TICMAN, ANALYN M.

ARC 029 : RESEARCH METHODS FOR ARCHITECTURE

AR. DAVID BAUTISTA

THESIS TITLE:LIWAWA: A Proposed Psychiatric Rehabilitation

Center (Integrating Vernacular Architecture Providing Solution for
a Sustainable Future)

REVIEW ON RELATED LITERATURE

This chapter reviews literature of the population of Filipinos, mental health profiles in

Philippines, the causes of mental illness, the stigma associated with the illness and the recovery

process of mental illness. The chapter also analysis what rehabilitation means to the mentally ill

and reviews literature on both local and foreign case studies of rehabilitation centres.

LOCAL RELATED STUDIES

The recognition of mental health as a basic human right in the Philippines finally came to pass

after the Philippine Mental Health Law (Republic Act No. 11036, or RA 11036) was signed into

law on June 21, 2018. The law not only affirms mental health as a basic human right, it also

enshrines the Filipinos’ access to mental health services as a fundamental human right.

 The law also recognizes that affirming the Filipinos’ right to mental health will remain

mere lip service if there are no mechanisms to rewrite the narrative around mental health

issues. More often than not, people suffering from mental health conditions are dismissed

or even derided.
 One of the most important aspects of RA 11036 is the recognition that the workplace is a

contributing factor in raising awareness of Filipinos on mental health issues. The Philippine

work sector is capitalist-economic in nature.

 These statistics highlight the profound influence of a person’s environment, including the

work place, to the mental health of the average Filipino. RA 11036 recognizes that

employers should be made partners with the State, to enable affordable and timely accessto

professional help, if the need arises.

Philippine health system

Health status has improved dramatically in the Philippines over the last forty years: infant

mortality has dropped by two thirds, the prevalence of communicable diseases has fallen and

life expectancy has increased to over 70 years. However, considerable inequities in health care

access and outcomes between socio-economic groups remain. A major driver of inequity is the

high cost of accessing and using health care. The Philippines has had a national health

insurance agency – PhilHealth – since 1995 and incrementally increased population coverage,

but the limited breadth and depth of coverage has resulted in high-levels of out of pocket

payments. In July 2010 a major reform effort aimed at achieving ‘universal coverage’ was

launched, which focused on increasing the number of poor families enrolled in PhilHealth,

providing a more comprehensive benefits package and reducing or eliminating co-payments.

Rehabilitation

has long lacked a unifying conceptual framework . Historically, the term has described a range

of responses to disability, from interventions to improve body function to more comprehensive

measures designed to promote inclusion . The International Classification of Functioning,

 Disability and Health (ICF) provides a framework that can be used for all aspects of

rehabilitation . For some people with disabilities, rehabilitation is essential to being able to

participate in education, the labour market, and civic life. Rehabilitation is always voluntary,

and some individuals may require support with decision-making about rehabilitation choices.

In all cases rehabilitation should help to empower a person with a disability and his or her

family.

Specific Objectives:

1. Describe the various physical, emotional, and cognitive disabilities experienced by people who

receive rehabilitation services and understand their functional limitations.

2. Understand the medical and psychosocial impact of disabilities.

3. Understand the impact of society's attitudes towards disabilities on the treatment of people with

disabilities.

4. Understand how physical, mental, gender, racial, cultural, and environmental variables interact to

affect the lives of people with disabilities.

5. Develop interaction skills to accommodate cultural sensitivity when working with consumers and

their families.

6. Be familiar with the wide variety of generic and specialized community resources available to

serve people with disabilities.

7. Describe the major services provided in rehabilitation (e.g., rehabilitation counseling, vocational

evaluation, adjustment services, job placement, physical restoration, environmental adaptations).

FOREIGN RELATED STUDIES

Psychiatric care in Ghana

This section discusses the history and current trend of psychiatry in Ghana. It also discusses the

various attempts made to treat mental health spiritual.

History of Psychiatric care in Ghana In the early colonial era (19th century), patients suffering

from mental illness in the Gold Coast (now Ghana) were usually kept in prison (Mental Health

Profile [MHP], 2006). Prior to this period, psychiatric patients were found roaming in towns,

villages and bushes with some locked up either in their homes or restrained by native doctors. In

1888, the colonial government passed a Legislative instrument (The Lunatic Asylum Ordinance)

signed by Governor Sir Edward Griffith to establish a lunatic asylum in a vacated high court

building in Accra (Ewusi-Mensah, 2001). It was not until 1904, that a purposeful psychiatric

hospital was built called Accra Psychiatric Hospital (APH). The hospital was officially

commissioned in 1906 initially to accommodate 200 patients. By the late 1940’s with psychiatric

psychiatrist south of the Sahara Dr. E.F.B. Foster, a native of Gambia was posted from the colonial

office in London to the Accra

psychiatric hospital in 1951. He transformed the Asylum into a hospital in conformity with the

world wide changes at the time. He initiated the training of doctors and nurses who became trainers

of trainees. He also arranged for a number of doctors to specialize in the field of psychiatry abroad

(MHP, 2006). APH has undergone major expansion in its 100 years of existence and currently

have 800 beds. There have been extensive changes in the hospital buildings; the staff training and

recruitment were expanded. Other reforms introduced were the removal of chains from patients
and discouraging isolation (Adlakha, 2006). APH during this period was the only established

Psychiatric hospital in West Africa. A second psychiatric hospital called Ankaful Psychiatric

Hospital was built in 1965 and later followed by Pantang Hospital in 1975.

• Accra Psychiatric Hospital built in 1904 with a capacity for 800 beds.

Current Trend of Psychiatric Care in Ghana

Mental health care in Ghana is concentrated in the southern part of the country but psychiatric

service in the north is almost non-existent (Ewusi-Mensah, 2001). There are currently three (3)

main psychiatric hospitals in the country namely;

• Ankaful Psychiatric Hospital built in 1965 in the central region of Ghana. It was initiated by Dr

Kwame Nkrumah and has a bed capacity of 500. • Pantang Hospital was commissioned in 1975 to

decongest the Accra Psychiatric Hospital and has 500 beds.

Psychiatric Rehabilitation: Key Issues And Future Policy

edical practitioners have long recognized the critical importance of treating the consequences of

physical illness as well as the illness itself. 1 This concept did not take hold in the mental health

arena until decades later, when the deinstitutionalization movement gained momentum, and

increased numbers of persons with severe psychiatric disabilities changed residence from the

back ward to the back street to, in many cases, the main street. 2

With increasing visibility, the functional limitations of some of these persons quickly became

apparent; in 1977 the National Institute of Mental Health (NIMH) launched the Community

Support Program (CSP). The CSP was designed as a pilot federal/ state collaboration to explore
strategies for delivering community-based services, including rehabilitation, to persons with

severe psychiatric disabilities. National data on the persons initially served by the CSP illustrate

the extreme functional limitations of this group. For example, median yearly income was $3,900;

50 percent received Social Security benefits; approximately 10 percent were competitively

employed, and only 9 percent of the unemployed were actively searching for work; 88 percent

were not married; and 71 percent rarely or never engaged in recreational activities with

others. 3 A more recent survey of CSP clients found a similar level of disability. 4

The Psychiatric Rehabilitation Educators’ Group

In 1993, the University of Medicine and Dentistry of New Jersey (UMDNJ) began offering

courses in its newly developed Associate of Science Degree Program in Psychiatric

Rehabilitation. At that time, offering an undergraduate degree in Psychiatric Rehabilitation was

considered breaking new ground and there was great interest among UMDNJ faculty to explore

and network with other schools and programs offering undergraduate courses and certificatesthat

emphasized psychiatric rehabilitation principles. Learning what other programs were offering in

terms of curricula and experiences could only broaden opportunities for our students and faculty

at UMDNJ. Housatonic Community College in Connecticut was the first program we visited to

share ideas about curricula, course materials, and fieldwork sites. After a very productive

discussion, the faculty from both schools concluded that it would be valuable to meet again and

to expand our efforts by inviting faculty from other academic programs to join our discussions.

Over the next several years, we continued to meet with both graduate and undergraduate

psychiatric rehabilitation educators throughout the United States to network, share information

and ideas and develop collaborative projects, such as consulting with one another on field
placement issues. Many psychiatric rehabilitation educators share concerns about supervisor

training, contracting, and student skill evaluations. In 2001, faculty at UMDNJ took the initiative

to organize a Psychiatric Rehabilitation Educators’ Symposium to “address the common

challenges faced by psychiatric rehabilitation educators in our efforts to produce knowledgeable

and competent psychiatric rehabilitation practitioners.” Over 40 educators from more than 20

institutions participated in a two-day meeting that took place on the UMDNJ campus in Scotch

Plains, NJ. Topics discussed at the symposium included the mutual goals of psychiatric

rehabilitation educators; the role of public funding to bridge the gap between educators and

services; web-based education as an alternative for multidisciplinary training; integrating

psychiatric rehabilitation curricula into established rehabilitation and mental health disciplines;

implications of the national certification of psychiatric rehabilitation practitioners; and the

development and impact of a career ladder in psychiatric rehabilitation education. Work groups

were also convened and participants were asked to record their recommendations for future study

or action. The work groups focused on the following areas of concern/interest:

Student access to scholarships, financial aid, and other stipends;

 The role of a living wage in developing Psychiatric Rehabilitation Specialists;

 Standards for Continuing Education for PSR Practitioners;

 The anticipated impact of PSR credentialing standards;

 Integrating research findings into PSR curricula; and

 Qualifications of effective psychiatric rehabilitation educators.

The first symposium was considered a successful event in that the presentations were well

received and the workgroups identified a numbers of areas of mutual interest for continuing
work. The symposium also provided a unique opportunity for a group of educators in an

emerging academic field. There was consensus to plan to meet on a bi-annual basis at the both

the IAPSRS Conference and at future symposia.

Bioclimatic Solutions Existing in Vernacular Architecture Rehabilitation Techniques

Popular wisdom related to the construction is a huge legacy in the history of vernacular

architecture. The culture, history and traditions of the people of each region were continuously

portrayed in buildings that are today part of our beautiful landscapes, constituting a heritage that

needs to be preserved and appreciated. The vernacular architecture has instinctively developed

bioclimatic concepts that are nowadays scientifically valid. Given the lack of resources, the

simplicity combined to the rationality has resulted in the application of techniques and solutions

which, although rudimentary, maximize the use of materials and available energy. The

adaptation to local environmental conditions implied that buildings have assumed an identity that

characterizes the architectural image of each region. The use of basic materials like wood, earth

and stone has evolved to more complex solutions built with huge negative impacts on the

environment. In recent decades, the sustainable construction concept has been developed based

on the principles of recycling and maximizing resources, protecting and stimulating the creation

of healthy environment which therefore lead to the reduction of the environmental impact of the

construction sector. In order to support the agents in the construction sector, research projects

and knowledge transmission on sustainable development construction have been carried on. This

work is part of the BIOURB project, a cross-border project between Portugal and Spain, which

intended to contribute to the change of the current constructive model toward a more sustainable

bioclimatic model, both environmentally and economically, reducing the energy consumption of
buildings and raising the value of bioclimatic heritage along the border. In order to achieve the

study a survey has previously been conducted on the bioclimatic solutions along the boundary,

more specifically between the areas covered by the municipalities of Bragança, Miranda do

Douro, Vimioso, Mogadouro, Salamanca, Zamora and, in particular, areas of the natural parks of

"Los Arribes del Duero" and "El Sayago".