PART II. RESEARCH FOCUS

CHAPTER II.1 RATIONALE

The early and widely used lunatic asylums, the treatment of patients/inmates was brutal and

focuses mainly on containment and restraint. Psychiatric hospitals have evolved as successive waves of

reforms were introduced. However, psychiatric care in the Philippines especially in terms of facility was as

if frozen in time, based on the research methodology conducted on the previous chapter of the research.

Modern psychiatric facilities starting to introduce evidence-based treatments that emphasize on curing

with the use of combination of psychiatric drugs and psychotherapy.

Authors and professionals criticize the outdated design of the facilities. Psychiatrist Thomas

Szasz insisted that Mental Institution and Prison or any detention facilities are identical to each other,

medication and nursing staff acts as if a judge and jailers. A book entitled Madness and Civilization was

an instrument used to criticize psychiatric facilities, the author was the French historian Michel Foucault.

The three mental disabilities that will be focused by this study are Mood Disorder, Substance

Abuse Disorder and Schizophrenia.

MOOD DISORDER

A psychological disorder distinguished by the elevation or lowering of a person's temper, such as

depression or bipolar disorder.

CLASSIFICATIONS:

1. Depressive Disorder

2. Bipolar Disorder

SYMPTOMS

1. Thoughts and attempt of suicide

2. Loss of interest in activities that were pleasurable in the past

3. Unyielding anxiety, sadness or feeling of emptiness

4. Feelings of worthlessness, helplessness or guilt

5. Prolonged periods of elation

6. Restlessness

7. Irritability

8. Feelings of grandiosity

9. Impulsive, risky or hedonistic behavior

TREATMENT

1. Medication

2. Psychotherapy

3. Family Therapy

4. Elimination of environmental stressors

SUBSTANCE ABUSE DISORDER

People with addiction to certain illegal drugs can experience one or more symptoms of a mental health

problem. Sometimes leading to alcohol or drug use are caused by mental health problem, misuse of this

substances for some people diagnosed with mental disability as a form of self-medication.

BEHAVIORAL CHANGES:

1. Lowering of attention in school

2. Frequently getting into trouble

3. Using substances in physically hazardous situations

4. Engaging in secretive or suspicious behavior

5. Changes in appetite or sleep patterns

6. Unexplained change in personality

7. Sudden mood swings

8. Periods of unusual hyperactivity

9. Lacking of motivation

10. Appearing fearful anxious or paranoid

PHYSICAL CHANGES:

1. Bloodshot eyes and abnormally sized pupils

2. Sudden weight loss or gain weight

3. Deterioration of physical appearance

4. Unusual smell on breath body or clothing

5. Tremors, Slurred speech, or impaired condition

SOCIAL CHANGES:

1. Sudden change in friends, hobbies and hangouts

2. Legal problems related to substance use

3. Unexplained need for money or financial problems

4. Using substances even though it causes problems in relationship

TREATMENT:

1. Rehabilitation

2. Medication

3. Support Groups

4. Talk Therapy

SCHIZOPHRENIA

Is a mental disorder often characterized by abnormal social behavior and failure to recognize what is real.

SYMPTOMS:

1. Hallucinations

2. Delusions

3. Disorganized thinking and speech

4. Social withdrawal

5. Sloppiness of dress and hygiene

6. Loss of motivation

7. Loss of judgement

8. Lack of responsiveness

9. Impairment in social cognition

10. Social isolation

11. Difficulties in long-term memories

12. Agitation

TREATMENT:

1. Medication

2. Psychosocial

3. Family therapy

4. Assertive Community treatment

5. Skills training

CHAPTER II.2 PRINCIPLES AND RELEVANCE TO THE STUDY

Maximizing the quality of medication not in a medicinal way but on the aspect of facilities

used by the patients, nurse, professionals and others involved. Research studies conclude that

environment can affect the healing process of patients.

The study will focus on the innovation of minimization of seclusion and restraints in mental

facilities, without compromising the security of other people using the same facilities. This is to maximize

the quality of healthcare getting by the patients with mental disabilities.

The study will also focus on the use of the concept of Maslows hierarchy of needs. This will be

used in the planning process of the facilities in the proposed complex. This concept will be used as a

motivational method which will help to hasten the recovery of the patients. The concept is to include the

curiosity of the persons to improve his/herself in order until he/she reaches the peak or the self-

actualization.

PHYSIOLOGICAL NEEDS

These are the most basic requirements of a human body. If these are not meant, the body will not

function properly and will be broken. These are the most important and will become the foundation of a

human body.

SAFETY NEEDS

After the most important needs or the physical needs, the second group would be the safety needs, a

mind where he/she will feel safe, comfortable and free. A satisfying surrounding.

This will include:

1. Personal security

2. Financial security

3. Health and well-being

4. Safety against accidents/illness

LOVE AND BELONGING

The third stage of human needs is Love and Belogings which involves emotions and feelings. If this is not

met, it can impact the individuals relationships in general, such as: Friendship, Intimacy and Family.

ESTEEM

After getting the acceptance of other people its for the acceptance of your true self. Self-respect is vital

for every individual. Imbalance of this level may result to individuals continuous seeking for fame or

glory. Which is not the answer the feeling of what they lack, this can cause individuals depression

because the feeling of failure.

SELF-ACTUALIZATION

Self-actualization or the final stage, this is the stage where you feel contented on all aspects of your life.

You are in a good state of mind and physical.

These principles will be a big help on the healing process of the patients. Applying a much

appropriate planning and design principles using these concepts and theory, will a big leap on the

modernization of the design standards of Psychiatric Institutions, not just in the Nation but in the whole

world. First, the minimization of seclusion and restraints, this will change the image of being a detention

facility, isolation rooms will not be seen any more as a punishment room, instead it will be seen as a

room for self-reflection. The facility will also promote self-dignity and self-reliance if this concept is

applied. The use of Maslows Hierarchy will boost the motivation of patients to heal faster. This will serve

as a challenge in order to get the self-actualization or being dismissed from the institution.

CHAPTER II.3 APPLICATION TO THE PROJECT

One of the planning principle used on this project is to design building based on the mental

disability of the user.

Architectural Solution:

Severe case of schizophrenia

1. Carpet Flooring

2. Carpeted Walls

3. High-ceiling

4. Neutral Colors

5. High, Unreachable windows

6. Open as much as possible

7. Small openings in doors for food and nurses monitoring

Mild case of schizophrenia/severe case of mood and substance abuse disorder

1. Family visiting area

2. Social Area

3. Group Therapy Area

4. Outdoor Environment View

5. Natural Light Exposure

6. Light Materials

7. Classrooms for Education

8. Recreational facility

Mild case of mood and substance abuse disorder

1. Privacy

2. Family visiting Area

3. Social Area

4. Group Therapy Area

5. Outdoor Environment

6. Natural Light exposure

7. Light Materials

8. Classrooms for education

9. Recreational Facility

The application of minimizing seclusion and restraints without compromising the security of

others is on the designs of all facilities used by the patients and their staff. Feeling of restraints and

seclusion is not just basically on the wards or isolation rooms, the patients can feel the inability to move

freely everywhere if its not design/plan properly. This is why design techniques all throughout the

building will be applied.

Innovative design approach to maximize the quality of healthcare the patients are getting in details:

1. Therapeutic Environment

The environmental surroundings can affect greatly on the mind of a psychiatric patients. A report

from The New York Psychiatric Institute stated that a large drop in number of patients needed to

be secluded when they occupied a new facility that has this kind of environment. Using this type

of design and consideration well promote individual dignity and self-reliance.

Therapeutic Environments must have this attributes:

- The usage of non-institutional materials which is lively, and a little bit of colors and textures. But

still keeping in mind the colors that might agitate the psyche of the patients.

- Natural lighting in all rooms.

- Outdoor views for every rooms, leading to outdoor environment.

- Providing a direct and easy access to secured outdoor areas.

- Sound insulations in private rooms which discussions are held like conference room, therapy

room etc.

- Rooms must be free from any unwanted noises.

- Giving patient own visual rights, controlling the views patients would see.

- Giving the control of his own decision on his private room as much as possible.

- Planning minimal walking distances, short and easily accessible planning.

- Signage for the patient knowledge of whereabouts, promoting self-reliance.

2. Aesthetics

A major factor on the institution public image and is a significant marketing tool. It will also

psychologically change the view of the public on metal institutions which is a detention facility.

Considerations includes:

- Use modern type of lighting systems, accessibility of natural lighting, indigenous materials.

- Soothing/calming colors and artwork.

- Awareness to details, color, scale and proportions.

- Wide and bright open public spaces.

- Comfortable nursing units and offices.

- Compatibility of the exterior faade to the surrounding environment.

3. Security and Safety

The possibility of suicide of patients is one of the main concerns of the facility. It must not create

openings for this type of accidents.

Security and Safety designs without resorting to confinement:

- Utilities devices to be tamper-proof.

- No clothes hook on shower rooms, and use of breakaway shower-rods and bars.

- Security of entrance and exits of staffs.

- Unbreakable glass for windows in bedrooms.

- Soft materials for walls like fiber-reinforced gypsum board.

- Elimination of all possibilities of self-injury in special features seclusion rooms,hardwares like door

knobs wil be eliminated.

- Solid material specified ceiling.

4. Green

The institution is serving for the healthiness and well-being of an invidual. The institution must

not only help individuals but also extends it potential on helping the well-being of the

environment.

This can change the image of mental facilities.

The use of Maslows hierarchy in the project will be on the site planning process. The proposal

will be a Mental Rehabilitation Complex composed of different buildings. Every building will have a

different approach on the design; the design of each building will reflect the 4 stages of needs in

Maslows Hierarchy of needs. And patients will start from the fundamental needs up to obtain the goal of

self-actualization or dismissal to the outside world.

For better understanding of the application:

The building will be design appropriate for their needs. For example physiological needs building will

focus on the fundamental needs of a patients, more on the survival needs and will be limited to that.

Mental Rehabilitation Complex

PHYSIOLOGICAL NEEDS

SAFETY NEEDS

LOVE AND BELONGING

SELF-ESTEEM

SELF-ACTUALIZATION OR OUTSIDE WORLD

Physiological needs will not have special facilities only available for example safety needs building like

entertainment are and the likes.

This method will motivate patients to recover faster in order to go to another building. Based on research

a patient driven by motivation is more likely to recover faster than other patients. This will also help

professionals taking care of them and giving medication because they can specialize on the different

stages of criticality of mental stability of the patients.

Therapeutic application

The gardens will be placed all around the the property especially adjacent to patient room. Garden will be overlooking on

all the patient rooms, to expose the patient on the natural environment. There wil be also visiting area on gardens to

maximmize the use of gardens.

Severe Schizophrenia room architectural solution detail

Mild case of Mood and Substance Abuse Disorder architectural Solution detail

OLD SITE DEVELOPMENT PLAN

REVISED SITE DEVELOPMENT PLAN

Detailed revisions of site development plan

-Decrease of parking slots, parking slots beside the opd and administration building will be replaced by outdoor recreation.

Detailed revisions of site development plan

-Decrease of parking slots on the rear side of educational and recreational building

Detailed revisions of site development plan -Replacing of parking slots near the two nursing buildings into garden. Patient rooms will be overlooking to gardens.

Old plan of Educational and Recreational Building

-

Revised plan of Educational and Recreational Building

Detailed revisions of Educational and Recreational Building - Placing of Nursing Station in canteen

Detailed revisions of Educational and Recreational Building - Placing of CCTV Room inside the building

Detailed revisions of Educational and Recreational Building - Natural Ventilation of C.R in Sterilization department

Detailed revisions of Educational and Recreational Building - Natural Ventilation of C.R in Canteen

Detailed revisions of Educational and Recreational Building - Entrance doors must be open inward and outward

Detailed revisions of Educational and Recreational Building - Classrooms are placed at the 2nd floor to widen the canteen to have a one level dining area

Detailed revisions of Educational and Recreational Building - The canteen was enlarged to have a one level dining area

Detailed revisions of Educational and Recreational Building - Natural ventilation of C.R. in locker rooms and staff sleeping quarters

Detailed revisions of Educational and Recreational Building - Fire exit in washing room

Old plan of Educational and Recreational Building 2nd floor

Revised plan of Educational and Recreational Building 2nd floor

Detailed Revisions in Educational and Recreational Building 2nd floor plan -Dining area in the second floor is replaced by classsrooms

Detailed Revisions in Educational and Recreational Building 2nd floor plan -Audio Visual room Light transition room and technician room

Old plan of OPD and Administration Building ( NO REVISIONS )

Old plan of Nursing Building 1

Revised plan of Nursing Building 1

Detailed Revisions of Nursing Building 1 -Placing of cctv room

-Natural Lighting in Group Therapy room and Social room, decreased of seats in group therapy room

Old plan of Nursing Building 2

Revised plan of Nursing Building 2

Detailed revisions of Nursing Building 2 -Group therapy room natural lighting and good view, decrease seating

Detailed revisions of Nursing Building 2 -Social room natural lighting, placing of CCTV Room

Old Plan of Nursing Building 3

Revised Plan of Nursing Building 3

Detailed revisions of Nursing Building 3 -Placing of CCTV Room