The Reorganization of a Psychiatric Unit During COVID-19: A Reflection for Psychiatric Hospital Design

Abstract

Objective: The COVID-19 pandemic has impacted healthcare systems worldwide. Although this disease has primarily impacted general medicine intensive care units, other areas of healthcare including psychiatry were modified in response to corona measures to decrease the transmission of the disease. Reflecting on the modifications to the environment provides an opportunity to design psychiatric environments for future pandemics or other demands for healthcare. Background: The therapeutic environment of psychiatric wards was modified in Friesland, the Netherlands, in response to COVID-19. During this time, an interdisciplinary team met consistently to contribute to the preliminary design of a new psychiatric hospital. Methods: During the first 18 months of the pandemic, clinical reflections were made to describe the impact of COVID-19 on the psychiatric care environment. Architects have created a preliminary design of a new psychiatric hospital based on these reflections, monthly collaborative design discussions based on virtual mock-ups and evidence-based design based on theoretical concepts and research. Results and conclusions: This theoretical and reflective study describes how an inpatient psychiatric environment was restructured to manage infection during COVID-19. The therapeutic environment of the psychiatric ward and patient care changed drastically during COVID-19. The number of patients accessing care decreased, patient autonomy was restricted, and the function of designated behavioral support spaces changed to manage the risk of infection. However, these challenging times have provided an opportunity to reflect on theories and consider the design of new hospital environments that can be adapted in response to future pandemics or be restructured for different care functions.

Seclusion and mechanical restraint in the wake of the COVID-19 pandemic: an increased use in mental health settings

“…In response, governmental authorities from the Canadian province of Quebec released an updated reference framework in 2015 that provides essential guidance on coercion reduction and outlines the proper application of seclusion and restraint [5]. However, COVID-19 pandemic-related restrictions have signi cantly changed the environment and the delivery of direct care in all health services, including psychiatric hospitals [6,7]. Describing restrictive practices use is complex since de nitions and medical records systems vary according to each country, which leads to heterogeneity in prevalence measurements [8,9,10].…”