Designing for young people experiencing mental ill health

Depression, anxiety and behavioural disorders are among the leading causes of illness and disability in young people. But with early intervention – and health care facilities designed to meet their needs – we can help support young people to get the help they need.

Judith Hemsworth is the Principal Design Advisor – Mental Health at the Department of Health. She explains that the needs and preferences of young people experiencing mental ill health can differ greatly according to their age, gender identity, social and cultural background, history of trauma and a host of other factors. The settings in which mental health and wellbeing services for young people are provided must allow for this variability.

Mental ill health defined

Psychological distress in young people relates to their overall level of psychological strain or pain. It manifests in psychological states such as depression and anxiety. Levels of psychological distress are higher in young women.

Mental illnesses are diagnosable health conditions. They are health problems that affect how a young person feels, thinks, behaves and interacts with other people. They vary in severity and duration but most mental disorders can be treated, especially if treated early.

Poor mental health can lead to thinking about suicide, making suicide plans, and later to suicide attempts. These can lead to admission to hospital for specialised mental health care. Deaths due to suicide are higher in young men than in young women.

Young Aboriginal and Torres Strait Islander people can face extra obstacles to good mental health. The effects of inter-generational trauma, racism and prejudice, and socioeconomic disadvantage are all relevant in understanding their experiences.

Designing for young people

The mental health service system is intentionally moving away from the use of seclusion and restraint, recognising their harmful aspects. To support this shift, settings for the provision of treatment and support for young people are designed to support them when they struggle with strong emotions.

Types of facilities

The types of mental health facilities we design and build include:

• Youth prevention and recovery care (YPARC) facilities which provide short-term residential treatment programs for young people who are unwell or recovering from mental ill health or psychological distress
• Acute mental health inpatient facilities, designed for young people experiencing serious mental illness
• Alcohol and other drug residential rehabilitation facilities for specialised rehabilitation treatment, care and support.

Design approaches

Judith Hemsworth explains that the contemporary design approach begins with the creation of a ‘beneficial physical environment’. This incorporates positive features such as:

• a legible and coherent layout
• adequate space that reduces social density and avoids occupants feeling crowded
• access to and free movement between indoor and outdoor spaces
• elements that delight all of the senses including pleasant views, acoustic treatment of spaces to reduce the level of unwanted noise, pleasant smells emanating from the kitchen and scented plants and careful design to avoid unpleasant smells (e.g. location of bin stores), spaces to sit and feel the sun or a cool breeze on the skin
• the ability for the young person to control and personalise aspects of their environment.

Bedrooms are grouped in small clusters, with a quiet lounge attached to each. This enables a young person to socialise with a small group of others with similar support needs to themselves.

This arrangement of spaces supports young people by providing them with options regarding the level of social interaction they feel able to engage in at any time.

Designers and architects have to make sure that the interior of the building can easily flex to meet the physical, social and emotional needs of young people that may change, even daily. For example, a bedroom and its ensuite may be able to belong to either of two-clusters of bedrooms clusters by the opening and closing of a door on a corridor. This means that services don’t have to turn someone away because they don’t have enough beds in a bedroom cluster appropriate to support the needs of that young person at that time.

When designing a mental health facility, it’s important to consider the needs of the people we are designing for. Who better to inform the design than those with lived experience of mental ill health?

That’s where co-design comes into play.

What is co-design?

Co-design is about involving people with lived experience in the design process. It means including their input in a meaningful way as equal partners so that the results of the design meet their needs. Co-design grew out of the Scandinavian participatory design movement in the 1970s and has two underlying ideas. The first is that everyone should have the right to participate in the decisions that impact on their life. The second is that everyone has valuable knowledge to contribute to a design process.

Think about designing a youth mental health facility. We want it to feel safe and welcoming to the young people who will use it. Imagine we’ve painted the interiors with bright colours and put bean bags everywhere because ‘that’s what young people like.’ Rather than relying on stereotypes, wouldn’t it be better to consult young people themselves, and in particular young people who have lived experience of mental ill health? By using co-design, we incorporate multiple perspectives into the design process. We can centre the lived experience of young people to not only identify the issues they face but to inform the design solutions as well.

When we talk about co-design we’re designing with young people, rather than for them.

As Judith Hemsworth explains, facilities that were designed 30 or 40 years ago are seen by young people as institutional, unsafe and unattractive rather than places that will empower and support them in their treatment and recovery. ‘It is critical that young voices are heard as equal partners in shaping the physical settings that house the services they have also co-designed. This will help ensure that these settings appear attractive and non-stigmatising to young people, encouraging and inviting them to engage with the services on offer and supporting them in that.’

Involving young people

Co-design of mental health facilities involves more than just having a one-off workshop. It’s an approach that benefits from involving multiple young people, at multiple touchpoints throughout the design process, using a mix of face-to-face and online methods, like focus groups, workshops, online surveys and webchats.

The co-design process works best when it’s as inclusive as possible, involving young people who have a diverse mix of experiences and backgrounds. This could include Aboriginal and Torres Strait Islander young people, young people from culturally and linguistically diverse backgrounds, LGBTIQA+, young people with experience of juvenile justice and young people who are disengaged from school or work.

Bringing nature into our building designs has been shown to have a positive effect on wellbeing. But it’s more than bringing some pot plants into a room. Biophilic design recognises that patterns, materials, sounds, smells and light can all contribute to feeling good. We can elevate the moods of the young people who use our mental health facilities by blurring the division between inside and outside, bringing nature in by using plants as well as natural patterns and materials.

A holistic view of the healing process

We know that exposure to natural light can help with mood and promote happiness. Views of nature have also been shown to reduce stress. Even small amounts of time spent in nature can improve our mental and physical wellbeing. Spending time in a garden can elevate our mood and reduce stress.

It is important for young people to have the therapeutic benefits that access to external spaces provides. As such, we incorporate various design elements that enable people to have access to external areas on each level of a building wherever possible.

As part of the Victorian Government’s response to the Royal Commission into Victoria’s Mental Health System, we’re designing and delivering contemporary, safe and high-quality mental health facilities across Victoria.