Architecture, Landscape Therapeutics, and Health
The Context: Due to their size and complexity, most healthcare environments are virtual islands, disconnected from their surroundings amid a sea of urbanity. This condition denies genuine connectivity with green spaces that could otherwise aid therapeutically in healing patients and improving the day-to-day experience of families and staff. The presence of green space interwoven holds the power to improve occupants’ morale, attitude, and overall disposition. Too often, hospital exteriors appear fortress-like, uninviting. This occurs both by design as much as by default, resulting from ineffective or insensitive campus master planning and from over-expansion, often, across decades. The immense megahospitals of the late 20th century were conceived and built in a manner that isolated patients from the natural environment. These complex structures cut building occupants off from the therapeutic affordances of natural daylight and ventilation, and from the many benefits of landscapes and gardens. A growing body of empirical research evidence strongly suggests that patients, visitors and staff experience environmentally induced stress in sensory-deprived architectural settings due to one’s lack of control, combined with and insufficient connectivity with the exterior world. These adverse outcomes are associated with a lack of engagement with nature in healthcare facilities.
Salutogenic Environments: Poorly designed healthcare environment consume valuable former open green space, including gardens, lawns, and open vistas, and destroy once-interesting views. In the most unfortunate cases, successive waves of expansion result in windows and views overlooking nearby walls, and parking decks. Such conditions are counterintuitive and counter-therapeutic to the ideals of a physical, salutogenic-healing environment that would otherwise aim to celebrate and promote the presence of nature. A major shift is underway in the healthcare campus planning and landscape architecture discourse. This movement rejects excessive hospital campus densification, not unlike excessive suburban sprawl. This movement draws upon 19th century precedents, and holds the promise of healthier places than at present.
The Thesis: I coined in 2010 the interdisciplinary concept of theraserialization to define a hybrid assemblage of the terms ‘therapeutic’ and ‘serialize.’ This concept provides a promising ‘best practices’ alternative to the status quo. It defines a continuum of indoor to outdoor space consciously designed in support of biophilic environmental design principles. It is about creating spaces that are consciously serialized in function and with regards to their sensory and cognitive affordances—by means of layering, collage, superimposition, and genuine transparency.
It is about the provision of sequenced spaces from the most highly public areas such as parking and main entrance approaches, to the interior main arrival lobby, to corridors throughout the entire facility that open up to and from corridors, gardens, and which afford views outward from semi-private spaces—and ultimately the quasi-private aesthetic realm of the inpatient room. The aim of this studio will therefore be to explore the functions of design in eradicating counter-therapeutic spatial conditions with regards to patients and families and staff, to foster more direct, sustained involvement with nature as a means to reduce stress and fatigue. In this studio, landscape architecture students will collaborate with architecture students throughout the term.
Learning from CAMH: The Centre for Addiction and Mental Health has its origins in the Provincial Lunatic Asylum that opened on Queen West Street in January of 1850. In the intervening decades CAMH and its predecessor institutions have sought to meet the mental health needs of a continually growing urban area and region. The organization is committed to remaining at its Queen West campus and is in the midst of a comprehensive, phased redevelopment initiative that is to be completed in about 2020. In addition, CAMH operates a state of the art outpatient clinic in Liberty Village. We will learn from CAMH’s past and its present facilities, drawing from its history, as a case study. To do this we will analyze its future goals for the main campus, the campus on College Street, and the Liberty Village clinic.
Studio Structure: The course will consist of two phases:
- A literature review on the topic of environments for mental health. Simultaneously, we will be interacting with CAMH staff, learning about the organization’s history, and learning about its current facilities with the aim of critiquing its master planning process together with recently completed buildings (Weeks 1-3). This will occur in tandem with precedent analysis, internal functionality studies, and a site analysis workshop.
- Architecture for mental health will be explored, based on the design of a 24/7 care and treatment environment that challenges the status quo regarding this rapidly evolving building type. A comparative site analysis/selection process will (at this point your site is to have been be selected—Week 4) be followed by the design of a 25-bed inpatient/outpatient mental health centre (Design Phase—Week 4 to end of term).
Testable Hypotheses: Theraserialization is expressed as a continuum of landscape-to architecture (and vice versa) fluidity. Transparency, as examined by architecture theorists, denotes continuous spatial sequencing, the blurring of demarcations between interior and exterior realms. Twelve hypotheses, or design considerations, will be ‘road tested.’ Each is derived from recent research, including a recent study of hospital outdoor environments. Collectively, they express a conceptualization of salutogenic space, i.e. to at once ‘be therapeutic’ and ‘to serialize’ within a continuum. Baseline hypotheses are: hierarchy of landscape realms, courtyards that breathe, vertical cutouts and hanging gardens, positive outdoor spaces, micro-landscapes along light wings, cascading roof terraces, transparent movement arteries, landscaped arrival zones, dematerialized boundaries, atrium gardens and green lightwells, half-hidden gardens, and framed views of nature. The studio’s activities will be reinforced and supplemented by field trips and interesting historical and contemporary readings.