McKellar Mental Health and Wellbeing Unit Barwon Health

The Barwon Health design process has made a timely and critically important contribution to system-wide reforms now underway in Victoria.

Fully described in our International Journal of Mental Health Nursing paper 'A first-hand experience of co-design in mental health service design' (Tindall et al. 2021), it demonstrates best practice in co-design through:

• Co-design team model: four people formed the core co-design team - clinician, consumer, carer and provocateur. They led development of the model of care and worked alongside the project architects and others to design the new facility. All co-design team members held formalised salaried roles and started from a place of feeling valued, with clear expectations and time taken to build trust. This enabled confidence in sharing perspectives and openness to vulnerability.
• Co-design approach: pushing the boundaries of normal service design, collaborative team decision-making was undertaken on all design elements, with reflective approaches allowing members to ‘be comfortable in the grey’. Integral throughout were person-centred and biophilic design elements, with service users and providers contributing equally to final outcomes.
• Power dispersal and partnership: project responsibility was provided to the team by the health service executive, enabling power dispersal and testing of co-design boundaries in a supported manner. This gave space for the status quo to be challenged and for new opportunities to emerge.
• Synthesis of insights to speak with one informed voice: all team members were responsible for engaging with a broader range of stakeholders who could add diverse experience, knowledge, insights and context, including lived experience networks, clinical networks, industrial partners, other key groups (e.g., information technology, infection prevention) and Deakin University. Reflecting together on feedback, the team spoke with one informed voice to external decision-making authorities. Importantly, nuances and differences in opinion were articulated in a considered manner, with all team members agreeing on messaging.

The project exceeds good design criteria in two key ways: through integration of biophilic design principles and integration of user experience.

Enhanced design through biophilic research translation

Through the Change to Improve Mental Health (CHIME) partnership between Barwon Health and Deakin University, the co-design team engaged with Associate Professor Phillip Roos to enhance the design of the new facility through biophilic design (connection to the natural environment).

More than just improving experiences, biophilic design is a key evidence-based healthcare design strategy which seeks to promote recovery and deliver better outcomes for all. Practical examples included ensuring the design maximised views of nature throughout, and that images, patterns and colours mirror those found within nature.

User experience and impact of hearing all perspectives

The co-design methodology ensured development of a holistic model of care and a facility design that will be both high-quality and fit for purpose. Each room has been carefully considered from the perspectives of all who will use it, ensuring that all will experience the unit as therapeutic and hope-inspiring.

The model of care includes innovative approaches to individual and group therapy, staffing and restrictive interventions. Very significantly, the new unit does not have seclusion rooms. Instead, it has two high-needs suites (bedroom, bathroom, lounge and courtyard) that will support people experiencing high distress.

However, the value of the co-design process extends well beyond this. The ideas that came from the project demonstrated to all involved the value that comes from hearing all perspectives. Having a space to reflect on the impact of decisions, interventions and physical spaces - and hearing testimonials from those affected - has changed the way treatment and care will be provided within the unit.

As described in our paper, these learnings can set a benchmark for future Australian and international mental health design initiatives.

Reducing coercive practices through innovative design and model of care

Through innovative design of high-needs suites and model of care, the MH&WU provides a therapeutic alternative to current seclusion rooms used in Victoria’s acute units. Historically, Victorian acute units have incorporated seclusion rooms to provide containment to people at immediate risk to self or others.

These rooms are very bare, and include a fixed bed and paper bed pan / urinal. More contemporary seclusion suites have a toilet. The impetus is minimal stimuli with nothing that could be used to cause harm to self.

During the Royal Commission and many other reviews of restrictive interventions, the trauma and harm caused by seclusion has been acknowledged. The Royal Commission recommended immediate reduction in use of seclusion and restraint, with the aim of eliminating their use within 10 years.

The co-design team directly addressed this challenge in both unit and model of care design, closely informed by engagement with national and international experts. Two 'high needs suites' have been incorporated in the unit, one in each 4-bed intensive care area, with a bedroom, bathroom, individual lounge and small courtyard. Additionally, a de-escalation suite (low stimulus room and courtyard) and two sensory modulation rooms are available).

These spaces allow consumers experiencing high distress a range of options to either self-soothe or be supported 1:1 with a preferred staff member. There are additional senior nursing staff (titled reducing restrictive intervention nurses) built into the staffing profile to support capacity building of ward staff in managing deterioration, or to work 1:1 with consumers at risk of, or currently experiencing deterioration.

Co-design of the McKellar unit and model of care demonstrates that real and impactful change is possible. It extends well beyond the capacity to effectively design a solution to a problem.

It offers the opportunity to practice and enact the values and principles we aspire to and that the Royal Commission and multiple other reviews have described as essential to a contemporary, compassionate, credible mental health system.

Both in design and in its capacity to change perceptions about acute mental health care and experiences, the MH&WU reflects generational reform – as a hope-inspiring and welcoming therapeutic environment that promotes recovery and helps rebuild a person’s connections and independence.

It contrasts starkly with, and will provide a model for, rebuilding aging Victorian acute mental health units which are often characterised by poor amenity, little or no access to nature and high rates of coercive practices.

For consumers aged 50+ with significant and complex needs, an innovative approach to treatment and care will be facilitated. Therapeutic spaces onsite will allow for both inpatient and outpatient care, delivering greater continuity across the spectrum.

Multiple welcoming spaces (all equipped with telehealth) will enable consumer engagement in a range of activities with family, friends, carers and community supports during an inpatient stay.

The McKellar co-design model adds significantly to our understanding of how successful co-design can be undertaken in mental health, and it is for this reason that we have shared our learnings internationally through our paper.

Barwon Health will continue to apply this model to other new mental health facilities (including the new Y-PARC for Geelong and the new headspace centre for Colac) and to a range of service transformation activities resulting from Royal Commission and Commonwealth-funded reforms.

A key driver for this project was a design that meets sustainability guidelines and embodies circular economy principles to deliver a low impact and environmentally sustainable exemplar for the future.

There were a number of leading-edge Environmentally Sustainable Design (ESD) principles utilised to ensure the new building provides a low carbon footprint and minimises waste:

• mechanical engineering systems that will achieve high-performance sustainability outcomes
• low-energy solutions in mechanical system installation with elements such as: heat recovery on discharge air for pre-cooling / pre-heating of outdoor air, high efficiency motors and leading edge low-energy control routines for optimised performance day and night
• low-energy LED lighting throughout, maximising natural light where possible in line with salutogenic design principles
• solar power array covering ~60% of the roof space, generating up to 40kw at peak power
• underground rain water harvesting with a 20,000 litre tank

Whilst ESD principles were crucially captured early in the design, this project is also focused on various methods of minimising environmental impact during construction including:

• reducing construction and demolition waste through smart design, material choices, prefabrication, segregation of waste streams and waste management contractor pre-qualification
• increasing water efficiency onsite, including harvesting rainwater for use in dust suppression and site office amenities
• establishing materials supply chain partnerships with a strong focus on environmental responsibility and stewardship.

This project also had a significant positive impact on local jobs and social procurement. It has engagements with Social Traders, Buyability, Kinaway, Supply Nation and WE Connect International to ensure that not only are jobs kept local but social procurement is kept at the forefront.

As one of the largest health projects in Geelong, there is significant expenditure being undertaken on both materials and trades. The projects partnerships with social procurement agencies are ensuring expenditure with local Aboriginal-owned businesses, social enterprises and disability enterprises.