Close to Home
离家近
Neighbourhood strategies for Beijing’s urban psychiatric care.
生活中的都市策略 THESIS PROGRAM
Cameron Clarke Student Number: 170175 Urbanism and Societal Change
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Cameron Clarke 170175
Unit Urbanism and Societal Change Institute IBBL Tutor Christine Bjerke Unit Directors Charles Bessard & Deane Simpson Spring 2019
Acknowledgements
I would like to express my sincere thanks to Dr Huan Wang of Beijing Capital Normal University, for ongoing support and encouragement in my undertaking of the research for this thesis programme.
In September 2018 I was able to visit two psychiatric hospitals in Beijing, inter view a mental health nurse and a professor of psychology from the Peking Institute of Mental Health all of which gave me a unique insight into the topic. Without Huan’s generous help, advice and translations this would have other wise been impossible, and I ver y gratefully acknowledge her assistance and friendship.
I would also like to thank my tutor, Christine Bjerke, for her enthusiastic and insightful engagement, feedback and support in the writing of this programme.
“It is not by confining one’s neighbour
that
one is convinced of one’s own sanity.” Dostoyevsky A Writer’s Diary - 1877 [Cover Image] Danwei - Desheng Sub-district, Beijing
Psychiatric Hospital, Sichuan
Credit: Author
Credit: Lu-Nan, Magnum Photos
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contents
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project synopsis
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the urban mental health crisis a global societal change
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the crisis in china global crisis, chinese characteristics
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the urban context urbanisation of places, not of people chinese urban planning mechanism
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the site: beijing a city between the past and the future site journey
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typological contexts hutong danwei megablock
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the design task design layers toolbox of neighbourhood interventions
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further research planned research and consultants
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planned output deliverables un sustainable development goals
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coda curriculum vitae bibliography
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project synopsis Can answers to China’s urban mental health crisis be found close to home? This programme sets out a brief to design a network of architectural interventions, adaptations and propositions, connected by a layer of emerging digital technology, which can enable neighbourhood communities of urban Beijing to respond to the mental healthcare crisis that China is facing.
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many their citizens have relocated from the countryside in search of the vast array of opportunities that urbanised China can offer.
Can answers to China’s urban mental health crisis be found close to home? In this project I will argue that answers may be found within existing community and neighbourhood structures. This is achieved by proposing a novel psychiatric care model based upon a urban acupuncture of care facilities across the city fabric, rather than the current model of centralised institutions. Architectural spaces and interventions can be networked together by a digital layer of communication technology, bringing mental healthcare physically - and virtually - closer to each of the city’s citizens, and in doing so increasing communal and neighbourly interaction, which is integral for good mental health (McCay, 2018) .
This has placed enormous strain on the built environment, its infrastructure and has caused widescale pollution. In the last 10 years there has been much debate over how the Chinese government can mitigate these decremental phenomena. These changes have also caused increased strain on Chinese citizen’s mental health, as the pressures and stresses of rapid change impacts upon all aspects of urban life. This has been relatively little discussed, and leaves the country ill prepared to face the scale of the mental health crisis which is upon it.
* Mental illness is now the leading cause of health burden in the country (Zhang & Zhao, 2015) , and it is already costing China many lives, and billions of dollars (Xu & Wang et al, 2015). In order to adequately deal with the scale of the crisis, China must look towards systemic change rather than piecemeal improvements. But the country has
In the last 30 years China has developed economically, socially and urbanistically at an unprecedented rate (World Bank, 2018) . Following the opening up of the country to the market economy at the end of the 1970s, China’s towns and cities have grown beyond previous comprehension, and
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shown, perhaps beyond all others in modern history, a remarkable capacity for large scale change over short periods of time. In the last 30 years, China has transformed a largely rural society into a rapidly urbanised one, now with six times as much urban area than in 1981 (Chen & Chen, 2014. p.102) – an urbanisation which has caused significant strains on its citizens, but also created enormous creative capacity for change, as a result of which the Chinese “tech revolution is now ubiquitous in urban life.” (Ash, 2018)
systemic technological, digital and virtual infrastructures. As urban life in China becomes increasingly digitised; and social relations move between offline and online, social services (such as mental healthcare) should be “seen as networks rather than as bounded and closed spatial units.” (Curtis, 2009. p.341).
There is an exciting opportunity for China to develop a new network which delivers mental healthcare through a holistic range of novel mediums, from VR to social networks, while retaining much that is effective and necessary in traditional Chinese urban culture. In this network the spaces that architects and urbanists create “should be seen as nodes in the network, or field, influencing and being influenced by other nodes” where increasingly “one cannot make a clear distinction between what is occurring ‘outside’ or ‘inside’ a place.” (ibid) .
Although slow to develop policy, the Chinese government has stated its commitments to prioritising finding new ways to treat mental health illness. But, as we find in Europe and the US, it will often be the tech innovators and creators who change modes of treatment before official policy catches up. This is a process architects and urbanists must engage with, as their contribution in designing spaces for care will be as vital as ever, even though the physical realities will be mediated increasingly through wider
In the last semester’s research I developed an understanding of the the traditional Beijing Hutong neighbourhoods through the lens 10
of my project ‘HomeMaking’, the process by which local communities were responsively adapting to meet the growing demands upon them by urban, economical and technological development. I discovered an incredible resilience and adaptability to this rapid change, and that its potentiality for success was based on its traditionally strong network of social connections and uptake of emerging digital communication platforms. This web of interconnection enabled incredible nimbleness of social and economic productivity. I intend to use this project to investigate if the same neighbourhood resilience could be meaningfully applied in a exploratory approach to tackling China’s impending mental health care crisis.
I propose to develop a design strategy at the scale of the nighbourhood, which takes the opportunities that are presented by emerging technologies such as virtual reality and the traditional scales of architectural / urban intervention. These scales of proposal will be woven together through a re-purposing and re-imagining of latent community & urban networks and structures, to form a proposal for an adaptive, responsive, scalable and contextual neighbourhood mental healthcare strategy.
I hope to offer some propositions about how these strategies can be manifest in the built environment, imagining how a networked approach to healthcare, which combines existing social resourcelessness, emerging digital technologies and contextual architectural intervention. 11
the urban mental health crisis A global societal change
Peking Institute of Mental Health Credit: Author, site visit
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A global societal change
As the graph below clearly shows, the global impact of mental health illness is steadily increasing year on year, and shows little sign of slowing down.
identified as being largely neglected by urban and medical policy. “To keep cities profitable into the 21st century,” the editorial asserted, “more attention will have to be paid to aspects of health other than the purely physical.”
By 2016 it was estimated that over 1.1 billion of the worlds citizens suffer from a mental illness (Ritchie & Roser, 2016) . During our lifetimes 25% of us will be effected by a psychological illness (WHO, 2001) .
(The Lancet [ed.], 1994. p.1303)
The potential for damage that could be done by ignoring the mental health of urban citizens would result in “violent behaviour, suicide, alcohol and drug abuse…” and that society should begin to seek solutions to this risk as a specific urban phenomenon, rather
In a 1994 editorial in Europe’s leading medical journal, The Lancet, the mental wellbeing of urban citizens was 6%
Dementias Schizophrenia % of
4%
Depression Global DALYs
Bipolar 2%
Anxiety
Other mental disorders 0%
‘90 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 ‘00 ‘01
‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09
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Graph showing increasing global prevalence of mental health disorders, given as a % of total Disability Adjusted Life Years Source: Institute of Health Metrics and Evaluation, University of Washington, 2018
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than to “regard it as an inevitable concomitant of urban life, as was done with cholera 200 years ago.” (ibid.) By equating the danger of ignoring an urban mental wellbeing with the damage wrought onto societies by cholera (a disease which had killed millions of urban citizens across Europe during the 19th century), The Lancet was being emphatic about the scale of the impending psychiatric crisis that our cities face.
healthcare at a few central sites, a better yield if health was seen to come from providing basic facilities close to where people live.” (The Lancet [ed.], 1994. p.1304)
Better consequences would come from addressing mental illnesses at a local, community scale. While there would always be a role for specialist inpatient care as could be provided at larger institutional teaching hospitals, “village clinics run by non-medical staff may be as appropriate to urban as to rural needs.” (ibid.)
The editorial goes on to describe how despite being “woefully underfunded” there were opportunities for cities to reverse the scale of this mental health crisis by learning from the treatment and prevention strategies which had been pioneered by the World Health Organization in the 1950s, and which had been effective against many infectious and predominantly rural diseases.
Written a week before the 2nd sitting of the UN Commission on Sustainable Development, the Lancet’s editorial ended with a plea to politicians, urban planners and the medical profession to consider the psychiatric consequences of urban growth, and to look to develop a highly contextual and localised community-centric approach to this global crisis.
The key to this strategy was that “rather than offering comprehensive
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the crisis in china Global crisis, Chinese characteristics
Psychiatric Doctors, Shanghai Credit: Gilles Sabrie, New York Times
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Global crisis, Chinese characteristics
The process of rapid urbanisation in China has impacted upon the country’s mental health, and this project aims to develop an understanding of the role that a network of contextual and community level architectural and urban interventions can play in the creation of a novel approach to psychiatric treatment.
of rapid growth and urbanisation, mental health disorders have overtaken cancer and cardiovascular disease as the leading cause of health burden in China (Zhang & Zhao, 2015. p. 628) , and it is a burden which has taken on unique urban characteristics. A growing body of research shows that the process of urbanisation has a directly detrimental relationship with mental wellbeing (Chen, J. et al, 2014) . Urban residents are more likely to be exposed to environmental, physical stressors during daily life, such as air pollution, noise pollution and overcrowded living conditions. Statistically, they are also more likely to directly experience traumatic personal events or circumstances, such as divorce or financial debt concerns (ibid) . Finally, and most relevant to the rapidity of Chinese urbanisation, there is a constant adaptation to new living practices and expectations required of urban residents, as greater pressure and competition grows in
China has urbanised at a rate never before experienced in human history, and so the effects of this transition from rural to city life on citizens psychology is profound. While the mental health burden is a growing problem globally, in China it is compounded by drastic changes to lifestyle and a latent underfunding of mental healthcare provision. While the impact of this development to China’s urban physicality is now being widely discussed, relatively little debate has taken place about the effects to China’s urban psychology. As a result of these three decades
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many aspects of life (Wang et al. 2018) .
The primary reasons for this healthcare shortcoming are twofold:
Today, almost 180 million Chinese citizens suffer from a mental health disorder, representing 17.5% of all adults (Xu & Wang et al, 2015 p. 137) - almost 1 in 5 of the population. Of these 180 million people living with a mental illness, 160 Million have not had any psychological treatment or care (ibid, p. 138) . This lack of treatment is a crisis inwaiting, and the economic and social consequences are yet to be fully comprehended.
1. The Chinese healthcare system, while having developed rapidly since 1978, has developed unevenly across the country, and across medical specialisms. Mental health-care has been left well behind the available treatment for other conditions. This discrepancy is best illustrated by Beijing University’s Institute of Mental Health’s estimate that the Chinese healthcare system has only 4,000 academically trained psychiatrists (Park et al, 2005. p. 43) - an order of magnitude smaller than that required to care for a country of 1.4 billion.
Psychiatrists per 100,000 people (2014)
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5 1.7 0 Japan
USA
Russia
Denmark
China
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Country Graph showing countries by number of qualified psychiatrists per 100,000 citizens Source: WHO Source: World Health Organisation, 2001
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Philippines
India
Laos
2. There is a latent social stigma in Chinese culture towards mental health. The divide between society and those with psychological problems has a historical precedent that runs back beyond the disassembly of China’s community based healthcare system under Mao (Zhang & Zhao, 2015. p. 628) . This divide is notably expressed architecturally and urbanistically by the physical separation between sufferers and society. What limited mental healthcare resources China has, are predominantly concentrated in centralised urban institutions, following the European model, itself a descendant of the Victorian asylum - where security and safety to society at large take precedence over care, de-stigmatisation and understanding (Lui et al., 2011) .
neighbourhood treatment services (Ibid p. 210; Park et al, 2005 p. 43; Xu et al, 2016. p.143;
. Evidence suggests that this not only makes for more effective patient treatment, it is also more economically efficient and simultaneously can tackle the social stigma which hampers understanding of and uptake of mental healthcare more generally. This suggests there is an opportunity to reimagine the form that mental healthcare facilities take, and how they interact urbanistically with the neighbourhoods and communities of urban China. Wang et al, 2018 p. 112)
There is also a danger that in responding to the urgency required to meet the demands of mental healthcare in China, that the strategies imposed are imported directly from other contexts, bringing with them existing failings, or creating novel negative consequences when applied in the unique Chinese urban context.
A growing literature which advocates that the Chinese government tackles this deficiency in its healthcare system with a radical approach. There is an opportunity to leapfrog the solely institutional response, in favour of a balanced holistic model which supplements inpatient care with a range of community and
Academic and clinical supports the importance of contextual approach to healthcare architecture,
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research a highly mental this is
summarized aptly in a 2014 paper by researchers at McGill University entitled Towards a New Architecture of Global Mental Health:
(Kirmayer, 2014)
mental wellbeing. The much discussed ‘Social Credit System Project (SCSP)’ is planned to standardise the assessment of citizens’ and businesses’ trustworthiness or social ‘credit’ by 2020 (Chinese State Council, 2014). It is feared that this system could enforce draconian punishments upon those deemed to have low credit score (likely to disproportionately affect those unable to work), such as travel bans and exclusions from access to certain schools, and a negative social status.
From within China too, there is a danger that other government policies will have adverse effects on citizens
It should be noted however, that some western discourse on SCSP is eager to over exaggerate the power
“The concern is that in the urgency to address disparities in global health, interventions that are not locally relevant and culturally consonant will be exported with negative effects including inappropriate diagnoses and interventions, increased stigma, and poor health outcomes.”
1. Beijing 4. Tianjin 7. Zhengzhou 8. Wuhan 2. Shanghai 9. Suzhou 6. Hangzhou 10. Chengdu
5. Shenzhen 3. Guangzhou
Map showing the 10 regions of China with the highest per capita demand for psychiatric services, with a concentration on rapidly growing urban centres.
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and influence that the system will have on average citizens’ lives (Hornsley,
misinterpretations, it is critical that a new approach to the architecture of mental healthcare is understood through a contextual appreciation of the Chinese urban condition: socially, politically, culturally and tectonically.
2018; Song, 2018).
Although there is currently no evidence that punishments from the Social Credit System will extend to the access to state healthcare, it will undoubtedly add to the existing stressors of modern Chinese urban life. However, used appropriately the system may be able to better enforce existing legislation (Dai, 2018) , including that designed to protect the rights of those who suffer mental illness. As the system will also extend to businesses, it will give the government further measures to ensure that employees are treated fairly and may add an incentive to businesses to act in a more caring nature towards its staff (Ibid). More generally, the system is hoped to raise the responsibility that citizens feel towards each other, and with extremely careful application, could improve the percived stigma towards those suffering from mental health illness.
Thus, it is critical that a new approach to the architecture of mental healthcare is understood through a contextual appreciation of the Chinese urban condition: socially, politically, culturally and tectonically.
Due to the rate of change throughout Chinese society, and its many inherent contradictions and western
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Danwei, surrounded by new super-high density residential development, Guangzhou Credit: Institute of Urban Dreaming, 2017
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the urban context Urbanisation of place, not of people “Society is becoming increasingly fragmented and disconnected as a consequence of the rapid urban transformation.”
(Wang & Shaw, 2018 p. 584) The process of rapid urbanisation in China has impacted upon the country ’s mental health, and this project aims to develop an understanding of the role that a network of contextual and community level architectural and urban interventions can play in the creation of a novel approach to psychiatric treatment. Uninhabited residential towers, Beijing Credit: Tim Franco
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Urbanisation of place, not of people
Despite China’s mental health burden existing at a national scale, the impact of its effects are to be most profoundly felt at a local, neighbourhood register. For sufferers of mental health illnesses, traditionally the treatment and care (or lack thereof) would have taken place within the home, the street and the neighbourhood. The reliance on family and neighbour relationships has been of critical importance to healthcare more generally, and prior to the Cultural Revolution (1966 - 1976) healthcare was largely administered at a highly localised scale (Liu et al, 2011. p. 210) .
major cities, which was particularly effective in minimising deterioration of chronic conditions (Park et al. 2005. p. 39) However, after the reforms to the healthcare system through the 1980s and ‘90s, there was an incentive for healthcare facilities to generate profit, and smaller neighbourhood clinics were enveloped by larger, city scale hospitals. Before 1990 there was at least one community psychiatric clinic or rehabilitation centre per district in Shanghai - by 2004 the number of these facilities had decreased by over 60% (Liu et al, 2011. p.211) . In a city of Shanghai’s scale - with a population of over 24 million - there are now only 98 outpatient rehabilitation programmes (Park et al. 2005 p.39), and over 80% of mental healthcare funding is directed to a few large inpatient hospitals (ibid).
In cities such as Beijing and Shanghai a number of local community care and rehabilitation centres operated, organised by neighbourhood committees - the lowest level of governmental body - and were situated within the residential areas of the city (Zhang, 1990 & Shen, 1990.) Community care was also an integral component of rehabilitation programmes within
There is a wide body of research in Western literature that shows a distinctive relationship between patient’s immediate neighbourhood
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of mental health in China is associated with “a dismantling of community safety nets [and] individuals’ inability to adapt to these drastic social changes.” (Graham, et al., 2017) .
context and the individual’s mental health. (Chen & Chen, 2014 p. 102) . While China’s urbanisation process is different in its scale and speed than most western contexts, many parallels can be drawn between these studies in European and North American cities, as many share similar neighbourhood conditions of health and income inequality to those found in cities such as Beijing and Shanghai
Thus, the neighbourhood is a vital scale in which to understand the causes of mental health burden, and to offer possible solutions for prevention and care: “Neighbourhoods are responsible for the conditions in which people are born, grow, live and age; neighbourhoodlevel characteristics may represent both and important driver of mental health problems and and opportunity for prevention.” (Chiavegatto, 2017 p.2)
(ibid).
While studies show that the impact of neighbourhood social relationships are more profound on mental wellbeing, the physical features of the local built environment have been consistently associated with conditions such as depression (Mair et al., 2008). The process of urbanisation in China has been described as an “Urbanisation of Place rather than an Urbanisation of People” (Chen & Chen, 2014. p. 108) and in doing so the deterioration
China has a long history of reliance upon close-knit communities to deliver much of the social and welfare provision at neighbourhood scales. During the Maoist era citizens lives were organised around the socialist work unit, or danwei system, where
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residents were colleagues in local industry and delivered community services to each other within their danwei (Zhu, 2015. p.45). While this system encouraged residents to rely upon each other at a neighbourhood level, some have argued that concepts such as community social capital, neighbourhood attachment and community participation have now a reduced emphasis in contemporary Chinese urbanism (Hazelzet & Wissink, 2012. Forrest & Yip, 2007.)
During the tremendous spatial and social transformations that have occurred following Deng Xiaoping’s reforms the “traditional cohesive social fabric [has given way to] the individualistic pursuit of privacy and anonymity in modern neighbourhoods.� (Zhu, 2015. p.46. ).
This social transition was mirrored in a change of governmental approach, as the state retreated from delivering services through the mechanics of neighbourhood level (communist Psychiatric Hospital, Beijing Credit: Lu-Nan, Magnum Photos
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party) organisations and shifted to top-down and centralised control and management, including for healthcare provision. The result is that Chinese urban citizens are living ever more isolated and independent lives, are unable to access the traditional safety nets that were once available from their local neighbourhood, and that this is a major contributor to the increasing urban mental health burden. The combination of increasingly individualistic lifestyles and a mental healthcare care system which is centralised has lead researchers to conclude that: “Although urban residents have access to superior healthcare facilities and services, our results indicate that they may not be strong enough to offset the adverse health effects of urban environment and lifestyle.� (Chen & Chen,
social and psychological burden on citizens, in proportion to a scarcity to supporting social amenities and space (Wang & Shaw, 2018 p. 579). As the diagram opposite shows, under the current planning mechanism the local government is incentivised to grant planning permission for very high density housing projects. The government derives land lease income from the commercial value of the land, & with reduced quantity of undeveloped land within their municipal borders the demands of developers are often catered to. Residents, many of whom are relocating from the countryside for work, have limited choice & combined with demand for property further exaggerated by investment homes, they are pushed out of the decision making process in the expansion of their neighbourhoods. Furthermore, despite the close proximity of large numbers of people, studies are reporting that social isolation is a problem in these communities (Chen et al, 2008; Yip, 2012) which in turn leads to a detrimental effect on psychological well being.
2014. p. 108).
Architecturally and urbanistically, the effects of a shift from total state control to a private developer lead market for real estate has lead to the creation of super high density neighbourhoods. These are shown to lead to overcrowding, lowering of living standards and an increase in
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Chinese Urban Planning Mechanism
Motives
Constraints Government
Cost savings on outsourcing building of amenities
Cost transfer
Income from land lease
Limited urban land area
High plot area ratio
High urban population increase
Promote efficient use of limited urban land
Developer Cost transfer
Profits from booming urban housing market
Extreme commercial competition
Social needs disconnected from planning process
Residents Resultant urban form
Need to be close to urban employment market & limited ammenities
Limited consultation as stakeholder
Super High Density Urban Neighbourhood
High Resident Turnover
Poor livabilty
Low social cohesion
Resident isolation
Degraded psychological wellbeing
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Limited social & healthcare amenities
the site: beijing A city between the past & the future During the tremendous spatial and social transformations that have occurred in Beijing following Deng Xiaoping’s reforms the “traditional cohesive social fabric [has given way to] the individualistic pursuit of privacy and anonymity in modern neighbourhoods.� (Zhu, 2015. p.46. ). The result is that Chinese urban citizens are living ever more isolated and independent lives, are unable to access the traditional safety nets that were once available from their local neighbourhood, and that this is a major contributor to the increasing urban mental health burden. Site location, Beijing Source: Baidu, 2019
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A: Forbidden City B: Tiananmen Square C: Olympic Park Solid Line: Desheng Subdistrict Dashed: Xicheng District
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A city between the past & the future
I will be basing my investigations at the edge of the central Xicheng District, the oldest of the 23 districts in Beijing, while containing the broadest spectrum of urban typologies in the city. The population of the district is 1.3 Million (Census Office of the State Council, 2012) , over twice that of Copenhagen
that of Copenhagen (United States Census Bureau, 2017; Statistics Denmark, 2018).
This site has been selected for investigation as it crosses the 2nd ring-road boundary which demarks the typological change from traditional hutong neighbourhoods & cultural revolution period Danwei work unit housing to the ultra high density gated community housing schemes which begun dominating the Beijing skyline from the late 1990s.
(Statistics Denmark, 2018).
Xicheng is further subdivided into 15 neighbourhoods, my proposals will focus on the Desheng Subdistrict. This is a neighbourhood which I have developed a understanding of during the last 12 months, and where I developed the design & research project ‘HomeMaking’.
Within this site I will work in detail on three zones of intervention, each developing a response to the unique architectural characteristics found from the complex overlapping of planning history in the city.
Desheng is a 4.14 km 2 neighbourhood, with a residential population of 116,199 and an additional transient population of 25,500 (Census Office of the State Council, 2012) . This gives a population density of upto 35,250/km2 (Ibid.) , higher than that of Manhattan and over 5 times
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Three Neighbourhood Sites within Desheng Subdistrict, Xicheng, Beijing Source: Baidu, 2019
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A journey travelling north through Desheng shows the incredible contrasting typological context which make up its neighbourhoods. Credit: Author, site visit & Baidu, 2019
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typological contexts A city between the past & the future Beijing plays unique role in Chinese urbanism. As the historic seat of government and rule for over 3,000 years, the city ’s fabric retains the legacy from numerous periods of development and social change. Unusually amongst Chinese megacities - Beijing’s population now exceeds 24 Million (OECD, 2017) - large sections of the inner city are still occupied by the ancient traditional Hutong street networks which once dominated Chinese urbanism. As the centre of Mao’s revolution, the city is also still largely planned according to the Danwei work units. Now, in the 21st century Beijing is a hotbed of Chinese capitalism, and superhigh density high-rise apartments are being built to meet the needs of a rapidly urrbanising population.
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Hutong
Tectonic massing of typical hutong Credit: Author
Dating from as early as the 13th Century, hutongs are the street communities formed by the connection of a row of courtyard houses or siheyuan. Before 1949 the number of hutongs in Xicheng district totalled over 800. There are now fewer than 500, as many have been demilished to make way for higher density high rise housing. (Xu & Yang, 2009) Typical Hutong Plan, Beijing Credit: Author
Typological Study Model, 1:500 Credit: Author
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Tectonic massing of typical Danwei building Credit: Author
A danwei, or work unit, constituted a form of social organization in Maoist China. Every citizen was assigned to a unit that would provide for their work, social, and cultural needs. “The Chinese system in the 1950s planned for each enterprise to provide for housing as well as social and cultural facilities of its employees making these units self-sufficient entities. Regardless of their size any enterprise was obliged to supply a full set of facilities including housing, schools, a canteen & local medical care.� (Lue, Rowe & Zhang 2001)
Typical Danwei Plan, Beijing
Typological Credit: Author Study Model, 1:100
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Tectonic massing of typical Megablock Credit: Author
In 1998 government regulations changed, banning employers from directly providing their workers housing, as had been done in the Danwei (Lue, Rowe & Zhang 2001) . This lead to a boom in the private developer lead housing market, and resulted in ever higher densities of accomodation being built to maximise investors and developers profits. While this has allowed for the massive influx of urban population to be accomodated close to the city centre, research shows that these developments have lead to a relative loss of public amenities.
Typical Megablock Plan, Beijing
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In addition, despite the close proximity of a large number of people, a lack of social contact is often reported, resulting in a lack of a sense of community and social cohesion in these developments. 41
the design task A medicine cabinet of interventions I propose to develop the project across a series of design layers to explore the systemic and spatial possibilities for mental healthcare that can be found at the interesection of technology, architecture & community networks.
Urban Community Networks
Technological Innovation
Architectural Spatial Intervention
Architectural Medicaments
National Strategy & Policy
Collage by Author
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The Design Task
The scope of the mental health crisis in China is undoubtedly too large and complex to be addressed comprehensively within one architectural or design project, and it would be naive to make such a proposal here.
between these scales. The primary scale will be that of the human, spatial interaction with a healthcare environment, whether that be within existing streetscapes, interiors or with a new typology or reformulation of ‘the clinic’.
However, it is the aim of this project to embrace a layered approach to design intervention which can offer suggestive proposals across a range of resolutions and scales. The hope that it unfolds into a conversation that explores the opportunities that can be created by imagining a neighbourhood scale approach to psychiatric care and the important role that architectural and urban design can play in this discourse.
As I discovered during my previous project in China, HomeMaking, there is a fascinating and unique resilience to be found within existing neighbourhoods in Beijing, and so I will develop my proposals by carefully considering how a ‘Toolbox of Interventions’ can find their place within or coincidental with existing neighbourhood functions & use patterns, whether that be spatial, temporal or programmatic. I will be interested to develop a response to the social and spatial implications of working within a theme which, while being globally relevant, is highly culturally & spatially specific and resonant.
I intend to develop design proposals on a number of design layers, each taking their own level of resolution, detail and scale, and to show how a system could be developed to mediate
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the object the clinic institution
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The Design Layers digital infrastructure Emerging technologies such as virtual reality holds enormous promise for the diagnosis and treatment of mental health conditions, and enable patients to interact with design and treatment proposals at a virtual 1:1 scale.
The use of mobile technology is already playing a large part in future visions for mental healthcare. The ability of networked applications of patients and healthcare workers to connect remotely has the potential to weave together interventiosn at all other scales
the interior By utilising latent potential for personal inginuity, family and local networks and combined with access to healthcare provision via affordable mobile applications and virtual reality, the home can be enabled to maintain its traditional role as a location of care, whilst benefiting from access to qualified healthcare professionals and treatment networks.
The home has historically been the primary location of healthcare in China. However, in China’s modernising economy, the home is increasingly the location of production as well as consumption.
the clinic As urban development in Beijing advances at a pace, mental healthcare facilities are being increasingly forced to the fringes of the city and are being conglomorated in imposingly scaled hospitals. This results in patients having to travel away from local, family support networks upon which they have traditionally relied.
By utilising advances in treatment, coordination and networking, the project will investigate how can the mental healthcare clinic be reabsorbed into the community fabric, providing local and accessable treatment, while improving wider societal understanding of mental health.
the neighbourhood Despite China’s mental health burden existing at a national scale, the impact of its effects are to be most profoundly felt at a local, neighbourhood register.
Thus, the neighbourhood is a vital scale in which to understand the causes of mental health burden, and to offer possible solutions for prevention and care.
There is a wide body of research in esearch literature that shows a distinctive relationship between patient’s immediate neighbourhood context and the individual’s mental health (Chen & Chen, 2014 p. 102).
In this project I will investigate how interventions at the other design layers can be networked together spatially and technologically to form a cohesive, robust and adaptive treatment environment. 46
Digital infrastructure enables connections through the design layers
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The Design Task
The project will primarily investigate a toolbox of new spaces at the threshold of digital and physical, and how they can be best incorporated into existing and developing urban and social fabric of Beijing, as well as existing healthcare infrastructure. This will work between the scale of the interior and street edge (and objects within it), the building (as a collection of homes & other overlapping functions) and the neighbourhood (as
the municipal and community node in the wider city). The project will further investigate how these spaces can be networked together, functioning as a larger organism, through innovative use of communication technologies. This will enable the project to operate from the scale of the individual patient experience, to the urban network that enables its novel functionality.
the clinic 50 0m 2 10 0 0m 2
the interior 25 - 50m 2 the object 0<10m 2
Proposed scale of interventions 1:1000
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Hutong Neighbourhood Plan, 1:1000
0
49
10m
50m
Toolbox of Neighbourhood Interventions
2
1 4
1.
Digital Infrastructure
2.
Public Awareness
3.
Streetscape Object
4.
Private / Public Interior
5.
Street Edge Space
6.
Urban Clinic & Community Facitity
50
3
6
5
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further research
Planned research & consultants
Peking Institute of Mental Health Credit: Author, site visit
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Planned research & consultants
In the development of this programme, and in the research and production for my previous research study essay “The Great Burden of China” I have been drawing upon the knowledge of a range of experts in the fields of Mental Healthcare and Urban planning in the context of China. This has been a highly valuable resource, and I intend to continue a dialogue with these sources as the project develops towards spatial and strategic proposals.
I have joined the UK based Design in Mental Health Network, a industry organsation which combines expertise from the healthcare , product design, policy and architecture professions and regularly publishes guidance and research documents on design best practices for mental healthcare design and implementation. I will also be returning to Beijing to undertake a detailed study of site and context, and continue my research collaborations with Dr Huang Wang of Beijing’s Capital Normal Univeristy, School of Architecture, who has been invaluable as a local source of insight into the urban, architectural & planning context of Beijing. I am grateful to have established a connection with Dr. Lui, Consultant Psychiatrist at the Peking Institute of Mental Health through my work with Dr Wang. He has enabled me to visit his institute and I look forward to the opportunity to share with him my completed thesis.
From February 2019 I will be working with the think-tank The Centre for Urban Design and Mental Healthcare as a Research Associate. This will allow me to share my ongoing research on a regular basis and seek a wider resource of critique as my designs and strategies develop.
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Journal of Urbanism and Mental Health
Design With People in Mind, architectural research report
Credit: Centre for Urbanism and Mental Health (February 2017)
Credit: Design in Mental Health Network (Feburary 2017)
Centre for Urban Design and Mental Health Director Layla McCay on the importance of neighbourhood to mental wellbeing Credit: Layla McCay, Quartz (September 25 2018)
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planned output
Deliverables Life in Desheng Subdistric Credit: Author, site visit
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Deliverables
The project will focus on the scale of interventions within the neighbourhood, to be connected together through physical, social and digital infrastructure as outlined in the Design Layers, above. The principle scale of investigation will be that of architectural proposal, through developing a spatial and social understanding of contexts outlined in chapters above. Interventions will described at a larger neighbourhood and city scale through a description of possible wider networks, mappings, novel infrastructures and integration with existing systems. I will also explore the potential for a role of a digital layer of design throughout the project scales. This may offer the possibility to create individual patient experiences (for example through use of virtual reality technology) or social & professional networking and knowledge sharing & collaboration platforms.
HomeMaking Streetscape 1:33 (2018) Credit: Author, A. Cantwell & H. Diamond
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Principle Scales 1:5 - 1:100
Supplementary Scales 1:500 / 1:2000
Neighbourhood interventions
Neighbourhood Strategic Plan
(clinic, interior, object &c.)
(network of spaces, digital infrastructure &c.)
Models, images & drawings
Models, drawings, mapping & diagrams
+ digital layer integration
+ digital layer integration
Park Hill Interior, 1:20 (2015) Credit: Author for Mikhail Riches Architects
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UN Sustainable Development Goals
The project will address the following UN Sustainable Development Goals: Good Health and Well-being Goal 3.4 “By 2030, reduce by one third premature mortality from noncommunicable diseases through provention & treatment & promote mental health and wellbeing.” (United Nations, 2015)
Reduced Inequalities Goal 10.2 “By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.” (United Nations, 2015)
Peking Institute of Mental Health Credit: Author, site visit
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coda
Appendix Peking Institute of Mental Health Credit: Author, site visit
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Curriculum Vitae
Architectural Employment 2017 - Present
Sangberg Architects Copenhagen
2016 - 2019
Oâ&#x20AC;&#x2122;Donnell + Tuomey Architects London & Dublin
2014 - 2016
Mikhail Riches Architects London
2013 - 2014
Fraher Architects London
2010 - 2012
Ben Cunliffe Architects Lake District
Education 2017 - Present
Royal Danish Academy of Fine Arts MA Architecture (Urbanism)
2014
Sheffield School of Architecture BA Architecture 1st Class Honours Design 80% Theory 79% Queen Elizabeth School Mathematics, Physics & Philosophy
20 08
A-Levels
Grades A A A
Awards & Exhibitions 2018
Beijing Design Week Exhibited in Danish Cultural Centre Beijing
2018
Royal Academy Summer Exhibition Architectural Model Exhibited London
2018
Travel Scholarship Tsinghua University Beijing
2014
RIBA Yorkshire Gold Medal Most accomplished student portfolio
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Other Experience 2019 - Present
Research Associate The Centre for Urban Design & Mental Health, London.
2018
SantanderX 21st Century Urban Challenge Tsinghua University, Beijing
2017
Cultural and Heritage Committee, London Community Land Trust
2014 - 2015
LOBBY, Architectural Journal Bartlett School of Architecture
2013 - 2014
The Samaritans, Listener Lancaster
2012 - 2013
Architectural Ambassador PLACED Manchester & Liverpool
2011
Tarlungeni Open Space Project Romania
2010 - 2011
Exhibition Assistant Centre for the Urban & Built Environment
20 08
Amnesty International , London National Youth Advisory Committee
20 06 - 20 08
Amnesty International Youth Group President
Software Competencies 5+ years professional experience
ArchiCAD Autocad Sketchup Adobe Photoshop Adobe Illustrator Adobe InDesign Microsoft Office
2+ years professional experience
Revit Vray Adobe AfterEffects Adobe PremierPro Cinema4D
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Blakenham, M. (2007). Maggie’s Centres: Marching on. Maggie Keswick Jencks Cancer Caring Trust, London.
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McCay, L. (2018). In the future, you’ll never have to leave your neighborhood [online] Quartz, The Future of Cities Available at: https://qz.com/1375277/in-the-futureyoull-never-have-to-leave-your-neighborhood/
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[Rear Cover Image] Hutong - Desheng Sub-district, Beijing Credit: Author, site visit
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The Royal Danish Academy of Fine Arts, Schools of Architecture, Design and Conservation
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