The Parkwood Institute Mental Health Building, London, ON, Canada

Parkin Architects Limited

EBD Goal 

To embody integration and openness, to provide a safe and welcoming environment for long-term mental health patients, and to promote healing and independence for patients in their recovery journeys. 
 

Overview

The Parkwood Institute Mental Health Building in London, Ontario was designed and constructed in conjunction with the Southwest Centre for Forensic Mental Health Care (St. Thomas, Ontario) to deliver full-service mental healthcare to southwestern Ontario. With 168 single-bed inpatient rooms, the new 450,000-square-foot facility provides both inpatient and outpatient programs, including geriatric psychiatry, dual diagnosis, treatment and rehabilitation, assessment, and adolescent psychiatry. 
 

Challenge 

The geriatric client population is at higher risk of developing mental disorders, neurological disorders, or substance abuse problems, in addition to physical deterioration and mobility impairments such as diabetes, hearing loss, and osteoarthritis. This study focused primarily on the design of a safe and secure room for geriatric mental health clients and effective methods to reduce falls.

The primary challenge centered on the design of a single-patient room type that would exceed the care requirements of the patient population. Goals included: 

• Removal of hazards or barriers in the room to encourage patient independence and recovery

• Flexibility to accommodate the needs of each patient population

• Safe and secure environment for staff, patients, and visitors that minimizes the potential for harm to one’s self or others

• Patient bedrooms that replicate a homelike environment

An additional challenge arose from the client requirement to locate the patient washroom at the entrance to the room, which reduced the field of visibility from the patient room entrance door.

Parkin’s peer-review of mental health bedroom layouts studied room types under five headings:

• Flexibility

• Connection to daylight and the exterior

• Reduction of hiding (person or contraband) opportunities

• Minimized potential for harm to oneself or others

• Ease of washroom access 

The review informed the first design move: to angle the washroom wall to broaden the field of vision from the entrance into the room. 

Furniture layout evaluations prompted locating the bed in clear view of the patient room door; however, patients would have to traverse the room from the bed to access the washroom. To minimize fall risk, a handrail was installed connecting the bed to room entry, reducing the length of unsupported patient journey. 

Further reviews of slip resistance and cleanability informed choices of linoleum flooring in the patient room and seamless resin for the washroom. Similarly, nightlights were located close to the door of the room for safety, while minimizing sleep disruption.
 

Results 

Parkin performed a post-occupancy survey to ascertain the success of the patient bedroom and washroom design in reducing patient falls in the geriatric psychiatry units. Results were largely qualitative, with respondents encouraged to provide comments and descriptions of their experiences, as well as any pertinent patient feedback. Staff responses were measured on a 5-point Likert scale. Sixty-five percent of respondents rated the success as 5 (very effective), with an average of 4.5 (effective–very effective). Staff responses confirmed that patients used the handrails for support.

At the time of the survey, no patient falls had been recorded. While it is most likely that measures implemented have increased patient safety, due to the limitations of the study and reliance on anecdotal evidence, there is no direct correlation between the safety measures implemented and the prevention of patient falls.

Parkin Architects Limited, (in conjunction with Saleh Kalantari, an Associate Professor at Washington State University), carried out a POE survey at both the Southwest Centre for Forensic Mental Health Care and the Parkwood Institute, Mental Health Care Building. The team completed the data analysis phase and anticipate the Journal paper detailing findings to be published in the near future.