Photographer Joanna Johnston’s “Here. This is what I feel” exhibit shows how hospital design works against its healing mission. Photo by Michael Swan

Bringing the human back into hospital design

  • June 13, 2015

TORONTO - People go to hospital in the hope of feeling better. But if patients are welcomed into a forbidding, institutional room with a strange bed, fluorescent lights and cold, hard floor, what then?

Toronto’s St. Joseph’s Hospital, with the second busiest mental health emergency room in the province, has begun thinking about how architecture could, or rather should, promote healing. The beat-up old ward that serves as both detox and mental health emergency room for about 6,500 patients a year is overdue for an update. The hospital foundation is trying to raise a modest $1.65 million to expand and enhance its mental health emergency services unit. To kick off the campaign, a unique photo exhibit, “Here. This is what I feel,” at Toronto’s Gladstone Hotel gave people a glimpse into what mental health care looks and feels like.

Photographer Joanna Johnston is uniquely qualified for the project. She’s the daughter of a hospital architect who began her career as an architect specializing in health care. The exhibition she put together June 4 and 5 at the Gladstone does more than document the inside of the hospital. It critiques how hospital design works against the healing mission of the institution.

“Hospitals have become almost the end of design. There’s no design in the hospital,” said Johnston. “There’s design for clinical function. There’s design for safety. But there isn’t design for humans to actually be human.”

Before Johnston began photographing, she spent three or four days hanging around the unit, getting a feel for the place and the people. Since the project was about the architecture, she decided against photographing people. But to explain how the architecture relates to patients, she interviewed seven volunteers — asking them about their feelings when they entered the hospital unit and the place where they feel most safe, comfortable and cared for. Johnston then photographed that most comforting place. Johnston’s photos contrast the hospital with the volunteer patients’ most comforting place by insetting pictures of these warm, cozy places in giant prints of hospital rooms and wards.

Unsurprisingly, none of the volunteers for Johnston’s photography project named the hospital as their safe and comforting place. Almost all chose their homes and private bedrooms, often describing the view out their windows.

In contrast, windows on the mental health emergency services unit are glazed, so that there are no views and only muted light from outside.

“I think something happened between the 1930s and 2000 in hospital design, where it transitioned from simpler ways of understanding healing in terms of having access to fresh air, light, the nursing staff, to we close it down, we put in mechanical systems to circulate the air, we keep it clean, we keep it functional, we keep it sterile,” Johnston said.

The foundation board at St. Joseph’s wants to break that pattern, said board member Louise Hucal. Good design, more human and less forbidding design is not a frill and need not cost a lot more, she said.

“We’re just going to put the patient back at the table (in the design process),” said Hucal.

St. Joseph’s mental health emergency unit was originally designed to take six to eight patients at a time. In recent years it has been slammed with as many as 20 at a time. Staff now limit intake to 12.

One of the issues is both patient and staff safety. Where mental health emergency units have been thoughtfully renovated and redesigned, violent incidents have dramatically decreased. Better architecture and a more comforting environment can go a long way to diffusing the anxiety and fear most patients are bound to feel when they check themselves in for treatment of addictions, suicidal thoughts, manic episodes and more.

“It’s not to say it should be the Shangri La,” said Johnston. “Maybe you could have a room where you could have a blind with a window, a light we could turn on and off, a place where the floors are warm so your feet aren’t cold.”

Hospitals have to rethink how the environment is a stimulant for mental health patients, she said.

“Hospital design has been geared around the idea that if you put nothing in the space that’s better than if you add something,” Johnston said. “Because someone might react  to something. But I think what is actually happening is the opposite. People’s anxiety rises in the absence of any articulated dimension.”

It’s always a tough sell for mental health, say Hulac and Johnston. Raising money for cancer or high tech surgical and diagnostic equipment never seems to be a problem. There’s no sexy, high-tech equipment to sell to donors when it comes to mental health care.

“Mental health doesn’t have any medical equipment requirements,” points out Johnston. “They have people and they have a building. There’s no impetus in terms of funding to get any money to renovate. Because it works — it works on paper. There are spaces for people to be treated. There are walls, there are doors. Treat them. But that’s very different from saying the building is actually going to be helping in the treatment of these patients.”

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