How the Hospital Environment Perpetuates Mental Illness

The Impact of a Space on Mental Health

At Tribeca Therapy, my colleagues and I take great care to create a welcoming space that inspires creativity and growth. The aesthetics and the feel of any office is reflective of the treatment you are going to receive. Our space has a clean modern feel that reflects our professionalism and seriousness about our work. But it also has a playfulness and leaves room for artistry, the clearest example of which is our large chalkboard in the center of the office.

As an art therapist and artist, I have always been particularly attuned to aesthetics.  And I learned early in my career in my work on an inpatient psychiatric unit that if you encounter a sterile, neglected physical environment, you are likely to have a very sterile therapeutic experience. I remember the space so vividly--the walls were painted a muted, puce green. The hospital wanted to try and steer away from the typical sterile white but somehow the green made it even more depressing. Artwork and decor was sparse and outdated- the few Van Gogh and O'Keeffe prints were bolted to the wall in case a patient became "aggressive" and wanted to use poor Georgia as a weapon. The chairs were a dull maroon and had a busy pattern to try and disguise any stains. The unit was for those in crisis and those desperately in need of some very good help, yet the help they often got corresponded with those worn maroon chairs. The staff themselves were mostly lovely and tried to do the best they could for these patients with the limited resources that they had. There was constant pressure to get the patients out of the unit as quickly as possible using as few resources as possible from the hospital executives and insurance companies.

We Can Do Better Than Puce

When I came across the Slate's Kristen Howenadel's piece about a British artist's ideas for a redesigned inpatient psychiatric ward, I was incredibly moved. The artist, James Leadbitter, a.k.a. "the vacuum cleaner", imagines a space that is the complete antithesis of the typical inpatient unit. It is expansive, fun and even the practical parts of the space that serve a purpose are also warm and welcoming. Leadbitter, someone who himself has spent time as a patient on inpatient units, collaborated with Hannah Hull and workshopped with 300 patients, architects, designers, and doctors in the U.K. for ideas. Named "Madlove" the finished space is on display in Liverpool, England until May 17th and has gotten support from the Welcome Trust and the British Psychological Society.

One part of the space, called the "Cooling Cell" is a redesigned "padded room" for people to cool down and "let off steam". This is drastically different from the real, padded cells that still exist in hospitals today. In my hospital, it was quaintly called, "the quiet room". These rooms are stark white and completely empty, so the patient has nothing to harm himself or herself with. There is a huge deadbolt on the outside of the door so the staff can lock the patient in. Oftentimes patients that are "agitated" are strapped to gurneys, wheeled into the quiet room, and injected with fast-acting medication like tranquilizers and anti-psychotics to calm the person down. It is an incredible challenge, how to best care for patients on psychiatric units with respect and dignity. On one hand, if someone is agitated and aggressive to staff and other patients and is not responsive to verbal limits, there needs to be a way to protect everyone else on the unit and make them feel safe. On the other hand, many of these patients are genuinely fearful and believe that they themselves are in danger and are were just reacting to a threat that felt incredibly real.

This is just one of the conundrums that make psychiatric units traumatizing places, for patients and staff alike. Even after three years, I never got used to seeing a patient getting "taken down" and injected with medication against their will. And what "Madlove" highlights is how much the space impacts a person's experience on one of these units. The current set up of hospitals perpetuates the "patient" identity: the people that are on these units identify themselves as sick, as having something wrong with them, and this is a message they internalize and take with them long after their stay. Being on the receiving end of a label, such as "patient", extends far beyond an inpatient psychiatric unit.  In my therapy practice, I work with so many people who have internalized negative labels that been given to them, such as "problem child", "crazy", and "troublemaker", which has been a real barrier to their ability to grow and thrive.

What Does a Supportive Space Look Like?

The one exception to the aesthetic standard of institutions is the "Living Museum" at Creedmoor State Hospital in Queens, NY.  The Living Museum was created in the 1970's and still stands today as a space for patients of Creedmor to create and display their artwork.  I had the pleasure of visiting the Living Museum in 2008 (on Halloween, nonetheless!) and the space had high ceilings and was covered in art and art materials.  After taking in the beauty of the space and all of the artwork that was everywhere, I was surprised to realize that I could not tell who was the staff and who was the patients. There was no stigma in sight. Artists worked in harmony, creating their own images while supporting their colleagues in their own artistic journey.  One can only imagine the profound affect that this level of support, creative freedom, and expansiveness has on mental health and self worth.

The takeaway from "Madlove" is two part. The first is that we need to treat those in need of help and support better and there are opportunities for institutions and other mental health resources to be more giving and creative, both in their treatment and in their aesthetic. The second is that if you are looking for therapy for you or a loved one, pay attention to the space. In the private therapy practice world, offices really run the gamut. I have been in some offices that are cluttered with papers, folders, and books, stacked on desks and chairs in precarious positions. Other offices are more sparse and clinical with some carefully curated landscapes on the wall.  I always make the somewhat cynical assumption that books displayed in a therapist office are less for reference and more for show. The space is an extension of the therapist and what they want to communicate to those who pass through it and is an indication of what the treatment. Allow yourself to carefully consider what type of help you need and what type of place you want to receive it.