AR_Manalo, Krishna Joy G.-Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital (2).pdf

Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital MANALO, KRISHNA JOY G. 2002103121

12/18/2012

MAPUA INSTITUTE OF TECHNOLOGY School of Architecture, Industrial Design, and Built Environment

Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital AR 200 - Thesis Research Writing

BY

Manalo, Krishna Joy G. 2002103121 12/18/2012

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Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital MANALO, KRISHNA JOY G. 2002103121

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12/18/2012

Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital MANALO, KRISHNA JOY G. 2002103121

12/18/2012

ACKNOWLEDGEMENT This dissertation would not have been possible without the guidance and the help of several individuals who in one way or another contributed and extended their valuable assistance in the preparation and completion of this study. First and foremost, my utmost gratitude to Arch. Christina G. Ealdama for her exemplary guidance, monitoring and constant encouragement throughout the course of this thesis; The Administrators of the Faculty of Architecture Mapua Institute of Technology, for their untiring effort in encouraging the teaching staff to pursue professional growth; For the unwavering moral, emotional and financial support of my family, friends and colleagues; Above all, the omnipresent God, for answering my prayers and giving me the strength to plod on despite mu constitution of wanting to give up and throw in the towel, thank you so much Dear Lord.

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Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital MANALO, KRISHNA JOY G. 2002103121

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Abstract

This research studied how environment both built and natural effects can be used as a tool to create a comfortable and therapeutic setting that can promote better recovery and psychological growth for the mentally ill.

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Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital MANALO, KRISHNA JOY G. 2002103121

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TABLE OF CONTENTS Abstract……………………………………………………………………………………………4 CHAPTER I ..................................................................................................................................... 8 1.1

Introduction ......................................................................................................................... 8

1.2

Background of the Study ....................................................................................................... 8 Table 1. .......................................................................................................................... 9

1.3

Statement of the Problem .................................................................................................. 10

1.4

Project Goals, Objectives and Strategies ............................................................................. 10

1.5

Significance of the Research ............................................................................................... 11

1.6

Review of Related Literature and Studies ............................................................................ 11 1.6.1

Different Types of Mental Illnesses and their Treatment Process .................. 11

Table 2. Types of Mental Illness and their treatment according to Comprehensive Reviewer for Nursing Licensure Examination by Leonora N. Reyes, RN and Ma. Estella M. Layug, RN, 2009 ...................................................................................................... 15 1.6.2 Patients,

The Effect of the Built and Natural Environment in Mental Health Units on Staff and Visitors ................................................................................... 18

Table 3. ........................................................................................................................ 19

1.7

1.6.3

Psychiatric Rehabilitation .............................................................................. 21

1.6.4

Healing Environment in Psychiatric Hospital Design ...................................... 25

Theoretical Framework ....................................................................................................... 28 Fig. 1 ............................................................................................................................ 28

1.8

Research Methodology ....................................................................................................... 29 1.8.1

Oral Investigation .......................................................................................... 30

Fig. 2 ............................................................................................................................ 30 Table 4. ........................................................................................................................ 34 Table 5. ........................................................................................................................ 35 1.8.2

Case Study of Mariveles Mental Hospital ...................................................... 35

Fig. 3 ............................................................................................................................ 36 Fig. 4 ............................................................................................................................ 36 Fig. 5 ............................................................................................................................ 37

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Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital MANALO, KRISHNA JOY G. 2002103121

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Fig. 6 ............................................................................................................................ 37 Fig. 7 ............................................................................................................................ 38 Fig. 8 ............................................................................................................................ 38 Fig. 9 ............................................................................................................................ 39 Fig. 10........................................................................................................................... 39 Fig. 11........................................................................................................................... 40 Fig. 12........................................................................................................................... 41 Table 6. ........................................................................................................................ 41 Fig. 13........................................................................................................................... 42 Table 7. ........................................................................................................................ 42 Fig. 14........................................................................................................................... 43 Fig. 15........................................................................................................................... 43 Fig. 16........................................................................................................................... 47 Fig. 17........................................................................................................................... 48 1.8.3

Case Study of Yuli Veterans Hospital ............................................................. 49

Fig. 18........................................................................................................................... 50 Fig. 19........................................................................................................................... 52 Fig. 20........................................................................................................................... 53 1.8.4

Case Study of Metro Psych Facility ................................................................ 54

Fig. 21........................................................................................................................... 56 1.9

Scope and Limitations of the Study ..................................................................................... 57

1.10 Definition of Terms ............................................................................................................. 57 CHAPTER II .................................................................................................................................. 58 2.1

Rationale ............................................................................................................................ 58

2.2

Summary of Findings .......................................................................................................... 58

2.3

Recommendations for Application ...................................................................................... 58

CHAPTER III ................................................................................................................................. 60 3.1

Site Profile and Analysis ...................................................................................................... 60

3.1.1 Setting the Criteria.............................................................................................................. 60 3.1.2

Description of Site Options .......................................................................... 60

Fig. 22 Map of Bataan .................................................................................................. 60 3.1.3 Site Selection and Justification ............................................................................................ 61 Fig. 23........................................................................................................................... 62

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Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital MANALO, KRISHNA JOY G. 2002103121

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Fig. 24........................................................................................................................... 62 Fig. 25........................................................................................................................... 63 Fig. 26........................................................................................................................... 63 Fig. 27........................................................................................................................... 64 3.1.5 Rules and Regulations Governing Health Facilities in the Philippines ................................... 64 Table 8. ........................................................................................................................ 69 CHAPTER IV ................................................................................................................................. 74 4.1

User’s Analysis .................................................................................................................... 74 Table 9. Definition of Users .......................................................................................... 74 Fig. 28........................................................................................................................... 74 Fig. 29........................................................................................................................... 75 Fig. 30 Space Zoning ..................................................................................................... 76 Fig. 31........................................................................................................................... 76

4.2

Space Programming ............................................................................................................ 77 Table 10. Space Programming Index ............................................................................ 78

4.4

Concept .............................................................................................................................. 86

4.5

Architectural Drawings ....................................................................................................... 86

Bibliography.............................................................................................................................. 102

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Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital MANALO, KRISHNA JOY G. 2002103121

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CHAPTER I 1.1

Introduction Mental illness is the third most common type of disability in the Philippines according to

National Statistics Office disability survey in 2000. This is highly prevalent among people living in poverty, people with HIV/AIDS, drug addiction or substance abuse and prisoners. Many people with mental health conditions experience severe stigma, discrimination and abuse; they encounter barriers to exercising their civil and political rights; they have limited access to educational program and healthcare facilities; and they are excluded from income-generating and employment opportunities. Since they are highly vulnerable it is crucial that people with mental health conditions are recognized and targeted for development interventions. A psychiatric hospital specializes in the treatment of serious mental disorders. One of the psychiatric facilities in the Philippines is the Mariveles Mental Hospital that was established in 1955. The Bureau of Quarantine donated the 3.8 hectares land and buildings of the old Quarantine Station. It has a 500-bed capacity in Central Luzon located at the seaside town of Mariveles, province of Bataan, about 170 kilometers from Manila. Most of the buildings are scattered around the area. Nursing students are conducting their therapy sessions with the patients seated on mono block chairs under the trees and inside the ruins of the Quarantine Station. The appearance of the wards replicates a prison cell. According to Luz A. Velasco, MD, one of the medical officers in Mariveles Mental Hospital, each ward has 50-70 patients cramped inside and just lay mats during the night to accommodate all.

1.2

Background of the Study Mental illness is any disease or condition that influences the way a person thinks, feels,

behaves, and/or relates to others and to his or her surroundings. The exact cause of most mental illnesses is not known, it is becoming clear through research that many of these conditions are caused by a combination of genetic, biological, psychological, and environmental factors. The prevalence of mental illness in the Philippines is at the average of 11% - 44% (27.5%) or approximately 22, 745,162 from a general population of 84, 241, 341(NSO 2005 estimate) according to DOH records of published studies. However included in the figure are substance related disorders which constitute 18% of 27.5%. If substance related disorder is excluded, the prevalence rate is at 9% or 7.5 million Filipinos are suffering from some form of mental disorder.

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Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital MANALO, KRISHNA JOY G. 2002103121

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Correlating the latter study with an earlier World Health Organization study by Shinfuku (1993) which states: •

About 1% of population suffers from severe mental & neurologic disorders = 842,413 Filipinos* are suffering from severe mental & neurologic disorder –

•

of which 1/3 is estimated to be suffering from psychosis or 280,804 Filipinos

About 5% of population suffers from moderate to mild forms of mental & neurologic disorder or 4,212,067 Filipinos* (*based on 84, 241, 341 population estimate in 2005) The current DOH bed capacity for mental disorder is 5,465. Of these, 4,200 beds are in

the NCR (at the National Center for Mental Health). The rest of the country shares the remaining 1,265 beds (CAR-40 beds, Region II-200 beds, Region III-500 beds, Region XI-200 beds). Regions I, IV, X, XII, CARAGA and ARMM do not have inpatient psychiatric facilities. Only twenty-seven (27) DOH medical centers and regional hospitals have mental health services. Mariveles Mental Hospital caters to seven (7) provinces in Region III and a few outside the region. The statistics shown below were based from the records in Center for Health Development III.

Table 1. Statistics showing number of patients in Mariveles Mental Hospital from JanuaryDecember 2011 based from records in Center for Health Development III

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Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital MANALO, KRISHNA JOY G. 2002103121

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Statement of the Problem The common notion for mental hospitals is a prison for psychotics. Furthermost, there is

a least chance of eventual recovery and discharge in most of the patients who are treated longer in a mental hospital thus the reason of overcrowding the facility. The place for the mentally ill needs to be more humane in order for them to recuperate. The design of a psychiatric hospital and its environment is very crucial to the extent that what might be considered irrelevant can have traumatic effects on patients. It is important to study the different cases of mental disorders treated in a mental hospital, the spaces they require, the everyday routine of the patients and staff in order to easily manage the facility, the effects of fundamental factors such as light, noise, color, equipment, facilities and other physical items present in the environment. This research aims to identify: 

What are the activities and processes inside the mental hospital that should be analyzed in order to design a more effective and easy to manage facility?



What are the strategies and undertakings that can help the patients to be more productive while inside the facility?



How to maximize the potential of the area in terms of bringing extra income to the facility for additional funds without interfering with the safety of the patients and staff inside the facility?

1.4

Project Goals, Objectives and Strategies Project Goal: 

To increase awareness about the effect of the built environment on mental health



To maximize the potential of the vast land of the psychiatric facility by researching on different activities that can be allowed to improve the well-being of the patients that may help them adjust to the community. o

Reintegration of patients with mental illness into society.

Research / Thesis Goal: 

To study how to create a comfortable and therapeutic setting that can promote better recovery and psychological growth for the mentally ill. o

To identify the critical factors needed to be considered when planning a mental hospital.

o

To study cases that is relevant to the project.

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Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital MANALO, KRISHNA JOY G. 2002103121

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Significance of the Research

The physical environment of a mental hospital where treatment occurs has an impact on both the treatment process and its result. Built and natural environments have emotional impact to all those who use it. In the present day, environmental psychologists study how environments affect people and architects who design the facility need to consider how it will affect the users. This study will help not only the patients but also the staff working in the facility. The vast land where the hospital stood can be maximized to its full potential where patients can be trained to their interests that can be used to help them become more productive in the community. Architecture as a tool in the therapeutic process, the design and execution of a psychiatric hospital has a potential to enhance their experience of space, increase their sense of power, build social bonds, & reintegrate them into society.

1.6

Review of Related Literature and Studies

1.6.1

Different Types of Mental Illnesses and their Treatment Process









Mental Illnesses Depressive Disorders Mental disorders characterized by either depressed mood or markedly diminished interest or pleasure in most activities of the day. Associated with any significant weight loss or weight gain, difficulty in sleeping or oversleeping, fatigue or loss of energy, psychomotor agitation and slowness, excessive guilt or feeling of worthlessness, diminished ability to think or concentrate or indecisiveness, recurrent thoughts of deaths, recurrent suicidal ideations. If they alternate with exaggerated elation or irritability, they are known as bipolar disorder (one pole depression, the other pole, elation or mania). The severity of the symptoms that often accompany the depressed mood and the duration of the disorder cause significant distress or impairment in social, occupational or other areas of functioning.

Treatment  There are clear guidelines for the treatment of depressive disorders. These include both antidepressant medications and psychological interventions like cognitive therapy, behavior therapy, interpersonal therapy and family therapy.  Individual: This therapy involves only the patient and the therapist.  Group: 2 or more patients may participate in therapy at the same time. Patients are able to share experiences and learn that others feel the same way, and have had the same experiences.  Marital/couples: This type of therapy helps spouses and partners understand why their loved one has depression, what changes in communication and behaviors can help, and what they can do to cope.  Family: Because family is a key part of the team that helps people with depression get better, it is sometimes helpful for family members to understand what their loved one is

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Proposed Sustainable Redevelopment and Expansion of Mariveles Mental Hospital MANALO, KRISHNA JOY G. 2002103121

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going through, how they themselves can cope, and what they can do to help. Bipolar Disorder  Bipolar disorder, sometimes called manic depression, is a disorienting condition that causes extreme shifts in mood. The length of each high and low varies greatly from person to person.  During a manic phase, patients tend to feel euphoric and may believe they can accomplish anything. This can result in inflated self-esteem, agitation, reduced need for sleep, being more talkative, being easily distracted, and a sense of racing thoughts. Reckless behaviors, including spending sprees, sexual indiscretions, fast driving, and substance abuse, are common.

 Medications are key in helping people with bipolar disorder live stable, productive lives. Mood stabilizers can smooth out the cycle of ups and downs. Patients may also be prescribed antipsychotic drugs and anticonvulsant drugs. Between acute states of mania or depression, patients typically stay on maintenance medication to avoid a relapse.  Talk therapy can help patients stay on medication and cope with their disorder's impact on work and family life. Cognitive behavioral therapy focuses on changing thoughts and behaviors that accompany mood swings. Interpersonal therapy aims to ease the strain bipolar disorder may place on personal relationships. Social rhythm therapy helps patients develop and maintain daily routines.  Friends and family may not understand bipolar disorder at first. They may become frustrated with the depressive episodes and frightened by the manic states. If patients make the effort to explain the illness and how it affects them, loved ones may become more compassionate. Having a solid support system can help people with bipolar disorder feel less isolated and more motivated to manage their condition.

Mental Retardation  A condition of incomplete or halted development of the mind, which is characterized by the impairment of skills as manifested during the developmental period that contributes to the overall level of intelligence (WHO).  Significantly below average intellectual functioning (IQ