Architects have designed a therapeutic environment specifically for patients with severe autism after permission was granted for a £2m facility in Caterham.
Construction of the building will begin later this year as part of Surrey and Borders Partnership NHS Foundation Trust’s estate modernisation programme.
The new unit, which will be known as Grandview, will replace an outdated facility at Oakland’s Hospital, providing residential accommodation for vulnerable male adults with severe autistic spectrum disorders who require 24-hour support from specialist clinical staff.
Speaking to BBH this week, Mark Nugent, project lead at Medical Architecture (MA), which has been commissioned to design the scheme, said the very special nature of the condition was central to the designs.
The building has to cater for a wide range of requirements and, while it has to meet the needs of a very specific group of people, it also has to be quite generic as the idea is that people will move on and someone else will move in
“What was very important was the early briefing process,” he said. “It quickly became apparent that the autistic spectrum of disorders covers such a wide range of symptoms that no two patients experience the same condition. This means the building has to cater for a wide range of requirements and, while it has to meet the needs of a very specific group of people, it also has to be quite generic as the idea is that people will move on and someone else will move in.”
To facilitate this progression, the building has three very distinct areas. There are four single bedrooms with shared communal spaces; two intermediate flats with their own private gardens, living spaces and small kitchens; and one independent flat, which is designed to feel separate to the rest of the building and to provide greater autonomy for residents before they move on into the community.
“The idea is that a range of accommodation types can offer different levels of support to suit the specific care and rehabilitation needs of each resident,” said Nugent. “In the intermediate flats, patients can choose to spend time in their own private gardens where they do not have to socialise, but if they want to socialise, and staff want to encourage this, there are areas where they can interact and mix with other people.
“For the independent flat, we have orientated this away from the rest of the unit and towards adjacent woodland where a footpath winds through the trees to provide a separate dedicated entrance, while a discrete link allows easy staff access to and from the main facility. The intention is to encourage a feeling of self-sufficiency and to provide residents with their own space where they can receive visitors and prepare for life outside of the facility.”
MA’s popular ‘courtyard’ design forms the basis for the scheme, increasing the amount of circulation space compared to traditional buildings.
The intention is to encourage a feeling of self-sufficiency and to provide residents with their own space where they can receive visitors and prepare for life outside of the facility
Nugent explained: “During early discussions we watched how the current facility was used and it quickly became apparent that patients were sitting in corridors and circulation spaces. These were very important parts of the building for them. The patients like to feel secure and to find a niche or cubby hole somewhere, but they also want to be able to monitor the activity going on around them and throughout the rest of the building. This made us think about circulation spaces as somewhere more than just a corridor or means of access.
“It is always very difficult for clients to justify allowing that much circulation space in a development and when you have a courtyard design such as this you do have to increase the amount of circulation space anyway in comparison to other schemes, towards 50% of the activity area and just over 30% of the whole building footprint. But, in this case, it is a very important part of the therapy and has helped with the overall design.
“The whole facility benefits from an acceptance that corridors provide much more than just circulation routes and the development of an architectural response to residents’ very special requirements has led to an improvement in the overall quality of the therapeutic environment.”
The whole facility benefits from an acceptance that corridors provide much more than just circulation routes and the development of an architectural response to residents’ very special requirements has led to an improvement in the overall quality of the therapeutic environment
Interior spaces will be orientated towards a central courtyard garden, which allows generous amounts of natural daylight and ventilation, with clear sight lines to enable staff to monitor patients from a discrete distance. This encourages independence as residents do not require a staff escort to use the external space.
As the building will be situated within a housing development, the idea is to emphasise the building’s domestic nature using appropriate scale and materials, moving away from any institutional connotations and resembling instead a modern country house.
Inside, the colour palette is neutral and designed to calm rather than stimulate the senses. Nugent said: “The autistic spectrum of disorders includes both hyposensitivity and hypersensitivity. Some patients are overloaded with sensory information, while others struggle to feel these sorts of senses, yet the same environment has to accommodate both groups.
“Bright lights, reflective surfaces and high patternation can be extremely unsettling for the hypersensitive, while surfaces that have specific acoustic or tactile properties may be subjected to significant wear or damage from repeated use by hyposensitive residents seeking sensory stimulation.
“In the building we will be using more natural visual stimulants, provided through natural elements in the courtyard and outside world, which can be controlled so that if a patient finds it upsetting it can be screened off and their focus diverted. It will be very much about neutral colours and sound dampening to reduce reverberation.”
He concluded: “For an architect, this project is a very interesting challenge as we are designing for a very specific group of people, but a group with very different individual needs. It is a very fine balancing act to ensure that when one person moves on, the space is going to suit the next person, who will have a very different set of symptoms and needs, but we feel we have achieved this with the design for Grandview.”
The building will be constructed by Laing O’Rourke.