The design of environments employed in the care of mentally ill people provides a number of challenges, not least in terms of the windows.
An article in the publication Psychiatric Times makes the point that hospitals that cater for mentally ill patients must be “devoid of means to commit suicide”.
And it goes on the explain: “The most common type of hazard was ligature anchor points, that is, protrusions capable of supporting the weight of a person more than 100 lbs. In the United Kingdom, hanging was the method in 77% of inpatient suicides between 1999 and 2007. The most common ligature points were doors, hooks or handles, windows.”
The specification of the fenestration in mental health establishments is, however, many faceted. Jason Davidson, Technical Sales Director of Crittall Fendor explains:
“Depending upon the type of building and the specific requirements each patient group might have, natural daylight, ventilation, security, anti-ligature, supervision, window operation and control are all considered.”
Unobstructed views onto the exterior spaces are known to aid recovery in some instances and the ability to clean the windows effectively has to be balanced against the need for adequate security. Key to correct choice of window is accurate knowledge of the precise type of patient group that a hospital – or specific wing of a hospital – serves.
For instance, escape through a window is not always one of the main concerns as some patients within the hospital can leave at any time. For others, escape might be a paramount issue.
“For years ventilation had been a problem in hospitals and secure units,” says Mr Davidson. “Any openable windows had to be restrained to stop people either falling out or escaping. Windows were restrained to only allow a 100mm gap. This obviously restricted the ventilation drastically. Now Crittall Fendor have openable windows that allow considerably more ventilation, whilst stopping people escaping through them.”
The company’s CleanVent window has been designed to satisfy these various requirements. The CleanVent is an external sliding window system designed to provide a maximum amount of natural light and ventilation. CleanVent allows the glazing to be cleaned quickly and easily behind a security mesh. The cleaning option within the CleanVent window can be either inward or outward opening which has the advantage of providing an external opening vent on ground floor windows meaning it can be cleaned without disrupting the patient. When installed at higher floor levels an internal opening cleaning option provides ease of access that keeps maintenance costs to a minimum, as no scaffold or platforms are needed externally to reach the window.
Also, the window offers no points at which a ligature – a cord, wire or belt – could be attached by a patient contemplating suicide. The flush frame offers no such points and the window is openable for ventilation by means of a Slipper Clutch – a dial shaped operating mechanism that similarly provides no protrusions for attaching a ligature. The fixture is so called because it is engineered to ‘slip’ repeatedly no matter how often it is turned and therefore cannot be forced to open the window wider than intended.
At a time when budgets are tight facilities managers responsible for mental health institutions are nevertheless keen to see to what extent their buildings can be “future-proofed” to meet ongoing requirements for patient care.
“If future proofing is considered then future risks and forward costs can be reduced,” argues Mr Davidson. “Manual and electric blinds are being used more and more. This is because that are now safe if used within the double glazed units of a window, there is very little maintenance needed and it gives both patients and staff a lot more control over their environment.”
Most important, however, is for building managers to discuss fully with window manufacturers all their requirements at an early stage. “There are advancements being made all of the time, which gives clients more options,” he says. “Getting a full size window demonstration is also very important. By seeing a full size workable sample of a window type you are considering allows you to see each benefit and risk a window has, as well as also being able to feel how it works.”
