Destigmatizing mental health treatment centers through architectural interventions; insights from national institute of mental health, Mulleriyawa, Sri Lanka.

Abstract

In the modern Sri Lanka context, despite frequent awareness programs and increased access to information, an inherent stigma associated with mental health disorders and treatment methods prevail. The Architectural characteristics and elements of existing mental health facilities have been found to amplify these negative perceptions hindering patients' access to effective mental health care. Within this backdrop, this study looks into the Architectural parameters that contribute to the stigmatization of mental health facilities, adopting a mixed-methods approach taking the National Institute of Mental Health (NIMH) in Mulleriyawa as a case study. Participants’ perceptions (n=36) on seven selected spaces [; admin building facade, old ward facade, specialized departments, new ward exterior, old ward interior, entrance lobby and main corridor] within the facility were gathered through an author designed online questionnaire survey, while their corresponding levels of well-being and depression, stress, and anxiety levels were evaluated using SACRA-15 Building Well-Being Scale and the DASS-21 scale respectively. A majority of the participants reported severe levels of depression, anxiety, and stress across all the spaces studied, with the highest percentage of participants relating to ‘old ward interior” [86%,72%,75] followed by new ward exterior [97%,55%,61%]. Consistent with this finding, the majority of participants demonstrated low levels of wellbeing scores across the spaces tested, out of which ‘old ward interior’ and the ‘new ward exteriors’ were significant with highest percentages of participants with low levels of wellbeing [81% and 70%]. The main corridor of the facility was the only space showing a moderate level of well-being due to significant attributes of natural light, ventilation, nature connectedness and spaciousness. The participants identified the Architectural quality of NIMH as “‘prison-like’, ‘unwelcoming’, ‘scary’ and ‘gloomy’, contributing to an oppressive atmosphere which reinforced stigma. Restricted visual and physical access, lack of visual connections, limited access to green spaces, inadequate natural lighting and color, unbalanced solid-to-void ratios and underutilization of vistas were found to contribute towards the existing and monotonous ambience with sense of containment, leading to the stigmatization of this mental health establishment. Based on these findings, the study recommends incorporating courtyards and green spaces, improving the use of color, removing visible demarcations while maintaining functional and psychological boundaries, and optimizing material choices and spatial volumes as supportive Architectural interventions to help de-stigmatize mental health treatment centers.