We all have an idea of what mental health design used to be like: institutional and one-size-fits-all with a safety-first approach. Over time it has moved towards creating more humane and therapeutic spaces, focusing on creating healing environments that provide safety and dignity in equal measure.
However, there remains a vital and still often underutilised source of knowledge: lived experience of patients who have navigated the complexities of mental health care firsthand. They can bring invaluable insights into what does and doesn’t work in clinical environments such as how furniture layout can affect their sense of safety. This insider feedback can highlight potentially overlooked details that significantly impact a service user’s recovery journey, no matter how well-intentioned the work of all the various people involved in creating mental health spaces.
For example, patients might identify that certain necessarily safe environments can feel very impersonal, making it harder to feel human and respected, or that sound from various areas spills over into zones intended for quiet calming activities, thereby causing discomfort and anxiety. While these observations are not always likely to emerge in architectural planning or clinical checklists, they do affect how the space functions in practice. Overlooking the emotional and psychological nuances of being a patient in these environments can lead to environments that are efficient and focused on risk management, control and even surveillance at the expense of patient comfort, autonomy and ultimately healing.
Patient feedback, if solicited at all, has often been requested later in the design process, reducing it to a formality rather than a foundational element. The shift towards co-design and co-production represents a meaningful evolution in mental health design, with patients, clinicians, architects and designers collaborating from earlier stages in the process.
In practice, this can include interviews, surveys, or group design sessions where patients share their critiques, needs and ideas on issues such as noise, light or smells and their impact on patients, or spaces designed to allow for both social interaction as well as solitude. Lived experience highlights the value of flexible, adaptable environments that accommodate different activities and levels of interaction. Involving service users in the co-design and co-production of their spaces empowers them to become active contributors rather than passive recipients, fostering a sense of agency that mirrors the therapeutic goals of mental health care itself.
While mental health conditions and recovery journeys are deeply personal and individual, there are three key themes that that emerge from lived experience insights, namely patient dignity, safety, and autonomy.
Design features such as private bedrooms, access to personal belongings, and environments that foster a sense of belonging support patient dignity. Welcoming, attractive decor, comfortable furnishings, and artwork can reinforce a sense of worth, whereas cold, institutional settings erode the sense of self and respect for the patient.
A good example is the comparison between walking into a fast-food outlet and entering a mental health facility. What makes a fast-food outlet feel like a fast-food outlet? The idea of speed and efficiency is emphasised by the combination of bright lights, hard, easy to clean surfaces, functional seating, the noise, and even the food aromas. There are many environmental cues telling you to do what you need to do and to leave to get on with your day. This is not a calming atmosphere, encouraging you to linger.
The same goes for mental health facilities, where you would expect cues telling you that you are welcome to stay and that this is a place to heal, but often the impersonal environment is telling you to get in and get out. So patients experience a juxtaposition between what they are being told they are there for, and the way their body is instinctively reacting to the environmental cues – which are at odds with what they are hearing from the staff.
While safety is paramount, service users often differentiate between physical safety and emotional safety. The lived experience can inform design solutions that reduce environmental risks without making spaces feel punitive or restrictive. Anti-ligature and other safety features can, for instance, be discreetly integrated so they do not dominate the aesthetic or contribute to feelings of constraint.
Empowering patients to make choices about their environment can also have a significant impact on their well-being. This could involve adjustable lighting, access to outdoor spaces, or adaptable design allowing for spaces to accommodate different moods, activities or levels of interaction. Such features enable patients to manage their sensory input and personal space according to their own comfort, resulting in a better healing process overall.
To fully harness the value of lived experience, it needs to be embedded into policies and practices involved in mental health design. This means making co-design a standard part of the process, investing in training for professionals to work effectively with service users, and evaluating outcomes based on patient-reported experiences.
Patients know better than anyone what helps or hinders their healing, and their voices are an integral part of the move to more effective, compassionate, and inclusive environments. Incorporating their lived experience is essential in creating healing spaces that are truly restorative, inclusive, and effective and design should place their insights at the heart of the spaces intended to support their recovery.
