Projects Office’s radical design for a new healthcare space for the Child and Adolescent Mental Health Service at Royal Hospital for Children and Young People was built on a basis of careful and consistent conversation with its end users. Here, Projects Office director James Christian talks about the power of design inspired by dialogue, the creative navigation of health codes and the hidden dangers of the domestic.

What drove you take on the challenge of designing a space for mental health patients? 

JAMES CHRISTIAN: This project sits in a body of work looking at design for good mental health that we've been working on pretty much since the inception of our practice in early 2015. It sprang from some quite speculative work we conducted with the artist James Leadbitter – a project he founded called Madlove – which crowdsourced ideas for the ideal environment for good mental health from service users throughout UK, both those residents in psychiatric hospitals and outpatients, as well as clinical professionals. We were brought into that project to spatialize the design concepts that had resulted from those conversations, which resulted in an installation at Fact in Liverpool. 

Wanting to continue that collaboration, we tackled a brief from Ginkgo Projects for the new Royal Hospital for Children and Young People in Edinburgh. The institution wanted to enhance the interior of its Child and Adolescent Mental Health Services Unit, which would see two units move from different locations in Edinburgh and be combined into a new facility on site at the new hospital. Our initial response was more of a working methodology than a design proposal, setting out the process of how we would work with all the stakeholders – but particularly the young patients – based on a series of workshops. It was a real, lived approach that focused firstly on users; that gave us a very strong basis and ultimately won us the project.

Can you share any insight into how you engineered these workshops to get people to talk candidly about such a difficult subject? 

Central to all our workshops was a very immediate sensorial question about what good mental health might feel like, smell like, taste like, etc. It helped to put people at ease. That’s especially important for parents, who were then better able to discuss some of the difficulties their child was experiencing more fluently. We had a particularly interesting dialogue with the mother of a teenage patient who was suffering from quite severe anorexia. She would visit her daughter every day, and always found it very difficult to find somewhere to sit. She would often feel forced to sit with her daughter in her bedroom, which was not adequately set up for social interaction. Sitting on the edge of the bed of her teenage child felt like an invasion of her personal space. That got us thinking about convivial seating environments and how they should be dispersed throughout the unit. 

How did you translate the information gathered in these workshops into an interior treatment? 

We had these recurring responses about the freedom of being by the seaside, the qualities of the coast. We were able to weave that into the narrative thread that gave a foundation to our designs. So, we created this loosely coastal theme that ranged from a slightly playful, brightly coloured seaside town approach for younger children, to something slightly more mature that was sort of offshore, with the kind of the maritime signal pennants, for the older adolescents These kinds of design concepts very much sprang out of those workshops.

Another strategy that was inspired by talking to parents in the workshop was this idea that mental health environments are often designed to be quite homely; actually, it became apparent that could mean those spaces almost collude with children who don’t want to believe that they are ill – that the severity of their condition is not something to be taken seriously. That took us down the route of thinking in terms of ‘third spaces’, as in neither wholly clinical nor domestic, but certainly offer a point of difference from the surrounding NHS context. 

How difficult was it navigate a design process subject to so much oversight? 

We took quite a bold approach, and I think in the back of our minds we were expecting greater pushback, but the NHS staff was largely receptive to our suggestions. Often small but significant gestures made the most impact: you almost never see darker colours in an NHS environment, for example. There we physical constraints of course. One of the most important spaces we created was the inpatient social space, which features a lighthouse structure. That room also has to function as a corridor – it’s quite a ‘leaky’ space with lots of entry and exit points, which could make it feel quite uncomfortable. It also had no access to natural light. We swapped a couple of other rooms around, moving a TV room adjacent to that space and creating glazed double doors so that there’s viewing corridor to the courtyard garden. The space had very low suspended ceilings so, in dialogue with the main architects and the services engineers, we were able to negotiate that we would be able to open that up to create a vaulted ceiling with skylights backed by LED panels. That gives the impression of being in a top-lit single-storey vaulted space when, in reality, you're on the bottom floor of a multi-storey hospital. 

Were there restrictions on the materials you could choose, given this space is part of a major hospital? 

As a brand-new hospital, obviously, it has extremely strict infection control standards that we had to meet. All of our materials were put before the infection control team for approval. That didn't mean that we couldn't use nice materials. We were able to just slightly subvert the typical hospital material palette, sometimes simply by just manipulating colour. We created these patchwork rugs, for instance, that are actually just cut into the floor. We also got creative within the established protocols, like by making more judicious choices about what was purchased from the approved mental-health-grade-furniture manufactures, and then upholstering them creatively. The space meets the right healthcare standards operationally but reaches very different standards in terms of what we’ve come to expect from the look and feel of a clinical environment.