N
I
A
T HE RAP EU T 1
F 0 R
S TA T E
0C
C
0 M MU N I T Y
THE
0 F
U TAH
August 10, 1959
Submitted to the Faculty of the Architecture Department,
Massachusetts Institute of Technology
in partial fulfillment for
the Degree of
Master of Architecture
Pietro Belluschi, Dean
Dept. of Architecture and Planning
Imre Halass, Ass't. Prof.
Dept. of Architecture
Nei1 A stle
ABSTRACT OF 'JHESIS
In n correspondence with Dr. Charles E. Goshen, head of the Architectural Study Project of the American Psychiatric Association, the mental
health problem was emphatically evaluated as follows:
'The field of Psychiatry has been dominated, during the past
100 years, by major architectural achievements.
This has been
due to the fact that mental health, until recently, has been
looked upon as a problem which was subject to solution by means
of building institutions.
The results of the trends during the
past century have been that we are now saddled with 6ooooo
institutional beds which are designed in such a way as to make
rehabilitation virtually impossible.
big, too remote,
These hospitals are too
too poorly staffed, too poorly designed to
serve the function of rehabilitating the patient.
As a result,
few patients get out of these institutions, and even when they
do, it
is only after such prolonged periods of hospitalization
that they have lost their rehabilitative resources on the outside and over a third of them return to the hospital.
Today we have a much different concept of what constitutes good
psychiatric care than we did in the past, and for these new
concepts we need an entirely new architectural approach.'
Realizing the need for new concepts of mental health design, it has
been the object of this thesis to explore present trends and treatment
procedures and to derive from these a working concept of a therapeutic
- ,-- . -. --.-. . ... ..-
w
h9. .~
--
---- - ---
R
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community.
The basic assumptions made in arriving at a concept are
based on the interviews, correspondence and writings of some of the
leading authorities in the field.
Although many factors such as cost, availability of land, etc., are
very important, the prime objective of this project will be the rehabilitation of the mental patient.
The intent of this thesis project might be stated as follows:
To aid in the resocialization of mental patients through the creation
of an environment based on organized vitality and freedom.
The en-
vironment must turn outward to the public inasmuch as the complex
must become an active part of the community which it serves and the
patient must ultimately return to this community. On the other hand,
the environment must offer privacy and security.
A maximum number of
choices must be available to the patient in the form of activities and
social relationships in order that the patient might choose and develop
those social skills that are best adapted to his individual rehabilitation.
CONTENTS
Title Page
Abstract of Thesis
Page
'IILE OF
0ONTENTS... . ..
*.*.................
THE NEED
The Need for Therapeutic Comunity..........
Needs of the Patient........................
HISTORY
History of Mental Hospitals.................
History of Mental Hospitals in Utah.........
BASIC THEORY AND DESIGN CRITERI
Therapeutic Criteria....................
Hospital........................
Activities.............................
The Day
1
3
5
16
19
31
37
39
THE ROLE OF THE ARCHITECT
Visual
Order..............................
StZ.............................................
sIT.............................................
47
51
52
PROGRAM
Genra1............................
General Diagnosis and Outpatient Treatment..
Public Facilities ..........................
Staff Facilities.......*............. .......
55
58
59
59
Educational Facilities......................
Adjunct Treatment Facilities................
61
61
Indoor Activities.......... ........
........
Outdoor Activities.. ........................
Service Areas............-..-.......
62
BIBLIOGRAPHY........*.O....*................0.
63
6
THE NEED
Need For Therapeutic Community
In general, mental hospitals are misunderstood.
The large
mental hospital we know today is antiquated and obsolete.
Many
of these hospitals have patient populations in excess of 2,000
with some ranging (in size) up to 5,000.
Institutions are still
being built even though it has become impossible to staff them
and for that reason to make true hospitals out of them. Only
fifteen states have more than 50% of the total number of physicians
needed to staff their mental hospitals.
In the words of Harry 0.
Solomon, M.D., 'I do not see how any reasonably objective view of
our mental hospitals today can fail to conclude that they are
bankrupt beyond remedy.
I believe therefore, that our large mental
hospitals should be liquidated as rapidly as can be done in an
orderly and progressive fashion."
There are already many signs of self-liquidation.
In Massachusetts
for example, there has been a steady increase in the number of
patients in hospitals followed by a leveling off and an actual
decrease in the number of patients.
This trend is common to most
of the states including the state of Utah. Utah's State Mental
Hospital reached a peak patient population of 1,389 in 1955 and
then decreased to a present patient population of 1,143.
This
decrease is, in general, due to improved curative methods which
include shock and drug therapy as well as group psychotherapy.
The decrease in patient population has occurred with a corresponding
increase in the number of admissions, a decrease in death rate and
a population increase.
This suggests that if the present trend
continues even less bed space will be necessary.
We are now in a period of change. Psychiatric wards are being
opened in general hospitals; day hospitals and out-patient clinics
are being developed and services for patients staying at home are
being studied. More psychiatrists are becoming interested in
community endeavors that do not impose institutional environments
upon their practice.
There is an attitude of greater optimism
and a corresponding liberalization in the discharge of patients.
What of the less readily recoverable, however?
Their outlook
remains grim unless new ways are found to meet their needs.
They
will be sent to large mental hospitals where they will accumulate
in an atmosphere of gloom, despair, and deterioration.
We cannot
allow this to happen.
Mental hospitals should take into consideration the factors involved in community life.
The basic needs of mental patients are
no different than our own, however, they exhibit some characteristics that are different. For this reason, the mental patient does
call for certain features over and above those necessary for other
types of buildings.
The most pressing need in the state of Utah arises from the overpopulation of some 1,500 patients in a hospital that is in itself
obsolete and only adequate to house 900.
The state seems to be in a state of conflict between two major
4
philosophies.
On the one hand there are those who would favor a
continuation of the consolidated system with practically all of
the mental health facilities at Provo, Utah. On the other hand
there are those who favor the dispersed system consisting of a
state-wide hospitalization system.
This would relegate the state
hospital to a custodial function and the care of geriatric and
mentally deficient patients.
Under the first proposal, favored
by the State Hospital Administration and the Welfare Commission,
the State Hospital would continue to develop as a focal point of
mental health, care and treatment activities for the mental patients
of the state.
The second proposal (see charts pages 44-45) would involve a series
of out-patient clinics located at widespread points throughout the
state which would utilize existing facilities as much as possible
and would be staffed by either full time or part time psychiatric
teams.
These clinics would render out-patient treatment to those
who live at home.
The system would also include an intensive
treatment center where acute cases with possibility for recovery
would be given intensive treatment for a relatively short period
of time and then returned to their homes.
Under this philosophy,
which is adopted in this thesis, the state is in need of an intensive treatment unit for approximately 200 patients.
Needs of the Patient
The following are some of the principles of design as outlined
from the writings of Dr. Charles E. Goshen:
1.
The patient's viewpoint:
The mental patient is more self-centered than the average
person.
His rehabilitation demands that his attention be
directed outward, to other people and his physical environment.
The design must emphasize features which will draw
and hold his particular interest.
The design should not be
considered from an administrative or maintenance viewpoint.
2.
The patient's needst
Since the mental patient may spend many years of his life
hospitalized, it is necessary to provide him with the means
for satisfying the needs which other persons find in their
homes, communities and places of work. He must have privacy;
he must be able to express individuality; he must be able to
find entertainment for himself; he must socialize with others;
he must develop skills; and he must have contact with people
who can offer constructive leadership.
Since most of his
contact is limited to other patients, the design must be such
that he is allowed maximum opportunity for contact with people
from the outside.
3.
Design and personnel function:
Above all, the patient needs careful personal attention of skilled personnel.
The design and location of the hospital has a
good deal to do with who will work there.
It must, therefore,
take their needs into account.
In general, the patient's schedule should be geared to that of the
"outside"; in other words, there should be little deviation in what
the patient would experience if he were out in the community. Since
the complex will ideally become a part of the commnity with an
6
interchange of participants it is important that their daily
schedules coincide.
Thefollowing is an "Expression of Human Needs" as outlined from
an article by Walter E. Barton, M.D.:
'EUPRESSIONS OF HLt
NEIDS
"The organismts systematic requirements are known as its needs.
Like its other traits, they are an outcome of the interaction between inherited predisposition and environment,$ writes Dr. Sandor
Rado.
He continues:
investigative tool.
"Need is an explanatory concept rather than an
It has proved to be far more fruitful to des-
cribe the motive forces of behavior in terms of feelings, thoughts,
and impulses to act; and the mechanisms of behavior as organized
sequences of feelings, thoughts and action."
"We should distinguish between motivating pressures according to the
nature of the goals," says Dr. Thomas M. French.
"Some motivating
pressures have only negative goals, they are urges to get away from
something; to escape from pain or from the object of one's fear, to
put an end to the distressing physiological state of hunger.
These
states of unrest we call 'needs' or krives'; they are characterized
by painful subjective 'tension', which tends to seek discharge in
diffuse muscular activity, like the restless thrashing about of a
hungry infant.'
Definitions of the concept $need" consistently mention deficits or
absences and relate these to activity around which to restore an
unstable equilibrium. One rather formidable definition, by
7
Dr. Andras Angyal, will serve as a point of departure.
"Need is a biospheric* constellation in which the environmental
factor which is necessary to carry out the given function is
absent or insufficient."
1. NEED AS AN EXPRESSION OF VEGETATION AND REFLEX FUNCTION.
Need for oxygen requires no conscious effort on the part of
the person to satisfy.
Initiation of the fulfillment of the need
may be activated by the accumulation of carbon dioxide.
The organ-
ism breathes more deeply and takes in more oxygen.
2.
NEED AS EXPRESSED IN 00MPLEX STANDARD REACTIONS SUCH AS FOOD,
SEX, FATIGUE,
(a) FOOD:
EXCRETORY FUNCTION AND PAIN.
There is a biologic need for food, associated with a
physiological state of tension familiar to us as hunger.
When
one has taken a sufficient amount of food andfluid, the tension
disappears.
We are aware of a sense of well being when
appetite is satisfied.
But suppose a person is hungry and
has no money to buy food.
He may sleep and dream of food or
look at a magazine advertisement for food or may peer through
a restaurant window and watch the chef in his high white hat
toss the dough as he makes a pizza.
steal as his hunger increases.
He may be tempted to
Customary habits and restraints
block the action and the tension increases.
Situations of
unsatisfied tension can lead to personality disorganization.
(b) SEX%
is more complicated than hunger for food because it
is less specific in the kinds of activities which reduce
*The biosphere refers to the living space of an organism in
the earth, air and water.
tension.
The emotionally starved sailor ashore after a long
sea voyage may find his need for sexual gratification stimulated by a hip-swinging, curvacious blonde.
The expression
of need from that point on will depend upon many factors;
the sailor, the blonde, the circumstances and the complicated
conditioning process of the persons involved. But on the long
sea voyage what dreams did he have and what consolation did
he give himself, and what of the inclination to choose substitute objects, which in olden times was the peril of cabin
boys?
Sexual appetite is but one small aspect of the express-
ion of the need related to the complex reaction - sex.
(a) FATIGUE: After severe physical or exhausting emotional
situations, we may be overwhelmed with a sense of fatigue and
require rest and relaxation. Adequate satisfaction of the
need will vary widely with the individual and the situations
that produce fatigue.
Rabbits kept from sleep, but otherwise
well cared for, frequently die. In one experiment with a
volunteer human subject, who maintained a waking state for two
weeks, paranoid ideas emerged.
The experiment was discontinued.
(d) EXCRETORY FUNCTION: Mioturation and defecation result in
part from a reflex function, arising from the accumulation of
waste material.
Traumatic emotional experiences and great ten-
sion may alter the excretory pattern. There may be an urge to
defecate while waiting for an athletic competition to begin.
Fear may produce involuntary elimination. Related by the earliest demanding learning situation, toilet training, the
expression of need in the excretory sphere may be tied up with
the desire to be clean in person; a concern with personal
appearance; and neatness of clothing. Some will look upon
dirt as bad, contaminating and defiling.
In the fullness of
their opposition to demands upon them, others may use excretory products aggressively in ways more distressing than our
universal tendency to "toilet talk" in states of anger.
Others may, in certain social situations, retain excretia to
the point where tensions arise that directly influence behavior.
(e) PAIN: In a normal state, every individual desires to avoid
pain, irritants, and injury.
He strives to maintain physical
health and to void physical illness.
however, are also well known.
Distortions of need,
It sometimes becomes Necessary
to protect a patient from his own hostile impulses, or he may
attempt to injure others as a result of intolerable inner tension.
The subjective experience of pain is apparently absent
in some so that illness is not signalled by pain and disability.
5.
NEED AS EXPRESSED IN CHOICE FUNCTION, LIMITED BY THE PERSONAL
EXPERIENOE OF THE INDIVIDUAL, HIS PERSONAL SITUATION AND BY
THE CULTURE.
These are, in fact, more "psychological" needs, subject to a
wider range of individual variations than those previously listed.
(a) DRIVE FOR ACTION: There is a drive within us all to do
things, to make things
happen, sometimes just for the sake
of experiencing one's self as the cause of change.
Some who
experience too much failure and frustration in life seem to
settle for fantasy or imagined activity.
(b) THE DRIVE FOR SUPERIORITY: This, we speculate is part of
our heritage if we can generalize from 'pecking orders" in
hens, dominance orders in subhuman primates and even bunting
orders in the docile cow.
We have a need to compete success-
fully with others and, where the need is free to express itself
we do one thing well or one thing better than anyone else.
Some have a need to dominate others, to inflict their will
upon those who are less self-assertive.
(o)
THE DRIVE FOR ACQUISITION: People desire to have something
of their very own, just as there are collectors of territory
and shining object among birds.
The patient, if allowed, has
his own bed, his own place to the table, his own living space.
There is a desire to extend this ownership, to accumulate
property and to accumulate material things.
Patients in mental
hospitals have less opportunity to satisfy this need, and when
there is a limitation of owned space, they may carry a shopping bag stuffed with an amazing collection of old newspapers,
a crust of bread, a glass or a spoon.
(d) THE DRIVE FOR EXPLORATION ( OR COGNITIVE MASTERY): There
is a natural curiosity within all of us that is relected in
an eagerness to know about the world.
We want to know about
things. We seek knowledge for the sake of knowing and sometimes to satisfy self-expansive tendencies.
We desire an
opportunity for growth in knowledge, in understanding and in
opportunity.
Satisfaction of this need would avoid situations
that tend to create dependency and deprivation.
(e) THE DRIVE FOR INTEGRITY:
privacy.
sometimes.
around."
We resist intrusion into our
We need a place to which we can retreat and be alone
We don't like to be dominated or to be "pushed
The trend towards self-expansion, the will to power,
aggression, are manifestations of the person's individuality
and his need to be a person, set apart from all others.
4.
THE NEED EXPRESSED 7OWARD BEING A PART OF THINGS OR SOMETHING
LARGER THAN ONE'S SELF:
We have a need to be a part of a family, of a social group,
of a community, of a nation.
Our need is to share something with
others and to belong to a larger unit.
We wish to choose our own
associates and to have opportunities for social interchange. We
relate to our pastor or rabbi, to a particular church, to our own
faith, to our beliefs in our part of a larger spiritual world beyond
earthly things.
5.
NEED FOR RECOGNITION, APPROVAL, POSITIVE RESPONSE.
We wish to be appreciated and recognized by others, to have
a good reputation, to have a good social standing, to hold ourselves
in good esteem.
We have a desire to be loved. People usually
resent being a part of a regimented group. A nice balance is required to be one of the group and yet to be different and individual.
Most people dread to deviate too much from the group norm. We don't
like to be shorter, taller or fatter than our associates.
We do
not like to be dressed bizarrely. We want to keep to the fashion
yet to reflect our own individuality in that fashion. We do want
to be noticed; some desire this more than others. All of us have
a desire for attention.
We desire someone to talk to and a group
with which we can identify.
6.
NEEDS MAY BE EXPRESSED AS SUBSIDARY TENDENOIES.
(a) THE DRIVE FOR SECURITY: This need expresses a conservative
action to preserve the "status quo."
It has no primary goal
and is based on the anticipation that situations may arise
that would interfere with the satifactions ofadher needs.
The
drive for security may be expressed in the field of economics
or occupation, or reflect a need for love. The elderly person,
particularly, may resist change and prefer the situation to
which he is accustomed.
Some "play it safe' throughout life
while others are constatnly "sticking their neck out."
(b) THE DRIVE FOR ORIENTATION: All of us have a need to know
where we stand.
We need to know what the reasons were for
hospitalization, what the treatment plans are, who the doctor
is, what is expected of us, who are parents are, and what our
goals and ideas are.
A person needs a self-image that satisfies
"who and what I am".
We also need to know, "am I a male or
female, and what are my bodily characteristics?" - for us
normals, a silly question, perhaps, but a very serious problem
for some schizophrenic patients.
"Am I ill?
ful?
There are the questions,
If I am, how ill am I? Am I courageous or fear-
What can I remember of my past experiences?
place in a social group?
in the hospital?
I am well?
Where do I belong?
How long must I stay?
Why must I be
How can I tell when
What must I do to gain my release?
attitudes towards major life issues?
What is my
What are my
Do I regard life as
something to be treasured or a punishment for all my wrongdoings?
Do I regard death as a natural phenomenon that comes
to all individuals or is death a terrible punishing fate? What
kind of conception do I have of my own personal picture of the
HOWEVER, SOME PATIENTS FROM DREAD, PERHAPS, DENT THE REVELANCE
OF THESE QUESTIONS AND SO ASSERT THEIR UNREADINESS TO ACCEPT
In OTHER WORDS, THE DRIVE FOR ORIENTATION CAN BE
ORIENTATION.
DISTORTED OR ASKED BY ILLNESS.
13
life I live?"
(c) THE DRIVE FOR INTEGRATION: To assist a person toward selffulfillment, goals for himself and some perspective of life
are in order.
accomplish.
Goab represent the ideal of what one wants to
The child wants to be grown up.
personal accomplishment does the adult have?
What ideas of
There is a need
to do one's share in life or to live up to one's expectation
of one's self.
There is also the need not to disappoint the
others whose opinions we value.
The mental patient hopes that
he will once again regain his rightful place in the community
and may express his own aspiration toward the pursuit of happiness.
Returning now to the idea of "needs",
as a basic motivational
concept and the corollary of unfulfilled need as productive of
disorganized behavior and personalities, we may ask to what extent
can a therapeutic agency - like the mental hospital - restore the
balance of re-establishing in the patient an outgoing equilibrium?
The hospital can satisfy some needs as food, clothing and shelter.
Other needs are not easily met, such as the need for sex.
Some
other needs depend on the patient as the active person - needs
such as for approval or achievement.
The hospital can help, en-
courage, and provide a good "biosphere" but here we are "treating"
needs not meeting them.
Some optimal balance between meeting needs
and treating them is indicated."
REFERENCES
AMYAL, Andrus,-Foundations for a Science of Personality, Harvard
University Press, Cambridge, Mass., 1941
BARTON, Walter E., M.D. - gpressions of Human Needs, Superintendent,
Boston State Hospital; Associate Prof. of Psychiatry, Boston
University School of Medicine.
GOSHEN, Charles E., M.D. - 'A Review of Psychiatric Architecture and
the Principles of Design', from Pyhiatric Architecture, American
Psychiatric Association, NW Washington, D.C.
OSMOND, Humphrey, M.D. - 'The Relationship Between Architect and
Psychiatrist', from Psychiatric Architecture, American Psychiatric
Ass'n. NW Washington, D.C.
SOLOMON, Harry C., M.D. - Exerpt from The American Journal of Pschiat,
Vol. 115, Number 1, July 1958.
SWENSON, Glen R., Utah State Bldg. Board 'Report on Mental Health',
Salt Lake City, Utah, 1958.
15
HISTORY
History of Mental Hospitals
In 1850 Thomas Kirkbride and his architect, Samuel Sloane, first
conceived of mental hospitals as a specialized field of architecture.
Kirkbride advocated moral treatemnt.
A period of 100 years passed
before the value of his treatment policy was realized.
In 1875
mental patients were given more freedom than in 1940.
During the
first quarter of the 20th century, there was a trend to build the
Kirkbride type of hospital but to detach it from the community.
It grew in size as it limited the patient's freedom.
Kirkbride felt
that hospitals should be limited to about 250 patients, or no more
than to make it possible for the superintendent to know everyone
in the hospital.
The hospitals built between the two world wars
were virtual warehouses.
Mental hospitals became similar in design
to prisons.
Insulin and electric shock treatments were introduced in the 1930's
and 1940's.
This type of physiological therapy still predominates
in private hospitals.
There has been a return recently to what is called moral treatmentnow called the therapeutic community or the open hospital.
The
essence of this type of treatment lies in allowing the patient to
maintain his dignity through constructive freedom.
Today then,
there exists a serious contradiction between the treatment program
and the existing hospital designs.
"All of our hospitals of the recent past have been designed for
16
efficient custodial care and isolation which is just the opposite
of contemporary treatment plans.3 according to Dr. Charles E.
Goshen of the American Psychiatric Association, 'We can learn very
little from existing hospital designs. Any study of past buildings
will only uncover many ways of not designing mental hospitals.'
The APA is crying for new ideas,as Dr. Humphry Osmond suggests
'Let us not make the same mistakes we made in the past, let us at
least make original mistakes."
Some of the factors that lead to the totally inadequate position
of our mental hospitals can be summed up by the list published by
the APA:
1.
The location of the hospital in a remote area--with a 'cordon
sanitaire" of grounds about it, to keep patients in and community
out.
2.
The construction of large, multi-story, unadorned brick build-
ings within extensive grounds; conspicuous features were window
screens or bars, 'sunporches" heavily grilled, and high fences.
3.
The housing of large numbers of patients in single buildings
and in large wards; by virtue of numbers alone the occupants were
deprived of any opportunity to express themselves as individuals.
4.
The use of obvious security devices, which not only depressed
the patients, but also had an adverse effect on staff and community
attitudes.
("this patient must be dangerous; he's in a barred room-
even the toilets are open to observation.")
5.
The use of uniformly drab furniture and colors, the almost
complete absence of accessories commonly recognized as being
expressions of individuality--pictures, draperies, floor coverings,
potted plants, a canary singing in a cage, and the absence of attention-getting and interest-holding design features such as picture
windows and so on.
6. The widespread use of building material designed primarily for
easy maintenance, such as tile walls, terrazzo floors, and so on.
7.
The absence of facilities where patients might store their
personal possessions, and the lack of opportunity for displaying
such personal items as pictures, family photographs and other
personal trivia.
8.
The use of uniform clothing for patients, somewhat resembling
prison garb.
9.
Mass feeding practices, with no choice of food, and the lack
of a full set of tableware.
10.
The mass transportation-"herding"-of patients from one place
to another.
11.
The lack of privacy for bathing and toilet facilities.
12.
The scarcity of means for the identification of time, place
arid persons--such as clocks, calendars, newspapers, photographs,
telephones, and other "normal* means of keeping in touch with reality.
13.
The absence of the traffic and activities common to ordinary
communities, such as shopping, holidays, meal getting, the "living"
activities of all kinds.
14.
The creation of construction features, such as a Usecure"
nursing station, which tend to limit personnel contact with patients.
(How often do you see a nurse "hiding" herself from patients by
busying herself with paper work in her isolated nursing station?)
15.
The use of materials and engineering features which allow
"institutional odors" to accumulate.
16.
The absence of objects which can become a matter of local
pride for individuals and groups of patients, such as pictures,
tropical fish tanks, plants and so on.
17.
The absence of facilities which would make it possible for a
patient to offer elementary hospitality- such as a snack, privacy,
conversation, etc.--to his visitors.
History of Mental Hospitalsin Utah
In 1880 the Utah Territorial Legislature made provision for what
was to become the present Utah State Mental Hospital.
The South
Wing of the 'Utah Territorial Insane Asylum" at Provo, Utah was
opened for reception of patients.
In 1927, the name was changed
to Utah State Hospital.
Since its establishment, the institution has experienced a more
or less steady growth. At the present time there are twenty-six
wards, 66,546 sq. ft. of bed space, 1303 beds and 16,491 sq. ft.
of day room space in conjunction with 34,746 sq. ft. of corridor
space.
The total admissions has increased steadily and now stands at over
630 per year. Likewise, the total number receiving care and treatment has increased on a yearly basis, until it now stands at 2667.
It is interesting to note that in spite of the rise in the rate of
admissions and the total receiving care and treatment, the average
patient population reached a peak of 1389 in the spring of 1955 and
has been decreasing since that time until it now stands at 1143.
The administration of the hospital attributes this decrease to
improvements in staff and curative methods which include shock and
drug therapy, and individual and group psychotherapy.
Four hospitals (two in Ogden and two in Salt Lake City) reported
a total of 1085 psychiatric admissions during the calendar year 1956.
Two more hospitals (both in Salt Lake) are planning to take psychiatric patients in the near future.
Compared to the 1085 psychiatric
admissions to general hospitals, the Utah State Hospital admitted
504 patients during the fiscal year, 1956-1957.
UMBER OF PSYCHIATRIC ADMISSIONS _
NAE OF HOSPITAL
UTH HOSPITALS.
d
COVERING YEAR
NUMBER OF ADMISSIONS
Dee Hospital
229
Jan. 1-Dec. 31, 1956
Salt Lake General Hospital
316
Jan. 1-Dec. 31, 1956
St. Benedict's Hospital
255
Jan. 1-Dec. 31, 1956
St. Mark's Hospital
285
Jan. 1-Dec. 31, 1956
Utah State Hospital
504
July 1956 - June 1957
TOTAL
18]
The state hospital at Provo has provisions for approximately 900
patients and yet it is presently housing about 1,143.
The buildings
are out-moded (and obsolete) and institutional in character.
Charts
on pages 22-29 perhaps best describe the present hospital situation
in Utah.
In general, the state is in a turmoil as to what policy to followwhether to continue with a consolidated system for which adequate
money has been appropriated or to switch to a decentralized plan
as favored by most psychiatrists.
ESTIMATED NUMBER OF PSYCHIATRIC PATIENTS ADMITTED TO GENERAL HOSPITALS
AND STATE HOSPITAL OF UTAH
BY COUNTY,
COUNTY
1. Beaver
2. Box Elder
3. Cache
Carbon
4.
5. Daggett
6. Davis
7. Duchesne
8. Emory
9.
Garfield
10. Grand
11.
Iron
12. Juab
13. Kane
14. Millard
15. Morgan
16. Piute
17. Rich
18. Salt Lake
19. San Juan
20. Sanpete
21. Sevier
Summit
22.
Tooele
23.
Uintah
24.
25. Utah
26. Wasatch
27. Washington
28. Wayne
29. Weber
STATE TOTAL
JAN. 1
ESTIMYA TED
NUMBER OF
ADMISSIONS
-
DEC.
31, 1956
*POPULATION
JAN. 1, 1957
4,500
21,500
35,000
21,500
PERCENT OF
TOTAL POPULATION
.54
2.59
4.16
2.59
.06
6.15
.90
.71
.42
.60
1.27
9
41
66
41
1
98
14
11
7
10
20
10
5
17
5
3
3
681
13
24
23
11
35
2Q
196
10
20
4
191
51,000
7,500
5,900
3,500
5,000
10,500
5,500
2,600
9,000
2,800
1,700
1,800
355,000
7,000
12,400
12,000
6,000
18,300
10,400
102,000
5,500
10,300
2,000
99,000
.31
1.09
34
.20
.22
42.78
-84
1.49
1.45
.72
2.21
1.27
12.29
*66
124
.24
11.93
1589
829,800
99.93
500
.66
EKISTING CONDITIONS
TOTAL AREA: 49,769 sq. ft.
ROOM AREAS
MEDICAL-SURGICAL BUILDING
UTAH STTE HOSPITAL
ADMINISTRATION:
Office
Office
Reception
175 sq. ft.
"
72
"
420
Conference
4r6
N
-
342
542
209
228
105
r00
=00
90
153
"
Office
Classroom
Office
Conference
Recording
Doctor
Nurses
Nurse
Nurse
Records
Nurse
Office
Nurse
Nurse
Nurse
Nurse
Nurse
"
N
4
"
"
N
"
*
166
"
404
228
N
404
58
58
58
58
TOTAL
a
"t
N
"
*
N
"
5,226 sq. ft.
10.5%
OPERA TORIES:
138 sq.
Exam
Exam
Exam
Exam
Autopsy
Histology
E.E.G.
Operator
EKG, BMR
Operating
Operating
Recovery
X-Ray
X-Ray
Cystoscopic
Exam
Exam
Exam
Ent
Surgical
Dental
Dental
Recovery
Ibid
Utah State Bldg.
138
138
N
'
132
a
340
153
"
"
96
N
68
100
"
"
382
"
382
126
"
"
388
N
336
"
225
99
99
94
N
213
279
"
94
N
"
N
N
94"
TOTAL
Board Report 1958
,
sq. ft.
8.4%
Page #2
LABORA TORIES:
Utility
Utility
Utility
Oxygen
Utility
170 sq. ft.
170
N
"
165
"
166
175
"
Lab
390
Preparation & Record
Film Viewing
Dark Room
Fracture
Splint Room
Plaster
225
90
189
210
41
31
66
Utility
Dark Room
85
Lab
48
Dark Room
Research Lab
TOTAL
"
"
"
"
0
"
"
'
'
33 "
340
2,594 sq. ft.
5.2%
sq. ft.
0.5%
23
PHA RMA CY:
BEDROOMS:
Wing
Wing
Wing
Wing
930 sq. ft.
930
"
"
2,376
'
2,460
B 2nd Floor
0 2nd Floor
B 1st Floor
C 1st Floor
TOTAL
7666
sq. ft.
SERVICE:
Lockers
Toilets
Toilets
Service
Janitor
Kitchen
Stretchers
Janitor
Dressing
Receiving
Washing & Sterilizing
Clean-up
Scrub-up
Service
Sub-Sterilizing
Shower & Bath
Toilets
743 sq. ft.
252
91
50
456
892
244
38
127
536
153
171
168
72
112
132
108
Shower & Bath
132
Toilets
Shower
108
149
"
*
"
0
"
N
"
'
"
"
0
0
"
"
N
"
"
"
"
13.4%
Page
#3
SERVICE, Continued
125 sq.
Toilets
Shower & Bath
Toilets
Janitor
TOTAL
ft.
N
128
105
"
l
5,123 sq. ft.
10.3%
STORAGE:
44 sq. ft.
'
44
"
44
"
44
'
127
'
81
'
150
'
96
N
88
3
30
"
709
27
"
Linen
Linen
Linen
Linen
Linen
Storage
Storage
Anesth.-storage
Storage
Storage
Supply
Storage
Storage
Storage
Linen & Clothing
Furniture storage
99
725
1,227
V
'
"
705
TOTAL
4,240 sq. ft.
8.5%
TOTAL
806 sq. ft.
"
806
"
1,405
"
1,543
770
"
755 x
a
3,801
"
4,419
2,8
17,041 sq. ft.
4.2%
CORRIDORS:
Wing
Wing
Wing
Wing
Wing
Wing
Wing
Wing
Wing
B
0
B
0
B
0
A
A
A
2nd floor
2nd floor
1st floor
1st floor
Ground floor
Ground floor
2nd floor
1st floor
Ground floor
MECHANICA L EQUIPMNT:
52 sq. ft.
Incinerator
Incinerator
Incinerator
Incinerator
Mech. Equi).
Mech. Equip.
Mech. Equip.
Mech. Equip.
M-ech. Equip.
52
TOTAL
"
52
40
750
800
'
74
'
"
"
"
210
"
2,441
4,471 sq. ft.
9-%
25
?ATIENT PoPULATION UTAH 3TATE HOSPITAL
BIENNIAL PERIODS 1948-PRESEIT
PERIoD
Total
12-1-47 to 11-30-48 - 1026
12-1-49 to 11-30-50 - 116
12-1-51 to 11-50-52 12-1-53 to 11-50-54 12-1-55 to 11-30-56 -
Under
o.&T.
1125
2151 - 91
1199
1174
1124
1174
1149
1195
1263
2310 -
97
Deaths
Discharges
77 168 - 272 338 610
79 176 -
12-1-57 to 11-30-58 -
2667 -
AVERAGE PA TENT ?OPULATION
54
54
55
1334
593
649
nd of Month
Biennial
1233
-
1285
-
1526
-
1341
1354
1361
1x48
13553
114
1284
1298
1315
1268
56
56
57
57
58
687
636
UTAH STATE HOSPITAL
1347
55
572
286
254
516
198 -
By Various Averages Based on Pts. in Hosp. at
6 Mo.
cal. yr.
Fiscal yr.
PERIOD
Periods
Jan-Dec.
July-June
Jan-June 48
1184
1195
July-Dec 48
1206
1217
Jan-June 49
125
1227
July-Dec 49
1243
1249
Jan-June 50
1254
1264
July-Dec 50
1273
1283
Jan-June 51
1294
1293
July-Dec 51
1292
1292
Jan-June 52
1292
1503
July-Dec 52
1315
1319
Jan-June 55
1527
1323
July-Dec 53
1332
1530
Jan-June
July-Dec
Jan-June
July-Dec
Jan-June
July-Dec
Jan-June
July-Dec
Jan-June
215
73 185 - 356
2323 -112
2325 -112
79 191 - 39
2450 -137 110 247 - 353
-
l-59
-
1299
PA TIENT POPULATION
1288
-
1291
1286
1502
UTAH STATE HOSPITAL
BIENIAL PERIODS 1948-?RESENT
Total
PERIOD
7-1-47/6-30-48
7-1-49/6-30--0
I
?irst Admissions
508 72o 628
354
289
643
7-1-51/6-30-52
574
7-1-53/6-30-54
7-1-55/6-30-56
7-1-57/6-50-38
351
384
257
262
317
631
615
701
Ibid.
833
Utah 3tate Bldg. Board Report 1958
Readmissions
74
119
101
902
88
139
175
144
116
150
213
294
245
208
218
272
Admissions
475
475
464 937
4o1 876
443
378 821
472
447 919
1105
PROVO UTAH STATE HOSPITAL STATISTICS
WARD
1
2
3
4
5
6
7
8
9
10
11
12
14
15
16
17
18
19
20
21
22
23
24
25
26
Ibid
SQ. FT. OF
BED SPACE
2579
2665
2592
2615
2592
2615
1796
1642
1932
1923
APA
RECOlMENDED
NO. OF BEDS
NO. OF
BEDS
264
264
2415
2404
2415
42
1076
49
44
4o
44
264
300
323
2898
2516
2549
58
559
3186
3508
46
47
5186
2346
2988
2346
47
46
34
43
34
CORRIDORS
49
50
52
51
46
FT.
OF
2404
2532
2404
45
38
26
25
27
27
41
36
A6
z186
5308
SQ-.
246
243
264
264
264
37
37
37
37
37
SQ. FT.
OF DAY RM.
SPACE
52
840
52
58
1096
830
60
1096
55
830
1096
51
52
830
1096
1096
64
2415
2404
978
937
16co
1600
800
727
800
727
800
52
830
36
53
62
1096
830
46
727
800
727
800
727
50
1096
8310
800
727
1305
16,491
54v746
46
3186
2522
3186
2884
41
66,546
953
55
Utah State Building Board Report 1958
27
COMPARISON FIGURES BETWEEN ADMISSIONS AND THE
AVERAGE PATIENT POPULATION AT UTAH STATE HOSPITAL,
PROVO, UTAH
750
1500
700
1450
650
1400
600
1350
550
1300
500
1250
450
1200
400
1150
350
1100
300
1050
250
1000
AVERAGE
PATIENT
POPULATION
ADMISSIONS
I
I
U
UK IAJ~
13
iDQC7
I
ADMINISTRATION
2
COTTAGE
3
COTTAGE
HARDY BLDG
4
5
DUNN BLDG
6
HYDE BLDG.
7
MEDICAL -SURGICAL
8
NURSES HOME
9
AMPHITHEATER
10 RECEIVING & TREATMENT
11 KITCHEN CENTER
12 GYMNASIUM
QUARTERS
13 RESIDENT TRAINEE
14 CHAPEL
I3
NO
TM
PRIOR ITY:
I
2
3
4
5
10
- 13
- 12
- Il
- 14
-
RECEIVING & TREATMENT
QUARTERS
RESIDENT
TRAINEE
GYMNASIUM
CENTER
KITCHEN
CHAPEL
NOTE:
FIRSTNUMBER = PRIORITY
SECOND NUMBER= BUILDING
NUMBER
o
so0to0
200
300
400
SYMBOLS:
PROJECTS
FEDERALLY
UNDER
DESIGN
FINANCED
OR CONSTRU/CTION
PROJECTS
(HHFA)
EXISTING
195 9
10
APPROPRIATION
YEAR
REQUEST
PROGRAM
FUTURE
U TA H
419
S T AT E
CAPI T OPL
MENTAL
BOUOI
L D IONPGOMT A R D
S ALT
LA KE
Cl TY
P R
APLO
S E D
M A SLT E R
HOS PI T A L
aUILDING
PLAANT"OE"A
P R OV 0
UTA H
JANUARY
1959
REFERENCES
KOHLER, Kivin J., Thesis, An Investigation of the Mental Hospital
Building2 Tn,
1954
PSYCHIATRIC ARCHITECTURE, American Psychiatric Association, 1700 Eighteenth Street, N.W., Washington, D. C.
50
BASIC THEORY AND DESIGN CRITERIA
Therapeutic Criteria
Anything that contributes to an institutional atmosphere or to
individual conformity is undesirable.
"The effects of institution-
alization on people in general and on mental patients in particular
are agreed to be a deterioration of morale and a suppression of
incentive to make constructive moves." says Charles E. Goshen, M.D.
Not all patients should be forced to feel and act alike and we
should in no way hamper the freedom of the psychiatric patient.
He should feel free to develop his own character.
In general,
human beings rebel against any influence that deprives them of
freedom and individualism and mental patients, although their actions might be different, react in the same way.
Patients need an environment that includes a wide variety of
activities.
As Dr. Kenneth E. Appel describes it, "Patients must
be able to be indoors or outdoors, to play with water, to write on
walls, to run and jump, to throw sticks and stones.
It is only
through such means that patients can express themselves in harmelss
ways."
The patient should be allowed to do almost anything as long
as he does not hurt himself or other human beings. We need, in
addition, more active energy outlets in the form of art expression
and with it self-realization.
Milieu therapy, which is the constant use of the patient's environ-.
ment for treatment, has become very important inasmuch as its only
supplement, psychoanalysis, suffers from a lack of adquate personnel.
A psychiatrist if he works very hard, might treat a total of 150
patients in a lifetime. With the shortage of psychiatrists we now
have, the failure to increase the enrollment of persons entering
medical schools, and the corresponding increase in population, it
is very likely that the situation might become even more acute.
Perhaps an even more important role in the patient's life is his
living experiences, activities and relationships.
A therapeutic community suggests, on the one hand, a place where
milieu therapy is employed, and on the other hand, an orientation
toward bridging the gap between hospitals as specialized institutions
and community life in general.
Anything that is strange gives rise to fear and anxiety.
In general,
our mental institutions are very different from our homes.
The in-
stitutional athletic field and amusement halls are very different
"The patient needs buildings
from those of the ordinary community.
that do not radiate crude force, restraint, herding, loss of control,
mystery, fear, danger, destructiveness, injury, death." says Dr.
Kenneth E. Appel.
Our present hospitals reinforce the public ideas
of mystery and danger in relation to mental patients.
The criminally
insane-those requiring some form of custody.- should not be located
near the intensive treatment units.
This in itself would alleviate
some of the public anxiety felt toward mental institutions.
Security has been the keynote in designs of the past.
This has been
the result of the community thinking it must have protection from
violence.
Dr. Goshen of the American Psychiatric Ass'n. is backed
by almost every contemporary authority and everyone interviewed for
this thesis, when he says, 'The fact is that only five percent of
32
mental patients are sufficiently destructive-and these only part of
the time-to require special measures of protection, and the best
way of curbing destructiveness is not necessarily through the use
of coercion, security, or other forms of restraint.'
Some authorities suggest a relaxed environment.
Others feel that
mental illness is similar to physical illness and that treatment
should be similar to surgical hospitals with emphasis on bed care.
Others think a remote location or monastic environment is ideal for
rehabilitation.
However, since the patient is required to return
to the community, it seems that the best solution would be one that
minimizes the break between the institution and the community.
The
patient should be kept as active as possible in fields that will
add to his social skills and better prepare him to return to society.
The patient we are concerned with spends up to six months in the
hospital and very little of this time is spent in bed.
datory that he has something to do.
both individual and group needs.
It is man-
Space should be supplied for
Emphasis should be placed on the
active part of the complex and not so much on the various wards.
The personnel should act as supervisors in the development of patient
activities which will help the patient establish social skills comparable to those of the larger society.
Although the social mores of different cultures vary greatly, most
socities distinguish between the normal and abnormal.
The line that
is drawn at this point is very sharp in contrast to the various
degrees of mental illness of which practically no one is free. And
yet, the mental patient has been cast out of the society which in
33
itself holds the only keys to rehabilitation.
When a person deviates in his actions from his fellow man he is
alienated to the point where he is deprived of his civil rights
by law.
"Alienation can happen quite apart from mental illness
when for any reason a person looses his ability to communicate with
society. Among the reasons for alienation are nationality, religion, criminal record, physical incapacities, political affiliation,
disease, etc.'
'Absolute power inevitably creates abuse", says Dr. Humphrey Osmond,
'and detention is a result of a high exertion of power.'
tion is a risk involved with all custodial relationships.
DegradaFor
this reason we must be very cautious in our use of custodial relationships especially as they involve persons who are not destructive.
'Persons then come to mental hospitals because they have been alienated from their friends and relatives and finally from their
community.1
Dr. Osmond goes on to say,
'The newly admitted person
is desocialized and one of the prime objectives of the mental
hospital is to repair it and strengthen his social relations.
At
present, our mental hospitals do not re-socialize, rather they
degrade and even brutalize.
Degradation can be avoided without
too much difficulty and we have known how to do this for 150 years.
However, a more subtle danger remains which is dis-culturation.
One can learn manners, values, etc., of a sub-society and never
really master the values of the greater society.
In other words,
a patient especially if he is institutionalized for a long period
of time, can adapt himself to a sub-society present in the hospital,
but never be able to handle himself in real life or in a greater
society. We must then maintain strong contact with the community.
Buildings which meet the psycho-social needs of our patients will
not by any means solve all of the problems of the mentally ill but
they will go some way to prevent the chance of degradation, reduce
dis-culturation and encourage re-socialization.... If a hospital is
not actively socializing it cannot help but be dis-culturing.'
Dr. Beaverly Mead of Salt Lake City suggests that the therapeutic
community of the future might be similar in principle to medical
treatment in the military during wartime.
Medical facilities are
almost immediately available on the front lines.
A man only slightly
wounded can be treated without changing environments and returned
to his duties as rapidly as possible.
If the wound is more serious,
the patient is taken to a station very near the front where he
might recuperate for a few days before being returned to the front.
If the wound is quite serious perhaps the patient must retreat to
another hospital further from the front and serving many small
sub-stations.
In this environment the patient might spend several
months before returning to the front.
And finally, if the wounds
are too great the patient is made as comfortable as possible away
from the battle area.
In the therapeutic development this might
take the form of (1)treatment in the home; (2)treatment in day
hospitals scattered throughout the area; (3)treatment in an intensive treatment hospital; and (4)custodial care.
The goals of the hospital can best be stated in the words of Dr.
Osmond:
"1.
To help people who have become alienated and expelled from a
35
community regain those skills which they have lost.
2.
To prevent any further loss of social skills remaining at the
time of admission to the hospital.
3.
To help patients acquire social skills which are lacking and
whose absence have reduced social effectiveness
and
so in-
creased the chance for alienation.
4.
To prevent the acquisition while in the hospitaJ of habits and
attitudes which unfit the patient for life in the larger
cummunity.2
Theoretically, the decentralized system suggested in this thesis
would alleviate many personnel problems.
The use of private hospitals
would make available psychiatrists primarily in private practice who
would probably never be interested in a full time hospital position.
These people might be interested in accepting responsibility for a
limited number of patients.
Most psychiatrists prefer the variegated
activities of private practice to the more uniform activities of
most state hospitals.
The decentralized plan would allow them to
continue the practice they have chosen and at the same time utilize
their skills for the care of state hospital patients.
The cost per patient would be higher for a decentralized plan for
that which exists in our state hospitals. With the new interest in
mental health and with the loosening up of insurance policies to
include mental disorders, we can expect more available money for
such a project.
The average cost per patient is now somewhere around
$6. per day as compared to $14. or $15. per day at surgical hospitals.
We should expect more allotments to be given to mental health above
$6. per day which is barely enough to let the patient exist.
In
addition there are many who are willing and are capable to pay much
more than they are asked by the state.
The Day
rospital
In the therapeutic development as outlined in the previous discuss.
ion, we have found the need for several "day hospitals" (as we shall
call them) scattered throughout the state to serve various communities
within the communities themself.
These will vary in size and design
according to the conditions of that particular area.
Such things
as site conditions, climatic conditions, the nearness to other medical facilities, the population served, etc., will influence all of
the designs independently and will make a proto-type day hospital
impractical.
This thesis is involved with all of the possible day hospitals, however, it will specifically deal with the design of the intensive
treatment portion of the overall plan which is fed by the various
day hospitals.
The intensive treatment hospital will most likely
include one of the day hospitals.
In such an outline the present
state hospital will be converted to the custodial function of caring
for the criminally insane and mental defectives (those who offer
little or no hope of recovery) and possibly some geriatric patients.
According to Dr. A. E. Moll, the day hospital may be considered
under completely different settings and any one may be employed
throughout the state according to the needs of that area.
1.
The Day Hospital as an integral component of the psychiatric
department of a general hospital:
In this case some of the personnel
responsible for day patients may also be responsible for the care
v
of patients in other areas of the hospital.
Some of the functions
may be shared with the inpatients.
The Day Hospital affiliated with a general hospital but situated
2.
in a separate building:
type described in
The difference between this type and the
1. is in the choice of personnel.
unit becomes more independent.
The entire
There is more chance for initiative
and spontaneity.
The Day Hospital as part of the community service of an Out
3.
Patient Department:
In this case, social services play a much larger
There is more communication between the day hospital and the
part.
community surrounding it.
4.
The Day Hospital affiliated with a mental hospital and situated
within its grounds:
ent aims.
In this case the hospital may vary with differ-
For example, the hospital might treat previous inpatients
who have been discharged from the mental hospital.
It may act as
the transition for commitment to the hospital, or it may care for
the psychiatric disorders within the community.
5.
The day hospital as a completely different treatment center.
*The day hospital may include all or some of the following:
a.
Individual or group psychotherapy.
b.
Therapy other than psychotherapy such as sub-coma, insulin,
E.C.T., narco-analysis, chemotherapy.
c. Occupational therapy.
d.
Educational diversional therapy such as the use of films,
discussion groups, etc.
*As outlined from article by Dr. A. E. Moll, 'The Nature of Day
Hospitals', from book, Psychiatric Architecture, A.P.A., 1959.
e.
Rehabilitation, vocational and training.
f. Therapy of the patient's family.
Day hospitals may fulfill different roles and the therapeutic management may emphasize one of many:
a. The hospital may be geared for patients reporting daily
such as from 8:30 a.m. to 5:30 p.m. (day patients),
b. Over and above day patients, it can also be geared to take
patients that spend only part of the day on the premises.
c. The Day Hospital premises may be used for treatment of
night patients, that is for patients who report daily after
working hours.*
The beds in the day hospital might be used for 24 hours of each day
by three different groups:
day patients for sub-coma or insulin
therapy in the morning, the O.P.D. patients for electric shock
treatments in the afternoon and the night patients from 6:00 p.m.
to 8:00 a.m. the following morning.
The day hospital is best located near public transportation and
patients' residences.
Urban or suburban settings are desired inas-
much as they should be readily accessable to community facilities
such as parks, civic centers, museums, shopping areas and others.
It should be inconspicious yet unhidden.
Activities
Persons who are well in addition to those who are hospitalized find
that activity is therapeutic.
A disturbed person is given the
*As outlined from article by Dr. A. E. Mll, 'The Nature of Day
Hospitals' from book, Psychiatric Architecture, A.P.A., 1939.
b
opportunity to find socially accepted ways of expressing himself
and of gaining self-confidence.
The patient can use activities as
a proving ground to seek out and apply himself to certain situations
that he will encounter in the greater society. He is given the
opportunity through activity to relate himself to himself and to
other human beings.
The patient should be made to feel normal in his surroundings.
should never feel that he is trapped into an activity.
He
There should
be a wide range of activities so that every individual might have
the opportunity to choose that to which he is best suited.
More than twenty individuals seldom act as a group.
It is advisable
then to design the activities to be used for several smaller groups.
Eight or ten is an ideal number. Isolation is undesirable but
privacy is essential.
The activity areas are the heart of the commnity and should be
located centrally if possible.
They should be readily accessible
to all of the patients.
Occupational therapy should include provisions for the usual crafts
such as wood working leather working, ceramics and weaving.
Vocational rehabilitation is becoming more and more important and
facilities should be provided to simulate vocational circumstances.
The patient should be placed in working conditions that test both
his innate ability and his capacity to perform during an eight hour
period.
In addition, provisions should be made to let patients work
within the community.
40
The design of the occupational therapy and the recreational therapy
areas should be such that they attract the patients and motivate
them to participate.
In addition tophysical activities there should also be a wide range
of social activities available such as theatres, kitchens, social
halls, barber shops, beauty shops, etc.
Some general recommendations for activities as set forth by the
American Psychiatric Association are as follows:
1.
All hospitals, special or general, should have facilities for
adequate recreation programs; the use of these facilities
should be promoted for the mental health of all patients,
even those who are confined for short periods of time.
2.
The detailed design and equipment of recreation facilities in
a hospital is a function in which professional recreation
leaders should participate jointly with administrators, architects, and other specialists.
5.
Maximum use should be made of community facilities, not only
to supplement institutional facilities, but also for the
therapeutic and public relations values of increasing contacts
with the community.
Conversely, the use of hospital facilities
should be offered to community groups whenever possible.
4.
Institutions and outpatient treatment centers for the mentally
ill should be encouraged to enter into agreements with schools,
parks, and other community agencies for the cooperative planning and joint use of their recreation facilities.
Such
cooperation would tend to lessen the problems resulting from
41
the isolation of the institution from the community.
5.
Recreation should be given strong consideration in planning
hospital landscapingto encourage a proper balance between
emphasis on the values of scenic beauty and on the values of
maximum and effective use of the areas for recreation. Where
large, undeveloped or reclaimed areas exist, they should be
incorporated in plans for recreation use.
6.
Indoor space allotted for activities should comprise at least
50 percent of the total patient space within the institution.
7.
The design of any recreation area should consider the flow of
traffic, safety hazards, durability of materials, ease of control, ease of maintanance, and ease of accessibility, as well
as aesthetic appearanoe.
8.
In planning recreation buildings or areas, careful attention
should be given to allowance for adequate parking space.
9.
Recreation buildings and athletic areas should be centrally
located with respect to the patients who are to use the areas.
10.
Outdoor areas require easily accessible service facilities,
which include toilet facilities, drinking water, and shower
and dressing rooms when necessary. Any area where patients
gather should provide the items mentioned above within a distance of 100 feet.
11.
Outdoor sports areas should be located sufficiently near
building units to permit patient spectatorship as well as
patient participation.
12.
All facilities should, where practical, be equipped with sufficient lighting to insure maximum use of the area.
15.
Adequate storage space for equipment is of paramount importance
42
to all activities.
14.
Wherever structurally feasible, ramps should be used in preference to steps.
15.
Careful attention should be given to acoustic problems in areas
where large groups gather.
16.
Fences should be used around areas only when they serve a specific recreation purpose rather than the confinement of patients.
Terraces or hedges may be used to confine activities to certain
areas.
17.
Sufficient benches should be provided for outside areas.
18.
Regardless of the size of the hospital, at least one bus and
one station wagon should be assigned for the full time use of
the recreation department.
19.
The specific equipment standards already established by other
agencies concerned with recreation should be adopted when, in
the opinion of the total therapeutic staff of the hospital or
the representative national societies, these standards are in
keeping with the therapeutic mission of the hospital.
20.
In order to keep equipment standards abreast of changes, an
agency should be established for testing and approving various
kinds of equipment for use with the mentally ill.
Such an
agency might be established by the cooperating agencies.
21.
An investigation should be made of those recreation facilities
needed for psychiatric wards in general hospitals and for such
special groups as geriatric patients.
*
Planning Facilities for Health, Physical Education and Recreation,
(Chicago: The Athletic Institute, 1956)
POSSIBLE STATE-WIDE HOSPITALIZATION SYSTEM FOR MENTAL ILLNESS IN UTAH
# Now available
##Participation
practically certain
##f Participation probable
#### Not presently available
1.
Utah State Hospital, Provo (#) including both
a. A Rehabilitation Hospital designed to care for
chronic, geriatric, custodial and long-term
rehabilitation patients.
b. An Intensive Treatment Center designed to provide
intensive treatment for patients received from
any county in the State but concentrating on
patients from Utah County.
2.
Dee Hospital, Ogden
(##)
3. St. Benedict's Hospital, Ogden
(46)
4.
(#4k)
L.D.S. Hospital, Salt Lake City
5. St. Mark's Hospital, Salt Lake City
(##4)
6.
University of Utah Medical Center, Salt Lake City
(###)
7.
Holy Cross Hospital, Salt Lake City
(#4&##)
8. Price City-County Hospital, Price
9.
Iron County Hospital, Cedar City
(###
10.
(Hospital in the planning stage), Richfield
(####)
11.
Dixie Memorial Hospital, St. George
(###)
12.
Uintah County Hospital, Vernal
(#-h*)
13.
Grand County Hospital, Moab
(##4)
14.
Logan L.D.S. Hospital, Logan
(###f)
44
POSSIBLE STATE-WIDE HOSP;TALIZATION SYSTEM FOR MENTAL ILLNESS
\N-HOSPITALS NOW GIVING
INTENSIVE PSYCHIATRIC
TREATMENT.
2-HOSPITALS SUGGESTED AS INTENSIVE PSYCHIATREC TREATMENT CENTERS.
[g.STATE HOSPITALS FOR BOTH LONG-TERM AND INTENSIVE TREATMENT.
50
OPEOPLE
}.ESTIMATED
OF
MILES
WITHIN
COULD
IHIS
HOMES.
THEIR AREA
BE
HOSPITILIZED FOR MENTAL
ILLNESS WITHIN
THESE
HOSPITAL ADMISSIONS FOR 1956 PER COUNTY.
BE HOSPITALIZED LOCALLY UNDER THE SUGGESTED
PEOPLE COULD
PLAN.
PREPARED BY DEPT OF PSYCHIATRY, UNIVERSITY OF UTAH, COLLEGE OF
FOR THE UTAH ASSOCIATION FOR MENTAL HEALTH.
MEDICINE
RE!FERENCES
APPEL, Kenneth E., M.D., 'Emotional Impacts', Design For Therapy;
Conference at Mayflower Hotel, Washington, D.C., 1952, American
Psychiatric Association.
BRILL, A. A., M.D., Pychoanalytic Pchiatry, Vintage Books, New York,
1956.
CAMERON, E. Owen, MD, 'The Development of the Day Hospital', selected
from 'Mental Hospital Design Clinic', _Pschiatric Architecture,
American Psychiatric Association, Washington, D.C., 1959.
GOSHEN, Charles E., 'Physical Facilities and Equipment', Psychiatric
Architecture, American Psychiatric Association, Washington, D.C.
GOSHEN, Charles E., M.D., 'A Review of Psychiatric Architecture and
the Principles of Design', Psychiatric Architecture, American
Psychiatric Association, Washington, D.C., 1959
MARTIN, Harold P., M.D., 'Architectural Planning for Activity Programs',
Psychiatric Architecture., American Psychiatric Association,
Washington, D.C., 1959.
MOLL, A. E., M.D., 'The Nature of Day Hospitals', Psychiatric Architecture
American Psychiatric Association, Washington, D.C., 1959.
OSMOND, Humphry, M.D., 'The History and Deciological Development of
Mental Hospitals', Psychiatric Architectur, American Psychiatric
Association, Washington, D.C., 1959.
OSMOND, Humphry, M.D., 'The Relationship Between Architect and Psychiatrist', Psychiatric Architecture, American Psychiatric Association,
Washington, D.C., 1959.
STANTON,- Alfred H. and SCHWARTZ, Morris S., Mental Hositals, Basic
Books, 1954.
SWENSON, Glen R., A.I.A., Director, Utah State Bldg., Board, Salt Lake
City, Utah, 'Report to State of Utah on Mental Health'.
INTERVIEWS
MEAD, Beaverly, M.D.,
SNYDER,
STANTON,
Benson R., M.D., Massachusetts Institute of Technology
Alfred, M.D., Director, McLean Hospital, Belmont, Massachusetts
HARRIS, Herbert I.,
Technology
SWENSON,
Salt Lake City, Utah
M.D., Psychiatrist, Massachusetts Institute of
Glen R., Salt Lake City, Utah
THE ROLE OF THE ARCHITECT--VISUAL ORDER
Man cannot tolerate chaos.
Out of the visual world, man must make order
and meaning so that he might live.
The mental patient is perhaps even
more acutely in need of a visual structuring of his entire environment.
He must be confronted with straight-forward, simply articulated spaces,
sounds and textures in order that he might easily relate himself to his
total environment.
The visual structure of the environment is important
along with the various functional requirements.
Man orders himself physically as well as mentally--the eye adapts to
light, sweat glands adjust to temperature, etc.
lated to a basic equilibrium.
The entire body is regu-
It is a dynamic equilibrium since bodies
and ideas are constantly changing.
There are, however, certain constant
identities that are retained by the person from the past that make up
the individual.
It is for this reason that the individual cannot isolate
himself from the world.
A psychological or a physical rigidity is un-
healthy for the individual, (since it has ceased to grow and man must
create new orders both physical and psychological to cope with the everchanging world.)
When someone creates a complete order, which is possible only in a work
of art, the degree of impact is much greater than usual since the degree
of order is much greater than that to which we are accustomed.
To obtain
a complete unity, one common denominator should be found in every aspect
of the surface.
Impulses such as color, form, scale, light, rhythm, etc.,
are always changing into infinite varities.
of possible impulses.
There are an infinite number
To relate yourself to another object, therefore,
you must find a common reference point and this can be in the form of
47
any one of the impulses mentioned above.
We respond more readily to
these common reference points because we are oriented by them.
We must
develop a continuity and heirarchy of spaces, rhythms, textures and colors
and we must find connecting links (analogies) that can orient all of the
parts to the whole.
Strong feelings are not enough for a work of art.
Artistic ability is
necessary to transform feelings into a visual form that can be enjoyed
by others.
Space is a quantity and space itself does not include all of ones experiences.
We are also concerned with quality of experience which is
necessary in a work of art.
Great architecture is not alone caused by a well formed building.
Great
architecture conveys a way of life, and it must express the human needs
(including mental health) of the period in which it is created.
The
way of life expressed in a work of art should compel an individual to
lead a fuller, richer, more meaningful life.
We as architects must con-
sider the life that is to surround what we create and express it in our
work.
The 20th century has done much in the way of exploring form.
simplified,
involved.
of art.
It has been
unified, etc.,
but we are far from portraying the human life
a
It is for this reason that we often fall short of/real work
Art today has a lack of quality due to its lack of realization
of human needs.
Every great work of art has been based on an awareness
of human life and yet there is no age that has taken life so lightly as has
ours.
We cannot create great works of art if we ignore any phase of
human life which includes birth, life, illness (mental as well as physical)
and death.
We must weigh the positive against the negative knowing that
the full value of the positive cannot be realized until the negative is
understood.
In other words, we must know and understand mental illness
before we can fully realize the full potential of mental health.
In
society we are in the midst of a conflict. We have a vast amount of
technical knowledge but we don't know how to use it. We have an ordered
aspect of life.-the machine-and a corresponding disorder of human life.
New freedom can be had only if we understand the total horizon.
There have been different attempts in recent history to find a new visual order.
There are two extreme routes that artists have followed:
1.
Order as an end in itself without respect for the individual.
2.
Man must first become familiar with himself.
We are in a struggle to find the means to express the order we need.
Perhaps the answer lies somewhere between the extremes mentioned above.
49
REFERENCES
MUMFORD, Louis, Professor,graduate course Massachusetts Institute of
Technology, 'Technics and Civilization'.
KEPES, Gyorgy, Professor, graduate course Massachusetts Institute of
Technology, 'Visual Design'
-4
SIZE
It is evident that the treatment criteria set forth in this thesis imposes size limitation, inasmuch as moral treatment and its desired
result- social adjustment-must be on an intimate basis.
Mental hospitals
with 1,500 patients were looked upon as small only a few years back and
today there is some controversy as to whether 500 patients might be too
large.
One hundred years ago, Kirkbride suggested that 250 patients
should be a maximum.
In studying the State of Utah, we see there are
approximately 1,500 admissions each year and an average patient population of about 1,100. Assuming that in a dispersed system, as advocated
in this thesis, a large majority of patients will never reach the intensive treatment center proposed, and attaching a certain degree of reality
to the capacity of the hospital to support the recreation facilities
proposed, I have concluded that the patient population should number 200.
SITE
Growing from the social needs of the patient and the obvious affiliation
the psychiatric community has with society, we must admit that the site
should be either urban or suburban.
This is the only means of gaining
complete intercourse between the larger and the smaller community.
The
center of population does not lie within the heart of Salt Lake City,
neither is it the most readily accessible locale.
The area to the south
is growing rapidly and has shifted the activities of the city in a great
portion to the Sugarhouse area.
The site chosen lies directly east of the present county hospital which
is located on the corner of State Street and 21st South Street, Salt
Lake City, Utah.
The site is bordered by 2100 South Street on the north,
and 300 East Street on the east.
Twenty-first South Street as well as
being a major traffic route is developing into a major shopping area
that is readily accessible to the hospital.
Two large parks are located
within one and one-half miles of the site and would be open to the patients.
The site also offers the facilities of the existing hospital.
Duplication of costly medical facilities and mechanical equipment would
be unnecessary.
ing hospital.
Service connections can be made directly to the existThe County Hospital is also affiliated with the Deaprtment
of Medicine and the Department of Psychiatry at the University of Utah
and such facilities as student dormitories are already provided and
could be utilized.
The site is presently occupied by old residences and is in need of redevelopment.
The site is flat and will be completely cleared.
-2K-
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2nd
East
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I
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J
1.
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4.
5.
6.
7.
8.
FLOOR
Surgery
Administration
Operating Rooms
Outpatient Dept.
2,3
1
2
1,2
Surgery Offices
2
Radiology
Anesthesiology
Personmel-Psyroll
Bsmt.
2
1
9.
10.
11.
12.
13.
14.
15.
16.
O0UNTT HOSPIIL ADJACENT SITS
Med. Libraxy
Med Records
Cardiovascular
To be removed
Open Ward N.P.
Pediatric Off.
Cafeteria
Psychiatry Off.
FLOOR
I
t7
17.18.
19.
20.
21.
22.
23.
24.
Closed Ward N.P.
Pediatric Ward
Medicine
Geriatrics
Medicine Off.
Personnel Laundry, Nurses'
Interns' Quarters
Obstetrics
2,5
1,2,3
2,3
Home
2
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SALT LAKE CITY AND VICINITY
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-
PROGRAM
General
Geriatric patients and those patients who are chronically ill and
who need custodial care will be located away from the site in what
is presently the Utah State Hospital.
The incoming patient should be given every consideration inasmuch
as admission can be a very agonizing experience.
Admission should
take place within a living unit similar to the living units to
which the patient will be exposed once he has been diagnosed..
Two nursing units of eighteen beds, each to be used for diagnosis
and requiring security measures, should be in direct relationship
to the admission area. Previously, patients were evaluated for a
minimum of one month.
At present, diagnosis periods vary with em-
phasis on rapid evaluation and placement.
Some patients can be
evaluated in a period of a few days, others require up to a months
time.
The average patient diagnosis period is now fourteen days.
The patient should be exposed to a loss of freedom for a period of
time as short as possible.
If the admitted patient has the capacity,
he should be given full freedom within the hospital and surrounding
community.
If the patient does not have the capacity for full
freedom he should be admitted to a nursing unit that will have
adequate staff to direct and control the individual.
Our defini-
tion of freedom is ever changing in such a way that our physical
interpretation of it must be flexible.
Dr. Alfred Stanton, is an attitude.
Freedom, as suggested by
No matter what the physical
restrictions might be, a person cannot have freedom without the
proper social relationship between individuals.
At McLean Hospital,
Dr. Stanton and his staff have given complete physical freedom to
approximately two thirds of the patients in the hospital which
contains geriatrics, custodial cases, and two large admission wards.
It is their hope that true freedom is given to one hundred percent
of the cases in the form of proper attitude and understanding.
Inpatient Care
Provisions should be made for 176 beds in one-patient and fourpatient bedrooms, divided into not less than nine nursing units
In addition,
and under the general control of the nurse's station.
facilities should be provided for twenty-four families.
1.
Open nursing units: Provide approximately ten 18 bed units.
Control is intended only to the degree the patient desires inasmuch
as too much freedom for some patients could be harmful rather than
helpful.
Control is only implied to help some patients feel more
secure.
a. 18 nursing units with storage
1800 sq. ft.
b. Doctor's office
150 sq. ft.
c. Nurse's station with workroom and toilet
200 sq. ft.
(1) Service pantry with direct contact
to general storage.
(2) Utility room with linen storage
100 sq. ft.
50 sq.
ft.
Treatment room
100 sq. ft.
Recovery room
100 sq. ft.
Seminar room for 12 people
200 sq. ft.
Seclusion rooms
200 sq. ft.
During periods of extreme mental anguish,
56
the patient may,of his own free will, desire
some sort of restraint.
This form of complete
privacy may be desired for several reasons:
(1)
The patient may need security and a sense
of complete privacy.
(2)
The patient may feel he is going to hurt
himself or some other person.
(3)
He may desire a completely undisturbed
atmosphere.
(4)
He may use such a room to expell surplus
energies without degrading himself or
other persons.
h.
Patient toilets
i. Patient's personal property storage
j.
2.
Toilet for male attendants
Family nursing unit:
200 sq. ft.
50 sq. ft.
Provide 24 units for normal family
life with individual bath, sleeping, living, and eating spaces.
a.
24 family living areas
14,400 sq. ft.
b. 4 seclusion rooms
500 sq. ft.
c. 2 treatment rooms
300 sq. ft.
d. 2 recovery rooms
200 sq. ft.
e. 2 nurse% stations with workroom and toilets 500 sq. ft.
f.
2 seminar rooms for 24 people
g.
Janitor and utilities
h.
Patient personal storage area
600 sq. ft.
57
General Diagnosis and Outpatient Treatment
This function of the hospital is to be used by a relatively high
number of outpatients.
Space should be provided for treatment of
twenty-four patients with a total six hour load of 150. Approximately ten of the thirty combination consultation office-treatment
room areas will be provided with concealed viewing devices such as
closed circuit television.
The outpatient department will use all of the indoor activities,
outdoor activities, school facilities, occupational therapy areas,
and community facilities made available to the inpatient.
a. Clinical director
200 sq. ft.
b. Secretary, receptionist, waiting
200 sq. ft.
c. Two staff conference rooms
400 sq. ft.
d. 24 offices for diagnosis and treatment
at 200 sq. ft. each
e. Seminar room for 56 people
6000 sq. ft.
400 sq. ft.
f. Admitting office
(1) Reception and waiting
150 sq. ft.
(2) Office
150 sq. ft.
g. Energency admitting
A separate covered entrance should be provided for
patients who are brought to the hospital in a disturbed state.
This entrance should be isolated from
normal community activities.
(1) Reception and waiting room
150 sq. ft.
(2) Office
100 sq. ft.
(3)
Two seclusion rooms
500 sq. ft.
58
h.
Utilities
i. Staff and public toilets
2.
Day patient department:
Private and community areas as des-
cribed in requirements for inpatient care should be provided for
thirty-six day patients.
Some patients must spend only their days
in the hospital, others must spend their nights; thus, this function
of the community will be in use twenty-four hours a day*
(See
section on The Day Hospital, this thesis, under chapter title 'Basic
Theory and Design Criteria'.)
a.
Two nursing units (see inpatient nursing unit
for requirements)
7,200 sq. ft.
Public Facilities
It is intended that the public play an active part in the therepautic community.
The surrounding society will use many of the
activity areas within the therapeutic development.
1.
Public areas:
a. Main lobby and waiting
600 sq. ft.
Information
100 sq. ft.
c. Public toilets
200 sq. ft.
b.
Staff Facilities
1.
Business administration:
a.
Director
250 sq. ft.
b. Assistant director
150 sq. ft.
c. Secretary
200 sq. ft.
d.
Secretary pool
300 sq. ft.
e.
Business manager
150 sq. ft.
59
f.
Business office
600 sq. ft.
150 sq. ft.
g. Supplies
2.
Medical administration:
a.
Medical director
200 sq. ft.
b.
Reception, waiting, secretary
200 sq. ft.
c.
Medical records
500 sq. ft.
d.
Medical library
400 sq. ft.
e.
Nurse's administration
(1)
Chief nurse
(2)
Waiting, reception,
(3)
Instructor's offices
150 sq. ft.
secretary
150 sq. ft.
150 sq. ft.
f. Psychologists
(1)
Chief psychologist
200 sq. ft.
(2)
Waiting reception, secretary
150 sq. ft.
(3)
Assistant's office
150 sq. ft.
g. Social workers
(1) Chief social worker
200 sq. ft.
(2) Waiting, reception, secretary
150 sq. ft.
(3)
3 assistant's offices (case workers)
450 sq. ft.
(4)
Trainee's room
500 sq. ft.
h. Doctor's facilities
i.
(1) Lounge
200 sq. ft.
(2) Intern's lounge
200 sq. ft.
(3)
5 doctor's bedrooms
(4)
Locker rooms
500 sq. ft.
(5)
Toilets
100 sq. ft.
Nurse's facilities
0 150 sq. ft. ea.
450 sq. ft.
(1)
(2)
Female
(a) Lounge
200 sq. ft.
(b) Lockers
200 sq. ft.
(c) Toilets
150 sq. ft.
Male
(a)
Lounge
200 sq. ft.
(b)
Lockers
200 sq. ft.
(c) Toilets
150 sq. ft.
Educational Facilities
Facilities will be provided to educate the interested lay person,
staff, families, therapists, aids, nurses, medical students from
the University of Utah, etc.
In addition, the surrounding community
can also use the facilities for group meetings, etc.
a. Auditorium:
To seat 300 and to include
stage and projection room
b. Classrooms:
4000 sq. ft.
At least five to instruct
20 students at 600 sq. ft. each.
3600 sq. ft.
Adjunct Treatment Facilities
Almost all of the medical needs of the complex will be accommodated
at the adjoining county hospital.
In addition, provisions will be
made for some specialized needs accessible from all sections of
the hospital to doctors, nurses, inpatients, and outpatients.
a*
Small general laboratory
300 sq. ft.
b. Electro shock therapy treatment room
150 sq. ft.
c. Recovery room for above
100 sq. ft.
Electro encephelograph treatment room
150 sq. ft.
Dressing rooms (men and women)
200 sq. ft.
Waiting area
150 sq. ft.
Storage room for mobile equipment
100 sq. ft.
Indoor Activities
a.
Reception, waiting, information
b.
6 offices for psychiatric social group
work at 100 sq. ft. each
250 sq. ft.
600 sq. ft.
a. Social room
(1)
Dancing
(2)
Ping-pong, pool,
shuffleboard
(3) Lounge wtith eating facilities
d. Library
2500 sq. ft.
4oo
sq. ft.
e. 4 music practice rooms and 2 dancing
practice rooms
750 sq. ft.
Barber shop
50 sq. ft.
g. Beauty shop
200 sq. ft.
f.
Gymnasium
8500 sq. ft.
i. Bowling lanes
3500 sq. ft.
j
Small meditation chapel
1000 sq. ft.
k.
Green house
h.
600 sq. ft.
1. Small grocery store
4oo
m. Wood carving, working
800 sq. ft.
n.
Weavery
800 sq. ft.
o.
Ceramics
200 sq. ft.
p.
Sewing
200 sq. ft.
sq. ft.
qo
Photography
200 sq. ft.
r. Painting and drawing
200 sq. ft.
s. Metal work
400 sq. ft.
t. Baskertry
200 sq. ft.
U.
Toilets as required
..
v. Tool and material storage
600 sq. ft.
Outdoor Activities
Many of the outdoor activities required by the patient will be
found in the community in general.
These will consist of nearby
parks, playing fields, and golf courses.
It is desirable to in-.
corporate as much outdoor activity into the planning as is possible
on the site.
The patient should have every opportunity to engage
in incidental outdoor activities such as badminton, lawn games,
weiner roasts, etc.
a. Play field
.
b. Two tennis courts
c. Two badminton courts
d. Swimming pool with bath houses
e. Picnic area
f. Promenade
g. Sitting area
h. Gardening
i.
Miniature golf
Service Areas
It is assumed that service facilities such as laundry, central stores,
kitchen, mechanical equipment, furniture storage, general repair
shops, etc., will be provided by the County Hospital through a
tunnel connection.
Certain areas, however, will be needed to
fulfill direct requirements.
1.
Patients:
Dining room will accommodate both sexes, to further
the results of social therapy.
A maximum group of forty persons
is considered desirable from a therapeutic standpoint.
Central
dining is advisable for most patients compared to private dining,
however, small dining facilities should be incorporated in the design
to allow a maximum choice.
Dining may occur in shifts allowing the
patient a variety of eating habits and associates.
a. Patient dining
2200 sq. ft.
b. Personnel dining
1400 sq. ft.
c. Dietitian
150 sq. ft.
d. Storage and services
600 sq. ft.
e. Kitchen for incidental food preparation
2.
Receiving and dispatching;
1000 sq. ft.
In charge of all supplies needed
and received and transferred to or from the County Hospital or
service facilities.
3.
a. Office housekeeper
4oo sq. ft.
b. Supplies and receiving
400 sq. ft.
c. Patient clothes and storage
300 sq. ft.
d. Soiled linen
250 sq. ft.
Non-professional staff:
a. Male help - toilets and lookers
500 sq. ft.
b. Female help - toilets and lookers
400 sq. ft.
4.
Parkingt
a. Outpatient
50 cars
b. Inpatient
50 cars
c.
Staff
d. Visitors
125 cars
50 cars
REFERENCES
Psychiatric Architecture. American Psychiatric Association, 1700
Eighteenth Street, N.W., Washington, D. 0.
Utah Stte Building Board R,
Salt take City, Utah
United States Department of Public Health
Salt Lake County General Hospital
New Haven Mental Health Center, Design program for Magnus T. Hopper
Fellowship 1958.
Interviews
Paul Nelson, Architect, Boston, Massachusetts
Dr. Benson Snyder, Chief Psychiatrist, Massachusetts Institute of
Technology.
Dr. Beaverly Mead, Salt Lake City, Utah
Dr. Alfred Stanton, Director, McLean Hospital, Blemont Massachusetts.
BIBLIOGRAPHY
ANGYAL, Andrus, Foundations for a Science of Personality, Harvard
University Press, Cambridge, Mass., 1941.
APPEL, Kenneth E., M.D., 'Emotional Impacts', Design for Therapy.
Conference at Mayflower Hotel, Washington, D.C., 1959, American
Psychiatric Association.
BRILL, A.A., M.D., Psychoanalytic Psychiatry, Vintage Books, 1956.
BARTON, Walter E., M.D., Expressions of uman Needs, Sup't. Boston
State Hospital; Associate Prof. of Psychiatry, Boston University
School of Medicine.
CAMERON, E. Owen, M.D., 'The Development of the Day Hospital', selected
from 'Mental Hospital Design Clinic', Psychiatric Architecture,
American Psychiatric Association, 1700 Eighteenth Street, Washington,
D.C., 1959.
FREUJD, Sigmund, M.D., Collected Papers, London, 1949.
GOSHEN, Charles E., M.D., 'A Review of Psychiatric Architecture and the
Principles of Design', Psychiatric Architecture, A.P.A., 1959.
GOSHEN, Charles E., M.D., 'Physical Facilities and Equipment',
Psychiatrie Architecture, A.P.A., 1959.
KEPES, Gyorgy, The New Landscape in Art and Science, P. Theobold,
Chicago, 1956.
KIEPES, Gyorgy, Language of Vision, P. Theobold, Chicago, 1951.
KOHLER, Irvin J., Thesis, An Investigation of the Mental Hospital Bldg.
T.e, 1954, Massachusetts Institute of Technology.
MARTIN, Harold P., M.D.,
'Architectural Planning for Activity Programs',
Psychiatric Architecture, A.P.A.,
MENNINGER, Karl A.,
The Human Mind,
1959.
New York and London, A.A. Knoph, 1950.
MUMFORD, Lewis, Conduct of Life, New York, Harcourt, Brack, 1895(1951).
MUMORD, Lewis,
Technics and Civilization, Harcourt, New York.
NELSON, Benjamin,
Freud and the 20th.Centur,
MOLL, A. E., M.D.,
'The Nature of Day Hospitals', Psychiatric Architec-
ture
Meridian, 1957.
A.P.A., 1959.
OSMONDHumphrey, M.D., 'The Relationship Between Architect and Psychiatrist',
Psychiatric Architecture, A.P.A., 1959.
67
OSMOND, Humaphry, M.D., ' The History and Deciological Development of
Mental Hospitals', Psychiatric Architecture, A.P.A., 1951.
PSYCHIATRIC ARCHITECTURE, American Psychiatric Association, 1700 E
Eighteenth Street, N.W., Washington, D.'., 1951.
SALT LAKE COUNTY GENERAL HOSPITAL
SOLOMON, Harry 0., M.D., Exerpt from The American Journal of Psychiatry
Vol. 115, Number 1, July 1958.
INTERVIEWS
HARRIS, Herbert I., M.D., Psychiatrist, Massachusetts Institute of
Technology.
MFADE, Beaverly, M.D., Salt Lake City, Utah
NELSON,
Paul, Architect, Cambridge, Mass.
SNYDER, Benson R., M.D., Director of Dept. of Psychiatry, M.I.T.
STANTON, Alfred, M.D., McLean Hospital, Belmont, Mass.
SWENSON,
Glen R., Architect, Salt Lake City, Utah
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