Caring for ourselves while facing challenging project demands and deadlines is a continuous balancing act. Stephanie Clarke shares insights about personal care, mental health awareness, imperfect activism and key lessons learned when working in the co-design of mental health spaces.
If you or someone you know needs support, see Resources for Mental Wellbeing.
The final report of the Royal Commission into Victoria’s Mental Health System was handed down in February 2021. Highlighting years of under-resourcing and systemic failures, it outlined 65 recommendations for improvement. In the wake of the report I have worked on some of the first mental health facilities developed in response, including Barwon Health’s Central Geelong Mental Health Hub. Learning how to co-design in this context has been a revelation – personally and professionally, in ways I could never have fully anticipated.
The pandemic has vastly increased the numbers of people experiencing and talking about mental health – in Australia and globally. This has helped to destigmatise mental health, but it also increased demand for services in an under-resourced system. After the Royal Commission, we were seeing increased funding and systemic change aimed at creating a more integrated, community-based system, where people can access health and wellbeing services close to home, work, family and other support.
We co-designed the Central Geelong Mental Health Hub with people with lived experience and clinicians, centring their experiences and insights. Designers who previously led user-engagement on projects were adjusting to the new reality of needing to earn their invitations into those discussions.
We listened and learned as silent observers of online meetings initially, and gradually built the trust required for active participation over time through the responsiveness of our language and design.
Now, 18 months later, the Central Geelong Mental Health Hub Project is well into construction. We’re stewarding it towards completion and learning afresh. How best can we deliver on design intent when the original co-design group is no longer on hand to consult about the inevitable changes and adaptations required once construction challenges inevitably emerge? As our design team navigates this new territory we’re also in the early stages of new projects for community mental health spaces and acute in-patient services. So, we’re drawing on what we’ve learned about co-designing sensitively and efficiently for maximum impact, but also staying nimble and open to responding in new ways to the requirements and opportunities of completely different projects.
To a degree, of course, designers are always developing new expertise and responding to changing needs and innovative new typologies. Empathy, collaboration and user experience are always at the core of our practice. We know every space we create exceeds form and function, influencing thoughts, emotions, productivity, recovery and so much more. We understand the psychological power of space and take seriously our responsibility to do all we can to design in ways that empower people, with the hope of improving the way they experience their lives through space. In healthcare design that’s particularly true. The statistics show us that good design can not only help to decrease patient length of stay and reduce pain levels and medication use, but also provide therapeutic benefits such as reduced stress and increased experiences of relaxation and calmness, and increased satisfaction from staff1.
Co-designing with people with lived experience and clinicians requires us to show up more personally in a setting with much higher stakes. Discussions about trauma can be confronting, and potentially triggering. This work requires ongoing self-education – about wellbeing, mental health, trauma, and trauma-informed design. It demands a real understanding of our own mental health and wellbeing – and an approach to self-care that goes well beyond managing the usual stresses of our deadline-driven industry.
For me, so far, it’s been immensely rewarding, a genuine privilege to be part of, but also undeniably challenging at times. I’m also reappraising everything I thought I knew about mental health awareness and activism, the power of design and language, and how to look after myself while I co-create with others.
Mental health awareness
There is a lot happening in the mental health and wellbeing space! It’s a topic increasingly widely discussed – from celebrities and Olympic athletes to climate activists and design professionals. Prioritising personal wellness has become a mainstream priority. More than ever before, communication and advocacy in public and in private is promoting mental health and wellbeing.
Imperfect activism
With so much information and messaging in society, media and social media around mental health and so many other issues deserving our attention and activism, it can be difficult to know what to prioritise as an individual and design professional. Consciously or unconsciously, many of us determined to make a positive difference in the world feel pressure to be the perfect activist – which, of course, does not exist.
Fortunately, I’m finding co-design with people with lived experience is more a call to imperfect activism – showing up as you are, acknowledging when you don’t get it right, and always remaining curious. It focuses our attention on the intersectionality of design. Mental health, gender, race, age, sexuality, disability, the environment – these all intersect. We all have individual experiences that derive from our identities. To a degree we can share or empathise, but we can’t know what we haven’t experienced or been told. To truly make a difference as a designer is to acknowledge these diverse drivers, challenge ourselves to incorporate them all, maintain our curiosity, ask questions and really listen to the varied answers from experts – those with lived experience.
I’ve come to see my role as an interior designer as part facilitator. My focus is creating space for my co-design colleagues to share their experiences, opinions and responses throughout the design process. Their unique, earned insights inform every step and lead to much better outcomes.
The power of design
The transformational impact of biophilic and trauma-informed design is well-documented2 and an inspiring place3 to begin preparation for co-designing for mental health. The negative impacts of poor design are equally well-known4.
People seeking help from mental health services are often faced with overwhelming, traumatic and triggering experiences, despite the goodwill and hard work of so many, including designers. Many prefer to wait outside for appointments to keep their time in those spaces to an absolute minimum. As architects and interior designers we have the privilege and responsibility of being able to co-design to improve that.
Our designs have the ability to either improve how people experience space and life, or reinforce trauma and stigma. There’s obviously no one-size-fits-all approach or easily formulated design response. Each brief and site are unique, and for every project we complete we build upon research. But here are some key learnings from our co-design experiences to date that are shaping our approach.
Key co-design lessons – the process
Understand our role
When co-designing mental health spaces with those with lived experience, our role as designers and communicators goes beyond translating space. We’re there to extract the key concerns and aspirations, to build trust over time and not rush the process, to collaborate and not consult, integrating them as early as possible and throughout the design process.
Listen, learn and develop trust
Language is powerful. Avoid design jargon and adopt the language used by people with lived experience. It shows we’re listening, learning from experts and helping to build trust, deepening communication over time. Developing this trust enables everyone to share valuable insights more freely and makes for more useful co-design sessions. Sessions earlier in the design process are often quieter, as everyone begins to find their feet, learn how the process works and develop trust in us as designers and listeners. We found that in later sessions, the feedback we received came with further explanation and details of life experiences, helping us to understand how to integrate it – people were more willing to share their ‘why’.
Use person-first language
Focus on people-centred design. This puts the emphasis on the individual, not their diagnosis or disorder. Your choice of words can help to de-stigmatise, break down stereotypes and misconceptions, and help create safe spaces, especially when working with those with lived or living experience. For example, instead of labelling someone as mentally ill, use “person living with a mental health challenge” or “has a diagnosis of” mental illness5.
Collaborate appropriately
When collaborating with any specialist or consultant, ensure they are remunerated for their time and involvement. The same goes for those with lived-experience. Having that transparency empowers their involvement and further reiterates the importance of their role in developing a good design.
Maintain informality
What we have found particularly successful is using group warm-ups and ice breakers before sessions, creating less formal and rigid environments. We offer refreshments and ensure there are dedicated pauses throughout for breaks and small talk. This creates a more engaged environment and reduces tiredness or stress through the collaborative process.
Maintain a clear direction
The success of the collaboration depends on clarity of deliverables, expectations and process. Touch upon these at every session and check in to see if everything is clear. Ask specific questions to focus feedback during the session, go beyond personal preferences and extrapolate valuable experiential information. Make sure participants do not feel lost in an unfamiliar process.
Be compassionate and curious
Embrace the nuance of the individual and stay curious about what they share. Repeat back to them the key information they’ve shared. It shows you’ve heard and understood them. Sometimes you may stumble across discussing spaces or experiences that are triggering. People may react or leave the room. It’s important to make space for this and normalise the experience, creating safe, destigmatised environments that enable people to share more openly.
Show respect and acknowledge vulnerability
Acknowledge the uniqueness of each person’s experience, language and communication preferences. You might not get it right all the time. As you journey through the design process, you learn and evolve. Going in with that mindset openly breaks down the barriers.
Give it time
The process is lengthy. Collecting and incorporating feedback takes time. Allow time between meetings to receive feedback and respond in the next iteration of drawings, plans and 3D visuals. This shows those you are working with that you are listening to them and helps reduce the feeling of being overwhelmed.
Key co-design lessons – design
Integrate trauma-informed design principles
Integrate the principles of trauma-informed care and centralise the human experience of space. Aim to create safe, healing spaces that empower the individual and their experience of identity, dignity and worth. These principles revolve around positively impacting mood, through the maximisation of natural light and views of nature within internal spaces. Use spatial planning to create clear sightlines and sensations of safety. Select materiality such as warmer whites and wood-look floors to intentionally create a more residential, less clinical-feeling physical environment. To alleviate stress, reduce visual clutter and balance with visual interest, avoiding overcrowding with a pleasant quantity of objects, symmetry, graphics and patterning. Provide more control over the environment, with flexible lighting and moveable furniture, so consumers can adjust to their needs and preferences.
Generously apply biophilic design principles
Biophilic design goes beyond adding greenery to spaces (which is particularly difficult in environments with stringent infection control considerations), providing views to the outside and nature, or the incorporation of natural light. Instead, it requires a multi-layered approach that seeks to apply multiple physical and sensory tactics – from deploying natural patterns, textures and tones to softening hard edges, and creating spaces of refuge and awe. This approach helps people find moments and reconnect to nature, themselves and others. Many biophilic design principles also overlap with trauma-informed design principles, highlighting the physiological and therapeutic benefits of integrating design strategies, such as softening corners in corridors, providing clear sightlines and oversight of spaces, and creating feelings of safety and calmness.
Create balance between stimulation and relaxation
People respond differently to stimuli. It’s important to provide a diversity of spatial experiences to give choice and agency to consumers. This also enables clinicians to tailor their provision of care to the individual. We found that when it came to wall applications, providing spaces with either abstract or realistic graphics was the preference. Within this, we kept abstract patterns simple and allowed for realistic graphics to be patterned.
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Looking after myself while I co-create
Working closely with those with lived and living experience has encouraged me to be more inquisitive about mental health – to acknowledge my own, to seek and show support, to challenge the stigma and improve the way I communicate about mental ill-health.
I’ve found caring for my mental health is a continuous balancing act that requires a multi-faceted approach. In the face of project demands and deadlines, life and work stresses and opportunities, caring for myself is partly tending to the basics – sleep, nutrition, physical activity, connections to others. Part of it is reflection, retrospection and introspection – showing myself the empathy and kindness I try to show others, making space for the discomfort of mental ill-health, and noticing when I start to feel unwell, establishing routines and practices that keep me well, such as practising gratitude, goal setting and mindfulness. It is also knowing when and where to seek help, either by reaching out to a close loved one or a professional resource (see resources in the link at the start of the article).
What I’ve found especially helpful through educating myself more on mental health is how to better communicate about it, advocate for it and share more openly about it. I’ve not only improved the co-design processes I’ve been involved in, but also experienced more meaningful conversations both professionally and personally. Destigmatising mental health for myself and others is hugely important and empowering, as not only do a large percentage of people struggle with their mental health during their lifetime, but it is part of caring for ourselves, just like our physical and social wellbeing.
Get in touch
If you’re interested and would like to share, I’d like to hear from you – your experiences, advice and questions as it relates to mental health, co-design and designing for mental health. I encourage you to get in touch.
Steph Clarke is an Interior Designer at ClarkeHopkinsClarke Architects and 2023 participant in Australian Design Review’s 30Under30 Award and industry mentoring program. Steph’s projects from New York to regional Victoria span healthcare, workplace, commercial and seniors living and care. Her design focus is supporting individuals and communities to thrive. Steph is active in mental health co-design, with research interests in biophilic design, neurodiverse-sympathetic interiors and intersectional sustainability.
Steph wrote about her early experiences co-designing a new type of facility for a new model of care in Victoria for INDESIGN magazine in 2022.
- Yuhgo Yamaguchi, “Better healing from better hospital design”, Harvard Business Review, 5 October 2015; “The case for good design: Healthcare”, Office of the Victorian Government Architect, accessed November 2023[↩]
- Stephen R. Kellert, Judith Heerwagen and Martin Mador, Biophilic Design – The Theory, Science and Practice of Bringing Buildings to Life (Hoboken, New Jersey: John Wiley & Sons, 2011); Neha Gill, “The Importance of Trauma-Informed Design”, Forbes.com, 9 December 2019.[↩]
- “Maggie’s Oldham”, dRMM Architects.[↩]
- Dr Dhruv Khullar, “Bad Hospital Design is making us Sicker”, New York Times, 22 February 2017 [paywall][↩]
- “Use Person-first language to reduce stigma”, Mental Health First Aid USA, 12 April 2022; “Language”, Mindframe, accessed November 2023.[↩]
