Architect: The new design must develop its potential

23:e apr. 2021

Karlsson Arkitekter designed the psychiatric hospital GAPS in Slagelse, Denmark, which opened in 2015.

Owner and architect Christian Karlsson believes that the design principles of transparency and hierarchy have already proved their worth for the hospital’s complex everyday routines. However, a cultural change will be needed to derive the full benefits of everything the architecture has to offer.

Troldtekt acoustic ceilings in healthcare buildings
Troldtekt acoustic ceilings in healthcare buildings

When bringing together multiple psychiatric units in a single large hospital, the architecture must accommodate many different needs. Some severely ill patients may have just been admitted, while others are close to being discharged. While in treatment, some patients exhibit externalising behaviour, while others withdraw from social contact. And naturally, many patients are critical of the hospital when they walk in the door.

This is also the case at GAPS in Slagelse, Denmark, where four smaller treatment centres in Region Zealand were combined into a 44,000-square-metre complex in 2015.

“The complexity was an inherent condition of the project itself. It is embedded in the entire treatment approach for recovery, the idea being that patients undergo a process from illness to health during their hospitalisation. During this process, patients have very different reactions to people and situations, which must be factored in both in traditional treatment centres as well as GAPS,” says Christian Karlsson, architect and owner of Karlsson Arkitekter.

Karlsson Arkitekter designed GAPS together with Vilhelm Lauritzen Arkitekter. Whereas traditional psychiatric hospitals have many closed doors and few visible people, GAPS required the opposite. The ambition was therefore to create transparency between rooms as well as between indoor and outdoor environments.

Another important design principle at GAPS is that there is a hierarchy in design, scale and detail that gives patients the possibility of different degrees of stimuli and allows them to alternate between private and communal spaces, depending on where they are in their recovery process.

Important to gather experience

The social consequences of transparency and hierarchy at GAPS are the main focus of the PhD thesis that Thorben Simonsen defended in 2020. During more than 200 hours of fieldwork, he observed everyday life at the hospital and suggests that the design principles present a number of challenges. Read about his observations and points in the article here.

Christian Karlsson points out that he welcomes Thorben Simonsen’s PhD project. Because it is important to have data that can strengthen our experience with healing architecture – even from disciplines not rooted in psychiatry or architecture.

“But in my view, the thesis focuses more on the negative reactions than on the things that actually work well, without always triggering reactions from patients and staff. Thorben Simonsen has registered a number of inappropriate incidents, but I don’t think that they necessarily have anything to do with the more open design and the connection between the staff’s workspaces and the patients’ communal spaces,” says Christian Karlsson.

“A number of the registered incidents can be prevented by changing the work culture and by staff using the facilities at GAPS more consciously. Part of the job of designing the hospital was to support a cultural change towards a more visible presence in the patient units. But it will take time, and perhaps also efforts on the part of management, for such practice changes to take effect,” he says.

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Staff must be visible

One of the examples highlighted by both Simonsen and Karlsson is the Dueslaget (Danish for ‘Pigeonhole’) staff room, which has glass walls and is situated in a communal area. This means that staff and patients can see but not necessarily hear each other.

“As the thesis also points out, sound is an essential indicator of people’s experience of a situation. We’re aware of this, but we’ve also had to comply with a number of legal requirements as regards sound between the rooms. So when staff laugh or have serious discussions behind a glass wall, it may make the patients feel unsure. However, this does not alter the fact that we see far more advantages than disadvantages in creating transparency and closeness between patients and staff in the specific design. And, course, you can always leave the door slightly ajar, so that a little sound escapes,” says Christian Karlsson.

“Overall, I believe that the idea works, as patients tend to gravitate to the area outside of Dueslaget. Patients have shown interest in changing the layout of the communal area by moving sofas up there, which shows that patients are interested in using it as a living and dining area. This means, of course, that the staff become more visible actors in a number of work situations, which has also been a definite goal aimed at creating a sense of safety and security,” Karlsson adds.

Troldtekt acoustic ceilings in healthcare buildings

Observation eliminates conflict

Karlsson further explains that the Dueslaget staff room should not be used for preparing medication (this must be done in special medication rooms in peace and quiet, in line with Danish standards) nor used for other particularly sensitive situations:

“Workspace and meeting rooms are actually available between the patient units, so that the staff can work backstage when necessary and generally cooperate across the units. It’s just ingrained in the experienced employees that they belong to one unit and can’t leave it without letting down their colleagues. That’s understandable, but this is one area where a change of culture is needed.

Transparency applies not only indoors, but also in relation to the outdoor environment. This includes the atrium courtyard, where patients can spend time while staff are able to observe what is going on from their workspace.

“It’s very positive that patients can go outside without having to be accompanied by staff. Not having to ask for permission or be accompanied when you want to go outside has led to fewer conflicts. Part of the idea with the hierarchy is that patients can seek out contact with one another outside, with a cup of coffee or when going outside to smoke,” says Christian Karlsson.

Hospitalisation time plays a role

During his own visits, Christian Karlsson has also found that the hierarchy can present challenges. The idea of patients being part of a community outside their units, for example in activity rooms or gyms, is not being fully utilised. This is particularly true in areas where hospitalisations are relatively brief.

“There’s a difference between short-term and long-term hospitalisations in the way that treatment can be organised, and thus in the use of the facility. In areas with longer hospitalisations, for example forensic psychiatry, we’re seeing to a greater extent that the treatment evolves based on knowledge of the individual patient, and that the various facilities outside the individual patient units are used by both patients and staff. And we definitely believe that the design and the new practice possibilities work, which can be seen, for example, by a decrease in the use of restraints in the high-security block at GAPS,” says Christian Karlsson.

“It’s a difficult task involving considerable dilemmas to accommodate everyone with one solution when the individual patient’s condition may change quite substantially over the course of their treatment. The ideas about healing architecture, including transparency and spatial hierarchy, present pros as well as cons. This would also be the case with any other type of design. I think that we’ve generally struck a good balance, and I can also see that a number of the design concepts have been adopted as standard elsewhere,” he says, adding:

“When I visit GAPS, I see people and dialogue. That’s not the case at most other psychiatric hospitals, where the staff are in the staff areas and the patients are in the patient rooms. Moving from the old structure to a new design requires a culture change, and it will be several years before the design principles are fully realised.”

>> Read interview with Thorben Simonsen, PhD

Interview with architect Christian Karlsson from Karlsson Architects in Troldtekt online feature about healing architecture

Owner and architect Christian Karlsson, Karlsson Architects.

Troldtekt acoustic ceilings in healthcare buildings

Psychiatric hospital GAPS

Project: Psychiatric hospital GAPS in Slagelse, Denmark
Architects: Karlsson Arhcitects, Vilhelm Lauritzen Architects
Client: Region Zeeland

Troldtekt products:

Ceiling panels: Troldtekt Plus acoustic panels
Colour: Natural wood
Structure: Fine (1.5 mm wood wool)
Edge design: 5 mm bevelled edges, K5
Installation: With Troldtekt screws

>> Read more about GAPS in the Troldtekt reference section

THEME: Healing architecture

Light, air, acoustics and spatial organisation. Architectural ideas are being applied in support of treatment, not least in new psychiatric facilities.

A new online series of articles from Troldtekt A/S focuses on visions and practices, opportunities and pitfalls within healing architecture.

>> Read further articles from the theme here

Troldtekt acoustic ceilings in healthcare buildings