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Compassionate containment? Balancing technical safety and therapy in the design of psychiatric wards

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  • Curtis, Sarah
  • Gesler, Wilbert
  • Wood, Victoria
  • Spencer, Ian
  • Mason, James
  • Close, Helen
  • Reilly, Joseph

Abstract

This paper contributes to the international literature examining design of inpatient settings for mental health care. Theoretically, it elaborates the connections between conceptual frameworks from different strands of literature relating to therapeutic landscapes, social control and the social construction of risk. It does so through a discussion of the substantive example of research to evaluate the design of a purpose built inpatient psychiatric health care facility, opened in 2010 as part of the National Health Service (NHS) in England. Findings are reported from interviews or discussion groups with staff, patients and their family and friends. This paper demonstrates a strong, and often critical awareness among members of staff and other participants about how responsibilities for risk governance of ‘persons’ are exercised through ‘technical safety’ measures and the implications for therapeutic settings. Our participants often emphasised how responsibility for technical safety was being invested in the physical infrastructure of certain ‘places’ within the hospital where risks are seen to be ‘located’. This illuminates how the spatial dimensions of social constructions of risk are incorporated into understandings about therapeutic landscapes. There were also more subtle implications, partly relating to ‘Panopticist’ theories about how the institution uses technical safety to supervise its own mechanisms, through the observation of staff behaviour as well as patients and visitors. Furthermore, staff seemed to feel that in relying on technical safety measures they were, to a degree, divesting themselves of human responsibility for risks they are required to manage. However, their critical assessment showed their concerns about how this might conflict with a more therapeutic approach and they contemplated ways that they might be able to engage more effectively with patients without the imposition of technical safety measures. These findings advance our thinking about the construction of therapeutic landscapes in theory and in practice.

Suggested Citation

  • Curtis, Sarah & Gesler, Wilbert & Wood, Victoria & Spencer, Ian & Mason, James & Close, Helen & Reilly, Joseph, 2013. "Compassionate containment? Balancing technical safety and therapy in the design of psychiatric wards," Social Science & Medicine, Elsevier, vol. 97(C), pages 201-209.
  • Handle: RePEc:eee:socmed:v:97:y:2013:i:c:p:201-209
    DOI: 10.1016/j.socscimed.2013.06.015
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    References listed on IDEAS

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    1. Wood, Victoria J. & Curtis, Sarah E. & Gesler, Wil & Spencer, Ian H. & Close, Helen J. & Mason, James M. & Reilly, Joe G., 2013. "Spaces for smoking in a psychiatric hospital: Social capital, resistance to control, and significance for ‘therapeutic landscapes’," Social Science & Medicine, Elsevier, vol. 97(C), pages 104-111.
    2. Quirk, Alan & Lelliott, Paul & Seale, Clive, 2004. "Service users' strategies for managing risk in the volatile environment of an acute psychiatric ward," Social Science & Medicine, Elsevier, vol. 59(12), pages 2573-2583, December.
    3. Wood, Victoria J. & Curtis, Sarah E. & Gesler, Wil & Spencer, Ian H. & Close, Helen J. & Mason, James & Reilly, Joe G., 2013. "Creating ‘therapeutic landscapes’ for mental health carers in inpatient settings: A dynamic perspective on permeability and inclusivity," Social Science & Medicine, Elsevier, vol. 91(C), pages 122-129.
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    Cited by:

    1. Melo, Sara, 2018. "The role of place on healthcare quality improvement: A qualitative case study of a teaching hospital," Social Science & Medicine, Elsevier, vol. 202(C), pages 136-142.
    2. Jacqueline McIntosh & Bruno Marques & Gabrielle Jenkin, 2022. "The Role of Courtyards within Acute Mental Health Wards: Designing with Recovery in Mind," IJERPH, MDPI, vol. 19(18), pages 1-21, September.
    3. Wood, Victoria J. & Curtis, Sarah E. & Gesler, Wil & Spencer, Ian H. & Close, Helen J. & Mason, James M. & Reilly, Joe G., 2013. "Spaces for smoking in a psychiatric hospital: Social capital, resistance to control, and significance for ‘therapeutic landscapes’," Social Science & Medicine, Elsevier, vol. 97(C), pages 104-111.
    4. Högström, Ebba & Philo, Chris, 2023. "‘Let there be light’ or life in the dark? Vital geographies of mental healthcare," Social Science & Medicine, Elsevier, vol. 333(C).
    5. Reavey, P. & Brown, S.D. & Kanyeredzi, A. & McGrath, L. & Tucker, I., 2019. "Agents and spectres: Life-space on a medium secure forensic psychiatric unit," Social Science & Medicine, Elsevier, vol. 220(C), pages 273-282.
    6. Taheri, Shima & Ghasemi Sichani, Maryam & Shabani, Amirhosein, 2021. "Evaluating the literature of therapeutic landscapes with an emphasis on the search for the dimensions of health: A systematic review," Social Science & Medicine, Elsevier, vol. 275(C).

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