nepean mental health centre case study

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Rooftop Refuge : an architectural oasis for mental health

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Evangelia Chrysikou, PhD

Therapeutic architecture can be described as the people-centered, evidence-based discipline of the built environment, which aims to identify and support ways of incorporating those spatial elements that interact with people physiologically and psychologically into design. Architecture is an important factor in people's lives when they are well; when they experience ill-health and are less able to cope it becomes even more important. This book explores the design of specialized residential architecture for people with mental health problems. It sets out to show how building design can support medical and health related procedures and practices, leading to better therapeutic outcomes and an enhanced quality of life. Based on almost two decades of research, it aims to understand how architectural design interacts with the therapeutic milieu, the care programs, and actually living in the spaces. The book is divided into two main parts covering theory and research. Part one consists of three chapters: a brief introduction to old practices, current medical psychosocial and architectural thinking, and alternative thinking. Part two explores the research and conclusions derived from fieldwork. This book provides a fascinating insight into the effect that architectural design can have on all of us, but particularly on those with mental health problems.

Medical architecture-therapeutic architecture or architecture for salutogenesis as it is also known-is an interdisciplinary field related to the evidence based, planning and design of healthcare facilities. It has been one of the first fields that addressed evidence based design and over the years becomes more and more inclusive, involving medical professionals, designers, planners, managers, carers as well as patient representatives actively in the decision making and design processes. In this paper, we report on work carried out within the project 'The social invisibility of mental health facilities: Raising awareness on social exclusion in urban environments through artwork', involving three schools at UCL, i.e., Architecture, Psychiatry and Fine Art, and describe our approach in using transdisciplinary research methods. Inequality has been reported in medical and healthcare management literature but not connected to building stock. However, the façades of mental health facilities buildings are directly visible from the community and contribute to the opinion of the public, staff and patients and convey messages on how society approaches the illness. It is also what service-users see just before crossing facility thresholds. The aim of this project is to juxtapose the exteriors of mental-health/health buildings and their urban integration, documenting this inequality from the socio-spatial perspective. We evaluate proximity of buildings to transport and analyse architectural materiality/façade using multimedia techniques to identify differences in service provision and contrast facilities of an inner-city catchment area in terms of access, condition and status compared to their surroundings. We present an attempt to develop new ways of approaching these facilities that extend beyond conventionally applied methods within traditional architectural education by adopting knowledge from the fields of psychiatry, psychology and medical architecture, on the pathology of mental illness, the stigma associated with it and the ways of social valorisation of people with mental illness and at the same time employ visual methods to support the interpretation and interrogation. That way, the

Health and Place

Paula Reavey

Historically, nature has been considered central to healing and recovery in institutional mental health settings, with inpatient spaces designed to mirror the restorative forces nature may afford. Within contemporary healthcare architecture, the discourse surrounding nature's role has once again become prominent, especially in the concept of 'healing architecture'. While the literature on 'healing architecture' primarily considers how to connect recovery to nature through interventions in the built environment, less interest has been directed towards how nature is configured in design processes and what implications that has for the everyday experiences of patients and staff. In this paper we consider the design and implementation of one particular psychiatric hospital in Denmark to show that the 'nature' brought into this healthcare space can be experienced as anything but 'natural' and may reduce rather than enhance a felt sense of 'vitality' amongst patients. Based on our analysis, we end the paper by suggesting four principles for future healthcare design.

Damien Riggs

To present a comprehensive review of the research literature on the effects of the architectural designs of mental health facilities on the users.BACKGROUND: Using a team of cross-disciplinary researchers, this review builds upon previous reviews on general and geriatric healthcare design in order to focus on research undertaken for mental health care facility design.METHODS: Sources were gathered in 2010 and 2011. In 2010 a broad search was undertaken across health and architecture; in 2011, using keywords and 13 databases, researchers conducted a systematic search of peer reviewed literature addressing mental health care and architectural design published between 2005 to 2012, as well as a systematic search for academic theses for the period 2000 to 2012. Recurrent themes and subthemes were identified and numerical data that emerged from quantitative studies was tabulated.RESULTS: Key themes that emerged were nursing stations, light, therapeutic milieu, security, privacy, designin...

International Journal of Environmental Research and Public Health

Bruno Marques

The role of courtyards and other outdoor spaces in the recovery of acute mental healthcare users has been gaining international appreciation and recognition. However, the physical properties and conditions necessary for therapeutic and rehabilitative engagement remain to be clearly established. This paper contributes to that knowledge by triangulating evidence from the literature, exemplar case studies of good practice and first-hand accounts of the experiences of staff and service users from four acute mental health facilities. The findings are then aligned with a well-established recovery framework (CHIMES) in light of existing landscape architecture knowledge. Within the complexity of varied mental health environments, this work establishes landscape architectural design requirements and qualities essential for recovery. Rather than adopting a prescriptive quantitative approach setting out areas, numbers of elements, etc., the proposed framework recommends a performance-based model and the creation of a cohesive network of microspaces that mesh into a design of outdoor areas. In this way, design details, materials, vegetation and the variety of spaces can be modified to suit service user population demographics and site-specific needs.

International Journal for Research in Applied Science & Engineering Technology

IJRASET Publication

As per the definition given by the World Health Population, health alludes to the condition of complete physical, mental and social prosperity and not just the nonappearance of sickness or infirmity. It acts as a crucial parameter in the country's development. It could disrupt due to various strains resulting in Stress-the body's response to anything or a situation that requires any attention or action. Architecture is deeply contextual and responds to its social and environmental context as much as its historical and physical one. If we are designing for the ripple effect consciously, we benefit the individuals and support the community. By creating a healing space, one evokes the feelings of serenity, calm, and relaxation and can contribute to an environment that facilitates the natural healing process-a process of repair, recovery, and return to wholeness in mind, body, and spirit. Since there have been strong human responses to nature because these responses appear in study after study and are consistent across social, economic, cultural, and racial boundaries, buildings are the structures that strengthen the local community and connect people. These help the neighborhood economy and how they work. In this way, when we configuration to amplify the positive-social, monetary, and natural variables become the waves of architecture and engineering. To look over the design consideration of such spaces in the institutions, how can the healing Space architecture become an integral part of healing itself? How can architecture have an active role in the healing process? The conventional design approach is missing the inspiration and connection with the built structure from its precincts. Thus, the architectural inputs can affect the building design and affect the healing process. It also creates a comfortable and interactive for both the patients/ visitor and the staff who spend the central part of their day in it and, most importantly, would create a network of community and built form. This study emphasizes the variation in the patient's mood and creates a healing place instead of the machine to treat people with patient-focused experiential perspectives. The dissertation has a framework with the chapters divided into different sections. The first section introduces the health and the role of psychology concerning the spaces that evoke different moods and emotions within the user. The next chapter discusses and brings the different parameters with the medical shreds of evidence by reviewing and analyzing a few previous research studies in the same field. The third chapter analyzed a few of the live architectural projects based on the parameters mentioned in the chapter before and made a comparative analysis of those projects. Lastly, in the fourth chapter, the inferences are developed with the design recommendations for the thesis's future study and guidelines.

Art Therapy Online

This paper is about the links between public and private space, the possibilities for increasing these and the impact that they can have on physical and mental health. A range of professional practice disciplines contribute to improving the health of populations. The paper focuses upon the role of architects who design the threshold between public and private space and art therapists who help people negotiate and cross these thresholds . It considers some of the ways architecture and art therapy might work together with other disciplines to help secure the basis for health. The main argument is about the need in cities for actual space to practice art therapy. Architects might be interested in designing city art therapy studios and art therapists might help vulnerable people to use them as a symbolic threshold between the private and the public. Time spent using art therapy can assist with empowerment and recovery for people with mental health issues, helping them to live fuller liv...

Ana Karinna Hidalgo

Streets can be designed as places that improve people's well-being on a daily basis and year round. The interrelation among urban design, environmental psychology and public health, as well as a coherent and systematic framework that focuses on restorative public spaces supports this research. Studies on winter landscapes, when the psychological response to the environment may increase mental health issues due to weather and reduction of sunlight, are needed. This research is aimed at establishing the causal effect of winter streets on people's psychological health by answering two questions: How can streets become public restorative environments that reduce people's daily stress and mental fatigue? What are the principles to design such restorative streets during the winter season? To answer these questions the following objectives are reached: 1) Gain an understanding of the functions of streets towards a comprehensive street categorization. 2) Determine which multidis...

Journal of Public Mental Health

Rona Stephen

Kathleen A Connellan

OBJECTIVE: To present a comprehensive review of the research literature on the effects of the architectural designs of mental health facilities on the users. BACKGROUND: Using a team of cross-disciplinary researchers, this review builds upon previous reviews on general and geriatric healthcare design in order to focus on research undertaken for mental health care facility design. METHODS: Sources were gathered in 2010 and 2011. In 2010 a broad search was undertaken across health and architecture; in 2011, using keywords and 13 databases, researchers conducted a systematic search of peer reviewed literature addressing mental health care and architectural design published between 2005 to 2012, as well as a systematic search for academic theses for the period 2000 to 2012. Recurrent themes and subthemes were identified and numerical data that emerged from quantitative studies was tabulated. RESULTS: Key themes that emerged were nursing stations, light, therapeutic milieu, security, privacy, designing for the adolescent, forensic facilities, interior detail, patients’ rooms, art, dementia, model of care, gardens, post-occupancy evaluation, and user engagement in design process. Of the 165 articles (including conference proceedings, books, and theses), 25 contained numerical data from empirical studies and 7 were review articles. CONCLUSIONS: Based on the review results, especially the growing evidence of the benefits of therapeutic design on patient and staff well-being and client length of stay, additional research questions are suggested concerning optimal design considerations, designs to be avoided, and the involvement of major stakeholders in the design process. KEYWORDS: Evidence-based design, hospital, interdisciplinary, literature review, post-occupancy

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The nature of healing

A new insertion into the existing campus at Nepean hospital in Penrith,

The Nepean Mental Health Centre is designed to respond to the increase in demand for mental health services as a result of the growing and ageing population.

The NMHC includes 64-mental health beds servicing high dependency, acute and Specialist Mental Health Services for Older Persons. The unit will include a dedicated inpatient ward and new facilities for the outpatient day program.

Talk to Edwina Bennett about Health

The hard steel and glazed exterior relates to the adjacent hospital buildings, and is contrasted with the non-institutional feel of the interiors and internal courtyards, where the focus is on healing by design and creating a sense of humanity and ownership.

With generous solar access, these therapeutic internal courtyards create visual connectivity and engage users with a tapestry of landscaping that changes with the passage of time, allowing regeneration to become visibly tangible.

The design of the unit provides a restorative health care unit, integrated into the local community and linked to the adjoining health precinct.

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PHOTO TOUR: Nepean Mental Health Centre

The Woods Bagot -designed Nepean Mental Health Centre (NMHC) in Penrith, New South Wales, Australia, is a new insertion into the existing Nepean Hospital campus and is designed to respond to the increase in demand for mental health services as a result of the growing and aging population.

The center includes 64 mental health beds serving high-dependency, acute, and specialist mental health services for older persons. The unit will include a dedicated inpatient ward and new facilities for the outpatient day program.

The NMHC is an example of how mental health care is shifting toward creating regenerative, healing environments for recovery. The design of the unit provides a restorative health care unit, integrated into the local community and linked to the adjoining health precinct.

The center was modeled on the construction of the human brain. As the brain is encapsulated by the skull, the exterior shell of the building—which addresses the public domain—was designed to be strong and shield-like. By contrast, the interior architecture is soft and interconnected. Internal courtyard façades create protected garden sanctuaries that signify growth and renewal.

The hard steel and glazed exterior relates to the adjacent hospital buildings, and is contrasted with the noninstitutional feel of the interiors and internal courtyards, helping to create a sense of humanity and ownership.

Social settings throughout the indoor and outdoor spaces are designed for interaction and community living. With generous solar access, the therapeutic internal courtyards create visual connectivity and engage users with landscaping that changes with the passage of time, modeling regeneration.

Project Summary

• Name: Nepean Mental Health Centre
• Location: Penrith, New South Wales, Australia
• Owner: Health Infrastructure
• Area: 7,278 square meters
• Cost: $44.2 million (part of the $138 million Nepean Hospital redevelopment)
• Official opening date: March 31, 2014
• Scope: 64 beds, purpose-designed triage, assessment, and consulting rooms
• Woods Bagot leadership team: ​Domenic Alvaro, Henry Ahn, Greg Harper, Stephen Taskin
• Builder: Build Plan /A W. Edwards

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Sod turned on Nepean Hospital’s child and adolescent mental health unit

The new unit will specifically cater to the mental health needs of young people aged between 12 and 17 years.

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Australia’s New South Wales (NSW) Government has announced the beginning of construction work on the new Child and Adolescent Mental Health Facility (CAMHS) at Nepean Hospital.   

The start of construction of this unit, which looks to enhance mental health services for young people in Western Sydney, was marked by a sod turn event.   

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Nepean Hospital, situated in Kingswood near Penrith in NSW, offers a variety of services to those residing in Sydney’s western suburbs.  

With the CAMHS, the hospital aims to specifically cater to the mental health needs of 12 to 17-year-olds in the region. 

CAMHS’ construction phase has begun with preparatory works, including the demolition of old structures and the relocation of the Aboriginal Reconciliation Garden to the space next to Building D.  

The new facility will house ten single bedrooms with ensuites, consultation rooms, a secure indoor communal area, two private outdoor courtyards, and workspaces. 

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Additional features include a dedicated sensory room, a learning centre, and a media room. 

The NSW government said that CAMHS has been designed with input from young people and carers.  

The unit will be situated adjacent to the current mental health facility and its Triage and Assessment Centre.  

Admissions to the CAMHS unit will be for young individuals with acute mental health issues, post-assessment at an Emergency Department or the Nepean Mental Health Centre’s Triage and Assessment Centre.  

Referrals for planned admissions can be made by a community Child and Youth Mental Health Service team or a doctor. 

The CAMHS is being developed as part of the NSW government’s A$700m ($459m) Statewide Mental Health Infrastructure Programme, which aims to reform mental health care services across the state. 

Nepean Blue Mountains Local Health District Mental Health director Matt Russell said: “We greatly value the voice of consumers and carers, and their input has been integral throughout the whole planning process. We want to ensure this building is providing models of care and support to aid people in their recovery.” 

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Audit report of physical health examination and baseline investigations on high dependency unit (HDU) and acute ward, Nepean Mental Health Centre, Sydney, Australia

Author information, affiliations.

• Mikes-Liu K 1
• Elmakki A 1

Bjpsych Open , 18 Jun 2021 , 7(Suppl 1): S328-S328 PMCID: PMC8771877

Abstract 

Free full text .

Nepean Hospital, Mental Health Centre,

Kristof Mikes-Liu

Christopher mah, amgad elmakki, riffat fatima.

All patients on High Dependency Unit (HDU) and Acute Ward, Mental Health Centre, Nepean Hospital, were included in a cross-sectional audit on 22nd January 2020. Out of a total of 43 patients admitted on both these wards, 88.4% had baseline blood tests done, but almost half did not have baseline ECG done and 1/3rd did not have a physical examination done. The physical examination on admission on these wards is better than in 2017 & 2018 when half and more than 1/3rd respectively did not have physical examination done.

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Mental health services in Nepean Blue Mountains

Mental health services in Nepean Blue Mountains LHD include a range of teams and health professionals to provide the care people need, when and where they need it.

Get help now

Emergency 000.

If you or someone you are with is in immediate danger, call 000 (triple zero).

24/7 crisis lines

You can call these free support services 24 hours a day, 7 days a week:

For a more complete list of mental health services and support see NSW mental health contacts , which includes a list of Aboriginal health and multicultural services, and other specialist services, including those for young people or older people and veterans.

Our services

We offer a range of services - including specialised services for children, young people, families and older people, through our community-based services, community health centres and inpatient services at Nepean Hospital and Blue Mountains Hospital. Find details below.

We take a collaborative approach to mental health care, with teams working together and consulting with each other regularly.

Many of our services are available through virtual care as well as in person.

Call 1800 011 511 any time to connect with any of our services.

See also Drug and alcohol services in Nepean Blue Mountains .

Our Access teams based at Penrith and Katoomba provide care across the Nepean, Blue Mountains and Lithgow areas. You can contact them to discuss any immediate mental health concerns.

The teams provide assessment and short-term support options, and referral to appropriate community-based services for ongoing care.

Call 1800 011 511 any time to connect with this service.

Our Adult Community Mental Health teams are based in Katoomba, Lithgow, Penrith, Springwood, St Marys and Windsor.

They are staffed by mental health clinicians and case managers from a range of professional backgrounds including nursing, social work, psychology and occupational therapy.

The assistance they provide will depend on a person’s mental health needs, goals and individual circumstances. It may include support with social and relationship skills, physical health, self-care management, housing, education and employment goals.

Our teams can also work closely with a person’s family and their existing support networks.

When you contact our service, we will ask for information about you in order to better understand your situation and to determine what service is the most appropriate for your care needs.

Child, youth and family

Child, Youth and Family Mental Health provides services and supports to children, young people and their families or carers living in the Penrith, Blue Mountains, Hawkesbury and Lithgow local government areas.

Child, Youth and Family Mental Health Services takes a collaborative approach to mental health care. Teams work together and consult with each other on a regular basis. A child, young person or family’s care team may consist of people from one or more of the following disciplines: psychiatry, psychology, social work, occupational therapy, family therapy and specialist nursing.

Services are delivered by community-based teams providing centre-based appointments and home visiting. Services are also provided at Nepean Hospital through consultation liaison services and outpatient clinics.

Virtual care (telehealth) appointments are also offered. Find out more about Virtual care in Nepean Blue Mountains .

Our Child, Youth and Family Mental Health Services are:

• Perinatal Infant Mental Health Service (PIMHS) and Safe Start Coordinator.
• Child and Youth Mental Health Services (CYMHS).
• Whole Family Team (WFT).

Child and Youth Mental Health Services (CYMHS)

Our Child and Youth Mental Health Service (CYMHS, pronounced “Kims”) assists children and young people aged 5 to 17 with moderate to severe or complex mental health problems.

Mental health assessment and therapeutic interventions are provided using a team approach to ensure the needs of the child or young person and their family or carers are addressed.

Interventions may consist of individual, family and/or group therapy. This can occur at the CYMHS office in Penrith, or at local community health centres. Staff are also available for home or school visits.

CYMHS has a specialist who provides educational and vocational support. CYMHS collaborates with schools through the School-Link and Got It programs. Find out more about these state-wide  Child and Adolescent Mental Health Services (CAMHS) - Mental health (nsw.gov.au) .

The Early Psychosis Intervention Team provides services for young people aged 12 to 24 years.

CYMHS is based at 606 High St, Penrith, in the same building as headspace.

For referral contact the Mental Health Line 1800 011 511 .

Whole Family Team (WFT)

The WFT is a team of mental health and drug and alcohol clinicians who work with families when a parent or carer has a mental health or drug and alcohol issue that is impacting on their child’s wellbeing.

The team works with families in a place that is most comfortable for them, which is often their home, or a local community health centre to help them be the best parent or carer they can be. WFT generally work with families for up to 12 months.

Families are referred to the Whole Family Team by the Department of Communities and Justice. They also work closely with other services that may be involved in a family’s welfare.

Caseworkers can refer families by calling us on (02) 4734 4464 .

Pregnancy support

NSW Perinatal and Infant Mental Health Services (PIMHS) is a free, state-wide mental health service that makes specialist services available to women with severe and complex mental illness during pregnancy.

In Nepean Blue Mountains LHD, PIMHS offers coordinated care for the mother’s mental health needs during pregnancy through:

• hospital in-reach
• community follow-up of mothers identified as vulnerable through the Safe Start pathway
• psychiatric review through the STAR antenatal outpatient clinic
• consultation to other teams and service providers caring for women during pregnancy and early parenthood.

Our staff are trained to identify women who may need extra services and supports through the Safe Start pathway when they book into the Birth Unit. Women may also be linked into PIMHS by their health care provider through the adult mental health service.

Read more about Pregnancy, birth and baby services in Nepean Blue Mountains.

In addition to our Child, Youth and Family Mental Health services, a range of other services and resources are available to support children and young people.

Child and family counselling 

Child and family counsellors are available at 7 of our community health centres.

They can help you work through issues or concerns, including child anxiety, behavioural issues and depression. They also run group programs for parents and children to help address particular issues or challenges.

Call 1800 222 608 for details.

Headspace provides mental health services for 12 to 25 year olds.

Penrith headspace offers online and in-person mental health, physical health, work and study support, and alcohol and other drug services.

Visit Penrith headspace  or call ( 02) 4720 8800 .

Inpatient units

We provide inpatient mental health services for people experiencing acute mental health issues at Nepean Hospital and Blue Mountains Hospital .

Admission can be voluntary, or involuntary under the  NSW Mental Health Act .

Admission can be through the Emergency Department at a hospital, through the Nepean Mental Health Triage and Assessment Centre, or by calling the Mental Health Line  1800 011 511 .

Disaster recovery (bushfire and COVID-19)

Nepean Blue Mountains LHD has 2 disaster recovery mental health specialists, to support individuals and communities affected by natural disasters including bushfire and flooding. Find out more about Mental health disaster recovery .

People seeking urgent mental health care at Nepean Hospital can get help 24 hours a day, 7 days a week at our dedicated triage and assessment centre, rather than going to the hospital's emergency department. Find out more about the Triage and Assessment Centre .

Anxiety disorders

If you are in need of urgent care, call the Mental Health Line on 1800 011 511 .

Patients aged 18 to 65 years can attend appointments at our Anxiety Disorders Clinic to help diagnose and manage anxiety disorders. Find out more about the Anxiety Disorders Clinic or call (02) 4734 3404 . 

Our Department of Psychiatry, located at Nepean Hospital, also provides teaching and research in relation to anxiety disorders. Call  (02) 4734 2585  for more information.

Families and carers

We recognise and value the important role that families, friends and carers play in supporting a person experiencing mental illness.

There are a range of resources and services to help you understand how you can support a person you care about who is experiencing mental illness, while also taking care of your own wellbeing.

Families, friends and carers sometimes play the role of designated carers and principal care providers under the Mental Health Act 2007 (NSW) .

Read about some local services below, and more information for  mental health carers in NSW .

The NSW Family and Carer Mental Health Program is a statewide program funded by the NSW Ministry of Health.

In Nepean Blue Mountains the program is delivered by Uniting  and provides:

• individual support for family members and carers
• workshops and education to help family members and carers learn about mental health problems, how they can support the person they care about, and how to look after their own wellbeing.
• support groups for carers to connect, share and learn together.

For details, call ( 02) 8880 8160 or email [email protected] .

Carer Gateway is an Australian Government program providing free  services and support  for carers.

In Nepean Blue Mountains, Carer Gateway services including support and counselling for carers are provided by Wellways.

Find out more about Wellways or call them on 1800 422 737 .

Carers NSW provides a range of services for family members and carers of people experiencing mental illness, including an online education program and a support program for young people who are carers.

Call the Carer Line 1800 242 636 for information, emotional support and referrals to other organisations.

Find out more at Carers NSW .

Become a mental health advocate

We invite consumers and carers to work alongside staff to ensure that the voice of people with lived experience is heard and acted on in improving our services.

Opportunities include representing on the Consumer and Carer Council (CCC), a governance committee that reports to the Director of Mental Health.

Contact us at [email protected] if you are interested in participating in future meetings, committees or co–design projects to help make sure our services meet the needs of the people who use them.

Find out more about getting involved with Nepean Blue Mountains LHD .

Tell us about your experience

We are passionate about providing the best possible mental health services to our local communities. Your feedback will help us improve our services.

Compliments and complaints

We also encourage you to tell us directly about any compliments, concerns or complaints you have about our services.

You can call us on ( 02) 4734 1912 or email [email protected] .

Please complete the anonymous NSW mental health service experience survey using the relevant Nepean Blue Mountains (NBM) service code from the list below.

Related information

• Adult Mental Health
• Child and Adolescent Mental Health
• Mental Health Commission NSW
• Mental health organisations and advocacy groups NSW
• Mental Health Review Tribunal
• NSW Mental Health Advocacy Service
• Suicide Prevention Outreach Team (SPOT)

Smoke-free policy

All our hospitals and locations are smoke-free. Smoking anywhere on the grounds may result in a $300 fine. View our policy .

Nepean Mental Health Centre

Service description.

Provides inpatient care for people experiencing acute mental health issues through the short-stay Psychiatric Emergency Care Centre (PECC), the Acute Mental Health Unit, Mental Health High Dependency Unit and Older Persons Mental Health Unit. They all provide 24-hour care by a skilled multidisciplinary team, including registered nurses. Patients are supported with medication and can be linked with a case manager for longer term support. Care is provided in a least restrictive environment appropriate to the person's needs.

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Forum on Neuroscience and Nervous System Disorders; Board on Health Sciences Policy; Board on Global Health; Institute of Medicine; National Academies of Sciences, Engineering, and Medicine. Providing Sustainable Mental and Neurological Health Care in Ghana and Kenya: Workshop Summary. Washington (DC): National Academies Press (US); 2016 Feb 25.

Providing Sustainable Mental and Neurological Health Care in Ghana and Kenya: Workshop Summary.

• Hardcopy Version at National Academies Press

4 Case Studies

Throughout the workshop, case studies were presented of some of the successful mental health projects in Ghana, Kenya, and around the world. Although each case study was multifaceted and addressed many challenges, the workshop participants focused on distilling lessons learned from each project that could be applied to potential mental health demonstration projects.

AFRICA MENTAL HEALTH FOUNDATION 1 : COMMUNITY PARTNERSHIPS

Founded in 2004, AMHF has stated the vision of being “the center of excellence in Africa for research, training, knowledge translation, and advocacy in mental health.” 1 AMHF uses a multidisciplinary, multisectoral approach to improve mental health through programs at all levels, from physician specialist training to community-based stigma reduction, including school-based programs. According to David Ndetei, AMHF's greatest successes have been in creating community partnerships and joint ownership of programs. One partnership in particular that has been successful is the relationship AMHF has built with traditional and faith healers. AMHF works with them to build awareness of mental health disorders, to develop skills to screen for and refer cases of mental illness, and to deliver evidence-based, mhGAP-adapted psychosocial interventions. Other partnerships critical to the success of their programs, noted Ndetei, include those with county government where health services have been devolved and with the government of Kenya.

BASICNEEDS 2

BasicNeeds was founded in 2000 with the goal of improving the lives of people around the world diagnosed with a mental illness or epilepsy, by ensuring that their basic needs are met and their rights are recognized and respected.

Ghana 3 : Building Capacity of NGOs

BasicNeeds' Mid-Ghana Project is focused on the Ashanti and Brong Ahafo regions. It is a community-based model that seeks to ensure that people with mental illness or epilepsy can access their human rights. Specifically, BasicNeeds' activities can be categorized into four main areas: identifying and supporting people who have treatment needs; training community health workers; creating awareness; and supporting service delivery through psychiatric outreach to communities. Since 2000, BasicNeeds Ghana has provided 7,800 women, men, and children with mental illness or epilepsy and caregivers access to mental health and development services through community-based mental health, and it has developed 130 self-help user groups as a mechanism for patients and caregivers to express their needs and claim their rights to inclusion and development. Peter Yaro, executive director of BasicNeeds Ghana, said that a key component of their work is training local partners such as NGOs. BasicNeeds trains and supports key local partners on their Mental Health and Development model to enable the organizations to gain accreditation as a BasicNeeds franchise partner. The components of the model include capacity building, community mental health, sustainable livelihoods (e.g., promoting social reintegration), research, advocacy, policy, and collaboration. The NGOs they work with are not necessarily mental health organizations: for the Mid-Ghana project, for instance, the organizations were focused on child labor, reproductive health care, education, and women's issues. Yaro said that this type of collaboration among NGOs is a great way to align mental health activities with what the NGOs are already doing. He cautioned, however, that even though many NGOs are interested in working in mental health, they “sometimes do not know how.” He said that if given the proper support and training, these NGOs can be valuable partners in improving community mental health. As a result, BasicNeeds Ghana established two regional mental health alliances that bring together more than 45 community-based organizations/NGOs and decentralized government ministries, departments, and agencies to foster these collaborations and implement work in mental health.

Kenya 4 : Patients as Ambassadors

BasicNeeds works at the community level to build the capacity of people with MNS disorders to participate in their own treatment and recovery, as well as to reduce stigma and prepare the rest of the community to help people with MNS disorders. Joyce Kingori reported that the critical partners of BasicNeeds are the adults and children with MNS disorders “who have taken the courage to come and get treatment, to share their stories, to provide their insights.” BasicNeeds uses mental health “ambassadors”: young people who have been treated and now work to create awareness among their peers, and to reach out to provide support to those in need. Kingori noted that in addition to the critical partnership with patients, BasicNeeds also has important partnerships with organizations such as KAWE and AMHF, as well as the MoH and local government and health officials.

DIRECT RELIEF 5 AND BREAST CARE INTERNATIONAL 6 : COLLABORATION

Founded in 1948, Direct Relief provides medical resources to areas affected by poverty or emergency situations. It focuses primarily on maternal and child health, disease prevention and treatment, emergency preparedness and response, and strengthening health systems. 5 In partnership with Breast Care International (BCI), a Ghanaian-based organization dedicated to breast cancer awareness, the two organizations conducted a mental health research project in the Ashanti region of Ghana. They are currently collecting data on the burden of mental health and examining what types of mental health services are available, with the purpose of using the data to recommend measures to address the challenges in the region. Andrew Schroeder, director of research and analytics for Direct Relief, and Samuel Kwasi Agyei, of BCI, stressed the importance of collaboration in their work. Schroeder noted that the collaboration with BCI was critical to the success of the project because they are a community-based organization that is trusted in the area in which they work. In addition, because of BCI's interest in broad-based health care, the project is working to embed mental health care services in the general health care system, rather than operating as a stand-alone mental health program, thus making improvements that are systematic and sustainable.

EMERGING MENTAL HEALTH SYSTEMS IN LOW- AND MIDDLE-INCOME COUNTRIES (EMERALD) 7 : STRENGTHENING HEALTH SYSTEMS

EMERALD, or Emerging Mental Health Systems in Low- and Middle-Income Countries, is a 5-year program (2012−2017) that works in six countries (Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda) to improve mental health outcomes by improving health system performance, said Jibril Abdulmalik, Co-Investigator of EMERALD at the University of Ibadan in Nigeria. The program consists of six work packages: (1) project management and coordination; (2) capacity building in mental health systems research; (3) adequate, fair, and sustainable resourcing for mental health (health systems inputs); (4) integrated provision of mental health services (mental health system processes); (5) improved coverage and goal attainment in mental health (health system outputs); and (6) dissemination. EMERALD seeks to strengthen the system itself through activities such as holding trainings for policy makers, researchers, and service users; providing scholarships for students seeking advanced degrees in mental health; developing curricula for master's training in public mental health; helping countries with cost projections; facilitating the integration of mental health into primary care; and improving health information systems. Abdulmalik added that having cultivated relationships with policy makers and key stakeholders was useful to understanding health care systems hierarchy, as well as leveraging existing platforms. He acknowledged that some of these individual efforts are “droplets” in a bucket, but he hoped that the EMERALD project, as a whole, would result in a comprehensive template for strengthening mental health systems in low- and middle-income countries.

FIGHT AGAINST EPILEPSY 8 : STAKEHOLDER ENGAGEMENT

WHO and the Ghana MoH, with support from Sanofi Espoir Foundation, have teamed up for a 4-year project (2012−2015) to reduce the epilepsy treatment gap, using a variety of strategies: promoting training of all health care providers, improving community awareness to reduce stigma and increase demand for care, and integrating epilepsy care within the primary health care system. Since the initiation of the project:

• A national/district coordinating committee was established;
• A situation analysis report was developed at the national, regional, and district levels;
• 330 volunteers and 404 primary health care providers were trained in epilepsy management;
• Gradual scale up occurred, with coverage now in 10 districts in 5 regions;
• A monitoring and evaluation strategy was developed; and
• A draft model of epilepsy care was developed.

Cynthia Sottie, national coordinator of the Fight Against Epilepsy project at the Ghana Health Service, said that engaging with stakeholders at all levels, at all stages of the project, has been critical to the project's success. She noted that they have involved the Minister of Health, representatives from the teaching hospitals, national and international NGOs, the Mental Health Society of Ghana, regional health directors, faith healers, and community members. By involving so many stakeholders from the beginning of the project, “everybody was involved [and] everybody knows what is going on at each time.” Sottie said that everyone's involvement was vital to getting the support and participation necessary to carry out the project.

KENYA ASSOCIATION FOR THE WELFARE OF PEOPLE WITH EPILEPSY 9 : PUBLIC EDUCATION

KAWE was founded in 1982 and seeks to improve the lives of those with epilepsy through a variety of efforts, including the training of primary health workers, awareness creation and stigma reduction through community projects, medical provision and support (e.g., epilepsy clinics, patient groups), and policy advocacy at the MoH in Kenya. Between 2000 and 2014, KAWE trained 1,814 clinical officers and nurses and 3,095 CHWs, and the organization's awareness programs reached an estimated 254,000 people directly and more than 3 million through mass media, said Osman Miyanji. In addition, more than 25,000 patients have been registered throughout clinics in Nairobi, Kenya, as a result of KAWE's community programs, and from a training perspective, the organization helped launch national epilepsy guidelines and developed a more comprehensive curriculum for medical training institutions. Miyanji reported that KAWE has demonstrated that they can close the treatment gap, and he noted that in 30 years of experience, public education to address social stigma and reduce ignorance has been a key element of their success.

THE KINTAMPO PROJECT 10 : FOCUS ON COMMUNITY-BASED CARE

The Kintampo Project, a collaboration between Ghana and the United Kingdom, is “training a new generation of mental health workers,” said Joseph B. Asare. The project trains clinical psychiatry officers (CPOs) and community mental health officers (CMHOs). CPOs can diagnose mental illness and prescribe medication, while CMHOs focus on detection of mental illness in the community, education of local people, and reducing stigma and discrimination. CMHOs work in part by developing relationships with local families, schools, prayer camps, and traditional healers. The organization's objective is to have one CPO and two to three CMHOs in each of Ghana's 216 districts by 2017. Through the Kintampo Project, workers have been trained and deployed all over Ghana, helping thousands of the most needy people. The project is on track to boost the mental health workforce by 60 percent and the number of patients treated per year by 500 percent. By focusing on community-based care, Kintampo is shifting the focus of mental health care away from large hospitals and into the community where it is most needed, Asare said.

PROGRAM FOR IMPROVING MENTAL HEALTH CARE (PRIME) 11 : BUY-IN, BUY-IN, BUY-IN

Tedla Wolde-Giorgis provided an overview of PRIME's efforts to integrate mental health into the existing health delivery system in five countries (Ethiopia, India, Nepal, South Africa, and Uganda). The purpose of the 6-year study, launched in 2011, is to research the magnitude, impact, and tractability of mental disorders in low- and middle-income countries. Using Ethiopia as an example, Wolde-Giorgis reported that integration was an incredibly complex process (beyond the instructions in the mhGAP intervention guide [IG]) that required buy-in from decision makers at all levels—national, regional, and community—as well as support from health care facilities and NGOs. Wolde-Giorgis said that, regardless of the level of support at the top, a top-down approach will not work; ultimately, the day-to-day work is done in the community and facilities, so it must be led at this level. He also noted that stigma reduction is a critical part of getting buy-in at the community level. For an effort to be sustainable, the buy-in must be continuous—it is not a one-time effort. Leadership must be continuously reminded of the importance of mental health and how it aligns with national priorities because there are so many other competing health concerns and health initiatives (e.g., MDGs).

PROJECT FIVES ALIVE! 12 : SCALING UP

The goal of Project Fives Alive! is to reduce mortality rates among children below age 5. Sodzi Sodzi-Tettey said the project uses a quality improvement approach, which requires forming quality improvement teams, having the teams develop initiatives on how to change mortality rates, implementing these initiatives, and then using data to assess if there was a positive effect. The project started in 9 hospitals but has since been scaled up to 200 hospitals. Sodzi-Tettey said that the initial 9 hospitals were chosen because they were high-burden hospitals with high rates of mortality for children below age 5. By the end of the first 18 months of operation, 6 of the 9 hospitals showed significant improvement in mortality reduction. By learning what worked in these high-burden hospitals, the project created a “change package,” which consisted of data-driven initiatives that had led to improvement related to improving delay in seeking and providing care and to reliable use of protocols. Sodzi-Tettey said that of the 134 hospitals in which the project currently operates, nearly 70 percent have adopted ideas from the change package, while also developing their own initiatives (e.g., targeted health education on early care-seeking using interactive platforms, triage systems for screening and emergency treatment of critically ill children, and training staff on protocols, followed by regular coaching and mentoring) ( Twum-Danso et al., 2012 ). In these 134 hospitals, there has been a 31 percent reduction in facility-based mortality in children younger than age 5. Sodzi-Tettey reported on three lessons learned from the project. First, initiatives should be tested promptly and on a small scale; this creates data that management can use to decide whether or not to implement a change. Second, teams should be empowered to know and use their own data. Sodzi-Tettey said that many workers were used to reporting data to the top but had not been aware of their own performance. Once they had the ability to track their own progress, they became even more invested in improvement. Finally, Sodzi-Tettey said that sustainability is only possible if a project understands and works within the existing health system, rather than with its own schedule and priorities.

PARTNERS IN HEALTH IN RWANDA 13 : INTEGRATION OF MENTAL HEALTH INTO THE GENERAL CARE SYSTEM THROUGH PUBLIC-SECTOR COLLABORATION AND LEVERAGE OF EXISTING HEALTH PLATFORMS

Partners In Health strives “to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair.” 13 The Partners In Health program in Rwanda focused on close collaboration within the public sector to integrate mental health care into the general community-based care system within the district. At each level (hospital, health centers, and community), health workers were trained in mental health care. Partners In Health's primary mental health endeavor in Rwanda was the integration of mental health care into health centers using existing structure of intensive supported supervision and quality improvement following training. One challenge that the program faced was resistance from the staff to admitting and treating psychiatric patients in the general ward. Smith offered several reasons for the resistance, including stigma and discrimination. She said the most successful strategy for reducing stigma among the health care workers was effective treatment of patients. When staff saw people come in with very acute psychiatric conditions, receive treatment, and get better, the workers' perspective on mental health was significantly changed. Smith recalled the story of a district hospital manager who unknowingly hired a former patient to work on the grounds of the hospital. When he learned that she had been admitted to his hospital as a psychiatric patient only 2 months earlier, and was now capable of holding a job, he “became a big advocate for the work.” Smith said, “It was the witnessing of people getting better that was the most destigmatizing.” In addition to reducing stigma, Smith said that another key element of successful integration was leveraging the existing system structures and human resources. Rather than restructuring or bringing in new people, they worked within the existing system by mapping skill sets and matching them to the skills needed for mental health care. Smith said that by using what was already available, a much more rapid and efficient integration into primary care was possible.

• MENTAL HEALTH CARE IN TURKEY: POLICY DEVELOPMENT

Oğuz Karamustafalioğlu, professor of psychiatry at Üsküdar University, provided an overview of mental health care in Turkey. He noted the high treatment gap for schizophrenia, depression, and substance use problems, and the lack of human and material (i.e., psychiatric beds) resources needed to adequately meet the demands of patients. In 2006, the MoH in Turkey released a National Mental Health Policy (NMHP) 14 aimed at mobilizing resources to ensure that mental health care services are accessible and balanced. Karamustafalioğlu stated that the NMHP encouraged preventative methods to decrease the burden of mental disorders, to increase attainable mental health care and services at both primary and secondary care levels, to encourage the respect of human rights for those with a mental illness, and to support the necessary legislation to protect their rights. Although there have been some successes since the NMHP was released—including an increase in the outpatient mental health care units at the general hospitals, the number of adult and child psychiatrists, and public education and awareness programs about mental health to reduce stigma—he emphasized that there is still more to be done to provide care and treatment to all patients.

• WORLD ASSOCIATION FOR SOCIAL PSYCHIATRY AND SANOFI: COUNTRY-SPECIFIC APPROACHES

Sanofi's Access to Medicines department works in some of the world's poorest countries, disseminating information about MNS disorders, improving diagnosis, and making treatment affordable and accessible to patients, said Francois Bompart. Programs are specifically tailored to each country in which they work, an approach that is critical to success. For example, Sanofi works in Comoros, a small group of islands off the coast of Mozambique. Bompart said that several issues complicate mental health care in Comoros: transportation is difficult and expensive, and there is only one psychiatrist in the country. In order to work within these confines, Sanofi is working to train primary health care providers to use telemedicine to connect to the one psychiatrist—a tailored approach that works for the specific context of Comoros but might be wholly inappropriate elsewhere. Similarly, in Guatemala, Sanofi tailored its approach by choosing to partner with a local NGO instead of the MoH because of instability in the government. With regards to cultural and societal sensitivities, Bompart noted that in some areas in countries such as Morocco, traditional and faith healers were not involved in the awareness programs given the local contexts.

• 686 PROJECT IN CHINA: FOCUS ON GENERAL PRACTITIONERS

The 686 project was a 2004 initiative that launched mental health reform in China after the severe acute respiratory syndrome (SARS) epidemic. Prior to the reform, mental health institutions (565 hospitals) were worn and outdated, there were no community-based mental health care services, and medical insurance was provided only to employed people. Ma Hong, deputy director of mental health programs at the China MoH, stated that initially, the government granted 6.86 million Yuan (860,000 USD) to train providers in mental health, and as the program continued, it covered free hospital treatment for patients and out-of-pocket medical costs for impoverished patients. Hong noted that it was critical to learn how to express the need for funding and the overall burden of mental health in the language of the government. The project consisted of 60 demonstration projects reaching a population of 42.9 million people, in which providers were trained; hospital services were expanded to communities; and, when universal medical insurance was implemented in China, the project covered out-of-pocket costs for impoverished patients. One significant challenge was that while there was adequate funding for services, the human resources necessary to actually provide care lagged behind. Hong said, “Money does not equal service—human resources development is much slower than simply building a new hospital.” She proposed that too much reliance on specialists in rural areas is misguided, and that when building a mental health program, the focus should be on expanding general practitioners' knowledge of mental health and building their capacity to diagnose and treat MNS disorders. Hong noted that a hospital–community continuous care system has since been established and 4.29 million patients have been registered in the health information system, including 3.41 million patients who have received community health care, 61.7 percent of whom are farmers.

See http://www ​.africamentalhealthfoundation ​.org (accessed July 14, 2015).

See http://www ​.basicneeds.org (accessed July 14, 2015).

See http://www ​.basicneeds ​.org/where-we-work/ghana (accessed July 14, 2015).

See http://www ​.basicneeds ​.org/where-we-work/kenya (accessed July 14, 2015).

See http://www ​.directrelief.org/about (accessed July 14, 2015).

See http://www ​.breastcareghana.com/about (accessed July 14, 2015).

See http://www ​.emerald-project.eu (accessed July 14, 2015).

See http: ​//fondation-sanofi-espoir ​.com/download ​/2012-10-22_CP_Ghana_EN.pdf (accessed July 14, 2015).

See http://www ​.kawe-kenya.org (accessed July 14, 2015).

See http://www ​.thekintampoproject.org (accessed July 14, 2015).

See http://www ​.prime.uct.ac.za (accessed July 14, 2015).

See http://www ​.ihi.org/engage ​/initiatives/ghana/pages/default ​.aspx (accessed July 14, 2015).

See http://www ​.pih.org (accessed July 14, 2015).

See https://www ​.mindbank.info/item/69 (accessed August 13, 2015).

• Cite this Page Forum on Neuroscience and Nervous System Disorders; Board on Health Sciences Policy; Board on Global Health; Institute of Medicine; National Academies of Sciences, Engineering, and Medicine. Providing Sustainable Mental and Neurological Health Care in Ghana and Kenya: Workshop Summary. Washington (DC): National Academies Press (US); 2016 Feb 25. 4, Case Studies.
• PDF version of this title (3.7M)

In this Page

• AFRICA MENTAL HEALTH FOUNDATION: COMMUNITY PARTNERSHIPS
• DIRECT RELIEF AND BREAST CARE INTERNATIONAL: COLLABORATION
• EMERGING MENTAL HEALTH SYSTEMS IN LOW- AND MIDDLE-INCOME COUNTRIES (EMERALD): STRENGTHENING HEALTH SYSTEMS
• FIGHT AGAINST EPILEPSY: STAKEHOLDER ENGAGEMENT
• KENYA ASSOCIATION FOR THE WELFARE OF PEOPLE WITH EPILEPSY: PUBLIC EDUCATION
• THE KINTAMPO PROJECT: FOCUS ON COMMUNITY-BASED CARE
• PROGRAM FOR IMPROVING MENTAL HEALTH CARE (PRIME): BUY-IN, BUY-IN, BUY-IN
• PROJECT FIVES ALIVE!: SCALING UP
• PARTNERS IN HEALTH IN RWANDA: INTEGRATION OF MENTAL HEALTH INTO THE GENERAL CARE SYSTEM THROUGH PUBLIC-SECTOR COLLABORATION AND LEVERAGE OF EXISTING HEALTH PLATFORMS

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Coronavirus Design Competition

GRAND PRIZE: $1,000

BRIEF Things aren't going too well right now. Each new day seems to add to the uncertainty about the immediate and long-term impact of the Coronavirus pandemic. Whether you think that people are overreacting or it is truly a global health emergency, one fact is objectively true: Covid-19 has affected billions of lives: if not physically than economically and mentally.

Entire cities in China have been on lockdown for weeks and now Europe faces the same pressures. Behind the news stories that love to flash statistics on infection rates are real people who are uncertain of what this

The Trends that Will Influence Architecture in 2019

It is, once again, the time of year where we look towards the future to define the goals and approaches that we will take for our careers throughout the upcoming year. To help the millions of architects who visit ArchDaily every day from all over the world, we compiled a list of the most popular ideas of 2018, which will continue to be developed and consolidated throughout 2019.

Over 130 million users discovered new references, materials, and tools in 2018 alone, infusing their practice of architecture with the means to improve the quality of life for our cities and built spaces. As users demonstrated certain affinities and/or demonstrated greater interest in particular topics, these emerged as trends. 

Exhibition: Living with Buildings

How does our built environment affect us? This major exhibition spanning two galleries examines the positive and negative influence buildings have on our health and wellbeing. From Dickensian London to the bold experiments of postwar urban planners, and from healing spaces for cancer patients to the role architecture can play in global healthcare provision, we look anew at the buildings that surround and shape us.

Is Architecture Synonymous with Stress?

The idea of becoming an architect and working in the field can seem to go against notions of a good work-life balance. With long journeys, pressing deadlines and the need to make informed decisions quickly, combined with potentially low wages and a quagmire of tricky working relationships and red-tape, architecture is conceived to be one of the most stressful professions.

A survey by Architect's Journal in 2016 found that 25% of UK architecture students are seeking mental health related treatments. In an article by Jennifer Whelan , published in May 2014 about mental health of architectural students, the author discusses the results of research conducted by the University of Toronto Graduate Student of Architecture, Landscape and Design (GALDSU) where the majority of students admitted to regularly pulling all-nighters, skipping meals, forgoing extracurricular social activities, and rarely exercising in order to finish projects on time.

New Study to Investigate Skyscraper-Induced Depression and Motion Sicknesses

Have you been experiencing motion sickness, depression, sleepiness, and even fear, as you gaze out of your window from the 44 th floor? If so, you may be prone to “Sick Building Syndrome” – the informal term for side effects caused by swaying skyscrapers , according to experts at the Universities of Bath and Exeter, who are launching a £7 million ($8.6 million) study into their causes and prevention through testing simulations .

“More and more people are living and working in high-rises and office blocks, but the true impact of vibrations on them is currently very poorly understood,” explained Alex Pavic, Professor of Vibration Engineering at the University of Exeter. “It will for the first time link structural motion, environmental conditions, and human body motion, psychology, and physiology in a fully controllable virtual environment.”

Study Finds 25% of UK Architecture Students Have Sought Treatment for Mental Health Issues

Are the rigors and tribulations of architecture school causing serious impacts on students ' mental health? A new student survey conducted by Architect’s Journal has found that more than a quarter of architecture students in the UK are currently seeking or have sought medical help for mental health issues related to architecture school, and another 25% anticipate seeking help in the future.

The results have prompted Anthony Seldon, vice-chancellor at the University of Buckingham and a mental-health campaigner, to describe the situation as “a near epidemic of mental-health problems.”