three implementation to practice categories were identified: (1) programmatic considerations, such as when to hold the groups and where; (2) the critical importance of staff involvement; and (3) harnessing patients’ interest in the program.Conclusion:Our results suggest that engagement in an intense video game-based group physical activity program has a positive impact on participants’ overall health. The group atmosphere, staff involvement, availability of the program at a mental health facility, and health benefits were critical.

A PHENOMENOLOGICAL STUDY ON THE EXPERIENCES OF CARERS OF THE MENTALLY ILL ON A MENTAL HEALTH FACILITY IN THE PHILIPPINES

In the Philippines, mental illness remains a stigmatized, under-researched topic. Few studies on mental health are available, and at present, there is scant literature concerning the experiences of people living with and giving care to mentally ill peoples. This qualitative study aims to help families, mental health professionals, and the general community, gain an understanding of the experiences of caregivers and the challenges they face in sustaining their roles. Phenomenological method was employed for this research to explore the experiences of caregivers of the mentally ill patients in a Mental Health Facility in Leyte, Philippines. The primary data were collected through in-depth interviews with carers/caregivers/relatives of five (5) mentally ill persons. Library and internet desk research in its related literature were also employed. General findings of the study showed that caring for a mentally ill is burdensome. Data analysis revealed four superordinate themes under the experiences of caregivers, these consists of 1) caregiving difficulties, 2) various emotional reactions, 3) attitude towards the situation, and 4) positive caregiving experiences. Several support programs and services such as provision of mental health education and counseling regarding facts about the illness, its treatment and management, and leniency on watcher requirements during hospital admission are recommended to facilitate better caregiving experience of carers of the mentally ill.