PhD.: Healing architecture is put to the test in practice

23:e apr. 2021

When architectural visions come up against the reality of psychiatric practice, it can cause friction for both patients and staff. This is the conclusion arrived at by Thorben Simonsen in his PhD project for Copenhagen Business School.

Through interviews and more than 200 hours of fieldwork, he has examined the importance of the design principles of transparency and hierarchy at the award-winning psychiatric hospital GAPS in Slagelse, Denmark.

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

GAPS in Slagelse, Denmark is a building without precedent. Therefore, the architects did not have many sources to draw upon as they sought inspiration for the psychiatry of the future. The result is a visionary psychiatric hospital that has attracted a great deal of international attention since it was inaugurated in 2015. The MIPIM Award 2017 for Best Healthcare Development is just one of the accolades received by GAPS.

Healing design principles were the focal point of the architecture. In the article, which you can read via this link, Christian Karlsson from Karlsson Arkitekter explains how the combination of daylight and advanced artificial light plays an important role in the therapeutic process. In addition, transparency (through the use of glass walls) and hierarchy (in the form of alternation between personal and communal spaces) have been fundamental concepts in the architecture.

But how exactly do transparency and hierarchy work for patients and staff on a daily basis? PhD student Thorben Simonsen set out to investigate these issues in depth. In February 2020, he defended his thesis, which – in his own words – “has not necessarily aroused enthusiasm, but rather a great deal of interest” in architectural circles.

A mismatch with a complex reality

This interest stems from the fact that Thorben Simonsen has elucidated a mismatch between the design principles on the one hand, and the social reality of the hospital on the other. He has come to this conclusion after more than 200 hours of fieldwork at GAPS as well as a series of interviews.

“Certain ideas about the function of the architecture have been shown to be unable to accommodate the complex reality of psychiatry,” says Simonsen, adding:

“Even though I have ‘only’ studied the conditions in-depth in two general psychiatric units at GAPS, my assumption is nevertheless that in several state-of-the-art psychiatry buildings, there are general challenges in making some of the healing principles work in the real world.”

Acoustic environment is important

At GAPS, robust materials such as brick, wood, concrete and Troldtekt acoustic panels in cement-bonded wood wool have been chosen.

Thorben Simonsen points out that the choice of materials, including their importance for light, sound and acoustics, generally play a major role in healing architecture.

“Sound and acoustics are quite important because research shows that staff in a psychiatric hospital actually use their hearing as much as their eyesight to monitor their surroundings. It can also be quite noisy in some areas, so it is important that the acoustics are regulated,” he says.

But back to the main focus of the thesis. Simonsen has studied the practical consequences of two principles in particular that played a key role during the GAPS design process:

  • Transparency, which is about using glass walls to create a visual connection across spaces – and between patients and staff. Glass also connects indoor spaces and the outdoor environment.
  • Hierarchy, which both inside and outside aims to offer patients different levels of stimuli depending on how they feel and how far they have come in their recovery process. The architectural principle at GAPS is that the hierarchy, for example, encompasses patient rooms as well as nearby living areas and communal activity areas with the possibility of sports/recreation.
Psychiatric hospital GAPS in Slagelse, Denmark | Troldtekt

Staff needs ‘backstage’ space

On the topic of transparency, Thorben Simonsen says:

“The challenges are most evident around Dueslaget, which is a transparent staff office that resembles a glass cube. It enables staff to withdraw yet still surveil patient activity. The idea was that it would give psychiatric patients a sense of security, but instead it seems that patients often feel insecure, or at least unsure of what is going on. So it has to do with uncertainty: ‘Why are the staff members laughing? What are they typing on the computer? Are they preparing that syringe for me, or for another patient?’

“For the staff, transparency means that they have to constantly appear professional and, for example, refrain from laughing. At the same time, they often have to negotiate with the patients and defend spending time in the office. Transparency was expected to contribute to forging relations, but instead the interaction is reduced to transactions between patients and staff. In some cases, it would be beneficial if staff could withdraw ‘backstage’ to more enclosed spaces.”

Thorben Simonsen acknowledges that some patients are happy with the transparency because they do not need to speculate about the whereabouts of their contact in the facility.

Troldtekt acoustic ceilings in healthcare buildings

Hierarchy causes social unease

The principle of hierarchy is another focus area in Thorben Simonsen’s PhD thesis. The idea of hierarchy should support the patients’ return to society. It is intended to reflect a recovery process in which patients can gradually move from their protected patient room to the semi-communal corridors, and then to the larger communal areas.

“In practice, however, patients find it difficult to distinguish between the different rooms and what social behaviours belong where,” says Simonsen, who provides specific examples:

“Just outside Dueslaget is a communal area where patients can eat, drink coffee or play games. But if a patient starts talking about their medication here, it is not appropriate.” The open and transparent architecture can thus make it more difficult to decipher what you can do where. Therefore, what behaviour is appropriate in which spaces is largely left to the staff to decide, which reinforces the ‘us and them’ hierarchy, despite the fact that the ambition of the architecture is to break it down.

“Another example is the patient rooms, which in practice are not only used as the patient’s personal space. They are also used for shielding and isolation when problems arise. There’s nothing inherently strange about that. But staff intervention fundamentally changes the function of the room from personal space to institutional space, and thus the control of the room also passes from patient to staff. The notion of a spatial hierarchy that patients progressively move through in their recovery process is therefore not unproblematic.

“And then there’s the atrium courtyard, which was intended as a healing outdoor space, but which in practice has become a smoking area. What’s surprising is that the courtyard, where patients are fully visible to staff, nevertheless serves as a sheltered space where patients can speak to one another privately because staff cannot hear them.

Important to gather experience

For Thorben Simonsen, it was important to examine the pitfalls of healing architecture with a great deal of thoroughness. Empirical knowledge in this area is limited.

“I’m not an architect, and so I don’t have all the answers to these challenges. My job has been to observe the behaviour of patients and staff in practice. And it’s important to gather practice experience, because healing architecture is a relatively new concept without a fixed definition,” he says, adding:

“Everyone agrees that the concept of healing architecture sounds great. However, I believe that there are clear limits to the healing effect of particular architectural concepts. In fact, more important to the health impact is how the spaces end up being used in reality, where the very different needs of staff and patient groups must be taken into consideration.”

>> Read interview with architect Christian Karlsson

Interview with PhD Thorben Simonsen from Copenhagen Business School in Troldtekt online feature about healing architecture

PhD Thorben Simonsen, Copenhagen Business School.

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