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Rooftop Refuge : an architectural oasis for mental health Mak, Helen Cherk Wing 2020-05

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ROOFTOPREFUGEAN ARCHITECTURAL OASIS FOR MENTAL HEALTHHelen MakROOFTOP REFUGEAn architectural oasis for mental healthBy Helen Cherk Wing MakBachelor of Architectural Studies, Carleton University, 2017Submitted in partial fulfillment of the requirements for the degree of Master of Architecturein The Faculty of Graduate Studies, School of Architecture and Landscape Architecture, Architecture Program Committee Jill BamburyJohn BassSophia FrangouSignatures_________________             _________________             © Helen Cherk Wing Mak, May 2020Jill Bambury Blair Satterfieldi iiTABLE OF CONTENTSTable of Contents      List of FiguresAcknowledgementsAbstract     Introduction      Mental Illness and Mental Health    A Brief History      Trends in Mental Health Practice   Relation of Illness and the Environment    Contemporary Precedents  New TypologiesDesign ProposalIllustrations CreditsBibliography   iiiiiviiix12710151933477175iii ivLIST OF FIGURESFigure 1: Updated Environmental Factors and InterconnectivitiesFigure 2: Dandenong Hospital Mental Health Facility exterior viewFigure 3: Dandenong Hospital Mental Health Facility courtyard viewFigure 4: Helsingor Psychiatric Hospital exterior viewFigure 5: Helsingor Psychiatric Hospital ground floor plan  Figure 6: Helsingor Psychiatric Hospital aerial viewFigure 7: Helsingor Psychiatric Hospital View from courtyardFigure 8: Nepean Mental Health Centre ground floor planFigure 9: Nepean Mental Health Centre aerial view Figure 10: Nepean Mental Health Centre exterior entrance viewFigure 11: Danish Psychiatric Hospital exterior viewFigure 12: Danish Psychiatric Hospital lobby viewFigure 13: Danish Psychiatric Hospital view from courtyardFigure 14: Psychiatry Bispebjerg aerial viewFigure 15: Psychiatry Bispebjerg exterior garden viewFigure 16: Psychiatry Bispebjerg exterior viewFigure 17: Psychiatric Hospital in Slagelse staircase viewFigure 18: Psychiatric Hospital in Slagelse atrium viewFigure 19: De Hogeweyk Dementia Village walkway viewFigure 20: De Hogeweyk Dementia Village exteriorFigure 21: Acton Ostry Child Care CentreFigure 22: Danbury Hospital NICU RooftopFigure 23: Magneten Sensory GardenFigure 24: Scandinave Spa Vieux-MontrealFigure 25: Mori Building Digital Art MuseumFigure 26: Zoom Video CallFigure 27: Location PlanFigure 28: Site PlanFigure 29: Site ContextFigure 30: Site Context (Continued)Figure 31: Key SurroundingsFigure 32: Surrounding ViewsFigure 33: N-W View Towards the MountainsFigure 34: Views to Site from SurroundingsFigure 35: Summer SolsticeFigure 36: Winter SolsticeFigure 37: Roof PlanFigure 38: PlanFigure 39: E-W Section A-AFigure 40: N-S Section B-BFigure 41: Pods Section C-CFigure 42: North Axonometric Viewv viFigure 43: South Axonometric ViewFigure 44: View of the Welcome FoyerFigure 45: View of the Lavender RoomFigure 46: View of Therapy PodsFigure 47: View of Worker’s LoungeFigure 48: Welcome Foyer Looking Towards MountainsFigure 49: Experiential Podsvii viiiACKNOWLEDGEMENTSA big thank you to my committee chair, Jill Bambury, for her continuous guidance and support. I’d also like to extend a thank you to my committee members, John Bass and Sophia Frangou, for their invaluable help. Finally, I’d like to thank my family and friends for their unwavering love and words of encouragement. I couldn’t have done it without you. ix xABSTRACTMental health is a vital aspect of one’s well-being that deeply infiltrates all facets of one’s life. Therefore, those afflicted with mental illness can experience significant distress, hardship, and even debilitating stigma. As mental health increasingly emerges at the forefront of medical discussions, architectural mindsets of the past need to dramatically alter as well. Architectural design principles coalesced with unprecedented remediation methods can inventively configure an environment which bolsters healing and promotes mental health. Situated in the bustling downtown Vancouver, elevated on the top of a parking garage, the complex of buildings interspersed throughout a garden imagines a new, reinvigorating atmosphere.  1 2INTRODUCTIONMental health is vital in leading an invigorated, nourishing lifestyle. However, 1 in 3 Canadians experience mental illness during their lifetimes.1 Mental illness does not discriminate in terms of who it affects, and it can lead to detrimental effects that impair one’s daily functioning. Mental illness disproportionately affects the homeless and those facing the criminal justice system.2 In drastic cases, it can lead to suicide, which is responsible for a considerable number of premature deaths in Canada.3 It has far-reaching consequences on family and friends, who may be tasked with taking care of those afflicted. However, the degree to which people are affected by mental illness varies greatly: they may be able to function on a day-to-day basis, or may face significant challenges. On a pragmatic scale, it can also affect the economy by reducing productivity.4 The total cost caused by mental illness in Canada is approximately $51 billion per year.5 Thus, beyond the client and their loved ones, the government and other stakeholders are also heavily involved in the preservation of mental health. 1  Public Health Agency of Canada, “About Mental Illness,” Canada.ca (Government of Canada, September 15, 2017), https://www.canada.ca/en/public-health/services/about-mental-illness.html2  Simon Davis, Community Mental Health in Canada (Vancouver: UBC Press, 2014), xiv. 3  Public Health Agency of Canada, “About Mental Illness.”4  Mental Health Commission of Canada, “Strengthening the Case for Investing in Canada’s Mental Health System,” Mental Health Commission of Canada (Health Canada, 2017), https://www.mentalhealthcommission.ca/English/resources/mhcc-reports/case-for-investing)5  P. Smetanin et al., The life and economic impact of major mental illnesses in Canada: 2011-2041. (Toronto: RiskAnalytica, 2011), 6.MENTAL ILLNESS AND MENTAL HEALTH According to the World Health Organization, mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.”6 Mental illnesses can cause significant impairment and difficulty performing daily tasks. As per the definition provided by the Government of Canada, mental illnesses “are characterized by alterations in thinking, mood, or behaviour.”7 Mental illnesses include mood disorders, anxiety disorders, schizophrenia, personality disorders, eating disorders, problem gambling, and addiction. They have biological and psychosocial origins which can agitate the illness as well. MOOD DISORDERSMood disorders are characterized by one’s perception and thinking of oneself, other people, and life in general. The types of mood disorders include depression, dysthymic disorder, and bipolar disorder.Depression is periods during which people feel low levels of mood, or a general sense of apathy towards life and activities one previously finds enjoyable. It can cause irritability, hopelessness, and guilt, and cause one to isolate oneself from others. Other symptoms include difficulty concentrating and recalling information, changes in sleep patterns and eating patterns, as well as lethargy. Types of depression include seasonal affective disorder and postpartum depression.8Dysthymic disorder is similar to depression; however, the symptoms are less severe and the duration of the episode is longer. Bipolar disorder consists of three different aspects: depression, mania, and periods of normal 6  World Health Organization, “Mental Health: Strengthening Our Response,” World Health Organization (World Health Organization), accessed December 11, 2019, https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response7  Public Health Agency of Canada, “Mental Illness,” Canada.ca (Government of Canada, December 9, 2019), https://www.canada.ca/en/public-health/services/chronic-diseases/mental-illness.html8  CAMH, “Depression,” CAMH (CAMH), accessed December 12, 2019, https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/depression3 4mood. The depressive phase is similar to depression in other mood disorders. Mania can cause excessive feelings of happiness, irritability, or anger. Symptoms of mania include a heightened sense of confidence, a lack of sleep, and racing thoughts. The severity and duration of depressive and manic phases vary from person to person, and individuals affected by mania and not depression are still considered to have bipolar disorder.9ANXIETY DISORDERSAlthough anxiety affects everyone, when it is severe to the extent where one’s ability to function normally is negatively impacted, it may be classified as an anxiety disorder.10 People afflicted by anxiety disorders may experience anxiety for varying lengths, which may seem to have no trigger. They may be unable to complete daily tasks due to these intense feelings and it may cause anxiety attacks which evoke fear and immobilization. The main types of anxiety disorders are specific phobia, panic disorder, agoraphobia, generalized anxiety disorder, social anxiety disorder, selective mutism, and separation anxiety disorder.11Generalized anxiety disorder consists of lasting and extreme worrying that inhibits daily tasks. It may include symptoms such as restlessness, fatigue, difficulty concentrating, muscle tension, or sleeping issues. Oftentimes, the worries are centered around daily activities. Panic disorders are characterized by reoccurring panic attacks, and extreme physical and psychological distress. A panic attack consists of symptoms such as palpitations, sweating, trembling or shaking, a shortness of breath, chest pain, and dizziness. At the highest level of severity, there may be a persistent fear of dying. People who experience panic attacks may believe that they are having a heart attack, leading to visits to the emergency room. Panic attacks may be expected or unexpected. A specific phobia involves being afraid of an object, situation, or activity despite knowing that it is not dangerous. Nonetheless, the fear persists and can cause the person to deliberately avoid 9  CAMH, “Bipolar Disorder,” CAMH (CAMH), accessed December 12, 2019, https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/bipolar-disorder10  Ranna Parekh, “What Are Anxiety Disorders?,” American Psychiatric Association (American Psychiatric Association, January 2017), https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders11  CAMH, “Anxiety Disorders,” CAMH (CAMH), accessed December 3, 2019, https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/anxiety-disordersthe object, situation, or activity. Agoraphobia is defined as being afraid of situations where it may be difficult to remove oneself or where one may be uncomfortable. The fear lasts 6 months or more and impairs daily functioning; in the most extreme cases, the individual may be unwilling to leave his/her house. According to the American Psychiatric Association, the fear manifests itself during two or more of these situations: “using public transportation, being on open spaces, being in enclosed spaces, standing in line or being in a crowd, [and/or] being outside the home alone”.12  Social anxiety disorder causes anxiety and distress about negative social interactions. Thus, avoidance typically happens. The episode has a duration of 6 months and affects everyday life.  Separation anxiety disorder manifests itself as a fear of being separated from certain individuals. The person afflicted by this illness will generally avoid being separated from the other individual.13Not elaborated on in this thesis are many other mental illnesses characterized by different symptoms and degr of prevalence.CAUSESIn North America, the prevailing viewpoint is that mental disorders that are considered more serious, such as bipolar disorder, are caused by biological determinants (the “somatogenic” viewpoint) and require biological treatments.14 Evidence for the somatogenic viewpoint comes from studies of genetic transmission and scanning and imaging techniques. Another viewpoint is that mental disorders are evoked by stressful or problematic life experiences (“sociogenic”).15PREVENTION AND PROMOTION12  Parekh, “What Are Anxiety Disorders?”13  Ibid. 14  Davis, Community Mental Health in Canada, 6. 15  Ibid., 8. 5 6The Mental Health Commission of Canada has defined a list of seven goals in the document, Toward Recovery and Well-Being, goal two of which is “mental health is promoted, and mental health problems and illnesses are prevented wherever possible.”16 According to the World Health Organization, “Prevention is concerned with avoiding disease, while promotion is about improving health and well-being.”17 Mental health promotion involves emphasizing good mental health, rather than focusing on mental illness. It requires considering biological, economic, social, psychological, and environmental factors that can affect mental health.18 Prevention consists of primary prevention, which is the prevention of the onset of an illness, thus reducing the number of people afflicted by the illness. It also involves secondary prevention, where the illness is contracted but intervention is early. Tertiary prevention is managing an illness, such as by using medication.Psychiatric treatment programs typically engage in tertiary prevention methods by establishing a “baseline” for the patient, and working towards preserving that.19 It is difficult to engage in primary intervention without knowing if an individual will be susceptible to the mental illness. Finally, secondary prevention can occur when individuals start to exhibit symptoms of mental illness.20In addition, there is universal, selective, and indicated prevention. Universal prevention involves interventions based on the whole population which is not identified to be at an augmented risk. Selective prevention involves intervention among individuals who are proven to have a higher risk of developing mental disorders, through biological, psychological, or social factors. Indicated prevention involves individuals that have identified symptoms of mental illness or a susceptibility to mental illness but are not currently diagnosed.21Mental health promotion and prevention have different end goals. Whereas promotion intends to increase mental well-being and resiliency, prevention aims to reduce symptoms and eventually of mental disorders. They are both often achieved together, as they are interrelated concepts.22  16  Mental Health Commission of Canada, Toward Recovery and Well-Being: a Framework for a Mental Health Strategy for Canada (Ottawa: Mental Health Commission of Canada, 2009), 6. 17  Davis, Community Mental Health in Canada, 45. 18  Davis, Community Mental Health in Canada, 45. 19  Ibid., 52. 20  Ibid., 52. 21  World Health Organization, Prevention of Mental Disorders: Effective Interventions and Policy Options: Summary Report (Geneva: World Health Organization, 2004), 17.22  Ibid., 17. STIGMAIn addition to dealing with the symptoms associated with mental illness, those suffering from mental illness also have to deal with society’s prevalently negative reaction towards them. There is also a phenomenon named “self-stigma” in which the individual believes prejudices against himself or herself.23 This stigma can cause a reduction of participation in society, difficulty acquiring a job, and a loss of self-confidence. The most predominant views of people with mental illness is that they are violent and thus should be avoided, they are insubordinate, or they are childlike. The resulting beliefs are that the individuals should be either excluded from society, decisions affecting the individual should be made by other, more “responsible” caretakers, and people with mental illness need a caretaker. Generally, people believe that the individual is responsible for their mental illness, which does not often occur for physical illnesses.24 Public stigma can lead to discrimination encountered during daily life by people with mental illness, and can manifest itself in media as well. Structural discrimination can also limit the activities of people with mental illness.25Three methods identified for reducing stigma include protest, education, and contact.26 Protest can be against public statements, media, and advertisements that cause stigma. Education can reduce stigma by providing a more realistic viewpoint that counteracts the negative perceptions. Lastly, contact with people with mental illness can work in conjunction with education to also reduce stigma. 23  Nicolas Rüsch, Matthias C. Angermeyer, and Patrick W. Corrigan, “Mental Illness Stigma: Concepts, Consequences, and Initiatives to Reduce Stigma,” European Psychiatry 20, no. 8 (2005): pp. 529-539, https://doi.org/10.1016/j.eurpsy.2005.04.00424  Rüsch, Angermeyer, and Corrigan, “Mental Illness Stigma: Concepts, Consequences, and Initiatives to Reduce Stigma.” 25  Ibid. 26  Ibid. 7 8A BRIEF HISTORYIn the past, the prevalent belief was that mental illness was a result of supernatural causes. Hippocrates challenged this notion by positing that mental illness had physiological roots. He identified mental conditions such as phobias, mania, depression, and paranoia.27 Nonetheless, by the Middle Ages, the belief was again that those afflicted by mental illness were associated with demonology and witchcraft.28 There were two key individuals that rejected the theory of witchcraft, including Johann Weyer (the father of psychiatry) and Paraclesus.29Philippe Pinel, the director of two institutions in Paris for the mentally ill, was one of the first individuals to treat his patients humanely. The Society of Friends in England backed William Tuke who created a country retreat for the mentally ill, however, he expected his patients to participate in manual labour. During the 19th and 20th centuries, Sigmund Freud was a key figure who heavily influenced psychology and concepts of mental health.30In the 19th century, mental illness was seen as a “moral or spiritual failing”, and thus the people afflicted by the illnesses were penalised and shamed, as were their families.31 Due to an increase of population and a resulting increase in density of population, institutions were established to house people with mental illnesses. In Canada, 1714 saw the establishment of the Hotel-Dieu in Quebec in which people who were mentally ill were housed. However, in most cases, it was expected that the family would have to take care of the mentally ill, otherwise, the afflicted individuals would be placed in jails and poorhouses in abysmal conditions.32 In 1835, an asylum was opened in St. John, New Brunswick, and another in 1841 in Toronto.33 The asylum was based on the idea of “moral treatment”, which postulated that individuals with mental illness could recover if “treated kindly and in ways 27  John T. Goodman, “Mental Health,” The Canadian Encyclopedia (Historica Canada, January 28, 2014), https://www.thecanadianencyclopedia.ca/en/article/mental-health28  Ibid.29  Ibid.30  Ibid.31  U.S. National Library of Medicine, “Diseases of the Mind: Highlights of American Psychiatry through 1900 - Early Psychiatric Hospitals and Asylums,” U.S. National Library of Medicine (National Institutes of Health, January 18, 2017), https://www.nlm.nih.gov/hmd/diseases/early.html#181732  Goodman, “Mental Health.”33  Ibid.that appealed to the parts of their minds that remained rational.”34 Instead, hospitals were established that were in country settings; provided fulfilling work and recreational activities; a reward system for reasonable behaviours; and milder forms of restraint that were used for shorter durations.35Thomas Kirkbride, the superintendent of the Institute of the Pennsylvania Hospital, created the “Kirkbride Plan” as a reference for hospitals with moral treatment in his book, “On the Construction, Organization, and General Arrangements Of Hospitals For The Insane”.36 It influenced many future private and public asylums, and had a plan with a central core and long, staggered wings that provided both natural daylight and fresh air to its occupants while not jeopardizing the patients’ privacy and comfort.37Key figures in the reformation of mental asylums in Canada and the United States were Dorothea Dix, Richard Bucke, Charles Clarke, Clifford Beers, and Clarence Hincks. Dix was a school teacher in Massachusetts who urged the public and legislators to improve the conditions faced by the mentally ill, and was successful in her efforts. Dr. Bucke was a superintendent of two asylums in Canada, and overturned the system of restraining patients and appeasing patients with alcohol. He established an infirmary for physical illnesses, and created events in which patients were encouraged to partake. Clarke was also a superintendent of two asylums successively, and converted the asylum from a jail to a hospital in which he taught nurses and attendants how to care for the mentally ill. He was against restraining patients, and promoted the dismissal of the term “asylum”. Beers had personal experience battling mental illness, and later published a book on the horrid conditions of asylums. He later founded the National Committee for Mental Hygiene, which was eventually renamed as the Canadian Mental Health Association. Hincks also experienced mental illness in the form of severe depression, and helped in the creation of the National Committee for Mental Hygiene. He acknowledged that it was important to treat symptoms of mental illness before they became too severe.38World War II saw a rise in the number of diagnosed cases of mental illness when recruits were 34  Patricia D’Antonio, “History of Psychiatric Hospitals,” University of Pennsylvania School of Nursing (University of Pennsylvania), accessed December 6, 2019, https://www.nursing.upenn.edu/nhhc/nurses-institutions-caring/history-of-psychiatric-hospitals/35  Ibid.36  L. S. Stuhler, “Thomas Story Kirkbride 1809-1883 — Physician, Psychiatrist and Developer of the Kirkbride Plan,” Social Welfare History Project (Virginia Commonwealth University, November 15, 2018), https://socialwelfare.library.vcu.edu/organizations/state-institutions/kirkbride-thomas-story/37  D’Antonio, “History of Psychiatric Hospitals.” 38  Goodman, “Mental Health.”9 10screened. This caused a change in public perception, and spurred research into prevention and treatment methods.39During 1946-1960, International Style psychiatric hospitals were built which followed the phrase, form follows function, with humanist concerns not being considered. The buildings were distinguished by their minimalism and the lack of control the patients had over their environment. Psychiatrists and academics agreed that the style was inappropriate for the humane treatment of individuals suffering from mental illness.4039  Ibid.40  Stephen Verderber, Innovations in Behavioural Health Architecture (London: Routledge, 2018), 16.TRENDS IN MENTAL HEALTH PRACTICERecent trends in mental health care include highlighting the significance of the biological nature of psychiatric research; more influence from patients; and an increase in the number of clinical guidelines. Mental health care is also affected by changes in technology.41 The trends in environments to treat mental illness are primarily more complex spaces with higher levels of access to the exterior. The environment ideally supports recovery, leads to shorter stays, and encourages patients to participate in their treatment. The use of seclusion is reduced through numerous techniques and resources such as emergency response strategies and pharmacological involvements. An important factor is a sense of control felt by the patient, which promotes recovery.42 In addition, predominant treatments do not fully account for the complicated challenges of mental illness.43 There is a shift of mental health care towards deinstitutionalization, residential settings and community care, and integrated care.DEINSTITUTIONALIZATIONIn Canada, deinstitutionalization began in the early 1960s.44 Deinstitutionalization was meant to provide independence for people with mental illness. The number of patients admitted into long-stay mental hospitals has trended downwards. The responsibility for people suffering from severe and lasting illness has changed to psychiatric units in general hospitals, community care programs, and other residential facilities. The costliest part of psychiatric care is hospital admission, therefore there is an emphasis on early discharge planning and release.45In community general hospitals, patients are increasingly more ill, and usually have substance 41  Samira Pasha and Mardelle McCuskey Shepley, Design for Mental and Behavioral Health (Taylor & Francis Ltd, 2017), 247.42  Ibid., 247. 43  James Lake and Mason Spain Turner, “Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care,” The Permanente Journal, 2017, https://doi.org/10.7812/tpp/17-02444  Davis, Community Mental Health in Canada, 195. 45  David Mechanic, “Emerging Trends In Mental Health Policy And Practice,” Health Affairs 17, no. 6 (1998): pp. 82-98, https://doi.org/10.1377/hlthaff.17.6.8211 12abuse comorbidities. The duration of stay at general hospitals have been reducing quickly and this trend is on-going. Long-term patients that used to occupy mental hospitals now are in small community institutions such as nursing homes, intermediate care facilities, community mental health institutes, board-and-care homes, and supervised residences.46In British Columbia in particular, in 1913, Riverview Hospital was opened and in 1951, it had 4,630 patients. Riverview offered custodial care, and patients were expected to follow institutional routine and had inadequate control of their own lives. Due to widespread deinstitutionalization in Canada, by the early 1990s, patients moved to the community, with 1,000 remaining at Riverview. In 2002, the Riverview Redevelopment Project, patients were fully transferred to community facilities on a “bed-by-bed” basis. Despite these promises, 200 beds at Riverview were never replaced. Unfortunately, after the closure of Riverview, there were insufficient community programs to accommodate those with mental illness.47Negative effects of deinstitutionalization include psychiatric patients being released before their condition is fully stabilized, leading to re-admittance. Furthermore, people with mental illness without access to support are susceptible to homelessness and drug abuse. Patients with suicidal ideation that are discharged prematurely are at a higher risk of suicide, as institutions allow for early recognition, control, and long-term treatment. Some people who suffer from mental illnesses require prolonged hospital stays to ensure that their condition is stabilized. In addition, to account for mental health shortfalls, the Burnaby Centre for Mental Health and Addiction was established in 2008. There are 100 beds and it provides support for patients over an average of nine months, and later allows for reintegration into the community. However, there are still not enough beds, as evidenced by the 500 people that are persistently mentally ill in the Downtown East Side. Furthermore, the Vancouver Police Department promote the creation of an Urgent Response Centre in which people with mental illness, addictions, and housing needs can be addressed. This reduces the incarceration of mentally ill individuals as well as hospital admissions.48 Thus, in Vancouver, steps can be made in order to better support those suffering from mental illness. 46  Ibid.47  Read, Alison. “Psychiatric Deinstitutionalization in BC: Negative Consequences and Possible Solutions.” UBCMJ 1, no. 1 (2009): 25. https://med-fom-ubcmj.sites.olt.ubc.ca/files/2015/11/ubcmj_1_1_2009_25-26.pdf.48  Read, “Psychiatric Deinstitutionalization in BC: Negative Consequences and Possible Solutions.”, 26. COLLABORATIVE AND INTEGRATED CARECollaborative care “acknowledges the need for various providers to partner, communicate, and provide services through means that support each other’s components of a holistic care plan... Providers have independent services and care plans but have agreed to work together for the betterment of comprehensive client care.”49 Collaborative care can be undertaken through communication between the different care providers. Integrated care is defined as “models of care where one care plan and a multi-disciplinary team is responsible for the overall care of an individual and often goes beyond the particular area of specialization to address numerous health and social needs. Individuals who require integrated care models would likely have complex health and social needs that require specialists, various health providers and support workers to work as a team to address and improve the determinants of health for these individuals.”50 Depending on the individual needs of the client, integrated care or collaborative care may be implemented. COMMUNITY MENTAL HEALTH SERVICESCommunity mental health services are more accessible than services offered at a hospital. According to the World Health Organization, key elements of community mental health services include “integrating mental health care within the primary health care system; rehabilitating long-stay mental hospital patients in the community; implementing anti-stigma programmes for communities; initiating population-based effective preventive interventions; and ensuring full participation and integration of people with mental disorders within the community.”51In terms of community mental health services offered in Vancouver, there are multiple resources that are inpatient, outpatient, and in one’s residence. The benefits of community care include 49  Monica Flexhaug, Steve Noyes, and Rebecca Phillips, Integrated Models of Primary Care and Mental Health & Substance Use Care in the Community: Literature Review and Guiding Document (Victoria, B.C.: Ministry of Health, 2012), 20. 50  Flexhaug, Noyes, and Phillips, Integrated Models of Primary Care and Mental Health & Substance Use Care in the Community: Literature Review and Guiding Document, 21. 51  World Health Organization, “Community Mental Health Services Will Lessen Social Exclusion, Says WHO,” World Health Organization (World Health Organization, June 1, 2007), https://www.who.int/mediacentre/news/notes/2007/np25/en/13 14employment, social assimilation, and avoidance of re-hospitalization.52 However, it may not be suitable for all patients, particularly when they are not supported sufficiently. Services include the Vancouver/Richmond Early Psychosis Intervention Program which offers individual counselling, family meetings, and group sessions. There is also the Vancouver Integrative Supervision Unit, in which support is provided for treatment, housing, living skills, financial management and health care as well as supervision of court orders. The Assertive Community Treatment is for those with acute substance use addictions. Finally, there is the Assertive Outreach Team that aids in the transition of patients with severe addictions of mental health issues from local emergency departments in Vancouver to suitable community services.53ELECTROCONVULSIVE THERAPYElectroconvulsive therapy is typically used to treat patients with severe major depression or bipolar disorder when other treatments, such as medication and psychotherapy, are unsuccessful. It is also used when rapid treatment is required due to the acuteness of the patient’s condition, such as a suicide risk. It involves a short electrical stimulation of the brain while the patient is anesthetized. For individuals with severe major depression, ECT provided considerable improvement in 80 percent of patients. Other brain stimulation treatments transcranial magnetic stimulation and vagus nerve stimulation.54PSYCHOTHERAPYPsychotherapy is a method for treating mental health issues by talking with a psychiatrist, psychologist, or other mental health provider. Psychotherapy aids in learning about one’s condition, moods, feelings, thoughts, and behaviours. It can be used to treat a host of other problems that do not involve mental illness, such as conflict resolution. 52  Read, “Psychiatric Deinstitutionalization in BC: Negative Consequences and Possible Solutions.”, 25. 53  Vancouver Coastal Health, “Community Mental Health Services,” Vancouver Coastal Health (Vancouver Coastal Health), accessed December 11, 2019, http://www.vch.ca/your-care/mental-health-substance-use/community-mental-health-services54  William McDonald and Laura Fochtmann, “What Is Electroconvulsive Therapy (ECT)?,” American Psychiatric Association (American Psychiatric Association), accessed December 12, 2019, https://www.psychiatry.org/patients-families/ectThere are numerous types of psychotherapy, however, the ones proven effective include cognitive behavioural therapy (CBT) which substitutes negative behaviours and thoughts with positive ones. Dialectical behaviour therapy is a type of CBT that allows for behavioural developments to better manage stress, emotions, and to better handle relationships. Other types of psychotherapy include acceptance and commitment therapy, psychodynamic and psychoanalysis therapies, interpersonal psychotherapy, and supportive psychotherapy.55EVIDENCE-BASED MEDICINEAccording to the World Health Organization, “evidence-based medicine and evidence-based prevention stimulate the use of the best available knowledge from systematic research in decision-making for clinical and public health practice.”56 Evidence-based medicine involves 4 factors, “use the best available scientific evidence, individualize the evidence, incorporate patient preferences, and expand clinical expertise.”57 It is notable that patient preferences are considered as this can greatly influence the programming and architecture of healthcare environments. In relation to design, it is referred to as evidence-based design.58 55  Mayo Clinic, “Psychotherapy,” Mayo Clinic (Mayo Foundation for Medical Education and Research, March 17, 2016), https://www.mayoclinic.org/tests-procedures/psychotherapy/about/pac-2038461656  World Health Organization, Prevention of Mental Disorders: Effective Interventions and Policy Options: Summary Report, 18.  57  Nimesh Desai, “Evidence-Based Practices in Mental Health: Distant Dream or Emerging Reality?,” Indian Journal of Psychiatry 48, no. 1 (2006): p. 1, https://doi.org/10.4103/0019-5545.3161158  Julie Queler, “The Aesthetics of Healing,” Behavioral Health Executive, September 1, 2006, https://www.psychcongress.com/article/aesthetics-healing15 16RELATION OF ILLNESS AND ENVIRONMENTThere have studies that have shown that the built environment and its surroundings can greatly influence the mental health of its inhabitants. Evidence suggests that effectively designed spaces can “reduce depression, restlessness, insomnia, anxiety, blood pressure, and perception of pain; elevate mood; improve immune system response; and enhance cognitive functioning.”59LIGHTLight is important in influencing mood, perception, and one’s circadian rhythm. An example which highlights the significance of light is how symptoms of seasonal affective disorder and the depressive phase of bipolar disorder were reduced through exposures between 2,500 and 10,000 lux. The most pronounced benefits were noticed in the morning rather than the evening. Furthermore, exposure to sunlight can allow patients to have less perceived stress, less pain, and therefore less pain medication. The natural circadian rhythm controls melatonin production, which impacts biochemical and hormonal body functions. Overall, access to natural day light has resulted in reduced depression, a decreased length of stay, improved sleep, less agitation, and relieved pain.60 THERAPEUTIC MILIEU Therapeutic milieu focuses on social and psychological aspects of environmental design, sometimes referred to as patient-centered design or healing environments. It is important to establish a home-like environment that is familiar for psychotic patients to help stabilize their symptoms. The patients should be encouraged to participate in day-to-day domestic tasks and not be segregated from the outside world.One model of care established by Angela Thieriot encourages human interaction, patient and 59  Jamie C. Huffcut, “Can Design Promote Healing?,” Healthcare Design 10, no. 2 (October 1, 2010)60  Kathleen Connellan et al., “Stressed Spaces: Mental Health and Architecture,” HERD: Health Environments Research & Design Journal 6, no. 4 (2013): pp. 127-168, https://doi.org/10.1177/193758671300600408consumer education, healing partnerships with the patients’ family and friends, nurturing through food and nutrition, spirituality, human touch, healing arts and visual therapy, integration of complementary therapies, and healing environments fostered in the architecture and design of the healthcare setting.61NATUREAccess to gardens and nature can aid in the healing process and can be one of the most positive aspects of psychiatric treatment. Gardens provide a safe outdoor environment, a place for contemplation, relaxation, and socialization. People experience less mental distress, less anxiety and depression, enhanced well-being and healthier cortisol profiles when living in urban environments with more access to nature.62CONTROL Studies have proven that when we perceive that we have more control over an environment, we feel more content, even if actual levels of control are unchanged. There can be an accommodation of how people use spaces and allow for a range of environments as well as personalization.63 COLOUR AND AESTHETICSColour has different associations depending on the culture, but in Western environments, yellow is typically associated with happiness and sunlight. Green and blue are considered calming, and therefore are suitable for bedrooms or quieter spaces. However, too much colour can be 61  Ibid.62  Jo Barton and Mike Rogerson, “The Importance of Greenspace for Mental Health,” BJPsych. International 14, no. 4 (2017): pp. 79-81, https://doi.org/10.1192/s205647400000205163  Ben Channon, Happy by Design: A Guide to Architecture and Mental Wellbeing (London: RIBA Publishing, 2018), 71-76.17 18overwhelming, so it should be used strategically. It can help distinguish different elements of a building.64 Art can take the form of artistic activities or artists in residence. There is evidence that suggests that abstract art causes more distress than when patients view a realistic landscape.65POSITIVE DISTRACTIONPositive distraction involves the shift of focus from negative aspects of the healthcare environment to more restorative aspects beyond the medical world. Examples of positive distraction include art, music, entertainment, books, social interaction, and nature. Positive distraction can also occur by introducing home-like aspects to the environment. It creates a non-institutional setting which can reduce boundaries between staff and patients.66SPATIAL ORGANIZATIONThe space should be organized in a logical manner. There should be clear distinctions between public and private spaces, intuitive wayfinding, and usage of materials that meets expectations. In fact, when the physical environment is disconcerting and hard to navigate, there is a negative reaction from individuals, whereas when it is organized, it can provide direction. Furthermore, wayfinding is one of the most important aspects of patient satisfaction.67SECURITY AND SAFETYSecurity involves all users of facilities, including patients, staff, and visitors. Crowding can cause security concerns, and density, privacy, and control are major elements that help reduce perceived crowding.68 64  Channon, Happy by Design: A Guide to Architecture and Mental Wellbeing, 71-76. 65  Connellan et al., “Stressed Spaces: Mental Health and Architecture.” 66  Pasha and Shepley, Design for Mental and Behavioral Health, 33.67  Ibid., 31.68  Connellan et al., “Stressed Spaces: Mental Health and Architecture.”SUPERVISIONSupervision is crucial in the safety of patients and staff. Open nurse stations allowed staff to interact more with patients, and patients agreed that the configuration increased their sense of well-being.69SOCIAL INTERACTIONThe environment should accommodate communication between patients, staff, and visitors to promote socialization. To effectively promote social interaction, there should be spaces for one-on-one discussions as well as common areas for interaction among a community.7069  Pasha and Shepley, Design for Mental and Behavioral Health, 37.70  Ibid., 34. ENVIRONMENT AS MEDIATIONINTERCONNECTED FACTORSLIGHTPOSITIVEDISTRACTIONSPATIALORGANIZATIONSECURITYAND SAFETYSUPERVISIONSOCIALINTERACTIONCOLOUR ANDAESTHETICSVIEWS ANDVISTASNATURETHERAPEUTICMILIEUFigure 1: Updated Environmental Factors and Interconnectivities19 20CONTEMPORARY PRECEDENTSMost of these precedents are drawn from a previous University of British Columbia architecture student’s thesis, Derek Landon Wong, in Design for Youth Mental Health. These precedents encompass many of the architectural and environmental factors that are mentioned previously, as well as following trends of mental healthcare. They are exemplary in their use of architecture as a method for healing. DANDENONG HOSPITAL MENTAL HEALTH FACILITYLocation: Dandenong, Melbourne, Victoria, AustraliaArchitect: Bates Smart with Whitefield McQueen Irwin AlsopCompletion: 2011The Dandenong Hospital Mental Health Facility has won several awards for its innovative design which, according to the architects, highlights:•	 Individual rooms for each patient with ensuite co-located clinical streams•	 Bedrooms organized within a stream•	 Non-institutional design•	 Outdoor and activity areas to encourage social interaction•	 A calm, safe, and therapeutic environment•	 Supervision and observation without unnecessary intervention•	 A sense of place and identity for each zone•	 Flexibility for sharing spaces•	 Blended interior and exterior environments•	 Avoiding stand-alone courtyard walls71In addition, it is made to replace an existing acute mental health facility for those with mental health issues in Victoria. Inspired by Dutch hospitals for mental health, they ensured that all 71  Bates Smart, “Dandenong Hospital Mental Health Facility Stage 1,” Journal (Bates Smart), accessed December 11, 2019, https://www.batessmart.com/bates-smart/projects/sectors/health/dandenong-hospital-stage-3-redevelopment-mental-health-facilities-part-1/interior spaces had a visual connection to exterior spaces.72 The architects stated that the intention was to have natural light and cross ventilation which would in turn aid with the recovery of the patients. The design language of wood cladding and wood elements on the interior are drawn from the vernacular of nearby buildings as to better integrate the patients into the community.7372  “An Escape in the City,” World Architecture News (World Architecture News, September 16, 2011), https://www.worldarchitecturenews.com/article/151885773  Ibid.Figure 2 (left): Dandenong Hospital Mental Health Facility exterior viewFigure 3 (right): Dandenong Hospital Mental Health Facility courtyard view21 22HELSINGOR PSYCHIATRIC HOSPITALLocation: Helsingor, DenmarkArchitect: JDS ARCHITECTS and BIGCompletion: 2006The design was envisioned through a collaborative process in which the staff, patients, and relatives were interviewed. The ultimate goal was to create a building that was both a psychiatric hospital and simultaneously not one.74 The building is integrated into the surrounding hilly landscape. It creates a variety of experiences and views for the patients and does not obstruct the view of the main hospital.The clinical nature of traditional hospitals was disregarded and a new typology was formed: cast-in-place floors of concrete, bright colours, and walls made of glass, wood, and concrete were utilized. The building has a central core from which wings with individual rooms radiate outwards to provide a sense of privacy for its inhabitants. The patients also have their own unique views from their rooms.74  “An Escape in the City,” World Architecture News (World Architecture News, September 16, 2011), https://www.worldarchitecturenews.com/article/1518857Figure 6 (top): Helsingor Psychiatric Hospital aerial viewFigure 7 (bottom): Helsingor Psychiatric Hospital View from courtyardFigure 4 (left): Helsingor Psychiatric Hospital exterior viewFigure 5 (right): Helsingor Psychiatric Hospital ground floor plan  23 24NEPEAN MENTAL HEALTH CENTRELocation: Kingswood, AustraliaArchitect: Woods BagotCompletion: 2014The Nepean Mental Health Centre (NMHC) was created in order to respond to the increasing demand for mental health services, to accommodate the growing and elderly population.75 The NMHC has 64 mental health beds for high dependency, acute, and specialist mental health services for the elderly. There is a dedicated inpatient ward and new facilities for the outpatient day program. The building exemplifies the shift of mental health care towards healing environments for recovery. The steel and glazed exterior shell recall the materials of the nearby hospital buildings, and diverges from the atmosphere of the internal spaces and courtyard. The courtyard changes with the seasons, in order to provide a visual representation of regeneration.7675  Karen Valenzuela, “Nepean Mental Health Centre / Woods Bagot,” ArchDaily (ArchDaily, September 29, 2014), https://www.archdaily.com/550968/nepean-mental-health-centre-woods-bagot76  Ibid. Figure 10: Nepean Mental Health Centre exterior entrance viewFigure 8 (left): Nepean Mental Health Centre ground floor planFigure 9 (right): Nepean Mental Health Centre aerial view 25 26DANISH PSYCHIATRIC HOSPITALLocation: Ballerup, DenmarkArchitect: CREO ARKITEKTER A/S and WE ArchitectureProject Year: 2014The Danish Psychiatric Hospital, currently under construction, has a courtyard which is surrounded by non-institutional gabled structures. The building respects its surrounding context and allows for communal spaces to have visual connections to the surrounding park and landscape. The hospital is composed of several different volumes that coincide with green spaces. The architects assert that the building is based on four tenets:•	 A sympathetic center that is broken down in scale•	 A dignified center with the patient in focus•	 A diverse center with an array of different interior and exterior spaces•	 An inspiring building complex where everyone has access to light, air and green outdoor spaces7777  Karissa Rosenfield, “CREO ARKITEKTER and WE Architecture Shares First Prize for Danish Psychiatric Hospital,” ArchDaily (ArchDaily, December 21, 2014), https://www.archdaily.com/579811/we-shares-first-prize-for-danish-psychiatric-hospitalFigure 12 (top): Danish Psychiatric Hsopital lobby viewFigure 13 (bottom): Danish Psychiatric Hospital view from courtyardFigure 11: Danish Psychiatric Hospital exterior view27 28PSYCHIATRY BISPEBJERG Location: Copenhagen, DenmarkArchitect: PLH arkitekter, FRIIS & MOLTKE ArchitectsProject Year: 2014The complex offers an environment for psychiatric treatment, while “ensuring the best conditions for research, education and training, knowledge sharing and the use of modern technology in courses of treatment.”78 The plan of the building allows for each unit to receive natural sunlight and views and access to a courtyard. The building design was influenced by three ideas: •	 To use the architecture to create a valuable environment for people, to make their time in the hospital a restorative stay•	 To create a clear, functional layout to support a professional, secure psychiatric treatment•	 To interact with the existing building complex, landscape and garden spaces of Bispebjerg Hospital and the intentions of the district plan/master plan7978  FRIIS & MOLTKE Architects A/S, “New Psychiatric Hospital, Bispebjerg,” FRIIS & MOLTKE Architects (FRIIS & MOLTKE Architects), accessed December 11, 2019, https://friis-moltke.com/architecture/health/new-psychiatric-hospital-bispebjerg/79  Ibid.Figure 15 (top): Psychiatry Bispebjerg exterior garden viewFigure 16 (bottom): Psychiatry Bispebjerg exterior viewFigure 14: Psychiatry Bispebjerg aerial view29 30PSYCHIATRIC HOSPITAL IN SLAGELSELocation: Slagelse, DenmarkArchitect: Karlsson ArchitectsProject Year: 2015The project includes general psychiatric, forensic, and high security wards, an outpatient clinic, emergency reception, training facilities and research facilities. It can accommodate 194 inpatients and 200-300 consultations at the outpatient clinic per day. The building is designed in order to provide access to inner courtyard gardens, and the merging of spaces. Most patients experience treatment through social interaction and basic skills. Physical activity is incorporated into therapy, with facilities such as two sports halls, a swimming pool, and outdoor training areas. There are over 40 different courtyards and gardens with their own unique configurations and sizes in order to provide outdoor green spaces for both patients and staff. The courtyards help provide porosity between the interior and the exterior.8080  Divisare, “Karlsson Architects · Psychiatric Hospital in Slagelse,” Divisare (Divisare), accessed December 12, 2019, https://divisare.com/projects/324243-karlsson-architects-psychiatric-hospital-in-slagelse Figure 18: Psychiatric Hospital in Slagelse atrium viewFigure 17: Psychiatric Hospital in Slagelse staircase view31 32DE HOGEWEYK DEMENTIA VILLAGELocation: Weesp, NetherlandsArchitect: MBVDAProject Year: 2009The De Hogeweyk Dementia Village is composed of several buildings imitating a small, self-contained village housing 152 dementia-suffering seniors. There are seven different lifestyles offered to the inhabitants: upper class, homey, Christian, artisan, Indonesian, and cultural.81 With the support of staff, the inhabitants are responsible for the upkeep of their households. There are streets, squares, gardens, and a park in which residents can freely roam in a safe environment. There are facilities such as a restaurant, a bar, and a theatre to accommodate not only the residents, but the surrounding community as well. Hogeweyk greatly values the importance of having privacy and a sense of autonomy established through having a household which one manages. Sharing a community with people who have similar ideas creates for a more comfortable environment. Six to eight people live in each household distinguished by the type of lifestyle chosen.8281  Hogeweyk, “Hogeweyk, Living in Lifestyles. A Mirror Image of Recognizable Lifestyles in Our Society.,” Hogeweyk (Hogeweyk), accessed December 11, 2019, https://hogeweyk.dementiavillage.com/en/82  Ibid. Figure 20: De Hogeweyk Dementia Village exterior viewFigure 19: De Hogeweyk Dementia Village walkway view33 34NEW TYPOLOGIESAfter consulting with the Dr. Sophie Frangou, a committee member, it was determined that the precedents shown previously were outdated in their techniques and typologies. Thus, it was necessary to look at different typologies in order to create a new type of treatment centre for patients with mental illness. In particular, I would be focusing on the atmosphere, environment, community, and treatment methods.I also chose some precedents that correlated with the garden portion of the project, which makes up a significant portion of the rooftop footprint. In addition, there was a precedent that was used that exemplified how buildings can exist on top of parking garages.It was also necessary to consider the environment as a form of mediation and select appropriate programmatic requirements. Most notably, Dr. Frangou mentioned that doctors and other health care practitioners would need to have a space in order to decompress and discuss matters pertaining to patients without patient interference or knowledge, and thus the Worker’s Lounge was developed. Virtual therapy pods also allow for a novel type of therapy method during which the patient is able to be engaged in a virtual environment that changes depending on the patient’s mood and desires to create a calming and relaxing atmosphere. STIGMAMEDIATIONPREVENTIONENVIRONMENT AS MEDIATIONRECEPTIONWORKERS’ LOUNGEPRACTITIONERS’ OFFICESPATIENT-PRACTITIONER OFFICESVIRTUAL THERAPY PODSMULTIPURPOSE SPACEGROUP THERAPY ROOMSOUTDOOR SEATINGGARDENSFORESTED AREAVITAL SPACES FOR HEALINGENVIRONMENT AS MEDIATION - PROGRAMMING35 36GASTOWN CHILD CARE CENTREActon Ostry Architects | Vancouver, Canada-Located atop a parking garage-Prefabricated, PassiveHaus certified-Study of parking garages done by City of VancouverGASTOWN CHILD CARE CENTRELocation: Vancouver, CanadaArchitect: Acton Ostry ArchitectsProject Year: Not yet builtThe set of two pre-fabricated buildings will be located on top of an existing parking garage in Gastown, Vancouver. They are LEED v4 Gold certified, and will achieve Passive House designation.83 A study was done of the existing parking garages in Gastown to establish that the rooftop would be able to withhold the weight of additional buildings. 83  “Gastown Child Care Centre,” accessed May 11, 2020, https://www.actonostry.ca/project/gastown-child-care-centre/.Figure 21: Gastown Child Care Centre37 38DANBURY HOSPITAL NICU ROOF GARDENDirtworks Landscape Architecture | Danbury, USA-Plantings create distinct regions within landscape-Transparency and transition between the interior and the exterior-Oasis from the busy NICU environmentDANBURY HOSPITAL NICU ROOFTOPLocation: Danbury, USAArchitect: Dirtworks Landscape ArchitectureProject Year: 2013This 4000 square foot roof garden accommodates patients and doctors and allows them to experience a reinvigorating atmosphere close to the NICU environment.84 It seamlessly blends the interior and exterior spaces through a sense of transparency and also provides different regions through a variety of plantings.84  “Danbury Hospital NICU Roof Garden,” Dirtworks Landscape Architecture, PC, accessed May 11, 2020, http://dirtworks.us/portfolio/danbury-hospital-nicu-roof-garden/.Figure 22: Danbury Hospital NICU Rooftop39 40MAGNETEN SENSORY GARDENMASU Planning | Frederiksberg, Denmark-Engages multiple senses—an olfactory, tactile, and visual experience-Elevated on a rooftop above a parking lotMAGNETEN SENSORY GARDENLocation: Frederiksberg, DenmarkArchitect: MASU PlanningProject Year: 2017Magneten provides treatment for adults with physical and mental disability.85 The garden, hovering on top of a parking lot, allows for a garden which engages most of the senses-- olfactory, tactile, and visual. 85  “SENSORY GARDEN MAGNETEN,” MASU Planning, accessed May 11, 2020, https://www.masuplanning.com/project/sensory-garden-magneten/.Figure 23: Magneten Sensory Garden41 42SCANDINAVE SPA VIEUX-MONTREALSaucier + Perrotte Architects -Relaxing atmosphere and environment through use of water, light, and furnishingsSCANDINAVE SPA VIEUX-MONTREALLocation: Montreal, CanadaArchitect: Saucier + Perrotte architectesProject Year: 2009The spa aims to engage all senses through the use of water, furnishings, and lighting to create a holistic healing environment for all visitors.Figure 24: Scandinave Spa Vieux-Montreal43 44MORI BUILDING DIGITAL ART MUSEUMteamLAB -Immersive and engaging atmosphere through the use of light and projectionsMORI BUILDING DIGITAL ART MUSEUMLocation: Tokyo, JapanArchitect: teamLABProject Year: 2018This museum hosts designs by a plethora of artists who are able to create an immersive environment through the use of compelling projections.Figure 25: Mori Building Digital Art Museum45 46ZOOM VIDEO CALLS-Calls that foster online interaction and a sense of community with enhancements through virtual backgroundsZOOM VIDEO CALLSZoom video backgrounds allow for virtual environments which foster a sense of community in a unique manner. Figure 26: Zoom Video Call47 48Figure 27: Location PlanDESIGN PROPOSALSituated in the bustling downtown Vancouver, British Columbia, Canada, elevated on the top storey of a parking garage, the complex of buildings interspersed throughout a garden imagines a new, reinvigorating atmosphere.The site is located on a 4-storey parking garage at the intersection of Cambie Street and West Pender Street. Notable nearby buildings include the Vancouver Community College and the Vancouver Film School, as well as apartments atop commercial spaces.  The site is surrounded by housing, educational buildings, and offices that attract and accommodate youths such as offices and commercial spaces.49 50Figure 28: Site PlanSITE CONTEXTVANCOUVER COMMUNITY COLLEGE DOWNTOWN CAMPUSSTANTEC OFFICESFATBURGER RILEY’S PRINT SHOPOFFICESCHILD & FAMILY SERVICES OFFICESAARM DENTAL GROUPAPARTMENTSSTANTEC OFFICESFATBURGER RILEY’S PRINT SHOPPARKING GARAGESTADIUM-CHINATOWN STATIONCHAMBER RESTAURANTOFFICESghijThe site is surrounded by housing, educational buildings, and buildings that attract and accommodate youths such as offices and commercial spaces. DEVIL’S ELBOW RESTAURANTJ M CAFOFFICESAPARTMENTSabcdefApartmentsOffices/CommercialEducational FacilitiesPark/Other Figure 29: Site Context51 52SITE CONTEXTTHE DIRTY APRON COOKING SCHOOLAPARTMENTSSTANTEC OFFICESFATBURGER RILEY’S PRINT SHOPApartmentsOffices/CommercialEducational FacilitiesPark/Other The site is surrounded by housing, educational buildings, and buildings that attract and accommodate youths such as offices and commercial spaces. klmnoIT GLUE SOFTWAREOFFICESWORKSHOP SALONOFFICESPOSH LASH BEAUTIQUEAPARTMENTSTHE PINT RESTAURANTLOTUS HOTELAPARTMENTSCLUB ROW GYMAPARTMENTSqrstARCHITECTURAL INSTITUTE OF BRITISH COLUMBIAVANCOUVER FILM SCHOOLpSUSHI RESTAURANTOFFICESAPARTMENTSVICTORY SQUARE PARKuKEY SURROUNDINGSVANCOUVER FILM SCHOOLVANCOUVER COMMUNITY COLLEGE DOWNTOWN CAMPUSApartmentsOffices/CommercialEducational FacilitiesPark/Other These identified buildings provide the most important amenities in relation to youths that will utilize the treatment centre. APARTMENTSVICTORY SQUARE PARKFigure 30: Site Context (Continued) Figure 31: Key Surroundings53 54SURROUNDING VIEWSN-WS-WS-EMany towering and iconic buildings are visible from the site at its corners. 12354N-EN6N-WN-W VIEW TOWARDS THE MOUNTAINS6Figure 32: Surrounding Views Figure 33: N-W View Towards the Mountains55 56VIEWS TO SITE FROM SURROUNDINGSN7N-E8E9WS1011N-W12The site is visible from many of the surrounding tall buildings, and thus should be visually appealing.7AM 8AM 9AMSUMMER SOLSTICE5AM 6AMThere is an abundant amount of light during summer months.12PM 1PM 2PM10AM 11AM5PM 6PM 7PM3PM 4PMFigure 34: Views to Site from Surroundings Figure 35: Summer Solstice57 58  9AM 10AMWINTER SOLSTICE 12PM 1PM11AM3PM 4PM2PMDaylighting in winter months presents a challenge due to the proximity and height of nearby buildings.8AMFigure 36: Winter Solstice1510mABCDEFGHIJKLMNWelcome FoyerConsultation StationPlaygroundThe ForestMountain View RoomReflection PondTherapy PodsExit StairsLavender RoomViewing StairsWorkers’ LoungeExit Stairs/ElevatorCanopyViewpointA-AA-AB-BB-BC-CC-CROOF PLANABCFHJLDEGIKMNFigure 37: Roof Plan59 60Level 2A-AA-AB-BB-BC-CC-C1510mPLAN E-W SECTION A-A 1510m15mWelcome Foyer Lavender RoomB-B C-CB-B C-CFigure 38: Plan Figure 39: E-W Section A-A61 62N-S SECTION B-B 1510m15mWorkers’ LoungeA-AA-A PODS SECTION C-C 1510m15mTherapy Pods Mountain View Room Workers’ LoungeA-AA-AFigure 40: N-S Section B-B Figure 41: Pods Section C-C63 64NORTH AXONOMETRIC VIEW SOUTH AXONOMETRIC VIEWFigure 42: North Axonometric View Figure 43: South Axonometric View65 66VIEW OF THE WELCOME FOYER VIEW OF THE LAVENDER ROOMFigure 44: View of the Welcome Foyer Figure 45: View of the Lavender Room67 68VIEW OF THERAPY PODS VIEW OF WORKER'S LOUNGE Figure 46: View of Therapy Pods Figure 47: View of Worker’s Lounge69 70WELCOME FOYER LOOKING TOWARDS MOUNTAINS EXPERIENTIAL PODSFigure 48: Welcome Foyer Looking Towards Mountains Figure 49: Experiential Pods71 72ILLUSTRATIONS CREDITSFigure 1: Illustration by authorFigure 2: Photograph by Peter BennettFigure 3: Photograph by Peter BennettFigure 4: Photograph from JDS ArchitectsFigure 5: Illustration by Bjarke Ingels Group and JDS ArchitectsFigure 6: Photograph from JDS ArchitectsFigure 7: Photograph from JDS ArchitectsFigure 8: Illustration by Woods BagotFigure 9: Photograph by Ethan RohloffFigure 10: Photograph by Trevor MeinFigure 11: Illustration by CREO ARKITEKTER A/S and WE ArchitectureFigure 12: Illustration by CREO ARKITEKTER A/S and WE ArchitectureFigure 13: Illustration by CREO ARKITEKTER A/S and WE ArchitectureFigure 14: Illustration by PLH arkitekter, FRIIS & MOLTKE ArchitectsFigure 15: Illustration by PLH arkitekter, FRIIS & MOLTKE ArchitectsFigure 16: Illustration by PLH arkitekter, FRIIS & MOLTKE ArchitectsFigure 17: Photograph by Lars MortensenFigure 18: Photograph by Lars MortensenFigure 19: Photograph by Madeleine Sars. EindhovenFigure 20: Photograph by Madeleine Sars. EindhovenFigure 21: Illustrations by Acton Ostry ArchitectsFigure 22: Photographs by Mark WeinbergFigure 23: Photographs by Kristine Autzen, Illustration by MASU PlanningFigure 24: Photographs by Marc CramerFigure 25: Unknown authorFigure 26: Illustration by authorFigure 27: Illustration by author Figure 28: Illustration by authorFigure 29: Illustration by authorFigure 30: Illustration by authorFigure 31: Illustration by authorFigure 32: Illustration by authorFigure 33: Illustration by authorFigure 34: Illustration by authorFigure 35: Illustration by authorFigure 36: Illustration by authorFigure 37: Illustration by authorFigure 38: Illustration by authorFigure 39: Illustration by authorFigure 40: Illustration by authorFigure 41: Illustration by author Figure 42: Illustration by author73 74Figure 43: Illustration by authorFigure 44: Illustration by authorFigure 45: Illustration by authorFigure 46: Illustration by authorFigure 47: Illustration by authorFigure 48: Illustration by authorFigure 49: Illustration by author75 76BIBLIOGRAPHY“An Escape in the City.” World Architecture News. 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