“Good housing is just good housing.”
Paulla Gates, chief operating officer for Coleman Professional Services in Stark County, Ohio, shared that thought with the Kent State University Urban Design Center of Northeast Ohio. UDC had interviewed Gates and other mental health service providers as well as architects, housing developers, advocates, clients, and families to develop best practices and design guidelines for supportive housing for people with mental illness. After we completed our research, we realized that Gates was right—it really is that simple.
Envisioning Living Environments for People with Mental Illness is intended to promote the most effective design strategies to support the healing and recovery process. Developed with input and support from the Margaret Clark Morgan Foundation, the design guidelines and best practices are based on UDC's interviews and a detailed literature search, including information from 34 articles and 25 books about the connection between health and the environment.
The document advocates that “living environments” support people with severe mental illness in their paths to recovery, and it includes architectural guidelines, landscape components, and neighborhood planning strategies. The paper provides evidence that housing can and should be an important component in promoting good mental health and helping people with mental illness regain control over their lives.
Examining the evidence base
The intention behind the document was to determine if there is a direct correlation between higher-quality residential environments and measurable outcomes—i.e., do better environments aid in healing and recovery? The literature review unearthed studies and articles that discussed components of residential environments, such as the need for natural light, but without quantitative outcome measures. Based on the research, interviews, and the guidelines we assembled, we do believe there is evidence that higher-quality environments can aid in healing and recovery, but this evidence is largely anecdotal.
Although we did not find any studies or articles making a direct scientific connection between residential environment and outcome, some articles did suggest that studying this would be valuable. In addition, we found little collaborative research involving a multidisciplinary team, such as the one assembled for our project. The interviews and literature support the notion that housing is an integral part of the recovery triangle, which includes available, quality, affordable housing; access and use of supportive services; and medical adherence. If any one of these is missing or underutilized, consumer outcomes are potentially reduced.
So how could we quantify what good housing is? Through our research, themes emerged that helped define design parameters and organize recommendations to make the guidelines a valuable tool for supportive housing designers and developers. “A place of my own” and “a space of my own” emerged quickly as guiding themes along with convenient location and the need for choices when selecting housing.
The architectural guidelines go into detail regarding safety and durability, functional criteria for design to increase user-friendliness, ways to create a homelike environment, and design issues that impact personal choice. Also covered in the document are privacy and opportunities for socialization, how design can reduce environmental stress, community integration strategies, and design principles for therapeutic landscapes.
A “normalized” environment
The single most important way that housing can promote the recovery process is by normalizing the environment and integrating people with mental illness into the community. As we all know, this is difficult to accomplish, as people with mental illness often are stigmatized and isolated from the larger community. The guidelines promote the idea that housing choice and its design can play a critical role in changing perceptions about people with mental illness.
To foster normalization, housing for people with mental illness should have a homelike, noninstitutional appearance, since this atmosphere has been associated with enhanced emotional well-being. This emerged as an important lesson to stress with architects because concerns over safety, durability, and maintenance can be transferred too easily into building details that become institutional in their function and appearance, as we witnessed in some of our site visits to existing housing.
Housing type and location
The paper advocates multiple options for good-quality supportive housing, such as dispersed, scattered site developments (e.g., group homes, independent living apartments, and condominiums) or concentrated facilities (e.g., an apartment complex or a residential campus) in urban, suburban, and rural locations. There are divergent opinions about which approach is better or more successful. An urban setting typically offers greater access to shopping, transportation, employment, neighborhood parks, and other conveniences, but it may include environmental stressors such as noise. In contrast, suburban and rural locations provide open space, fresh air, and less noise, which can have a positive impact on mental health, but residents may become stressed by lack of transportation, access to employment, and conveniences.