Compassionate containment? Balancing technical safety and therapy in the design of psychiatric wards
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- 作者：Sarah Curtis ; Wilbert Gesler ; Victoria Wood ; Ian Spencer ; James Mason ; Helen Close ; Joseph Reilly
- 关键词：England ; Psychiatric hospitals ; Mental health care ; Hospital design ; Risk governance ; Technical safety ; Surveillance ; Therapeutic landscapes
- 刊名：Social Science and Medicine
- 出版年：November, 2013
- 年：2013
- 卷：97
- 期：Complete
- 页码：201-209
- 全文大小：267 K
文摘
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 鈥榩ersons鈥?are exercised through 鈥榯echnical safety鈥?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 鈥榩laces鈥?within the hospital where risks are seen to be 鈥榣ocated鈥? 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 鈥楶anopticist鈥?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.