Stigma and architecture of mental health facilities

Stigma associated with mental illness is very common. Patients face prejudices, stereotypes, misunderstanding, discrimination, and self-stigma. They are afraid of being labelled. Another fear is the fear of mental health services, which makes patients avoid taking up treatment. ¹ Apprehension of treatment increases when a patient has to be treated in a psychiatric hospital. Fear of stigma associated with a facility appears. For many patients, hospitals become their home for weeks or months. Despite all improvements introduced to mental health facilities, they are still labelled and stigmatised. Psychiatric hospitals are often associated with a penitentiary, an asylum, or a substitute of a panopticon. The stereotypical image of a psychiatric hospital is inseparably linked with this object.

The architecture of psychiatric hospitals is sometimes referred to as the architecture of madness. That applies to both the architectural form and the quality of the built environment. Very often, architecture not only fails to guarantee appropriate conditions of stay, but it is also inadequate for its function. Some psychiatric hospitals were not adapted to the changing requirements for healthcare facilities, and in some cases they were not designed to accommodate people. That creates inappropriate spatial and functional connections and results in inability to introduce required changes, provide particular technical conditions, and create a suitable environment for patients.

The popular perception of mental health architecture, considering all local issues, is closely related to the mental illness label. Existing technical and functional problems and the low quality of buildings arise from popular attitudes both to people with mental illness and to mental healthcare. Poorly financed and organised, the system cannot provide adequate conditions for in-patients. ² That may lead to further discrimination of people with mental illness through the quality of the mental healthcare setting. Moreover, extrapolating a Western approach that is irrelevant to local determinants may fail to respond to patients' needs and further increase stigma. ³ When cultural and local issues are not implemented in the design process, the outcome often falls short of the required mental health facility standards.

The task of reducing mental health stigma associated with the place (architecture) necessitates considering a wide range of diverse issues. To meet standards of quality for mental health facilities the designers need to create spaces that ensure the protection of in-patients' dignity and privacy while maintaining security, as well as appropriate humanisation of hospital space with respect for local and cultural determinants. This allows focusing on the patients and facilitates their engagement on a personal and social level while appropriate therapy is being carried out.

Mental health architecture should be neither the architecture of madness nor the architecture of stigma, but an architecture of therapy, humanity and safety.