Psychiatric clinic in Podgorica, Montenegro by jovanavuletic

Psychiatric clinic

in Podgorica

University of Maribor Faculty of Civil Engineering, Transportation Engineering and Architecture Jovana VuletiÄ&#x2021;

Psychiatric clinic in Podgorica Master Thesis

Univerza v Mariboru Fakulteta za gradbeništvo prometno inženirstvo in arhitekturo

Psychiatric clinic in Podgorica

študentka: Jovana Vuletić Študijski program: Arhitektura, II stopnja Smer: Trajnostna stavba Mentor: Nande Korpnik univ. dipl. inž. arh Somentor: doc. dr. Branko Gabrovec, mag. ing. log. Lektor: Marija Jojić, Aleksandra Repe

Magistersko delo magisterskega študijskega programa arhitektura Maribor, Januar 2019

Acknowledgements At the very beginning, I would like to thank my mentor, Nande Korpnik dipl. eng. arch professor at the University of Maribor, for his patience, guidance, and knowledge transferred throughout the duration of this masterâ&#x20AC;&#x2122;s project. I am also thankful to my co-mentor, doc. dr. Branko Gabrovec, mag. ing. log. for the precise and straightforward direction provided during the research. I would like to extend my thanks to doc. dr. Dragan Ä&#x152;abarkapa, Director of the Psychiatric Clinic Dobrota in Kotor, Montenegro, for the useful information, and overall contribution to my research. I am deeply thankful to my family and all the important people who accompanied me, and provided understanding and support, or participated in the development of the master project.

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Psychiatric clinic in Podgorica Keywords: psychiatry, arhitecture, psyhiatric hospital, deinstitucionalization, stigmatization, clinic centre Montenegro UDK: 725.1:[614.21:616.89](043.2)

ABSTRACT: The theme of this masterâ&#x20AC;&#x2122;s project is research on the significance and influence of the architecture of psychiatric facilities on the process of treatment of people with mental disorders. The capital of Montenegro, Podgorica, has been struggling with a lack of adequate facilities for its Psychiatric Clinic, which has not had the capacity to hospitalise, or provide treatment and rehabilitation services to mentally ill persons for years. With the aim of gaining an understanding of the best practices that could be transferred to the new Psychiatric Clinic, this paper delves into the historic development of psychiatry, treatment and types of hospitals, as well as the position of patients in the society. The great revolution or milestone in psychiatry, the deinstitutionalisation process, caused the closing-down of many psychiatric clinics around the world. Mental health centres that do not force long-term hospitalisation on patients, but offer a wide range of therapeutic, rehabilitation and recreational activities, started to emerge as an alternative. The main goal of this project is to create a clinic in Podgorica that would use a modern architectural language and concept to break environmental prejudices, while providing patients with all the necessary contents for a pleasant and safe stay. The project aims to create a clinic that would respect the function and dynamics of the site, while maintaining its own irreplaceability and uniqueness within that environment.

Psihiatrična klinika v Podgorici Ključne besede: psihiatrija, arhitektura, psihijatrična bolnica, deinstitucionalizacija, stigmatizacija, klinični center Črne Gore UDK: 725.1:[614.21:616.89](043.2)

POVZETEK: Tema tega magistrskega projekta je raziskovanje pomembnosti in vpliva arhitekture ter psihiatričnih ustanov na tretmaje ljudi s psihiatričnimi boleznimi. Glavno mesto Črne Gore se že vrsto let spopadi s problemom neustreznosti prostorov za zdravljenje in rehabilitacijo psihiatričnih bolezni. Da bi spoznali dobre ideje, ki bi lahko izboljšale psihiatrično bolnišnico, smo raziskali zgodovinski razvoj psihiatrije, tretmajev in tipe bolnišnic ter status pacientov v družbi. Velika revolucija ali temelj v psihiatriji t. i. de-institucionalizacijski proces, ki je vplival na zaprtje mnogih psihiatričnih bolnišnic po vsem svetu. Začeli so se pojavljati duševnozdravstveni centri, ki ne vsiljujejo dolgoročnih hospitalizacij pacientom, ampak širok spekter terapevtskih, rehabilitacijskih in raznih aktivnosti. Glavni cilj tega projekta je ustvariti kliniko v Podgorici, ki bi skozi jezik moderne arhitekture in koncepta spremenila predsodke okolja, hkrati pa zagotavljala pacientom vse potrebne vsebine za prijetno in varno nastanitev. S tem projektom se osredotočamo na objekt, ki bo spoštoval funkcijo in dinamičnost lokacije. V

VII

INTRODUCTION

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1.1 Problem description 1.1 Opredelitev oz. opis dela 1.2 Thesis objectives 1.2 Namen in cilj teze 1.3 Assumptions and restrictions 1.3 Predpostavke in omejitve 1.4 Povzetek v slovenskom jeziku

THE DEVELOPEMENT OF PSYCHIATRY AND ITS INFLUENCE ON MONTENEGRO

SITE AND ARHITECTURE ANALYSIS

HISTORICAL DEVELOPMENT OF TREATMENTS AND HOSPITALS 2.1 Psychiatric treatment in ancient history 2.2 The Middle Ages 2.3 From the renaissance to the end of the 18th century 2.4 The 19th century 2.5 The concept of the mental asylum 2.6 The 20th century 2.7 Deinstitutionalisation 2.8 Social psychiatry

PSYCHIATRIC TREATMENTS AND THE IMPORTANCE OF CLINICS 3.1 Present-day psychiatry and stigmatisation 3.2 Psychology of patient and psychiatric treatment 3.3 Connection and influence of architecture on psychiatry 3.4 Important factors in the design of psychiatric clinics 3.5 Centre de psychiatrie du Nord vaudois 3.6 Southern Oslo psychiatric centre by Hille Melbye architect

4.1 Montenegro 4.2 Development of psychiatric treatment in Europe and its influence on Montenegro 4.3 Montenegro and the Balkans 4.4 Development of psychiatric treatment in the Balkan countries, and their influence on Montenegro 4.5 Bethlem Royal Hospital, London, England 4.6 Psychiatric clinic VrapÄ?e, Zagreb, Croatia 4.7 Special hospital in Dobrota, Kotor, Montenegro

5.1 Podgorica 5.2 Administrative centre of Montenegro 5.3 Blok 5, Podgorica, Montenegro 5.4 Clinical Centre of Montenegro 5.5 Existing psychiatric clinic, Podgorica 4.6 Foto Documentation 4.7 Detailed site analysis

CONCEPT 6.1 Concept 6.2 Construction 6.3 Materials 6.4 Program

PROJECT 6.1 Ortophoto 1:2500 6.2 Site plan 1:1000 6.3 Site plan 1:500 6.4 Concept diagrams 6.5 Floor plans 1:300 6.6 Sections 1:300 6.7 Details 1:30 6.8 Elevations 1:300 6.9 Patient room 1:50

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3D PRESENTATION

IMAGES AND TABLES

lITERATURE AND REFERENCES

VIII

INTRODUCTION

1.1 Problem description 1.1 Opredelitev oz. opis dela 1.2 Thesis objectives 1.2 Namen in cilj teze 1.3 Assumptions and restrictions 1.3 Predpostavke in omejitve 1.4 Povzetek v slovenskom jeziku

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1.1 Problem description

1.2 Thesis objectives

1.3 Assumptions and restrictions

The capital of Montenegro, Podgorica, has been struggling with challenges related to accommodation, treatment and rehabilitation of mentally ill persons for many years. The existing psychiatric clinic is located near the Clinical Centre of Montenegro. The current location of the clinic is not suitable, since it is located within one of the most beautiful parks in Podgorica, Park PetroviÄ&#x2021;, and its shape violates the harmony of the park. The capacity of the clinic is 40 beds, with conditions that are below the required minimum standards set by the European Convention for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), providing no possibility to satisfy the needs and demands of mentally ill persons. Last year, 350 patients were hospitalised, and 11.000 were tested. The building is extremely damaged and old, which contributes to the bad reputation and stigmatisation surrounding the topic of mental illness in the country. Equally, it provides a negative perspective on how little the society cares about patients. The problem of stigmatisation, rejection and disregard by mentally healthy persons can only be improved by raising awareness of the citizens and by improving current conditions. One part of the building has already been severely damaged, which renders the clinic unusable, as it fails to provide adequate conditions for patients. Therefore, a vast number of patients are located in one of the most significant facilities for psychiatric healthcare in Montenegro, the clinic in Dobrota, Kotor, which began operating in 1953. At present, the psychiatric hospital in Kotor has over 100% occupancy rate. Based on these statistics, it is possible to infer that opening a new psychiatric clinic in Podgorica would satisfy all the necessary conditions, in addition to solving the problem of over-occupancy. The new facility would be located within the complex of the Clinical Centre of Montenegro, as a separate entity, but an integral component of the health system.

The main goal is to create a new facility that will enable patients to feel comfortable, safe and unrestrained, with all the necessary contents. The contents of the facility are to be adapted according to the needs of the users, and dimensioned according to the standards and norms defined for this type of facility. The new facility ought to accommodate a sufficient number of patients, with a total capacity of 57 beds. Thus, the workload of the hospital in Kotor will be reduced, and the overall conditions for patients will be improved. Emphasis is placed on creating a pleasant and stimulating environment, intended for this type of patients, with multipurpose green areas. A stimulating outdoor environment is required so that the freshness and positivity of the greenery may induce enhanced recovery and rehabilitation of patients. Group, individual, and occupational therapies, artistic, drama, music and sports activities are also included in the design of the facility. One of the most significant challenges is adaptation of the new object to the existing architectural complex, while creating a new, dynamic, innovative and interesting clinic. By overcoming the said challenge, the new clinic will draw attention and interest through its form and design, and help with de-stigmatisation of mental health institutions.

The location of the planned facility is within an existing complex. The said complex has a high concentration of patients, which is why insulation remains one of the top priorities for this project. This can be achieved by planting greenery, with the aim of reducing noise. It is necessary to provide inhibited movement of patients, as well as a clear and simple approach to the facility. All areas should be accessible to, and adjusted for people with disabilities. It is necessary to integrate a new road with the existing traffic, and form additional parking spaces along the road. All the functions of the clinic should be organised in such a way that the recovery of patients is logical and gradual. Patients must be allowed to move easily, without vague and complex connections, in case of fear and loss of orientation when they find themselves in a new area.

1.1 Opredelitev oz. opis dela:

1.2 Namen in cilj teze

1.3 Predpostavke in omejitve

Glavno mesto Črne Gore, Podgorica, se že vrsto let spopada s problematiko nastanitve, tretmaji in rehabilitacijo mentalno bolnih oseb. Trenutna psihiatrična klinika je locirana v bližini kliničnega centra Črne Gore. Zdajšnja lokacija ni primerna, saj je v enem izmed najlepših podgoriških parkov (Park Petrović). S svojo obliko namreč uničuje samo harmonijo parka. Klinika ima kapaciteto 40 postelj s pogoji, ki so pod minimalnimi zahtevanimi standardi evropskega komiteja, brez možnosti, da bi zadovolljili potrebe ter zahteve mentalno bolnih oseb. Leta 2017 je bilo hospitaliziranih 350 pacientov, testiranih pa je bilo 11.000. Zgradba je zelo poškodovana in stara, kar prispeva k slabemu slovesu in stigmatizaciji mentalnih bolezni v Podgorici. To meče slabo luč na skrb družbe za mentalne bolnike. Problem stigmatizacije, zavrnitve in neupoštevannje psihičnih bolezni oseb lahko popravimo z osveščanjem meščanov in reševanjem problemov trenutnega stanja. Del zgradbe je že porušen, kar onemogoča, da bi klinika ponujala ustrezne pogoje bolnikom. Veliko število pacientov je zato nastanjenih v eni izmed pomembnejših ustanov za psihiatrično zdravljenje, Dobrota v Kotoru, ki je začela obratovati leta 1953. Današnje kapacitete psihiatrične bolnišnice v Kotorju presegajo 100 % svoje zmogljivosti. Na podlagi te statistike bi odprtje nove psihiatrične bolnišnice v Podgorici zadovoljilo vse pogoje kot tudi rešilo trenutno problematiko prezasedenosti. Nov objekt bi bil lociran v kompleksu Kliničnega centra Črne Gore, in sicer kot ločena entiteta, ampak še vedno kot del zdravstvenega sistema.

Glavni cilj je ustvariti nov objekt, v katerem se bodo pacienti počutili udobno, varno in svobodno z vsemi potrebnimi vsebinami. Vsebino objekta se adaptira glede na potrebe uporabnikov in dimenzionirajo po standardih ter normah za to vrsto objekta. Nov objekt mora nastaniti dovolj bolnikov, kar je 57 postelj. Po tej poti bo pritisk nad bolnišnico v Kotorju zmanjšan, ustvarjeni pa bodo tudi boljši pogoji za nastanitve pacientov. Največji poudarek je na ustvarjanju prijetnejšega, stimulativnega okolja, namenjenega za tovrstno obliko pacientov, z multifunkcionalnimi zelenimi površinami. Tovrstno stimulativno okolje je nujno potrebno, saj svežina in zelenje vplivata na hitrejše okrevanje in rehabilitacijo pacientov. Skupinske, individualne, poklicne terapije, likovne delavnice, gledališke igre, glasbene in športne aktivnosti so vključene v sam slog. Eden izmed največjih izzivov je prilagoditi nov objekt že obsotječim arhitekturnim kompleksom in ustvariti novo dinamično, inovativno ter zanimivo kliniko. Na ta način bo nova klinika pritegnila pozornost in zanimanje skozi svojo obliko ter slog ter tako pripomogla k destigmatizaciji psihiatričnih institucij.

Lokacija načrtovanega objetka je znotraj že obstoječega kompleksa, kjer je koncentracija ljudi večja, kar pomeni, da je izolacija prioriteta. To lahko dosežemo s postavitvijo dreves za zmanjšanje hrupa. Pacientom je treba omogočiti enostaven in hiter dostop do objekta. Vsa območja morajo biti dostopna in prilagojena invalidom. Treba je narediti novo cesto in jo povezati z že obstoječo ter ustvariti nova parkirišča. Vse funkcije klinike morajo biti organizirane tako, da je rehabilitacija pacientov logična in postopna. Omogočiti jim je treba lahke povezave, v primeru straha ob izgubi orientacije, ko se znajdejo v novem prostoru.

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1.4 Povzetek v slovenskom jeziku

Razvijanje psihiatrije in psihiatričnih bolnišnic skozi zgodovino

20. stoletje in deinstitualizacijski proces

Vpliv in pomen arhitekture na zdravljenje in tretmaje

Psihiatrija kot znanost, ki se okvarja s študiji mentalnih motenj, je imela skozi zgodovino različne percepcije. Mentalni pacienti so imeli slab družbeni status, ki se kljub revulucionarnim spremembam do danes ni drastično spremenil. Od začetnih predzgodovinskih časov, v katerih so bili mnenja, da so duševne motnje višja sila, so ljudje verjeli, da se tega stanja ne da spremeniti, tako da je bila edina rešitev v izolaciji in zapiranju take vrste ljudi. Psihiatrični bolniki so bili prepuščeni duhovnikom in vračem, ki so kasneje iz njih izganjali demone. V rimskem obdobju je prišla potreba po zaščiti duševno bolanih, ki je trajala do začetka temne dobe. V srednjem veku se je vrnilo staro mnenje, da so bolniki obsedeni z demoni, za katerega pa je bila najbolj odgovorna cerkev. V tem obdobju so bile tako ustanovljene prve bolnišnice kot tudi zavetišča. Najslavnejša psihiatrična bolnišnica je bila ustanovljena leta 1409 v Valenciji, v zgodovinskih knjigah ni omenjena v dobrem kontekstu. Veliko število terapij v tem obdobju je bilo zasnovanih na fizičnih tretmajih. Novo stoletje je bilo zaznamovano z napredki na področju znanosti, ki je močno vplivalo na medicino. Ta čas se imenuje medicinska renesansa. Najbolj izrazit zdravnik tega obdobja Paracelsus je poskušal dokazati, da psihične bolezni niso posledica demonske obsedenosti. Kemični procesi v telesu so posledica psiholoških motenj in se zdravijo z ustreznimi kemičnim kompozicijam. Še vedno obstaja strah in potreba po izolaciji bolnikov, ki so trpinčeni in obravnavani kot podeželjski norci. 18. stoletje je bilo označeno kot čas revulucionarnih sprememb, v bolnišnici Biceter v Parizu so iz pacientov odstranili verige, ki so jih zadrževale, in sicer po zaslugi Philippe Pinela. Želel je, da ljudje razumejo, da bolniki potrebujejo pozornost, vljudnost in humanitarni pristop. Pinel je znan kot začetnik humane psihiatrie. 19. stoletje je znano po veliko dosežkih, čeprav so bili še vedno prisotni fizični tretmaji po bolnišnicah. Ljudje so začeli verjeti, da imajo na psihološke motnje velik vpliv: težko otroštvo, alkoholizem, različne travme, nezdrav življenski slog. Začela so se odpirati zavetišča ob jezerih, na pobočjih gora ki so bila podobna počitniškim domovom, cilj je bil, da bi pacienti in zdravniki živeli skupaj. Znanost je težila k temu, da so pacienti konstantno ločeni od zunanjega sveta, misleč da potrebujejo mir in tišino. Težili so k izgradnji pavilijonskega tipa zgradb psihiatričnih bolnišnic.

Iščejo se nove metode psihokirurgije, elektrošok terapije in psihofarmakologije. Verjame se, da bi se duševne motnje morale obravnavati kot fizične bolezni, biokemična neravnovesja v telesu. Vse terapije so imele negativen efekt na paciente, zato so se sredi 20. stoletja začele raziskave na področju psihofarmakologije in zdravila, ki je bilo predstavljeno, litij. Po predstavitvi litija so se pojavila tudi druga zdravila ki so oblažila simpotme različnih psihičnih bolezni. Psihoterapija je bila v veliki meri zlorabljena v komunizmu, fašizmu in nacizmu, tako da se je v 70-ih letih 20. stoletja ustanovilo antipsihotično gibanje. Po 2. svetovni vojni se je pričel proces deinstutalizacije, ustanovljen s strani italijanskega psihoterapevta Franca Basaglia. Glavni cilj je odpraviti povezavo med psihoterapijo in velikimi institucijami. Ena izmed osnovnih političnih idej je, da psihiatrične bolnišnice kot inštitucije ne bi več obstajale ter da bi vsi ljudje, ki se borijo s psihičnimi motnjami, živeli v komuni. Morala bi biti dobro organizirana skozi zdravstvene centre. Deinstitucionalizacija ni rušenje zidov, ampak sprememba v strukturi moči, da bi lahko slišali trpljenje druge osebe. Socialna psihiatrija je del psihiatrije, ki se je začela razvijati kot zadnja, vendar je imela največji vpliv na bolj human odnos do duševnih bolezni. Temelji na razumevanju, da so duševne motnje sprejemljive in da se pri njihovem zdravljenju uporabljajo socialnoterapevtski ukrepi.

Vpliv arhitekture na ljudi je zelo pomemben, in sicer tudi v psihiatriji. Ker duševno bolni ljudje različno dojemajo in razumejo prostor, je zelo pomembno raziskati in ustvariti institucijo, v kateri se bo bolnik počutili varno in udobno. Največji problem danes je slika psihiatrije iz 17. in 18. stoletja. Gradnja psihiatrije velja za zapor brez upanja za napredovanje. Treba je upoštevati vtis, ki ga daje psihiatrična bolnišnica in kako to vpliva na okolje. Pomembno je ustvariti predmet, ki bo zadovoljeval potrebe pacienta in ki bo s svojo strukturo, prostorom in dodatno vsebino ustvaril vtis prijetnega in udobnega prostora. Treba je ustvariti most med institucijo in preostalim okoljem, mostom med svetoma. Različne študije so opredelile prostore, ki pozitivno vplivajo na duševne bolnike. Prisotnost zelenih površin in vrtov lahko izboljša sposobnost ljudi za delo, vpliva tudi na zmanjšanje stresa, ki potencialno izboljša zdravstvene rezultate. Občutek varnosti in zasebnosti v bolnišnicah je zelo pomemben. Treba je zaščititi bolnika in mu zagotoviti upanje za okrevanje. Obstaja več nasvetov za oblikovanje psihiatričnih bolnišnic. Zdi se, da je vsak od njih na svoj način zelo razumen. Treba je razumeti, kaj je pomembno, kaj je primerno za okolje, paciente in kateri prostori bodo imeli največji učinek. Najpomembnejše je oblikovanje prostorov, jasnih in očitnih poti, da bolniki ali obiskovalci ne poiščejo pomoči. Z zaprtimi azili se psihiatrične bolnišnice bolj prilegajo mestnemu svetu.

Razvoj in vpliv psihiatričnih klinik na Črno Goro

Podgorica in analiza lokacije

Koncept

Vprašanja duševnega zdravja so imela pomemben gospodarski in družbeni vpliv po vsej Evropi, saj je vsaj 25 % ljudi doživljalo duševne motnje skozi vse življenje. Večina držav v Evropi ima politiko na področju duševnega zdravja, strategije in načrte za razvoj storitev duševnega zdravja v skupnosti in vključevanje duševnega zdravja v primarno oskrbo. Jasno je, da obstajajo velike razlike v politikah med državami, mnoge so v zadnjih letih doživeli znaten napredek, drugi pa si prizadevajo za izboljšanje. Države zahodne Evrope se obračajo na človekove pravice, socialno vključenost in zdravljenje bolnikov zunaj duševnih institucij. V državah vzhodne Evrope in zlasti v državah z nizkimi in srednjimi dohodki (južna Evropa) je dostop do zdravstvene oskrbe v skupnosti pogosto omejen. Velike ustanove za duševno zdravje so še vedno osnova sistema, skupnostne službe pa so pogosto omejene na klinike ali storitve, ki so povezane s psihiatričnimi stanovanji. Proces deinstitucionalizacije se je v različnih delih razlikoval, večina jih je imela dobro načrtovane procese, v katerih so bile stranke v posebnih ustanovah. Večina držav se ni mogla izogniti katastrofi, izjemno visoki stopnji umrljivosti in povečanju števila sodno medicinskih postelj. Vojno obdobje 20. in v začetku 21. stoletja je imelo velik vpliv na duševno zdravje večine južnih držav. Psihiatrične ustanove na Balkanu ob koncu 20. stoletja so še vedno imele oznako nasilnih institucij. V tem obdobju je bilo mnenje, da psihiatrične bolnišnice niso pomagale in že sama omemba te institucije je pozročila strah tudi pri duševno zdravih ljudeh. V teh časi je vladal režim 18. in 19. stoletja v skoraj vseh balkanskih državah. Velik vpliv na nadaljnji razvoj in napredek psihiatrije je imela predvsem Italija, sledila ji je preostala Evropa z deinstitucionalizacijskim procesom. Treba je spremeniti družbo iz korena, pa tudi razmerja moči med oblastmi in bolniki. Večina balkanskih držav ima dolgo zgodovino psihiatričnih klinik, zato je danes mogoče z gotovostjo trditi, da je napredek v veliki meri občuten. Psihiatrična bolnišnica Dobrota v Črni Gori, Kotor, je bila odprta leta 1953. V teh letih je velik vpliv prišel iz sosednjih držav. Kot v bližnjih bolnišnicah tudi zaposleni v Kotorju poskušajo uvesti nove reforme. Gre za izobraževanje, seminarje, spoznavanje novih režimov po zahodni Evropi. Bolnišnica je tipično sredozemskega stila. Tip paviljona, s 6 ločenimi stavbami, v katerih je 9 oddelkov.

Podgorica je glavno mesto, upravno, gospodarsko in univerzitetno središče Črne Gore. Najpomembnejša zdravstvena ustanova države, Klinični center Črne Gore kot terciarna zdravstvena ustanova, se nahaja v Podgorici, ki poleg tega zagotavlja sekundarne storitve za prebivalce Podgorice, Danilovgrada in Kolašina. Že vrsto let pospešuje in uvaja nove tehnologije v diagnostiki in zdravljenju. Leta 1974 je bila uradno odprta impozantna zgradba Kliničnega centra Črne Gore. Stavba izžareva postmodernistični slog, kjer uporaba betona daje vtis trdnosti in stabilnosti. Zavrne se homogenost in enotnost, kar je značilno za predmete po 2. svetovni vojni. Razbijanje strogih, brezosebnih oblik predmetov je pritegnilo pozornost in občudovanje mnogih opazovalcev. Obstoječa Psihiatrična klinika v Podgorici se nahaja nedaleč od kompleksa kliničnega centra, znotraj parka Petrovic. Stavba je izjemno draga in stara. Zaradi svojega obstoja povzroča strah in sramoto tako duševno motenih kot tudi duševno zdravih ljudi. En del stavbe je že uničen in ni možnosti za sanacijo. Ključni problem je pomanjkanje ležišč (trenutno 20) znotraj klinike, kar ne zagotavlja možnosti za bivanje vsem ljudem, ki potrebujejo pomoč. Velika pozornost je namenjena izgradnji nove klinike, ki bi bila del kompleksa kliničnega centra. V skladu z značajem je predmet zasnovan kot ločena celota, ki bi se na nek način prilegala in ustvarjala celoto z ostalimi zdravstvenimi ustanovami. Nova klinika mora spoštovati obstoječe okolje in prostorsko rešitev.

V skladu s projektno nalogo pristojnega Kliničnega centra Črne Gore je predvideno, da obstajajo 3 ločene funkcionalne enote: stacionarna, dnevna bolnišnica in ambulanta. V zvezi z raziskavami predhodnih hospitalizacij in pregledov v novi ambulanti je 57 postelj. Poleg tega je treba zagotoviti prostor za večnamenske sobe in različne skupinske, individualne ter glasbene terapije. Z različnimi analizami in raziskavami je bila ideja o postavitvi objekta vzdolž vertikale najboljša možnost. S postavitvijo bolnikov iz tal na vrh, odvisno od stanja, v katerem so, je bolnikom omogočila postopno prilagajanje bolnišnici. V tem primeru se atriji pojavljajo kot strešne terase, s čimer se doseže dinamika objekta in prepletanje zunanjega in notranjega prostora. Oblika predmeta je zasnovana tako, da sledi dolgi strani objekta, kar omogoča več prostega prostora okoli samega objekta. Okoli stavbe je priložnost za varovalni pas s postavitvijo zelenja, ki bo pacientom dajalo občutek zasebnosti, miru in tišine. Glavni vhod klinike je obrnjen proti Kliničnemu centru Črne Gore s poudarjenim in jasnim pristopom k rešilcu. S potegom kocke in ustvarjanjem strešnih teras se ustvari ena vrsta pregrade med odseki, ki fizično ne smejo biti v dolgem stiku. Na ta način je bil cilj vsakemu oddelku zagotoviti določen prostor, ki bi služil kot terasa in ki bo imel poseben namen. Celotna zgradba je oblikovana tako, da z zanimanjem izpodbija svojo obliko in jo v vsakem trenutku prilagodi potrebam uporabnikov.

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2.1 Psychiatric treatment in ancient history

2.1 Exorcism or expeling evil spirits (painting by Francis Borgia, S.J.)

2.2 Trepanning skulls (from the painting Cutting the Stone by Hieronymus Bosch)

Psychiatry, a branch of science that deals with the study of mental disorders, treatment and rehabilitation of people with mental disabilities, has been interpreted through numerous different perspectives throughout history. People with mental illness have had an unfavourable social status since the beginning of civilisation, which hasn't changed significantly, despite revolutionary changes that marked our history. At present, the most prevailing mistake is to look at mental illness as an incomprehensible phenomenon, a view usually based on ignorance or primitive beliefs. Fear and the tendency to close off and isolate people with mental disorders from the rest of society exist to this day. [1] A large body of evidence has emerged since prehistoric times, when primitive tribes viewed mental illness as a force of the higher power. It was not possible to affect mental illness for the better, which is why isolation of patients is associated with this period. Mental patients at that time were left to priests and doctors who would ruthlessly expel evil spirits from them. Even at the beginning of the Old Ages, mental disorders that were considered mystical were treated by priests, which lasted until the ancient times, which were a turning point in the treatment of social disorders. In the meantime, several theories were developed, all of which were trying to properly define mental disorders. Hippocrates considered that the cause of the disease was the imbalance of the four fluids in the body "humor". There were various ways to bring the so-called humor to a state of normality. Despite the fact that the methods used to achieve normality were terrifying, most of his theories were accepted at a later stage. In Egypt, a mental disorder was thought to be caused by a loss of reputation, or by poverty. Even in such cases, there was an apparent tendency towards a mild and humane approach; patients would stay in illuminated rooms, and be exposed to music and work therapy. The focus was on exposure to daily activities that normal people performed. In the Roman law, mental patients did not have legal free will, so the ill patient could not be held responsible for a criminal offense. Protection of mental patients emerged in this period. However, it did not last long. [2]

2.2 Middle Ages The Middle Ages, often called the dark ages, were characterised by the return of perspective that patients were possessed by evil ghosts. Knowledge from Greek, Roman, and Arabic medicine became neglected. Medicine was lagging behind in those years. Mental disorders were viewed through a prism of mystical interpretation. Due to the great influence of the church, mental patients were viewed as persons possessed by demons. They were labelled as vampires, and the therapy was reduced to throwing them into dark dungeons, where they were restrained with chains. In spite of the poor historical developments that marked the Middle Ages, the first hospitals for mental illnesses and asylums were built precisely at that time. Mental patients were stigmatised in most countries of the world. The stigma would frequently extend to the patientâ&#x20AC;&#x2122;s family as well. Consequently, they would be abused, separated from the society, imprisoned, and connected with criminals.[1] The Arabs built the first psychiatric hospital in 875. The first European psychiatric hospital was founded in 1409 in Valencia. However, this institution was not an example of adequate patient treatment. Mental patients did not have the right treatment nor comfort. In fact, they were forced to live in inhumane conditions, suffering cruel forms of abuse. In this period, mental disorders were perceived as a matter of choice. Most therapies were based on physical treatment. Immersing patients in extremely cold or hot water so that the shock would return their mind to normal was a common form of treatment. The heating chair was used to cause vibration of the body and blood of a person so that the balance of the well-known humor could be restored. Mental patients were often imprisoned with various criminals and homeless people in dark basements. Near London, a psychiatric hospital was established in 1247, called St Mary of Bethlehem Hospital. On occasion, mental patients were placed in monasteries, along with the poor and the infirm. They were locked in dark rooms without light and heat. Miraculous cures were also common in this period. For example, in the 13th century, a small Flemish town of Gheel, Belgium, became known for the work of Saint Dimfna, who became the saint patron of mental patients. The Middle Ages was a fatal period for mental patients. The only light spot was doctor Avicenna, who recommended psychotherapy through singing and conversation, as well as work therapy.[3]

2.3 Cage

2.4 Hydrothepary, Pilgrim State Hospital, Brentwood, NY, 1938

2.5 The Tranquilizing Chair Of Benjamin Canvas Print by Everett

2.3 From the renaissance to the end of the 18th century The new century was marked by the development of both science and medicine, although the development of psychiatry was still lagging behind. However, the number of doctors who dealt with mental disorders was increasing. This period, which started circa the 16th century, is often referred to as medical renaissance, as a result of the progress of science and advanced medicine. The most prominent doctor of the time was Paracelsus, who wrote the first document on mental illness. He proved that mental illness was not a consequences of demonic forces, and accordingly treated them with chemicals. He investigated hysteria and epilepsy, and made a new classification of mental illnesses. Johann Weyer, a German doctor, argued that witches and attacked persons were mentally ill patients who required humane treatment. He is considered the founder of modern psychiatry. In the 17th century, no major shifts in the understanding of mental illness were recorded. In this period, protestant countries started to devote great attention to mental disorders. [3][2]

Until the second half of the 18th century, mentally disturbed people were still subject to corporal punishment, especially in rural areas. People with schizophrenia were considered to be rural fools. At that time, asylums were institutions that took care of mental patients. Significant changes occurred in Paris in 1972. The most famous psychiatrist at the time, Philippe Pinel, from the Bicetre psychiatric hospital in Paris took off chains from mental patients. It can be argued that this initiated a revolution within psychiatry. Pinel developed the hypothesis that mental patients needed attention and courtesy. He strived for the hospitals to be clean, the rooms of the patients to be well-lit, and he also advocated for recreation inside the hospital. Removing chains spread not only to other European countries, but to other continents as well. This removal of chains contributed to positive changes among the patients as well. This is why Philippe Pinel is considered the founder of the humanist psychiatric revolution. [2]

2.6 Hospital de Bicetre, near Paris

2.4 The 19th century The beginning of the 19th century was marked by the beginning of a new era in psychiatry, especially in France. Various achievements took place in this period. Even at the end of the 18th century, mental patients were separated from criminals, and specialised hospitals were built in Prague in 1783 and Vienna in 1784. However, methods similar to those applied in the Middle Ages were still being used in these institutions. A while later, psychiatry started to develop independently in these countries, with the construction of psychiatric hospitals. It was believed that poor education, miserable life, alcoholism, trauma and various other factors had a great effect on psychological disorders. In addition to psychotherapy, therapists paid great attention to work therapy. All cruel methods were left aside. [5] The main feature of psychiatry in the 19th century is the division of psychiatrists into somaticians and psychologists. The somatist approach was based on chemistry, anatomy, and functional brain organisation, so it was evident that they advocated the view that a psychiatric disorder was a type of damage of certain parts of the brain. A psychologist advocates the psychosocial dimension of psychiatric disorders and emphasises the psychosocial model of understanding of the disease. Mental illness was still considered a consequence of sin. Faith in God and a religious lifestyle were prescribed as therapy. Psychotherapy was based on moral restoration. At the end of 19th century, psychiatrists agreed that mental illness was caused by various factors.

The removal of chains by Philippe Pinel brought positive changes and notable improvements. An English doctor, John Conolly, abolished all compulsive and mechanical means used for containing patients. The belief advocated by the Egyptians was echoed by Bénédict Augustin Morel, a French psychiatrist, who thought that external factors, primarily poverty, resulted in organic changes in the brain. He argued that mental disorders differed in severity, rather than cause. [1] At the beginning of the 19th century, numerous asylums were established. Severely mentally ill persons were accommodated in various types of asylums, while neurosis, hysteria and mild depression were treated by family doctors. Private asylums were located on mountain slopes, alongside lakes, resembling holiday houses. Mental patients were usually sent to large institutions outside the community. The main goal of such institutions was preservation and isolation of mentally ill persons with two to three doctors without a nurse. There were often only guards who maintained order. Such circumstances affected the departure of the family and the decline in number of patients returning home following treatment. As psychiatry developed, the open-door system started to gain grounds in hospitals, and became focused on the free movement of patients and their employment. Specialised institutions for certain categories of psychiatric patients - those suffering from epilepsy, addiction and mental retardation - started to emerge. The pavilion type of building psychiatry hospitals was typical for that period. [2][5]

2.5 The concept of the mental asylum Conceptually, construction of mental asylums relied on two tendencies: isolation that had a therapeutic nature, separation of patients from the community, and moral treatment that allowed the patient to use their own influence to control the disturbed mind. Doctors and patients were meant to co-inhabit asylums. They sought to permanently separate the patient from the outside world, believing that they needed peace and isolation for further recovery. [2][5] The institutions were comprised of two separate departments for men and women. Both departments were isolated from the administrative building. Each department included two blocks of three arranged apartments. The squares were “U” shaped and faced the yard. These blocks enabled separation not only by gender, but by social status. Patient classification was subject to estimation of the severity of disturbance of patients. Consequently, there were silent, semi-disturbed and disturbed patients that included epileptics. Private patients were always located in the south, and this unit was somewhat more expensive than others. Such units had private gardens, which provided isolation from other patients suffering more severe disorders. Large-scale structures of this type enhanced the physical separation of healthy and mentally ill people. [4]

ward

dining rooms

kitchen library

court-yard court-yard

ward

public

administration

2.7 Cheshire lunatic asylum, Cheste, England

2.8 The state lunatic asylum, Utica, New York

2.9 Block plan of the Royal Herbert Hospital

2.6 The 20th century

The development of psychiatry in the 20th century continued under the influence of Sigmund Freud and his psychoanalysis. This phase is known as the second psychiatric revolution. It was based on a method that implied patients writing down their dreams, which was used as material for research. The focus was on what was happening in the mind of the patient during sleep, and to what extent those phenomena affected their mental health. Only from the brain springs our pleasures, our feelings of happiness, laughter and jokes, our pain, our sorrows and tears. This same organ makes us mad or confused, inspires us with fear and anxiety. Hippocrates, The Holy Disease [5] The doors opened with new methods of psychosurgery, electroshock therapy and psychopharmacology. Mental health problems were perceived as physical illness, a biochemical imbalance in the body that psychosurgery (lobotomy - brain surgery) could heal, or mitigate the symptoms. The process reduced the nerve that regulates behaviour and emotions. The idea of lobotomy was to induce a feeling of calm in patients who were uncontrollably hysterical or emotional, especially in conditions such as schizophrenia, depression and bipolar disorder. However, there were increasingly negative effects of lobotomy. The patients did not have control over their behaviour and organs, and suffered numerous other side-effects, such as frequent vomiting, the occurrence of apathy and hunger. Electroshock therapy was considered promising as experiments in Italy proved to be extremely successful in treating patients with schizophrenia. However, it was quickly abandoned because patients were involuntary to take part in the procedure on their own accord. Psychopharmacology grew in importance in 1949, when a new drug was introduced, lithium. Lithium did not cure patients, but it was the best suppressor of symptoms available at the time. Additional pharmaceutical products that caused reduction of symptoms for various mental disorders followed the discovery of lithium. The third psychiatric revolution relates to the discovery of psychopharmacs, and is therefore called psychopharmacological. Psychopharmacs are defined as agents that have an effect on the psychological functions and perception of the diseased.[7]

Psychotherapy has been abused to a great extent in history, especially under communism, Nazism and fascism. People who did not share the view of the ruling government would often be forced into psychiatric hospitals, and a large number of people were killed with the justification that they were mentally ill and did not serve the country. There is evidence that over 300 000 people with mental illness were killed under the Nazi Germany regime. For the first time in history, gas chambers were introduced in German hospitals, and the majority of psychiatrists belonged to the national socialist party. It was precisely for these reasons that the antipsychotic movement was established in the late 60s and early 70s of the 20th century. Western intellectuals accepted theoretical considerations, but there was no significant impact on psychiatric practice itself. [1] Former popular asylums lost their prestige, primarily due to geographical distance. Moral asylum treatment was focused on activating patients: they were not closed or hidden; rather, they were involved in maintaining the facility. Doctors would encourage patients to participate in manual work, intellectual conversation, thereby preparing them for reintegration into the society. However, certain critics found these methods ineffective, as they made patients dependent on medical staff. Another approach to treatment advocated at the time was therapy outside of institutions. Attention was paid to psychiatry in the community, which was mostly caused by the psychopharmacological revolution. Patients were being released from institutions, and received treatment within the context of their social environment. However, untreated patients who would commit offenses were placed under forensic psychiatric treatment after judicial procedures. Following the closure of Franco Basigliaâ&#x20AC;&#x2122;s psychiatric institution in Trieste in 1971, a network of institutions for mental health that took care of the mentally ill was opened. In addition, in 1973, the Society for Democratic Psychiatry was founded, which contributed to the change of laws, closure of psychiatric institutions, and treatment outside institutions. However, there were certain negative aspects of these reforms, one of them being that patient care was only focused on the most urgent interventions. A large number of chronic patients were left in the streets, as most of them had no family to refer to. [8][10]

2.10 Treatment lobotomy

2.11 Electroshock therapy

2.12 Psychopharmacology

2.13 Advantages of group therapy

2.14 Sociotherapy - Group therapy (Personal, based on external source)

2.7 Deinstitutionalisation

2.8 Social psychiatry

The deinstitutionalisation movement began after World War II. The movement aimed to abolish the strong link between psychiatric treatment and major institutions. Its goal was to enable treatment within the social community, rather than in isolation. Psychopharmacology and a large number of different types of antidepressants were introduced on the market, which had a strong influence on the development of this movement. One of the basic political ideas was that psychiatric hospitals, as institutions, should no longer exist, but that all people, whatever their suffering or mental illness, should live inside the community. Their integration had to be well organised, which was to be achieved through mental health centres. The creator of the concept and the term antipsychiatry is the psychiatrist David Cooper, a South African who lived and worked in London. In summary, his view was that we all faced some kind of trauma or pain, and some of us ended up seeking or receiving psychiatric help, while others did not. In cooperation with Ronald David Laing, he opened up therapeutic communities, in which people lived through their emotional states, and expressed things that they did not have a chance to share before. Prior to the closure of psychiatric institutions, Dr. Franco Basaglia and his team had to push for a law that would change the understanding of what it meant to be a mental patient, what it meant to suffer a mental illness, and what it meant to pose a threat to oneself and others. The law passed in 1978 changed the definition of threat to oneself and others, which implied that people went through various emotional phases. While some of these phases may induce behaviours that are potentially threatening for oneself or others, they are not more dangerous than the various types of abusive behaviour encountered on a daily basis among mentally healthy individuals. One study showed that the institution of psychiatry was, in reality, not there to meet the needs of people it served, but rather to meet the needs of the institution itself. [8][10] Deinstitutionalisation did not imply demolition of walls but a change in the balance of power, in order to provide the ability to hear the suffering of another person. The key to the movement is that the process was not reduced to the fact that all the patients were to be immediately put in the streets; rather, it implied understanding the kind of support they needed [9]

Social psychiatry emerged in the middle of the 20th century, and it rested on the foundations comprised of various psychological approaches. At present, social psychiatry involves various models and disciplines. It is a branch of psychology that, in its widest sense, deals with sociocultural processes and mental illnesses. It is based on the understanding that mental disorders are acceptable and sociotherapeutic measures should be applied in their treatment. The focus is on early treatment, rehabilitation of persons who suffer emotional disturbance, behavioural disorders, or in general exhibit forms of social deviation. The social approach formed part of other schools of thought throughout history: Hippocrates included group exercises, work and music in therapeutic procedures, and Plato advocated that family ought to take care and participate in the treatment of mental patients. If we are to argue that psychiatry today is more than a medical specialty, this is especially true for social psychiatry. A mental disorder can be understood as a "communication disorder" that arises in interpersonal relationships.[11] [12] At the onset of the development of social psychiatry, and the initiation of the deinstitutionalisation process, the "goals of treating people with major mental illness" were set, with a strong focus on enabling normal behaviour of patients in the community. In order to achieve this goal, it was necessary to keep the patient away from the weakening consequences of institutionalisation as much as possible. If the patient needed hospitalisation, they were to be sent back home and to their community as soon as possible, and kept in that environment for as long as possible. Social psychiatry as a branch of a psychiatry was among the latest developments in the field, but it has had the greatest impact on the development of a humane attitude towards the mentally ill. The breadth and variety of procedures within the framework of social psychiatry are the most significant aspects of the approach, and the results can best be seen in the reduction of the number of hospitalised patients, the improvement of the quality of their lives, the de-stigmatisation of mental illness, and the reorganisation of the psychiatric service (primarily deinstitutionalisation). [12]

PSYCHIATRIC TREATMENTS AND THE IMPORTANCE OF CLINICS

3.1 Present-day psychiatry and stigmatisation 3.2 Psychology of patient and psychiatric treatment 3.3 Connection and influence of architecture on psychiatry 3.4 Important factors in the design of psychiatric clinics 3.5 Centre de psychiatrie du Nord vaudois 3.6 Southern Oslo psychiatric centre by Hille Melbye architect

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3.1 Present-day psychiatry and stigmatisation Mental health problems are present in all cultures regardless of the age and physical health of individuals. According to studies, one-fifth of mankind faces mental disruptions that significantly affect their social and working function. Psychiatry as a medical science that deals with the study, rehabilitation and treatment of mentally ill persons has progressed to a great extent throughout history. However, the attitude towards the patient is currently not being discussed, which causes fear in people and negative attitudes. The attitude, behaviour and acceptance of the mentally ill persons on behalf of the social environment is crucial. A mental disorder can be viewed as a lifelong process. At present, there is strong advocacy of the view that mental health is exactly our ability to accept our own weaknesses and limitations and to deal with them. The most prevalent problem in the context of mental illness has been the presence of stigma - the negative labelling of mentally disturbed people. The cause is precisely a combination of fear and ignorance, as well as the belief that mental illness cannot be cured. Stigmatisation implies labelling of persons who are different from "normal" people, which results in a lack of acceptance or exclusion from the society. Stigmatisation present in schizophrenic and similar disorders is much stronger than in people suffering from depression and anxiety disorders. Stigmatisation is a problem that needs to be solved in order to eliminate the negative impact on the treatment and the quality of life of the diseased. Education plays a major role in this context, i.e. provision of accurate information versus unsubstantial beliefs or myths based on which prejudice is generated. The belief that problem solving depends on one's own strength and that people with mental disorders are characterised by weakness, is based on stigmatisation and lack of understanding of mental disorders. The consequences of stigmatisation do not always have to be negative. For example, stigmatisation of minorities can raise self-esteem. If a person experiences labelling as an injustice, that may cause anger that turns into a motive to fight for oneâ&#x20AC;&#x2122;s rights.

Mental health can be defined as the result of a dynamic nteraction between biological, psychological, socio-economic, socio-cultural and institutional factors. Mental disorders are driven by several factors, such as genetic disposition, the mentality and the social environment. National and international studies have shown that every other person will, at some point in their life, meet the criteria associated with a certain mental disorder.[9] People who experience sudden changes and loss in life face a high risk of mental disorder. Major changes in life such as schooling, adolescence, job search, divorce, retirement, professional failure or violence can greatly affect the development of mental problems. Youth in their early 20s (20 to 25) face the highest risk of mental illness. There are different opinions about why there are more people who suffer from mental disorders now than ever before. One such opinion advocates that a faster lifestyle and greater exposure to stress are among the main drivers of mental disorders, which is why the concept of mental health is more revered than ever before.

The society has greatly influenced the attitude towards mentally disturbed people. New medical sciences developed and invested in research and treatment methods. At present, each psychiatric clinic has its own approaches and methods of dealing with patients. In some of them, the patient is the most important guest, while others are trying to ignore the patient. Different relationships and positions actually make sense because patients need different levels of care at various stages of the illness. Compulsory hospitalisation and treatment in closed departments is a very important factor. Forced hospitalisation is still present in society. If one in five patients is hospitalised against their will, 20 people will feel frightened and insecure as a result. Evidently, stigmatisation is ever-growing and affects everyone, including mentally ill people who may feel reluctant to seek due to external environmental pressures. That is why there are late interventions, when people have already reached the acute phase. It is very important to improve the image of psychiatry in the population in order to reduce stigmatisation, which can be done through architecture [13] physical health disability

Biological

genetic vulnerabilities drug effects

temperament

Mental Health

peers

Social

family relationships

trauma family circumstances

IQ self - esteem

Psychological coping skills

3.1 Influence of factors in the development of mental disorders

3.2 Psychology of patient and psychiatric treatment Staying in a psychiatric hospital, despite the great development and progress in psychiatry, is not an easy experience neither for the person suffering from a mental disorder, nor for the family of that person. A patient separated from his or her surroundings, family and friends, loses the various roles he or she held in the society. The patient needs to be strong in character and ready to accept that he or she is dealing with a problem of a psychiatric nature. In fact, this is one of the most difficult steps in the process. The patient needs to accept the inevitable loss of privacy, as a result of being under daily supervision of doctors, social workers, or friends and family. Furthermore, the patient must understand that in the coming period he or she will be surrounded by people with similar problems, who are going to be dissatisfied, broken, depressed and angry. The label of a mentally ill person is long-lasting, and the patient is exposed to a great deal of social pressure, which is the reason why most people give up on treatment. A large number of patients lose contact with the reality, emotions and thinking. They start to feel that they are not the ones who are disturbed, but their environment. [4][9]

Different forms of psychoses have been in existence since the dawn of man. A person loses a realistic view of oneself and the environment, and starts to change the way of thinking, feeling and behaving. The family and people around this person notice the change, but the patient often does not. The ill person is convinced of their wellbeing, while suspecting changes in the environment and other people. Psychoses are mostly divided into two groups: accompanying or organic, and endogenous or functional. Accompanying psychoses occur as an expression of an organic disorder. They disappear if the main disease or disorder is removed, under the condition that the disease is remediable. Schizophrenia is a typical functional psychosis. In this case, withdrawal of patients, as well as disturbance of emotions and thoughts is quite characteristic. It is followed by hallucination and fear. Another functional psychosis is manic-depression (or bi-polar disorder), mostly typified by changes in the patient’s emotional behaviour. Excessive cheerfulness, for no reason, very sad states of mind, melancholy, feeling of absurdity, and feeling of guilt are all indicators of a bipolar disorder. [9][13]

Organic, including symptomatic, mental disorders

acute crisis

Mental and behavioural disorders due to use of psychoactive substances

stationary acute hospital

Schizophrenia and delusional disorders

Mood / affective disorders (depression)

Neurotic, stress-related and somatoform disorders

F5 F6

Behavioural syndromes associated with physiological disturbances and physical factors Disorders of personality and behaviour in adult persons

day-care center

Mental retardation

sheltered workeshop

Disorders of psychological development

Behavioural and emotional disorders with onset usually occurring in childhood and adolescence In addition, a group of «unspecifi ed mental disorders«.

Other 0

stationary clinic intermediate structure

100 (%)

3.2 Diagnosis by type of institution

rehabilitation

reintegration

prevention

stationary tehabilitation hospital day-care hospital

stationary clinic intermediate structure

therapeutic club ambulatory long-term structures

ambulatory

long-term structure

3.3 Coverage by type of treatment facility

Rehabilitation of a psychiatric patient is a comprehensive and complex process that strives for a healthy life despite the symptoms of the disease. Rehabilitation consists of various therapies, among which the most important is psychiatric pharmacotherapy, psychotherapy and sociotherapy. The therapeutic program is specifically composed for each patient, depending on the type and phase of mental illnesses. The greatest issue for doctors is to determine which treatment methods should be enabled. Sociotherapeutic approaches are different, but they all have a common goal: improving the patient’s functioning and strengthening his or her social adaptability. The final goal of sociotherapy and overall rehabilitation is re-socialisation and reintegration of mentally ill persons in the community. Therapeutic procedures primarily aim at supporting patients in the acute phase in order to reduce and mitigate the symptoms. Sociotherapeutic procedures aim to utilise psychiatric treatment to prepare the patient for the environment. Steps in psychiatric rehabilitation include setting diagnosis, training in problem solving skills, pharmacotherapy, and community and family support. The diagnosis helps the psychiatrist to provide an objective prognosis of the disease, and to estimate how much support is needed to reduce the damage caused to the patient. Over the past 20 years, there has been enormous progress in treatment and prevention owing to the use of antipsychotics, anti-depressants, and mood stabilisers. It is important to explain to the patient that the medicines are not omnipotent and often serve to mitigate the symptoms and prevent the progress of the disease, under the condition that they are taken regularly. Employing people with mental illness increases cognitive capacity, because working requires concentration, memory, and decision making. Moreover, work provides money that ensures the existence and satisfaction in everyday life. Work positively influences mental health and recovery from mental illness. Unemployment leads to social exclusion. Most people who are cured of a mental illness are trying to work so as to achieve their goals and desires. [4]

3.3 Connection and influence of architecture on psychiatry The influence of architecture on people is of great importance, which is considered a significant factor in the field of psychiatry. A mentally disturbed person experiences and understands space in a unique way, different from a mentally healthy person. An important factor is how space influences perception, thinking, security, and confusion of mentally ill persons. The main problem that psychiatry faces is stigmatisation of mental patients, and on the basis of this, the question arises as to whether architecture can reduce prejudice and stigma surrounding the issue of mental illness. The most significant problem with perception is the image of psychiatric clinics carved into the minds of individuals, which dates back to the 17th and 18th century. Underdeveloped countries and countries with extremely low investments in the field of psychiatry face those issues to a great extent. However, as psychiatry developed, the architecture of health facilities developed as well, with the main goal to fulfil the requirements and wishes of patients, and provide them with facilities and activities that will contribute to the healing process. Most people can not imagine life inside a psychiatric clinic, and conditions and activities are based on rumours. The building of psychiatric hospitals is seen as a prison, without hope for further advancement, as a psychiatric treatment apparatus. Architecture is just there to break the prejudices based on the past and to influence a warmer and more acceptable attitude towards these institutions. [6] There is a tendency for such institutions not to be built in remote places, isolated from society, but at the very centre, which constitutes an important step in reducing stigma. Such a step does imply certain risks, including condemnation and judgement of patients by the community. It is necessary to create a sense of community in the clinic, similar to the atmosphere in hotels or homes. Removing the feeling of imprisonment, and exercising precisely planned and strict treatment with expressed authority by doctors and staff is crucial. Contact with nature and society should be obligatory. The accent is on socialisation, which depends on to what extent each patient feels the need for it. [7][4]

It is necessary to consider the first impression given by a psychiatric hospital and how it affects the environment. Architecture has progressed to the extent that it has a strong influence over people, which may be leveraged in suppressing the feeling of agitation, danger and trouble. A hospital is primarily a facility whose structure, space and additional content serve the needs of the patient, and give the impression of a safe, pleasant, comfortable place to all those who need it. For years, architecture has been trying to create a bridge between this institution and the rest of the society, the bridge between the two worlds. In order to counter stigmatisation, hospitals are now referred to as "Intervention Centres", and "Psychiatric Care". The tendency was primarily to treat the patient as a person, because throughout history, patients were treated like prisoners, and were passive, full of suffering. Modern psychology wants to provide patients with a sense of usefulness and belonging. As already mentioned, the hospital aims to enable interaction between patients and staff, greater consideration, joint activities and socialising. The structure of the hospital, the space it offers, can contribute to supressing prejudices, where the encounter between the patient and the population appears natural and without compulsion. It is possible to achieve the delivery of activities and services that are intended not only for patients but also for the public. [7][14]

3.4 Psychiatric clinic once (simple arhitecture) (personal source)

Bearing in mind the motto "what cures the sick is good for the healthy", it is important to point out that the factors that ought to be considered in the construction of psychiatric hospitals are very similar to the factors considered in housing. Thus, numerous studies have shown that exposure to high level of daylight can significantly alleviate pain and depression. Engagement by doctors, staff and family plays the primary role. A view of nature is also of crucial importance, as it can lead to a reduction in the level of stress in a short time. The level of stress is also clearly reduced when good sleep and low noise are provided. This is achieved by single rooms, which are more comfortable for patients.

3.4 Psychiatric clinic maybe today (dinamic arhitecture) (personal source)

3.4 Important factors in the design of psychiatric clinics

Patientsâ&#x20AC;&#x2122; rooms must be as exposed to natural light as possible, in order to create a warm atmosphere, in which the patient does not feel trapped. The same principle applies to single and double rooms. Emphasis is placed on the analysis of the window and their impact on the patient. The first example shows a standard window without additional precautions, grids. A new type of window, presented as the third example, allows patients to view the environment with a small barrier, a parapet that serves as comfortable support for sitting. It provides contact with the environment without the feeling of being trapped.

Various pieces of research showed important results in the context of what is needed in the hospital and how to enrich the space with various forms of positive influence on mentally ill persons. The presence of greenery and gardens can improve people's ability to work, while contributing to stress reduction, and to overall wellbeing. Greenery, sunlight and fresh air are considered essential components of wellbeing and health in the 20th century. Psychiatric hospitals are usually built in urban settlements, with a view of balconies, terraces, cars and parking lots. The emphasis is on providing green areas where physical, horticultural and other therapies can take place. [7] Mentally ill people, especially those who suffer from depression, often hide from the environment, seek their own peace and private space. Therefore, it is necessary to bring them into contact with people. When designing psychiatric hospitals, care must be taken of circulation and meeting points, which are exactly the corridors. Corridors must not be narrow and long, nor should they be deprived of daylight, and serve the sole purpose of directing patients to move from point A to point B; rather, they should be used as a place of informal encounters, constant interaction and communication. The sense of security in the hospital is extremely important. Patients arriving in an unknown place face moments of crisis and fear, which is why they frequently need a lot of time to get used to the new space, and to feel safe. It is important that the areas in which the patient spends the most time, rooms, dining rooms, and lounge areas follow the principles of harmony and proportion, with calm colours and natural materials. The most important thing is to protect the patients from themselves and provide them with hope for recovery.

Each hospital must decide what takes precedence while considering the aforementioned questions. The issue of privacy of a person living in a hospital has been explored for a long time. The most adequate solution is single or, preferably, double rooms, which have the option of closing the door as desired, and offer some common space. It is also necessary to provide facilities for private conversations and family meetings. Although there is an impressive volume of criticism regarding patient dependency on staff, work has been invested in training staff members to encourage independence among patients, thereby preparing them for reintegration into society as useful members of the community. Such results are accomplished through various work activities, depending on the type of needs the patient exhibits: music rooms, different types of music, socialising with other patients, access to kitchen elements where patients can prepare meals, etc. It creates a sense of competence in the patient when they can utilise space and work without additional help of excessive supervision. There is a number of useful tips for designing psychiatric hospitals. Each one seems to be highly reasonable in its own way. It is necessary to understand what is important in a particular case case, what is appropriate for the environment, the patients, and which spaces may have the greatest effect. Among the most important factors to be considered is the design of real spaces, which are lacking. At present, space utilised in architecture is endangered by intentions. There is an unrealistic atmosphere in hospitals. The reason for that is precisely the architectsâ&#x20AC;&#x2122; intention to design a building that has a soothing and relaxing effect, which in the end becomes strange and unnatural.

3.8 Analysis of the corridor (personal source)

3.9 Natural environment (personal source)

3.10 Green roof - garden (personal source)

The hallways should become places of communication and interaction. The level of light should also be primary in this case, as the hallway would not give the impression of a narrow space. Additional facilities, living and dining rooms can be open-type in order to enable easy access to patients.

Many questions remained unanswered. Most clinics, depending on the type of mental illness, respond to them in different ways. How to enable interaction with the environment, or just experience of the environment when windows cannot be left open? [14][7]

At present, a great deal of attention is paid to the concept of the building, with clear paths, so that patients and visitors do not need to seek help. Buildings no longer have circular and complicated communications, so patients can adapt to the new environment, and manage their affairs with relative ease. [14]

3.6 Types of room patient (Personal, based on external source) [4]

3.7 Types of windows (Personal, based on external source) [4]

3.5 Centre de psychiatrie du Nord vaudois

room for therapeutic purpose

Architects: / Location: Yverdon-les-Bains, Switzerland

The psychiatric clinic in Yverdon is intentionally placed near the city centre, in order to help with suppression of stigmatisation and prejudice. The concept of the building also indicates that the environment is an important component of patientâ&#x20AC;&#x2122;s therapy: the strong red concrete with small openings expresses a protective character of the building, and its unusual location shows that people with mental illnesses should not be excluded from the society. The H shaped clinic is designed as a freestanding building with access from three sides, and with four entrance points: the main entrance, emergency entrances reachable from the road, the ambulatory access and the delivery access. Since these types of institutions require privacy for their users, the main entrance is separated from passers-by with a green area, which creates a slow transition from the city to the clinic and vice versa. The central administration block with two floors connects two other wings with three floors. Four stationary units with the capacity of 56 beds are located on the second and third floor, each with twelve patient rooms that are grouped into units of four. [4]

3.13 Centre de psychiatrie duofNord vaudios Analysis the corridor

office

horizontal circulation

ground floor

toilets

1st floor

vertical circulation

3.12 Terrace in the Centre de psychiatrie duofNord vaudios Analysis the corridor common space

restaurant

patient room

2nd floor

3rd floor

3.11 Floor plan (Personal, based on external source)

3.14 Centre de psychiatrie duofNord vaudios Analysis the corridor

The green areas are an important part of the building concept, and it is an element that the clinic offers. Even the second floor has roof terraces as a form of a protected outdoor space. This space is designed for patients who are not able to leave the building unsupervised, such as people suffering from dementia, or patients in an immediate crisis. Access to roof greenery is also beneficial for patients who are independent, but whose unit is not directly linked to the terrace.

3.15 Centre de psychiatrie duofNord vaudios Analysis the corridor

3.6 Southern Oslo psychiatric centre Architects: Hille Melbye architects Location: Oslo, Norway

ground floor room for therapeutic purpose

staff

vertical circulation

toilets

common space

patient room

tehnical rooms

office

1st floor

3.16 Southern Oslo psychiatric centre (the inner courtyard)

3.18 Southern Oslo psychiatric centre

3.17 Floor plan

The most important task for the Hille Melbye architects was to design a safe environment for the patients, with a pleasant design and inviting outdoor areas, which was achieved by a decorative brick centre, tucked in a beautiful landscaped courtyard. The choice of the site plays an important role in designing the complex: by choosing the site close to residential areas and transportation, the psychiatric centre becomes a part of the of the community. Architects wanted to reduce the environmental impact by creating a scheme with a large open atrium. The complex consists of two departments for patient accommodation and treatment that are surrounded by greenery, with the goal to reduce the impression of a rigid institution. Courtyards are used to divide accommodation into three blocks with 10 bedrooms, each with a common area and a kitchen. This allows patients to choose whether they want to socialise or to enjoy privacy in a room with large openings, which creates dialog between the indoors and the outdoors. [15]

3.19 Southern Oslo psychiatric centre

THE DEVELOPEMENT OF PSYCHIATRY AND ITS INFLUENCE ON MONTENEGRO 4.1 Montenegro 4.2 Development of psychiatric treatment in Europe and its influence on Montenegro 4.3 Montenegro and the Balkans 4.4 Development of psychiatric treatment in the Balkan countries, and their influence on Montenegro 4.5 Bethlem Royal Hospital, London, England 4.6 Psychiatric clinic VrapÄ?e, Zagreb, Croatia 4.7 Special hospital in Dobrota, Kotor, Montenegro

2 24

4.1 Montenegero Montenegro is one of the smallest countries in Southeast Europe. Geographically, the country lies in the southernmost area of the Dinaric Alps, with a coastline in the south-eastern part of the Adriatic sea. According to the 2003 census, Montenegro has about 620,000 inhabitants. The territory of Montenegro is, approximately, shaped like a square, with its corners in the north, south, west and east. The total area is only 13.812 km2, divided into 23 municipalities. The country borders with Croatia, Bosnia and Herzegovina, Serbia, Kosovo, Albania and the Adriatic Sea. Montenegro is located between the latitudes of 41° and 44° N, and longitudes of 18° and 21° E. The southernmost point of Montenegro is the spot where the river Bojana flows into the Adriatic Sea, while the northernmost point of Montenegro is on the banks of the mountain Kovač, at the border with Bosnia and Herzegovina. The capital and the most populated city is Podgorica, inhabited by a third of the country’s population, while Cetinje is designated as the historical capital city of Montenegro. Both cities are important destinations for numerous school excursions - Podgorica as the capital city, and Cetinje due to its historical value ("city museum"). In the vicinity of Podgorica, there are ruins of the ancient Roman settlement Duklja, and above Cetinje, on top of the Lovćen mountain, sits the mausoleum and tomb of the Montenegrin ruler and poet Peter II Petrović Njegoš. The climatic conditions in this country are mostly affected by its position in the moderate geographical region of the northern hemisphere, the vicinity of the warm Adriatic Sea, the high mountain barrier near the coastline, the basin-lowlands and higher regions in the immediate hinterland of the coast, and a distinctly mountainous relief mixed with valleys, canyons and basins in the north and northeast. The effects of all these elements determine the climate regionalisation of Montenegro. The southern region is typified by a Mediterranean climate with hot summers and mild, rainy winters. In the close hinterland, the climate is sub-Mediterranean, with a stronger continental effect, which is mostly reflected in lower temperatures. The northern and north-eastern regions are strongly influenced by the high relief, and feature continental and mountain climates. It is characterised by smaller amounts of precipitation and a modified precipitation regime. [16] 4.1 Montenegro’s position in Europe ( personal source)

4.2 Development of psychiatric treatment in Europe and its influence on Montenegro Before the 19th century, throughout the European continent, the difference between asylums and madhouses, known as primitive mental health facilities, was quite small. Improvements only became visible mid-19th century. Following the deinstitutionalisation process, most of the countries already had a well-planned programme for accommodating patients, rather than letting them stay in the streets. The problem arose in countries that lacked alternative services and facilities. The mortality rate was on the rise, along with the rate of suicide. Significant plans and reforms in the early 20th century resulted in mental health becoming a priority, which lately had an impact on the development and strengthening of mental health services. Most countries in Europe set up strategies and plans for the development of mental health in the community, with the aim of defining mental health as a priority for citizens. Significant differences between countries remains the most evident problem. Notable progress has been made in many countries over the past few years, while others are still striving for it. In accordance with economic differences, the division is mainly between Western Europe and the rest, Eastern and Southern Europe. In Western European countries, the number of community-based services has been on the rise, alongside improvements in the context of human rights, and the social environment, which is crucial in treating patients outside mental institutions. In Eastern European countries, especially in countries with lower or middle income (Southeast Europe), access to community health care has been limited. While in some countries, the number of fixed beds has declined due to improvement made in the field of mental care in the community (Great Britain and Italy), in others (Albania and Turkey) the small number of beds is a result of a lack of funding and provision of mental health services as a whole. Countries such as Belgium, France, Germany and the Netherlands have both a large number of hospital beds and community services. However, most European countries still have about 2/3 hospital beds in mental hospitals. [17]

In order to reduce the gap inside Europe, the focus should be on the development of community-based services in low-and middle-income countries, along with maintenance and improvement of services in high-income countries. Such an example is Montenegro, which has undergone improvements in the sector of mental health, mainly indirectly, as a result of the influence of Western Europe. Through various seminars, action plans and visits, Montenegro aims at implementing the Western model of organisation of the mental service. The accent is on shorter hospitalisation, decreasing the number of patient beds, and improving the life of the patient in the community. 180 160 140 120 100 80 60 40 20 0

4.4 Share of population with mental health and substance use disorders, 1990 (Personal, based on external source)

4.2 Hospital beds - psychiatric care bads, 2015, 100 000 inhabitants

Despite the extensive changes, the problem of stigmatisation, discrimination and prejudice prevails. People still retreat and are reluctant to seek out help. Analyses have shown that depression is among the most critical present-day problems. Depression Specific phobias Somatofrom disorders Alcohol dependence Sleep apnoea Social phobia Generakisted anxiety disorder Agoraphobia Panic disorder Post-traumatic stress disroder Dementias Psyhotic disorders Attention-deficit hiperactivity disorder Bipolar disorder Obsessive-compulsive disorder Drug dependence Eating disorders

4.3 Number of Europeans affected mental disorders, 2010 (Personal, based on external source)

12.5 %

15%

17.5 %

20%

4.5 Share of population with mental health and substance use disorders, 2006 (Personal, based on external source)

4.3 Montenegro and the Balkans Montenegro has regained its sovereignty in 2006, and it is one of the youngest countries in Europe. However, it is simultaneously one of the oldest countries in the world, since it was recognised as the 27th independent country in the world during the Berlin congress in 1878. Montenegro has a diverse population as well. Montenegrins make up the largest share in the population, about 45%, while Serbs, Bosniaks, Albanians, Muslims and Croats form the rest of the country’s population. Montenegro is also a multi-religious country. The majority of citizens have declared themselves as orthodox Christians, and are immediately followed by Muslims and Catholics. Montenegro is home to a diverse landscape due to its position on the Balkan peninsula, and exposure to the Adriatic Sea. The highest mountain peak is Bobotov Kuk, located in the Durmitor range, 2.522 m above sea level. About 60% of the country is more than 1.000 m above sea level. Most of the rivers are characterised by narrow valleys that transform into steep canyons in certain areas. The Tara River Canyon, 78 km long and 1.300 m deep, is the deepest canyon in Europe. There are many important areas in Montenegro that have a special protection status. Lovćen, Durmitor, Biogradska gora and Skadar Lake have been declared national parks, the Tara River is included in the list of International Reserves of Biosphere, Kotor is listed on UNESCO’s World Cultural Heritage List, and Skadar Lake, as a rare marshy habitat, is recorded in the Ramsar List. It should be noted that Montenegro was declared an ecological state in 1991, thereby adding obligations, and placing even greater emphasis on the protection of natural values. The tourism and hotel industry are the main engine of Montenegro’s economy. Together with the catering industry, they make for 30% of the total social product of Montenegro, right behind industry and mining (35%), but more significant than traffic (15%) and agriculture and forestry (10%). The abundance of diverse natural beauty and architectural and cultural heritage is a great potential for tourism development. However, these potentials remain underutilised, especially in the continental part of the country. [16]

SLOVENIA CROATIA

BOSNA IN HERCEGOVINA SERBIA

MONTENEGRO

BULGARIA

MACEDONIA

ALBANIA

4.6 Montenegro’s position in Balkans (personal source)

Slovenia Croatia BIH Montenegro

7 hospital 8 hospital 8 hospital 1 hospital

21.7% Other

3.7% Albania Macedonia Bulgaria Serbia

4.4%

1 hospital 4 hospital 10 hospital 4 hospital

Neurological ry irato tal Resp kele

s culo Mus seases di

Injuries

The wartime during the 20th and early 21st century had a significant impact on the mental health of people in several countries in Southeast Europe. Adults exposed to war in the Balkans that still live in the same countries are struggling with various mental disorders. A few years after the end of the war, the number of people suffering from mental disorders was significant, with little difference between the Balkan countries. War experiences have caused anxiety, mood disorders and depression, which had tremendous consequences for people's lives. Traumatic experiences have contributed to unemployment, lower standards in the education system and abuse of substances. Most Balkan countries, except Greece and parts of former Yugoslavia, have been separated from progress of the free, democratic world Psychiatric institutions in the Balkans, at the end of the 20th century, wore the label of violent institutions. There was a division between patients, outdated methods were still in use, alongside straight jackets, bindings, electroshocks, and isolation of those who were considered dangerous. A high mortality rate was a direct result of hiding of mental illness, and people refusing to seek help, which led to an increase in the number of people suffering from depression, and even greater stigmatisation of mental illness. Until recently, the Balkan countries health systems resembled regimes typical of the 18th and 19th century. Due to a lack of significant progress, psychiatric institutions were dark structures resembling prisons, which did not provide help and did not allow patients to return to the community. Italy and the process of deinstitutionalisation had the greatest influence on further development and progress of psychiatry, which was followed by the rest of Europe. Medical staff have been attending various trainings and seminars across Europe, and joining the therapeutic community. The life-style of people living in psychiatric clinics, with the possibility of having separate rooms and excellent organisation of patient adjustment to further life, has had a positive effect on the Balkans as well. Equal relations between staff and patients has played a key role, and it should always be a priority area of work. Stigmatisation continues to be the most significant issue. Great efforts are being made to renovate hospitals, which will have a positive effect on the mentally ill after a short time.[18]

Mental-health disorder

4.4 Development of psychiatric treatment in the Balkan countries, and their influence on Montenegro 17.4%

s cer n a C

Ca rid io dis vasc ea ses ular

14.8%

9.2%

4.7 Representation psychiatric hospital today, Balkan, 2018 (personal source)

4.8 The ratio of the most common diseases and mental disorders, Balkan 2018 (Personal, based on external source)

Slovenia BIH Croatia Montenegro Serbia Bulgaria Macedonia Albania

14%

12%

1990

15.9%

1995

2000

2005

2010

2016

4.9 Share of population with mental health and substance use disorders between 1990-2016 (Personal, based on external source)

The most important aspect of deinstitutionalisation is the change of society in its very roots, as well as the relationship between the healthy person and mentally ill. Most countries in the Balkans have a long history of psychiatric clinics, and significant progress has been made in that regard. The oldest psychiatric hospital in the Balkans is located in Serbia, the 154 years old Dr Laza LazareviÄ&#x2021; clinic. Although it has a dark history, it is currently trying to carry out various reforms, to break the prejudice and remove the label of a violent institution and a prison. Various projects are being carried out, with the aim of adapting to the modern environment, by introducing various forms of group and individual therapy. [19]

The Psychiatric Hospital Dobrota in Kotor, Montenegro, was opened in 1953. At the time, the clinic was under significant influence from neighbour countries. The hospital staff in Kotor, as well as institutions in the region, are working hard to introduce new reforms. The biggest challenge the hospital is facing is the large number of hospitalised patients, with over 100% of occupancy rate. Patients whose state improves during hospitalisation should be sent back to the community for continuation of rehabilitation outside of the institution. This treatment should include a wide range of therapeutic, rehabilitative and recreational activities, including group, occupational therapy, art and music activities.

4.5 Bethlem Royal Hospital London, England

4.10 The Hospital of Bethlem [Bedlam] at Moorfields, 1676

4.12 Bethlem Hospital at St George's Fields, 1828

4.11 First floor plan, Bethlem, 1247-1633

The asylum Bethlem in London was established in 1247, as the oldest European centre devoted to the care and treatment of people suffering from mental illness. It is known as the oldest European hospital with a work history of more than 600 years. Its location has changed a few times, but the purpose of the institution has always remained the same, with a wide range of treatment and therapy options that were current at the time. The location for the first 400 years was at the current Liverpool Street station in the city of London: it occupied 2 hectares of land and it was centred around the yard. In 1676, the hospital was relocated to Moorfields, a city in London where the financial cost of maintaining the building were very high. In 1791, it was again moved to St George Fields, and today, it is located at Monks Orchard House. Despite its many years of dark history, the asylum has been greatly advanced with a variety of group and individual therapy options, and the first thing seen through the hospital door is a museum. [20]

4.13 Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, 1930- today

4.6 Psychiatric clinic Vrapče Zagreb, Croatia The psychiatric Hospital Vrapče is the largest and oldest institution in Croatia. The hospital has 130 years of history, and it is the only one in Croatia built exclusively for psychiatric patients. The main building and pavilions were designed in 1879 by the architect Kuno Waidman, and can accommodate approximately 300 patients. The number of patients has increased to more than 1.000, resulting in the addition of several more pavilions and auxiliary buildings. The hospital was designed according to the standards of the time. Although certain changes were introduced over time, the number of patients in the rooms decreased, while additional therapeutic facilities were formed. The hospital Vrapče is considered to be the first hospital in the Balkans that used electrotherapy. At present, it has about 800 beds and 750 employees. It is divided into 13 medical departments. A new building for 70 forensic patients is under construction. Alongside the basic activity of treating the mentally ill and engaging in scientific work, a large number of semi nars are organised and much attention is devoted to reducing the sigma surrounding mental illness. [21]

4.16 Psychiatric clinic Vrapče, Zagreb, Croatia

Clinical laboratory Radiology Institute for psychiatric research Pharmacy Dental clinic urg Emergency psychiatry service 11 Department of integral psychiatry - 2. 9 Department of integral psychiatry - 1. The department of psychogeriatrics Department for the treatment of psychoneurosis 8 Center for resocialization 6 Center for alcoholism and other addictions 5b Extended treatment service – men 4.15 Museum of Psychiatric clinic , Zagreb 5a Clinical department for forensic psychiatry The Museum of Psychiatric Hospital Vrapče 4 Extended treatment service – women was opened in 1954. The museum presents Clinic for general and forensic psychiatry different kinds of therapy used throughout and clinical psychophysiology history. Most of the exhibited aids have not Clinical department of general psychiatry been in use in the last 50 years, when 2 Clinical department of psycholysis psychopharmatics became leading practise 4.14 Situation of psychiatric clinic Vrapče, 2018

Integral psychiatry service – men

in psychotherapy.

4.17 Psychiatric clinic Vrapče, Zagreb, Croatia

4.7 Special hospital Dobrota, Kotor, Crna Gora The first psychiatric hospital in Montenegro was built in 1953. It still represents one of the most important institution for people with mental disorders. Throughout history, it changed name and status, but the role remained the same: recovery, rehabilitation and adaptation to community for people with mental disorders. It is located on the coast of Montenegro, so it can be said that the location is extremely inspiring, chosen following the old rules of construction of psychiatric clinics, far from the urban area. It represents a typical pavilion type of building, and it is strongly adapted to the natural environment. Contact with nature has a very positive effect on patients, as it offers a range of possibilities for relaxation and rehabilitation. Treatment in the hospital is carried by voluntary hospitalisation, or on the basis of the decision of the competent judicial authority. It is the type of psychiatric hospital that makes this institution so specific. The regime of forced hospitalisation has been abolished all over Europe and has not been applied for years. The extremely large number of patients poses a significant challenge for the hospital. Most of the forensic patients in Montenegro are located in the hospital. It is the only institution that offers the possibility of prolonged and chronic treatment, which results in hospitalisation programmes that can run for several years. For years, the number of patients has been on the rise, which is why it comes as no surprise that the hospital’s occupancy rate is over 100%.The capacity of the hospital is 241 beds, while the number of patients ranges from 250 to 280, from all over the country. In recent years, efforts have been made to reduce this number to the absolute minimum. Opening new services that would accept patients after a particular treatment, when the hospital no longer has a role in treatment, would greatly help in reducing the number of patients, and contribute to overall progress. The hospital has a vast number of patients who do not need hospital treatment but continue to live there, since most of them do not have a home to return to. The state has not offered a solution, which is why such patients end up taking 45% of hospital accommodation. The record number high number of court / forensic patients in 2015 was 112. This beautiful city needs to be released from such overcrowding, which would allow the hospital to progress, introduce new therapies, teach people to adapt to the community, environment, and to deal with the problem of stigmatisation. [22][23]

PLJEVLJA

ŽABLJAK

BIJELO POLJE MOJKOVAC

ŠAVNIK

KOLAŠIN

BERANE

ROŽAJE

NIKSIC

PODGORICA

30km

HERCEG NOVI

90 km

150km

KOTOR

BUDVA

4.18 Special hospital’s Dobrota position in Montenegro(personal source)

BAR

31 ULCINJ

The hospital is a typical Mediterranean style facility: a typical pavilion type complex, with 6 separate buildings with 9 departments. Pavilions are positioned at a certain distance from one another, with green areas that offer various possibilities to patients. The view from this complex is picturesque: beside the view of the Bay of Kotor, the top of the old Catholic churches are also visible. The location offers the possibility of connection with the natural environment. However, separation from the urban area creates the problem of stigmatisation. For years, the very name of the hospital caused fear and lack of understanding. Although development and adaptation to the European system is visible, stigmatisation is still one of the biggest challenges of today, and it took years for mentally healthy people to accept this institution, as well as for the patients who are undergoing treatment. The hospital has been renovated - the patients received a library, a gym and a playground. It is designed to provide space for various forms of therapy, recreational activities, individual psychotherapy, artistic, drama, music and sports activities. It is important that the patients be hospitalised during the acute phase of mental illness, in order to be released and sent home after improvement. Most of the changes were introduced in the last 7 years. Currently, the conditions are not ideal, which is why progress and development of the hospital must be continuous. The lack of staff is another large-scale challenge faced by the hospital. Such an approach is expected to result in greater understanding of the system of shorter, but more effective hospitalisation, and the development of psychiatry in the community.

4.21 Special hospital Dobrota

9 1 10

7 3 8

2 12

2012

1105

2013

1172

2014

1170

2015

1238

2016

1142

2017

1059

6 Hospitalized patient from 2012-2017 13

4.19 Situation of Special hospital Dobrota (personal source) 1 Reception department 2 Acute medical unit VII for 3 Department for the treatment of women 4 Acute medical unit VII for addiction men 5 Judicial department 7 Working occupational therapy 6 Medical unit: VIII women, 9 Working therapy - a carpentry VIII men, VI i II workshop 8 Warehouse, laundry, kitchen 11 Dental clinic 10 Administration 13 Football, basketball court 12 Conference room

4.22 Special hospital Dobrota

2012

3238

2013

3230

2014

3429

2015

3258

2016

6426

2017

3745

4.20 Outpatient medical examination from 2012-2017 (Personal, based on external source)

The key guideline for hospital progress is reduction of stigmatisation in the society. Moreover, the way in which a new regime of psychiatry works should be better explained to society, pointing out the importance of accepting patients and supporting them in recovery. In the past few years, the Director of the Special Hospital, Dr. Dragan Ä&#x152;abarkapa, MD, has largely devoted himself to improving the conditions of patientsâ&#x20AC;&#x2122; life. A vast number of seminars have been held, and action plans have been implemented in order to minimise the majority of problems. Collaboration has been established with hospitals from many European countries. The aim of the reforms is to implement the regime of deinstitutionalisation, and create the best offer for patients in Montenegro.

SITE AND ARHITECTURE ANALYSIS 5.1 Podgorica 5.2 Administrative centre of Montenegro 5.3 Blok 5, Podgorica, Montenegro 5.4 Clinical Centre of Montenegro 5.5 Existing psychiatric clinic, Podgorica 5.6 Foto Documentation 5.7 Detailed site analysis

2 34

5.1 Podgorica

arhitecture faculty

Ribnica

5.1 Podgorica (Source: Personal collection)

Podgorica is the capital city, and the administrative, economic, educational and political centre of Montenegro. It occupies an area of 1.491 km2 or 10.43% of the territory of Montenegro. To the east, it borders with Albania, to the south with the Skadar Lake and the Bar municipality, to the west with the royal capital Cetinje and the municipality of Danilovgrad, while to the north, it borders with the municipalities of Kolašin and Andrijevica. Podgorica is 36 km far away from Budva (as the crow flies), and 45 km far away from Sutomore. Podgorica is influenced by the Mediterranean climate. The period of the average daily temperature above 0°C lasts over 320 days a year, and above 5 °C for about 180 days. The mean annual temperature is 15.5 °C in the range of minimum 5 °C in January and maximum 26.7 °C in July. This makes Podgorica one of the hottest cities in Europe. The basic organisational structure of the health care system comprises a network of state health institutions and private institutions. The State of Montenegro is the founder of all health care institutions that perform healthcare activities as public health institutions. They are established to ensure legally set citizens’ rights in the field of health care. The most important health institution of the state is the Clinical Centre of Montenegro, which represents a tertiary health care institution. It is located in Podgorica, which in addition provides secondary level services for people in Podgorica, Danilovgrad and Kolašin. [24] 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Clinical center Montenegro Institute of child diseases Institute for public health Psychiatric hospital Sports center Morača Hotel Podgorica Administrative center of Montenegro Stadion Saborni Hram REsidental block 5 University of Montenegro Shoping center Delta Atlas capital center Mall of Montenegro

20 m

40 m

5.2 Podgorica

5.2 Administrative centre of Montenegro The building of the Central Committee of the Communists Party of the Socialist Republic of Montenegro ("The Old Government") is the work of the architect Radosav ZekoviÄ&#x2021;, built in 1979, almost 14 years after winning the competition. The building is connected to the city network and creates a complete system. The ground floor of the Old Government is partly free, with a porch, which makes the parter fluid, allowing the visual continuity of the green space and the necessary flow of air towards the east-west direction. The grid on the ground floor in the longitudinal direction varies from 7, 9, 12 to 18 m in the part of the conference hall. In the transverse direction, the range is from 5, 6 to 7 m. In the sense of design and functionality, the architect adopted certain traditional elements of the local architecture, such as a pitched dual roof on cubic structures on the floors, and a roof lantern above the main hall. It is not a mere folklore, but rather a critically re-examined local construction, in the sense of a modernist paradigm. The sun protection is provided by a double facade, with an air tampon layer between the glass wall and the facade shading.[25]

5.6 Administrative centre of Montenegro

5.3 Section

5.4 Floor plan

5.5 Administrative centre of Montenegro

5.7 Administrative centre of Montenegro

5.3 Blok 5, Podgorica, Motenegro Blok 5 is a typical example of the town-planning policy in the period of late 1970s – early 1980s in Podgorica, Montenegro. It was constructed on the basis of the town-planning project of Vukota Tupa Vukotić and the architectural solution of Mileta Bojović. It consists of eight residential buildings and five residential skyscrapers up to 16 floors high – the symbol of this neighbourhood – and it provides wide streets and avenues, sufficient parking space, pedestrian zones, lots of playgrounds, one elementary school and two kindergartens, a policlinic, supermarkets, sports grounds and plenty of greenery. In the last couple of decades, the dwellers of these buildings have taken it upon themselves to modify and change them in a series of dubious interventions, thus violating their appearance and original structure. All internal partition walls, apart from the sanitary block, are movable – they can be screwed, unscrewed, moved to the left or right, or completely removed. The project offered solutions for all these different options, and plans were developed well in advance. [26]

5.8 Graphic representation of the building (personal source)

5.9 Blok 5, Podgorica

5.10 Blok 5, Podgorica

5.11 Clinical center of Montengro

The Clinic Centre in the capital is a very good example of how the building can be structured according to the type of construction chosen solely by the architect. The technically advanced prefabrication in reinforced steel construction, which was popular in Yugoslavia at the time, requires absolute precision in execution, resulting in durability, which has paid off in the long run. Even today, three decades after completion, the function and condition of the building are good. With the design of the cross section of the building – low where the arrivals come in, higher sections toward the par where the inpatient wards are – the architect intended to improve the view from the city onto the relatively large building with its three-dimensional dynamic form, including the broken-up facade in the upper stories. The stairwell towers with their massive presence appear to anchor the multipartite light-looking building to the ground and are thereby also positively marked. [26]

5.4 Clinical Center of Montenegro The Clinical Centre of Montenegro is a healthcare institution in which all the necessary health services at the tertiary level of health care are provided to the citizens. This institution is also a scientific research centre and a teaching base of the Faculty of Medicine of the University of Montenegro. For years, the tenants have been upgrading and introducing new technologies in diagnostics and treatment. With very well planned investments in medical education, and development of professional educational programs the Clinical Centre has significantly raised the level of knowledge of highly specialised medical services. The structure of the Clinical Centre consists of more than 30 organisational units. Based on a piece of analysis conducted in 2014, a total of 36.186 patients were hospitalised in a building with a capacity of 758 hospital beds. The imposing building complex of the Clinical Centre of Montenegro was ceremoniously opened in 1974. The designers of this unusual and complex building are the famous architects, B.Sc. Božidar Milić and B.Sc. Milan Popović. The building represents the postmodernist style, where the use of concrete gives the impression of solidity and stability. The homogeneity and uniformity is denied, which is the general characteristic of objects constructed after World War II.

5.13 Clinical center of Montenegro (personal source)

5.12Situation of Clinical center of Montenegro (personal source)

1 2 5 7 9

Existing psychiatric clinic Medical faculty New oncology clinic Institute for public health Medical high school

2 A planned psychiatric clinic 4 Institute of pathology 6 Oncology and radiotherapy 8 Department of infection 10 Institute of child diseases

5.14 Clinical center of Montenegro (personal source)

5.15 Clinical center of Montenegro (personal source)

5.5 Existing psychiatric clinic, Podgorica The psychiatric clinic in Podgorica is located not far from the complex of the Clinical Centre, within the PetroviÄ&#x2021; Park. The current location of the clinic is not favourable, primarily because its presence is disturbing the landscape of the park. Although the main focus while choosing the site was on placing the clinic within an urban environment, the capacity of people to be around patients should have also been taken into account. In this case, the clinic is just across the High Medical School, which gathers a large number of people on a daily basis, and that in turn may cause retreat of patients. Despite the fact that they have a couple of small yards, their position on the side of the entrance facade does not contribute to a sense of peace for patients. Indeed, the most significant challenge faced by the clinic are the miserable conditions, even below the minimum standards of the CPT. The building is extremely friable and old, and its appearance causes fear and disgrace among the patients and the observers. One part of the building has already collapsed, and cannot be remediated. Given the lack of additional protection measures within the park, safety poses a challenge as well. [27][28]

Psychiatric clinic, Podgorica(personal source)

The key problem is the lack of beds (currently 20) within the clinic, which does not provide the opportunity for all the people in need to receive help. Great attention is paid to the construction of the new Clinic, which would be part of the complex of the existing Clinical Centre. In accordance with the character, the object is conceived as a separate entity, which would in a way fit within the existing complex, and create a sense of unity with the rest of the health facilities. The selection of the site was under the influence of the idea to provide the patients with the possibility to socialise and be in contact with green surfaces that would give them peace not far away from the urban life of the rest of the population. Access to the location is simple, easy and direct. Walkways can be provided from all sides. The number of existing parking spots at the location, and ones to be added along the roadway meets all the criteria. The future object should have the capacity of 57 beds, with 3 units, within which a daily hospital will be located, with the hope of approaching the advanced development of psychiatry achieved in the greater part of Europe. The future clinic should respect the existing environment.

Vieuw from planned and existing location (personal source)

5.6 Photo Documentation 4

Location for new Psychiatric clinic (personal source)

5.7 Detailed site analysis

road-primary

50 m

100 m

road-secondary

50 m

100 m

Site analysis (personal source)

50 m

100 m

50 m

100 m

road-tertiary

river

full

empty 50 m

100 m

Residential, public-social buildings Security buildings Cultural buildings, restaurants Educational buildings Public buildings Sport buildings Medical buildings Housing

50 m

100 m

Site analysis (personal source)

green areas

park

50 m

100 m

concentration of people

Site analysis (personal source)

50 m

100 m

CONCEPT 6.1 Concept 6.2 Construction 6.3 Materials 6.4 Program

2 48

6.1 Concept Through various studies, we have concluded that the architectural design of the building plays a significant role in the development of psychiatry and its integration into the environment. The main goal was to create an architectural concept that can provide all the necessary elements of the psychiatric clinic and result in overall reduction of stigmatisation. The new clinic is planned as an addition to the Clinical Centre of Montenegro, at the very end of the site for the entire complex. The location is inspiring although it has some limitations. It is covered with greenery and placed closer to the river than the existing facilities. The goal is to adjust the facility to the location, and to make the final design dynamic, interesting and inspiring. The focus is also on creating an enjoyable ambient for this type of patients by designing a safe environment with a pleasant design and inviting outdoor areas. In recent years, the effectiveness of the institutions that provide long-term care has been questioned, and there are more and more initiatives for designing treatment that is based on prevention and the development of mental health centres. However, despite some positive aspects of the deinstitutionalisation process, due to the high degree of suicide rates and alienation among people, various departments are still needed. Our main idea was to create an institution that will provide all the necessary contents for patients to make them feel comfortable, safe and free. The content of the institution is planned to meet the needs of the users, and it is, of course, dimensioned according to the standards and norms for this type of facility. The goal is to create an atmosphere similar to homes or hotels, which is, in a way, a form of preparation and transition to the future life outside the clinic, without the feeling of isolation and rejection from the society. According to the project requirements given by the Clinical Centre of Montenegro, tree separate functional units are planned: stationary, daily hospital and dispensary. The new facility will provide 57 beds, a multipurpose space - a space for group, individual and music therapies.

6.1 Object function analysis (personal source)

By analysing different elements of the project, the first idea was based on an internal open space in the form of an atrium around which, on the ground level, all the departments would be arranged. The goal was to give the users the opportunity to interact with each other, thereby reducing the separation and isolation. The atriums were included with the aim of enabling a gradual process of socialisation of patients and mutual encounters, but also separation from the rest of the environment with a certain amount of privacy. In the initial design, along with the atriums, the building would occupy most of the site.

6.2 First concept(personal source)

psychotic conditions

medical staff process psychosis and affective states addiction disease medical staff children and adolescents daily medical centre administration dispenser for mental health

6.3 Object function analysis (personal source)

6.4 Final concept (personal source)

6.5 Diagram (personal source)

Following various analyses and researches, the idea of organising functional units alongside the vertical surface area was chosen as a more adequate option. By placing patients from the ground floor to the top, depending on their condition, it was possible to gradually adapt to the internal logic of the hospital, with moderate socialisation as well as simpler adaptation to the environment. People who are accommodated at the top of the building are the type of patients who need their peace, moderate socialisation and short-term communication with other patients. In the first project proposal, the facility was occupying a large area of the site, which is why the attention is now focused on raising the base from the horizontal to the vertical position, so that the atriums retain their function, but in the form of roof terraces. We can therefore achieve a dynamic effect, and avoid the monotony and simplicity while interweaving the inner and the outer space. The new shape of the object is designed to follow the longer side of the site, allowing more open areas around the facility. With the central position of the building, there is more space for green areas that will create many different private places for the users. The emphasised horizontality and green surfaces around the building is quite typical for the architecture of Podgorica, which can be seen from the previously mentioned example of the old government building. The main entrance to the clinic is facing the complex of the Clinical Centre with additional approach for the ambulance, in case of critical situations. Pulling and pushing cube elements of the building, and creating roof terraces results in a form of barrier between departments that should be physically separated. The inspiration for the dynamic facade of the object, achieved by different positions of the cube elements was derived from the architecture of the residential complex of Block 5, where the architect strived to create architecture that would leave room for multipurpose common areas. The daily hospital on the south side has a separate entrance, for users that prefer privacy. This side of the object is designed to be a peaceful oasis, separated from the rest of the complex, with a pleasant design and inviting outdoor areas suitable for various activities. Patient rooms on the south side of the building, which has a view of the MoraÄ?a river, are distant from densely populated city buildings. The main goal of the project is to meet the needs of users, while maintaining an attractive and interesting design.

children and adolescent

medical staff

psychotic disease

psychoses and affective states

cinema

roof garden

1 4

main hall

entrance to the day hospital

entrance for administration

auxiliary building

room for patients

daily hospital

caffe bar

addiction disease

mental health dispenser

6.6Function and object position (personal source)

6.7 Visualization of green roof and additional content

6.2 Construction The structure of the building is a reinforced concrete skeleton. The pillars that carry the building are 30 by 30 cm, set on every 4.5 m, in addition to two exceptions of 9 m and 5.8 m, set in order to adjust the construction to the function. The entire building is 12,000 cm long, which required dilatation of objects, in order to prevent improper and arbitrary breaking of the walls. As the base of the building is a simple rectangle, two dilatations are placed by vertical communications. The building is in this way protected in case of an earthquake or a collapse.

Green rooves or roof gardens are of great importance for modern architecture for esthetical and functional reasons, as well as due to their impact on biodiversity in urban settlements. They enhance the city landscape and provide extra space for enjoying nature. Green rooves, when executed correctly, last longer than standard rooves, and have additional economic benefits, such as reduced costs for water draining and reduced energy consumption. It is important to emphasise that the green rooves are excellent thermal insulators, as they preserve the heat of the building during the winter and keep it cooler during the summer. Recent research has shown that green rooves can have a positive impact on patients’ psyche and productivity. An intense green roof is a system of green areas that involves the formation of a rich garden that can be used intensively, and for various purposes. They can be used for rest, recreation, cultivation of grassy and bushy species, flowers or even trees.

Since the building is positioned so that patients' rooms are facing the south, due to the high amount of sunlight, the use of façade panels was an ideal solution. The installation of panels on a flat, concrete façade, combined with the dynamic geometry of the building and green rooves, will improve the overall design of the building and enrich the experience of the patients. The panels are to cover the entire south facade. Because of the dynamic design of the building and the installation of windows where the function requires it, the facade panels will have their own logic, with the maximum width of the panels being 150cm. At certain time intervals, when the panels are closed, the object will receive a completely new, modern appearance.

+120

Fround floor (personal source)

+80

comunication comunication

450

580

900

580

Section (personal source) seismic separation gap

colum

floor coverings metal plate

fire protection

6.8 An example of dilatation details

Section and green roof (personal source) Green roof seed mix Green roof substrate Filter layer Drainage layer Protection mat Waterproof Insulation Vapour control layer Plywood deck

6.9 An example of dilatation details

6.10 An example of facade panels

6.3 Materials Concrete was selected as the final material for the clinic, which was tremendously used in Montenegrin architecture in 80-90s, and is still used at present. On major, important structures, concrete was used as an expression of the massive, stable and dominant character of the structure. By using concrete, the new clinic is better adapted to the existing complex and the overall architectural expression of Podgorica. Despite its modern approach, which is reflected in the dynamic structure, it is also adapted to the architectural style of Podgorica, which makes it unique and irreplaceable for the proposed location.

Windows are typically used to satisfy the function of the facility, as is the case with the Clinical Centre, as well as most health facilities in Montenegro and throughout Europe, without consideration for design of the building. The use of panels can be seen on the building of the old government in Podgorica. Based on these examples, the newly-designed object represents a modern interpretation of the existing architectural styles in Montenegro. On the roof terraces, simple glass fences were used, and dimensioned according to the norms. The combination of glass and concrete is also characteristic for the post-war architecture of Montenegro.

Concrete

Glass railings

Facade panels

6.4 Program Basic information: Project: Psychiatric clinic in Podgorica Type of project: concept design Location: Podgorica Site area: 1781.06m2 Building area: 1228.70 m2 Site: The shape of the site is a rectangular, and the terrain is flat. It is located within the Clinical Center of Montenegro, on the south side nearby the river Moraca. Hospital capacity: 57 beds The main entrance to the building is facing the Clinical Center of Montenegro, while the entrances to the administration and daily hospital are placed on the south side. The economic entrance to the building is on the east side, which leads to the basement with all the technical and auxiliary rooms of the building. The road is connected from the north side to the existing street and enters the circle of the Clinical center. There are 20 parking places predicted for patients, while the parking for the staff is located on the south side along the new road. The building is designed as free-standing, so that its form respects the architectural expression of the complex. It is P + 4 story building. The building is designed so that the zones are divided by the floors. It consists of 3 separate functional units: stationary, daily hospital and dispensary. The materialization is concrete in combination with aluminum facade panels located on the south side of the building. Level -1: 1. Auxiliary room 2. Archive 3. Clean laundry 4. Toilet with a wardrobe 5. Food supply room 6. Tehnical rooms 7. Wardrobe 8. Dirty laundry 9. Medication room 10. Parking 11. Security

25.51 m2 28.10 m2 13.00 m2 14.52 m2 37.06 m2 19.11 m2 28.42 m2 18.58 m2 22.78 m2 34.72 m2 9.00 m2 775.10 m2

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40.

Ground floor: Entrance Security Wheelchair storage Hall with an info point Storage Stairs and elevators Tehnical room Toilet Farmacy Hygienist Waiting room Medic Conference room Adinistration entrance Storage Secutity Breakroom for employees Toilet and wardrobe Main nurse of dispenser Chief medical of dispenser Main nurse in the hospital Director of the hospital Caffe bar entrance Caffe bar Toilet Preparation of food and drink Daily hospital entrance Storage Security Info point Stairs and elevators Tehnical room Storage Hall Nurse room Toilet Waiting room Group psychotherapy Occupational therapy Day care

9.00 m2 6.00 m2 6.60 m2 78.82 m2 7.35 m2 50. 38 m2 5.90 m2 23.78 m2 8.95 m2 2.00 m2 83.60 m2 34.45 m2 37.10 m2 5.07 m2 3.45 m2 3.00 m2 17.50 m2 9.37 m2 17. 35m2 20.85 m2 14.85 m2 26.34 m2 5.37 m2 72.80 m2 16.71 m2 25.00 m2 6.50 m2 4.32 m2 4.32 m2 29.21 m2 50.38 m2 5.90 m2 3.75 m2 65.05 m2 18.01 m2 18.41 m2 47.95 m2 37.20 m2 37.20 m2 37.20 m2 1228.70 m2

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35.

Level 1: Nurse Emergency room Toilet Bedpan washer Medic Group psychotherapy Patients room Common space Common space/green terrace Dining room Toilet and wardrobe Psychologist Social worker Defectologist Psychiatrist Ambulance Commo space/green terrace Defectologist Psychiatrist Psychologist Social worker Main nurse in the daily hospital Toilet and wardrobe Breakroom for employees The head of the daily hospital Storage Individual therapy Mediatheque Common space Individual therapy Cinema Painting therapy Nurse Toilet Occupational therapy

11.55 m2 15.68 m2 15.65 m2 4.93 m2 16.16 m2 19.22 m2 28.60 m2 4.87 m2 53.31 m2 14.46 m2 10.70 m2 14.46 m2 16.75 m2 16.75 m2 16.75 m2 16.75 m2 101.92 m2 16.10 m2 16.10 m2 16.10 m2 16.10 m2 16.10 m2 9.23 m2 16.15 m2 16.15 m2 8.75 m2 23.33 m2 42.48 m2 22.50 m2 21.12 m2 44.33 m2 57.13 m2 17.78 m2 18.05 m2 36 m2 1203.37 m2

1 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30.

Level 2: Patients room Common space/terrace Common space Daily care room Office Badpan washer Toilet Nurse Admission ambulance Room for visits Psychologist Social worker Defectologist Psychiatrist Main nurse Duty doctor Breakroom for emoloyees Toilet Ambulance for therapies Reading room Musical therapy Drawing room Daily care room Nurse Common space Toilet Bedpan washer Storage Office Common space/green terrace

28.60 m2 20.60 m2 4.87 m2 16.16 m2 19.22 m2 4.93 m2 15.65 m2 13.50 m2 13.50 m2 14.90 m2 14.90 m2 14.90 m2 14.90 m2 14.90 m2 14.90 m2 22.62 m2 15.00 m2 10.10 m2 15.00 m2 24.92 m2 55.33 m2 24.92 m2 26.26 m2 17.96 m2 21.37 m2 17.03 m2 4.66 m2 3.00 m2 19.30 m2 105.42 m2

1 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

Level 3: Patients room Gathering place Daily care room Nurse Toilet Bedpan washer Common space/green terrace Music therapy Closed garden Painting room Nurse Toilet Bedpan washer Office Daily care Common space/green terrace Nurse Toilet Bedpan washer Daily care room

28.60 m2 12.73 m2 11.55 m2 15.89 m2 23.76 m2 11.55 m2 91.23 m2 70.00 m2 45.00 m2 30.23 m2 15.46 m2 15.00 m2 11.55 m2 20.56 m2 25.50 m2 177.00 m2 15.46 m2 15.00 m2 11.55 m2 20.56 m2

1 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.

Level 4: Breakroo for emloyees Patients room Gathering place Common space Group psychotherapy Reading room Space for yoga Individual therapy Bedpan washer Toilet Nurse Daily care room Common space/green terrace Cinema

26.46 m2 28.60 m2 20.60 m2 12.73 m2 26.45 m2 23.76 m2 23.76 m2 11.88 m2 4.45 m2 15.73 m2 15.89 m2 11.55 m2 145.62 m2 105.43 m2 714.00 m2

1150.00 m2

1182.96 m2

2 56

PROJECT 6.1 Ortophoto 1:2500 6.2 Site plan 1:1000 6.3 Site plan 1:500 6.4 Concept diagrams 6.5 Floor plans 1:300 6.6 Sections 1:300 6.7 Elevations 1:300 6.8 Patient room 1:50 6.9 Details 1:30

2 58

9.00

4.00 16.50

12.40

8.00

9.00

4.00 4.00 4.00

25.50

4.00

16.00

3.00

15.00

13.00

16.40

Âą0.00 13.00 3.50

7.70

16.00

11.55

3.50

19.97

15.40

19.97

3.50

Âą0.00

4.00

Legend Concrete blocks Pavement

Greenery Stone slabs

SITE 1:1000

Main entrance Daily hospital entrance Administration entrance Service entrance

Tree Wooden panels

4.5 m

18 m

Âą0.00

7.70

16.00

11.55

19.97

15.40

19.97

Âą0.00

Legend

Concrete blocks Pavement

Main entrance Daily hospital entrance

Greenery

Administration entrance

Stone slabs

Service entrance Tree

SITE 1:500

Wooden panels

4.5 m

18 m

6.4 Concept diagrams

4 3 2 1 0 -1

Fourth floor

Third floor

Second floor

First floor main entrance

Ground floor

service entrance

entrance for administration

Basment

Communication

entrance to entrance for the day hospital daily hospital

Medical staff

Administration

Psychoses and affective states

Psychotic disease

Psychoses and affective states

Children and adolescent

Daily hospital

Staff

Addiction disease

Administration

Dispanser

caffe bar

Tehnical room and storage

Patient room

Common space / green terrace

Group, individual and occupational therapy

6.5.1 Floor plans- basement 1:300

15.

14.

13.

10.

11.

12.

Legend

Basement Stairs and elevators

1. Stairs and elevators 2. Storage 3. Techincal room 4. Auxiliary room 5. Archive 6. Clean laundry 7. Toilet with a wardrobe 8. Food supply room 9. Techincal rooms 10. Wardrobe 11. Dirty laundry 12. Medication room 13. Parking 14. Security 15. Cargo scales Total 4.5 m

/ / / 25.51 m2 28.10 m2 13.00 m2 14.52 m2 37.06 m2 19.11 m2 28.42 m2 18.58 m2 22.78 m2 34.72 m2 9.00 m2 / 775.10 m2 9m

6.5.2 Floor plans- ground floor 1:300

33. 36.

26.

30.

18.

22.

25.

17.

18.

38.

39.

40.

38.

29.

34.

27.

32.

21.

20.

19.

28.

12.

13.

7. 15.

12.

9. 10. 11.

14.

37.

16.

24.

23.

31.

35.

Legend

Main entrance

Daily hosiptal Caﬀe bar Administration Main hall Mental health dispenser

Employers and Adm. entrance Daily hospital entrance Caﬀe bar

1. Entrance 2. Security 3. Wheelchair storage 4. Hall with an info point 5. Storage 6. Stairs and elevators 7. Technical room 8. Toilet 9. Farmacy 10. Hygienist 11. Waiting room 12. Medic 13. Conference room 14. Administration entrance 15. Storage 16. Security 17. Breakroom for employees 18. Toilete and wardrobe 19. Main nurse of dispenser 20. Chief medical of dispenser Total

9.00 m2 6.00 m2 6.60 m2 78.82 m2 7.35 m2 50.38 m2 5.90 m2 23.78 m2 8.95 m2 2.00 m2 83.60 m2 34.45 m2 37.10 m2 5.07 m2 3.45 m2 3.00 m2 17.50 m2 9.37 m2 17.35 m2 20.85 m2

21. Main nurse in the hospital 22. Director of the hospital 23. Caﬀe bar entrance 24. Caﬀe bar 25. Toilet 26. Preparation of food and drink 27. Daily hospital entrance 28. Storage 29. Security 30. Info point 31. Stairs and elevators 32. Technical room 33. Storage 34. Hall 35. Nurse room 36. Toilet 37. Waiting room 38. Group psychotherapy 39. Occupational therapy 40. Day care 4.5 m

14.85 m2 26.34 m2 5.37 m2 72.80 m2 16.71 m2 25.00 m2 6.50 m2 4.32 m2 4.32 m2 29.21 m2 50.38 m2 5.90 m2 3.75 m2 65.05 m2 18.01 m2 18.41 m2 47.95 m2 37.20 m2 37.20 m2 37.20 m2 1228.70 m2 9m

6.5.3 Floor plans- first floor 1:300

38.

41.

39.

31. 26.

40.

26.

27.

28.

15.

29.

3. 14.

20.

11.

12.

11.

30.

13.

14.

34.

35.

33.

25. 24.

32.

23. 22.

21.

16.

17. 18.

19.

10.

37. 36.

Legend

Daily hospital

Medical stuďŹ&#x20AC; Green terrace Medical stuďŹ&#x20AC; Addiction disease

1. Stairs and elevators 2. Techincal room 3. Storage 4. Nurse 5. Emergency room 6. Toilet 7. Bedpan washer 8. Medic 9. Group psychotherapy 10. Patients room 11. Common space 12. Common space/green terrace 13. Dining room 14. Toilet and wardrobe 15. Psychologist 16. Social worker 17. Defectologist 18. Psychiatrist 19. Ambulance 20. Common space/green terrace 21. Defectologist

/ / / 11.55 m2 15.68 m2 15.65 m2 4.93 m2 16.16 m2 19.22 m2 28.60 m2 4.87 m2 53.31 m2 14.46 m2 10.70 m2 14.46 m2 16.75 m2 16.75 m2 16.75 m2 16.75 m2 101.92 m2 16.10 m2

22. Psychiatrist 16.10 m2 23. Psychologist 16.10 m2 24. Social worker 16.10 m2 25. Main nurse in the daily hospital 16.10 m2 26. Toilet and wardrobe 9.23 m2 27. Breakroom for employees 16.15 m2 28. The head of the daily hospital 16.15 m2 29. Storage 8.75 m2 30. Stairs and elevators / 31. Storage / 32. Techincal room / 33. Individual therapy 23.33 m2 34. Mediatheque 42.48 m2 35. Common space 22.50 m2 36. Individual therapy 21.12 m2 37. Cinema 44.33 m2 38. Painting therapy 57.13 m2 39. Nurse 17.78 m2 40. Toilet 18.05 m2 41. Occupational Therapy 36.93 m2 Total 1203.37 m2 9m 4.5 m

6.5.4 Floor plans- second floor 1:300

30.

35.

12.

27.

23.

25. 26.

21.

28.

11.

10.

22.

1. 18.

17.

16.

15.

6. 5.

14. 2.

13.

31.

20.

24.

29.

19.

32.

34. 33.

36.

Legend

Green terrace Children and adolescents Medical stuﬀ Psychoses and aﬀective states

1. Stairs and elevators 2. Technical room 3. Patients room 4. Common space / terrace 5. Common space 6. Daily care room 7. Oﬀice 8. Bedpan washer 9. Toilet 10. Nurse 11. Admission ambulance 12. Storage 13. Room for visits 14. Psychologist 15. Social worker 16. Defectologist 17. Psychiatrist 18. Main nurse Total

/ / 28.60 m2 20.60 m2 4.87 m2 16.16 m2 19.22 m2 4.93 m2 15.65 m2 13.50 m2 13.50 m2 / 14.90 m2 14.90 m2 14.90 m2 14.90 m2 14.90 m2 14.90 m2

19. Duty doctor 20. Breakroom for employees 21. Toilet 22. Ambulance for therapies 23. Reading room 24. Musical therapy 25. Drawing room 26. Stairs and elevators 27. Storage 28. Technical room 29. Daily care room 30. Nurse 31. Common space 32. Toilet 33. Bedpan washer 34. Storage 35. Oﬀice 36. Common space / green terrace 4.5 m

22.62 m2 15.00 m2 10.10 m2 15.00 m2 24.92 m2 55.33 m2 24.92 m2 / / / 26.26 m2 17.96 m2 21.37 m2 17.03 m2 4.66 m2 3.00 m2 19.30 m2 105.42 m2 1182.96 m2 9m

6.5.5 Floor plans- third floor 1:300

21.

22.

20.

23.

19.

15.

14.

12. 13.

18.

10.

16.

17.

11.

Legend

Green terrace

Children and adolescents Psychotic conditions Psychoses Additional content

1. Stairs and elevators 2. Technical room 3. Patients room 4. Gathering place 5. Storage 6. Daily care room 7. Nurse 8. Toilet 9. Bedpan washer 10. Common space / green terrace 11. Music therapy 12. Closed garden Total

/ / 28.60 m2 12.73 m2 / 11.55 m2 15.89 m2 23.76 m2 11.55 m2 91.23 m2 70.00 m2 45.00 m2

13. Painting room 14. Nurse 15. Toilet 16. Bedpan washer 17. OďŹ&#x20AC;ice 18. Daily care 19. Common space / green terrace 20. Stairs and elevators 21. Nurse 22. Toilet 23. Bedpan washer 24. Daily care room 4.5 m

30.23 m2 15.46 m2 15.00 m2 11.55 m2 20.56 m2 25.50 m2 177.00 m2 / 15.46 m2 15.00 m2 11.55 m2 20.56 m2 1150.00 m2 9m

6.5.6 Floor plans- fourth floor 1:300

17.

15.

16.

14.

12.

13.

11.

10.

6. 2.

Legend

Additional content Green Terrace Psychoses

1. Stairs and elevators 2. Technical room 3. Breakroom for employees 4. Patients room 5. Gathering place 6. Common space 7. Group psychotherapy 8. Reading room 9. Space for yoga 10. Individual therapy 11. Bedpan washer 12. Toilet 13. Nurse 14. Daily care room 15. Storage 16. Common space / green terrace 17. Cinema Total 4.5 m

/ / 26.46 m2 28.60 m2 20.60 m2 12.73 m2 26.45 m2 23.76 m2 23.76 m2 11.88 m2 4.45 m2 15.73 m2 15.89 m2 11.55 m2 / 145.62 m2 105.43 m2 714.00 m2 9m

16.00

1.5%

19.97

1.5%

15.40

1.5%

1.5% 1.5%

1.5%

11.55

7.70

1.5%

6.5.7 Floor plans - roof 1:300

19.97

71 4.5 m

18 m

6.6.1 Sections "1-1" 1:300

19.74

19.25

15.4

14.76

15.51

15.4

-15.02

-15.01

11.55

-11.17

11.55

-11.17

10.86

7.70

-7.32

3.85

-3.47

-3.21

± 0.00

-0.38

-3.50

-4.29

4.50

9.00

-4.29

6.6.3 Sections "2-2" 1:300

6.6.2 Sections "3-3" 1:300

19.74

19.25

15.4

-15.02

11.55

10.86

7.70

-7.32

-7.06

3.85

-3.47

± 0.00 ± 0.00

-0.38

-0.79

-3.50

-4.29

3 3

9.00

4.50

6.7 Detail 1:30

W1 R1 - Roof construction 200 mm 80 mm 20 mm

100 mm min 30 mm 200 mm 615 mm

+19.74

200 mm 5 mm 60mm

+19.25

Concerete wall Thermal insolation Plaster

373 mm

Vegetation Soil Filter fabric Drainage layer Protection course Double Waterproofing barrier Termal insulation Moisture retention layer Bitumen membrane Screed Concrete slab

+15.40

786 mm

W1 - Wall construction

60 mm 100 mm

F3 - Floor construction

+15.02

60 mm 200 mm

+11.55

85 mm

300 mm 60 mm

20 mm

+10.86

150mm

Laminate Bitumen membrane Screed PVC Waterproofing barrier Termal insulation Concrete ground slab

+ 7.70

20 mm 80 mm

+7.32

+ 3.85

+3.47

Âą 0.00

Laminate Screed PVC membrane Termal insulation Damp-proof membrane Concrete ground slab Termal insulion Waterproofing barrier Termal insulation Lean concrete Gravel

-0.79

F2 - Floor construction

F1 - Floor construction

30 mm Topsoil 50mm Drainage / protecition mat Equalizing layer / waterproofing 120mm Thermal insulation Equalizing layer / vapor barrier min 30 mm Screed 200 mm Concrete slab 5 mm Plaster 76

300 mm

445 mm

6.8.1 South elevation 1:300

6.8.2 North elevation 1:300

6.8.3 East elevation 1:300

6.8.4 West elevation 1:300

6.9.1 Patient room

2.25 m

4.50 m

Tipical unit 1:100

Patient room 1:50

6.9.2 Patient room

Tipical unit 1:100

4.50 m

2.25 m

Patient room 1:50

3D PRESENTATION

2 84

IMAGES AND TABLES

2 96

List of images and tables 2.1 Exorcism or expeling evil spirits (painting by Francis Borgia, S.J. http://assassinscreed.wikia.com/wiki/Francis_Borgia 2.2 Trepanning skulls (from the painting Cutting the Stone by Hieronymus Bosch)

http://www.inquiriesjournal.com/articles/1673/the-history-of-mental-illness-from-skull-drills-to-happy-pills 2.3 Cage http://batstar.net/item/ulrichmi.htm 2.4 Hydrothepary, Pilgrim State Hospital, Brentwood, NY, 1938 http://time.com/3506058/strangers-to-reason-life-inside-a-psychiatric-hospital-1938/ 2.5 The Tranquilizing Chair Of Benjamin Canvas Print by Everett https://www.alamy.com/stock-photo-the-tranquilizing-chair-of-benjamin-rush-a-mental-patient-is-strapped-3511 5935.html 2.6 Hospital de Bicetre, near Paris https://commons.wikimedia.org/wiki/File:Hospital_de_Bicetre,_near_Paris_Wellcome_M0013528.jpg 2.7 Cheshire lunatic asylum, Cheste, England https://historic-hospitals.com/mental-hospitals-in-britain-and-ireland/mental-hospitals-in-england/ 2.8 The state lunatic asylum, Utica, New York http://cantonasylumforinsaneindians.com/histor y_blog/tag/utica-state-lunatic-asylum/ 2.9 Block plan of the Royal Herbert Hospital https://www.flickr.com/photos/quadralectics/4327615064 2.10 Treatment lobotomy https://thepsychologist.bps.org.uk/volume-27/january-2014/looking-back-interpreting-lobotomy-%E2%80%93-patients-st ories 2.11 Electroshock therapy https://boredomtherapy.com/historical-medical-treatments/

2.12 Psychopharmacology https://www.ebay.co.uk/p/Psychopharmacology-by-R-H-Ettinger-Paperback-2017/233117801 2.13 Advantages of group therapy https://www.shutterstock.com/vide clip - 24480251 - group therapy - animated - word - cloud - text - designade 3.1 Influence of factors in the development of mental disorders https://www.ksde.org/Portals/0/SES/SEAC/16-17/16-11-09-SchoolMentalHealthInitiative-TASN.pdf?v er=2018-02-16-183929-033 3.2 Diagnosis by type of institution https://archivesma.epfl.ch/2011/051/schue_wicki_eno nce/ Wicki_Schuetz_Enonce%20theorique_architecture%20for%20psychiatric%20treatment.pdf/ page 33 3.3 Coverage by type of treatment facility https://archivesma.epfl.ch/2011/051/schue_wicki_eno nce/ Wicki_Schuetz_Enonce%20theorique_architecture%20for%20psychiatric%20treatment.pdf/ page 39 3.12 Terrace on the Centre de psychiatrie du Nord vaudios https://archivesma.epfl.ch/2011/051/schue_wicki_enonce/Wici_Schuetz_Enonce%20theorique_architecture%20for% 20psychiatric%20treatment.pdf/ page 103 3.13 Centre de psychiatrie du Nord vaudios http://www.dl-c.ch/proj_detail.php?projId=0490

3.17 Floor plan https://www.dezeen.com/2017/04/10/psychiatric-centre-landscaping - gardens-decorative-brick-welcoming -environment oslo-norway/ 3.18 Southern Oslo psychiatric centre https://www.dezeen.com/2017/04/10/psychiatric-centre-landscaping - gardens-decorative-brick-welcoming -environment oslo-norway/ 3.19 Southern Oslo psychiatric centre https://www.dezeen.com/2017/04/10/psychiatric-centre-landscaping - gardens-decorative-brick-welcoming -environment oslo-norway/ 4.2 Hospital beds - psychiatric care bads, 2015, 100 000 inhabitants https://ec.europa.eu/eurostat/web/products-eurostat-news/-/DDN-20180126-1?inheritRedirect=true 4.4 Share of population with mental health and substance use

disorders, 1990 (Personal, based on external source)

https://ourworldindata.org/grapher/share-with-mental-and-substance-disorders

4.5 Share of population with mental health and substance use disorders, 2006 (Personal, based on external source) https://ourworldindata.org/grapher/share-with-mental-and-substance-disorders

4.8 The ratio of the most common diseases and mental disorders, Balkan 2018 (Personal, based on external source) http://www.dl-c.ch/proj_detail.php?projId=0490

3.14 Centre de psychiatrie du Nord vaudios https://www.chuv.ch/fileadmin/sites/chuv/images/yverdon.jpg

4.9 Share of population with mental health and substance use

3.15 Centre de psychiatrie du Nord vaudios http://www.dl-c.ch/proj_detail.php?projId=0490

https://ourworldindata.org/grapher/share-with-mental-and-substance-disorders?tab=chart&year=1990&country

3.16 Southern Oslo psychiatric centre (the inner courtyard) https://www.dezeen.com/2017/04/10/psychiatric-centre-landscaping - gardens-decorative-brick-welcoming -environment oslo-norway/

4.10 The Hospital of Bethlem [Bedlam] at Moorfields, 1676 https://historicengland.org.uk/research/inclusive-heritage/disability-history/1050-1485/from-bethlehem-to-bedlam/

disorders between 1990-2016 (Personal, based on external source)

4.11 First floor plan, Bethlem, 1247-1633 https://www.huffingtonpost.co.uk/2013/10/02/roman-skulls-crossrail-archaeology-dig_n_4028721.html 4.12 Bethlem Hospital at St George's Fields, 1828 https://www.alamy.com/stock-photo-new-bethlem-hospital-st-georges-fields-shepherd-metropolitan-improvements-7 3519034.html 4.13 Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, 1930- today https://wtlh.wordpress.com/author/hmile002/#jp-carousel-3685 4.14 Situation of psychiatric clinic Vrapče, 2018 https://www.zagrebacki.hr/2017/04/15/povijest-vrapca-se-lijecilo-elektrosokovima-terapijom-inzulinskom-komom/ 4.15 Museum of Psychiatric clinic , Zagreb http://bolnica-vrapce.hr/web/?p=3149 4.16 Psychiatric clinic Vrapče, Zagreb, Croatia https://narod.hr/hrvatska/otvorena-vrata-klinike-za-psihijatriju-vrapce

5.3 Section https://ivanjovicevic.blogspot.com/?view=classic 5.4 Floor plan https://ivanjovicevic.blogspot.com/?view=classic 5.5 Administrative centre of Montenegro http://architectuul.com/architecture/government-of-the-montenegro 5.6 Administrative centre of Montenegro Arhitektur in Ringturm XXXIII, Montenegro, Adolph Stiler, Bojan Kovacevic, 2013 Muru Salymann 5.7 Administrative centre of Montenegro http://www.sacg.me/brutalizam/ 5.9 Blok 5, Podgorica https://www.realitica.com/en/listing/1695531 5.10 Blok 5, Podgorica Arhitektur in Ringturm XXXIII, Montenegro, Adolph Stiler, Bojan Kovacevic, 2013 Muru Salymann

4.17 Psychiatric clinic Vrapče, Zagreb, Croatia http://mef.unizg.hr/o-nama/ustroj/nastavne-baze

5.11 Clinical center of Montenegro http://velizar1.blogspot.com/2017/05/omaz-jednom-o-d-kljucnih-nosilaca.html

4.21 Share of population with mental health and substance use disorders between 1990-2016 (Personal, based on external source)

6.8 An example of dilatation details https://www.slideserve.com/dani/1-sklop-konstrukcije-4

https://m.cdm.me/drustvo/dobrota-prebukirana-neki-pacijenti-u-bolnici-jos-od-njenog-osnivanja/

4.22 Centre de psychiatrie du Nord vaudios https://skalaradio.com/pomoc-i-humanost-drustvenoj-zajednici-rotary-kluba-kotor/ 5.2 Podgorica https://travelmassive.com/companies/tourism-organisation-podgorica

6.9 An example of green roof http://42.koch-foerderbandtrommeln.de/wiring/green - roof diagram.html 6.10 An example of facade panels https://www.archdaily.com/785670/leawood-speculative-office-el-dorado/5713295de58ece9e94000030-leawood-specula tive-office-el-dorado-detail

lITERATURE AND REFERENCES

2 100

Literature and references [1] Horvat Maja, Stigmatizacija psihički oboljelih osoba, Sveučilište sjever, Varaždin, 2016. [2] sunrisehouse.com, The History & Evolution of Mental Health Treatment, [Online] Available at: https://sunrisehouse.com/research/history-evolution-mental-health-treatment/#ancient [3] Roberts R. Albert, Linda Farms Kurtz, Historical Perspectives on the Care and Treatment of the Mentally Ill, Indiana University, USA, 1987 [4] Schütz Benjamin & Wicki Livia, Arhitecture for Psychiatric Treatment, École polytechnique fédérale de Lausanne, Switzerland, 2011 [5] psychologytoday.com, A Brief History of Psychiatry, 2017 [Online] Available at: https://www.psychologytoday.com/us/blog/hide-and-seek/201206/brief-history-psychiatry [6] archinect.com, Changes in the Architecture of Mental Facilities , 2017 [7] Levin Aaron, Psychiatric Hospital Design Reflects Treatment Trends, Washington 2007 [8] Mlađenović Lepa, Antipsihijatrijski pokret i deinstitucionalizacija, Projekat „Van izolacije – ostvarivanje prava pacijenata sa mentalnim oboljenjima“ finansira Evropska unija, Kotor 2016. [9] Peković Mirko, Psihijatrija, Univerzitet Crne Gore, Podgorica 2010. [10] kultivisise.rs, Antipsihijatrija – pobuna protiv ustaljenog delanja psihijatrije, 2017, [Online] Available at: https://kultivisise.rs/antipsihijatrija-pobuna-protiv-ustaljenog-delanja-psihijatrije/ [11] Šerić Maja, Resocijalizacija psihijatrijskih bolesnika u zajednici, Sveučilište u Splitu, Split, 2016

[12] Jakovljević Miro i Begić Dražen, Socijalna psihijatrija danas: izazovi i mogućnsti, Klinički bolnički centar Zagreb, Zagreb, 2013. [13] Babić B., Stavovi psihijatrijskih bolesnika prema samima sebi i njihova percepcija diskriminacije ljudi s psihijatrijskim oboljenjem, Sveučilište u Zagrebu, Zagreb, 2013. [14] researchgate.net, Stressed Spaces: Mental Health and Architecture, 2013. [Online] Available at: https://www.researchgate.net/profile/Damien_Riggs/publicat ion/257310003_Stressed_Spaces_Mental_Health_and_Archite cture/links/54311c070cf27e39fa9e45d4.pdf [15] dezzen, Oslo psychiatric centre by Hille Melbye features planted courtyards and decorative brickwork, 2017 [Online] Available at:https://www.dezeen.com/2017/04/10/psychiatric -centre -landscaping - gardens - decorative-brick- welcomingenvironment-oslo-norway/ [16] Šehić Denis and Šehić Demir, Atlas Crne Gore, Nezavisni dnevnik Vijesti, Podgorica, 2005 [17] Knapp Martin, David McDaid, Elias Mossialos, Graham Thornicoroft, Mental health policy and practice across Europe, Open University Press, England 2007. [18] jamanetwork.com, Mental Disorders Following War in the Balkans, 2010, [Online] Available at: https://jamanetwork.com/journals/jamapsychiatry/fullarticle /210768

[22] Cdm.me,“Dobrota” prebukirana, neki pacijenti u bolnici još od njenog osnivanja, 2018. [Online] Available at: https://m.cdm.me/drustvo/dobrota-prebukirana-neki-pacijen ti-u-bolnici-jos-od-njenog-osnivanja/ [23] Radokotor.info, Mladjenović: Zatvorimo bolnice koje ne liječe već ponižavaju, 2016, [Online] Available at: http://www.radiokotor.info/radio/index.php/78-lokalne-vijesti /12391-mladenovic-zatvorimo-bolnice-koje-ne-lijece-vec-poni zavaju [24] [Online] Available at:http://www.podgorica.travel/upoznaj_pg. [25] Jovićević Ivan, Izmedju strukturalizma i kritičkkog regionalizma, Inžinjerska komora Crne Gore, Podgorica 2017. [26] Adolph Stiler, Bojan Kovačević, Arhitektur in Ringturm XXXIII, Montenegro, Muru Salyma, 2013 [27] VolimPodgoricu.me, PODGORICA: Nova klinika za psihijatriju do kraja 2018?, 2017. [Online] Available at: https://volimpodgoricu.me/2017/05/08/podgorica-novaklinika-za-psihijatriju-do-kraja-2018/ [28]VolimPodgoricu.me, PODGORICA: HOROR fotografije sa klinike za psihijatriju KCCG, 2016. [Online] Available at: https://volimpodgoricu.me/2016/04/30/uzasavajuce-fotografij e-horor-i-uzas-na-klinici-za-psihijatriju-u-kccg/

[19] dnevno.rs, Prva duševna bolnica na Balkanu, Beograd, 2015. [Online] Available at: https://www.dnevno.rs/istorija/prva-dusevna-bolnica-na-balk anu-znate-li-gde-se-nalazi-i-ko-je-bio-prvi-pacijent/ [20] historicengland.org, From Bethlehem to Bedlam England's First Mental Institution, [Online] Available at: https://historicengland.org.uk/research/inclusive-heritage/dis ability-history/1050-1485/from-bethlehem-to-bedlam/ [21] bolnica-vrapce.hr, “Vrapče” – hram čovječnosti, 2009, [Online] Available at: http://bolnca-vrapce.hr/web/?page_ id=124

Neufert, E 2012, Arhitektonsko projektovanje, Građevinska knjiga, Beograd Constructing Architecture- Materials Processes Structures, A Handbook, Andrea Deplayes, Berlin IZVJEŠTAJ O RADU ZU Specijalne bolnice za psihijatriju „Dobrota” Kotor za 2017.godinu.

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