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.”

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.

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

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.

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