Design Meets Psychiatric Disability: Designing Environments That Don't Disable

Background: A maxim of the disabilities rights movement is that the environment disables, not the individual’s condition. In his book Design Meets Disability, Graham Pullin (2011) presents design paradigm approaches to ensure a better environment-individual fit for some of the physical conditions of people with disabilities.  What is and is not included in Pullin’s book highlights that it may be more difficult to use design paradigms for creating a better environment-person fit for people with “hidden disabilities,” such as psychiatric, cognitive, developmental, and intellectual. This paper reports on a naturalistic example of a community (BnI) in Hokkaido, Japan, designed as an environment that enhances rather than disables people with psychiatric disabilities.  It joins other efforts at environmental design, such as residences for people with dementia, that enhance what people with similar “hidden disabilities” can do, and minimize what they cannot.  The objective of this study is to begin to explore some of the ways the design of the environment can promote collective and individual outcomes for people with psychiatric disabilities.

 Methods:  This is naturalistic research of an existing mental health community in Hokkaido, Japan, embedded in a slightly larger village of people without mental health conditions.  It uses ethnographic and participant-observer methods.  Research participants are adults with serious mental health conditions and the staff that support them in their community.  The research includes ethnographic visits in 2006, 2007, 2012, and 2016. The researcher worked with bilingual Japanese-English research assistants.  The paper is based upon ethnographic notes of observations of community locations, apartments, businesses, and artifacts; participation in group events; photographs and a video ethnography produced by another researcher; BnI publications, and participation in a community celebration/conference. 

 Results: The design of this unique community has enhanced the competencies of community members to have social lives, work, interact as equals with the broader community in which it is embedded, collectively cope with the psychiatric symptoms of community members, eliminate its psychiatric hospital beds, and develop the artistic, leadership, and productive potential of many community members.  BnI has created community businesses, social and artistic venues and events, and a culture of mutual support that enhances the lives community members.

 Conclusion/implications:  Design approaches related to disabilities include those that enhance individual conditions (e.g., prostheses) and those that modify environments to be less disabling (e.g., sidewalk cutouts), and thus have individual and collective benefits.  It may be more feasible to focus on environmental design approaches for many “hidden disabilities,” including psychiatric, than on individual conditions that have often been medicalized.  This research suggests that social and environmental approaches to serious mental health conditions, which internationally are under explored and underfunded, may produce more desirable outcomes than those focused predominately upon dysfunction and psychiatric symptoms. The paper explores policy implications and policy strategies for increasing design-based models.