Deinstitutionalising mental health: lessons from the design and construction of Highgate East and Lowther Road

Developments in recent years around mental health conditions has begun lifting some of the stigma around mental health, highlighting that mental health facilities should not be peripheral to our communities. This is because service users could one day be any and all of us. NHS figures show that 3.8m people were in contact with services during 2023 to 2024, compared with 2.7m in 2018 to 2019 [1].

NHS providers are seeing more patients needing support linked to financial stress, while housing instability and pandemic related consequences are costing £1.4bn annually. The landscape of mental health care in the UK is undergoing a significant transformation, particularly in London, where new facilities reflect a growing recognition of the importance, of not only clinical care, but environments that are integrated within their communities to support the emotional and psychological wellbeing of service users.

This thought piece explores the key outcomes of an event hosted by Ryder Architecture on 25 September 2024. The event brought together Highgate East replaces ageing facilities at St Pancras Hospital in Camden, offering 78 single ensuite rooms, each designed to provide a therapeutic environment that supports the recovery of service users. This new facility is coproduced with input from service users, carers, staff, and the wider community, ensuring that the design aligns with the needs of all users. voices from clients, architects and contractors, to discuss two case studies designed by Ryder, recently completed for the North London NHS Foundation Trust. The evening was introduced by Mark Carter, a partner at Ryder and specialist for nearly three decades in design for mental health. The discussions centred around the stigma often associated with mental health care, and how the design and placement of mental health services can blur the boundaries between the service and the community, deinstitutionalising and destigmatising mental health services, and ultimately fostering a sense of belonging for service users.

Amongst the panel were Dr Vincent Kirchner, clinical director at North London NHS Foundation Trust; Bev Harrison, design manager at BAM Construction; Marion Wibaux, architect at Ryder; and Victor Muniz, director at Ryder. The two case study projects are the Highgate East inpatient facility designed by Ryder and built by BAM and the Lowther Road outpatient facility designed by Ryder and built by KIER construction.

Their presentations and debate provide insight into the challenges and opportunities involved in designing modern mental health facilities that integrate into their surrounding communities. The aim is to highlight firstly, how the design of the right environments can support recovery and wellbeing in an urban context, whilst meeting, planning and other criteria? And, secondly, how challenges are faced during construction to ensure the original brief requirements are maintained?

Each of the speakers delve into key areas, including the integration of mental health services into the community, the importance of user involvement in the design process, and the role of new technologies and construction methods.

It will also reflect on the potential impact of these modern facilities on the mental health system as a whole, examining how such projects can reduce stigma, improve recovery pathways, and create spaces that truly serve the needs of both individuals and the community. Through these insights, it is hoped to provide more information on these projects, and support others who design mental health services within communities.

Dr Vincent Kirchner, Chief Medical Officer, North London NHS Foundation Trust

We have long recognised the disconnect between what mental health services deserve and what they often get. On the whole, mental health services are often located in dark, unwelcoming spaces, in old buildings that were not designed for mental health care. These spaces can feel like the leftover, forgotten parts of the built environment, and they certainly don’t convey the right message or create the best environment for recovery. It just doesn’t feel very welcoming or very nice.

The building we replaced with the new Highgate East building was an old Victorian workhouse. The very notion of placing people with mental health challenges into a Victorian workhouse is completely out of touch with the message we want to send. It is not the right setting for the care and dignity people with mental health needs deserve.

Old buildings like this are incredibly difficult to adapt for mental health services. Issues like ligature safety become major challenges, and staff have to work relentlessly to ensure that every space is safe. Added to that, people on certain mental health medications struggle with regulating their body temperature, and if you do not have a building with proper temperature control, it becomes uncomfortable for those already vulnerable.

Typically, our wards hold around 18 patients, and when the space is small and shared with strangers, it creates an even more difficult environment. Its often the lowest point in someone’s life, and trying to recover in that setting can be incredibly challenging, not only for the patients but also for the staff trying to manage these services.

Historically, mental health buildings were far removed from society, often out of sight and out of mind, creating a sense that people with mental illness weren’t considered ‘good enough’ to be part of the community, or good enough to be living with other people around you. When we think about what makes a good mental health facility, we look to examples like the f loating hospital in Paris [2,3].

We saw this as a brilliant example of a building that truly benefits its users. What is great about buildings like this is that they are integrated into the community. People walk by, see them, and in doing so, they help remove the stigma associated with mental health. We also came across an inspiring children’s hospital in Belgium, and we felt this approach was something we could emulate for our own facilities. When we look at Highgate East, what’s good about this building is it looks good and it is in the community.

The Highgate East building is not just a functional hospital, it is a place where people feel welcome, and it is situated right in the community. There’s even a café at the entrance, so when you walk into the building, it doesn’t immediately say mental health facility. There’s plenty of natural light, and the space itself is uplifting. You are removing that stigma of mental health. It is a world apart from something like St Pancras. The difference is striking. For people staying in these rooms, it feels far more like staying in a hotel than in a traditional mental health hospital. This is something patients have expressed to us—they feel more at ease in this environment. There is the ability for each service user to control the temperature in their room, or able to control the light coming into the building.

One thing I’m especially proud of is the sports hall in the building (Figure 3)

We fought hard to make sure this space wasn’t cost engineered out of the project. We know that physical health is just as important for mental health, and they are closely linked.

Our physiotherapist is already developing several programmes to improve physical wellbeing as part of the recovery process. Then there is Lowther Road (Figure 4), our community building. It fits seamlessly into its environment and is equally welcoming. There’s so much activity in this building, and the design puts people who use our services at the centre of the experience. A key feature is the focus on consulting rooms. The majority of the building is dedicated to these spaces, and that was a critical decision.

In many of our older buildings, there are only a few consulting rooms, often small. They feel a bit cell like, whereas here, people are in a comfortable environment when they’re coming to access our services.

We still have a long way to go, though. As a large organisation, many of our other buildings are in a poor state of repair. It is an ongoing challenge, but we are committed to improving the environments in which our patients receive care.

Marion Wibaux, Architect, Ryder Architecture

The Highgate East project was a response to a growing need for compassionate, community focused mental health care. The aim was to move away from outdated, institutional approaches and create a space that supported recovery through thoughtful design.

Site challenges
Highgate East is located on Dartmouth Park Hill in Islington, North London. The site presented numerous constraints. Situated within a conservation area, it is surrounded by sensitive contexts, including several Grade II listed buildings, most notably the Neo-Georgian Jenner Building to the south.

The site itself is steeply sloped, complicating both the design and construction process (Figure 5). The location was constrained on every side.

To the north was a line of mature trees that needed to be preserved, while the south faced the Jenner Building. The western edge was bordered by a busy main road, and to the east, the site adjoined Whittington Hospital. Together with Highgate West across the road, these facilities would form a healthcare campus. The topographical challenges were particularly difficult, requiring the design to address the hill, while providing accessible and functional spaces.

Massing and landscape
The massing of Highgate East directly responded to these site constraints. To integrate the new building with its surroundings, the structure steps back as it rises, mirroring the terraced form of the Jenner Building. This approach allowed us to maintain a sensitive relationship with neighbouring properties while creating outdoor terraces on each ward, offering service users access to fresh air and views of the surrounding greenery.

At ground level, the stepped design opened up the space to create a pedestrian boulevard between the new building and the Jenner Building. This space, designed in collaboration with the landscape team, became a breathing area. It softens the urban edge and blends with the wider healthcare campus (Figure 6). On the west facing elevation, the building engages with the main road through an active façade featuring large glazed areas. This houses the café, which provides a welcoming point of entry for visitors and the wider community.

Heritage and aesthetic constraints
Designing within a conservation area brought aesthetic challenges alongside the practical constraints. The Jenner Building, a Grade II listed Neo-Georgian structure, heavily influenced the design approach.

Its proportions and materiality informed the new building’s design language. The brick tone of the new building closely reflects that of the Jenner Building (Figure 7). Window proportions and detailing were carefully considered to echo the Jenner Building’s features. Edge panels were inspired by the Jenner’s staircase treads. All these incorporated subtle connections between the two buildings.

Modern methods of construction (MMC)
The physical constraints of the site necessitated the use of MMC. Prefabricated brick panels were chosen for their efficiency and precision, enabling much of the work to be completed offsite and reducing the impact on the tight site. The prefabrication process involved detailed collaboration to ensure that each panel aligned perfectly during assembly. This approach not only streamlined construction but also allowed a high quality articulation of the design intent.

Balancing safety and comfort
One of the most complex challenges was reconciling the conflicting needs revealed during stakeholder engagement. On one hand, the building had to provide robust, anti ligature safety features to protect vulnerable service users. On the other hand, it needed to feel homely and welcoming to support recovery. The solution lay in carefully zoning the building according to the progressive privacy principle outlined in Health Building Notes (HBN).

Public spaces, such as the reception and café, are located at the front of the building, engaging directly with the street. Moving inward, semi public spaces, including communal dining and lounge areas, create opportunities for social interaction. Finally, the private spaces, including bedrooms, are situated on the quieter eastern side of the building, ensuring service users have peace.

This zoning strategy achieved a balance between openness and seclusion, creating an environment that feels safe without being too restrictive.

Designing for quality of life
The design process was deeply informed by the HBN Quality of Life checklist. Bedrooms are organised into gender zoned areas to promote privacy and safety. Every ward includes direct access to outdoor terraces, ensuring service users have opportunities to connect with nature. Natural light is a recurring theme throughout the building. Large windows and carefully placed openings flood communal spaces with daylight (Figure 8 and 11), creating a sense of openness and connection to the outside world. The open plan dining and living areas exemplify this approach, with uninterrupted sight lines that support both safety and social interaction. These are far removed from the institutional environments of older institutions.

A softer interior design approach
The interior design was developed in collaboration with multiple stakeholder groups, including staff and individuals with lived experience of mental health challenges. The goal was to create a space that felt warm and adaptable, moving away from the stark clinical aesthetic often associated with healthcare environment.

Natural wooden tones were used extensively to provide warmth and texture. Colour was introduced sparingly through painted elements, allowing flexibility for future updates. Furniture was carefully selected to balance safety with comfort. Each piece is robust and weighted for security, but upholstered in fabrics that are soft to the touch and visually appealing.

Ensuring these materials met infection control standards without compromising on aesthetics required significant effort and collaboration. Even transition spaces, such as the lift lobby, were designed with care. Positioned between public and semi public zones, the lobby is bright and airy, creating a natural flow while maintaining clear orientation for users.

Bev Harrison, Design Manager, BAM Construction

I was involved a solid three years of work on the Highgate East project. This wasn’t just another building; it was something special, and we wanted to ensure that the design intent carried through every phase. As the main contractor, we faced unique constraints, but the strength of our early engagement with the design team and stakeholders was key to delivering something remarkable.

Early engagement and design intent
One of the key things which was very important was that we were brought in very early. That’s not something we always get as a main contractor, but it made a huge difference. It allowed us to really understand Ryder’s vision for the building, the key spaces, and what would be critical for the facility at the end of the day. With early engagement with the supply chain as well.

A key document for us was the anti ligature risk profile plan, which became central to our communication—not just with the design team, but with our supply chain too. While some suppliers had experience with mental health facilities, others didn’t, so we used the risk profile plan to ensure everyone understood the requirements from day one.

There was this one line that we always used, and it was so important to convey the project, this was the destigmatisation of mental health. It made it on our induction slides. It was the first thing that people saw when they came onto our site. This was kind of our slogan that we took on board.

Overcoming constraints on a tight site
From a planning perspective, one of the key challenges was delivering a high quality façade within a constrained site. Given the limitations of the space, we opted for a precast façade, which required a great deal of coordination. Traditional construction methods, such as scaffolding and brickwork, were simply not feasible. The tight site made it impossible to surround the building with scaffolding or equipment, so we had to carefully plan our crane positions and deliveries. We had a one way access route in and out of the site, which added more challenges.

To add to the challenge, we had to tunnel underneath a road to access the substation on the other side. This unusual constraint wasn’t fully appreciated by everyone from day one, but because we were involved from the early stages, we were able to work closely with our specialists to navigate these issues.

We brought in a range of consultants and specialists, including MEP experts, who carried out audits on the design. These audits provided valuable advice and asked the right questions, helping both our team and the design team, to give that advice and ask the right questions, just because it was so specialist for all of us.

Collaboration and digital tools
We leant heavily on digital tools throughout the project. The precast façade team modelled every connection detail, which we then federated with the architect, structural engineers, and other specialists.

This wasn’t just about getting things to fit; it was about ensuring the spaces inside remained open and functional while preserving the design intent. We also used the model for fly throughs during inductions and to help our supply chain understand their zones and tasks. It is something we’ll take forward into future projects because it helped everyone—from stakeholders to subcontractors—see the bigger picture. This also helps the facility management to understand what these spaces look like at the end and how we can ensure that there’s enough access for them to be maintained going forward.

Commitment to the specification and quality
A key point is in bringing the design intent through with a focus on the key interfaces. It was a very complex project and just one interface holds many details that a lot of people don’t see once it gets covered up. We were determined not to compromise on the quality of the materials or the design intent, even with the budgetary pressures we faced.

We wanted to honour the choices Ryder, and the specialists had made. Most of the time these products were common to us, but others such as the doors from Kingsway Doors were specialist to a facility like this. The weight of them required us to understand how we have to install them. We were well aware how important the facade was and bringing that in as a piece of quality to the community to invite people into the space, such as the cafe at ground floor.

The specification of doors, for example, were critical to the safety and durability of the facility, and we worked closely with suppliers to make sure they were installed correctly. Every choice we made was about delivering a building that met the needs of the end users while maintaining the quality thread from design to construction. We’d like to think that the client and the design team thought we never compromised on the quality of the materials that were specified, always making sure that we didn’t change it. This is even more key today with the Building Safety Act and having that thread of what was specified and having it still the same at the end. These products have been chosen for a reason by the specialists themselves. Ryder has such a mass experience of mental health. At times, we needed to lean back on them, to get that advice of what is best for this facility.

Stakeholder engagement and COVID-19 challenges
Stakeholder engagement was key in the process, even though COVID-19 added some hurdles. We made sure to involve the right departments at the right time, whether through mock ups, benchmarking, or virtual sessions. The collaboration didn’t stop with stakeholders. Ryder’s team was consistently on site, which made a huge difference.

Seeing those regular faces, being able to have those regular discussions. It is not something we always see, but having that regular open interaction helped our subcontractors feel supported and kept the design intent alive throughout. It is one of the things that I think the team really appreciated the subcontractors really appreciated. So having that relationship throughout the whole three years I was there was key and at the end really spoke for what we delivered. It was bringing everyone on the journey from the beginning right away to the end.

Delivering complexity with simplicity
The facility’s simplicity belies its complexity. Every element, from the shallow service voids— constrained by planning restrictions next to a Grade II listed building—to the intricacies of the precast facade, required careful planning and execution. We held countless workshops to coordinate services and ensure the building was functional and true to the design.

Victor Muniz, Director, Ryder Architecture

As part of the wider St Pancras transformation programme, Lowther Road Community Centre has emerged as a vital outpatient companion to Highgate East. The redevelopment has been an inspiring journey, blending modern design principles with the goal of creating a welcoming, functional, and inclusive space for both service users and the community.

Limitations of the original site
When I first encountered the original site at Lowther Road, its shortcomings were immediately clear. The two storey building, with its modest car park at the rear and fenced in park at the front, lacked both capacity and aesthetic appeal. The bright red entrance door, tucked away and uninspiring, set the tone for the existing building’s overall inadequacy.

Vincent rightly pointed out that this facility simply couldn’t support the Trust’s ambitions for its service users. The structure was outdated and unable to accommodate the modern, integrated services required for effective mental health care. The fenced pocket park, though a green presence, felt isolated rather than inviting. While it provided some greenery, its potential as a communal, welcoming space was unrealised. The decision to demolish the building and start afresh was not taken lightly, but it was the only viable option to align with our aspirations for a community centred hub.

Collaborative design
From the outset, collaboration was at the heart of this project. There was an extensive stakeholder engagement process so the design would meet the needs of everyone involved—service users, staff, local residents, and planners.

Before the pandemic, we held in person workshops, which allowed us to gather detailed input and begin crafting a shared vision. Once COVID-19 struck, the transition to remote meetings enabled us to continue this dialogue.

Key discussions focused on creating an active, community friendly frontage with features such as a café at the entrance, collaboration spaces for shared use, and careful zoning to maintain privacy where required. Feedback helped shape the building’s design, ensuring it aligned with the needs of service users while also enhancing its relationship with the surrounding neighbourhood. At every stage, we worked closely with consultants, including daylight and sunlight specialists, to address the challenges of the site. The limited space required careful planning to balance the project brief with the need to minimise the building’s impact on neighbouring properties. This input was balanced with NHS Health Building Notes (HBN) and best practices in mental health design.

Green spaces
The pocket park at the front of the site was a defining feature from the beginning. Retaining the mature trees was a non negotiable priority, both for planners and for us. These trees not only add character to the site but also play an important role in making the space feel natural and inviting. One of the most transformative changes was removing the fence around the park. By opening it up, we turned this once enclosed area into a vibrant community space. Pathways now guide visitors through the greenery towards the main entrance, which features a fully glazed frontage. This transparency allows the café to be visible from the outside, establishing a welcoming and accessible atmosphere with outdoor seating areas.

Community and privacy
Indoors, the vision of a space that balances openness and privacy came to life. The ground f loor is a hub for community interaction, with a spacious reception area, a café, and group rooms designed for flexibility. These group spaces can be adapted to suit different activities, thanks to folding doors that allow for customisable layouts. We introduced a colour coded wayfinding system, assigning a distinct colour to each floor to help visitors navigate the building with ease. This system incorporates inclusive elements such as Braille signage.

Privacy was a central concern, particularly for spaces dedicated to interviews, counselling, and treatment. To maintain dignity for service users, these areas are located on the upper floors, away from the more public ground floor. The transition between public and private spaces was carefully designed to feel natural and intuitive.

On the second floor, where the designated colour is purple, interview rooms and treatment spaces have more natural light. This creates a calming environment for staff and service users. Separate waiting areas for each cluster enhance the sense of privacy and comfort. Planning and design Navigating the planning process was not without its challenges. The constrained site, with its neighbouring properties and existing trees, required us to be innovative and collaborative. We worked closely with local authority planners, engaging in multiple rounds of consultation to refine the design and address concerns.

Dedicated spaces for staff
The third floor is reserved for staff, providing spaces that prioritise functionality and wellbeing. Open plan offices, meeting rooms, and a ‘refresh zone’ offer a variety of settings for work and relaxation. The addition of a roof terrace gives staff access to outdoor space for breaks—a feature that contributes to a healthier, more balanced work environment. Every detail of this floor has been designed with care, from the layout of the workspaces to the inclusion of private meeting areas. These touches recognise the importance of staff wellbeing in delivering care.

Planning and design
Navigating the planning process was not without its challenges. The constrained site, with its neighbouring properties and existing trees, required us to be innovative and collaborative. We worked closely with local authority planners, engaging in multiple rounds of consultation to refine the design and address concerns.

The massing of the building was carefully developed to minimise overshadowing and maintain harmony with the surrounding environment. This iterative process involved detailed analysis and input from a range of specialists, ensuring that the final design struck the right balance between functionality and sensitivity to its context.

Conclusion

These projects embody a shift towards creating spaces that prioritise inclusivity, functionality, and community, especially in the context of mental health recovery. All those contributing to the event have emphasised the importance of stakeholder engagement throughout the design process. This collaborative approach ensured that service users, staff, and local communities all had input, resulting in facilities that meet the unique needs of those they serve.

A central theme across the projects, as pointed out by both Victor and Marion, was the balance between functionality and aesthetics. Integrating elements such as natural light, garden spaces, and open designs, the aim was to foster an environment conducive to mental health recovery. For example, at Lowther Road, Victor highlighted the transformation of a previously enclosed pocket park into an open, welcoming space, reinforcing the connection between the facility and its neighbourhood. The idea was to not only enhance the environment but also create a sense of place. At Highgate East, Marion explained how the building’s massing and materiality created a relationship between the old and new, heritage and physical context.

Privacy and zoning were crucial considerations in both projects, with both Marion and Vincent stressing the need for a seamless transition between public and private spaces. Progressive privacy principles ensured that spaces like the café and reception area were easily accessible, while areas dedicated to treatment and rest were kept secluded to maintain dignity and comfort.

Modern methods of construction (MMC) played an essential role in addressing the site constraints of both projects, as Victor and Marion explained, with the application of digital tools highlighted by Bev. Prefabricated brick panels were employed at Highgate East allowing much of the construction to be completed offsite.

Along with early contractor engagement, this minimised disruption, met tight deadlines, and aided quality control.

The sensitivity to the surrounding environment was another vital aspect Victor highlighted, recognising the importance of integrating the new buildings into their respective contexts.

At Highgate East, Marion explained how the building’s massing and materiality created a relationship between the old and new, heritage and physical context.

Staff wellbeing was also a key focus in the designs. Dedicated areas such as roof terraces and refresh zones were incorporated into both Lowther Road and Highgate East, offering spaces for staff and service users to rest and have a biophilic connection.

Finally, the involvement of staff and service user experience was integral to shaping the design, with focus on using natural materials where possible and creating adaptable layouts. This resulted in spaces that contrast traditional institutional aesthetics.

These projects demonstrate how innovative thinking, stakeholder collaboration, and sensitivity to context can result in spaces that are not only functional but also compassionate, inclusive, and supportive of mental health recovery pathways.

References

1 NHS. England’s NHS mental health services treat record 3.8m people last year. 2024 10 October [cited 2024 13/11/2024]; Available from: https://www.england.nhs.uk/2024/10/ englands-nhs-mental-health-services-treatrecord-3-8-million-people-last-year/

2 Goldszal, C. Aboard the Adamant in Paris: A special approach to psychiatry. 2023 20 April [cited 2024 14/11/2024]; Available from: https://www.lemonde.fr/ en/m-le-mag/article/2023/04/20/aboardthe-adamant-in-paris-a-special-approach-topsychiatry_6023574_117.html

3 Oltermann, P. ‘I’d be a wreck without it’: the f loating daycare centre where Parisians paint, dance and heal. 2023 2 November [cited 2024 14/11/2024]; Available from: https://www. theguardian.com/film/2023/nov/02/nicolasphilibert-on-the-adamant-paris