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Problem Statement

Population growth, changes in our population’s profile and associated increases in demand for services threatened to overwhelm the adult Acute Mental Health Unit’s capacity and capability.

The old facility was substandard and constrained service models. It also had a limited viable life, due to issues with the building (it was a leaky building) and was unable to support the requirements of future demand. The poor standard of the building had been highlighted through independent reviews and internal technical reports since 2009. By 2012/2013, the occupancy levels were consistently over 95%, creating significant service and workforce pressures, and potential risk of service user and staff harm.  

What are we trying to achieve?

Our goals are to create a hospital setting that provides the support and security required by our service users. It must also be attractive, comfortable and welcoming. While safety is a foremost concern, it is also essential that the building does not appear cold and institutional. It needs to provide a setting that fosters mental health recovery, offering access to the outdoors, privacy, and places to relax and compose one’s thoughts.

We also wanted to ensure that whanau and families were offered an environment where family members of all ages could safely and comfortably visit or meet.

It was also recognised that hospitalisation in a Western medical setting can be particularly frightening and off-putting for many Maaori and Pacific service users and their whanau and families; the new environment needed to reflect awareness of their cultural needs and respect for their heritage.

What have we done?

A comprehensive co-design initiative was undertaken to inform the planning for a new mental health hospital. This included meetings with numerous stakeholder groups – service users, family and whaanau members, nurses, clinicians, support staff, police, administration, Maaori advisors, and community members of diverse ethnicities. The planning group traveled to contemporary mental health hospitals to see their designs, and to talk with their staff and administration about successful aspects of the design and things they would like to have changed.

After a painstaking design process, building of the new hospital started in 2016. Because the new hospital was to be built on the site of the existing Tiaho Mai hospital, it was decided to demolish one half of the old building, relocating one of the wards to the main hospital, and to build one half of the new structure. Once completed, the remaining half of the old hospital could be vacated to the new building and construction of the second half of the new hospital could commence.

The first half of the building was completed in November 2018. Staff participated in extensive training in order to learn how to use the new safety features in the building. Service users moved to the first half of the new building on 6 December 2018.

What did we find?

The new Tiaho Mai is a beautiful, modern building that is welcoming to service users, staff, and whanau and families. One of the two principal entries is through our whare, Nga Whetu Marama. The whare is used for new admissions and whaanau meetings, service user activities, and specific staff functions. It is adjacent to the whare kai. Maaori and Pacific patterns and design are integrated into the interior spaces and furnishings. Multiple rooms and meeting areas, having varying amounts of space and privacy, are available to service users and their visitors. These are accessible from the public spaces of the building, so that visitors do not need to enter the inpatient units and the privacy of the service users is preserved.

Many safety features on the unit protect the service users and allow the staff to discreetly monitor their safety. The floor plan is open, with centrally located courtyards that are surrounded by windows to allow staff to easily see all corridors and doorways. Rooms are equipped with magnetic blinds, door-top pressure sensors, soft break-away privacy screens in the bath, and ligature-free fixtures. Nurses work at large interactive hubs in the central part of the unit, allowing for informal discussion and assessment of service users.

How did we make a difference?

At the most basic level, everyone who uses the new hospital benefits from its beautiful design and serene atmosphere. At a more analytic level, we have had concrete evidence of the effectiveness of the new safety features in the form of decreased aggressive episodes and seclusion, and prevention of several suicide attempts on the unit.

Where to from here?

Demolition of the remaining half of the old Tiaho Mai and construction of the second half of the hospital began in May 2019. This work is projected to be completed in September 2020. Already, a number of groups from other sites in New Zealand and Australia have visited the new hospital to learn about our design process. Feedback from service users and their whanau and families has been overwhelmingly positive. We are so pleased to be able to offer them this exceptional environment for their healing and recovery.

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