ANTIDEPRESSION CENTER June 2020 Final Year B.Arch Thesis Report by Aman Kumar Agarwal 15AR10001
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ANTI DEPRESSION CENTRE Kirba Chowk, Sambapur, Odisha A dissertation submitted to the Indian Institute of Technology Kharagpur in partial fulfillment of the requirement for degree of
Bachelor of Architecture (Hons.) by
AMAN KUMAR AGARWAL Roll No. 15AR10001
Under the guidance of
Dr. Shankha Pratim Bhattacharya
Department of Architecture and Regional Planning Indian Institute of Technology Kharagpur
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CERTIFICATE Department of Architecture and Regional Planning Indian Institute of Technology Kharagpur November 2019 I hereby recommend that the Project prepared under my supervision by Mr. Aman Kumar Agarwal, Roll no.:15AR10001, entitled “Anti-Depression Centre, Sambalpur, Odisha� be accepted in the partial fulfilment of the requirements for the degree of Bachelor of Architecture.
_________________________ Prof(Dr) S.P. Bhattachary Project Supervisor
_________________________ Prof(Dr) Joy Sen Head of Department
_________________________ Approved External Examiner 1
_________________________ Approved External Examiner 1
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Acknowledgement The success and final outcome of this report required a lot of guidance and assistance from many people and I am extremely privileged to have got this all along the completion of this report. All that I have done is only due to such supervision and assistance and I would not forget to thank them. First of all, I would like to take this opportunity to express my gratitude to my supervisor Prof (Dr.) Shankha Pratim Bhattacharya. A person with an amitable and positive disposition, he always made himself available to discuss and clarify my doubts despite his busy schedules. With his spontaneous design inputs,constructive criticism and constant encouragement and he has been more than a project guide. I am also indebted to our Thesis Coordinator, Prof. Haimanti Banerji for her unending patience in managing a very big batch and for a gamut of requests from the students. A note of thanks goes to all the professors of the jury during the various stages of viva whose comments and suggestions have helped me constantly better my work and do justice to my thesis report. I owe my heartfelt thanks to parents and my sisters who have been my pillars of support in my every action. Also thanks to my seniors and juniors for their assistance. They are the source of my inspiration and energy. I am also thankful to the Architect Meera Vishal Jogi, Creative Curves, for believing in my first year to grab an internsahip in architecture. From then, there was no turning back. Thanks to all my architecture batch mates specially, Atul, Preetish, Kashyap, and Keshav who have made the entire duration of thesis an easier journey. I would also like to thank my friend Neelkamal Semwal and Luv Rathrore and my junior Shivam Singh for their inputs and motivation. Not to forget, the final year batch of Patel Hall who have helped me during the pandemic time. And I would like to aknowledge the support of all the people who have been instrumental in any step development of this thesis project. Thank You Aman Kumar Agarwal 15AR10001
A. LIST OF FIGURES B. LIST OF TABLES
1.PROJECT BRIEF
1.1 What is depression? 1.2 Why is it important to address depression? 1.3 Depression In India 1.4 Need of the Anti-Depression Centre 1.5 Aims and Objectives 1.6 Scope 1.7 Limitations 1.8 Clients
2.PSYCHOLOGICAL DISORDER
2.1 Introduction 2.2 Classifying Disorder
3.LITERATURE REVIEW
3.1 Psychology (11th Edition),D.G.mayers, C.N.Dewall
3.1.1 Major Depressive Disorder 3.2.2 Diagnosing Depressive Disorder 3.2
3.2.1 Types of Psychotherapy
3.3 designguide | MENTAL HEALTH FACILITIES Department of veterans affairs Office of construction and facilities management
3.3.1 Operational narrative 3.3.2 Principles 3.3.3 design RECOMMENDATIONS 3.3.4 PLANNING RECOMMENDATIONS
3.3.5 Patient room design 3.3.6 dining room design
3.3.7 TWO BEDROOM SUITE and living room 3.3.8 Typical Therapy room
3.4 Time-Saver Standards for Building Types 2nd Edition, Edited by Joseph De Chiara and J H Callender ADC | 8
3.4.1 Spatial Needs of Program Elements
3.5 Sambalpur Development Authority Regulations
4.CASE STUDY
4.1 Primary Case Study
4.1.1 Department of Psychiatry, VIMSAR 4.1.1 inpatient department 4.1.2 outpatient department 4.1.3 Scope for improvement 4.1.4 inference
4.1 Secondary Case Study
4.1.1 Socso Rehab Centre, Malacca Malaysia 4.2.1 building program 4.2.2 Architecture concept 4.2.3 planning concept 4.2.3 therapeutic Design (TD) Element
5.SITE
5.1 Why Sambalpur 5.2 Site Analysis 5.3 Observations 5.4 User and Vicinity Analysis
6. DESIGN DEVELOPMENT 7.AREA PROGRAMMING 8.BIBLIOGRAPHY
A. LIST OF FIGURES figure 1.1-Graph showing the percentage of people suffering from Neuropsychiatric disorder 14 Reference: https://www.who.int/mental_health/media/investing_mnh.pdf 14 figure 1.2-Figure showing the current and future scenario of depression 15 figure 1.3- We must take care of our menatl healt 17 Reference: https://yourstory.com/2018/10/india-needs-focus-mental-health-wellbeing 17 figure 2.1-Figure showing one of the symptom of psychological disorder 23 Reference: healthcare-in-europe.com/en 23 figure 2.2-Iron Man 3 (2013) portrayed the main character, shown here, with posttraumatic stress disorder 24 Reference: https://www.psychologytoday.com/au/blog/ 24 Reference: 24 PYSCHOLOGY, D.G.Mayers 24 figure 3.1-Figure showing stacks of books 31 Reference: http://www.sfwa.org/2010/10/sfwa-annual-business-meeting/ 31 figure 3.2- In August 2014, the actor and comedian Robin Williams hanged himself. Although he built his career on making people laugh, Williams appears to have struggled for years with depression, along with drug and alcohol problems. 34 Reference: https://en.wikipedia.org/wiki/Robin_Williams#Death 34 figure 3.3- figure shows percentage of adults experiencing major depression in year 2011 35 Reference: Pyschology, (11th edition) D.G.Mayers, C.N.Dewall 35 figure 3.5- Patient Room, One Bed, Inboard Toilet Option, 135 NSF [12.5 NSM] 44 figure 3.6- Patient Room, One Bed, Sideboard Toilet Option, 135 NSF [12.5 NSM] 44 figure 3.7- Patient Room, One Bed, Bariatric, Inboard Toilet Option, 180 NSF [16.7 NSM] 45 figure 3.8- Patient Room, One Bed, Bariatric, Sideboard Toilet Option, 180 NSF [16.7 NSM] 45 figure 3.9- Patient Room, Two Bed, Inboard Toilet Option, 230 NSF - [21.4 NSM] 46 figure 3.10- Patient Room, Two Bed, Sideboard Toilet Option, 230 NSF - [21.4 NSM] 46 figure 3.11- Dining Room 700 NSF [65.0 NSM],Serving/Pantry ( - 235 NSF [21.8 NSM] 47 figure 3.12- Bedroom, One Bed, Standard - 100 NSF [9.3 NSM] 48 Bedroom, One Bed, Accessible - 120 NSF [11.2 NSM] 48 Bathroom, Two Bed Suite, Accessible - 100 NSF [9.3 NSM] 48 figure 3.13- Living Area 150 NSF [13.9 NSM] 49 Dining Area 120 NSF [11.2 NSM] 49 Kitchenette 90 NSF [8.4 NSM] 49 Resident Living Storage 100 NSF [9.3 NSM] 49 figure 3.14-Key Plan 49 figure 3.15- Therapy Room - 300 NSF [27.9 NSM] 50 figure 3.16- Photo of Winston Churchill 51 Reference: google.com 51 figure 3.16- Fallingwater by Frank Lloyd Wright 54 Reference:en.wikipedia.org/wiki/Fallingwater 54 figure 3.16- Potarit of Salvador Dali 64 Reference:https://www.tomslatin.com/salvador-dali-quote/ 64 figure 4.1- Graphics showing a woman visiting the site 69 Reference: freepik.com 69 From bottom left clockwise- 71 Figure 4.2 View towards entry of Inpatient area which is low height structure as mentioned in section 3.3.3 Design Recommendations, point number 2. 71 Figure 4.3 View of administration block having spaces like conference room, seminar hall, out-patient deparmtent (O.P.D) 71 Figure 4.4 Small open spaces with trees near inpatient building entry 71 figure 4.6- Graphics showing the location of the department of Psychiatry, VIMSAR 72 Reference: google.com/maps 72 figure 4.5- Key plan of Inpatient department of Department of Psychiatry VIMSAR 73 Plan N.T.S., The plan has been drafted for reference purpose only. 73 figure 4.7- View from the entry of the building showing how the nature has been incorporated 73 From top left clockwise- 74 Figure 4.8 View of male ward 74 Figure 4.9 View of female ward from entry of building 74 Figure 4.10 View of staff room 74 Figure 4.11 View of store room infront of ETC room 74 Figure 4.12 View towards male ward from female ward 74 Figure 4.13 View from site entry showing people resting under the huge tree planted infront of inpatient
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department 75 figure 4.14- Key plan of outpatient department ground fllor of Department of Psychiatry VIMSAR 76 Plan N.T.S., The plan has been drafted for reference purpose only. 76 From top left clockwise- 77 Figure 4.15 View of outpatient department from site entry 77 Figure 4.16 Exterior view of outpatient department inclu ding 2 wheeler parking with green vegetation 77 Figure 4.17 Entrance of outpatient department showing staircase leading to seminar room. 77 Figure 4.18 View of outpatient ticket counter 77 Figure 4.19 View to dispensary and OPD 77 Figure 4.20 Balconies are eliminated in OPD 77 From top left clockwise- 78 Figure 4.20 View from site entry showing stagnant water in front of pump room and also clothes are kept for drying which degrades the aethetic quality of the environment 78 Figure 4.21 View towards back side of male ward showing the how badly the area is maintained 78 Figure 4.22 View to trash enclosure which is designed to collect garbage in one place but not maintained which degrdes the space quality 78 Figure 4.23 Exterior perspective 83 Reference: https://architizer.com/ 83 Figure 4.24 Integration of pocket garden with internal spaces while manipulating light and color emulate a positive space 84 Reference: https://architizer.com/ 84 Figure 4.24 Exterior perspective showing how the topography is maintained and enhanced wherever possible 86 Reference: https://architizer.com/ 86 Figure 4.25 The roof plan of overall facility and services provided by the facility 87 Reference: https://architizer.com/ 87 Figure 4.26 Use of natural lighting to light up the interior space of the rehab center 89 Reference: https://architizer.com/ 89 Figure 4.27 Intergration of color element into the space design to help with the stimulation of patiets sense 89 Reference: https://architizer.com/ 89 Figure 4.27 Glass House in New Canaan 91 Reference: https://en.wikipedia.org/wiki/Philip_Johnson#/media File:Glasshouse-philip-johnson.jpg 91 From top to bottom 96 Figure 5.2: View of Biju Patnaik e-Learning Center from site 96 Figure 5.3: View of Mahanadi Coal Field Limited(MCL) from site through the water body 96 Figure 5.4: One of the site entry through the access road 96 Figure 5.5: View of major vegetationa and abadoned structures in site 96 From top left counterclockwise 97 Figure 5.6: View of access road from site entry 97 Figure 5.7: The site is accessible via taxis and autos that can be seen in the figure 97 Figure 5.8: View of the water body from site 97 Figure 5.9: Local public transport i.e. buses etc are frequently avaibale that travel inter city 97
B. LIST OF TABLES Table 3.1: Percentage of Selected Psychological Disorders 36 Reference: PYSCHOLOGY, D.G.Mayers 36 Table 3.2: Signs of Depressions according o DSM-V 38 Reference: PYSCHOLOGY, D.G.Mayers 38 Table 3.3: Minimum Distance from the Electric Line 61 Table 3.4: Plot Size Wise Permissible Set Backs 62 Table 3.5: Provisions of Exterior Open Spaces around the Building 65 Table 4.1 Relationship between the building program and its function Table 4.2 Therapeutic Design Elements with explanation 92
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1 PROJECT BRIEF 1.1What is depression? 1.2 Why is it important to address depression? 1.3 Depression In India 1.4 Need of the Anti-Depression Centre 1.5 Aims and Objectives 1.6 Scope 1.7 Limitations 1.8 Clients
“On an individual, community, and national level, it is time to educate ourselves about depression and support those who are suffering from this mental disorder.� ADC | 16
1.1 WHAT IS DEPRESSION? Depression is an extremely common illness affecting people of all ages, genders, different socioeconomic groups and religions in India and all over the world. Globally, an estimated 322 million people were affected by depression in 2015. Depression contributes to significant disease burden at national and global levels. At the individual and family level, depression leads to poor quality of life, causing huge social and economic impact. Depression is one of the two diagnostic categories that constitute common mental disorders (CMDs), the other being anxiety disorder. Both are highly prevalent across the population (hence they are considered “common�) and impact on the mood or feelings of affected persons. Depression includes a spectrum of conditions with episodes, illnesses and disorders that are often disabling in nature, vary in their severity (from mild to severe) and duration (from months to years) and often exhibit a chronic course that has a relapsing and recurring trajectory over time. It is well acknowledged that depression influences the occurrence and outcomes of several diseases and conditions. Depression and suicide are closely interlinked; at its worst, depression can lead to suicide. Globally, depression is the top cause of illness and disability among young and middle-aged populations, while suicide ranks second among causes of death for the same age groups. Depression is associated with poverty in a vicious cycle. Depression often results in impaired functioning, which has an impact on all aspects of an individual’s life and family affecting multiple areas of education, marriage, work and social life. These in turn lead to loss of productivity, increased health care costs and significant emotional suffering.
figure 1.1-Graph showing the percentage of people suffering from Neuropsychiatric disorder Reference: https://www.who.int/mental_health/media/investing_mnh.pdf
1.2 WHY IS IT IMPORTANT TO ADDRESS DEPRESSION? • Depression is a major public health problem in India, contributing to significant morbidity, disability as well as mortality, along with significant socioeconomic losses. • Depressive disorders affect large numbers of children, adolescents, middleaged groups and the elderly, both men and women, residing in urban and rural areasand slumsofIndia. • Depression and suicide are closely interlinked.At its worst, depression can lead to suicide. Recognizing depression at an early stage is critical for reducing suicidal deathsand deliberate self-harm across the spectrum. • People with depression are often stigmatized and excluded by family and society.They also tend to under-perform in education and work, thereby remain increasingly deprived of economic and social opportunities, with a decreased qualityoflife. • People with depression do not get adequate care due to various reasons, ranging from non-availability of services to prevailing stigma and discrimination.
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1.3 DEPRESSION IN INDIA According to WHO, India is home to an estimated 57 million people (18% of the global estimate) affected by depression. With India witnessing significant changes (including globalization, urbanization, migration, and modernization) that is coupled with rapid sociodemographic transition, depression is likely to increase in the coming years. As per NMHS (2015-16) in India, one in 20 (5.25%) people over 18 years of age have ever suffered (at least once in their lifetime) from depression amounting to a total of over 45 million persons with depression in 2015.
figure 1.2-Figure showing the current and future scenario of depression
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1.4 NEED OF AN ANTI-DEPRESSION CENTRE? Accordinf to recent survey by WHO, 150 million people in India need care for their mental health condition. We are quick to rush to the hospital if we experience chest pain; to pop in pills for conditions like high BP, high cholesterol, and diabetes. But we are reluctant to seek treatment for mental health issues. So there has to be a centre where people of any caste, gender, age can be treated. Main reason for the need of an anti depression centre are: • According to INDIATODAY news dated October 10, 2018, it was mentioned by WHO that India is the most depressed country in the world • From 2005-15, cases of depressive illness increased by nearly five times. • Depression can lead to suicide. Over 8lac people die due to suicide every year in 15-29 age group • The economic impact of depression is also one of th driving factor. Athough the effects of poor health on poverty are by no means unique to depression, the longer duration of a proportion of depressive illnesses makes their
negative impacts greater than for most acute physical conditions. These various impacts increase the risk that households will fall into severe economic hardship, with major consequences for the national economy. Such risks are likely to increase during times of economic crisis, making it even more important not to neglect mentalhealth. • Depression interfers with day to day life activities like workig, studying, eating and sleeping. So the centre will help the peoples to tackle with all these. • The mental hospitals in the current scenario do provide treatment but it doesnot help the people who are facing problems that can lead to depression. So the center will help such kind of people. • Till today, there is a research gap on depression. There may be various causes of depression which might not have found yet. So the centre will provide a research facilities to the researchers to rearch on depression and to its related topics. • The centre will provide a platform so that doctors and reachers can work in collaboration.
figure 1.3- We must take care of our menatl healt Reference: https://yourstory.com/2018/10/india-needs-focus-mental-health-wellbeing
1.5 AIM OF THE PROJECT • To establish a natural residential atmosphere and facilities to treat persons (for ages 21 years onwards) suffering from clinical depression that don’t require hospitalization • To provide a place so that researchers and doctors can work together
OBJECTIVES OF THE PROJECT TIME
COST
TIME
QUALITY
• Increase efficiency of Mental Health care delivery Systems • Architecture Legibility
COST
• Diversity in Function • Locally available materials • Accessibility
QUALITY • • • • •
Meeting Required Standards Evaluated & inspected by MCI Importance to mental health Research on depression Improve quality of life
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1.6 SCOPE The following aspects of building design are within the scope of the thesis project • Spatial organization • Site Study and analysis • Concepts • Structural Systems
1.7 LIMITATIONS • Technical detailing of passive design strategies applied, electrical and plumbing systems, WStructural Systems is beyond the scope of the thesis. Also the project will not cover a detailed cost estimate and structural analysis of building structural systems. • Among all the depression types i.e. BIPOLAR depression, SEASONAL depression, PREMENSTRUAL DYSPHORIC depression, CLINICAL depression, PERSISTENT depression, PSYCHOTIC depression, clinical depression will be treated in the centre Why CLINICAL DEPRESSION ONLY? • More in women than in men • Common reason why people seek out mental health services • Interference with day to day life activities like working, studying, eating and sleeping • 39% of Depression
1.8 CLIENT Government of odisha The project has to be recognized by Medical Council of India • Recognition of medical qualifications • Gives accreditation to medical schools • Monitors medical practice in India. • Grants registration to medical practitioner
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2 PSYCHOLOGICAL DISORDER 2.1 Introduction 2.2 Classifying Disorder
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PSYCHOLOGICAL DISORDER
figure 2.1-Figure showing one of the symptom of psychological disorder Reference: healthcare-in-europe.com/en
2.1 INTRODUCTION *Extract from Psychology, D.G.Mayers
A psychological disorder is a syndrome (collection of symptoms) marked by a “clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior” (American Psychiatric Association, 2013). Disturbed, or dysfunctional thoughts, emotions, or behaviors are maladaptive- they interfere with normal day-to-day life. And occasional sad moods that persist and become disabling may likewise signal a psychological disorder. The most common tool for describing disorders and estimating how often they occur is the American Psychiatric Association’s 2013 Diagnostic and Statistical Manual of Mental Disorders, now in its fifth edition (DSM-5). Physicians and mental health workers use the detailed “diagnostic criteria and codes” in the DSM-5 to guide medical diagnoses and treatment.
figure 2.2-Iron Man 3 (2013) portrayed the main character, shown here, with posttraumatic stress disorder Reference: https://www.psychologytoday. com/au/blog/
Figure 2.3 Culture and normality Young men of the West African tribe put on elaborate makeup and costumes to attract women. Young American men may buy flashy cars with loud stereos to do the same. Each culture may view the other’s behavior as abnor-
Reference: PYSCHOLOGY, D.G.Mayers
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2.2 CLASSIFICATION 2.2.1 Anxiety Disorder
2.2.1.1 General Anxiety Disorder
2.2.1.2 Social Anxiety Disorder
2.2.1.3 Panic Disorder
2.2.1.4 Phobias
2.2.2 Obsessive Compulsive Disorder 2.2.3 Posttraumatic Stress Disorder 2.2.4 Depression 2.2.4.1Major Depressive Order (known as Clinical Depression)
2.2.4.1.1 Postpartum Depression
2.2.4.1.2 Atypical Depression
2.2.4.1.3 Melancholic Depression
2.2.4.2 Persistent Dipressive Disorder
2.2.4.3 Bipolar Disorder
2.2.4.4 Seasonal Affective Diosrder
2.2.4.5 Psychotic Depression
2.2.4.6 Premenstrual Dysphoric Disorder
2.2.5 Schizophrenia 2.2.6 Dissociative Disorder 2.2.7 Personality Disorder 2.2.8 Eating Disorder *Disorder in Red colour is under the scope of the project
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“Who in the rainbow can draw the line where the violet tint ends and the orange tint begins? Distinctly we see the difference of the colors, but where exactly does the one first blendingly enter into the other? So with sanity and insanity.� HERMAN MELVILLE AMERICAN NOVELIST
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3 LITERATURE REVIEW 3.1 Psychology (11th Edition),D.G.mayers, C.N.Dewall 3.2 Psychological science (5th Edition) Michael Gazzaniga | Todd Heatherton | Diane Halpern 3.3 designguide | MENTAL HEALTH FACILITIES Department of veterans affairs Office of construction and facilities management 3.4 Time-Saver Standards for Building Types 2nd Edition, Edited by Joseph De Chiara and John Hancock Callender 3.5 Sambalpur Development Authority Regulations
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LITERATURE REVIEW
figure 3.1-Figure showing stacks of books Reference: http://www.sfwa.org/2010/10/sfwa-annual-business-meeting/
3.1 PSYCHOLOGY(11 D.G. MAYERS, C.N.DEWALL
TH
EDITION)
In the section 2.2 Classification of Psychological disorder we classifed the psychological disorder into 8 broad categories and 19 total categories. Worldwide one can find peoples sufffering from these disorders but why focus on Major depressive disorder (also know as clinical depression)? TABLE 3.1 below shows the percentage of selected Pyschological disorders and one can find from the table that Depressive disorder and bipolar disorder are amon the highest among all psychological disorders.
3.1.1 MAJOR DEPRESSIVE DISORDER (aka CLINICAL DEPRESSION) Major depressive disorder occurs when at least five signs of depression last two or more weeks mentioned in TABLE 3.2. The symptoms must cause near-daily distress or impairment and not be attributable to substance use or another medical or mental illness.
Table 3.1: Percentage of Selected Psychological Disorders Reference: PYSCHOLOGY, D.G.Mayers
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“If someone offered you a pill that would make you permanently happy, you would be well advised to run fast and run far. Emotion is a compass that tells us what to do, and a compass that is perpetually stuck on NORTH is worthless.” DANIEL GILBERT
AMERICAN SOCIAL PSYCHOLOGIST
3.1.2 DIAGNOSING MAJOR DEPRESSIVE ORDER The DSM-5 classifies major depressive disorder as the presence of at least five of the following symptoms over a two-week period of time (minimally including depressed mood or reduced interest (American Psychiatric Association, 2013). Table 3.2: Signs of Depressions according o DSM-V Reference: PYSCHOLOGY, D.G.Mayers
Adults diagnosed with persistent depressive disorder (also called dysthymia) experience a mildly depressed mood more often than not for two years. Other symptoms which may be shown by people suffering from major depressive order are: • Difficulty with decision-making and concentration • Feeling hopeless • Poor self-esteem • Reduced energy levels • Problems regulating sleep • Problems regulating appetite
figure 3.2- In August 2014, the actor and comedian Robin Williams hanged himself. Although he built his career on making people laugh, Williams appears to have struggled for years with depression, along with drug and alcohol problems. Reference: https://en.wikipedia.org/wiki/Robin_Williams#Death ADC | 38
Women’s risk of major depression is nearly double men’s.
figure 3.3- figure shows percentage of adults experiencing major depression in year 2011 Reference: Pyschology, (11th edition) D.G.Mayers, C.N.Dewall
3.2 PSYCHOLOGICAL SCIENCE
(5TH EDITION) MICHAEL GAZZANIGA | TODD HEATHERTON | DIANE HALPERN
While one when reading Chapter 2.2, might have found the major pychological disorder by which individuals can experience mental illness. Fortunately, psychologists and other providers of mental health care have worked intently to create therapies that address the full range of psychopathology. The major types of treatments currently used by health-care providers: psychoanalysis, behavior modification, cognitive alteration, humanistic therapies, and drug therapies. Clinical social worker: A mental health professional whose specialized training prepares him or her to consider the social context of people’s problems. Pastoral counselor: A member of a religious order who specializes in the treatment of psychological disorders, often combining spirituality with practical problem solving. Clinical psychologist: An individual who has earned a doctorate in psychology and whose training is in the assessment and treatment of psychological problems. Counseling psychologist: Psychologist who specializes in providing guidance in areas such as vocational selections, school problems, drug abuse, and marital conflict. Psychiatrist: An individual who has obtained an MD degree and also has completed postdoctoral specialty training in mental and emotional disorders; a psychiatrist may prescribe medications for the treatment of psychological disorders. Psychoanalyst: An individual who has earned either a PhD or an MD degree and has completed postgraduate training in the Freudian approach to understanding and treating mental disorders. These different types of therapists practice in many settings: hospitals, clinics, schools, and private offices. Some humanistic therapists prefer to conduct group sessions in their homes to work in a more natural environment. Community-based therapies, which take the treatment to the client, may operate out of local storefronts or houses of worship. Finally, some therapists work with clients in the life setting that is associated with their problem.
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3.2.1 TYPES OF PSYCHOTHERAPY Psychologists use two basic categories of techniques to treat psychological disorders: psychological and biological. Either may be used alone or in combination. The generic name given to formal psychological treatment is psychotherapy. The particular techniques used may depend on the practitioner’s training, but all forms of psychotherapy involve interactions between practitioner and client. These interactions are aimed at helping the person understand his or her symptoms and problems and providing solutions for them. Psychodynamic Therapy: In psychodynamic therapy the client would lie on a couch while the therapist sat out of view. Techniques included free association and dream analysis. In free association, the client would say whatever came to mind and the therapist would look for signs of unconscious conflicts, especially where the client appeared resistant to discussing certain topics. In dream analysis, the therapist would interpret the hidden meaning of the client’s dreams. Humanistic Therapy: Humanistic therapy focuses on whole person. The goal of humanistic therapy is to treat the person as a whole, not as a collection of behaviors or a repository of repressed thoughts. Behaviour Therapy: Behaviour therapy is the treatment based on the premise that behavior is learned and therefore can be unlearned through the use of classical and operant conditioning. Cognitive Therapy: Cognitive therapy is based on the theory that distorted thoughts can produce maladaptive behaviors and emotions. Treatment strategies that modify these thought patterns should eliminate the maladaptive behaviors and emotions. Cognitive-behavioral Therapy: CBT is a therapy that incorporates techniques from cognitive therapy and behavior therapy to correct faulty thinking and change maladaptive behaviors. Group Therapy: In some instances group therapy offers advantages over individual therapy. The most obvious benefit is cost. Group therapy is often significantly less expensive than individual treatment. In addition, the group setting provides an opportunity for members to improve their social skills and learn from one another’s experiences. Group therapies vary widely in the types of people enrolled, the duration of treatment, the theoretical perspective of the therapist running the group, and the group size—although some practitioners believe around eight people is the ideal number. Family therapy: The person’s family often plays an almost equally important role. Each person in a family plays a particular role and interacts with the other members in specific ways. Over the course of therapy, the way the individual thinks, behaves, and interacts with others may change. Such changes can profoundly affect the family dynamics.
Electroconvulsive Therapy (ECT): ECT involves placing electrodes on a person’s head and administering an electrical current strong enough to produce a seizure Alternative Neurostimulation Therapies: Magnetic Stimulation, Magnetic Stimulation Rational-Emotive Therapy (RET): RET is a comprehensive system of personality change based on the transformation of irrational beliefs that cause undesirable, highly charged emotional reactions, such as severe anxiety. Clients may have core values demanding that they succeed and be approved, insisting that they be treated fairly, and dictating that the universe be more pleasant. Eye Movement Desensitization and Reprocessing (EMDR) Therapy: EMDR is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. It’s growing in popularity, particularly for treating post-traumatic stress disorder. At first glance, EMDR appears to approach psychological issues in an unusual way. It does not rely on talk therapy or medications. Instead, EMDR uses a patient’s own rapid, rhythmic eye movements. These eye movements dampen the power of emotionally charged memories of past traumatic events. Light Exposure Therapy: Light therapy is a way to treat seasonal affective disorder (SAD) and certain other conditions by exposure to artificial light. SAD is a type of depression that occurs at a certain time each year, usually in the fall or winter. To counteract winter depression, some people spend time each morning exposed to intense light that mimics natural outdoor light. Light boxes are available from health supply and lighting stores. Drug Therapy: Drug therapy, or psychopharmacotherapy, aims to treat psychological disorders with medications. Drug therapy is usually combined with other kinds of psychotherapy. The main categories of drugs used to treat psychological disorders are antianxiety drugs, antidepressants, and antipsychotics.
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“Prevention is better than cure.” DESIDERIUS ERASMUS ROTERODAMUS
DUTCH PHILOSOPHER AND CHRISTIAN HUMANIST
3.3 designguide | MENTAL HEALTH FACILITIES DEPARTMENT OF VETERANS AFFAIRS OFFICE OF CONSTRUCTION AND FACILITIES MANAGEMENT
While one when reading Chapter 2.2, might have found the major pychological disorder by which individuals can experience mental illness. Fortunately, psychologists and other providers of mental health care have worked intently to create therapies that address the full range of psychopathology. The major types of treatments currently used by health-care providers: psychoanalysis, behavior modification, cognitive alteration, humanistic therapies, and drug therapies.
3.3.1 OPERATIONAL NARRATIVE Mental health care delivery is often delivered within an interdisciplinary team context, where team members interact and work together as partners in the treatment process. Interdisciplinary treatment teams may be comprised of mental health professionals from the core mental health disciplines (psychiatry, psychology, social work, nursing), as well as other professions. These professionals include, but are not limited to: • • • • • • • • • • • • • •
Psychiatrists Psychologists Social Workers Advance Practice Nurses/Nurse Practitioners Registered Nurses Licensed Practical Nurses Licensed Vocational Nurses Dieticians Chaplains Vocational Rehabilitation Specialists Rehabilitation Technicians Recreational Therapists Peer Support Technicians
3.3.2 PRINCIPLES Mental Health Design Guide was developed based on the premise that the environment of care can significantly impact the recovery process – either in a faciliatory or inhibitory fashion. The specific principles and approaches emphasized in this Guide are based on a recovery-oriented, evidence-based design paradigm. Specific guiding principles for the development of this Design Guide and related attributes are summarized below: ADC | 44
Principle #1: Mental health services should be recovery-oriented • Patient and family-centered • Rehabilitation/recovery-focused • Evidence-based • Emphasis on community reintegration Principle #2: Mental health services should be provided in a therapeutically enriching environment • Home-like • Familiarity • Visual and physical access to nature to promote healing • Patient autonomy, respect, and privacy Principle #3: Mental health services should be provided in a safe and secure environment • • • •
Minimize potential physical hazards Enhance staff visibility and engagement with patients Use of abuse-resistant materials, furnishings, and fixtures Incorporate safety-promoting technologies (e.g., personal duress alarms, pressure sensitive door head alarms)
Principle #4: Mental health services should be integrated and coordinated • Promote collaboration among care providers • To the largest extent practical, treat the patient for multiple diagnosis in the same setting • Use of technologies to promote continuity of care Principle #5: Mental health services should be provided in settings that respect and can accommodate a diverse range of patient populations and care needs • Provide appropriate accommodations for specific patient groups • Promote safety, privacy, and dignity of female Veterans • Provide separation within inpatient units or provide distinct units, where necessary
3.3.3 DESIGN RECOMMENDATIONS 1. Bring the services to the patients and maximize therapeutic opportunities 2. Create Non-Institutional Treatment Environment (home-like in appearance and feel). Inpatient and residential facilities, where feasible, are single story or village-like, with multiple exterior courtyards bringing in more natural light and views of nature. 3. Create private Patient Rooms and Bathrooms. Single occupancy patient rooms have the benefit of being more private and having less noise, which may be agitating to some patients and can disturb sleep. Double occupancy rooms may be desirable for some patients for social or clinical reasons. 4. Create nurse station. The facility is not locked into a 10 or 12 bed unit concept, but can be eight or even 14 without modification to the plan. 5. Create On Stage and Off Stage Design. The “on-stage, off-stage” concept separates, where possible, patient pathways (“on-stage”) throughout the facility from materials management, food service and clean materials delivery within the facility, as well as staff support areas (“offstage”). This minimizes noise, disruption and distractions in areas actively used by patients. 6. Spaces should be universally designed to accommodate a range of related functions. 7. Group spaces in particular need to be designed and grouped to accommodate a range of functions and to accommodate change if possible.
8. Support spaces, such as storage and utility rooms, should be designed to be shared where possible to reduce the overall need for space. 9. Create courtyards instead of fenced outdoor areas. 10. Simple circulation with no blind spots. 11. Equipment, carts, and other supplies should be adequately stored in locked rooms. Alcoves should not be used for storing or parking of equipment, carts and assistive devices in corridors and other unsecured areas.das 12. To reduce patient and staff injuries, appropriate accommodations for disabled and bariatric(obesity) patients and staffs. 13. Eliminate balconies, openings, etc. that would allow a patient to jump from an elevated platform. 14. To reduce patient and staff stress, natural light and ventillation has to penetrate the staff and patient areas. 15. Open layout, with no unnecessary barriers between staff and patient. 16. Space for both patients and staff is designed so neither feels trapped or vulnerable; overcrowding is avoided. 17. Use of natural materials, a soothing color palette and residential character in the interior design of the facility. 18. Patient and staff areas that allow for relaxation and controlling one’s social environment (e.g., quiet rooms, staff lounges, secure outdoor space). 19. Courtyards must be designed with hard-scape and landscape features that do not support self-harm or assaultive behavior. 20. Trees within the courtyard area should not facilitate climbing over a wall or fence. Shrubs should be small and low enough that a patient can not hide behind them.
3.3.4 PLANNING RECOMMENDATIONS Inpatient Units 1. Inpatient mental health units will typically be located relatively close proximity to the Emergency Department 2. Create a non-institutional, home-like environment through careful attention to external and internal architectural features and interior design elements. 3. Layout should incorporate an open and bright design. 4. Absent of long corridors in order to promote social engagement and interaction with staff and provide for a more domestic and less institutional feel. 5. Layout should be free of blind corners. 6. Portions of the unit, such as the office suite, should be designed to be closed off after hours to reduce the amount of area within the unit required to be supervised by staff. 7. Provide ample visual and physical access to nature, which promotes healing. 8. Incorporate wall color, trim, accent colors, and securely-anchored artwork in common areas and patient rooms. ADC | 46
9. The nursing station should blend in both in scope and design with the therapeutic environment. The nursing station should have direct visibility of all patient wings and activity areas. Patient Activity Areas 10. Patient activity areas consist of living room/dayroom, dining, therapy, group and family meeting room spaces, a quiet room for retreating, and secure outdoor spaces. 11. There should be no sharp wall, furniture or fixture edges that patientscould injure themselves on. 12. Adequate secure storage rooms should be provided on the unit to prevent carts and other equipment from being stored in the corridor or open alcoves off the corridor. 13. Equipment used by patients while supervised, such as computer equipment, and other facility equipment, should be located in rooms that can be locked when not in use. 14. The dining room may be enclosed or open Nurse Station 15. Smaller, more integrated space should be developed for the nursing station on an inpatient mental health unit, to fit with a recovery-oriented model. 16. The nursing station should be open and not enclosed. Open nursing stations promote nursing staff engagement with patients and involvement on the unit. 17. Bedroom corridors and primary patient activity areas should be directly visible from the nursing station. Outdoor Courtyards 18. Courtyards must be located within the unit to be visible by staff from the nursing station. 19. There should be a secure and safe outdoor space directly accessible from every inpatient unit. 20. Inpatient mental health units be on the ground level to allow for easy access to the outdoors and for incorporation of nature in a village design concept. 21. Outdoor courtyard space should be large enough to allow for greater functionality, including walking pathways for patients, and to limit confinement or overcrowding.
3.3.5 PATIENT ROOM DESIGN
figure 3.5- Patient Room, One Bed, Inboard Toilet Option, 135 NSF [12.5 NSM]
figure 3.6- Patient Room, One Bed, Sideboard Toilet Option, 135 NSF [12.5 NSM]
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figure 3.7- Patient Room, One Bed, Bariatric, Inboard Toilet Option, 180 NSF [16.7 NSM]
figure 3.8- Patient Room, One Bed, Bariatric, Sideboard Toilet Option, 180 NSF [16.7 NSM]
figure 3.9- Patient Room, Two Bed, Inboard Toilet Option, 230 NSF - [21.4 NSM]
figure 3.10- Patient Room, Two Bed, Sideboard Toilet Option, 230 NSF - [21.4 NSM]
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3.3.6 DINING ROOM DESIGN
figure 3.11- Dining Room 700 NSF [65.0 NSM],Serving/Pantry ( - 235 NSF [21.8 NSM]
3.3.7 TWO BEDROOM SUITE AND LIVING ROOM
figure 3.12- Bedroom, One Bed, Standard - 100 NSF [9.3 NSM] Bedroom, One Bed, Accessible - 120 NSF [11.2 NSM] Bathroom, Two Bed Suite, Accessible - 100 NSF [9.3 NSM]
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figure 3.13- Living Area 150 NSF [13.9 NSM] Dining Area 120 NSF [11.2 NSM] Kitchenette 90 NSF [8.4 NSM] Resident Living Storage 100 NSF [9.3 NSM]
figure 3.14-Key Plan
3.3.8 TYPICAL THERAPY ROOM
figure 3.15- Therapy Room - 300 NSF [27.9 NSM]
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“We shape our buildings and afterwards our buildings shape us” WINSTON CHURCHILL
PRIME MINISTER, UNITED KINGDOM (1940-45)
figure 3.16- Photo of Winston Churchill Reference: google.com
3.4 TIME-SAVER STANDARS FOR BUILDING TYPES 2ND EDITION , EDITED BY JOSEPH DE CHIARA AND JOHN HANCOCK CALLENDER
3.4.1 SPATIAL NEEDS OF PROGRAM ELEMENTS 3.4.1.1. Inpatient Unit This is a short-term residential facility for living under a supervised therapeutic program, requiring a domestic or college-dormitory rather than a hospital atmosphere . 3.4.1.1.1 Patient Needs
Privacy for sleeping, dressing, and bathing. Provision for personal grooming needs. As few regulations for use of facility as possible. Patients should be able to rearrange furniture, hang pictures on wall, etc. Patient belongings should not be out of reach-lockable storage space should be provided in each patient’s bedroom unless specifically prohibited by program. 3.4.1.1.2 Socialization Areas Space for small conversational groupings or quiet individual use (2-4 persons) . Activity spaces for games, dancing, music, group living (1624 persons) . Two living areas are desirable to allow noisy and quiet activities to occur simultaneously. Quiet activity space could also be used for group therapy. 3.4.1.1.3 Domestic Areas Laundry and snack kitchen for use by each living group (16- 24 patients) . 3.4.1.1.4 Visiting Areas Space should be provided for private visiting with family and friends. 3.4.1.1.5 Recreation Areas Space in the form of an exercise room, gymnasium, or outdoor space (especially in warm climates) should be provided . 3.4.1.1.6 Staff Areas • Storage for personal property • Staff toilet • Area for charting/private discussion with therapists • Security for drugs • Multiuse patient interview space, family discussion
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3.4.1.1.7 Housekeeping Areas Domestic housekeeping : Linens-in patients’ bedrooms or locate for central distribution Each bedroom unit to have own linen supply Bathroom and personal items Central janitor’s closet
3.4.1.2. Emergencies Emergencies area has to be close proximity to the patient rooms. 3.4.1.3. Outpatient 3.4.1.3.1 Admitting Spaces Should be convenient to receptionist 3.4.1.3.2 Ancillary Services • Waiting areas • Secretarial space • Public and staff toilets, lounge (coffee, sink, refrigerator), and library-workroom 3.4.1.3.3 Wating Areas • Limited to 8-12 patients • Distributed throughout office areas • Receptionist by front door-open, friendly, encourage contact between receptionist and patient 3.4.1.3.4 Office Areas Should motivate communication between patient and therapist, should contain doctor (staff) and at least four or more patients and be flexible in arrangement of furniture. 3.4.1.3.5 Conference Areas • Sufficient to accommodate 16 people • Accessible to main entrance and/or office spaces and rest rooms • Suitable for group therapy • Provides storage closet 3.4.1.3.6 Staff Lounge Should be comfortable for 8 people adjacent to staff toilets, storage, and small kitchenette (coffee-making, lunch, refrigerator); also adjacent to staff library and workroom . 3.4.1.4. Administration • Reception-waiting area • Director’s office-meeting room nearby • Offices for program directors • Volunteers and part-time office and loungewith lockers and toilets • Conference room • Library-workroom• Staff lounge • Business-secretarial pool • Central records for all service elements
“I believe in God, only I spell it Nature.”
FRANK LLOYD WRIGHT AMERICAN ARCHITECT
figure 3.16- Photo of F.L.Wright Reference:https://en.wikipedia. org/wiki/Frank_Lloyd_Wright
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figure 3.16- Fallingwater by Frank Lloyd Wright Reference:en.wikipedia.org/wiki/Fallingwater
3.5 SDA REGULATIONS 2017 PLANNING AND BUILDING STANDARDS
In the following draft by Sambalpur Development Authority(SDA) gives the planning and building standard, bye-laws. 1. According to Part-1 subsection ‘s’, the proposed project i.e. Anti-Depression Centre falls under the category of “Institutional Building”. Under Part-1, subsection ‘s’ of SDA Regulations ”Institutional Building” refers to a building constructed by Government, SemiGovernment Organizations or Registered Trusts, buildings used for medical or other treatment, Research and Training Centre, Public or Semi Public offices, Hospitals, Dispensaries, nursing homes, poly clinics and Health Centers or for an auditorium or complex for cultural and allied activities or care of orphans, abandoned wowen, children and infants, convalescents, destitute or aged persons and for penal or correctional detention with restricted liberty of the inmates ordinarily providing sleeping accommodation and includes dharamshalas, hospitals, sanatoria, custodial and penal institutions such as jails, prisons, mental hospitals, houses of correction, detention and reformatories etc. 2. “Canopy” means cantilevered projection at lintel level over any entrance, provided that 2.1 It shall not project beyond the plot line. 2.2 It shall not be lower than 2.3 m or 7’ 6” when measured from the ground. 2.3 There shall be no structure on it and the top shall remain open to sky.
3. “Coverage” means percentage of covered area on the ground floor which is not open to sky excluding the chajja/ roof projections up to 0.75 m width overhanging the open space to the total plot area;
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4. “Covered Area” means in respect of ground floor, area covered immediately above the plinth level by the building but does not include the open space covered by: 4.1 Garden, rockery, well and well-structures, rainwater harvesting structures, plant nursery, water-pool (if uncovered), platform round a tree, tank, fountain, bench, chabutara with open top unenclosed on sides by walls, boundary wall, swing, and area covered by chhajja without any pillars etc., touching the ground; 4.2 ‘Drainage culvert conduit’, catch-pit, gully pit, inspection chamber, gutter and the like; and 4.3 Compound wall, gate, slide/ swing door, canopy, and areas covered by chajja or similar projections and staircases which are uncovered and open at least on three sides and also open to sky; 4.4 Watchmen booth, pump house, garbage shaft, electric cabin or substations, and such other utility structure meant for the services of the building under construction; 5. “Habitable room” means a room having area of not less than 9.0 sqm., width 2.4 m (min.), height 2.75 m (min.) occupied or designed for occupancy by one or more persons for study, living, sleeping, eating, cooking if it is used as a living room, but does not include bathrooms, water closet compartments, laundries, serving and storage pantries, corridors, cellars, attics and spaces that are not used frequently or during extended periods. 6. Distance from Electric lines:- As provided in clause 6.4 of the National Building Code of India, no verandah, balcony or the like shall be allowed to be erected or re-erected or any additions or alterations made to a building within the distances quoted below in accordance with the rules made under the Indian Electricity Act, 1910 between the building and any overhead electric supply line;
Table 3.3: Minimum Distance from the Electric Line
7. Plantations:- As per PART III of SDA i.e. LAND USE CLASSIFICATION AND PERMISSIBLE USES (ZONING REGULATIONS) section 25,in Institutuional building area, at least 20% of the land shall be covered by plantation.
8. Minimum setbacks for non-high rise buildings: As per PART III of SDA i.e. LAND USE CLASSIFICATION AND PERMISSIBLE USES (ZONING REGULATIONS) section 28 Table 3.4: Plot Size Wise Permissible Set Backs
Institutional Buildings:- In case of plots upto 1000 sqm, the open spaces around the building shall not be less than 3 m and for plots above 1000 sqm the open spaces around the building shall not be less than 6 m. 9. Height of a building:- As per PART III of SDA i.e. LAND USE CLASSIFICATION AND PERMISSIBLE USES (ZONING REGULATIONS) section 31, the height of the building is decided by distance of site from nearest runway end. If the distance is greater than More than 1560m, the height of the buildings are restricted to 30m. 10. Floor Area Ratio:- As per PART III of SDA i.e. LAND USE CLASSIFICATION AND PERMISSIBLE USES (ZONING REGULATIONS) section 30, in case of Institutional and Assembly building the maximum permissible FAR shall be 1.50 for plots up to 1000 sqm. and 1.75 for plots above 1000 sqm. 11. Provision of Lift:- As per PART III of SDA i.e. LAND USE CLASSIFICATION AND PERMISSIBLE USES (ZONING REGULATIONS) section 37, Lift shall be provided for buildings above 10 m. height in case of apartments, Housing Projects, commercial, institutional and office buildings. There shall be at least two car lifts for 2000 sqm. of roof area.
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12. Mezzanine Floor:- As per PART III of SDA i.e. LAND USE CLASSIFICATION AND PERMISSIBLE USES (ZONING REGULATIONS) section 38, Mezzanine floor may be permitted above any floor in all types of buildings up to an extent of one-third of the actual covered area of that floor. All Mezzanine floors shall be counted toward FAR calculation. It shall have a minimum height of 2.2 m. 13. Barrier free access for the differently abled person, elderly and children:As per PART III of SDA i.e. LAND USE CLASSIFICATION AND PERMISSIBLE USES (ZONING REGULATIONS) section 40: 13.1 Applicability: The regulations are applicable to all buildings and facilities used by the public such as educational, institutional, assembly, commercial, business, mercantile buildings and Housing Projects, etc. constructed on plots having an area of more than 2000 sqm. 13.2 Access Path: Access path from plot entry and surface parking to building entrance shall be minimum of 1800 mm. wide having even surface without any steps. Slope, if any, shall not have gradient greater than 5%. 13.3 Parking: For parking of vehicles of differently abled people the following provisions shall be made: (a) Surface parking for two car spaces shall be provided near entrance for the physically handicapped persons with maximum travel distance of 30 m from building entrance. (b) The width of parking bay shall be minimum 3.6 m. (c) The information stating that the space is reserved for handicapped persons shall be conspicuously displayed. 13.4 Building requirements: The specified facilities for the buildings for handicapped persons shall be as follows: (a) Approach to plinth level: Every building must have at least one entrance accessible to the handicapped and shall be indicated by proper signage. This entrance shall be approached through a ramp together with stepped entry. (b) Minimum width of ramp shall be 1800 mm. with maximum gradient 1:12, length of ramp shall not exceed 9 m having 800 mm high hand rail on both sides extending 300 mm beyond top and bottom of the ramp. (c) For stepped approach width of tread shall not be less than 300 mm. and maximum riser shall be 150 mm. Provision of 800 mm high hand rail on both sides of the stepped approach similar to the ramp approach shall be made. (d) Exit/Entrance Door: Minimum clear opening of the entrance door shall be 900 mm
(e) Entrance Landing: Entrance landing shall be provided adjacent to ramp with the minimum dimension 1800 mm X 2000 mm. 13.5 Corridor connecting the entrance/exit for the differentlyabled: The specified are as follows: (a) The minimum width shall be 1250 mm. (b) In case there is a difference of level, slope ways shall be provided with a slope of 1:12 (c) Hand rails shall be provided for ramps/slope ways at a height of 800 mm. 13.6 Stair ways: One of the stairways near the entrance/exit for the handicapped shall have the following provisions: (a) The minimum width shall be 1350 mm. (b) Height of the riser shall not be more than 150 mm and width of the tread 300 mm. (c) Maximum number of risers on a flight shall be limited to 12. 13.7 Lifts: Lift recommended for passenger lift of 13 person capacity by Bureau of Indian Standards. (a) The lift should have a clear internal depth: 1100 mm; clear internal width: 2000 mm; entrance door width: 900 mm. (b) A handrail not less than 600 mm. long at 1000 mm. above floor level shall be fixed adjacent to the control panel. (c) The lift lobby shall be of an inside measurement of 1800 mm x 1800 mm or more. 13.8 Toilets: One special Water Closet, in a set of toilets shall be provided for the use of differently-abled with essential provision of washbasin near the entrance for the differently-abled. (a) The minimum size shall be 1500 mm X 1750 mm. (b) Minimum clear opening of the door shall be 900 mm and the door shall swing out.
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14. Fire Protection Standards according to Annexure IV Standards for Fire Protection & Fire Safety Requirements as per SDA are as follows: 14.1 Provisions of Exterior Open Spaces around the Building Table 3.5: Provisions of Exterior Open Spaces around the Building
14.2 Arrangements of Exits: Exits shall be so located so that the travel distance on the floor shall not exceed 22.50 m for residential, educational, institutional and hazardous occupancies. All the exits shall be accessible from the entire floor area at all floor levels. 14.3 Capacity of Exits: The capacity of exits (staircase, ramps and doorways) indicating the number of persons which could be safety evacuated through a unit exit width of 50 cm for institutional building is: Staircase: 25 Ramps: 50 Doorways: 75 14.4 Staircase Requirements: There shall be minimum of two staircases and one of them shall be enclosed stairway and the other shall be on the external walls of building and shall open directly to the exterior, interior open space or to any open place of safety. 14.5 Width Provision for Stairways: For institutional building width of stairway is 2m. 14.6 Width Provision for Passageway/Corridors: For institutional building width of corridor is 2.4m. 14.7 Doorways: For institutional building width of exit doorways shall not be less than 1.5m. Doorways shall not be less than 2.10 m in height. Exit doorways shall open outwards, that is away from the room but shall not obstruct the travel along any exit. No door when opened shall reduce the required width of stairway or landing to less than 1m. Overhead or sliding door shall not be installed. 14.8 Stairways: For institutional building the minimum tread shall be 30 cm. The maximum height of riser shall be 15cm. These shall be limited to 13 per flight.
14.9 Staircase Enclosures: The external enclosing walls of the staircase shall be of the brick or the R.C.C. construction having fire resistance of not less than two hours. 14.10 Ramps: The minimum width of the ramps in the institutional building shall be 2.4 m. Ramp shall lead directly to outside open space at ground level or courtyards of safe place. The minimum slope of ramp is 1:10. 14.11 Fire Lifts: The lift shall have a floor area of not less than 1.4 sqm. It shall have a loading capacity of not less than 545 kg (8 persons lift) with automatic closing doors. The electric supply shall be on a separate service from electric supply mains in a building and the cables run in a route safe from fire, i.e. within a lift shaft. 14.12 Alternate Source of Electric Supply: A stand by electric generator shall be installed to supply power to staircase and corridor lighting circuits, lifts detection system, fire pumps, pressurization fans and bowlers, exit sign, smoke extraction system, in case of failure of normal electric supply. 14.13 Electric Sub-Station: Clear independent approach to the sub-station from outside the building shall be made available round the clock. The floor of the sub-station should be capable of carrying 10 tons of transformer weight on wheels. The substation area shall have a clear height of 3.6 m below beams. 14.13 Automatic Sprinklers: Automatic sprinkler system shall be installed for institutional buildings of 15 m and above 14.14 Control Room: There shall be a control room on the entrance floor of the building with communication system (suitable public address system) for all floors and facilities for receiving the message from different floors.
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“Have no fear of perfection -- you’ll never reach it..” Salvador Dali
Spanish Surrealist painter
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figure 3.16- Potarit of Salvador Dali Reference:https://www.tomslatin.com/salvador-dali-quote/
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4 CASE STUDY 4.1 Primary Case Study
4.1.1 Department of Psychiatry, VIMSAR
4.1 Secondary Case Study
4.1.1 Socso Rehab Centre, Malacca Malaysia
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CASE STUDY
figure 4.1- Graphics showing a woman visiting the site Reference: freepik.com
4.1 DEPARTMENT OF PSYCHIATRY VEER SURENDRA SAI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH (PRIMARY CASE STUDY) Following a methodical research through analyzing literature review, sudy area observation and face to face interview, it is empirical to explore an existing example of the research topic where I had probed and examine the above mentioned case study to break down in order to identify any weakness that I could overcome or strength that I can extract and improve upon. Case studies method enables a researcher to closely examine the data within a specific context. In most cases, a case study method selects a small geographical area or a very limited number of individuals as the subjects of study. In the above mentioned case study I tried to explore and investigate contemporary real-life phenomenon through detailed contextual analysis of a limited number of events or conditions. Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), formerly Burla Medical College (BMC) and Veer Surendra Sai Medical College and Hospital (VSSMCH), popularly known as VSS, is a government-run medical college and hospital in the Indian state of Odisha. Established in 1959, it imparts medical education at both the undergraduate and postgraduate levels. Objectives of case study: • To understand the functionality • To understand the spatial distribution
From bottom left clockwiseFigure 4.2 View towards entry of Inpatient area which is low height structure as mentioned in section 3.3.3 Design Recommendations, point number 2. Figure 4.3 View of administration block having spaces like conference room, seminar hall, out-patient deparmtent (O.P.D) Figure 4.4 Small open spaces with trees near inpatient building entry
Location and Accessibility Department of Psychiatry, VIMSAR is located in the town Burla, district Sambalpur in the state Odisha. It is located 5.5km away from city railway station i.e. Hirakud railway Station,4 km away from National Highway 53(NH 53), 11km away from Sambalpur railway station, and about 70 km away from Jharsugda Domestic Airport.
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figure 4.6- Graphics showing the location of the department of Psychiatry, VIMSAR Reference: google.com/maps
4.1.1 INPATIENT DEPARTMENT
figure 4.5- Key plan of Inpatient department of Department of Psychiatry VIMSAR Plan N.T.S., The plan has been drafted for reference purpose only.
Design Considerations: • There has been made an attempt to create non-Institutional Treatment Environment (home-like in appearance and feel) • The staff duty room has been kept in close proximity to the patient wards. • Storage facilities for female ward, male ward and staff romm has been provided. • The department is universally designed. • Service room like generator room, electrical room etc is not at the juxtaposition of the entrance. • Nature has been incorporated in the design. • Visual and physical access to nature to promote healing
figure 4.7- View from the entry of the building showing how the nature has been incorporated
From top left clockwiseFigure 4.8 View of male ward Figure 4.9 View of female ward from entry of building Figure 4.10 View of staff room Figure 4.11 View of store room infront of ETC room Figure 4.12 View towards male ward from female ward
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Figure 4.13 View from site entry showing people resting under the huge tree planted infront of inpatient department
4.1.2 OUTPATIENT DEPARTMENT
figure 4.14- Key plan of outpatient department ground fllor of Department of Psychiatry VIMSAR Plan N.T.S., The plan has been drafted for reference purpose only.
Design Considerations: • • • • • • • •
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Visual and physical access to nature to promote healing Enhance staff visibility and engagement with patients The department is universally designed. Spaces are designed and grouped to accommodate functions. Support spaces, such as record room and bathroom, are designed to be shared to reduce the overall need for space. Simple circulation with no blind spots. Balconies, openings, etc. are eliminated that would allow a patient to jump from an elevated platform. To reduce patient and staff stress, natural light and ventillation is penetrating the staff and patient areas.
From top left clockwiseFigure 4.15 View of outpatient department from site entry Figure 4.16 Exterior view of outpatient department inclu ding 2 wheeler parking with green vegetation Figure 4.17 Entrance of outpatient department showing staircase leading to seminar room. Figure 4.18 View of outpatient ticket counter Figure 4.19 View to dispensary and OPD Figure 4.20 Balconies are eliminated in OPD
4.1.3 SCOPE FOR IMPROVEMENT
From top left clockwiseFigure 4.20 View from site entry showing stagnant water in front of pump room and also clothes are kept for drying which degrades the aethetic quality of the environment Figure 4.21 View towards back side of male ward showing the how badly the area is maintained Figure 4.22 View to trash enclosure which is designed to collect garbage in one place but not maintained which degrdes the space quality
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4.1.4 INFERENCE Architecture Features: • • • • • • • • • • • •
Non-Institutional Treatment Environment Close proximity of staff to the patient wards Justaposition of storage facilities with patient and staff areas Universally designed. Services are grouped together Incorporation of nature in design Visual and physical access to nature to promote healing Spaces are designed and grouped to accommodate functions Simple circulation with no blind spots Natural light and ventillation to reduce stress Variation of heights in elevation Use of versatile building materials like tiles
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4.2 SOCSO REHAB CENTRE MALACCA, MALAYSIA
This is the first rehabilitation complex in the world that combined medical and vocational rehabilitation with an allied health institute. Design Brief Architect Location Land Size Project GFA Status Category Year
Anuar Aziz Architect Melaka, Malaysia 55.42 acres 5,261.00 sq.m Completed Masterplan, Healthcare 2013
Objectives of case study: • To understand the functionality • To understand the spatial distribution • To understand site planning
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Figure 4.23 Exterior perspective Reference: https://architizer.com/
4.2.1 BUILDING PROGRAM This rehabilitation center provides conducive healing program to those who are afflicted with physical disabilities where it excels in providing physiotherapy, occupational therapy, hydrotherapy, speech impairment therapy and vocational training and healing that will help the people to return to the work Generally this rehabilitation facility is the first of its kind that introduce an integration between the program of therapeutic vocational rehabilitation, medical institute with an allied health institute. Located at Mukim Durian Tunggal, Melaka, this space composition of this facility were design to form several cluster that were connected to one another to ease the circulation of the pedestrian and wheelchair user. For those who are afflicted with the mobility impaired, a buggy was prepared to help with their movement. When this project was planned, the main objective that they want to achieve is to be ranked as the best planned rehabilitation facility
Figure 4.24 Integration of pocket garden with internal spaces while manipulating light and color emulate a positive space Reference: https://architizer.com/
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comparable to the international standards. The segregation of spaces of this facility were mainly divided through physical division. Every block that were erected will sustain its own program among the same cluster. Each block in each cluster of space is supplementing one another in terms of the program each cluster will supplement others cluster thus creating a whole ecosystem of program within the facility itself. Table 4.1 will illustrate the relation between the program and the purpose of each one of them.
Table 4.1 Relationship between the building program and its function
Facilities
Program/Description
Explanation
Speech Therapy
Speech impairment therapy
Help those who afflicted with speech difficulties i.e. ther they were born with it or due to traumatic experiences
Hydrotherapy
Arthritis and related rheumatic
Using water as a medium of treatment, it can be used to treat several illness but mostly use to treat arthritis and other related rheumatic conditions
Gymnasium
Physical exercise
This facility is to provide intense physical training for the patient to test their physical capabilities while undergo rehabilitation and therapy
Physiotherapy
Treatment on physical injuries
The process of treatment of the patient through physical interaction and medium such us exercise, body massage or heat treatment
Assessment Clinic
Assess patient health level
This facility will assess the condition of the patient prior to admitting to the facility, while undergo treatment and after completing their treatment to make sure that the patient is healthy
4.2.2 ARCHITECTURE CONCEPT • The buildings are placed sensitively on existing topography; maintaining & enhancing wherever possible • Each buildings are given different outlook / identity for easy recognition and orientation • Great emphasize on ‘green design’ such as orientation, maximise natural lighting and ventilation, creation of ‘wind corridor’, low e-glass, fixed and movable shading panels • A conscious move from hospital outlook into a more corporate / resort environment; again to expedite the healing process
Figure 4.24 Exterior perspective showing how the topography is maintained and enhanced wherever possible Reference: https://architizer.com/
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1. Guard post 5. Hostel & dining block 9. Recreational park
2. Administration block 6. Vocational rehab block 10. Recreational pond
3. Staff canteen 7. Surau 11. Dry pond
Figure 4.25 The roof plan of overall facility and services provided by the facility Reference: https://architizer.com/
4.2.3 PLANNING CONCEPT • The main tenants are people with disabilities and their caretakers. • The whole planning was orchestrated based on ease of movement and compliance to universal ‘access for all’ concept, and Malaysian Standard Code of Practice on Access for Disabled Person to Public Buildings and other relevant guidelines • The creation of a ‘primary spine’ will provide ease of movement either for walking, wheelchair or buggy. • Multiple experience created by landscape and resting areas provide ‘pausing stations’. • Buildings are clustered according to principle function; and each cluster is intimately connected via the ‘primary spine’ • There are five main clusters : i. Administration Block & staff canteen; ii. Medical & Vocational Rehab Blocks, Hostel and Canteen Blocks; iii. Allied Health Institute Block; iv. Surau (Muslim prayer hall) & main car park v. Services blocks • The administration block creates the starting point in the journey for healing. It is designed as an impressive building to emphasize its formal function.
4. Medical block 8. Allied health block 12.STP
• The main rehab blocks, canteen & hostel are set radially with the surau being the axis; signifying spiritual healing. • The medical block is designed based on the ‘healing hand’ where main facilities & wards forming the palm; while the five fingers housed the therapy blocks. • Shaded garden formed a sanctuary for the patient to rest post therapy. • Soft and hard landscaping is a very strong element that holds the whole development together. It is intended that the greenery and ‘ spiritual therapy’ as part of the healing process
4.2.4 THERAPEUTIC DESIGN (TD) ELEMENT Looking on the perspective of architectural concept approach, the placement of the building is taking into consideration so that minimal amount of changes that required to be implemented during the construction process while preserving and enhancing if necessary. To increase the legibility of each cluster for easy identification, each building from each cluster were given a unique architectural language with all the cluster will be given an emphasize on ‘green design approach’. A special treatment was to be given to the building orientation, maximizing the use of natural ventilation and lighting and standing panels. This approach that look a different route from the cnventional hospital and focusing more to create corporate environment is mean to speed u the healing space.
Table 4.2 Therapeutic Design Elements with explanation
TD Approach
TD Element
Explanation
Biophilic Design
Pocket Integration
Act as node for the patient to stop and rest during their commute through the facility
View framing
Provide the feeling of closeness to the nature and providing a boost to the recovery of the patient
Lighting
The facade of the building mostly consist of large windows with shading devices to allow lighting to penetrate the building
Color
Utilization of color will help to stimulate the patient senses
Sensory design
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Figure 4.26 Use of natural lighting to light up the interior space of the rehab center Reference: https://architizer.com/
Figure 4.27 Intergration of color element into the space design to help with the stimulation of patiets sense Reference: https://architizer.com/
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“Architecture is the art of how to waste space.” PHILIP JOHNSON AMERICAN ARCHITECT
Figure 4.27 Glass House in New Canaan Reference: https://en.wikipedia.org/wiki/Philip_Johnson#/media File:Glasshouse-philip-johnson.jpg
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5 SITE 5.1 Why Odisha? 5.2 Site Details 5.3 Site Photographs 5.4 Observations
5.1 WHY ODISHA? Location: Burla, Sambalpur, Odisha, India Why Odisha? One of the economically backward states. According to 2011 census, 83.3% people lives in rural areas. With respect to area, Odisha is most backward state.
Figure 5.1 Graphical representation of site Reference: googel.com
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5.2 SITE DETAILS Location with respect to city: The site is located infront of Veer Surendra Sai Institute of Technology (VSSUT), the oldest engineering college of Odisha. The site is also just 2km away from Veer Surendra Sai Institue of Medical Science and Research. Water ,being a natural element, is very close to the site and is also the primary reason of site selection with respect to the city. Site Accessibility/ Connectivity: 1. 3km away from Hirakud railway station 2. 8km away from Sambalpur Junction 3. 67km away from Jharsugda Airport 4. 1.5km away fro Mumbai Kolkata NH Other Facilities: 1. VIMSAR Hospital: is a government-run medical college and hospital which will act as major concerned hospital in case of emergency. 2. Nursing Homes and private clinics: Besides VIMSAR, there is one nursuning home and other private clinics which are under doctors of the VIMSAR whci will also act as treatment spaces. 3. Guest Houses: In the cases of fulfillment of living facilities in the site, the patient can also prefer guesthouses available near the site. 4. Research Labs: The labs of Sambalpur university and VSSUT are located in close proximity can also provide additional support to the Center.
Neighbouring Properties (VSSUT Institutional Building)
10m access raod
5.3 SITE PHOTOGRAPHS
From top to bottom Figure 5.2: View of Biju Patnaik e-Learning Center from site Figure 5.3: View of Mahanadi Coal Field Limited(MCL) from site through the water body Figure 5.4: One of the site entry through the access road Figure 5.5: View of major vegetationa and abadoned structures in site
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From top left counterclockwise Figure 5.6: View of access road from site entry Figure 5.7: The site is accessible via taxis and autos that can be seen in the figure Figure 5.8: View of the water body from site Figure 5.9: Local public transport i.e. buses etc are frequently avaibale that travel inter city
5.4 OBSERVATIONS • • • • •
Area – 11.5 Acres with scope of expansion. Good connectivity with roads and railways Sambalpur- 20 mins via road Bargarh – 40km Due to water body there is no possibility of development in south area • Very quite and calm environment • Existing trees and water body • Climate –Hot and Humid
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“When you feel architecture just click, as though it couldn’t have been anything else, it’s due to a true understanding of the site and the plan and section ” STEPHEN KANNER
AMERICAN MODERN ARCHITECT
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6 DESIGN DEVELOPMENT 6.1 Site Development 6.2 Site Plan and Sheets
6.1 SITE DEVELOPMENT
• Majority of wind flows from north, north east, east direction • here is a university campus across the road responsible for noise • A huge lake at south side with mounatin in backdrop is having a higher potential for views
• Patient residence was designed considering noise and view factor
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• Location of staff residence was decided as it should be near access road and near patient residence.
• Transformers, dg room, STP and underground water tank are at the SW corner of the site. • In the entry, a huge area has been dedicated as plaza.
6.2 SITE PLAN AND SHEETS
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7 AREA PROGRAMMING
SPACE
TOTAL UNITS
AREA OF 1 UNIT
TOTAL AREA
Waiting Reception Staff Room Cloak Room Activity Room/ Socializing Space Visitors Meeting Room Public Toilets Single Bed Room (with toilets) Double Bed room (with toilets and without common area) Double Bed room (with toilets and with common area) Dining Area(common)
2 2 2 2 2 2
78 25 12.5 6.5 128 30
156 50 25 13 256 60
42 16
30 45
1260 720
4
62
248
1
300
300
Doctor’s Chamber/ Therapy Room Nurse Station Gymansium Utility Area
4 10 1 3 2 2 1 1
32 52 125 56 30 57 19.5 19.5 25
128 520 125 168 60 114 19.5 19.5 25 6550
INPATIENT
Laundary and Housekeeping Surveillance room Electrical Room Public Toilets TOTAL AREA OF INPATIENT UNIT
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ADMINISTRATION Reception & Waiting Directors office Meeting Rooms Assistant Office Manager Office Pantry Toilets Lounge Clerk Office Record room Surveillance room Security Room Accountant’s Office Maintenance Room Courtyard TOTAL AREA OF ADMINISTRATION UNIT
1 1 1 1 1 1
20 42 36 17.5 24 6 40 30 30 26 12
1 1 1 1 1 1 1
24 40 200 737
STAFF RESIDENCE Double Bed room Double Bed room toilet Single Bed room Single Bed room toilet Stations Utility Area Discussion Area Courtyard TOTAL AREA OF STAFF RESIDENCE UNIT
11
10
3 1 1
36.5 7.5 44 27 7 34 50
484
340 150 120 29 640 2231
SERVICES STP Underground Water Tank Transformr Area DG Room Gate House TOTAL AREA OF SITE SERVICES
1 1 1 1 1
176 98 84 80 20 458
OUTPATIENT Reception Outdoor Ticket Counter Waiting Areas Toilets Public Toiet Pharmacy OPD Counceling Room Physiotherapy Room Psychiatrist Chamber Thumanistic Therapy Room Group Therapy Room Psycho Dynamic Therapy Room Cognitive Therapy Room Waiting Areas
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1 1 1 1 1 2 1 1 4 2 2 2 2 2
14 5.5 95 18 108 18 22 25 32 12 12 18 24 30 18
14 5.5 95 18 108 18 44 25 32 48 24 36 48 60 36
RESEARCH Collaboration Room 2 EMDR 1 LET 1 ECT 1 Reception 1 Seating Area 1 Toilets Conference Room 2 Cubicles 4 Electrical Room 1 HVAC 1 Reprography 2 Storage 4 Research Lab 2 Seminar Room 1 Cafeteria 1 TOTAL AREA OF OPD AND RESEARCH BLOCK
54 12 12 12 12 115 44 36 33 7 14 7 12 22 136 240
108 12 12 12 12 115 44 72 132 7 14 14 48 44 136 240 2080
8 BIBLIOGRAPHY BOOKS/ JOURNALS Newfert
Ernst,
Newfert
Peter,
Architecture
Data
Time Saver Standards for Architecture Data Time-Saver Standards for Building Types 2nd Edition, Edited by Joseph De Chiara and J H Callender Psychological science (5th Edition) M Gazzaniga | T Heatherton NBC 2016 Architecture - Form, Space, and Order, 3rd Edition Kendler KS, Gardner CO (February 1998). “Boundaries of major depression: an evaluation of DSM-IV criteria”. The American Journal of Psychiatry. INTERNET https://yourstory.com https://www.psychologytoday.com/au/blog/ https://en.wikipedia.org/ https://architizer.com/ https://www.archdaily.com/
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AMAN KUMAR AGARWAL Roll No. 15AR10001
Department of Architecture and Regional Planning Indian Institute of Technology Kharagpur ADC | 136