Good architecture brings lower levels of violence in psychiatric care

Aggression linked to psychiatric care is on the increase and represents a serious and global problem. On average, every patient is involved in over two (2.24) violent incidents during their time in care. Over a third (37 percent) of these results in physical harm to staff.

In Sweden, it is estimated that 85 percent of psychiatric care staff have been subjected to physical violence during their professional career, and 57 percent have been subjected to physical violence during the last 12 months.

"When we design buildings for psychiatric care, an important goal is to help reduce aggressive behaviour," says Roger Ulrich, visiting Professor of Architecture at Chalmers University of Technology. Examples of good design which help to achieve this goal include single-patient rooms, which afford patients privacy, and access to a garden and the stress-reducing effects of nature.

Other examples of design which reduce levels of aggression include a subdued sound environment, and moveable furniture in day rooms and other common spaces which let patients control their proximity to others.

"The aim is to minimise environment-related and psychosocial stressors which can lead to aggression," says Roger Ulrich. "Crowding and noise should be avoided. The environment should give the patients control, and access to enjoyable distractions, such as a garden.

Up to now, however, there has been a dearth of research to support this hypothesis. A study carried out at Östra Hospital in Gothenburg, Sweden, has now enabled researchers at Chalmers and Gothenburg University to demonstrate the validity of the argument. A new psychiatry building opened at this hospital in 2007. Unlike the old psychiatry building, the new building has almost all the environment-related features which are thought to reduce patient stress and thereby lower their levels of aggression.

The findings show that coercive measures in the form of belt restraint and injections were reduced by 21 percent and 44 percent respectively in the new building, compared with the old building. In the same period, the researchers also studied a control hospital which did not undergo renovation. At the control hospital, the number of injections increased by 29 percent.

"This has provided scientific evidence suggesting that well designed medical architecture can help reduce aggression and violent situations within psychiatric in-patient care," says Roger Ulrich.

The findings were recently presented at the first Swedish conference on medical architecture, which was held at Chalmers recently. Other findings presented at the conference include evidence of the benefits of single rooms in the care sector in general. Single-patient rooms reduce the spread of infection, give the patients peace and quiet, enable patients to speak to care givers without being disturbed, and increase the opportunity for interaction with relatives. This gives scientific weight to the conversion of buildings to create single rooms which is taking place at many hospitals.