Architektur und Design psychiatrischer Einrichtungen

Zusammenfassung

Hintergrund: Über die Wirkung von Architektur und Design auf Patientinnen und Patienten psychiatrischer Einrichtungen existiert bisher kaum wissenschaftliche Evidenz.

Methode: Es wurde eine systematische Literaturübersicht durchgeführt über Studien in Einrichtungen der Erwachsenenpsychiatrie.

Ergebnisse: 25 Publikationen wurden in die Übersicht eingeschlossen (vorwiegend Prä-Post- und Kontrollgruppen-Designs). Die Unterschiedsbedingungen reichten von Kunstinstallationen bis hin zu Komplettrenovierungen. Die überwiegende Mehrheit der Studien zeigte positive Ergebnisse.

Diskussion: Dieses Ergebnis sollte vor dem Hintergrund erheblicher methodischer Probleme vieler Studien interpretiert werden.

Abstract

Background: The physical environment of mental health institutions is regarded as a therapeutic agent within the treatment. There is only little scientific evidence on the consequences of architecture and design on psychiatric patients available.

Methods: A systematic review was conducted on studies from adult mental health institutions.

Results: 25 studies were included into the review. Pre-post-studies and control group conditions were predominant study designs. Randomized controlled trials were not available. Interventions reached from art installations up to entire ward renovations. Outcome indicators were rather heterogeneous, including psychopathology, behavioural observations and aggression incidents. Overwhelmingly, the studies revealed positive results of interventions into the physical environment.

Discussion and conclusions: We found positive outcomes independent from the intervention in detail. This result should be interpreted in the light of the generally low study quality and further methodological problems.

Schlüsselwörter

Psychiatrie - Architektur - Design - Auswirkungen

Keywords

mental health - architecture - design - effects

• Literatur

• 1 Müller N. Historische und aktuelle Bauprinzipien psychiatrischer Kliniken. Nervenarzt 1997; 68: 184-195
• 2 Skalevag SA. Constructing curative instruments: psychiatric architecture in Norway, 1820 – 1920. Hist Psychiatry 2002; 13: 51-68
• 3 Sine DM. The architecture of madness and the good of paternalism. Psychiatr Serv 2008; 59: 1060-1062
• 4 Wing JK, Brown GW. Institutionalism and Schizophrenia: A Comparative Study of Three Mental Hospitals 1960 – 1968. Cambridge: Cambridge University Press; 1970
• 5 Mahoney JS, Palyo N, Napier G et al. The therapeutic milieu reconceptualized for the 21st century. Arch Psychiatr Nurs 2009; 23: 423-429
• 6 Moos RH, Harris R, Schonborn K. Psychiatric patients and staff reaction to their physical environment. J Clin Psychol 1969; 25: 322-324
• 7 Moos RH, Houts PS. Assessment of the social atmospheres of psychiatric wards. J Abnorm Psychol 1968; 73: 595-604
• 8 Engel RR, Knab B, von Doblhoff-Thun C. Stationsbeurteilungsbogen, SBB: Manual. Weinheim: Beltz; 1983
• 9 Huisman ERCM, Morales E, van Hoof J et al. Healing environment: A review of the impact of physical environmental factors on users. Building Environm 2012; 58: 70-80
• 10 Lawson B. Healing architecture. Arts Health 2010; 2: 95-108
• 11 Ulrich RS, Zimring C, Zhu X et al. A review of the research literature on evidence-based healthcare design. HERD 2008; 1: 61-125
• 12 Drahota A, Ward D, Mackenzie H et al. Sensory environment on health-related outcomes of hospital patients. Cochrane Database Syst Rev 2012; 3 CD005315
• 13 van de Glind I, de Roode S, Goossensen A. Do patients in hospitals benefit from single rooms? A literature review. Health Policy 2007; 84: 153-161
• 14 Hoffmann H. Soteria – Atmosphäre als Therapeutikum in der Schizophreniebehandlung. In: Debus S, Posner R, Hrsg. Atmosphären im Alltag – Über ihre Erzeugung und Wirkung. Bonn: Psychiatrie-Verlag; 2007: 15-41
• 15 Benedetti F, Barbini B, Colombo C et al. Chronotherapeutics in a psychiatric ward. Sleep Med Rev 2007; 11: 509-522
• 16 Andes M, Shattell MM. An exploration of the meanings of space and place in acute psychiatric care. Issues Ment Health Nurs 2006; 27: 699-707
• 17 Arya D. So, you want to design an acute mental health inpatient unit: physical issues for consideration. Australas Psychiatry 2011; 19: 163-167
• 18 Gulak MB. Architectural guidelines for state psychiatric hospitals. Hosp Community Psychiatry 1991; 42: 705-707
• 19 Gross R, Sasson Y, Zarhy M et al. Healing environment in psychiatric hospital design. Gen Hosp Psychiatry 1998; 20: 108-114
• 20 Karlin BE, Zeiss RA. Best practices: environmental and therapeutic issues in psychiatric hospital design: toward best practices. Psychiatr Serv 2006; 57: 1376-1378
• 21 Ulrich RS, Bogren L, Lundin S. Toward a design theory for reducing aggression in psychiatric facilities. Conference Arch 12: Architecture, Research, Care, Health. November 12-14 2012. Gothenburg: Chalmers Institute of Technology; 2012
• 22 Royal College of Psychiatrists. Do the right thing: How to judge a good ward. Ten standards for adult in-patient mental healthcare. Occasional Paper. London: Royal College of Psychiatrists; 2011
• 23 Department of Veteran Affairs. Mental Health Facilities Design Guide (Dezember 2010). Im Internet: http://www.cfm.va.gov/til/dGuide/dgMH.pdf (Stand: 16.12.2013)
• 24 Dijkstra K, Pieterse M, Pruyn A. Physical environmental stimuli that turn healthcare facilities into healing environments through psychologically mediated effects: systematic review. J Adv Nurs 2006; 56: 166-181
• 25 Daykin N, Byrne E, Soteriou T et al. The impact of art, design and environment in mental healthcare: a systematic review of the literature. J R Soc Promot Health 2008; 128: 85-94
• 26 Dobrohotoff JT, Llewelllyn-Jones RH. Psychogeriatric inpatient unit design: A literature review. Int Psychgeriatr 2011; 23: 174-189
• 27 van Hoof J, Kort HSM, van Waarde H et al. Environmental Interventions and the Design of Homes for Older Adults With Dementia: An Overview. Am J Alzheimers Dis Other Demen 2010; 25: 202-232
• 28 Calkins MP. Evidence-based long-term care design. NeuroRehabilitation 2009; 25: 145-154
• 29 Pressly PK, Heesacker M. The physical environment and counseling: A review of theory and research. J Counseling Develop 2001; 79: 148-160
• 30 Corey LJ, Wallace MA, Harris SH et al. Psychiatric ward atmosphere. J Psychosoc Nurs Ment Health Serv 1986; 24: 10-16
• 31 Devlin AS. Psychiatric ward renovation: Staff perception and patient behavior. Environm Behav 1992; 24: 66-84
• 32 Nijman H, Bowers L, Haglund K et al. Door locking and exit security measures on acute psychiatric admission wards. J Psychiatr Ment Health Nurs 2011; 18: 614-621
• 33 Guyatt GH, Oxman AD, Montori V et al. GRADE guidelines: 5. Rating the quality of evidence – publication bias. J Clin Epidemiol 2011; 64: 1277-1282
• 34 Brunt D, Rask M. Ward atmosphere – the Scarlet Pimpernel of psychiatric settings?. Issues Ment Health Nurs 2007; 28: 639-655
• 35 Brusilovskiy E, Salzer MS. A study of environmental influences on the well-being of individuals with psychiatric disabilities in Philadelphia, PA. Soc Sci Med 2012; 74: 1591-1601
• 36 Schauss AG. Tranquilizing effect of color reduces aggressive behavior and potential violence. Orthomol Psychiatr 1979; 8: 218-221
• 37 Pellegrini RJ, Schauss AG, Miller ME. Room color and aggression in a criminal detention holding cell: A test of the 'Tranquilizing Pink' Hypothesis. Orthomol Psychiatr 1981; 10: 174-181
• 38 Gilliam JE, Unruh D. The effects of Baker-Miller pink on biological, physical and cognitive behaviour. J Orthomol Med 1988; 3: 202-206
• 39 Birnbach DJ, Nevo I, Scheinman SR et al. Patient safety begins with proper planning: a quantitative method to improve hospital design. Qual Saf Health Care 2010; 19: 462-465
• 40 Lorenc T, Clayton S, Neary D et al. Crime, fear of crime, environment, and mental health and wellbeing: mapping review of theories and causal pathways. Health & place 2012; 18: 757-765
• 41 Lorenc T, Petticrew M, Whitehead M et al. Environmental interventions to reduce fear of crime: systematic review of effectiveness. Syst Rev 2013; 2: 30
• 42 Andrade C, Lima ML, Fornara F et al. Users’ views of hospital environmental quality: Validation of the Perceived Hospital Environment Quality Indicators (PHEQIs). J Environ Psychol 2012; 32: 97-111
• 43 Johansson M, Brunt D. The physical environment of purpose-built and non-purpose-built supported housing for persons with psychiatric disabilities in Sweden. Issues Ment Health Nurs 2012; 33: 223-235
• 44 Marcheschi E, Brunt D, Hansson L et al. The influence of physical environmental qualities on the social climate of supported housing facilities for people with severe mental illness. Issues Ment Health Nurs 2013; 34: 117-123
• 45 Wright PA, Kloos B. Housing environment and mental health outcomes: A levels of analysis perspective. J Environ Psychol 2007; 27: 79-89
• 46 Kasmar JV, Griffin WV, Mauritzen JH. Effect of environmental surroundings on outpatientsʼ mood and perception of psychiatrists. J Consult Clin Psychol 1968; 32: 223-226
• 47 Higgs WJ. Effects of gross environmental change upon behavior of schizophrenics: a cautionary note. J Abnorm Psychol 1970; 76: 421-422
• 48 Ittelson WH, Proshansky HM, Rivlin LG. Bedroom size and social interaction on the psychiatric ward. Environm Behav 1970; 2: 255-270
• 49 Holahan C. Seating patterns and patient behavior in an experimental dayroom. J Abnorm Psychol 1972; 80: 115-124
• 50 Holahan CJ, Saegert S. Behavioral and attitudinal effects of large-scale variation in the physical environment of psychiatric wards. J Abnorm Psychol 1973; 82: 454-462
• 51 Holahan C. Environmental change in a psychiatric setting: A social systems analysis. Hum Rel 1976; 29: 153-166
• 52 Whitehead CC, Polsky RH, Crookshank C et al. Objective and subjective evaluation of psychiatric ward redesign. Am J Psychiatry 1984; 141: 639-644
• 53 Baldwin S. Effects of furniture rearrangement on the atmosphere of wards in a maximum-security hospital. Hosp Community Psychiatry 1985; 36: 525-528
• 54 Christenfeld R, Wagner J, Pastva G et al. How physical settings affect chronic mental patients. Psychiatr Q 1989; 60: 253-264
• 55 Beauchemin KM, Hays P. Sunny hospital rooms expedite recovery from severe and refractory depressions. J Affect Disord 1996; 40: 49-51
• 56 Benedetti F, Colombo C, Barbini B et al. Morning sunlight reduces length of hospitalization in bipolar depression. J Affect Disord 2001; 62: 221-223
• 57 McGonagle IM, Allan S. A comparison of behaviour in two differing psychiatric long-stay rehabilitation environments. J Psychiatr Ment Health Nurs 2002; 9: 493-499
• 58 Daffern M, Mayer MM, Martin T. Environment contributors to aggression in two forensic hospitals. Int J Forensic Ment Health 2004; 3: 105-114
• 59 Kagan I, Kigli-Shemesh R. Relocation into a new building and its effect on uncertainty and anxiety among psychiatric patients. J Psychiatr Ment Health Nurs 2005; 12: 603-606
• 60 Vaaler AE, Morken G, Linaker OM. Effects of different interior decorations in the seclusion area of a psychiatric acute ward. Nord J Psychiatry 2005; 59: 19-24
• 61 Olver J, Love M, Daniel J et al. The impact of a changed environment on arousal levels of patients in a secure extended rehabilitation facility. Australas Psychiatry 2009; 17: 207-211
• 62 Payne H, May D. Evaluation of a refurbishment scheme incorporating the King's Fund 'Enhancing the healing environment' design principles. J Facilities Mangem 2009; 7: 74-89
• 63 Edgerton E, Ritchie L, McKechnie J. Objective and subjective evaluation of a redesigned corridor environment in a psychiatric hospital. Issues Ment Health Nurs 2010; 31: 306-314
• 64 Southard K, Jarrell A, Shattell MM et al. Enclosed versus open nursing stations in adult acute care psychiatric settings: does the design affect the therapeutic milieu?. J Psychosoc Nurs Ment Health Serv 2012; 50: 28-34
• 65 Long CG, Langford V, Clay R et al. Architectural change and the effects on the perceptions of the ward environmen in a medium secure unit for women. Br J Forensic Pract 2011; 13: 205-212
• 66 Nanda U, Eisen S, Zadeh RS et al. Effect of visual art on patient anxiety and agitation in a mental health facility and implications for the business case. J Psychiatr Ment Health Nurs 2011; 18: 386-393
• 67 van der Schaaf PS, Dusseldorp E, Keuning FM et al. Impact of the physical environment of psychiatric wards on the use of seclusion. Br J Psychiatry 2013; 202: 142-149