A refreshingly different view of mental health

Suburban Liverpool is home to a highly praised example of the new generation of sophisticated mental healthcare facilities that are emerging across the UK. Ray Philpott explores how its design contributes to a better patient experience.

Clock View Hospital in Walton represents a step-change in improvement to mental healthcare in the North West of England.

Located on the site of the now demolished Walton Hospital, the 80-bed, five-ward facility has been designed by the architects at specialist practice Medical Architecture.

Taking its name from the old hospital’s fully renovated Grade II listed Clock Tower, it provides emergency and inpatient care for people with mental health issues including dementia, anxiety and depression.

Carefully designed to foster recovery and well-being, with input from user groups, it is essentially a sequence of low pavilions with semi-private and secure gardens interlinked by more prominent treatment rooms and offices.

Patients benefit from en-suite, individual rooms in a complex that maximises natural light, contains its own unique and original artwork and features attractive inner courtyards and attractive landscaping.

More than 200 people work at the £25 million hospital, which has attracted positive comments from politicians, journalists and celebrities.

User engagement
Medical Architecture had been evolving the project for many years with clients Liverpool and Sefton Health Partnership (LSHP) and Mersey Care NHS Trust, as part of a drive to upgrade and replace outdated mental healthcare facilities in the area.

Work leading to business case approval commenced in 2009, with planning approval granted January 2011. Main contractor FHJV, a joint venture between Farrans and Heron Brothers, completed the work in 22 months and Clock View opened its doors last year.

Mersey Care took a highly proactive approach to user involvement in design development, with carers and user representatives contributing to the design team and arts group meetings.

“This approach was highly significant in guiding the development of both the planning strategy and building design,” says Medical Architecture founding Director Christopher Shaw.

“The user/carer viewpoint gave us a real world outlook, adding authenticity to design features and grit to some of the value-engineering. More subtly, a user presence ensured the design team made technical decisions that could be both understood and justified.”

He adds:

“We worked closely with Mersey Care and its Clinical Project Director, Modern Matron Noirin Smith, which meant resolution of detailed design went hand-in-hand with service and operational planning.”

Working with clinical users to agree final room and equipment layouts took many months longer than planned but were pivotal in building a sense of ownership.

Materials and structure
There were continual capital and revenue cost pressures on the project. Mechanical and services engineering systems were greatly simplified and planned photovoltaic and solar thermal systems were too costly.

The central ventilation plant with heat recovery was reconfigured to a hotel-like arrangement with individual vents and no recovery. The planned green roof was omitted and single-ply membrane used.

However, the planned building fabric cost effective and resilient, super-insulated timber panel cassette system was retained.

Dry construction using off-site timber panels and metal studwork for internal partitioning – combined with in-situ concrete – provides robustness and acoustic performance while allowing fast construction and an early first-stage mechanical and electrical fix.

The main entrance features deep structural veneer laminated (SVL) timber spandrels with curtain walling. The external finish is white acrylic render, this is low maintenance and maximises the reflection of daylight in courtyards. Solid hardwood windows punctuate the elevations and add warmth and a non-institutional feel to the design.

Site challenges
The site had been occupied by redundant medical buildings and, although well located, it posed a number of challenges for the architects.

It is fairly constrained for the car parking and accommodation required, while the L-shaped site geometry made organisation awkward. The change of level across the site, with a large in-situ concrete retaining structure already existing at the rear, limits the aspect. It also has an unprotected boundary on two sides destined for future residential use.

In response, the design evolved from a building of separate elements to a linked pavilion-type layout. It has a single, controlling entrance point going into a two-storey spine that connects the single-storey pavilions. The spine contains central facilities, offices and shared therapy areas and also encloses the retaining structure at the rear of the site.

This provides opportunities for standardised layouts while offering a degree of customisation for different care groups. Other advantages include:
• residential wards separated from therapy spaces to encourage meaningful, self-directed activity
• garden spaces between buildings
• maximum natural light on the floor plan
• familiar, residential-scale, single-storey ward pavilions with ‘front doors’

Distribution routes for food and linen are external, albeit under sheltered cloisters to reduce floor area, and provide a degree of separation between patient and service flows. The 17-bedroom wards are in back-to-back pairs where possible to enable reduced staffing during evenings and weekends.

Interior design

“Psychiatric hospital interiors are too often the product of unmoderated risk management that can result in a joyless and institutional setting,” says Shaw.

“Interior design makes a huge difference to the quality of experience for patients, staff and visitors. It embraces safety, communicates a professional caring ethos and gives a sense of self-worth and dignity to service users and healthcare professionals alike.

“Design quality and the inclusion of art became increasingly strong drivers.”

Landscape Architects Camlin Lonsdale worked alongside Medical Architecture’s landscape team to provide a thoughtful and enjoyable group of therapeutic garden spaces.

An arts initiative, co-curated by the Trust’s Berenice Gibson and Tate Liverpool, devised a creative brief with the aim of embedding works in the environment rather than applying them as an afterthought.

Artists David Mackie and Heather Parnell were selected to develop a number of works for the project. Cargo-themed images reflecting local maritime heritage are closely woven into the design and feature prominently as one moves through the building.

Shaw adds:

“Furniture and fittings were selected at an open day organised by the Medical Architecture interiors team at Aintree. Manufacturers were invited to exhibit modern, friendly and non-institutional furniture for those who were to work in the building to select. The results speak for themselves.”

Welcoming entrance
Clock View was conceived as a beacon, acting as a catalyst for the regeneration of a run-down part of town, and stands in complete contrast to its surroundings – highly visible, bright and clean.

The placement and design details of a hospital entrance make a vast difference as to how mental healthcare relates to the individual user, visitors, people who work there and, more broadly, to the whole community served.

Clock View’s entrance acts as a lantern, illuminating the approach. Recycled dockside granite benches with thoughtful embedded bronze settings by Mackie and Parnell provide reassuring stepping stones on what may be a very difficult personal journey toward the entrance and form an intrinsic part of the recovery pathway when leaving.

“First impressions really matter,” explains Director Bob Wills, Medical Architecture’s project lead. “The relationship between individuals and their health service is pre- conditioned by the arrival experience before meeting any receptionist or clinician.

“In the case of mental health this is doubly important, given the debilitating stigma surrounding mental illness.”

With almost 70 per cent of recorded assaults against NHS staff occurring in mental health or learning disability settings Medical Architecture incorporated design features aimed at significantly reducing the potential for violent incidents.

The architects used spatial form, along with calming daylight and views, to reduce stress. The environmental design prevents overheating and provides pockets of cooler spaces, while dead-ends have been eliminated. Carefully designed acoustics with attractive and varied finishes minimise anxiety.

Effective space
In design for mental health there is sometimes a natural tension between orthodox clinical planning and good design when it comes to circulation.

Movement and transition space in mental health is functional. Working closely with the client, the design team has been able to achieve the right balance of dedicated activity space and purposeful circulation.

The hospital features circulation with rooms on one side only and windows with a view. This has recently become the norm as the benefits of a therapeutic setting have become valued. Furthermore, the hospital’s ring-shaped circulation layout leads to ward staff being immersed in the patient setting rather than controlling from a single observation point.

Gardens and courtyards are an essential element of the therapeutic environment. Safe and self-directed access means the range of activities and quality of experience can be widened, speeding recovery.

Wills says:

“A carefully shaped landscape provides for a range of activities and therapies reducing the sense of containment and fostering wellbeing. We believe Clock View provides a stunning example of positive interaction between landscape and buildings to support better mental healthcare.”

He concludes:

“Ultimately, at every level we have strived to ensure the hospital’s design enhances the experiences of patients and the staff who care for them.”