The Kingfisher: Revaluating the Norms

This two storey unit will offer inpatient accommodation for up to 10 service users, alongside dedicated spaces for therapy, staff, and facilities management. The design also incorporates two courtyards and a private garden for each bedroom, thereby ensuring that service users can access outdoor space. This initiative is intended to provide a higher standard of care and innovative services for individuals with learning disabilities, autistic people and the local community.

Context
The Southwest of England has been allocated a capital grant of £40.5 million to enhance services for individuals with learning disabilities and autistic people across the region. As of May 2022, approximately 103 adults with autism, learning disabilities, or both, were receiving care within hospital settings commissioned by Integrated Care Boards. Of these individuals, approximately 70% have been placed outside the region, which is suboptimal for several reasons:

• Individuals lose vital community connections, which can diminish their independence and increase their vulnerability
• Many families are required to travel significant distances to visit, which impacts their human rights, particularly the right to family life
• Local community teams, who often have a deep understanding of the individual, lose contact, increasing isolation, reducing the monitoring of expected outcomes, and making it more difficult to support the individual’s treatment plan within the community, ultimately complicating the return to their home.

In response to this critical need, the Avon and Wiltshire Mental Health Partnership NHS Trust commissioned the development of a 10 bed facility as part of a broader community initiative aimed at reducing the overall need for inpatient care. Where inpatient care is necessary, the new unit will:

• Provide acute mental health inpatient care and treatment for individuals with learning disabilities and/or autism closer to their homes
• Improve the care and overall experience for individuals with learning disabilities and/or autism requiring acute inpatient mental health treatment
• Offer a more therapeutic and sensory enriched inpatient environment
• Implement a consistent regional service model designed to deliver positive outcomes for service users
• Establish a clinical pathway that supports better outcomes, strengthens community connections, and reduces the length of inpatient stays through a comprehensive, system wide approach to care delivery.

Design processes
To ensure the proposal meets the requirements of the Trust, the design underwent a comprehensive briefing and co design process over the past two years, leveraging the lived experiences of key stakeholders to inform every aspect of the design, from general spatial adjacencies to the selection of internal finishes. A series of workshops were conducted to identify suitable settings and environments conducive to improving the wellbeing of service users with learning disabilities and autism, with the design team working diligently to address and mitigate these triggers wherever feasible.

Co developed with the broader design team and all relevant stakeholder groups, the design process has proven to be both enlightening and eye opening. A diverse range of methods were employed to collect feedback, each tailored to the specific needs and perspectives of the stakeholder groups involved.

Conflicting briefs
Designing for mental health presents a complex and often contradictory set of requirements. On one hand, the design must be inherently robust, incorporating specific measures such as reduced ligature and ensuring unobstructed sightlines to monitor all service users effectively. These are critical aspects to safeguard the wellbeing of individuals and maintain the overall safety of the space. However, on the other hand, the space must also be conducive to promoting serenity, calmness, and a sense of security, whilst providing a normalised living environment.

The difficulty lies in the fact that these two objectives can sometimes be seen as mutually exclusive. Creating a therapeutic, home-like environment for service users often requires thoughtful consideration of elements such as colour schemes, furniture choices, lighting, and the integration of nature, all of which must be carefully balanced with the need for rigorous safety features.

In our experience, addressing these conflicting requirements can only be successfully achieved through active engagement, open dialogue, and a commitment to collaboration with all relevant stakeholders. Service users, with their firsthand experience, offer essential insights into the psychological and emotional needs of individuals in such environments, particularly in terms of how to foster a sense of normality and comfort within the constraints of clinical requirements.

Methods for engagement
Ryder has developed various methods of presenting information tailored to the diverse needs of service user groups. To make the information more accessible and encourage hands on engagement, we conducted several ‘Post-it’ workshops to gather direct feedback on existing designs. These sessions allowed participants to share their initial impressions spontaneously, using red or green Post-it notes to indicate their views.

This approach proved particularly effective in larger groups with varied personalities, as it encouraged open participation in a non intimidating environment. Due to its success, this method was repeated on multiple occasions, enabling us to gather valuable insights that directly informed the design process.

To assess occupancy levels and the functional suitability of the proposed spatial arrangements, we conducted a series of ‘Day in the Life’ workshops throughout the design process. In these workshops, stakeholders are assigned to represent specific user groups in a variety of scenarios. The primary objective is to determine whether the space allocations made during the briefing phase are appropriately sized and effectively designed for their intended functions.

These strategies have proven particularly successful in engaging service user groups, including those with learning disabilities and autistic people, ensuring their perspectives are effectively integrated into the design process.

Challenging the ideal
As architects we often adhere to conventional design principles associated with aesthetically pleasing and functional spaces. However, extensive stakeholder engagement and collaboration with service users with lived experience highlighted the importance of challenging these norms. The following aspects of architecture were reevaluated on multiple occasions:

Open spaces
The need for smaller, more private spaces was identified early in the design process, underscoring the fact that not all individuals are inclined to seek seating in communal areas for dining or relaxation.

In response, The Kingfisher incorporates a variety of seating options, including:

• Communal dining tables to encourage social interaction,
• Small, quiet dining booths positioned away from the main activity areas,
• Seats facing walls to offer privacy and mitigate peripheral vision triggers,
• Window seats strategically placed around the building to facilitate interaction without direct engagement.

Moreover, large open spaces can exacerbate the spread of noise and odours across multiple areas. During the initial design discussions, it was emphasised that addressing the mitigation of excessive noise and smells was a critical design consideration. Consequently, the decision was made to separate the dining and lounge areas using glazed screens, which effectively block noise and odours while maintaining light flow and sightlines.

Natural light
Natural light is widely regarded as a positive factor in architecture, integral to creating uplifting and open spaces. However, this concept was challenged by service users with heightened sensitivity to light, for whom a brightly lit room does not always evoke a sense of calmness and serenity, as it is traditionally perceived. In response, the design incorporated several tailored solutions, including:

• Adequate shading in the courtyards to prevent communal rooms from being overwhelmed by excessive sunlight
• Opaque glazing on selected windows to reduce natural light intensity while still allowing light to permeate
• Full blackout blinds in quiet rooms, bedrooms, and other sensitive areas to provide the necessary control over light levels.

Less is more
The design establishes a careful balance between minimalist aesthetics and functionality in its interior design approach. Whilst neutral internal design palettes are preferred, clear and informative signage is imperative throughout the layout to ensure that service users can navigate the space without confusion.

In a similar vein, the use of multi purpose rooms was discouraged, as it was observed that ambiguous designations or an excessive range of activities within a single room could potentially be disorienting or distressing for some service users. To address these concerns, the following design strategies were incorporated:

• The integration of colour coded signage throughout the building to facilitate wayfinding
• The precise naming and delineation of each room type, supported by carefully considered furniture and colour selections
• A neutral design palette applied consistently throughout the space, complemented by LED lighting within bedroom furniture, enabling service users to personalise their individual rooms.

Range of choice
Through extensive stakeholder engagement, it became increasingly evident that there is no universal blueprint for designing spaces for individuals with learning disabilities and autistic people, akin to the more standardised designs found in other healthcare settings. Given the wide range of personal preferences and sensitivities that may provoke trigger reactions, a variety of spatial options are offered to accommodate diverse needs:

• Two quiet rooms, one designated for each gender, featuring natural light and views to the courtyard, with blackout blinds provided based on user preferences
• A calm room situated away from the main ward, offering direct views of a garden
• A fully equipped Snoezelen room, designed to provide visual, auditory, and sensory stimuli
• A variety of external spaces, including private gardens, communal courtyards, and an activity courtyard specifically designed for external activities and horticultural gardening.

Visual awareness
Visual awareness was a key design principle from the outset, ensuring clear lines of sight for both staff safety and service user security. It was highlighted that courtyards should only feel inviting if their occupancy is visible from a distance.

• Both courtyards feature large opening windows for direct sightlines, allowing service users to assess the space before entering
• Internal glazing ensures visibility while maintaining privacy

Vistamatic panels in all bedrooms and quiet rooms preserve privacy and dignity while enabling necessary visibility.

Industry partners
Stakeholder engagement extended beyond service users and staff, incorporating the expertise of specialist suppliers in all aspects of the design process. In an increasingly complex architectural landscape, our collaboration with specialist manufacturers has been vital in developing a robust, reduced ligature design. From ligature resistant doors and windows to durable mental health furniture, every element of The Kingfisher unit has been proposed and designed in accordance with stakeholder feedback.

By May 2025, The Kingfisher will have been under construction for approximately one year, with progress advancing steadily in line with the project programme. The contractor, Willmott Dixon, has played a crucial role throughout this process, inputting on buildability, cost and programme aspects, facilitating discussions and collaboration as needed from the initial project stages through to the current construction stage; ensuring the design and customer ambitions for the project will be delivered. With established non negotiable requirements, such as workmanship standards to reduce ligature risks and the specification of materials and products, the collaboration continues throughout the construction phase.

The project is procured through the ProCure23 Framework and the framework design assurance tools such as the Design Appraisal Toolkit have been utilised, further enhancing collaboration and giving reassurance that the design meets the needs of all stakeholders.

As the demand for specialist, purpose built facilities of this nature continue to rise across the country, it has become increasingly apparent that designers must place collaborative design at the forefront of their approach. A successful design process requires not only technical expertise but also a deep understanding of the unique needs of service users and the wider community.

Giving a voice to service users and stakeholders is critical to creating environments that facilitate recovery and promote wellbeing. By actively engaging these groups, designers can better understand the daily challenges and sensitivities faced by those with additional needs. This engagement ensures that the spaces are not only safe and accessible but ultimately creates a space where every individual can feel understood and supported in their journey toward recovery.