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Compassionate containment? Balancing technical safety and therapy in the design of psychiatric wards.

Curtis, S.E. and Gesler, W. and Wood, V.J. and Spenser, I. and Mason, J. and Close, H. and Reilly, J. (2013) 'Compassionate containment? Balancing technical safety and therapy in the design of psychiatric wards.', Social science & medicine., 97 . pp. 201-209.


This paper contributes to the international literature examining design of inpatient settings for mental health care. Theoretically, it elaborates the connections between conceptual frameworks from different strands of literature relating to therapeutic landscapes, social control and the social construction of risk. It does so through a discussion of the substantive example of research to evaluate the design of a purpose built inpatient psychiatric health care facility, opened in 2010 as part of the National Health Service (NHS) in England. Findings are reported from interviews or discussion groups with staff, patients and their family and friends. This paper demonstrates a strong, and often critical awareness among members of staff and other participants about how responsibilities for risk governance of ‘persons’ are exercised through ‘technical safety’ measures and the implications for therapeutic settings. Our participants often emphasised how responsibility for technical safety was being invested in the physical infrastructure of certain ‘places’ within the hospital where risks are seen to be ‘located’. This illuminates how the spatial dimensions of social constructions of risk are incorporated into understandings about therapeutic landscapes. There were also more subtle implications, partly relating to ‘Panopticist’ theories about how the institution uses technical safety to supervise its own mechanisms, through the observation of staff behaviour as well as patients and visitors. Furthermore, staff seemed to feel that in relying on technical safety measures they were, to a degree, divesting themselves of human responsibility for risks they are required to manage. However, their critical assessment showed their concerns about how this might conflict with a more therapeutic approach and they contemplated ways that they might be able to engage more effectively with patients without the imposition of technical safety measures. These findings advance our thinking about the construction of therapeutic landscapes in theory and in practice.

Item Type:Article
Keywords:England, Psychiatric hospitals, Mental health care, Hospital design, Risk governance, Technical safety, Surveillance, Therapeutic landscapes.
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Publisher statement:NOTICE: this is the author’s version of a work that was accepted for publication in Social science & medicine. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Social science & medicine, 97, 2013, 10.1016/j.socscimed.2013.06.015
Date accepted:No date available
Date deposited:10 January 2014
Date of first online publication:November 2013
Date first made open access:No date available

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