Social Impact: Endcliffe Case Study / P+HS Architects

Based at the Longley Centre at the Northern General Hospital in Norwood, Sheffield, the Endcliffe Psychiatric Intensive Care Unit (PICU) is a 10-bed secure unit providing 24-hour care for people experiencing a mental health crisis. As an offering of the Sheffield Health and Social Care NHS Foundation Trust, Endcliffe ward provides a safe, controlled, and low stimulus environment with high levels of observation and high intensity care. The project involved new building alongside extensive refurbishment to the previous mental health facility which had limited access to external spaces and was cramped and outdated. With the physical environment playing such a key role in mental health care and recovery in relation to both the indoor environment, and access to outdoor space and engagement with nature [1], this project offered significant improvements to mental health care delivery for some of the most vulnerable people. The facility also provides an occupational therapy room, sensory room, a prayer/quiet room, lounges, activity room, staff facilities, and offices.

[1] Walker, C., Hart, A., & Hanna, P. (2017). Building a new community psychology of mental health. London: Palgrave Macmillan.

Social Impact of the Design

Co-production & social impact

In recent years, co-production has become the ‘gold-standard’ in the design and development of healthcare facilities. Such an approach challenges the traditional orthodoxy of ‘expertise’ residing within individuals with professional qualifications and recognises the expertise of individuals with lived experience [1]. In healthcare, these experts by experience include service users, carers, staff, and potentially the public.

Whilst many healthcare projects engage in the process of consultation with a range of stakeholders, the current project adopted a process of genuine co-production from the outset. For example, the design team worked with a variety of stakeholder groups at the Trust to develop and design the healthcare spaces and ensure that they are relevant to experts by experience and also enable them to effectively deliver existing service models whilst also providing the spaces to enable new clinical service models.

Across the project lifespan 3 primary co-production workshops were held, in addition to design review sessions and follow up engagement. The project adopted a robust design sign off and approval process with all stakeholders engaged in the sign off of the building design, the service operating model and the staffing structure. This specifically informed the inclusion of varied garden spaces for specific uses including Occupational Therapy, Seclusion and female only space, and a graffiti wall in the Occupational Therapy space.

This co-production approach to design and delivery has been shown to empower individuals and produce better healthcare environments [2].

Below: example of layout created through the process of stakeholder engagement and co-production.

[1] Boden, Z., Larkin, M., & Springham, N (2019) Using experience-based co-design to improve inpatient mental health spaces. IN McGrath, L & Reavey, P. The Handbook of Mental Health and Space. Routledge.

[2] Boden, Z., Larkin, M., & Springham, N (2019) Using experience-based co-design to improve inpatient mental health spaces. IN McGrath, L & Reavey, P. The Handbook of Mental Health and Space. Routledge.

Health & Wellbeing: The design process involved a large co-production component with the resulting design including a range of design decisions that are beneficial to health and wellbeing.

For example, the 10 bedrooms were set around three central courtyard areas. Not only is this an improvement on the previous outdoor space which consisted of one outdoor smoking shelter, but is also allows for access to the outdoors in multiple ways, including enabling participation in outdoor activities, providing views from inside and offering service users and staff access to natural light and ventilation.

In addition, the space draws on aspects of biophilic design through its use of natural materials, planting, and green roof. Combined, the views of and access to the outdoor spaces will likely have a positive impact on service users, carers, and staff due to the proven health and wellbeing benefits of biophilic design and access to nature[1].

[1] 1 Gillis, K., & Gatersleben, B. (2015). A review of psychological literature on the health and wellbeing benefits of biophilic design. Buildings, 5(3), 948-963.

Social Impact Diversity Equity Inclusion

Diversity, Equity & Inclusion: The Endcliffe PICU is a mixed sex unit and as a result the design adopts a progressive and adaptable approach which considers the diversity of the service users, ensures the environment is inclusive, recognises the difficulties and vulnerabilities service users might be experiencing, and provides privacy.
In addition to the adaptability of the environment, the design approach integrates service user artwork into the environment. Art has long been used as a mental health support resource and recent research highlights the benefits of incorporating artwork into both mental health practice (e.g., art therapy) and environments (e.g., displaying service user artwork on wards) to both the service users as a means of expression and diarising experiences, and staff in terms of gaining a deeper understanding of service users experiences[1].
The design team were also aware that art had played a role in the former ward and ensured the successful transfer and display of the artwork from the previous facility demonstrating a further
consideration for the service users and enabling the narrative of experiences to transition from old to new.

[1] Wakeling, B., & Hall, J. (2019) The Outsider Gallery: using art and music to open up mental health spaces. IN McGrath, L & Reavey, P. The Handbook of Mental Health and Space. Routledge

Social Cohesion: Creating spaces which enable interaction between different service users, and between service users and staff has been shown to offer positive experiences, enhance caring relationships, reduce stress and anxiety, and reduce serious incidents[1].

With open plan living and dining areas, alongside level access and curtain walling, the design of the Endcliffe ward embraced the notion of social interaction and service user agency, whilst also allowing for sufficient observation to enable care. Such features help to create positive social impact for all users of the space and enabled service users and staff to form meaningful caring relationships.

Broader Social Impact

Whilst the above highlight the specific design aspects which have created positive social impact for the users of the clinical environment, and will likely have reduced incidents of conflict and length of stay, and enhanced staff retention, such impacts extend beyond the immediacy of the clinical setting through the use of external building materials which link to Sheffield’s historical social identity as a place of industry and specifically steel production.

In addition, as the Endcliffe ward is in a prominent position as visible to the public, the use of stainless-steel shingles against the white rendering attracts the gaze to the building to provide the implicit messaging that mental distress is not something to be hidden away, rather it is something to be open about, helping to challenge social stigma and reduce mental health discrimination and marginalisation [1].

[1] Meechan, H., John, M., & Hanna, P. (2021). Understandings of mental health and support for black male adolescents living in the UK. Children and Youth Services Review, 129, 106192.

Social Perceptions of the Project

As the above highlights, P+HS Architects' work on Endcliffe PICU has had a significant social impact when considered in the light of existing theory and research evidence. To support this, there follows a selection of direct quotations from individuals using the environment, including both the Ward Manager and Clinical Director commented on the significant positive impact on service users and staff. Adelaide Mukasa, (Ward Manager SHSC NHS FT):

"Bigger, brighter space where you can have some privacy and there is more opportunity for individual care..It's good, not only for the service users but also the staff."

Dr Mike Hunter (Clinical director SHSC NHS FT):

"How the before and after building compares is like night and day..From a dark old building to this fantastic bright, spacious environment, it's going to be brilliant for patient care."

Staff comments:

"It is much better to have separate spaces for people to work in, really positive to have the staff room. The unit is much quieter even when there are distressed service users there."

Assistant Services Director Lisa Johnson also reflected on feedback from service users obtained through focus groups, highlighting the following positive impacts:

"Outdoor space is so much better than in the old unit" "There are more areas to be in therefore avoiding conflict" "Less use of seclusion" (at the time of the meeting, none had been used since opening)

Social Impact: Endcliffe PICU