TECHNOLOGICAL INSTITUTE OF THE PHILIPPINES

938 AURORA BLVD, CUBAO QUEZON CITY

COLLEGE OF ENGINEERING AND ARCHITECTURE

ARCHITECTURE DEPARTMENT

HAYAG: A Proposed Rehabilitation Center for Persons with Schizophrenia

through Holistic Architecture in Antipolo, Rizal

Submitted By:

Epondulan, Jhossa Mae V.

AR 491 - ARCH 42S8

Submitted To:

Ar. Jayann Juliet Rosilio

CHAPTER 1: Background of the Study

1.1 The Project

The prosperity of a nation depends on several factors, including the standard of care given to its people's
mental as well as physical health. More support services for those with behavioral issues should be made available in
this nation. The Philippines, sadly, does not excel in this respect. Schizophrenia is the most common mental disorder,
however it is poorly treated in the Philippines. Persistent changes in mood and behavior, as well as symptoms like
delusions and hallucinations, are diagnostic of this condition. They could have problems in home, work, and school.

Due to this stigma, the Filipino government and public sectors have paid minimal attention to mental health.
Despite the recent passage of the nation's first Mental Health Act and Universal Health Care Law, barely 5% of
healthcare expenditures are allocated to mental health treatment. In addition, there are only 7.76 hospital beds and
0.41 psychiatrists for one hundred thousand people (World Health Organization—Assessment Instrument for Mental
Health Systems, 2007; Department of Health, 2018). According to the World Health Organization, 154 million
Filipinos suffer from depression, 1 million from schizophrenia, and 15.3 million from drug use disorders, while
877,000 die annually from suicide (Department of Health, 2018)

Regional Mental Health Coordinator, Paulina A. Calo disclosed that schizophrenia (25%) and psychosis
(22%) are among the most frequently reported mental health conditions in CALABARZON in 2019.
From 1990 to 2010, CALABARZON or region IV-A experienced the greatest annual increase, and according to the
World Health Organization and  the region is one of the most afflicted. As a result of the growing population of people
diagnosed with schizophrenia there is a demand for a mental facility close to CALABARZON and nearby regions.
Based on the Report of the Department of Health, Antipolo has the highest rate of individuals that suffer from different
mental illnesses.

1.2 Statement of the Problem

One of the most serious issues that has to be addressed in the Philippines is the shortage of facilities that
provide mental health care. The lack of proper facilities in a Rehabilitation Centers in the country is being noticed by
many. The National Center for Mental Health (NCMH) is a government organization that offers services for mental
illness and specializes in Mental Health care. Owing to the large number of patients admitted to institutions, there is a
need for a facility and institution that offers better accommodations and services to facilitate the patient's recuperation
and healing. Concerning the development of the research, the following difficulties impede the feasibility of the
proposal:

Main Statement of the Problem

● Only nearby regions of the NCR have the benefit of easy access to mental health services and institutions;
whilst, the absence of mental health institutions in the province of CALABARZON is still lacking.

Sub-Statement of the Problem

● The current state of Mental Health Institutions containing social gatherings for those with mental illness is
inadequate; thus, the proposed project would construct a spacious area for families to visit their loved ones
in the Institution.
● Only limited individuals are able to admit in a Mental Health Facilities, the lack of facilities in other regions
specifically in CALABARZON, knowing it is one of the highest rates of persons with schizophrenia, is still
lacking.
● Patients who are admitted to the Philippines' primary mental health institution are placed in the same wards
regardless of the diagnosis that has been given.

1.3 Objective of the Study

The goals of the study are a combination of the objectives of the project and the design objectives. This
information is provided to help readers understand why the research is oriented in the manner in which it is. The
following are the anticipated conditions or results that will be attained upon completion of the project:

● Since schizophrenia is one of the mental health conditions that is reported the most often in CALABARZON,
it is important to provide residents of Tanay, Rizal, priority access to mental health services.
● To provide patients access to a high-quality rehabilitation facility while ensuring that the treatment plan
meets all of the requirements necessary for patients to experience the fullest possible recovery from their
mental and physical conditions.
● Through Holistic Architecture, the rehabilitation center in Antipolo, Rizal would be designed to help to
provide a therapeutic atmosphere within hospice care.
● To provide a space specifically a ward that depends on the categorization of a patient's diagnosis including
their gender and age.

1.4 Scope and Limitations of the Project

 The purpose of this project is to propose a specialized rehabilitation facility for Schizophrenia patients in
Antipolo, Rizal, using architecture that may foster a psychological and spiritual healing environment. The purpose of
this study is to determine and analyze the spaces of a provincial rehabilitation center that is desperately needed for
the treatment of Schizophrenia and other mental health disorders. This will be accomplished by consulting the
National Center for Mental Health (NCMH) for types of treatment, the facilities required for a patient's rapid recovery,
statistical data, and the design guidelines that must be followed when designing and planning spaces.

The fundamental objective of this project is to use Holistic Architecture to the planning and design of spaces
for the planned Schizophrenia-specialized Rehabilitation facility.

The technical aspects of medical facilities, laws regarding the legal cases of Schizophrenia and other
included mental health disorders are beyond the researcher’s control.

1.5 Definition of Terms

Depression - characterized by persistent sadness and a lack of interest or pleasure in previously rewarding or
enjoyable activities
Holistic Architecture - Designing spaces according to people's perception and physiology, and therapeutic practice.
It involves using the environment to be restorative and support health and wellbeing.
Inpatient Care - highest level of care designed to treat the most severe symptoms. Residential treatment can
provide medium-level care and often acts as a transition from an inpatient setting.
Mental Hospital - also known as a psychiatric hospital, is a facility that provides specialized inpatient care for mental
health conditions.
Outpatient Care - a less intensive level of care where people receive treatment as needed but still lead their
personal and professional lives outside of treatment.
Psych Ward - A behavioral health ward is a specialized unit in a general hospital that offers psychiatric services.
Rehabilitation Center - a facility where in-patient nursing and/or medical care is provided to persons who have
medical, psychological, or psychiatric conditions. It is a facility that provides rehabilitation, treatment, counseling, or
assessment and evaluation services related to alcohol and drug abuse.
Schizophrenia - a chronic, severe mental disorder that affects the way a person thinks, acts, expresses emotions,
perceives reality, and relates to others. Schizophrenia may result in some combination of hallucinations, delusions,
and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling.

1.5.1 Abbreviations
DOH - Department of Health
NCMH - National Center for Mental Health
CALABARZON - CAvite, LAguna, BAtangas, Rizal, queZON
1.6 Assumption

Schizophrenia is the most prevalent form of brain disorder in the Philippines, according to the most recent
report from Johnson & Johnson's Philippine Health Information System on mental health conditions (PHIS-MH),
which utilized data collected from ten government hospitals and four private hospitals. Schizophrenia does not get as
much attention as despair and anxiety when it comes to mental health-related initiatives and campaigns, despite the
fact that it affects at least 42 percent of patients who seek psychological consultation.

According to statistics supplied by the Regional Mental Health Coordinator for CALABARZON, Paulina A.
Calo, 25% of all instances of mental illness documented in 2019 are attributable to schizophrenia, while 22% are
attributable to psychosis. Schizophrenia is the most prevalent mental condition among Filipinos, affecting an
estimated 1 percent of the population. It is a persistent, incapacitating mental health disorder.

Individuals with this condition are clinically diagnosed, and depending on the severity of their condition, they
may be treated with a combination of antipsychotic agents and non-pharmacologic interventions. In 2019, Calo
revealed that schizophrenia (25%) and psychosis (22%) are among the most frequently reported mental health
disorders in CALABARZON.

The World Health Organization identifies Calabarzon, also known as zone IV-A, as one of the places most
severely afflicted by the illness between 1990 and 2010. As the number of people diagnosed with schizophrenia
rises, there is a growing demand for a mental health facility near CALABARZON and its surrounding districts.

1.7 Importance of the Study

The study of the proponent would be significant and beneficial to the following:

The project's study will aid in the design and development of rehabilitation facilities that are suitable for
individuals with Schizophrenia and their prescribed and administered treatments. The project was thus developed to
the level expected of a prominent medical center.

To contribute knowledge for those who want to design a rehabilitation center in other provinces while
incorporating the project to sustainable design this project would be beneficial to them. The project would also be
significant to the community, thus it could be another way to raise awareness regarding mental disorders such as
Schizophrenia.

The students of this project will contribute knowledge for those who want to design a Mental Health
Institution related study with appropriate information. It will help the researchers and most especially the architecture
students in terms of planning, designing, and how they contribute to the environment and development of the country

2.0 Research Framework

2.1 Review Related Literature

Locale:
Muni-Muni: Mood Analyzer and Screening Tests for the National Center of Mental Health using Sentiment

Analysis

In the current technological age, innovation and progress have become so commonplace that practically
everything has become simpler and more efficient. Psychological well-being is an essential aspect of one's life,
however it is often neglected, particularly in the Philippines. Under the direction of the National Center for Mental
Health, this project intends to produce a web and mobile application that will enhance mental health among users.
The system made use of Sentiment Analysis, in which the program examined the text supplied by users and
processed the data using a Lexicon-Based Method that gave polarity findings such as Positive, Neutral, and
Negative. Current mental health conditions in the Philippines are dismal. As of 2018, there are 19 million Filipinos
diagnosed with schizophrenia, major depressive disorder, and bipolar disorder. According to Medenillia, Ordinario,
and Manawis, intentional self-harm is the ninth highest cause of mortality among young adults aged 20 to 24. (2019).
These are merely the documented instances from mental health facilities; there are many more individuals who are
battling psychiatric disease but are unable to declare it due to the stigma associated with it. The primary purpose of
this Capstone Project is to improve the mental health of users through an accessible, cost-free website and mobile
application that adheres to the National Center for Mental Health's recommendations. Thus, the overall objective of
this project has been achieved based on the statistical findings and opinions of NCMH and external behavioral
experts. The primary purpose of this Capstone Project is to improve the mental health of users through an
accessible, cost-free website and mobile application that adheres to the National Center for Mental Health's
recommendations. Thus, the overall objective of this project has been achieved based on the statistical findings and
opinions of NCMH and external behavioral experts.
International:
‘Therapeutic Landscapes’ And The Importance Of Nostalgia, Solastalgia, Salvage And Abandonment For
Psychiatric Hospital Design

This article is based on results from a qualitative study of the transition of mental inpatient treatment from
an older to a newly constructed institution. The researcher was able to identify emotional responses to changes in
medical settings of care in relation to previous experiences and they were able to demonstrate how prior
interpretations of 'therapeutic landscapes' may generate feelings and memories, expressing as notions of nostalgia,
solastalgia, salvaging, and abandonment, which might impact one's current therapy experience. Consideration of
these concepts may improve the future design of mental inpatient institutions and the well-being of individuals who
are considered as users of these facilities.

The notion of therapeutic landscapes (Gesler, 1993, Gesler, 2003, Williams, 2007) has structured a growing
body of research studying how the material, social, and symbolic qualities of places may be seen as helpful to an
individual's health and well-being. Places constituting a therapeutic landscape may include medical settings for the
treatment of serious mental illness, where the therapeutic experiences of patients can be influenced by
characteristics of the built infrastructure, the relationships they encounter, and the meanings they assign to these
aspects of the caring environment (Curtis et al., 2007, Gesler et al., 2004, Wood et al., 2013). This research
contributes to the literature by examining the relevance of change in hospital landscapes for emotional well-being and
the ways in which prior meanings are attached to therapeutic landscapes. In conclusion, this case study reveals
therapeutic landscapes as dynamic, ever-evolving environments, which in turn reflect the development of care
models through time and the development of societal perspectives on the causes of disease. Our research sheds
light on how these differences in opinion give rise to tensions that render the whole concept of a therapeutic
landscape up for debate. In particular, we emphasize differences in how people in different social groups see the
world via the lens of our study.

Mental and behavioral health environments: critical considerations for facility design

The goal of the study was to discover aspects of the physical environment considered to have a favorable
effect on staff and patients in psychiatric settings and to utilize these qualities as the basis for future research on the
design of mental and behavioral health institutions.In pursuit of these objectives, a grounded theory informed by
interviews with physicians, researchers, and designers was developed to identify the most important factors to
consider when developing or doing research on MBH facilities. Instead of conducting open-ended interviews, the
study team conducted a comprehensive literature analysis to develop a framework for posing questions.

This paper provides an analysis of the physical environment undertaken at MBH Facility. In the study, there
is no summary of therapy settings for individuals with developmental disabilities, autism spectrum disorder, or
dementia. In the literature, emphasis is placed on inpatient hospitals of varying severity levels and outpatient settings.
The aims of this study are twofold: (1) to identify design elements that are judged significant in terms of their impact
on staff and patients in psychiatric settings; and (2) to develop the content for an evaluation instrument that will be
used to evaluate MBH facilities. This instrument is being created in the context of new policies recommended by the
Joint Commission and the Department of Veterans Affairs. As a result, The interviewees were able to provide insight
on the issue surrounding the effects of deinstitutionalization on patient and staff safety. Overall, respondents
preferred open nurse stations over closed ones. Access to nature and the cultivation of an aesthetically pleasant
environment had widespread support. While lower room densities lower an institution's atmosphere, most
respondents responded that private rooms are highly sought for. Yet, several respondents were adamantly against
private rooms because they thought that more patient monitoring would reduce the likelihood of self-harm. Less than
half of respondents agreed that smoking-only areas need further research.

Start making sense: Applying a salutogenic model to architectural design for psychiatric care

The purpose of this research is to investigate the importance of architectural design in mental care
institutions. There is a close relationship between perceptual impairment, mental disease, and the patient's
surroundings. So, even simple design decisions may have significant effects in a mental clinic. It is crucial, therefore,
that a psychiatric environment be supportive and does not worsen psychosis. Using an architectural extension of
Antonovsky's salutogenic theory, which asserts that improved health arises from a state of mind with a strengthened
feeling of coherence, this research examines the architectural components that may benefit mental health. According
to the idea, a patient's capacity to grasp the environment (comprehensibility), be successful in his activities
(manageability), and discover meaning all contribute to his feeling of coherence (meaningfulness). The study
presents an architectural extension of salutogenic theory as a practical strategy for making design judgments (in
practice) in the absence of proof. As illustrated, the findings seem to represent the existing facts, although actual
proof is always preferred to reasoned supposition. This technique cannot demonstrate the effectiveness or suitability
of design choices, nor is it designed to do so.
Design for Mental and Behavioral Health

This book outlines design concepts and design studies for people planning to build new mental and
behavioral health institutions as well as those desiring to assess the quality of existing facilities. The writers examine
mental and behavioral health systems, design principles, design research, and current standards, as well as present
examples of best practices. Although the demands of behavioral and mental health populations differ, the major
emphasis is on settings that support acute care, outpatient and emergency care, residential care, veterans, pediatric
patients, and chemical dependence therapy. The research demonstrates that the physical environment impacts
health outcomes, emotional state, preference, satisfaction, and orientation, but mental and behavioral health settings
have received relatively little attention. According to Mardelle McCuskey, Prior to the community care movement in
1963, there were only 160 institutions offering emergency psychiatric treatment.
It was also shown in the data that there is an urgency of the patient’s need including the unavailability of
community options at the time of need, and the perception of a shorter wait time prompted patients to seek
assistance from the Emergency Department. From the standpoint of mental patients, emergency rooms may fail to
treat them on par with regular patients. D. E. Clarke, D. Dusome, and L. Hughes discovered that mental patients felt
classified and triaged regardless of the reason for their Emergency Department visit. The design suggestions for
emergency mental and behavioral health institutions are categorized under the following subheadings: general
recommendations, entrance, waiting spaces, assessment rooms, seclusion rooms, and public/private space, which
covers risk assessment. In Conclusion, the importance of the spaces for Emergency patients could not only affect
their physical well-being but also their mental health. Design should be able to support the flexibility required for
integration and According to T.Bewley, the importance of participation of the patient and other users in the process of
design could help the designers to identify the need of each space to the patients and might help to develop an
impact on users' healing process.

Healing architecture: a spatial experience praxis

The intent of this paper is to investigate architecture that provides spatial experiences that children and
adolescents can participate with, presenting them with a powerful sense of positive energy that transforms into true
healing. Its unique design may promote a transition toward prolonged healing. It also demonstrates how the spatial
experience approach to the creation of the user is important in architecture and how it has played a significant part in
the development of architecture, given that the works of modern approach architects were made using this technique.
Additionally, the researcher was able to identify the architectural practices of renowned architects and describe their
spatial knowledge. It also discusses the themes using four examples of architecture emphasizing a holistic approach
via young people, which might aid in the healing process of these folks through architecture. Few people believe that
architecture is just about aesthetics, therefore stating that there are several architects that can contribute to the
creation of a sustainable design is significant.

Psychiatric ward design can reduce aggressive behavior

The article provides a conceptual model which proposes that aggressiveness in mental hospitals may be
minimized by constructing the physical environment with 10 stress-reducing elements supported by empirical
research. The model was evaluated at a Swedish hospital with nine of the 10 characteristics. Two clinical indicators
of violent behavior, compelled injections and physical restraints, were compared with data from an earlier facility
(replaced by the modern hospital) that had just one stress-relieving component. Several studies of violent behavior in
mental hospitals have focused only on the environment-related variable of overcrowding. Several studies have
hypothesized that ward overcrowding increases aggressiveness by exposing patients to unfavorable or stressful
settings such as increased stimulation levels, ward chaos, and lack of privacy (Brooks et al., 1994, Chou et al., 2002,
Daffern et al., 2004, Palmstierna et al., 1991).

There is no theory for designing the physical environment of psychiatric hospitals to decrease aggressive
behavior, and few studies have explored the effect of ward architecture on aggressiveness and other outcomes. The
first section of the paper offers a conceptual model for building wards based on the premise that stress promotes and
instigates aggressiveness. The concept proposes that architecture may aid in reducing violence if wards are
constructed with a number of environmental elements that minimize stress.

2.2 Theoretical / Conceptual Framework

2.3 Hypothesis