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YOUTH MENTAL REHABILITATION COMPLEX:

PREPARING YOUTHS WITH MENTAL DISABILITY IN THE


MAINSTREAM SOCIETY THROUGH SELF-RELIANT FACILITY

A Thesis Presented to the


School of Architecture, Industrial Design & the Built Environment
Mapua Institute of Technology

In Partial Fulfillment of the Requirements in Architectural Design 11/ AR200/ AR200S


for the Degree of BACHELOR OF SCIENCE IN ARCHITECTURE

Presented by
Cabangunay, Vergel G.
2010121904

Architect Junar Pakingan Tablan, uap, MSAE


Adviser

DECEMBER 2014

PART I
CHAPTER I.1

GENERAL OVERVIEW

I.1.1.

INTRODUCTION

For the ages 10 to 24 years old, suicide is the third leading cause of death, more
than 90 percent of those are suffering from mental disabilities/disorders. Only one out of every
four of those received professional medications. Parents most common question was where to
go, which leads to the thought of just managing it on their own. Mental disability/disorder is not a
minor problem that can be solved at home. This may lead to being socially unstable, insecurity or
even death. These patients need medical attention through medication and rehabilitation. A good
environment for interaction and self-redevelopment, a place that will help them improve not only
their mental capabilities but also physical, social and spiritual.

Mental rehabilitation for adults is different from youths. Mental disorders like ADHD,
anxiety, depression and substance use disorders are much more common on youths than adults
and need different type of medication approach. Youths age bracket is the most prone to mental
illness compared to other age bracket. Meeting the unique needs of youth is a one factor out of
many, on why they should be separated.

I.1.2.

BACKGROUND OF THE STUDY

The study aims to differentiate the needs and type of facility needed by children and
adolescents from the standard mental hospital. In Philippines, has the only facility where youth
only can get medication are the 28% of outpatient community psychiatric center. There is no inpatient facility that will solely cater the needs of children and adolescents. Not all
disabilities/disorders can be treated by regular check-up in a community center, and all of the inpatient psychiatric hospital in the Philippines cannot provide the unique needs and environment a
youth requires. Which is why, this study aims to provide a specific design standard that will

provide children and adolescents a residential multi-disciplinary facility, where they can get a 24/7
medical supervision. There are certain youth needs that a regular mental hospital lacks like,
education, facilities for other medication like pediatric, a space for privacy, a homey environment
and the like.

I.1.3.

STATEMENT OF THE PROBLEM

Youths and adults have different needs in terms of facilities and environment. Mental hospital
in the Philippines caters all types of age bracket for in-patients. However, the design suggests
that it focuses mainly on the rehabilitation and environmental needs of an adult. Peoples image
of a mental facility is like a detention facility, which is why, relatives never thought of sending the
patient, because of the thought that they are not helping them and just locking them away. Even
though children or adolescents have a psychiatric problem, it doesnt mean we should focus solely
on the mental healing. A child needs for an education, nutrition and other health medication,
social stability, space for privacy and an environment that promotes self-reliance and interaction
should also be prioritized which the mental facilities for in-patient in the Philippines fails to
provide. Specific problems that needs to be addressed:
1. Does the mental facility reflect an image of a detention facility?
2. Does the environment appropriate for the specific mental disorders? Or is it just
monotonous?
3. Does it provide a place for privacy; does the hospital promote individual dignity?
4. Does the hospital provide facilities for the special needs of health medication for youths
like pediatrics, educational and physical needs?
5. Does the hospital provide cognitive and physical training for youths?
6. Does the hospital promote interaction with the outside relatives?
7. Does the facility promote self-reliance, do patients move around independently?
8. Does it provide physical, social and spiritual rehabilitation?
9. Does the treatment and the facility adapting to the change in terms of modernization?

I.1.4.

PROJECT GOALS

The main goal of this proposal is to promote self-reliance to the patients, while
rehabilitating mentally and physically without compromising their social, educational and family
interaction in order to prepare them for the mainstream society.

I.1.5.

OBJECTIVES AND STRATEGIES

1. A design character that feels like a home and recreational facility rather than a detention
facility.
2. Space planning promoting freedom and individual dignity without compromising the
security.
3. A calming room that can serve as a private room.
4. Recreational facility that will promote moderate up to hard physical training and cognitive
skills.
5. A highly-technological research center for continuous improvement of rehabilitating
knowledge.

I.1.6.

SIGNIFICANCE OF THE STUDY

Youth mental rehabilitation through self-reliance facility study focuses mainly on 2


parts, analyzing the flaws on the current designs and spatial planning of in-patient mental
facilities in the Philippines and secondly, coming-up with complimentary solutions that will be
developed and used on designing the said facility for children and adolescents.
This study will be helpful to psychiatric medication community, because of how it
addresses the flaws on current in-patient psychiatric facilities, and will also enlighten them
through addressing the issues on why adults and youths with mental disabilities must be
separated. This study will also be helpful on coming-up with a design standard that can be used

for future psychiatric facilities development for children and adolescents, the project aims to be
the first in-patient psychiatric facility for the youths.

I.1.7.

SCOPE AND LIMITATIONS

The scope of the study is children and adolescents age ranging from 8 to 20 years
old. The study will include analysis of current in-patient psychiatric facilities in the Philippines
focusing on the design and planning flaws on the design standard for mental institution.
The study does not cover any psychiatric facilities for out-patient and day treatment
psychiatric facilities. The study will also not cover the types of medicinal medication and types of
educational development program for children with mental disability, and will focus solely on the
environmental rehabilitation through architecture.

I.1.8.

ASSUMPTIONS

The thesis assumes that children and adolescents undertaking in-patient medical
supervision need different type of environment and facilities than adults, in order to cope-up with
youths unique needs.
I.1.9.

TARGET MARKET

This proposal is a regional Youth mental rehabilitation Facility for both male and
female patients from at least 5 different regions in Luzon. The facility is for ages 5 to 21 years of
age, patients that has a chronic condition that significantly limits his/her social function, a patient
that cannot be treated by outpatient basis. The facility will accommodate all mental disabilities
from minor to crisis stabilization disabilities or patients that inflicts suicidal behavior. It will also
works across all interfaces like education, social care, youth justice, pediatrics and the like.
The Psychological Research Institute will be accessible to professionals on the field of
psychology in the whole country especially the ones specializing for children mental health. And
will have modern and updated facilities like laboratory examination room, observation room and
the like, that will help to improve the medications.

I.1.10.

Review
of
related
literature

Analyze
and make
a report

Cavite
Center for
mental
health site
visit

Submit
manuscripts
to the adviser

Write the
conclusion and
recommendation

CONCEPTUAL FRAMEWORK

Confer
with the
adviser

Review of
studies in the
same field
both foreign
and local

Study the
facilities,
gather
data,
survey, take
pictures and
get the built
plan

National
center for
mental health
in
Mandaluyong
site visit

Study the
facilities,
gather
data,
survey, take
pictures and
get the built
plan

Seek
professional
advise

Analyze
and make
a report

Confer
with the
adviser

I.1.11.

DEFINITION OF TERMS

Person with mental disability - Is a person with mental or behavioral pattern or anomaly that
causes either suffering or an impaired ability to function in
ordinary life (disability), and which is not developmentally or
socially normative.

Medication - Treatment using drugs.

Rehabilitation The restoration of someone to a useful place in society.

Children People age ranging from 3-12 years old.

Adolescent People age ranging from 13 to 20 years old

Mental Hospital/facility - A hospital for the care and treatment of patients affected with acute or
chronic mental illness. Also known as psychiatric hospital.

Self-reliant The ability to move on your own. Independent.

CHAPTER I.2

REVIEW OF RELATED LITERATURE AND STUDIES


I.2.1.

RELATED LITERATURE

Neurologically challenged individuals often have difficulty following environmental


cues. Many cannot distinguish normal visual cues such as exit or restroom signage. Yet careful
attention to way finding and places of transition is crucial to their successful use of environments.

A childs attention span and safe navigation can be greatly impaired by their ability to
distinguish between important and unimportant stimuli. For example, a developmentally delayed
child walking into a classroom may be unable to recognize the space because all the chairs are
pulled out from their desks.
Classrooms, that have too much stimulus on the walls, doors, and desks can create havoc
in a neurologically delayed individuals mind. It becomes difficult for the individual to pay
attention to verbal instruction when there are many things occupying their sight. Therefore, in
areas where learning is essential, modifications should be made to simplify the environment and
reduce the amount of stimuli. This goal is illustrated through the conversion of a childs play room
into a therapy room by simplifying the space. (see photos A and B). The striped, yellow wallpaper
with a primary color border (photo A) was changed to a muted pink (photo B), which has been
shown to be a favorable color for people with learning disabilities. Additionally, all wall hangings
and visual stimuli have been removed or placed out of the view of the child while sitting at the
table. The carpeting was removed due to allergies and a pre-finished hardwood floor was
installed. A 100% wool carpet with jute back for play therapy and floor activities was chosen for
its low toxic, off-gassing (allergy related) attributes.
-

Impications, volume 6 issue 04, A.J Paron-Wildes, 2005

Mentally impaired children must have a different approach in terms of design, in this article they
use classroom as an example, little detail that can affect the learning and comfort ability of a
child, finishes, lighting fixtures and even signages can affect so much on the child learning ability.

In creating outdoor environments for children across the autism spectrum, design
considerations must address a broad range of challenges experienced by this population. Because
many of these challenges are shared by children with related disorders, the issues faced by a
large population of children with special needs can be accommodated with thoughtful, creative,
inclusive design.

One goal of these environments should be to help children apply the lessons they learn in
the classroom to real-world environment, providing them with coping skills outside of the
classroom. However, heightened sensory issues are one of the most common challenges for
children with ASDs. It can be difficult for them to filter the amount of information coming at them
all at once in outdoor, public spaces. Therefore, outdoor environments for this population should
be both comfortable and supportive as they encourage skill-building.
-

Outdoor Environments for Children with Autism and Special Needs, Naomi Sachs,
ASLA and Tara Vincenta, ASLA, 2011

Indoor environment should not be the only focus of the designer, the outside environment of the
building can largely affect the rehabilitation of a child with mental disability. For example, a
garden of a school should be carefully planned and designed, because this is the transition space
of them from indoor to outdoor community.

My design solution focused on providing unique spaces that would give the best possible
experience for residents who come from very difficult situations, as well as promote Mountain
Comprehensive Cares foster care services so that this project might encourage the receipt of
additional funding for projects that arise in the future. The result called for a home that comforts
users with soft, but durable textures, subtle colour, and easy flow of space. The use of natural
light, visual connections to the landscape, colour and a manipulation of space to create a pleasant
uplift to the occupants were integrated into a cohesive design solution. A vision of how the house
was to function was developed early, focusing on the users daily schedule and personal
responsibilities within the house. When space planning, it was necessary to address interactions
between male adolescents and plan for opportunities in which they could engage in community. A
stream words geared to a researched and psychological design response narrowed into three,
becoming the core of my design solution: heal, grow and become. These three words became the
core concept of my design and were translated into three dimensional space diagrams driven by
program requirements from the user. These three words work together, creating programs that

often overlap. They may also operate individually, to define an area of program, unique to itself
and separate from others.
In healing, the child needs views to the outside in an open atmosphere. The child
also needs views to the outside in an open atmosphere. The child also needs areas of intimate,
private space. The design addresses this through personal spaces, such as bedroom, it is also
addressed with a therapy room that can be used for individual sessions, significant as a separate
place of recovery.
In growing, just as a plant needs space, light and flexibility, there are spaces within
the home that offer each of these things. Community spaces on the first level transform from
eating area, to lounge, to places to do homework, create, play games, chat on the back porch, or
play outside. An open landing on the second floor creates new community within the living core.
Here, a glass curtain wall overlooks the first floor and enables a child upstairs to see when their
housemate comes home or when a guest arrives. The design of this wall also enables light to
filtrate upstairs, brings second level monitoring capabilities for staff, and establishes a cohesive
relationship between the once separate two floors. In order to become one needs personal
space, areas to reflect, and opportunities of responsibility. The design addresses this through
adequate bedroom space for each individual equipped with furniture they can call their own.
Responsibilities include gathering personal laundry and linens each week and the potential of
contributing to a community garden on the plot of land behind the home. While activity in the
home is staff-monitored and well-organized, these new programs for space now create safe areas
in which the users have choices in their experiences in the house; a sense of freedom to enjoy
home as they choose.
-

The Design of a Psychiatric Residential Treatment Facility in Wheelwright, Kentucky


Serving Adolescent Males, Jenna Clem, 2011

The basic design concepts like texture, color, light and others must work accordingly in order to
properly rehabilitate in-patient residence with mental disability. The imbalance use of these basic
design concepts can greatly affect the health of the patients. In this article, the writer suggests

that the facility must promote freedom without comprising the patients privacy. Rooms and
spaces must be flexible to make them feel that they are not inside an institution but instead, a
facility to enjoy and learn.

Community-based psychiatric inpatient units


There are 19 community-based psychiatric inpatient units available in the country for a total of
1.58 beds per 100,000 general population. Only 1% of beds are reserved solely for children and
adolescents. Thirty seven percent of admissions are female, while 6% of admissions are
children/adolescents. The diagnoses of admissions to community-based psychiatric inpatient are
primarily from the following two diagnostic groups: schizophrenia and related disorders (63%)
and mood disorders (24%). On average patients spend 69.65 days per admission. The majority
(51-80%) of patients in community-based psychiatric inpatient units received one or more
psychosocial interventions in the last year. All of community-based psychiatric inpatient units
have at least one psychotropic medicine of each therapeutic class (anti-psychotic, antidepressant,
mood stabilizer, anxiolytic, and antiepileptic medicines) available in the facility.
Community residential facilities
There are fifteen community residential facilities, or what is casually referred to in the Philippines
as home-care facility. They are mostly available in urban areas. They provide for a total of .61
beds/places per 100,000 general population. About 3% of the beds in community residential
facilities are reserved for children and adolescents only. Thirty three percent of users treated in
community residential facilities are female and only 2% are children and adolescents. The
number of users in community residential facilities is 1.09 per 100,000 general population.
Mental hospitals
There are two mental hospitals available in the country for a total of 5.57 beds per 100,000
general population. Two percent of these beds are reserved for children and adolescents only.
Thirty eight percent of admissions in mental hospitals are female. The two hospitals are
organizationally integrated with mental health outpatient facilities. The patients admitted to
mental hospitals belong primarily to the following two diagnostic groups: schizophrenia and

related disorders (71%) and mood disorders (18%). The number of patients in mental hospitals is
8.97 per 100,000 general population. The average number of days spent in mental hospitals is
209. Sixty-four percent of patients spend less than one year, 18% of patients spend 1-4 years,
13% of patients spend 5-10 years, and 5% of patients spend more than 10 years in mental
hospitals. Some (21-50%) patients in mental hospitals received one or more psychosocial
interventions in the last year. One hundred percent of mental hospitals have at least one
psychotropic medicine of each therapeutic class (anti-psychotic antidepressant, mood stabilizer,
anxiolytic, and antiepileptic medicines) available in the facility. There has been neither an
increase nor a decrease of number of beds in the last five years. The occupancy rate is about
92%.
Forensic and other residential facilities
In addition to beds in mental health facilities, there are also 400 beds (0.47 per 100,000 general
population) for people committed by courts for confinement in forensic inpatient units. All forensic
beds are located at the National Center for Mental Health. Thirty three percent of patients spend
less than one year, 38% of patients spend 1-4 years, 25% of patients spend 5-10 years, and 4%
of patients spend more than 10 years. There is only one residential facility (with 540 beds)
specifically for people (of any age) with mental retardation. This facility is managed by the
government social welfare service, which now operates beyond its bed capacity. There are six
facilities (250 beds - private and public combined) specifically for people with substance abuse
problems. There is one facility that cares for senior citizens aged 60 and above, both male and
female, who are abandoned, neglected and mostly suffering from dementia.
-

WHO-AIMS REPORT ON MENTAL HEALTH SYSTEM IN THE PHILIPPINES, 2007

The need for a youth in-patient with mental disability is clearly shown through these statistics,
there are no facilities that solely belong to the youth, they share with adults with them in a little
percentage, imagine living in a world where there is only a little to interact with, instead of
rehabilitating this can add to the stress of the patient.

The Philippines have a National Mental Health Policy and spends about 5% of the total
health budget on mental health. The National Program Management Committee of the
Department of Health (DOH) acts as the mental health authority. There are 46 outpatient mental
health facilities available, of which only 28% are allocated for children and adolescents. There are
only four day-treatment facilities, of which 7% of the patients are children and adolescents. There
are 19 community-based psychiatric inpatient units, of which only 1% of beds are reserved for
children and adolescents. There are 15 community residential facilities, known as home-care
facilities, located mostly in urban areas. Approximately 3% of the beds in these home care
facility beds are reserved for children and adolescents, and these age groups comprise 2% of its
patients. There are two mental hospitals available in the country, and only 2% of their beds are
reserved for children and adolescents. There has been no increase in the number of psychiatric
beds in five years. On average, approximately 27 per 100,000 of the general population use these
services. The average length of stay in mental hospitals is 209 days. In each of these facilities
and programs psychotropic medications are reportedly 100% available (WHO AIMS, 2007).

In 2002, the National Mental Health Program (NMHP) was reactivated. They identified the
following four of six areas of concerns to be prioritized: mental disorders, substance abuse,
disaster and crisis management, and women, children and other vulnerable groups. In the
treatment of mental disorders, the NMHP has indicated support for the policy shift from mental
hospital-based psychiatric treatment to community-based mental health care. This integration of
mental health care in general health services proposes, as a first step, the opening up of acute
psychiatric units and outpatient clinics in all 72 government hospitals, and the provision of
psychiatric medications. Budgetary constraints have allowed only 10 hospitals to open outpatient
clinics (Conde, 2004).
-

Child Mental Health in the Philippines, 2013, Consuelo Cagande

Just like the previous article the need for mental facility solely for the youth is shown clearly on
the statistics.

I.2.2.

RELATED STUDIES

RELATED STUDY ( FOREIGN )


Child and Adolescent Mental Health In-patient Unit, Merlin Park, Galway

Architects: MOB Moloney OBeirne

No. of wards: 2

Architects

No. of beds: 20

Location: Taylor Hill, USA

Age: 0-18 years

Year: 2010

MAJOR SPACES:
Sports hall

Childrens unit

Dining Area

Adolescents unit

Conference room

Special care unit

Art therapy

Special care unit garden

Staff room

Clinical support

Catering

Nurse station

Court yard

Games room

Parents apartment

Therapy room

Observation room

Administration

SITE DEVELOPMENT PLAN

SECTION

ELEVATION

The facility is the relocation of St. annes childrens centre from their older location in taylor hill. It
was relocated within the grounds of Merlin Park Hospital. Administration, childrens in-patient,
therapies, adolescent in-patient and special school are the five main functions of the facility.
The goal of the children psychiatric facility is to provide appropriate levels of assessment and
intervention to the children with mental or behavioral problems, in order to attain and maintain a
good state of mental health.
In order to identify specific goals for medication, rehabilitation and recovery, the in-patient and
day patient treatment program will focus on working with children and their families to clearly
apprehend the nature of their problems, in a cutting edge youth mental health programs, striving
to offer a flawless transition between in-patient, day hospital and community services.

FEATURES
1. Facilities were modern, good natural lighting, spacious and well ventilated.
2. Internal glass walls gives a sense of space and light reaches throughout the inside
facilities.
3. Large windows to provide views on the outside landscape.
4. Rooms has a direct access to gardens
5. A sleeping quarter for parents visiting from afar.
6. A very bright atmosphere which can help the patient in a therapeutic sense.

FACILITY COMPLIANCE WITH MENTAL HEALTH ACT 2001 (APPROVED CENTRES)


REGULATIONS 2006

1. DETAILS OF WARDS IN THE APPROVED CENTRE

2. RECREATIONAL ACTIVITIES

3. RELIGION

4. VISITS

5. CHILDRENS EDUCATION

6. CARE OF THE DYING

7. CHILDRENS EDUCATION

8. PRIVACY

9. PREMISES

10. USE OF CCTV

CHAPTER I.3

RESEARCH METHODOLOGY

In this chapter, research design, population and sampling, research instruments used
for data collection will be discussed.

I.3.1.

RESEARCH DESIGN

Case study, Interview and brainstorming research design was used, because its the
most suited to answer the stated problem and purposes of the study.
The case study research is one in which studying the strength, weakness,
opportunities and threats of an existing same facility which can serve as a guide to the study.
Interview and brainstorming research design is in which you gather informations, suggestions,
and other data needed for the study through communicating orally with the professionals, nurses,
maintenance, security and other people which can serve as a stand-in respondents for the target
market which is the mentally-disabled children and adolescents.

CASE STUDY

Administration Building ( Main Lobby )

Administration Building ( Hallway )


Main lobby of the whole complex of NCMH is located at the center. Offices like directors office,
engineering office and other offices are located at this building. Compare to other buildings,
Admin Building are well maintained. Offices are too crowded except the directors office, it was
not photo documented because of privacy.

Outdoor Recreation Facility


This court is located in front of the Administration Building. Outsiders can rent this court to play.
Shade is not provided, which is why it cant be used during the day , if there is too much sun, and

cant be used during evenng because there is no lighting fixtures installed to light the court. It is
very dangerous to use by the patients because the flooring is the same as driveway which is
rough concrete.

Drive way/Walk way going to Childrens Dept.

Drive way/Walk way going to Childrens Dept.

You have to go to Admin Building before going to Children Department. There is no sidewalk
available on the driveway going to the said department. It is also the route to go to outside
recreation activity.

Outdoor signages
There are few outdoor signages around the complex, it is 2.3 m high and little text on every
signages. It is difficult for patients to read which will is not recommended, because the complex
will not be self-reliant.

School for Special Education

Interior of School
The school has only 2 classrooms. Its already deteriorating, and the classrooms plan is like the
normal classroom design. The interior of classrooms was not photo documented because its
locked. The school is used once a week.

Boys Facility (Shang-Rila)

Playground
The playground is located outside of the Shang-Rila and adjacent to porch of the building. The
playground is unusable. According to the nurses its unsafe to let the children play on their own,
because of the risk of injuries and security, flooring is rough concrete, and the equipments are
already deteriorating and full of rust.

Nurse station
Nurse station of the Shang-Rila is Facing the wards and isolation that is divided by rehas. At the
back are nurse locker and doctors office.

Dining Area
Tables and chairs are fixed, made of concrete finished by ceramic tile. Window are made of steel
for protection just like the other windows on the building. Lack of lighting fixtures and high ceiling
make the room dark during the evening.

Kitchen/Storage Area
There is no cabinet available for proper storage of dining wares. The place are very unhygienic
because they just put the utensils and plates on the counter top.

Outdoor View
The landscape surrounding the building is lke forest, a landscape which is not well maintained.
This is also the reason why patients can move around outside because of lack of security.

Fire Exit
Signage on top of the fire exit doors hard to read cause the text are already fading. Fire exit
leads to outdoor landscape.

Indoor Signages
Indoor signanges are placed in top of every door room.

C.R
Window are also made of rehas, high ceiling for the patients safety in case they want to take
suicide. C.R. are dark and cramped.

Girls department ( Zonta )


Zonta is the building for children and adolescents girls.

Zontas Lobby
Zontas lobby are composed of nurse station, waiting are and visitors are. Nurse station are
facing backwards towards the ward which is not favorable to nurse on duty, because they will not
see immediately what the patiens are doing. Visitors area are not private and overlooking to the
wards.

Zontas Social hall

This is the place where they conduct their activities once or twice a week. Furniture like chairs,
tables, blackboards and the like available inside. Flooring is made of ceramic tile, windows are
made of steel bars.

Therapy Room

EXISTING SHANG-RILA FLOOR PLAN

EXISTING SHANG-RILA FLOOR PLAN

AS-BUILT SITE DEVELOPMENT PLAN

A mock facility review under the compliance with administrative order no. 2005-0029
of the DOH for custodial psychiatric care facility. The researcher is the one who scored the
checklist. Summary and recommendation after to prove the scores.

Republic of the Philippines


Department of Health
CHECKLIST FOR REVIEW OF FLOOR PLANS
ACUTE-CHRONIC PSYCHIATRIC CARE FACILITY

Name of Facility: NCMH, Zonta and Shang-rila division


Address: Mandaluyong City
Rate the Condition: 1=excellent

2=good

3=fair

4=bad

*note: unanswered facilities are not available or not visited by the researcher
1 PHYSICAL PLANT
__3__ 1.1 General Administrative Service
_3__ 1.1.1 Waiting Area
__3__ 1.1.2 Information, Reception and Business Office
__2__ 1.1.3 Office of the Administrator
__4__ 1.1.4 Toilet
__4__ 1.1.5 Laundry and Linen Area
__2__ 1.1.6 Garage
__2__ 1.1.7 Supply Storage Area
__3__ 1.1.8 Waste Holding Area
____ 1.1.9 Dietary
__4__ 1.1.10 Dining Area

__3.75__ 1.2 Clinical Service


__3.5__ 1.2.1 Admission, Discharge and Follow-up Unit
____ 1.2.1.1 Admitting and Records Area
____ 1.2.1.2 Consultation Area
__4__ 1.2.1.3 Examination and Treatment Area
___3_ 1.2.1.4 Equipment and Supply Storage Area
_4___ 1.2.2 Nursing Unit
__4__ 1.2.2.1 Private / Semi-Private Room
__4__ 1.2.2.2 Ward
__4__ 1.2.2.3 Observation Room
___4_ 1.2.2.4 Toilet
__4__ 1.2.2.5 Nurse Station with Work Area and Lavatory/Sink
__3.5__ 1.3 Ancillary Service
_3.5___ 1.3.1 Psychosocial Unit
__4__ 1.3.1.1 Indoor Activity Area
__3__ 1.3.1.2 Outdoor Activity Area
2 PLANNING AND DESIGN
__4__ 2.1 Floor plans properly identified and completely labeled
__2.5__ 2.2 Conforms to applicable codes as part of normal professional service:
__2__ 2.2.1 Minimum of two (2) exits, remote from each other, for each floor of the
building
__2__ 2.2.2 Exits terminate directly at an open space to the outside of the building
__4__ 2.2.3 Minimum of one (1) toilet on each floor accessible to the disabled
_3,5___ 2.3 Meets prescribed functional programs:
__2__ 2.3.1 Main entrance of the facility directly accessible from public road
__4__ 2.3.2 Admission, discharge and follow-up unit located near the main
entrance of the facility
__2__ 2.3.3 Separate toilets and wards for male and female patients

__4__ 2.3.4 Nurse station located and designed to allow visual observation of
patient and movement into the nursing unit
_4___ 2.3.5 Toilet immediately accessible from each room in a nursing unit

COMMENT:
The Znnta and Shang-Rila department needs an overall rehabilitation inside and
outside/landscape. They failed almost all of the category especially the nursing unit were the
review is bad. Especially the wards and isolation rooms. Materials on flooring, partitions and
lighting fixtures must be replaced. Rubberized flooring to avoid harm is advisable, prevention of
using rehas as a partition and replacements of broken lighting fixtures. Security of the patients
is also at risk because of the orientation of nursing station.

I.3.2.

POPULATION OF THE STUDY

The target populations of this project are children suffering from psychiatric disorder
from at least 5 regions in Luzon and Visayas, and their families. Professionals, nurses and
students in the field of psychology and neurology specializing in children and adolescents mental
health.
10% of all types of disability in the Philippines are suffering from psychiatric and
intellectual disorders. Central Luzon has a total of 38, 889 residents with disability according to
2010 NSO census age ranging from 0-19. The number of residents suffering from mental and
intellectual disability is 3, 889. 25% of those are treated in community based inpatient,
community residential facilities and mental hospitals or a total of 972 children. The total
population which this proposal will cater according to statistics excluding patients coming from
different regions that may be admitted.

I.3.3.

SAMPLE OF POPULATION

The sample population of this study will be limited to professionals, nurses,


maintenance, security and others using the same facility which can give information regarding the
type and structure if the facility proposed. Numbers of how many are not specified because the
method use is a qualitative research method through interviews and brainstorming. Patients are
not included because of inability to answer question and give information.

I.3.4.

RESEARCH INSTRUMENTS

The researcher firstly scheduled a study visit on a mental hospital, including photo
documentation, interview, site inspection, and getting as-built plans of the facility. Photo
documentation was not allowed on some area especially rooms or areas where there are patients.
Areas like wards are not documented due to this issue. Interview questions was derived from the
stated problems listed on chapter 1.1 statement of the problem, suggestions and reactions on the
proposals were also asked for better improvement of the study. The facility will undergo a mock
facility review under compliance with administrative order no. 2005-0029, checklist for review of
plans, custodial psychiatric care facility.

CHAPTER 1.4:

SUMMARY OF FINDINGS

All of the study: facility case study, interviews, brain storming and photo
documentation were all conducted in the National Center for Mental Health ( NCMH ) except for 1
interview conducted in Philippine General Hospital, children and adolescents in-patient psychiatric
department.

5 people interviewed: 4 nurses and 1 maintenance


SUMMARY:

1. 4 nurses from NCMH agreed that the mental hospital reflects a detention facility
atmosphere because of the materials and design used on partition walls.
2. Patients are not allowed to move around the gardens and landscape areas because of
poor security, the NCMH surrounding are like forest. PGH doesnt have outdoor area for
psychiatric patients.
3. Children in NCMH doesnt have a private room , wards only. PGH facility was not studied.
4. PGH and NCMH provide children their regular health medication, education and physical
exercises needs. However there are flaws, in education on NCMH , there are only 2
classrooms, and the facility was a rubble.
5. Physical activities was provided in NCMH , for boys: Basketball, for girls: Zumba
6. On NCMH the visitors area was just adjacent to wards, so according to nurse its much
better if separated a few meters away or outdoor would be preferred. On PGN there is
none only visit inside the wards.
7. Patients on both hospitals cant move around freely because of security in landscaping
are poor, they only move around the hallway around their wards for those patients that is
already healed and just needs more time.
8. NCMH conducts mass in their gymnasium once a week, social outdoor activity was not
provided.
9. The NCMH facility was not adapting to change in terms of modernization, the facility is
very outdated because of lack of funds.

SUGGESTIONS:
1. Better landscape, but within the eyesight of nurses.
2. Better facility for education.
3. Dayroom and sports complex which is secured for children suffering from mentaldisorder.
4. Dull colors of rooms, neon colors are not advisable because it can trigger patients on
doing something.

5. Rubberized isolation rooms and wards.


6. Much better partition that nurses can se the patient inside, not rehas.
7. Non-skid tiles are advisable.
8. Lighting fixtures that is not that bright in wards.
9. Much better natural ventilation because air-conditioning is not provided.

I.4.1. COLLECTED DATA

INTERVIEWS:
KENNETH CATAPANG
ARISTOTLE TRINIDAD;
NCMH, Shang-rila department nurses.
1. What do you think about the proposal ?
-

It good that the children are separated from adults.

2. Does your facility reflect an detention facility atmosphere?

Yes

3. Does the children have private rooms?


-

No , only an isolation room, and the partition is rehas

4. Do you have facility for pediatrics, educational and physical needs?


- pediatrics=yes
- educational , yes but needs rehabilitation
-physical needs- not really , sports complex are not safe.
5. Do you place dor family visit?
-

Yes, adjacent the wards

6. Do patients move around freely?


-

Yes inside the pavilion, outside no, security is poor.

7. Do you place for spiritual activity?


-

Yes , every Sunday mass at gymnasium.

8. Does the facility adapting to modernization ?


-

No, lack of budget

9. Any suggestions?
-

More safer sports complex

Ideal isolation room

Dull colors finishes

Non-skid tiles

Better landscape

HANNAH SANTOS
JESSA MAE MANZANO
NCMH, ZONTA department nurses
1. What do you think about the proposal ?
-

Better facility for children

2. Does the children felt discomfort if they are surrounded by adults?

Not realy, they are usually separated, they will just meet occasionally for certain
events.

3. What can you say about the education of the children?


-

Under-sped, same room for all

4. What type of physical activities do children do?


-

Zumba, monthly activities

5. Is there any facility you lack that you think is important?


-

Spiritual activity for children

6. What is your common problems inside the facility?


-

Hot, broken lights

7. Is there a need for a modernized psychological research center ?


-

Yes.

8. Suggestions?
-

Better isolation room

Nursing station must see all the wards ( no blind spot )

Light colors

Lighting fixtures that is not to bright

ACEJO CATULANG
PGH, children psychiatric ward department
1. Does your facility reflect an detention facility atmosphere?

Not really

2. Does the children have private rooms?


-

None, restricted because of the facilities

3. Do you have facility for pediatrics, educational and physical needs?


- Pediatrics, yes, doctors maintenance support
- Education, none
- Physical needs, exercise
4. Do you place for family visit?
-

None, ward visit only

5. Do patients move around freely?


-

Yes inside the department, outside is prohibitted

6. Do you have place for spiritual activity?


-

Yes, chael

7. Does the facility adapting to modernization ?


-

Dont know

8. Any suggestions?
-

None

I.4.2.

NEED ANALYSIS

According to WHO-AIMS report on Mental Health Systems in the Philippines back in


2007, there are 19 community-based psychiatric inpatient units in the country, for a total of 1.58
beds per 100,000 general populations; only 1% is for children and adolescents. And a total of 15
community residential facilities in the Philippines or home care facility. They provide a total of
.61 beds per 100,000 general populations; about 3% of the beds are reserved for children and
adolescents. There are only 2 mental hospitals in the Philippines, a total of 5.57 beds per 100,000
general population 2 percent of those are reserved for youths. There has been neither an
increase nor a decrease of number of beds in the last five years. The occupancy rate is about
92%.
Average number of days spent in mental hospitals/facilities in the Philippines are;
64% of patients spend less than a year, 18% of patients spends 1-4 years, 13% of patients
spend 5-10 years, 5% spend more than 10 years. In the U.S the average length of stay in the U.S
is 7.2 days

Luzon has 7 regions; NCR, Bicol, Cagayan Valley, Calabarzon, Central Luzon,
Cordillera and Ilocos. The average patients per region in Luzon are 47 patients/region. The total
population of Luzon according to NSO as of 2010 is 48, 520,774. Number of People with disability
ranging from 0-19 years of age according to 2010 NSO census:
REGION

NO. OF PERSONS

NO. OF PEOPLE

NO. OF PATEINTS

WITH DISABILITY

W/PSYCHIATRIC OR

THAT NEEDS

INTELLECTUAL

TREATMENT IN AN

DISABILITY (10% OF

INPATIENT

PEOPLE WITH

FACILITY (25% )

DISABILITY)
NCR

34, 244

3, 424

856

CORDILLERA

7, 049

705

176

ILOCOS

19, 067

1, 907

477

CAGAYAN

14, 200

1, 420

355

CENTRAL LUZON

38, 889

3, 889

972

CALABARZON

45, 917

4, 592

1148

BICOL

26, 254

2, 625

656

TOTAL

185, 620

18, 562

4, 640

Central Luzon has a total population according to NSO census in 2010 of 10, 137,737.
If we used the information the WHO-AIMS report in 2007 these are the number of beds provided
for children and adolescents treated right now in an in-patient psychiatric facility are as follows:
Community Residential Facilities

.62

Community-based psychiatric Inpatient units

4.81

Mental Hospitals

11.29

TOTAL

16.72

The total number of children and adolescents that needs treatment in an inpatient
facility in Central Luzon Region is 972 youths and the numbers of beds provided for them are only
16.72 beds and this numbers doesnt increase in the last 5 years.
The need for a new Regional Psychiatric Facility is clearly shown in numbers. Only
1.72% of patients that needs inpatient treatment are provided with bed/shelter. Overcrowding in
metal facilities will surely increase more in numbers in the near future, and this facility can help
control those issues especially in Central Luzon and also can provide help for other institutions in
the country.

I.4.3.

QUANTITATIVE ANALYSIS

Total number of patients: 972


))
n=24.6=25 respondents
*The actual questionnaire presented on the respondents

The survey was posted on the website forum of some notable organization for parents of children
with mental disabilities.
The organizations are as follows:
1. Alay sa may mga Kapansanan Association, inc.
2. Birthright Educators Foundation
3. Lingap Pangkabataan, Inc
It is also given to nurses on the NCMH child and adolescents department.

RESULTS OF SURVEY
PROFILE OF RESPONDENTS
1.1. AGE OF RESPONDENTS
AGE

NUMBER

PERCENT

20-29

30-39

22

40-49

13

52

50 and above

20

TOTAL

26

100

1.2. GENDER OF RESPONDENTS


GENDER

NUMBER

PERCENT

Male

11.5

Female

23

88.5

TOTAL

26

100

1.3. NUMBER OF CHILDREN W/ MENTAL DISABILITY


CHILD

NUMBER

PERCENT

21

81

2 or more

19

TOTAL

26

100

1.4. STATUS
STATUS

NUMBER

PERCENT

Single

16

Married

20

78

Widow

TOTAL

26

100

1.5. EDUCATIONAL ATTAINMENT


EDUCATION

NUMBER

PERCENT

Elementary

15

High School

15

58

College

27

TOTAL

26

100

1.6. RELIGION
RELIGION

NUMBER

PERCENT

Catholic

21

82

Christian

14

Iglesia ni Cristo

TOTAL

26

100

PARENTS BASIC KNOWLEDGE


2.1. How sure are you on the disability of your child.

Percentage breakdown
Very Knowledgeable
Knowledgeable
Not Knowledgeable
Don't have a clue

The percentage of respondents answered very knowledgeable that they are aware of
the disability of their child are 83%. Some of the respondents answered; knowledgeable, not
knowledgeable and dont have a clue with the percentage of 12%, 3% and 2% respectively.

2.2. How confident are you that you can control him/her.

Percentage Breakdown
Very Confident
Confident
Not Confident
Strongly Not Confident

The respondents was asked to rate how confident are they that they can stop the
child is the worst case scenario happen. The respondents rated are as follows: Very Confident=
19%, Confident= 11 %, Not Confident= 16% and Strongly Not Confident= 54%.

2.3. How secured are you feeling when he/she is around.

Percentage Breakdowm
Very Secured
Secured
Not Secured
Scared

The respondents were asked if they are feeling some insecurity whenever the patient
is in the surrounding/their home. They are asked to rate it as Very Secured to Scared if they are
very uncomfortable whenever the patient is around. The respondents responds in terms of
percentages are as follows: VerySecured = 2%, Secured = 9%, Not Secured = 34% and Scared=
55%.

2.4. Are you shy about having a child like that?

Percentage Breakdown

Yes
No

The respondents were asked how shy are they to other people knowing they have
relatives with a mental disability. The respondents answers were: 62% said they are shy having a
relative like that while 38% said no.

2.5. How sure are you that he/she will recover.

Percentage Breakdown

Very Sure
Sure
Not Sure
Hopeless

The respondents were asked to rate if they are still hopeful that their child will
recover on his/her disability. This is to identify which respondents are willing to give their child
the prescribed medication of the professional. The respondents were asked to rate how hopeful
are they being 5 as Very Sure/hopeful and 2 as the Hopeless. These are percentage as follows:
Very Sure = 67%, Sure = 28%, Not Sure = 4% and hopeless in 1%.

2.6. How confident are you that an institution/hospital can help him/her.

Percentage Breakdown
Very Confident
Confident
Not Confident
Dont trust

The respondents were asked to rate their confidence/trust they are giving on the
institution or hospitals were their child is confined. The percentage breakdown were as follows:
Very Confident = 67%, Confident = 32% , Not Confident = 1%.

2.7. Do you keep it a secret/ having a mentally disabled child?

Percentage Breakdown

Yes
No

The respondents majority answer was No having an 83% and some of the
respondent answered that they are shy or keep it a secret between family members with a 17%
percentage.

PARENTS INSTITUTION/HOSPITAL SATISFACTION

3.1. Are you still seeking for institution/hospital that will suit the needs of your child?
(if there is already rate how contended are you )

Percentage Breakdown
Very Contented
Contented
Not Contented
Strongly Not
Contented
The respondents were asked to rate how satisfied are they on the current Institution
or hospital were their child is confined. The respondents Percentage Breakdown of answers were:

Very Contented at 43% , 32% answered that they are Contented, not contented parents were
19% of the respondents and 6% of the respondents was Strong not satisfied on the institution or
hospital.

3.2. How confident are you on giving the full responsibilities of your child to the
institution/hospital?

Percenntage Breakdown
Very Confident
Confident
Not Confident
Strongly Not
Confident

The respondents were asked to rate how confident they are on trusting and giving
the institution or hospital the full responsibility over their children. The detailed percentage
breakdowns are as follows: 61% said they are very confident and 39% said confident.

3.3. Do you see it as a detention facility?

Percentage Breakdown

Yes
No

The respondents were asked if they think the hospital or institution as a detention
facility just like a prison. The detailed percentage breakdown are as follows: 38% said yes and
62% answered no.

3.4. Does it provide the needs of your child in terms of facility complimenting his
disability?

Percentage Breakdown

Yes
No

The respondents were asked if they are happy and contented on what they are child
getting in terms facilities provided for them. Thus the facility compliments the needs of different
type of mental disabilities. 91% answered that they think they are getting what are needed for
their child and 9% said that they dont.

3.5. How satisfied are you on the wards and isolation rooms?

Percentage Breakdown

Very satisfied
Satisfied
Not Satisfied
Strongly Not Satisfied

The respondents were asked to rate what they think and probably the patient think
on the wards and isolation rooms provided for them. 31% said that they are Very Satisfied, 42%
are Satisfied, 22% are Not Satisfied and 5% are not Strongly not satisfied.
3.6. Rate how satisfied is you on the education they are giving your child.

Percentage Breakdown

Very Satisfied
Satisfied
Not Satisfied
Strongly Not Satisfied

The respondents were asked if they are satisfied on the education and educational
facilities the patient are getting on their own Institution or Hospital. 42% were Very Satisfied,
18% were Satisfied, 16% were Not Satisfied and 4% were Strongly Not Satisfied.

3.7. How satisfied are you on the facilities provided for physical activities or sports?

Percentage Breakdown

Very Satisfied
Satisfied
Not Satisfied
Very Not Satisfied

The respondents were asked how satisfied are they in terms of physical activities or
exercise, are they provided with the facilities, if yes how satisfied are they. 22% of the
respondents were Very Satisfied, 47% were Satisfied, 27% were not Satisfied and 4% were Very
Not Satisfied.

3.8. How was the place or room intended for you when you visit?

Percentage Breakdown

Very Satisfied
Satisfied
Not Satisfied
Very Not Satisfied

The respondents were asked to rate their satisfaction on the room or place intended
for them when they are visiting the patients, are they happy, are they given enough privacy and
so on. 23% of the respondents were Very Satisfied, 38% were Satisfied, 29% were Not Satisfied
and 10% were Very Not Satisfied on the facility.

3.9. Does it provide spiritual facilities complimenting your religion?

Percentage Breakdown

Yes
No
Doesnt matter

The respondents were asked if the facility intended for spiritual activity are
complimenting to their religion. 57% of the respondents who said Yes are Catholic in majority,
while the respondents that said No are all non-Catholic, the other 25% said that it doesnt matter
whether they are provided with the said facility.

3.10. Can they move around freely? (for the patients near recovery)

Percentage Breakdown

Yes
No

The respondents were asked if the patients near recovery can move around within
the facility and the outdoor environments like gardens, courtyards and other outdoor area. 38%
said that their child can move around freely but not outdoor because of security, the other 62%
said No.

I.4.4.

QUALITATIVE ANALYSIS

INTERVIEW APPROACH
The method used on the interview conducted is combination of the informal
conversational method and the standardized open-ended interview.
The informal conversational method questions flow from immediate context; there is
no predetermination of questions, topics or wordings. This to better understands the needs and
to better express their thoughts on the topic.
Standardized open-ended interview however is a method were the questions you
asked on each of the interviewees are the same, in order and predetermined. This was used in
order to get the informations needed for the research.

INTERVIEW RESPONDENTS
In total, there are 3 qualitative interviews conducted. It was single out to staffs,
because of their familiarity to children and adolescents with mental disabilities department or
institution. Staffs from two different hospitals that has this type of department were visited, the
National Center for Mental Health located in Mandaluyong City and Philippine General Hospitals
Located in Manila City, around the Taft avenue. There are 2 head nurse and 1 maintenance that
was interviewed.

Hannah Santos
Head Nurse, NCMH, Zonta Pavilion

Aristotle Trinidad
Head Nurse, NCMH, Shangri-La Pavilion

Acejo Catulang
Maintenance, PGH, In-patient Psychiatric
Department

SUMMARY OF THE DATA GATHERED

Hannah Santos Interview:


-

She insists on a much better facility because their department was already old and
deteriorating. The education of her patients in terms of facility is not appropriate for them
because it was mostly monotonous, means they only have single facility and type of
education for all types of mental disability of the children. Physical activities like Zumba
(patients in this department are all girls) were conducted on the sports complex. Spiritual
activity was conducted weekly on the indoor sports complex, but a facility solely for
spirituality without compromising the security of the patients is more favorable.
Ventilation is also a big problem on Zonta department, walls are made of concrete on the
bottom and a rehas on top. He also point out the positioning of their nursing station
where it was not directly facing the wards. The materials and finishes was also been part
of the discussion, a neutral paint finish is the most appropriate for this type of facility.
She also point out the use of lighting fixture, she suggest that a dimmer lighting for the
wards just like in a normal bedroom.

Aristotle Trinidad
-

Mr. Trinidad promote their facility because the children and adolescents are separated
from adults unlike in the other facilities. He insisted that the facility has a tremendous
potential which is thrown to waste because of lack of support from the government.
There are various activities for the patients of Shangri-La Department, like therapeutic
and basketball activities which is done in the existing sports complex of the NCMH. Even
though Sports Complex is provided he point out that it would have been better if the
materials used are much safer, he also insisted on a safer dayroom. A visitors room
which is private must be provided. A much better landscaping is highly advisable, unlike
on the existing outdoor areas of the NCMH. Just like Ms. Santos said a dull colors for wall
finish are advisable. A rubberized floor and walls for the ward and isolation room are
preferable if the budget is not limited. He also point out the type of isolation room they
have which is open, it would have been better if its private.

Acejo Catulang

Unlike the previous two interviewees Mr. Catulang is a Maintenance staff of the PGH,
Psychatric Department. Because of it being inside a General Hospital the patients were
restricted inside on their wards only they cannot move around. Adults and Youths are
both on the same department. There is no place for education, physical and spiritual
activities. Visitors are accommodated inside the wards and doesnt have a proper place
for visit where they have privacy.

I.4.5.

CONCLUSION

The data gathered in different types of method was a big help to achieve the main
goal of the proposal which is to promote self-reliance to the patients, while rehabilitating mentally

and physically without compromising their social, educational and family interaction in order to
prepare them for the mainstream society.
Using the review of related literature, gathering of the information needed in order to
prove that the stated problems and significance of the study really exists. Through this review of
articles, books and other literatures, the researcher have now a wide range of view of what is the
facility about and the existing problems other than the problems stated.
Related facilities were studied to become a model facility to better understand the
planning and facilities required and necessary on this kind of facility. The researcher uses 3
methods of gathering informations, which is: interview, survey and case study. The researcher
picked National Center for Mental Health, shangri-la and zonta pavilion to conduct a case study,
the facility was documented through photographs. The researcher conducted survey on the
parents of patients suffering from mental disability. The survey was divided into three parts the
respondents profile, parents basic knowledge and facility satisfaction. The researcher interviewed
three persons 2 nurses and 1 maintenance.
Through this research method that was used to gather necessary informations, and
the data collected, the researcher therefore conclude that problems stated in Chapter 1.1 actually
exist and needed actions.
Specifically:
1. Mental facilities/hospital projecting an image of a detention facility like prison.
2. Environment is were not designed to meet the needs of the users, especially the special
needs of a person suffering from mental disability.
3. Further minimization of patients hurting themselves inside the wards and isolation room
through materials, finishes and proper orientation.
4. The plan and design of educational facilities is not meant for patients suffering from
mental disability but rather designed using the standard of an ordinary classroom for
normal people.
5. Sports complex that is safe for the users.
6. The promotion of individual dignity.

7. Space for relatives interaction.


8. And self-reliance of the facility were patients can move around whether indoor or outdoor
without compromising the security.

I.4.6.

RECCOMENDATION

The following recommendations are suggested for related research in the field of
psychiatry and neurology specializing on children and adolescents.

1. Because of the lack of time in doing this research study, I would suggest to continue this
research which will include outpatient facilities.
2. For further improvement and development of the design standards done in designing this
type of facilities, I would suggest a research on the technological advances of the field of
psychiatry in terms of facility.
3. I would also suggest the study of the laws governing the design standards used on the
existing facilities.

PART II.

RESEARCH FOCUS

CHAPTER II.1

RATIONALE

The early and widely used lunatic asylums, the treatment of patients/inmates was
brutal and focuses mainly on containment and restraint. Psychiatric hospitals have evolved as
successive waves of reforms were introduced. However, psychiatric care in the Philippines
especially in terms of facility was as if frozen in time, based on the research methodology
conducted on the previous chapter of the research. Modern psychiatric facilities starting to
introduce evidence-based treatments that emphasize on curing with the use of combination of
psychiatric drugs and psychotherapy.

Authors and professionals criticize the outdated design of the facilities. Psychiatrist
Thomas Szasz insisted that Mental Institution and Prison or any detention facilities are identical to
each other, medication and nursing staff acts as if a judge and jailers. A book entitled Madness
and Civilization was an instrument used to criticize psychiatric facilities, the author was the French
historian Michel Foucault.
Seclusions and restraints are the method used for treatment and management of
undisciplined and aggressive people suffering from serious psychiatric disability. The methods
used for seclusions vary from different institutions.
Seclusions and restraints are still a valuable method for treatment especially for
uncontrollable patients. These methods are used for security of other persons using the same
facility. However this method was debatable if it is really a method for curing or a method for
punishing? Even though how practical and safe these methods may be, the use of it could lead to
a greater morbidity and death.

CHAPTER II.2

PRINCIPLES AND RELEVANCE TO THE STUDY

Maximizing the quality of medication not in a medicinal way but on the aspect of
facilities used by the patients, nurse, professionals and others involved. Research studies
conclude that environment can affect the healing process of patients.
The study will focus on the innovation of minimization of seclusion and restraints in
mental facilities, without compromising the security of other people using the same facilities. This
is to maximize the quality of healthcare getting by the patients with mental disabilities.
The study will also focus on the use of the concept of Maslows hierarchy of needs.
This will be used in the planning process of the facilities in the proposed complex. This concept
will be used as a motivational method which will help to hasten the recovery of the patients. The
concept of the theory is include the curiosity of the persons to improve his/herself in order until
he/she reaches the peak or the self-actualization.

PHYSIOLOGICAL NEEDS
These are the most basic requirements of a human body. If these are not meant, the body will
not function properly and will be broken. These are the most important and will become the
foundation of a human body.
SAFETY NEEDS
After the most important needs or the physical needs, the second group would be the safety
needs, a mind where he/she will feel safe, comfortable and free. A satisfying surrounding.
This will include:
1. Personal security
2. Financial security
3. Health and well-being
4. Safety against accidents/illness
LOVE AND BELONGING
The third stage of human needs is Love and Belogings which involves emotions and feelings. If
this is not met, it can impact the individuals relationships in general, such as: Friendship,
Intimacy and Family.

ESTEEM
After getting the acceptance of other people its for the acceptance of your true self. Self-respect
is vital for every individual. Imbalance of this level may result to individuals continuous seeking
for fame or glory. Which is not the answer the feeling of what they lack, this can cause
individuals depression because the feeling of failure.
SELF-ACTUALIZATION
Self-actualization or the final stage, this is the stage where you feel contented on all aspects of
your life. You are in a good state of mind and physical.

These principles will be a big help on the healing process of the patients. Applying a
much appropriate planning and design principles using these concepts and theory, will a big leap
on the modernization of the design standards of Psychiatric Institutions, not just in the Nation but
in the whole world. First, the minimization of seclusion and restraints, this will change the image
of being a detention facility, isolation rooms will not be seen any more as a punishment room,
instead it will be seen as a room for self-reflection. The facility will also promote self-dignity and
self-reliance if this concept is applied. The use of Maslows Hierarchy will boost the motivation of
patients to heal faster. This will serve as a challenge in order to get the self-actualization or being
dismissed from the institution.

CHAPTER II.3

APPLICATION TO THE PROJECT

The application of minimizing seclusion and restraints without compromising the


security of others is on the designs of all facilities used by the patients and their staff. Feeling of
restraints and seclusion is not just basically on the wards or isolation rooms, the patients can feel
the inability to move freely everywhere if its not design/plan properly. This is why design
techniques all throughout the building will be applied.
Innovative design approach to maximize the quality of healthcare the patients are getting in
details:

1. Therapeutic Environment
The environmental surroundings can affect greatly on the mind of a psychiatric patients.
A report from The New York Psychiatric Institute stated that a large drop in number of
patients needed to be seclude when they occupied a new facility that has this kind of
environment. Using this type of design and consideration well promote individual dignity
and self-reliance.
Therapeutic Environments must have this attributes:
-

The usage of non-institutional materials which is lively, and a little bit of colors and
textures. But still keeping in mind the colors that might agitate the psyche of the
patients.

Natural lighting in all rooms.

Outdoor views for every rooms, leading to outdoor environment.

Providing a direct and easy access to secured outdoor areas.

Sound insulations in private rooms which discussions are held like conference room,
therapy room etc.

Rooms must be free from any unwanted noises.

Giving patient own visual rights, controlling the views patients would see.

Giving the control of his own decision on his private room as much as possible.

Planning minimal walking distances, short and easily accessible planning.

Signage for the patient knowledge of whereabouts, promoting self-reliance.

2.

Aesthetics
A major factor on the institution public image and is a significant marketing tool. It will
also psychologically change the view of the public on metal institutions which is a
detention facility.
Considerations includes:

Use modern type of lighting systems, accessibility of natural lighting, indigenous


materials.

Soothing/calming colors and artwork.

Awareness to details, color, scale and proportions.

Wide and bright open public spaces.

Comfortable nursing units and offices.

Compatibility of the exterior faade to the surrounding environment.

3. Security and Safety


The possibility of suicide of patients is one of the main concerns of the facility. It must
not create openings for this type of accidents.
Security and Safety designs without resorting to confinement:
-

Utilities devices to be tamper-proof.

No clothes hook on shower rooms, and use of breakaway shower-rods and bars.

Security of entrance and exits of staffs.

Unbreakable glass for windows in bedrooms.

Soft materials for walls like fiber-reinforced gypsum board.

Elimination of all possibilities of self-injury in special features seclusion rooms,hardwares


like door knobs wil be eliminated.

Solid material specified ceiling.

4. Sustainability
The institution is serving for the healthiness and well-being of an invidual. The institution
must not only help individuals but also extends it potential on helping the well-being of
the environment.
This can change the image of mental facilities.

The use of Maslows hierarchy in the project will be on the site planning process. The
proposal will be a Mental Rehabilitation Complex composed of different buildings. Every building
will have a different approach on the design; the design of each building will reflect the 4 stages

of needs in Maslows Hierarchy of needs. And patients will start from the fundamental needs up
to obtain the goal of self-actualization or dismissal to the outside world.

For better understanding of the application:

SELF-ACTUALIZATION
OR OUTSIDE WORLD

LOVE AND
BELONGING

SAFETY
NEEDS

SELF-ESTEEM

PHYSIOLOGICAL
NEEDS

Mental Rehabilitation Complex

The building will be design appropriate for their needs. For example physiological needs building
will focus on the fundamental needs of a patients, more on the survival needs and will be limited

to that. Physiological needs will not have special facilities only available for example safety needs
building like entertainment are and the likes.
This method will motivate patients to recover faster in order to go to another building. Based on
research a patient driven by motivation is more likely to recover faster than other patients. This
will also help professionals taking care of them and giving medication because they can specialize
on the different stages of criticality of mental stability of the patients.

PART III.

SITE IDENTIFICATION AND ANALYSIS

CHAPTER III.1

SITE SELECTION PROCESS

III.1.1.

CRITERIA FOR SITE SELECTION

1. Lot Size
2.

Site Physical Characteristics

3. Utilities
4. Zoning/Permitting
5. Neighborhood

Site selection criteria were established to serve as a guidelines or requirements of the site that
will be analyzed and will undergo site selection process with various proposed sites that will
house the proposed Youth Mental Rehabilitation Complex. This are the criterias identified: Lot
size, Site physical Characteristics, Utilities, Zoning/Permitting and Neighborhood.
Below is an itemized list of the criteria, along with specific questions that were considered when
evaluating each variation and option.

1. Lot/Site Location

Is the site large enough to accommodate future development? Will there be enough
outdoor areas?

Is the existing road accommodating vehicular and pedestrian traffic safe and accessible?
Thus unloading and loading for commuters available?

Will the frontage of the development accessible to the eye? Will there any hindrances
exist that will block a sight?

Will the frontage of the development accessible to the eye? Will there any hindrances
exist that will block a sight?

2. Site Physical Characteristics


-

What is the slope of the terrain? Flat, rolling, etc. (5% for parking; 10% for buildings)

Are the soils well drained?

Was it located in a hazardous area? Flood? Earthquake?

3. Utilities
-

Thus the water and sewer available?

Is the electrical service sufficient?

Thus the telephone and cable television available?

Any provisions for storm water disposal? Like pumps.

4. Zoning/Permitting
-

Is this a permitted for a Institutional use?

Are some parts of the land under protection of the government?

Are there any restrictions or laws?

Could the site comply with Planning/Zoning criteria?

5. Neighborhood
-

Were the site situated in an Institutional area?

Were the site located or near a Residential area?

Is the site located or near a mixedUse area?

Is this a rural, suburban or urban setting?

Are there any opportunities in views?


III.1.2.

SITE OPTION DESCRIPTION

These were 3 possible sites picked from different provinces of Central Luzon which will be the
target region of the proposal.
1. A site located in Brgy. Tabe, Guiguinto municipality of Bulacan Province.
2. A site located in Brgy. Mamatitang, Mabalacat City of Pampanga Province.
3. A site located in San Nicolas Pob., Concepcion municipality of Tarlac Province.

1. Brgy. Tabe, Guiguinto municipality of Bulacan Province.

SITE CRITERIA
1.

Lot/Site Location

Known as machine capital of Guiguinto.

An access road (Tabe Road) to the North Expressway was built by mobilizing resources
from the national government and local private sector.

A road leads to MacAthur Highway.

A total population of 7,204 people based on 2010 NSO census.

Located in a municipality that has a density if 3,300 persons per square kilometer.

2.
-

3.
-

Site Physical Characteristics


The terrain of the municipality was relatively flat in general.
The site is free from any types of hazards especially hazards due to water flooding.

Neighborhood
The site is located in Guiguinto municipality which is bounded on the East by the town of
Balagtas, on the west by Malolos, on the North by Plaridel, and on the South by Bulacan.

4.

The barangay is located in an urban setting.

Zoning/Land Use

Located in an Institutional zone.

Nearby Institutional facilities:


Tabe Elementary School
Immaculate Concepcion Seminary
Angel of Light Academy
Tabe Health Center
Bethany Orphanage

2. Brgy. Mamatitang, Mabalacat City of Pampanga Province.

SITE CRITERIA
1. Lot/Site Location
-

Located in the center of Mabalacat City.

Has a direct acces to major highways of SCTEX and MacArthur Highway.

Located in a municipality that has a density if 2,600 persons per square kilometer.

2. Site Physical Characteristics


-

The terrain of the municipality was relatively flat in general.


No apparent Erosion

Located in a slightly flooded aone during a storm.

The soil is a mix of Angeles Coarse Sand and Undifferentiated Angeles Soil

3. Neighborhood

The barangay is located in Mabalacat which is bounded by Concepcion, Magalang


and Mexico on the East, Angeles on the South, Porac on the West and Bamban
on the North.

The barangay is located in an urban setting.

4. Zoning/Land Use
-

Located in an Residential, semi-Institutional zone.

Development possible subject to conversion procedure.

Nearby Institutional facilities:


Mabalacat Institute
Mabalacat Elementary School
San Joaquin Elementary School

3. Brgy. San Nicolas Poblacion, Concepcion municipality of Tarlac Province.

SITE CRITERIA
1. Lot/Site Location
-

The barangay has a population of 5,412 as of 2010 according to NSO census.

Located in a municipality with a 580 persons/square kilometer density.

Beside Plaridel road connecting to SCTEX.

400 m away from A. Mabini Provincial Road.

2. Site Physical Characteristics


-

The terrain is ranging from level (0% ) to very gently (3% ).

It is not located in any hazardous area like flood and earthquake prone area.

The majority of the soil is Tarlac Clay Loam

3. Neighborhood
-

The barangay is located in the west of concepcion municipality which is situated at the
center of the province. To its north is Gerona and Santa Ignacia, west is San Jose, south
is Capas and Concepcion and eastern boundaries are Victoria and La Paz. This is also the
location of Tarlac River.

The barangay is located in an urban setting.

4. Zoning/Land Use
-

Located in a built-up zone.

Nearby Institutional facilities:


Atanacio Hospital
Concepcion Municipal Building
Concepcion South Elementary School
Benigno Servillano National High School
Concepcion North Central High School

III.1.3.

SITE SELECTION AND JUSTIFICATION

The site that was selected was the site located in Brgy. Tabe, Guiguinto municipality
of Bulacan Province mainly because of the advatages of the site compared to the other two, in
particular:
1. Accessibility to national road of North Luzon Expressway and Regional Road of
MacArthur Highway. The most critical in the site selection is the accessibility of
the site in other provinces in Central Luzon. The site has a direct access on the
two major road of the Region.
2. The site is located in a low density structures area, many unused in the
surroundings. Preferred because there will be less works on the buffer for
pollution caused by too much population.

3. The terrain of the municipality was relatively flat in general. Less construction
works is needed.
4. The site is free from any types of hazards especially hazards due to water
flooding. A safe location that will shelter the patients.
5. It is located in an Institutional zone, development of this type of facility is
possible in this location.

CHAPTER III.2

SITE EVALUATION AND ANALYSIS

III.2.1.

THE MACRO SETTING

CENTRAL LUZON REGION

Located in the north of Metro Manila, bordered by regions of Ilocos, Cordillera


Administrative Region and Cagayan Valley in the north; NCR, Calabarzon and the waters of Manila
Bay to the south; South China Sea to the west and Philippine Sea in the east. Known as the fertile
central plains, the rice basket of the Philippines, Central Luzon produces most of the countrys
dining staple: rice.
Composed of 7 provinces namely as: Aurora, Bataan, Bulacan, Nueva Ecija,
Pampanga, Tarlac and Zambales. A total of 10,137,737 people in a 21,543 km2 area, a total
density of 470 people/square kilometer.

BULACAN PROVINCE

1. Lot/Site Location

Bulacan has a total land area of 262,500 hectares or roughly 14 percent of the total area
of Central Luzon, the biggest Philippine island, and 0.9% of the country's total land area.
The province has 21 municipalities, 3 component cities and 569 barangays. Malolos in the
southwestern part is the capital of the province. Of the 21 municipalities and 3
component cities of the province, Doa Remedios Trinidad (DRT) is the biggest
municipality having a total land area of about 93,298 hectares or almost 36 percent of
the provincial land total. DRT is followed by the municipalities of San Miguel and
Norzagaray with land areas representing more than 6 percent of the provincial total.
Obando, on the other hand, has the smallest landmass with only 1,458 hectares or 0.56
percent of the entire area of Bulacan.

The MacArthur Highway traverses the province from north to south. Most major towns
can be reached through the North Luzon Expressway. A good number of motor vehicles
owned largely by private individuals provide mobility to Bulacans populace. Aside from
five main highways that traverse the province, all roads are widely dispersed throughout
Bulacan.

Bus terminals of Baliuag Transit, California Bus Line, Sampaguita Liner and Royal Eagle
are in Baliuag, Balagtas and Hagonoy. The main bus lines of Philippine Rabbit, Victory
Liner, Aladdin Transit that originate from their main terminals in Manila, Pasay and
Quezon City and travel northward to cities and towns in Pampanga, Tarlac and Zambales,
pass through Bulacan via the Tabang exit

2. Site Physical Characteristics

The province's total land area indicates that its topography ranges from level to rugged
terrain. The western portion of Bulacan for instance has been classified in the Landscape
Map as belonging to the lowland category with an approximate coverage of close to 50

percent of the provincial land area. On the other hand, the eastern part of the province
covers those areas that are hilly to mountainous. This is where the province interfaces
with the southeastern part of Luzon. In the middle of these two major landforms are the
piedmont landscapes, which have elevation of about 50 to 100 meters above sea level.
Over one half of Bulacan's overall land area have been classified as having slopes less
than 8 percent or those considered as having level to gently sloping terrain and this is
found on the western part of Bulacan.

3. Neighborhood

Bulacan has 569 barangays from 19 municipalities and five cities (Malolos, the capital
city; Meycauayan, Marilao, Sta. Maria, Bulacan and San Jose del Monte). Bulacan is
located north of Metro Manila. Bordering Bulacan are the provinces of Pampanga to the
west, Nueva Ecija to the north, Aurora and Quezon to the east, and Metro Manila and
Rizal to the south. Bulacan also lies on the north-eastern shore of Manila Bay.

4. Zoning /LandUse

The Land Use Plan of Bulacan consists of two major sub-components, namely: Production
Land Use and the Protection Land Use. The production component of the land use plan
deals with those areas used for the production of goods and/or services as croplands,
mining or quarrying areas, fishery, timber and fuel wood forests, etc. The protection
component, on the other hand, are those areas designed to be protected from human
activities for purposes of protecting its unique physical and biological significance.

SITE
GUIGUINTO, BULACAN

1. Lot/Site Location
-

Guiguinto has a total population of 90,507 as of 2010 according to 2010 NSO census in a
land area of 27.50 square kilometer, a desity of 3,300 persons per square kilometer.

An acces road(Tabe Road) to the North Expressway was built by mobilizing resources
from the national government and local private sector. Though three major highways
traversed the barangays of Guiguinto.

2. Site Physical Characteristics


-

The terrain of the municipality was relatively flat in general.

The site is free from any types of hazards especially hazards due to water flooding.

3. Neighborhood
-

Guiguinto is bounded on the East by the town of Balagtas, on the west by Malolos, on the
North by Plaridel, and on the South by Bulacan.

The municipality is located in an uraban setting.

4. Zoning/Land Use
-

From a predominantly agricultural Municipality, Guiguinto has gradually urbanized and


developed into a third class municipality based on income classification. This is due to the
growth in light industries and commercial establishments as a result of the overspill of the
urbanization in Malolos and Metro-Manila. Guiguinto is also known for its small-scale
garden that is now gradually expanding.

There is a significant decrease in the percentage of land Guiguinto has classified as


agricultural and an increase in the percentage of residential, industrial and commercial
land ( Ecological Profile of Guinguin to 2004 ).

III.2.2.

MICRO SETTING

Brgy. Tabe, Guiguinto Municipality of Bulacan Province.


SITE CRITERIA
1. Lot/Site Location
-

At the back of the Guiguinto Hospital

Near NLEX tabe road exit

Near MacArthur Highway.

A total population of 7,204 people based on 2010 NSO census.

Located in a municipality that has a density if 3,300 persons per square kilometer.

2. Site Physical Characteristics


-

The terrain of the municipality was relatively flat in general.

The site is located in a high susceptibility to flooding zone due to the near river.

3. Neighborhood
-

The site is located in Guiguinto municipality which is bounded on the East by the town of
Balagtas, on the west by Malolos, on the North by Plaridel, and on the South by Bulacan.

Adjacent to Guiguinto Hospital.

One ride aeway to municipal hall of guiguinto.

Near RIS Industrial Compound

One ride away Guiguinto Centra School

Near Bethany House Sto. Nino Orphanage.

Near Tabe Elementary School

4. Zoning/Land Use
-

Located in a Agri-Vacant zone, the MPDO is on the process of classifying the land into a
Institutional zone to mazimize the potential of the hospital of Guiguinto. It will be
included on the updated 2015 CLUP plan of the Municipality of Guiguinto, a letter of
certification is included on the last page.

Nearby Institutional facilities:


Tabe Elementary School
Immaculate Concepcion Seminary
Angel of Light Academy
Tabe Health Center
Bethany Orphanage

LAND-USE MAP
The site is located in a Agri-Vacant
zone according to the latest CLUP of
the Municipality of Guiguinto.
According to Municipal Planning and
Development Office of the Guiguinto
the site will be classified into
Institutional zone to maximize the
potential of Guiguinto Hospital. It will
be seen on the udpdated CLUP of the
Municipality.
A letter of certification signed by the
head of MPDO of Guiguinto is

presented in this paper.

HAZARD MAP
The site is located in a High
susceptibility to flooding zone. The
maximum height of the flood is up to
knee height according to the people
living there. The flood is caused by the
river near it.

SOIL MAP

DESCRIPTION
The site is located in barangay Tabe,
Guiguinto, Bulacan. Located at the
back of Hospital of Guiguinto. The site
is divided into different parcel of land.
A total of 14, 728 sq. m. its near the
North Luzon Expressway and a minor
road on the left side.

SITE LOCATION

NEIGHBORHOOD

VICINITY MAP

III.2.3.

RELATED LAWS AND ORDINANCES

1. Administrative Order NO. 2012-0012 DOH:


Rules and Regulations Governing the New Classification of Hospitals and Other Health
Facilities in the Philippines.

2. Administrative Order No. 2012-0012:


Rules and Regulations Governing the New Classification of Hospitals and Other Health
Facilities in the Philippines.

3. Administrative Order No. 2005-0029:


Amendment to Administrative Order No. 147 s. 2004
Amending Administrative Order No. 70-A s. 2002 re
Revised Rules and Regulations Governing the Registration, Licensure and Operation
of Hospitals and Other Health Facilities in the Philippines

CHAPTER III.3.

SITE DEVELOPMENT OPTIONS


III.3.1.

SITE ANALYSIS

DESCRIPTION
The site is easily accessible to 2
national roads. The barangay and
municipal roads near the site, is
connected to the said national roads
which is MacArthur Highway

connecting the whole Central Luzon


Region and North Luzon Expressway
connecting some provinces of the
region and also the Metro Manila.
Municipal Planning and Development
is planning to construct an emergency
road for the hospital, so that the

CIRCULATORY ANALYSIS

accessibility to hospital will be easy.

WIND ANALYSIS

SUN PATH ANALYSIS

DESCRIPTION
The vehicles driving on the national
road of North Luzonn Expressway are
the one giving the most noise in the
surrounding of the site. A little noise
coming from the residential houses are
also one of the source of noise.

SENSORY ANALYSIS

III.3.2.

SCHEME 1

PROPOSED SITE DEVELOPMENT PLAN

SCHEME 2

REFERENCES:
1. Int. J. Ment. Health, Vol. 6, No. 1, pp. 96 -119, M. E. Sharpe, Inc., 1977
2. COPING STRATEGIES OF PARENTS OF CHILDREN WITH DEVELOPMENTAL DELAY: A
QUANTITATIVE ANALYSIS, Vol. 1. No. 4. November 2012
3. Mental Health Facilities, Department of Veterans Affairs, Dec 2010 rev. Aug. 2014
4. Enhancing Mental Health Care Delivery: Changing the Image of Mental Health Care
through design solutions, Don Thomas, Brian Buchholz and Richard Dahl, May 2011
5. Pampanga CLUP, June 2009
6. Tarlac CLUP, 2001-2010
7. Guiguinto CLUP, 2001-2009
8. Psychiatric Facility, Robert F. Carr, April 2011
9. Multipronged Strategy Reduces Use of Seclusion and Restraints to Manage Aggression at
Inpatient Behavioral Health Facility, Robert P. Roca, MD, MPH, MBA, Barbara Charen,
BSN, CPHRM, March 2009
10. Municipality of Guiguinto Bulacan, MPDO
11. Municipality of Guiguinto Bulacan, Assessors office
12. DOH website
13. Implications, volume 6 issue 04, A.J Paron-Wildes, 2005
14. Outdoor Environments for Children with Autism and Special Needs, Naomi Sachs, ASLA
and Tara Vincenta, ASLA, 2011
15. The Design of a Psychiatric Residential Treatment Facility in Wheelwright, Kentucky
Serving Adolescent Males, Jenna Clem, 2011
16. WHO-AIMS REPORT ON MENTAL HEALTH SYSTEM IN THE PHILIPPINES, 2007
17. Child Mental Health in the Philippines, 2013, Consuelo Cagande
18. FACILITY COMPLIANCE WITH MENTAL HEALTH ACT 2001 (APPROVED CENTRES)
REGULATIONS 2006

19. Child and Adolescent Mental Health In-patient Unit, Merlin Park, Galway, Archdaily article
20. National Center for Mental Health