Taking care in the community – Cygnet Hospital, Coventry

For Tangram Architects, a new mental health unit for women on a constrained but high-profile urban site in Coventry required careful handling and expertise to get the balance right. James Parker reports.

Cygnet Hospital Coventry is a new 56-bed facility located on a tight urban site 1 km east of Coventry city centre, offering a range of specialist mental health services for women. The hospital is run by independent provider Cygnet Healthcare, which works “in partnership with the NHS, Clinical Commissioning Groups and local authorities,” and for whom specialist healthcare architect Tangram has designed several mental health schemes.

The building includes a 16-bed Psychiatric Intensive Care Unit (PICU) plus a 33-bed rehabilitation service which has the aim of preparing service users for independent living in the community once they leave the PICU. This includes a seven-bed ‘Transitional Living Unit’ where users have their own facilities for washing
and cooking.

The ‘care pathway’ typically begins with service users admitted to the low secure unit-designated PICU located in the L-shaped Dunsmore Ward on the ground floor, which provides 24-hour cover assessment, treatment and support for women in crisis, together with its own adjacent locked rehabilitation area. The aim is that following a risk assessment they will move as soon as possible to the 16 bed locked rehabilitation unit above the PICU on the first floor, or the locked (but lower-security) rehabilitation unit (Middlemarch Ward), offering 17 beds on the ground and first floor of a linked, adjacent building.

The locked rehabilitation service offers what Cygnet Healthcare calls an “extremely wide range of therapies” and tailor-made rehabilitation programmes in collaboration with carers and local teams. There is also a Personality Disorder Unit on the first floor offering a range of therapeutic interventions such as Dialectical Behavioural Therapy and Schema Focused Therapy.

The ‘pathway’ concludes with the Transitional Living Unit found on the second and third floors of the linked build- ing also housing the ground / first floor locked rehab, with seven individual, self-contained flats. With staff support tailored to each service user’s need, the facilities in this area have been designed to increase their chances of successfully reintegrating

into the community upon discharge. Despite the aim of providing a greater degree of independence, the normal security provisions you would expect are present, as David Whitehead explains: “There is still anti-ligature ironmongery and anti-barricade doors to minimise risks wherever possible.”

A narrow gateway

Director at Tangram Architects David Whitehead describes the site as “quite complicated,” and it certainly had its challenges, its 1.3 acres hemmed in by terraced Victorian housing to the north and east, and major arterial road Sky Blue Way to the south. Beyond squeezing 56 beds plus the normal support spaces and a gym onto this brownfield site, there was the separate challenge of installing a sensitive psychiatric unit in a prominent, urban location without compromising residents or service users.

Project architect Alex Smith says: “The site is very complex, some of the mental health schemes we work on are on greenfield sites, and they have their own constraints, but it’s not like a building in the middle of an urban context.” Despite the challenges, the relatively prominent nature of the site for such a development was embraced by Coventry council’s design officer, which in turn gave Tangram more scope to design a distinctive building that was fit for its varied purposes. David Whitehead: “As the proposal was located on the main arterial road and was therefore a gateway site for Coventry, the design officer to make something special here – a landmark building.”

Broken form

Tangram sought to break down what might have been a monolithic building on this constrained site, by creating a series of sloping forms linked with green roofs and terraces. Combined with this, the architects also embraced the notion of the building being a ‘landmark’, graduating the rooflines up from two stories to three towards the highly visible corner of the site on Sky Blue Way. This change in gradient takes the rhythm of the terraced housing behind the hospital up to a scale which will compete with more substantial buildings on this main road and “create some grandeur” as David Whitehead puts it. “There are a number of large-scale buildings adjacent to Sky Blue Way, such as the university halls of residence,” adding: “In order to compete with the scale of these buildings the build-ing had to punch above its weight.”

The gymnasium sits at the centre of the site between the square shaped building housing PICU, locked rehabilitation and administration at first floor, and the more rectangular locked rehabilitation and transitional living unit. This provides a major element of its visual impact in this prominent location, with a butterfly roof clad in translucent Rodeca polycarbonate cladding which gives the gym a night-time glow when activities are taking place inside. As Whitehead says, “It sort of acts as a lantern, it’s a focal point of the site. Smith adds: “It used to be a tired and overgrown piece of hard-standing and now it has something beautiful on it, and the ‘lantern’ acts as a beacon for the building.”

The brise soleil and window surrounds also help the building tie in visually with the bay-windowed red-brick housing. The cladding mix is partially brick and partially a complementary Trespa rainscreen panel which further ties in with the local vernacular, along with rendered blockwork.

Windows, provided by Crittall Fendor, all have “embedded security measures,” now typical of mental health schemes and are a mix of sliding windows and fixed, in various size and heights, and taller at the ground floor to maximise daylighting. Smith says: “It’s an interesting mixture without overdoing it – we have created some characterful elevations, and importantly the service users have control over opening their own windows.”

Next to the gym is a “therapeutic and service-user led space” consisting of a hairdressers and beauty parlour. As Smith says, “You need some joy in the building too, avoiding an institutional feel without adding risk.”

Ward design & security

The ward layout reflects best practice design accumulated over many years in mental health care and which Tangram hones and optimises for clients, from linear, and T-shaped to space-efficient L-shaped wards – as have been adopted here. Whitehead says although the client Cygnet “likes the L-shaped ward, as it gives them a central nurse station with good observation across the day space and bedroom areas,” during the design process they “still come back with comments and we enhance the layout from there.”

He adds: “the L-shape allows you to enter the ward from the corridor and this spine of circulation also accesses the ancillary and support accommodation. It suited the site and allowed us to join the dots.”

Each ward has a seclusion suite – including the seclusion room itself plus an
en suite, a sitting room and an adjoining external space – on the ground floor walled courtyards but on the first floor a terrace.

Within a unit of this type, despite its generally low-secure nature, security and means of escape in a fire remain key design drivers alongside creating therapeutic spaces. Therefore as well as getting the clinical adjacencies correct within wards, means of escape need to always be carefully thought through. An established concept of creating a ‘secure line’ was used, meaning areas within this secured perimeter allowed free movement of staff and service users avoiding the need of having to go through the secure line ‘airlock.’

Whitehead explains further: “The client wanted one of the locked rehabilitation wards adjacent to the PICU within the ‘secure line’, which also includes the tribunal services therapy and interview rooms and the gym.” By contrast, the locked rehabilitation area over two stories (ground and first) is slightly lower risk, so this and the transitional living unit sit outside of the secure line.

External therapeutic space

Although there is a park opposite the site, across what is a busy main road, due to the constrained size of site the architects “didn’t have a great deal of options for soft landscaping” beyond a small garden at the back. Staff can allow service users to access this as part of ‘grounds leave’ whereby they are able to use landscaped areas.

It was a key design goal to provide direct access to outside space for all wards to benefit patients, however while it was relatively simple to create walled courtyards on the ground floor, how could this be achieved for the locked rehabilitation unit on the first floor? The answer was to create a substantial 120 m2 terrace, which also contributes to the aim of breaking up the building’s facade, providing visual separation between the two buildings.

The terrace was created to be a warm roof for the day space beneath, with the attendant thermal benefits this offered. According to Smith it “is reminiscent of a Mediterranean courtyard setting.”

The design of the terrace also had to navigate the balance between providing a feeling of openness while also ensuring the area was not overlooked. David Whitehead:

“We tried really hard to avoid people overlooking into the terrace but also provide some kind of a view out. So we have a timber slat and polycarbonate sheet detail to the walls of the terrace, which are designed to be anti-climb and anti-ligature but hint at transparency.”

Smith explains further how the issues of potential overlooking from neighbours have been considered generally across the site: “Where possible, service user rooms have been located sympathetically to avoid direct overlooking.”

Ceilings, clashes & BIM

Tolerances in the design became challenging in instances where the structure, M&E services and the architecture were fighting for space, and BIM was employed to help alleviate this. HBN guidance for secure environments requires 3 metre ceiling heights in service user areas, but in a steel framed building this can be difficult to achieve in all areas.

Tangram’s David Whitehead explains:

“With a steel framed building, you tend to get clashes with services, but we worked them out ‘the best we could’ using clash detection software and BIM techniques.” Where these clashes were unresolvable, he says it’s about “working out carefully where you can have dropped bulkheads below the 3 m height, whilst remaining compliant.” Smith adds: “We have coffered the ceilings in service user day space areas to provide routes for services, and it helped create a sense of space and interest to the ceiling scape in these areas, providing both an attractive as well as compliant solution.”

Whitehead adds that one aspect of the building’s interior, that of the bespoke fitted furnishings (by Taurus) was beneficial because it made it possible to work around some of the “inevitable small intrusions” of the steel frame. He says this was particularly helpful in the bedrooms.

The bedrooms have been designed in pairs, with a central services riser. Whitehead says that in the 12 years the practice has been working with Cygnet, the client has moved from highly serviced buildings with full comfort cooling, to an approach much more orientated towards natural ventilation.

He says the “middle ground” ventilation approach at Coventry had implications in terms of accommodating it within the frame: “There was a significant amount of plant to get through the steel frame. It was a challenge, however using BIM helped enormously. Structural engineer BSP modelled the frame in Revit, we modelled the building in Revit, and we could align the two.”

The building was designed to be BREEAM ‘Good’, however this meant that “eco-bling” as Smith puts it, such as solar PV, was not required. He says:

“‘Good’ still demands a certain thermal performance, and we used A+ materials. We looked keenly at construction methods for rainscreen, roofs, floors and insulation.” An attenuation tank was also provided under the car park for surface water run off from the roofs, and efficient boilers were employed. Experienced in working with BREEAM accreditation, Tangram are currently targeted to deliver BREEAM ‘Very Good’ on another project with Cygnet Healthcare in Maidstone in Kent.

This fairly complex and sensitively designed building is also a striking example of how such psychiatric facilities can be carefully integrated into more prominent urban sites than previously seen in many cases. The expertise of Tangram, especially when novated in a Design & Build contract as they were in this case (to Clegg Construction) was critical to the building’s success. As its architect Alex Smith asserts, the practice’s role was to bring rigour not only in the initial design but also once novated:

“We are there to help and where possible, working the client-side project managers, maintain design integrity.”

PROJECT FACTFILE

  • Client: Cygnet Healthcare Architects: Tangram Architects
  • Structural engineers: BSP Consulting Structural Engineers
  • Client side M&E: Harniss Engineering
  • Project management: Fed3 Projects
  • Start on site: September 2015
  • Completed: February 2017
  • Number of beds: 56

SUPPLIERS

  • Internal doors & ironmongery: Kingsway Hunter Doors
  • Windows & curtain walling: Crittal Fendor
  • Carpets: Danfloor
  • Sanitaryware & taps inside of service user areas: Dart Valley
  • External paving: Marshalls