Beyond the walls of the asylum...new building type for psychiatric patients?

Summarised from:
Yanni, Carla. "Beyond the Hospital: the Clubhouse Model for Psychiatric Patients."  In The Architecture of Hospitals, edited by Cor Wagenaar, 432-442. Rotterdam, The Netherlands: NAi Publishers, 2006.
Yanni, Carla. The Architecture of Madness. Insane Asylums in the United States, Minneapolis: University of Minnesota Press, 2007.

Carla Yanni, an associated professor of art history at Rutgers University, has written extensively on the history of psychiatric hospitals and 'therapeutic design'. For example, in The Architecture of Madness. Insane Asylums in the United States, she describes the American medical establishment's preoccupation with 'therapeutic' architecture as a way to cure psychiatric disorders during the last century, and it's subsequent decline in importance.

Mental illness is currently considered to be treatable but not curable. There is no vaccine or instant cure as there is for an infection.It remains shrouded in mystery which contributes to the stigma associated with psychiatric illness. Those recovering from severe psychiatric illness must deal with this social stigma, in addition to their often difficult path to recovery.
Architecture plays a much less significant role in this path to recovery than it did 100 years ago. For the past 40 years, "...almost every developed country has abandoned the mass institutionalization of the mentally ill" (1). The role of the environment is less clear than the role of biology. While it's true that long term stays in mental health units are far less common now than 50 years ago, there is debate over the need for permanent places where people with mental illness to reside long term. Large hospitals where patients dwell for a lifetime are no longer a cherished or central part of psychiatric practice, though they do still exist.
As the pyschiatric profession has shifted its attention to noninstitutionalised, milder cases of mental illness, architecture has declined in it's importance in psychiatric therapy.
Deinstitutionalisation reached it's height during the 1970s both in the USA, Britain and in New Zealand. Drugs improved and allowed many patients to live comparatively normal lives within the community, but only with support. Those without support fell through the cracks. Critics of pharmacological intervention described the drugs as just a replacement for the old chains and shackles of insane asylums, and the adverse effects of these drugs meant that many people with schizophrenia and bipolar disorders refuse to take them. Those with no support often found themselves on the streets - estimates of the percentage of homeless people suffering from mental illness in the USA ranges from 25 to 40%(find reference). So, the final architecture for a welfare-dependant schizophrenic after institutionalisation was not a building, it was the street...

Where does a recovered person go after a hospital stay?

In 1948 a group of patients recently released from a state hospital began meeting casually to help each other adjust to their new lives. They, along with 2 investors, began Fountain House in New York city. This was the start of the 'clubhouse' model - 300 have since been initiated worldwide.
The main features:

• provide a place to work and interact, support each other adjust to life outside hospital
• not a hospital, not walled or confining; no bars on the windows or doors
• modeled on gentlemen's clubs of New York - if healthy, wealthy people benefit from a civilized oasis in the city, a place to get away from business and home, recovering mental health patients could too
• focused on building a community rather than based on a medical model; a casual environment for daily interaction
• look beyond the patient (therapy, medication) to the person (relationships, work, living)
• not a hospital, not a treatment centre - no doctors or nurses or treatment administered; this separates the person from the disease
• not a residence - no one lives there; spatially separate from 'home'
• a member's diagnosis has nothing to do with their status at the clubhouse
• codes of behaviour and rules apply
• architectural brief was to be  like a small hotel, the communal areas without the bedrooms; the common areas of many hotels are similar to gentlemen's clubs - a 'club' ought to look and feel quite different to home
• the recovering person must travel from home to here - it is a place to go during the day; the movement from home to club and back again is part of the steps in learning to live away from hospital - it requires the patient to encounter other people and new spaces
• A Victorian critic of the 19th century institution described living as a patient in an insane hospital 'he will breath the same air, occupy the same space and be surrounded by the same objects night and day'. Whereas the clubhouse model is more like real life.

((Finish this))

(1) Melling, Joseph and Bill Forsythe. Insanity, Institutions and Society, 1800-1914: A Social History of Madness in Comparative Perspective. London: Routledge (1999), 18.