An architecture that promotes healing and rehabilitation, throughartandnature.
By Glorivette Correa Núñez ARAD410_FALL2022 Prof.J,Emmanuelli&Prof.L.Díaz
Photo by Almighty Shilref
Edited by Glorivette Correa Núñez
An architecture that promotes healing and rehabilitation, through art and nature.
To everyone who has helped me to be who I am: to my dear parents Gloria and Luis, who have always supported me and have been there, even when I thought about giving up, and when I didn’t even believe in myself; to my brothers Eli and Luis A. and my large family; to my best friend Melanie who has always believed in me; and to my friends and classmates that I have met during these years of studying architecture who have been fundamental in making this process more fun and bearable, during these long years of stressful nights and goals achieved.
I take this opportunity to thank all my teachers and professors who have given me their patience and wisdom. And to my dog Leia, who has been my emotional support and companion since she came into my life during the times of quarantine due to the pandemic.
PHASE1:INVESTIGATION . . . . . . . 6-34
INTRODUCTION . . . . . . . . 8-10
SOCIO-CULTURAL ASPECTS . . . . . . 11-18
ECOLOGICAL ASPECTS . . . . . . . 19-22
ECONOMIC ASPECTS . . . . . . . 23-26
THEORETICAL ASPECTS . . . . . . . 27-30
INTERVIEW SUMMARY . . . . . . . 31
CONCLUSION . . . . . . . . 32
ANTECEDENTS . . . . . . . . 33-34
PHASE2:PRE-DESIGN . . . . . . . . 35-50
PROBLEM . . . . . . . . . 37
LOCATION FOCUS. . . . . . . . 38 POSSIBLE LOCATIONS . . . . . . . 39-40
ARCHITECTURAL PROGRAM . . . . . . 41-48
STAKEHOLDERS . . . . . . . . 49
PHASE3:CONCEPTUALDESIGN . . . . . . 51-58
STRATEGIES & CONCEPT . . . . . . 53-54
PROGRAMMED VOLUMETRY . . . . . . 55
PROPOSALS . . . . . . . . 56-58
PHASE4:SCHEMATICDESIGN . . . . . . 59-90
SCHEMATIC PROPOSALS . . . . . . 61-62
THESIS . . . . . . . . . 63-76
ANTITHESIS . . . . . . . . 77-90
REFERENCES . . . . . . . . . 91-94
(https://www.pexels.com/photo/monochrome-photo-of-woman-sitting-on-floor-3104178/)
Photo by Sam Pineda
Mental health problems are very common throughout the world. It is estimated that millions of people suffer in silence, being their daily lives negatively affected with each passing day. In the past years and even decades, the human being was ashamed to ask for psychological help. Well, going to therapy was considered a “taboo” or that it was something for the “crazy” people. It is now in the 21st century that people hear more about mental health and that is when it begins to take on a certain degree of importance. Currently, the number of people who continue without seeking help continues to be high. This may be due to the lack of information, insecurity, fear of discrimination or the absence of services (WHO, 2022)1 .
The World Health Organization describes mental health as an integral part of our lives and considers that it should be a fundamental human right. Having stable mental health means being better able to relate, function, face difficulties and thrive (WHO, 2022)2. Suffering from a mental disorder results in a state of suffering and emotional pain that could affect not only the well-being of people, but also their biological and immunological functioning (Domínguez, 2013)3.Themostcommondisordersworldwide
thatcancausestatesofvulnerabilityarestress, anxiety and depression.
These disorders are traditionally treated through psychotherapy. According to the Center London 94 psychiatry and psychology office, this psychological treatment is based on the patient-therapist relationship. The objective of this therapy is to help the patient develop the necessary resources to face, assimilate and adapt without difficulties to individual psychosocial circumstances (Sabaté, n.d.)4. It is a therapy where verbal communication is essential to create a bond of trust, with which a therapeutic alliance can be developed.
As psychotherapy is mainly verbal, it becomesadifficultyforpeoplewhofinditdifficult to express themselves in this way, either due to some event, insecurity or a condition. This is why the search for other alternatives arises, which can be applied to people with different mental illnesses or who are going through difficult situations. Many resources are found in the art itself. Which we know from its first findings in caves and tombs (Cosme, 2013)5 , approximately 40,000 years ago according to history. Which shows how this has been an important part of the development of language and has covered the need of the human being
1 OMS, “Informe Mundial Sobre Salud Mental: Transformar La Salud Mental Para Todos”, 2022, https://www.who.int/es/publications/i/ item/9789240050860.
2 OMS, “Informe Mundial Sobre Salud Mental: Transformar...”
3 Domínguez Toscano, Pilar, “Arteterapia En El Tratamiento De La Depresión: Revisión De La Producción Científica .” Essay. In Arteterapia En El Ámbito De La Salud Mental, (2013) 49–84.
4 Sabaté, N. (n. d.) “La Psicoterapia.” Centre Londres 94. Centro Paidopsiquiátrico Del Barcelonas, http://www.centrelondres94.com/documento/ la-psicoterapia.
5 Cosme Ramírez, Mariana, “El Uso Del Arteterapia Como Alternativa Psicoterapéutica En El Área Clínica De La Psicología: Un Estudio De Caso,” (Dissertation, Universidad Nacional Autónoma de México 2013).
Is the human capable enough to accept that he needs help?
to express and communicate, without the need to speak.
In addition, it has been shown how our ancestors attributed therapeutic properties to thepaintingsandfiguresfound(Cosme,2013)6 . Therefore, art since ancient times shows how it can be used as a therapeutic tool. Able to help establishgreatercommunicationfortheunderstanding of emotions and the development of social skills. In the 19th century, art was questioned as a possible alternative to traditional therapy and it was not until the 20th century that the term art therapy emerged.
Art therapy can treat specific problems such as bipolar disorder, eating disorders and schizophrenia. It also helps to manage depression, reduces anxiety and stress, and encourages the development of interpersonal skills (Cosme, 2013)7. These are some of the problems that a large part of people constantly face and even more so in these times. After the confinement, due to the Covid-19 Pandemic, the World Health Organization affirmed an increase in anxiety and stress disorders. Due to the fact of having to communicate and live at a long distance (through a screen), which has disrupted people’s ability to relate to others. Therefore, art therapy could be a way to treat these problems, although “the field is relatively new and innovative, even more so in Puerto Rico.” (Ocasio, n.d.)8
And after the start of the pandemic, the deterioration of mental health systems and services tomeettheneedsofpeoplewasverified(WHO, 2022)9. Thus resulting in the need to invest in new alternatives to help with this problem. Therefore, the purpose of this research is to rescue the idea of art as a healing tool. The objectives being to expand the traditional medicine market, by developing new spaces that focus on providing other treatment alternatives, such as creative-artistic therapies. Also, it seeks to apply architectural aspects that promote healing, as well as the concept of art itself. In addition, the architectural capabilities that can be achieved together with art and nature will be explored, to meet the appropriate conditions in a space to provide these therapies. With these actions, a place of rehabilitation outside the stigmas and models followed by traditional mental treatment centersisachieved.Arttherapyisatoolquiteopen to people, in which it is not necessary to have artistic knowledge or skills. It only requires having the interest to seek help and try other means beyond words to express what we feel.
6 Cosme Ramírez, Mariana, “El Uso Del Arteterapia Como Alternativa Psicoterapéutica En El Área Clínica De La Psicología: Un Estudio De Caso,” (Dissertation, Universidad Nacional Autónoma de México 2013).
7 Cosme Ramírez, Mariana, “El Uso Del Arteterapia Como Alternativa Psicoterapéutica...”
8 Ocasio Figueroa, Maricel. (n. d.) “Sobre Arte Terapia.” Arte Terapia Puerto Rico. https://arteterapiapr.com/sobreat/.
9 OMS, “Informe Mundial Sobre Salud Mental: Transformar La Salud Mental Para Todos”, 2022, https://www.who.int/es/publications/i/ item/9789240050860.
Photo by cottonbro (https://www.pexels.com/photo/photo-of-an-elderly-man-sitting-on-a-bed-8860195/)
“Sometimes all we need is paint and a piece of paper.” - gcorreanunez
Photo by: Nicola Barts
Photo from: Pexels
Edited By: Glorivette Correa
At least 1000 million people suffer or will suffer some type of disease, this translates to 1 in 4 people of the world population, according to data from the World Health Organization (WHO). Data that also show how depression and anxiety increased by 25% during the first year of the pandemic (García, 2013)10 . A figure that takes health professionals by surprise, since people are more open, there has been an increase in the demand for psychological assistance. Now people request help not so much to get cured because they are sick, but to overcome the difficulties that arise in their daily lives (Tovar, 2016)11. Well, they have realized that it is something that they cannot solve on their own and that not having stable mental health affects them not only emotionally but also physically.
The WHO for before 2020 had already warned about the need to expand specific quality mental health care services that meet the needs (WHO, 2021)12. The organization had proposed a plan to increase these services, since the arrival of the pandemic showed that the world is not prepared to meet the needs of psychological assistance. Therefore, the WHO affirms that by 2030 mental health will have become the main health problem in the world and therefore proposes the
10 García Santos, Pablo, “La Crisis De Los 25” El Español, (2022) https:// www.elespanol.com/ciencia/salud/20220805/crisis-alertan-psicologos-vez-jovenes-van-consulta/692180968_0.html.
11 Tovar, Javier, “¿Quién Acude a Las Consultas De Psicología?” EFE Salud, (2016), https://efesalud.com/quien-acude-las-consultas-psicologia/.
12 OMS, “Un Informe De La Oms Pone De Relieve El Déficit...” (2021) https:// www.who.int/es/news/item/08-10-2021-who-report-highlights-globalshortfall-in-investment-in-mental-health.
expansion of its Comprehensive Action Plan on Mental Health. Which proposes research on mental health and its integration into primary health care, so that access to these services is easier. Since there are countries that are not prepared to provide this assistance or need to expand their field. An example of this is Mexico, according to specialists from UNAM (National Autonomous University of Mexico), the percentage of people who receive psychological support when they need it does not exceed 20%. (Gomez, 2016)13. While the Illustrious Official College of Psychology affirms that in Spain there has been a 30% increase in psychology consultations since the beginning of the pandemic (Solano..., 2021)14 when before only 10% of Spaniards were faced with questioning to go to a psychologist (La Razón, 2019)15. While the magazine El País talks about a demonstration that occurred in Spain in 2021, where the right and improvement of mental health services were demanded. Well, during the pandemic, people began to deal directly with loneliness, economic problems, the fragmentationofsocialrelationships,andoverwhelm. During 2020 the number of suicides reached up to eleven daily suicides in Spain and it is estimated that about ten people attempted it. In addition, the magazine places a lot of
13 Gómez Maqueo, Emilia, “En El Mundo, 25 Por Ciento De La Población Ha Sufrido Algún Problema De Salud Mental.” (Boletin UNAM, 2016, https:// www.dgcs.unam.mx/boletin/bdboletin/2016_695.html).
14 Solano, Fátima, Angel, Sara, Maria, and Nicolas, “La Salud Mental De Los Jóvenes Tras La Pandemia.”(2021) https://variacionxxi.com/2021/12/24/ salud-mental-jovenes-pandemia/.
15 La Razón, “¿Acudir a UN PSICÓLOGO?”(2019) https://www.larazon.es/ atusalud/acudir-a-un-psicologo-solo-un-10-de-los-espanoles-se-lo-plantea-OB25244587/.
emphasis on paying attention to the most impoverished or disadvantaged social sectors; since they are more likely to suffer from a mental health problem and also these are the ones with the fewest resources (Errejón, 2021)16 .
Everyone should have access to receive psychological assistance. Stress and anxiety are disorders that anyone can experience, regardless of age, race, or social class; according totheNationalAssociationofClinicalandResidentPsychologiststheserepresentatleast80% of mental health problems (Fundipp, 2021)17 Other circumstances for which a person attends therapy or seeks help are: behavioral disorders, learning problems, difficulty maintaininginterpersonalrelationships,copingwith difficult situations and learning to solve problems. As well as to treat couple, family, work, abuse and violence problems. Like people who seek help to deal with chronic diseases such as: Alzheimer’s, dementia, cancer, bipolarity, schizophrenia and among others. The typical treatment for these diseases is psychotherapy, in which one must have “a voluntary commitment and the desire to establish a therapeutic relationship” where language is the main means of communication (Cosme, 2013)18 .
“Artisnotjustacontemplation,itisalso an act, and all acts change the world, at least a little” - Tony Kusher
After the increase in the need to satisfy psychological assistance, the opportunity arisestogivewaytoothertherapyalternatives, whichevenprovidenon-verbaloptionsforpeople who do not find it easy to establish a communicative and/or expressive link. This makes it difficult to get the help they need to treat or cope with their problems. This alternative could be creative-artistic therapies, which use the arts to treat illnesses. To understand these therapies, one must first understand what art itself is; and according to the Royal Spanish Academy, art is a “manifestation of human activitythroughwhichtherealisinterpretedor the imagined is captured with plastic, linguistic or sound resources”. While the fine arts are a concept used to mention the seven manifestations, which are: architecture, sculpture, music, literature, dance and cinema (El Corte Inglés, 2021)19. This, in clinical terms for therapeutic and rehabilitation processes translates into the following therapies: music therapy, dance therapy, drama therapy and art therapy.
16 Errejón, Iñigo, “La Vida No Debería Doler Tanto a Tantos.” Revista de Prensa, (2021), https://www.almendron.com/tribuna/la-vida-no-deberiadoler-tanto-a-tantos/.
17 FUNDIPP. (2021). “Las Cifras De La Salud Mental En España ANPIR.” Fundación para la investigación en psicoterapia y personalidad, https://fundipp. org/las-cifras-de-la-salud-mental-en-espana/#.
18 Cosme Ramírez, Mariana, “El Uso Del Arteterapia Como Alternativa Psicoterapéutica En El Área Clínica De La Psicología: Un Estudio De Caso,” (Dissertation, Universidad Nacional Autónoma de México 2013).
19 El Corte Inglés, “¿Cuáles Son Las Bellas Artes?” Blog, 2021, https://www. elcorteingles.es/entradas/blog/cuales-son-las-bellas-artes/#:~:text=Desde%20el%20siglo%20XX%2C%20las,manifestaciones%20culturales%20 y%20art%C3%ADsticas%20modernas.
20 Gete Sabater, María, “Terapia Expresiva En Educación Infantil” (Dissertation, Universidad Internacional de La Rioja 2013).
21 Tifatino, Enrica, (2019), “Qué Es La Danzaterapia - Técnicas y Beneficios”, https://www.saludterapia.com/glosario/d/18-danzoterapia.html.
Which are described below:
Therapy through music, which uses rhythm, harmony, intensity and melody; to enhance the possibilities of expression and creativity. 20 .
Therapy through theater, which uses the use of theatrical images and metaphors, based on the interaction between spontaneity-creativity and imitation 20 .
Therapy through plastic arts
Art therapy has different definitions, but these two pioneering associations in the field are the ones that come close to defining this therapy in a more accurate way. The Spanish Professional Association of Art Therapists defines art therapy as:
A healthcare profession that uses artistic creation as a tool to facilitate the expression and resolution of emotions or psychological conflicts. In art therapy the objects resulting from the artistic creation process act as intermediaries in the therapeutic relationship,allowingcertainconflictingfeelings or emotions to find a complementary or alternative way of expression to words (ATe, 2006)22 .
[On the other hand, the British Art Therapy Association defines it as]:
A form of psychotherapy that uses artistic media as the primary mode of communication. This is practiced by art therapists, who work with children, youth, adults and the elderly. It can be used for different diagnoses such as emotional disorders, physical disabilities or neurological situations. Art therapy is not a recreational activity or an art class, although it can be enjoyed. Clients do not need prior experience or expertise in art (BAAT, 1969)23 .
In general, creative-artistic therapies help both children and teenagers as well as adults and the elderly. These therapies treat people with functional diversity, mentally ill, cancer patients, individuals who have suffered abuse, geriatrics, with physical problems and among others (Gete, 2013)24. Creative-artistic therapies themselves treat depression, anxiety and stress disorders. But these also help to develop a good self-esteem, help to improve the expression, acceptance and confrontation of problems and / or diseases. It also helps to improve mood and well-being. That is why they can be applied to all types of population (Cosme, 2013)25 .
Forthepurposesofthisresearch,wewill focus on art therapy, focused on stress, anxiety and depression. Which are defined below:
Stress: It is a physical or mental response to an external cause, be it for example: school, work, some traumatic event or some important change in life. It is a factor that occurs in the short term or suddenly (NIMH, n.d.)26 .
Anxiety: is the body’s reaction to stress or to a situation of uncertainty in the face of a possible threat or event to occur.
22 ATe (Definición de Arteterapia. Asociación Profesional Española de Arteterapeutas, 2006), https://arteterapia.org.es/codigo-etico/#:~:text=2%20 definen%20la%20arteterapia%20como,o%20psicol%C3%B3gicos%20 de%20las%20personas.
23 BAAT (Definición de Arteterapia. Asociación Británica de terapeutas de arte, 1969), https://www.baat.org/About-Art-Therapy.
24 Gete Sabater, María T. (“Terapia Expresiva En Educación Infantil.” Dissertation, Universidad Internacional de La Rioja, 2013).
25 Cosme Ramírez, Mariana, “El Uso Del Arteterapia Como Alternativa Psicoterapéutica En El Área Clínica De La Psicología: Un Estudio De Caso,” (Dissertation, Universidad Nacional Autónoma de México 2013).
26 NIMH. (n.d.). “¿Es Estrés o Ansiedad?” National Institute of Mental Health. U.S. Department of Health and Human Services, https://www.nimh. nih.gov/health/publications/espanol/estoy-tan-estresado#:~:text=El%2 0estr%C3%A9s%20es%20la%20respuesta,suceder%20repetidamente%20durante%20mucho%20tiempo.
Depression: are the symptoms of sadness, lack of interest, demotivation and frustration. Being these symptoms that do not disappear in a short time, affecting daily activities such as sleeping, eating or working (NIMH, n.d.) 27 .
Depression due to physical illnesses: Depression due to critical life stages:
According to Pilar Domínguez, Ph.D. in Fine Arts and Psychology graduate (2013) 28, there are various types of depression, which are classified and have been treated by art therapy, showing its effectiveness in:
Art therapy, despite being a concept that has been studied, has not yet been fully explored and lacks information. There are countries like the United States and England where its effectiveness has already been proven, but in many others the benefits of this therapy must be demonstrated and its use promoted. Well, unlike traditional therapies, this is mainly based on a “Triangular Relationship”, developed by the English psychoanalyst Donald Winnicott (2000)29. This relationship is made up of the art therapist, patient and the presence of the work; This is contrary to traditional therapy that is based solely on verbal communication. Art therapy introduces this new agent, this being the work that is performed by the patient. In addition, art therapy, like traditional therapies, interventions can be carried out in the following way: individual, dual, family and group(Cosme,2013)30.Arttherapyhassomuch to contribute that it can be a tool together with psychotherapy to satisfy the needs for therapeutic services that the world is facing.
27 NIMH. (n.d.). “Depression.” National Institute of Mental Health. U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/ topics/depression.
28 Domínguez Toscano, Pilar, “Arteterapia En El Tratamiento De La Depresión: Revisión De La Producción Científica .” Essay. In Arteterapia En El Ámbito De La Salud Mental, (2013) 49–84.
29 Winnicott, D. (2000). Realidad y juego. Barcelona, España: Gedisa
30 Cosme Ramírez, Mariana, “El Uso Del Arteterapia Como Alternativa Psicoterapéutica En El Área Clínica De La Psicología: Un Estudio De Caso,” (Dissertation, Universidad Nacional Autónoma de México 2013).
Photo of https://www.bkkkids.com/blog/the-rise-in-popularity-for-art-therapy/
“It is estimated that the world population is affected between 10% and 25% of depression,beingalsothemain causeofsuicides”
- Domínguez, 2013.
Photo by:Edu Carvalho
Photo from: Pexels Edited By: Glorivette Correa
Where is the problem located? Is the city, or the lack of natural elements, the cause of this problem?
Recognizing the lack of psychological services and that psychotherapy is identified as the main tool to treat mental health problems, we can determine that this is an urgent problem worldwide. The Health Organization itself (2022)31 establishes that half of the world population lives in countries where there is only one psychiatrist for at least every 200,000 inhabitants. In many places there are no formal mental health services and if they do exist, they are inaccessible. Well, mental health can be affected by an endless number of situations in our environment. Whether it is due to problems in the home itself, the climate, the social environment and even the work environment. Other factors, according to the Puerto Rican mental health company INSPIRA32, are the following:
Aesthetics: messy spaces produce anxiety, while order invokes calm.
Sensory: the lighting, temperature, sounds, smells, and colors of an environment influence people’s moods. An example of this is loud and/or excessive noise which can cause anxiety or agitation.
People: Conflicts or unreliable people can be sources of stress.
31 OMS, “Informe Mundial Sobre Salud Mental: Transformar La Salud Mental Para Todos”, 2022, https://www.who.int/es/publications/i/ item/9789240050860.
32 INSPIRA. (2021) “Cómo Tu Ambiente Afecta Tu Salud Mental.” INSPIRA, https://www.inspirapr.com/post/como-tu-ambiente-afecta-tu-salud-mental.
33 Rodríguez, José A. (2013). “La Salud Mental En Las Ciudades.” https://www.consumer.es/salud/la-salud-mental-en-las-ciudades.html.Consumer,
Culture and values: people are sociable beings, not connecting with other people can manifest in feelings of isolation and depression.
Familiarity: Being in new environments with unfamiliar people can bring up feelings of depression and anxiety.
Especially where you live can significantly affect your mental health. Consumer magazine33 talks about research by Jens Pruessner in which he concludes that “living in a city increases the probability of suffering anxiety, depression and stress disorders by 21%.” This compared to people who live in rural areas, since it is in the cities where there is more population density, car traffic, more noise, fast pace of life, lack of green spaces and more pollution. The World Health Organization34 mentions that currently morethanhalfoftheworld’spopulationlivesin cities. And it is then expected that by the year 2030, at least 60% of the population will live in urban areas. Since living in cities also has its advantages, it is in these where there are more job opportunities and there are more health services; this compared to life in the countryside or slightly more rural areas.
34 OMS, “Informe Mundial Sobre Salud Mental: Transformar...”
Although the simple fact of living in the countryside, surrounded by vegetation does not mean that people do not suffer from these disorders. It is in these areas where higher levels of poverty, limited services, long travel distances and fewer social opportunities can be found; which makes people prone to depression and anxiety. But this is not necessarily a determining factor, since people who live in the countryside or in more isolated areas tend to share the same socioeconomic characteristics, and there is usually greater communication and collaboration between people. This is compared to cities, where there is usually social and labor competition, which increases people’s stress (Grisales, 2018)35. Therefore, the solution to suffer less risk of suffering from a mental problem is not simply to go to live in the country, but that urban conditions should be healthier, there should be more contact with nature.
“...a space can help people heal or make people even sicker.”
Green areas have a beneficial power, the simple fact of seeing vegetation helps to combatcognitivefatigueandstress.Ithasbeen proven that green areas can reduce stress levels by up to 20% (Zamora, 2016)36. Spending time in close proximity to nature can improve
not only the perception of general health and well-being, but also strengthen the immune system. In addition, it increases interaction between people, reduces anxiety and increases self-esteem (Querol, 2022)37. As it has also been proven that nature encourages creativity and makes people less aggressive. However, nature also has its negative effects, because just as it helps to improve the well-being of people, it can also affect them. It is useless to go out for air, if it is contaminated, or to go for a walk through abandoned areas full of garbage. Without a healthy environment, we cannot have stable mental and physical health.
Actually, each space, whether rural or urban, has its own stressors. Although what is clear is that in a certain way cities increase the risk of suffering from a mental problem. Either due to social skills, density, excessive noise or the lack of green areas. It is then that art, together with nature and architecture, become part of the solution to remedy the problem.
“...sometimes all it takes is a momentary change of environment.”
35 Grisales, Paula, “Para Tener Una Mente Sana, ¿Mejor El Campo O La Ciudad?” Revista Pesquisa Javeriana, (2018) https://www.javeriana.edu.co/ pesquisa/para-tener-una-mente-sana-mejor-el-campo-o-la-ciudad/.
36 Zamora, Mey, “Por Qué El Diseño Urbano y La Salud Mental Deben Ir De La Mano.” La Vanguardia, 2016, https://www.lavanguardia.com/vivo/ciudad/20160823/403986990529/ciudad-diseno-urbano-salud-psicologia. html.
37 Querol, Mireia. (2022) “Beneficios De La Naturaleza Para Tu Salud Mental y Física.” Biologueando, https://www.biologueando.com/beneficios-naturaleza-salud/.
“living in a city increases the probability of suffering from anxiety, depression and stress disorders by 21%”. - Jens Pruessner
Photo by Ricardo Ortiz
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Photo by Ricardo Esquivel
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Photo by: Cottonbro
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Edited By: Glorivette Correa
How do mental health problems, along with the lack of psychological services, affect the economy?
Mental health problems affect millions of people. When proper treatment is not received, this could become a mental disorder that not only affects people emotionally, but also affects their normal functioning. Usually it is not given enough attention, the symptoms are overlooked, until they begin to interfere with daily life and even until these problems begin to become a disability. The World Health Organization (2004)38 describes mental health as “a state of well-being in which the individual is aware of his own abilities, can work productively and fruitfully, and is able to make a contribution to his community.” . And that is precisely the consequence of when mental problemsbecomeadisabilityfortheindividual, since the economy, both personally and in general, is affected.
The World Health Organization (2022)39 talks about the economic consequences of mental disorders, since low productivity and indirect costs to society often exceed the costs of general health care. An example, if we talk about the schizophrenia disorder, it is proven that approximately 1 in 200 adults suffer from this disease. In economic terms, this is the most expensive disorder per person. However, despite the fact that depressive and anxiety disorders are less costly per person, they are
38 OMS (2004). Invertir en Salud Mental, Ginebra, Suiza.
39 OMS, “Un Informe De La Oms Pone De Relieve El Déficit...” (2021) https:// www.who.int/es/news/item/08-10-2021-who-report-highlights-globalshortfall-in-investment-in-mental-health.
40 OMS, “Un Informe De La Oms Pone De Relieve El Déficit...”
more frequent, so it largely affects national spending. If we compare this with the WHO figures from 2013, where it was estimated that at least 151 million people in the world suffer from depression and some 26 million people suffer from schizophrenia, we see trulyalarmingfigurescomparedtotheestimates that countries are giving to the mental health system.
Well, mental disorders are expensive and governments to deal with this problem are providing countries with only or less than 2% of the budgets allocated to the health sector. This is why there has been a notorious deterioration of the mental health system, since it lacks information, research, resources and services. Well, a large part of the budget is directed to other diseases and they forget that mental health is also important (WHO, 2022)40. Suffering from these disorders can affect not only the productivity of individuals, but also can unleash physical problems, such as the difficulty of doing daily tasks such as eating, sleeping, getting out of bed and among others. That causes people to become less efficient.
Resources to treat these conditions are insufficient, in “high-income countries, between 35% to 50% of people with severe
mental disorders do not receive adequate treatment.” While in low-income countries up to 85% of people do not have access to any treatment (Sarmiento, 2017)41. Services are not only scarce, but in many countries they are not even covered by health insurance, which makes it even more difficult to receive help. So weseehowthedemandfortreatmentsexceeds the supply of these and how the lack of these services. The time in which people go without receiving help, the disease continues to worsen and this is seen in the impact of the level of functioning of people (Sarmiento, 2017)42
The economic impact is reflected in personal income, the ability of people to work and make contributions to the national economy. Well, people with mental health problems not only have the difficulty of obtaining a job, but also of keeping them. Well, suffering from thesediseases,relapses,poorperformanceand absenteeism, not only affects the person but alsoaffectstheemployer.“IntheUnitedStates, it is estimated that 59% of the economic costs due to loss of productivity are due to mental health problems, even if a person is not absent from work” (WHO, 2004)43. According to the 2022 Global Health Care Outlook report by the financial company Deloitte, between 2011 and 2030, a loss of economic output associated with global mental health is expected of up to 16.3 billion dollars. It is even expected that the
direct and indirect costs of poor mental health exceed 4% of global GDP (gross domestic product), a high figure compared to the combined costs of cancer, diabetes and respiratory diseases (Vera, 2022)44. Health costs are divided in three ways (Palma, 2010)45 :
Direct costs: the cost of personnel, medicines, medical equipment and real estate.
Tangible indirect costs: loss or gain in productivity.
Indirect intangible costs: pain, suffering and uncertainty.
Mental health is essential for human development, this should be recognized as equally important as other diseases, also providing a larger budget to provide the necessary services. Investing in mental health helps social and economic development. This is exactly what the World Health Organization Comprehensive Action Plan for 2030 proposes. Countries start to invest more in this sector, promote these services and deepen the value of mental health. This transformation must be a contribution from not only governments, but this must include health care providers, non-governmental organizations, employers, and society in general. Everyone’s collaboration is needed to provide a favorable environment for transformation.
41 Sarmiento Suárez, M.J. “Salud Mental y desarrollo. Medicina.” 39, 3 (sep. 2017), 246–254 https://www.revistamedicina.net/index.php/Medicina/article/view/118-7
42 Sarmiento Suárez, M.J. “Salud Mental y ...”
43 OMS (2004). Invertir en Salud Mental, Ginebra, Suiza.
44 Vera, J. (2022). “El Impacto De La Salud Mental En La Economía Global” PlantaDoce. https://www.plantadoce.com/entorno/el-impacto-de-la-salud-mental-en-la-economia-global-16300-millones-de-euros-\de-perdidas-entre-2011-y-2030.html.
45 Palma Cortés, Mauricio. (2010). “Economía De La Salud Mental”Review of Punto de vista. El Residente 5, no. 1, 9–13. https://www.medigraphic. com/cgi-bin/new/resumen.cgi?DARTICULO=24105.
Share of population with mental health disorders, 2019: This includes depression, anxiety, bipolar, eating disorders and schizophrenia. Due to the widespread under-diagnosis, these estimates use a combination of sources, including medical and national records, epidemiological data, survey data, and meta regression models.
Chart from https://ourworldindata.org/mental-health
Worldwide mental health is alarming, where more cases have been registered are:
Spain Canada
United States of AmericaThe Caribbean
Australia Among others Latin American countries
Photo by: Tima Miroshnichenko
Photo from: Pexels
Edited By: Glorivette Correa
Architectureispartofthesevenfinearts, soperhapsarchitectureitselfcouldbe,together with art, a healing tool? Being the main concept ofarttherapyatriangularrelationshipbetween the patient, the work and the therapist; the SouthAfricanarchitectManthekiKarabo,inher dissertation: Holistic Therapy: The Antidote: Art and Architecture, likens this relationship to an architect’s thinking when designing a building. Turning this triangular relationship into:
The architect mentions that: “We need to liberate the limits of the rules of the art and explore the therapeuticqualitiesthatcanenhanceall of us. Art, whether in the performing arts (acting, dancing, singing), painting/sculpture, cooking, or even gardening is a form of meditation where thecreatorisintunewiththeircenter.In this sense, art is a spirit that one unconsciously experiences with a sense of healing” (Karabo, 2011)46 .
46 Karabo Mafisa, Mantheki. (“Holistic Therapy: The Antidote: Art and Architecture.” Dissertation, 2011),
47 Karabo Mafisa, Mantheki. (“Holistic Therapy: The Antidote...”)
During her research, she searches for a relationship between the healing qualities of art and architecture as a healing space; the architect Karaba opts for the following key objectives when choosing a place and as concepts for the architectural intervention (Karabo, 2011) 47:
Retrospect space, the space should be comfortable and a reflection of oneself.
The site must be part of the city, but at the same time it must be separated from the most trafficked areas, since these move at a very fast pace, causing a lot of noise.
In the same way, the site must be able to connect with the public transport system, for easy access by people who are looking for a place for healing.
Connection with nature, a physical and visual link with nature has positive beneficial qualities that aid in healing and overall health.
Natural sunlight kills harmful bacteria and cleanses the air. Natural light gives a space a sensual character that gives the space an emotional quality that can be felt by the end user.
Our physical environment affects the way we feel and react. Considering that the spaces and places that appeal to the senses are remembered and become part of the user, the empty and deserted places in the city must be healed and given a target.
While the graduate in Fine Arts, Art Therapist and co-founder of ATE (Spanish Association of Art Therapy) Montse Omenat (2006)48 mentions that in art therapy practice as such, there is no specific space that meets all the appropriate conditions to provide these therapies. However, he affirms that the space should stimulate expressive behaviour, where patients are not afraid of staining the place and in which they can experiment and reflect. Omenat describes a closed space, so that “external attributions do not interfere in the creative process”, so this place must be conditioned with ventilation, have an adequate temperature and have inclusive furniture for all types of patients. The place must also have a materials cleaning area, a reception area, a space for exhibition or drying of works, and a storage area for both materials and works, as well as for clinical records. The studio should have two differentiated areas, one being for work and the other the space to exhibit and discuss the work done (López, 2009)49 .
Art therapy can take place in a variety of settings, such as: art studios, community centers, hospitals, private therapy offices, wellness centers, shelters, and among others(Cherry,2021)50.A(built)exampleofthis is the Emily Cooper Welty Expressive Therapy Center located at Akron Children’s Hospital in Ohio, United States. The hospital uses visual arts and music to transform the clinical environment and create opportunities for children to express themselves and connect. Among the goals of these treatments within the hospital are: reducing the perception of pain, treating anxiety, social stimulation and promoting expression.
Another example (design proposal) is the project that corresponds to an Art Therapy Center,theareachosenforthisprojectislocated in the municipality of Cruz Alta in the state of Rio Grande, Brazil. The center will promote a “therapeutic environment that would use artistic practices as a form of expression and treatment of psychological conflicts.” The author of this project, Alanna Göttens (2021)51, talks about the growing importance of maintaining mental health and how alternative therapeutic centers are increasingly necessary to meet this demand. When choosing a site, Göttens looks for the place to have easy access to the roads that connect to the largest medical centers. At the same time, look for the place to provide
48 Omenat García, M. (2006). Arteterapia: una experiencia de grupos de apoyo a mujeres. Arteterapia. Papeles de arteterapia y educación artística para la inclusión social, 1,137-148.https://revistas.ucm.es/index.php/ARTE/ article/view/ARTE0606110137A
49 López M. (2009). La intervención Arteterapeutica y su Metodología en el contexto profesional Español. Tesis Doctoral. Universidad de Murcia: Departamento de expresión plástica, música y dinámica.
50 Cherry,Kendra.(2021).“HowArtTherapyWorks.”VerywellMind.https:// www.verywellmind.com/what-is-art-therapy-2795755#:~:text=Art%20 Therapy%20Can%20Take%20Place,Art%20studios.
51 Göttens Bigolin, Alanna. (2021) “Centro De Arteterapia.” Prêmio IAB RS, https://premioiabrs.org.br/projetos/centro-de-arteterapia/.
52 Göttens Bigolin, Alanna. (2021) “Centro De Arteterapia...”
privacy, tranquility and should encourage contact with nature and the pure air. The center will function as an alternative therapeutic center, offering private and group sessions. It will also have outdoor areas with free access for visitors and indoor exhibition and rest areas (Göttens, 2021)52 .
The idea of implementing these concepts is to get rid of the traditional stigmas of what healing spaces and hospitals should be like. Well, it has been proven that “a space can help heal or make people even sicker.” I understand that all of the aforementioned are concepts and principles that can be used to solve the problem of generating healing spaces focused on creative or alternative therapies. This being the objective of this research.
Photo of https://www.akronchildrens.org/departments/Expressive-Therapy.html
Photo of https://premioiabrs.org.br/projetos/centro-de-arteterapia/
Emily Cooper Welty Expressive Therapy Center located at Children’s Hospital Akron in Ohio, United States.
For the purposes of this research, 3 interviews were conducted, with an art therapist, a music therapist and a dance therapist; all three studied their specialty at universities in the United States and are currently residing and practicing their professions in Puerto Rico. Ten questions related to mental health in general, mental health in Puerto Rico, and creative-artistic therapies were asked.
Some of these questions were:
What do you think of the mental health system in Puerto Rico?
Do you think that in Puerto Rico it is necessary to promote the use of other therapy alternatives?
Are there spaces in Puerto Rico dedicated to creative-artistic therapies such as art therapy, music therapy or dance therapy?
Some conclusions:
Puerto Rico’s mental health is archaic and traditional compared to the systems of other countries.
In Puerto Rico there are currently very few or no places that have the conditions to provide creative-artistic therapies. And if these therapies are given, they are in the metro area.
There are very few certified therapists in these branches; and it is not studied here in Puerto Rico either. When people decide to study these careers, they move to the United States and usually stay there for the best opportunities.
The spaces to provide these therapies should elude people without much sensory stimulation. They should be a cozy and neutral spaces. They must also have a free floor and inclusive furniture.
UraniaDomínguez Arttherapist AmarillisVázquez Dance&Movement therapist AdrianaLizardi MusictherapistRecognizing the lack of psychological assistance as well as the need for alternative therapies, this research finds art as the main resource to satisfy this problem. This through creative-artistic therapies, which use the arts to treat patients. For this, a therapy center focused mainly on stress, anxiety and depression is proposed. It is intended that this be an inclusive place by treating a diversity of patients from infants to older adults with different conditions and diagnoses.
This proposal seeks to respond to these needs by seeking to create a place where not only these alternative therapies are provided, but also a place that provides tranquility, security and confidence. Where when people enter, they feel the comfort they need to heal and rehabilitate. For this, it is sought that the architecture itself responds accordingly, proposing an architecture that together with art and nature coexist to generate a space of serenity, harmony and that promotes expression. Through its materiality and variety of spaces. To achieve this in the investigation it is concluded to create a Wellness Center specialized in creative-artistic therapies. Where its main function is the four main parts (art, music, dance and drama), but also provides the opportunity to give other alternative therapies such as yoga and meditation.
Following one of the criteria of the architect Karabo, “Healing Dead Spaces” seeks for the placetocollaboratewiththeexistingcommunity,notbeingaplacethatisinhibited,butrather,that seeks to integrate and help the community. Since it is understood that this is where more people can be reached, who can be educated about the importance of maintaining stable mental health, and that it is bad for us to seek help when needed.
This is important to stress not only globally, but also in our own homes, communities, and everyday environments. Psychological services should be within easy reach and must be inclusive. For this reason, this research focuses on Puerto Rico, which, according to what was analyzed, is one of the countries with the highest incidence of mental problems and with serious problems in satisfying the need for psychological services. Well, its mental health system is archaic compared to the systems of other countries, it is traditional and there is a shortage of professionals on the island. For this reason it is determined necessary to propose this type of project on the island, where its need is proven.
The aims of this thesis are to study how art and performing art are used as a traumatic process, and how could architecture help improve these processes. Office workers have been suffering from stress and anxiety for centuries, especially those who work in a big city like Bangkok.
The art and music therapy intervention and architecture should be integrated, providing a space for simply reduce
Phimphakanstress and anxiety for office workers, and specifically healing depressive disorder patients. The architecture aims to provide a place for rehabilitation, different type of expressive arttherapyspaces,andprogramsalongsidemusic therapy programs. An architecture should support three-stage of privacy as depressive disorder treatment space should be the most private space, followed by rehabilitation space for simply reduce stress and public activities of art and music for people in the area.
Photos of https://soad.kmutt.ac.th/work/art-and-music-therapy-center/
The global mental health system is DETERIORATING, so much that a large part of the population suffering from a mental disorder does NOT receive the necessary treatment or any type of help, due to lack of information, insecurity, fear of discrimination or LACK OF SERVICES. While the population served is LIMITED TO A GENERAL TRADITIONAL TREATMENT, which in many cases is not the help they need.
Mental health will have become the main health problem intheworld.
As the COVID-19 pandemic begins anxiety and depression increased to more than 25%.
As the number of suicides increased.
EXPAND the traditional medicine market, by developing new spaces that focus on providing other treatment alternatives, such as creative - artistic therapies.
EXPLORE the architectural capabilities that can be achieved together with ART & NATURE, to meet the appropriate conditions in a space to provide these therapies.
APPLY architectural aspects that promote healing, as well as the very CONCEPT OF ART.
Through the project I seek to create a Wellness Center focused on creative-artistic therapies and where other alternative therapies are also provided. Where the center of attention is art as a means of healing and a tool of expression. I want it to be a place where anyone feels safe to express themselves and trust that there are treatment options. In addition to the fact that it collaborates with the existing community, not being a place that isolates itself, but one that seeks to integrate and help the community.
I will be a place of peace, not only in terms of the environment, but from the architecture itself.
In Puerto Rico the number of people with mental problems continues to rise. Many people don’t have access to these services and there aren’t enough professionals to satisfy the need for psychological consultations.
Registered patients with a mental problem: (According to the Department of Health of Puerto Rico) 57%
43% Male Female 114,521 Patients =
Percentages of patients with a mental health problem registered in the potential locations. (According to the Department of Health of Puerto Rico).
Arecibo: Patients Arecibo Region: Patients
9.9% 15.2%
Humacao: Patients Caguas Region: Patients 3.5%
Ponce: Patients
2.2% 1.5% 10.9%
Ponce Region: Patients
Criteria according to the South African architect Mantheki Karabo: (Holistic Therapy: The Antidote: Art and Architecture)
Connection with the CITY:
Thesitemustbeseparatedfromthemosttraffickedareas,away from noise, but should be able to connect with a public transport system.
Connection with the NATURE:
Physical and visual bond with nature.
Opportunity to impact a community, through the development of empty, abandoned or deserted spaces.
Healing of DEAD SPACES:
Connection to SELF:
It must be a comfortable place that provides privacy and tranquility.
Site aprox. sq. ft. 155,000 Land Classification: SU
Current Status: LevelGround Flood Zone: X Commercial Churches Residential Area
Site aprox. sq. ft. 324,000 Land Classification: SU
Current Status: LevelGround Flood Zone: A
Population: 87,754
Commercial Schools Residential Area
Site aprox. sq. ft. 161,600 Land Classification: SU
Current Status: Abandoned Past use: Commercial Flood Zone: AE(1.5’) Public Transportation System: SITRAS Population: 137,491
SITRAS route Flood Hazard Zone Church Commercial Schools Residential Area
Expressive or creative therapies help all kinds of population, regardless of age, race, social class or disability or condition you suffer from.
Government entities with the capital to invest, and/or promote the use of creative or expressive therapies.
Non-profit entities that help provide psychological help or resources for people.
Private entities with the capital to invest, and/or promote the use of creative or expressive therapies..
2. 1.
Get out of the traditional form. Move away from the surrounding buildings and the street, to create a vegetal buffer to avoid the noise and the fast-paced life, but still being within “the city”.
3. 4.
Open towards the public, inviting people to enter.
Provide private, semi-private, semi-public and public spaces.
Central space where the arts and nature are manifested.
The central space where the arts are manifested is formed or surrounded by the buildings.
The central space where the arts are manifested is embedded in the building, where in a certain way the structure itself directs you to this center.
Thesis Schematic North Elevation
Thesis Schematic West Elevation
Art Therapy Pediatric
Theater Public Galley
Dance & Drama Therapy
Music Therapy Pediatric
Antihesis Schematic North Elevation
Antithesis Schematic West Elevation
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Art is not only a contemplation, it is also an act, and all acts change the world, at least a little.
- Tony Kusher
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