Table 1 Template for a forensic facility design brief
From: Modern forensic psychiatric hospital design: clinical, legal and structural aspects
Main design issues to be addressed | Details | Tasks and tools |
|---|---|---|
1. Define the need | ||
Define the patients that are to be served by the facility | What clinical and legal issues affect patient selection; i.e. who are the forensic inpatients to be catered for? What variation is there in the patients’ length of stay? What is the diagnostic variation in terms of psychotic states, personality disorders, substance abuse, autism spectrum disorders, learning disabilities, paraphilias, mood disorders, organic brain disorders and somatic problems? What is the patient profile in terms of gender, age, ethnicity, risk level, and acuteness of symptoms? | Compile demographic, legal and clinical descriptors to be used to define and measure patient characteristics relevant to clinical and security needs 1. Demographic and legal descriptors [14]. See also WHO AIMS 2.2 [82] 2. Patient characteristics as per DUNDRUM-1 [83] and DUNDRUM-2 [84] 3. Diagnostic data according to ICD/DSM 4. Define risk-level criteria by using suitable structured clinical judgement-tools (e.g. HCR-20 [85], START) |
What is the facility’s role and profile in the overall organization of forensic services, general psychiatric services and prison services? | Which service should, or is legally bound to, care for each patient category? | 1. Map existing assets and resources (institutions, buildings, staff, skills) [63] 2. Map existing pathways, legal processes and clinical criteria (e.g. DUNDRUM-3, DUNDRUM-4) [86] 3. Map existing volumes of flow (admissions, transfers and discharges) between the parts of the map |
Does the facility have a role as a university-affiliated research and teaching hospital? | How must academic needs be catered for? How can the facility’s status and recruitment-appeal be raised by high-quality teaching and research? | 1. Define training needs in order to establish and maintain care quality [87] 2. What research is required to fulfil the facility’s tasks? |
2. What are the options? | ||
What issues in the service have created the need for a new facility? | How well are current facilities serving the patients in terms of treatment and security? What can be done do develop the service without building new facilities? | Compare possibilities against each other and against the ‘do nothing’ option by defining a set of scoring criteria and a scoring grid |
Can existing facilities be renovated/upgraded? | Can existing buildings be modified with reasonable cost and effort, as opposed to designing a completely new facility? | |
What options are there for locations? | Urban vs. rural? What synergy can be obtained from other nearby services? How can accessibility be facilitated for families of patients, and visiting professionals? How can access to courts, and prison and hospital transfers etc. be most conveniently managed? Where is the best-quality staff located? What location has recruitment appeal? How will the neighbours react? | |
3. Policy issues | ||
Regional policy | What is the attitude of regional medico-legal authorities, healthcare organizations and other services, such as the police and social services? What level of knowledge and support is available from these bodies? | National and international policy makers, medico-legal authorities, service users, their families/carers and staff should all be engaged in each stage of the development and implementation process [68, 88] |
National policy | What is the relevant national legislation? Does current legislation support your facility development plans? If not, can legislation be changed? What is the correct level for creating a supportive and healthy discourse on forensic issues among national decision-makers? | |
International policy | Are the developmental plans in line with international recommendations, such as those formulated by relevant professional bodies and quality networks, CPT and WHO? | |
Financial policy | What are the financial resources available to invest in the development project? Which collaborators and national and international funds must be explored as possible sources for funding? | |
Patient advocacy | Are the development plans in line with the policies of patient advocacy organizations? | |
4. Functional content | ||
Quality of design and materials | How can therapeutic and security requirements be combined in the design? How are the different facets of security, i.e. physical, procedural/organizational and relational, taken into consideration? How is the way patients are valued evidenced in the quality of materials? How are the materials tested in terms of being subject to unusual force and other stress? How are life-space issues taken into consideration, particularly the need to prevent institutionalization and boredom? | See above. Monitoring bodies, service users, carers and staff should be involved at each stage by establishing groups to participate in the process [4] |
How will different needs be catered for? | How will the overall lay-out of the facility be structurally compartmentalized to serve patient populations, as defined in 1 and 5, with different needs? How will the overall design support rehabilitative progress through the facility? What is the pace/rhythm of treatment interventions in different subsections of the facility? What range of professional skills is needed? What number of staff must be recruited in each professional category? | 1. Define TAU (treatment as usual) [89] 2. Define programs necessary to deliver TAU 3. Draft space and adjacency requirements to enable provision of all the necessary clinical services and supporting services |
What services can be outsourced or linked with surrounding facilities and services? | E.g. pharmacy, kitchen, cleaning, maintenance, IT-services, personnel services | |
5. Growth and change | ||
What issues must be taken into consideration in order to ensure that designs have longevity and don’t become outdated too soon? | Design to accommodate high security, and grade down if clinically possible Design for flexibility of patient transfers, both within the facility and in and out of it Take into consideration the change in demographics in society at large, e.g. aging of the population, immigration, growth of urban areas, possible social decline in catchment area, substance misuse trends Take into consideration that if the number of general psychiatric beds falls, for instance due to national policy, there may be an increase in pressure on the remaining (forensic) beds | Again, planning ahead means involving the various experts and interest groups mentioned above in each step of the planning process |