How do you co-design a mental health facility?

Co-design at its very core is about bringing citizens and stakeholders together to design new products, services and policies.

In the design of mental health services and facilities, co-design requires that people with lived experience are equal partners with clinicians, staff and other experts and involved at every stage in decision making – from problem identification to design, development, delivery and evaluation.

When we talk about co-design we mean designing with people, rather than for them. It requires building relationships and building capability.

'Doing co-design means bringing together people with lived experience, professionals and other experts. It involves developing a shared understanding of the problem, defining the solution, and testing it.'
 

Mental Health Reform Victoria (MHRV)

Co-design is more involved and takes more time than a standard consultation process. Delivering the Mental Health Beds Expansion Program quickly is a priority, due to the critical shortage of hospital-based mental health beds identified by the Royal Commission into Victoria’s Mental Health System.

However, taking the time to co-design each of the four facilities was crucial – to both meet the Royal Commission’s recommendation and to ensure the future facilities are innovative, person-centred and responsive to the needs of consumers.

As the design phase for the four new facilities began, lead architect Codey Lyon from NTC Architects coordinated regular round-table workshops to ensure the design of the facilities were informed by its end users.

'What we did is get everyone at the design table – people with lived experience, clinical staff, research partners, capital representatives, consultants and the design team. Everybody brought their expertise, and the lived experience and carer voice had an equal value to that of an architect or a clinician. It was about making sure everyone felt valued in the process and that their voice was heard.'
 

Codey Lyon, NTC Architects

The workshops covered all facets of design for the four sites. From how the buildings were integrated and how the bedrooms were laid out, to what the shared spaces looked like and how the landscape could be designed to promote wellness.

Craig Wallace and Michelle Swann were two people with lived experience involved in the design workshops. As on-staff lived experience advisors at Mental Health Reform Victoria, their role was to ensure lived experience perspectives were at the centre of the design process.

Craig was able to draw on his significant experience accessing Victoria’s mental health system to provide lived experience expertise on the design of the facilities.

'Over 30 years, I’ve spent 172 nights in a mental health bed. That’s a fair bit of experience to draw upon, and these experiences are useful to make spaces and buildings work better. You can have a building created by architects, engineers and builders, and the person who is going to use it can walk in and identify issues straight away. By involving us early, we can get the design right. The people that use it, know what is needed.'
 

Craig Wallace, Senior Advisor, Lived Experience (Consumer), MHRV

As a long-time carer, Michelle was able to provide insights and feedback from the perspective of people who provide support to, or care for, people with mental illness.

'There are so many things that people don’t think about if they don’t have a lived experience. I’ve been a carer for a very long time – my mother has accessed mental health services – so I’ve seen a lot of bedrooms and hospitals.'
 

Michelle Swann, Senior Advisor, Lived Experience (Carer), MHRV

Over 300 people were involved in the design workshops. Workshops had different themes and focuses, so people with relevant expertise could attend.

At the start of each workshop, the team would go through how feedback and decisions from the previous workshop had been incorporated into the design.

‘People need to see that what they’re telling us is making it into the design. We track and action feedback and decision – we implement it, or we explain why we can’t implement it and open the conversation up again. The process is completely transparent,’ Codey Lyon says.

In the design workshops, participants based their decisions and feedback on 2D architectural drawings of the design.

However, one challenge was recognising that not everyone around the table had experience working with architectural drawings. It was challenging to visualise what the space looks like, how it would feel and how each space would fit together to create a cohesive, well-designed building. Compounding this was the virtual nature of the workshops, with each one conducted online due to COVID-19 restrictions.

To address this, and provide workshop participants with a greater opportunity to shape the designs, two immersive engagement approaches were used:

• a purpose-built prototype of a mental health bedroom
• a full-size projection of the floor plan.

'In a hospital, a bedroom is the one place that is yours for the time you are there; a place to rest in safety, to recover. This takes on a particular significance in mental health settings where bedrooms, though not the primary location for treatment and care, need to be a home away from home and your place of refuge. Designing mental health bedrooms that are at the same time safe and pleasant is a real challenge.'
 

Personal Space: Interior design approaches to mental health bedrooms (2011)

For the Mental Health Beds Expansion Program, getting the design of the bedrooms right was crucial. Each bedroom needed to be:

• home-like, with a comfortable, welcoming and private feel
• safe, allowing observation and meeting anti-ligature requirements.
• healing, following the latest evidence-based design research.

While these requirements were front of mind in the design workshops, the protype provided the opportunity to move beyond the 2D plans, so the space could be experienced in real life.

Modscape constructed a prototype bedroom at their facility in Melbourne’s western suburbs. The prototype followed the design specifications that had been developed in the workshops and included all of the design and safety features that might be delivered in the final product and the attached ensuite bathroom.

Design workshop participants were invited to visit the prototype, to experience the space and provide their feedback.

'The prototype allowed everybody to touch and feel the materials and to look at the quality of the fit-out. It also allowed us to capture how people felt when they entered the space. Did it feel safe? Was the bathroom private? Did the space feel supportive? What was missing? It also gave people an idea of how the colours and materials chosen would apply to the entire facility. It was a bite-sized piece of where we were going in the design process and what was going to be achieved in the design.'
 

Codey Lyon, NTC Architects

For Craig Wallace, seeing the designs come to life via the prototype was a vital part of design process.

‘The prototype gave a greater insight into how the room might feel if you were staying there. A floorplan or list of what’s in the room could only tell us so much – we needed to see how it all fit together,’ he says.

Experiencing the room in real life also resulted in some key design changes. Judith Hemsworth, Principal Design Advisor for Special Projects at the Victorian Health Building Authority, explains:

‘A bathroom door design was agreed upon in the design workshops, with a cut out at the top and bottom of the door. At the prototype, there was feedback that it didn’t fit in with the home-like design of the bedroom – it felt more like a toilet partition. A decision was then made to update the design of the door to remove the gap at the top, utilising a weight senor strip instead to ensure the door remained safe. That way, it felt more like a standard door,’ Judith says.

The project team gathered feedback from participants throughout their tour of the prototype. Participants were also asked to complete a survey at the end, ensuring their feedback was captured correctly and in detail. An online survey, supported by videos, was also available for stakeholders who were unable to make it to the physical prototype.

Overall, the feedback on the prototype was positive – with participants surprised by the quality and healing feel of the bedroom.

'The prototype looked a lot nicer than any room I’ve been in. The times I’ve been in hospital in the public health system, this room far surpasses those experiences. Particularly on the homelike, healing environment – rather than a harsh environment with polished floors and metal beds.'
 

Craig Wallace, Senior Advisor, Lived Experience (Consumer), MHRV

After visiting the prototype, the next step was to look beyond the bedroom and at the whole building. To understand the scale, how each room flowed into the other, and how the building would connect with outdoor space with outdoor space.

The project team partnered with Melbourne company Big Plans to project the architectural plans of each site full scale onto a large white floor using overhead projectors. This allowed the design workshop participants to walk through full-scale floor plans of the new facility.

'Big Plans served a very different purpose to the prototype. It went beyond the room and allowed participants to understand the scale of the whole building and the relationships that spaces have with each other.'
 

Codey Lyon, NTC Architects

Participants could move around the layout, testing the spatial practicality of the design. They were also able to use iPads to view the layout, interiors and sightlines in 3D.

Following the prototype and Big Plans, workshops continued as feedback and changes were incorporated into the designs.

A final online survey was offered to health service staff, recognising that operational requirements and coronavirus (COVID-19) restrictions meant that not all staff were able to attend the prototype and Big Plans consultations.

Detailed floorplans and renders gave staff a sense of the project, and their feedback was incorporated into the design process. Designs were released in March 2021 – providing an indicative look at the exteriors, grounds and internal fit-outs for all four of the new facilities.

Lendlease Building has been appointed as the managing contractor for the program. Construction of the buildings will be a combination of modular design solutions and traditional construction and refurbishment, with works set to begin in mid-2021. All four facilities are expected to be operational by 2023.

While the co-design process has been complex and often challenging, the result will be four new acute mental health facilities shaped by the people who use them.

By putting people with lived experience at the centre of designing and delivering the Mental Health Beds Expansion Program, we can ensure that these facilities meet the needs of people who have experienced mental illness – and those who care for them.

'I think people are sometimes reluctant to involve people with lived experience because they think it’s going to be messy and take longer – and those two things are true. It is messy and it does take longer, but it results in a better product or outcome at the end.'
 

Craig Wallace, Senior Advisor, Lived Experience (Consumer), MHRV

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