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Inner space
01 March 1999

The limitations of a Grade II listed asylum in west London did not stop client and architect refurbishing it as a modern, well equipped and attractive environment for treating the mentally ill. Peter Scher reports for HD on a model project.

The first phase of this major refurbishment of the St Bernard’s Wing at Ealing Hospital came into use at the end of last year. This marked a new chapter in the history of the building, which was in 1827 the winning competition design by the architect William Alderson for the new Middlesex County Asylum. Architecturally it had a formal, symmetrical plan, its wings projecting from two octagonal ‘crossing’ towers one at each end of the central entrance block. Originally three storeys high in yellow brick with stone dressings and large arched windows with many small panes, it opened in 1831 with 300 beds. It was soon enlarged and an attic floor was added in the 1850s, a succession of different architects contributing to the development of the asylum. Within a high security wall the extensive grounds were cultivated for produce and contained a number of separate agricultural and industrial buildings. Entry to the site was through a big formal archway on the building’s main axis. In 1881 a large gothic revival chapel was erected in the middle of the frontage.


By 1960 the asylum now known as St Bernard’s, Southall, had 2500 staffed beds but this had reduced to 950 by 1985 and the new Ealing Hospital had been built adjacent to it. Designed in the seventies, this is a DGH in the form of a multistorey concrete slab with lower blocks around it. Since then St Bernard’s, a Grade II listed building, has become a ‘wing’, albeit a large one, comprising the central and eastern parts of the original, the western part having been sold for redevelopment.

Transformation of the building has been less dramatic than that of society’s attitudes and responses to mental illnesses. Until the nineteenth century there were private for-profit madhouses for those who could pay and ‘charitable’ lunatic asylums of various kinds for paupers. The County Asylums Act of 1808 was the first national, humanitarian attempt to deal with the growing number of ‘lunatic paupers’ and the Middlesex County Asylum was one of the first wave to be built. At the time the overriding requirements were security and hygiene; treating mental illness and rehabilitating patients for ‘normal’ life in the community is a comparatively recent trend.


Indeed the developments in approach to mental health provision since the 1960s have been both rapid and various. Over some years now no two mental health projects reviewed in HD have been truly comparable. The Horton Mental Health Unit is yet another – unlike Luton (HD, Oct ’98) or Zoersel, Belgium (HD, Feb ’97) or Woodland, Lambeth (HD, Jan ’96) or Wanstead (HD, Sept ’90). In variety of users and eventual size Horton bears some resemblance to Glan Clwyd (HD, Apr ’96) which is also neighbour to a 1970s high-rise DGH; but Glan Clwyd was an entirely new building. Yet this continuing reappraisal of types of care and provision with genuine attention to meeting specific local needs and inputs is testing the imagination and skills of clients and architects alike. My impression is that these recent outcomes are better than those – and there are many of them – obtained in the past using standard departmental briefing, uninformed by local users’ requirements.

For designers the WHO Public Health Paper No 1, ‘Psychiatric Services and Architecture’, published in 1959, remains one of the most intelligent and useful guides. It wears far better than the much-revised HBN 35 which determined so many of the DGH psychiatric units in the great hospital building programme that are now largely unloved.


Tackling the problems of mental health provision de novo can be much more problematical than refurbishing an existing facility. Nightingale Associates, blessed with clients of clear vision and enthusiasm, have made an excellent job of revitalising the old institutional blocks. The great asset has been plenty of available enclosed space, the great difficulty a heavy loadbearing Grade II-listed structure that could not be altered freely or economically.

Apart from replacing a section of unsympathetic infill with an elevation matching the original design the exterior, with cleaned brickwork, is almost unchanged. Additional canopies, balconies, covered ways and rainwater goods in black painted aluminium have been designed to match the historic ironwork there. The first phase has also included a large, extensively landscaped garden, which will form such an important element of the environment for patients in recovery as well as for staff and visitors.


Inside, the architects have ingeniously exploited a number of possibilities for creating very agreeable places in the 25 bed secure and semi-secure wards. Plans for asylum blocks developed in the eighteenth and nineteenth centuries had rows of individual small cells opening from long wide galleries (see existing first floor plan). Each cell in the St Bernard’s wing has an area of about 5.5 m2, well below any current standard for single bedrooms; they are enclosed by thick loadbearing walls, prohibitively costly to alter.

Clinical and architectural collaboration has come up with the solution of keeping the cells as patients’ bedrooms, with built-in furniture and storage fittings, and high quality finishes (see illustration, p25). They appear to be very comfortable sleeping cabins which, being so small, are believed to encourage patients to ‘emerge out of the womb’ and to begin to socialise (a belief that surely ought to be tested independently as experience is gained in practice). This is facilitated by the ample space existing and available in the galleries, dayrooms and staff accommodation within the original fabric. The architects have opened up these spaces which are extremely generous in comparison with HBN norms and they provide a number of different areas for dining, recreation, relaxing and smoking (see first floor plan, below).


Another benefit of using nineteenth century asylum blocks is that their architects did not employ ‘deep plans’. Inboard rooms with no daylight are rare in this refurbishment and where used the architects have countered the claustrophobic effects by using glass blocks in the partitions, sometimes curved and enhanced with coloured lighting systems (see illustrations, p27 and p30). This is all part of the unusually careful attention given to the interior design at the Horton Mental Health Unit.

The three ward floors each have their individual colour schemes, well coordinated and integral with the new architectural layouts and detailing (see illustration, top of p25). Suspended ceilings and cornice lighting have been introduced in many areas without concealing all of the high soffits and nineteenth century structures which occasionally seem intrusive and jar (see illustration, above). Nevertheless the resulting spaces are very varied and interesting to experience.

The entrance to the unit is not impressive for the visitor due to the security procedures required and the cramped ‘airlock’; this is an authentically institutional aspect of the facility. On the other hand the lift has been designed with an all-glass car in a windowed shaft large enough to accommodate numerous flourishing indoor plants that will be seen from all levels as they grow taller. Though not needed for most journeys a trip in the lift will be worth making anyway.


The refurbished ward blocks are on two sides of a spacious garden. This has been designed in collaboration with staff and patients and incorporates varied spaces defined by changes in level, terraces, seating and winding pathways as well as shrubs flower beds and trees (see illustration, p27). When visited on a bleak day in February it was already looking good and cannot but develop into a marvellous asset for all users. It is hard not to be aware at first of the security fencing and anti-climb bars but one hopes the exuberance of nature will soon counter this.


It has not been possible to analyse the plans in detail. The content of the unit comprises two 25-bed wards and one 8-bed ward, with supporting occupational therapy, gymnasium, patients’ recreation and administration facilities. Objective comparisons with similar units have also been impractical for this report.

The conventional hidebound bureaucratic approach, using building notes, functional units and schedules of accommodation does not appear to have been used by client and designers for this project – or if it has it is not evident.

Given the existing building and an open-minded determination to create high-quality clinical and environmental facilities quickly and economically the client and design team have done well. A presentation of the project appears to have impressed a critical and expert forum at the RIBA recently. Construction for this £4.5m phase was also completed very rapidly.

As with the Birmingham Children’s Hospital (see HD, Jan ’99) another admired and useful building belonging to the NHS has been retained and put to excellent use by modernising the interiors to a very high standard of design and quality.Client: West London Healthcare NHS Trust, Cost: £4.5m, Start on site: Feb ’98, completion: Aug ’98, Total area: 5500 m2, Architect: Nightingale Associates, M&E contractor: Charter House Building Consultants, Structural engineer: Mellis & Partners, Quantity surveyor: WC Inman & Partners, Landscape architect: Quartet Design, CDM planning supervisor: APM, Contractor: Mansell

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