Physical Design of Supported Accommodation

Check out this abstract for a presentation given by a colleague at the most recent Architecture, Media, Politics and Society (AMPs) conference, 1st – 3rd December 2021.

The physical design of buildings can have an impact on physical and mental health. Numerous studies have identified physical design features of inpatient facilities and their impact on a range of outcomes. However no studies to date have synthesised the evidence for physical design of supported accommodation for people with mental ill health and intellectual disabilities. The aim of the scoping review was to synthesise the evidence for the use of physical design in supported accommodation to achieve a range of outcomes. The objectives included 1) to review the physical design of supported accommodation, 2) to identify the potential impact of physical design on outcomes and 3) to identify what works and for which populations in which setting. Literature searches were conducted across seven electronic databases. Studies were included for review if they met the following criteria; 1) conducted in a community supported accommodation setting; 2) reported at least one measure or description of physical design; 3) the mean age of participants was over 18 years; 4) included adults with mental ill health or intellectual disabilities; 5) full text and available in English. Eight studies were eligible for inclusion in the review. Results indicate that design features including: private rooms which support autonomy with opportunity for personalisation; common areas with natural light and homely features; outdoor spaces with greenery and furniture, located in good neighbourhoods with access to green spaces; and community accessibility are key design features of supported accommodation. The results from this review may be used to inform the planning, building and adapting of supported accommodation for people with intellectual disabilities and mental ill health. There is a dearth of research on physical design of supported accommodation, further research is warranted to create a robust evidence base.

Johnston, A., Davidson, G., Webb, P, McCartin, N., McAllister, K., Broughton, R, Sutherland, D., Kennedy, C. (2021)  Physical design of supported accommodation for people with mental ill health and intellectual disabilities: a scoping review. In Architecture, Media, Politics and Society (AMPs) Conference: Environments by Design, Syracuse University, Northumbria University, Italian Society for the Study of Health, Chalmers University of Technology, Virtual Conference, December 1st – 3rd 2021.

Components of Supported Decision Making

Our paper on the key components of supporting and assessing decision making ability was published today in the International Journal of Law and Psychiatry.

Abstract

People’s ability to make decisions may be impaired for a wide range of reasons, including by mental health problems and learning disabilities. Individual autonomy, the ability to make decisions about our own lives, is a fundamental tenet of democratic societies. This has been reinforced by laws governing substitute and supported decision making and most significantly by the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Article 12 of the UNCRPD requires everyone to have equal recognition before the law and, to achieve this, the necessary support and safeguards must be available. There has been considerable debate about the important theoretical and philosophical issues involved and growing research about the practice complexities of supporting and assessing decision making ability or mental capacity. This article aims to present some of the key components of the support and assessment process to inform further service development and training in this area. The key components were identified as part of a qualitative, participatory research project which explored the decision making experiences of people with mental health problems and/or learning disabilities. The conventional approach to the assessment of capacity is to consider four main components, whether the person is able to: understand, retain, use and weigh, and communicate the information needed to make the decision at that time. The findings from this research study suggest that people generally don’t usually talk about their experiences of decision making in terms of these four components and approaches to supporting people to make decisions don’t necessarily break the support down to explicitly address the assessment process. However, considering support for all aspects of the functional test may be helpful to ensure it is as comprehensive as possible. The challenges involved in providing effective support and assessing decision making ability are discussed and the article concludes with some of the implications for training, service development and practice.

Webb, P., Davidson, G., Edge, R., Falls, D., Keenan, F., Kelly, B., McLaughlin, A., Montgomery, L., Mulvenna, C., Norris, B., Owens, A. & Shea-Irvine, R. (2020) Key components of supporting and assessing decision making ability, International Journal of Law and Psychiatry, 72, C, 101613. https://doi.org/10.1016/j.ijlp.2020.101613