[00:00:00] Introduction: Navigating Mental Health Crisis and Autonomy

[00:00:00] Stephen Parker: So how do I help someone navigate a crisis and foster that sense of autonomy by giving them back a sense of control over their environment? 

[00:00:08] If you come in with a shopping cart, and that is all of your life possessions, and you want to know what's going to happen to your stuff.

[00:00:14] Because every clinician I talk to wishes they didn't have to open their doors, wishes that an individual in crisis didn't have to find need of being in an emergency psychiatric facility or being in a lockdown facility of some kind and needing that level of intervention because it's quite intense. And so prevention is a huge topic. How do you think about mental wellbeing and mental wellness and resilience? 

[00:00:42] Welcome to Third Space

[00:00:42] Sola DaSilva: Welcome to third space. I am your host Sola DaSilva. I am an architect and storyteller. And third space is where we have meaningful conversations about architecture and wellbeing. Giving you the tools to design a life that works for you. I'm passionate about creating a world that is inclusive and full of beautiful spaces that truly reflect our humanity and inspire us to be our best selves. I'm so happy that you're listening. Let's get into it.

[00:01:17] Meet Stephen Parker: Architect and Mental Health Advocate

[00:01:17] Sola DaSilva: My guest today is Stephen Parker. He's a licensed architect and dedicated mental and behavioral health planner at Stantec. I consider him a mentor and a friend. He's a proponent of architect as advocate for colleagues, clients, and communities alike. He believes and exemplifies leadership through service in the work he does designing and advocating for mental health clients. Stephen has served a diverse client base, both in US and Canada, including Johns Hopkins health system and the US Department of Veterans Affairs, helping to develop the VA's new inpatient mental health guide. 

[00:01:54] So I'm really pleased to have Stephen on the show and there's so much to talk about when it comes to the intersection of architecture and mental health. Stephen, thank you for joining me. 

[00:02:04] Stephen's Journey into Mental Health Architecture

[00:02:04] Sola DaSilva: My first question is, how did you get into this niche of architecture?

[00:02:09] Stephen Parker: I always like to think that you practice with purpose. So that singular sense of focus can obviously manifest in a number of different ways part of which I see the problem is that we have a lot of silos and not a lot of connected tissue and we're trying hard as designers connecting with patients, connecting with communities, connecting with clinicians, kind of other stakeholders. And so, part of that for me is what drives that sense of purpose and my practice. Just having, a number of family members who have, you know, like many of us, one degree of separation between us and a loved one who may be going through crisis or has gone through crisis, um, or in my case, it's a parent, um, who's been admitted more than once, um, my namesake, uh, being, um, a victim of addiction, um, and lost his life. Um, my godfather being a Vietnam veteran, um, and kind of dealing with those invisible wounds of war, um, which kind of led me down my path educational path, um, and thesis work and by getting my master's in architecture and then in practice, it snowballed over time with a number of projects that kind of again, spoke to my sense of purpose in addressing humanity at its most vulnerable, and that is, mental and behavioural patients, those contending with addiction or those with different sensory perception than you or I that might feel very vulnerable in facilities where they lack a lot of dignity. And so what is design's role in that? I found that that provided a profound sense of going beyond passion. I like to tell the students I work with that transcending passion with purpose takes grit because not everything is going to go your way. And so that's kind of helped define my path moving forward.

[00:03:44] In this role at Stantec around mental behavioral health design and planning and that's kind of allowed me to engage with a lot of different interesting organizations doing a lot of interesting work, trying to move the needle around stigma and what is the role of design and advocating for that. 

[00:03:57] Sola DaSilva: Yeah. 

[00:03:58] Understanding Stigma in Mental Health

[00:03:58] Sola DaSilva: So this makes me ask, why is there so much stigma around mental illness and addiction?

[00:04:03] Stephen Parker: I think this makes me think that more kudos to those that do step forward and share their lived experience as we call it, or those that are experts by experience. Partially it's cultural, whether it's the family or the community that you grew up in that context among what you do share and what you don't share, what is private and what is being comfortable with vulnerability and especially because the stigma that you might experience in one community will be very different than the next. In the same way when we talk about like stigma in place and how some communities address that is to really respect the privacy of those individuals seeking treatment because you know that if so and so has their car parked outside that clinic, then everyone's going to know in the town pretty quickly and they don't want to be the focus of that attention because they may not want to be defined by that, um, in the same way that a diagnosis does not have to define you. It simply refines the perspectives you bring to the world. So I think there is that unfortunate stigma around this is all I'm going to be known for. It could be that they have adverse childhood experiences or ACE where they don't want that to be known as to how that occurred. If it's, you know, pick a topic of domestic abuse, generational trauma, having an adverse history with addiction that could impact your employment history and prospects moving forward. As well as, the relationships you look to build if someone finds something out about you that you weren't ready for them to know at that point in time. So I think there's a multitude of reasons why stigma exists. I think that partially why I talk about culture and these facilities that we design is that culture eats policy for breakfast, but also policy should reflect that kind of more aspirational culture of a parity funding mental health services to the same parity of health services and that there shouldn't be a stigma that limits access to these places. Because every clinician I talk to wishes they didn't have to open their doors, wishes that an individual in crisis didn't have to find need of being in an emergency psychiatric facility or being in a lockdown facility of some kind and needing that level of intervention because it's quite intense depending on what they're there for and their acuity. And so prevention is a huge topic. How do you think about mental wellbeing and mental wellness and resilience? The individual, family and community level can go a long way to overcoming that sense of stigma because until you sort of recognize the issues, you don't really find a way to address them.

[00:06:27] Sola DaSilva: I think one of the difficult things about mental illness and addiction is that sometimes people struggle in silence. And so all of a sudden we then realized that they can't cope. It's like they hit a breaking point. They can't keep up with life. Their chores their job. And that's when we actually start to see what's going on internally manifest on the outside. And I wish it didn't have to get to that point. 

[00:06:52] Stephen Parker: Oh yeah. It's a great way of putting it. And as architects, you might want to think about in the same way that we learned around steel and concrete, whereas steel, you see it failing. In the same way that in a cancer diagnosis, there are signs and indicators and tests and diagnoses, whereas if it's other materials that failure is instantaneous and there's no warning. And that is that the point of crisis for some individuals, right? And to use that kind of language that we're may might be familiar with as designers to equate that to those contending with those invisible wounds. There is not a set surgery or treatment or diagnostic procedure out there to kind of really hone in and see a metric for success, a metric for being quote unquote cured and or treated. It's much messier. Like the human condition is messy. It could take a very long time. It could take a lifetime. And in some cases much like, you might be in remission from cancer, you might only ever be sober as much as you are vigilant if it is, you know, talking about addiction.

[00:07:58] But for those maybe who are born with a different sensory perception than you or I, and they might have developmental disorders or things of that nature, their perception of reality just doesn't reflect our own, or what might be agree on that. And it's simply that the world just hasn't been able to contend with that well and that's why maybe they have gone into crisis or escalated. Otherwise, they'd be perfectly healthy in their own sense of well being and how they were created. But that takes us as a society and as a world kind of looking to accommodate and better understand those perspectives for someone struggling with addiction for someone struggling at the edge of crisis, or might just be overloaded and at that breaking point and we just never know until it happens. 

[00:08:37] I think, again, lots of times to talk to organizations, they really wish they that patients didn't have to come to their front door. So how do you prevent that? There's great models like recovery cafes, like third places, if you will, third spaces, where in the case of one facility in Toronto called Stella's Place is the intent that young people going to college who might be, having lost their kind of support network, going to another part of the world and in a really anxious time in their lives where a lot of their future is determined by their next exam or their next test or what the professor thinks of them or their social standing and the idea that you could go to a third place, that doesn't look like a clinic, that doesn't look institutional where you can talk to people, peer support specialists, as we call them, those with lived experience that have clinical training to help you navigate that you might be your same age and can relate to you much more authentically and meet you where you are, but not leave you there. And so, you can do that with space and in that setting and in such a way that it is welcoming and destigmatizing by design. 

[00:09:43] Sola DaSilva: In your interviews with psychiatrists and clinicians, patient groups, other stakeholders. 

[00:09:50] Designing for Dignity and Autonomy

[00:09:50] Sola DaSilva: What are some of the needs and wants that are typically expressed in terms of design?

[00:09:56] Stephen Parker: Thankfully as architects, we typically have individuals and organizations coming to us to aspire to do better, right? They want to manifest in space what their organizational values are and what their mission is and how they want to envision the future. And, we have the responsibility and this great honor to help them shape that vision three dimensionally and spatially. Oftentimes it's that aspirational aspect that kind of really gets me going. And so I try to tap into that. What are you trying to accomplish? And why is it going to be different than what you have now that will make it so much better for those that you serve? That's why we talk about dignity a lot. We talk about these kind of big amorphous topics because they can then drill down and manifest in details and design. 

[00:10:38] Dignity, for example. Oftentimes individuals who are in crisis, if they're in an inpatient setting, for example, a lot of their freedoms are taken away. A lot of indignities are experienced by them because of the kind of lack of agency and autonomy that we may take for granted outside of those four walls for most institutions. And so how can we give back a sense of autonomy and agency? How can we foster dignity? And that goes back to how do you foster self worth? When someone may not feel as if they have any worth or value, if you're just simply seen, then it starts to validate your existence for some folks that really may need that at that point in time of their crisis. What about the environment can help them have a sense of control over what is happening to them and not simply be a number in an institution or otherwise lacking the sense of self worth of like, I can't go get a drink of water. I can't eat. I can't sleep. I can't bathe. I can't do anything without someone else telling me to do it or the environment not allowing me to do it. So oftentimes it's going back and like, how do I do that safely? How do I help someone navigate a crisis and foster that sense of autonomy by giving them back a sense of control over their environment? That can be any number of things of like, where are my belongings? If you come in with a shopping cart, and that is all of your life possessions, and you want to know what's going to happen to your stuff. If you've ever had a sibling or a roommate, you know, what happens when someone mess with your stuff in your own personal space. That's how conflict arises. So it's same thing if you have to share a bathroom with another individual. Your definition of hygiene may be different from your sibling or your roommate. So what about those things come from a simple planning standpoint of like, How do you foster belonging by simply taking care of your belongings? You don't have the anxiety and anxiousness of not knowing where your, all your worldly possessions may be. It's a very simple thing. Um, but you know, it could mean the world for a child, if they can have their binky or their blanket or that book that they always were read to. And if they've slept on the street for an extended period of time, until you've experienced that, until you've slept rough, and you don't know if someone's going to mess with you in the middle of the night, and you've never had the trauma of never having a good night's sleep, and not really understanding that, yeah, being able to lock your door, and the safety and security of that not just physically, but psychologically can be profound. Because obviously if you don't sleep well, you're going to be a little cranky. I have a one year old and trust me, I know all about that. Obviously it's a lot harder if you're sleep deprived and cranky and stressed out than to go to therapy the next day and then to engage well. And then to make meaningful connections and build rapport with the providers that are trying to help you. So we talk about the sanctity of sleep a lot of times, if it's an inpatient or like setting where individuals are going to lay their head. An organization is going to take on that responsibility and defining what that responsibility is and then how does that manifest in space? 

[00:13:33] Sola DaSilva: So you just touched on a couple of concepts that I really like you talked about self-worth, you talked about dignity. And it's interesting to think about that in terms of responsibility and what an architect has to take into consideration when they're designing. 

[00:13:49] Stephen Parker: Yeah, you can create safety, but no serenity, right, in an environment. And that is the more qualitative approach to the design. Like you're going to help someone in a very vulnerable part of their life but that is only to help them build to a greater sense of potential and aspiration for them. So if they feel as if they have hope, that is huge. If we have some small role as a designer in that, that's obviously, I think, extremely purposeful. I think it's a harmonizing between those two because there's a lot of need. There's a quantitative need. There's a, deficit of beds for mental and behavioral health and addiction treatment. There's a deficit of providers to provide those services and facilities that can accommodate that in a trauma informed way and a culturally sensitive way and a dignified way and then to do that with quality and to do that at scale, I think that's always the struggle. And so maybe the intensity of my connections with a lot of different organizations is to kind of do quality at scale. That's going to look different community to community. um, because, yeah, if you can help someone make the decision, because they are no longer counting the number of screws in the room on their door so they feel as if they are trusted when they are locked into their room for the first time that night and they realize that I'm safe here, and I'm not simply mistrusted, it can be a huge change on a little bit of a moment in time in how they're feeling, of going between that sense of despair and that sense of hope. 

[00:15:18] Sola DaSilva: So as an adult, I discovered that I'm neurodivergent. I felt a lot of relief having that information because it provided a framework for me to understand myself, to have a language to understand some of the things that I'm feeling on a personal level and to sort of navigate the world from that lens.

[00:15:37] Stephen Parker: Oh yeah. Absolutely.

[00:15:39] Sola DaSilva: When you meet people who may not understand your life experiences, how do you explain to them in a language they can understand? 

[00:15:47] Stephen Parker: So I was touring a school for individuals learning differences and they really celebrate those differences and they have all this art from all these students all over the campus and they might be really challenged. I might be really challenged with adverse experiences growing up, or at any other point in my life. And I think that kind of, for some people, it's a physical scar, for some people, that's a scar they don't wear on their body. But that provides some sense of character and defines maybe who they are and what their perspective is. I like to think that it can foster empathy because you hopefully can share some vulnerability with the world and the world will be willing to share vulnerability back with you and then you're able to see each other as human beings. And that's usually the safest environment is where you don't see an us versus them, but you see a more collective opportunity to do better so that a child doesn't have to go through living out on the street or in my case, going through third grade, coming in as a left handed person and leaving as a right handed person because that's the way they taught a cursive And that's one of the more gentle experiences that may have happened in any number of learning environments, public, private or otherwise. So I think there is a sense that your life experiences really define and kind of shape your perspective in that lens. And I like to think that every community has a collective lens as well. Some communities that are dealing with generational trauma by not treating the individual in isolation, but treating them collectively as families. If you think about some indigenous communities that have through intentional policies been the victim of cultural genocide and they have been disconnected from their linguistic, cultural, spiritual, and religious roots very intentionally. And then having to mend back family units who are dealing with that for successive generations is huge. Instead of taking the individual out of a toxic environment, only to send them back when they're actually probably more vulnerable because they've achieved some level of recovery only to have it taken away from them is to help maybe treat the entire family unit or kinship unit to address generational trauma holistically.

[00:17:56] I've had the privilege of working on one or two facilities that have looked to address that and that's fascinating to me because that's one community's approach. And that's very culturally sensitive to their needs and they found a unique way of going about it. That could be very different from another community down the street of having to understand what their vulnerabilities are and how to address them through specific services and the facilities that would hopefully reflect the values that they're trying to achieve.

[00:18:24] It could be that you can only really treat addiction in one community by having our harm reduction clinic on the main street, like very out front and in the public sphere because they need to make sure that access is readily available and others are wanting to blend it in with any and all other health care facilities so that way you can go into a clinic and you don't know if you're going to go see an OB or an addiction counselor or whatnot, but there's this sense of parity and equality with that. But it also respects some degree of the privacy of the individual or the family seeking out treatment. So how to overcome that sense of stigma through placemaking, through signage, through wayfinding, how you talk about it, the nomenclature, like when you said that when you found out that there was language to describe what your experiences were, that gave you a sense of ownership over it, perhaps, and like, oh, I can do something with this. I don't have to be in fear of it. I don't have to have this question mark or unknown. I think that every community is struggling with that in their own way and they're coming up with unique solutions accordingly. 

[00:19:27] Sola DaSilva: Um, so for a designer who does not have a similar experience, maybe they've never dealt with addiction or homelessness, and so they have no reference point for the client how can they approach design as somebody who doesn't have direct experience with that situation? ? 

[00:19:46] Stephen Parker: It's a great question. Inspiring empathy in designers is probably very foundational to designing for any number of users that aren't yourself. Right? Outside of designing your own home, your own personal spaces, you're designing for all these other folks and you're never going to sit in everyone's shoes, but you can definitely exercise empathy like a muscle. And I think part of that is to first understand yourself. What are your own bias? What are you bringing consciously and unconsciously to the table that are coloring whether or not you do or do not make a design decision in favor of or against something? Because architecture is not neutral. It can either help or hinder. So understanding maybe your own perspective and what you bring to the table culturally, your background, your education, and understanding that you're going to be designing for someone different than yourself is to really dive deeply into understanding yourself and then understanding and empathizing deeply with those, especially very vulnerable groups and how to do that in a sensitive way that doesn't retraumatize them in the process. You definitely don't want to obviously objectify the trauma they've gone through and to otherwise put it up on such a pedestal that you make light of it. And so how to do that sensitively is going to be different context to context. 

[00:20:58] I think one part of it is there's a great little exercise that it's pretty easy to do. If you stand 12 paces or 12 feet away from someone else and you just walk towards each other until one of the others says, I feel uncomfortable. That's the idea of proxematics, your sense of intimate, personal, social, and public space is going to be different person to person, but also it's going to be different depending on who that other person is, right? If that person is taller than you or shorter than you, for those of us that are under six feet, like myself, or if that person is your same ethnicity or of a different gender, if you know that person or not. It's If you know that person and you feel more comfortable, uncomfortable, it might speak to that personal history that we may have been unknown about or never put words to and that's a great exercise to do within hopefully a trusted group of individuals within your studio or your friend group to understand what that is for you and that then might help you. And I'm going to understand that it's different for different people and how you lay out a waiting room or reception area or a lounge or any space where people are intending to socialize and realizing that, hey, maybe the trauma informed way to go about this is to understand that they might want to see where they're going and who they may interact with and if they do want to interact with them or not, if they choose to socialize, that they have more than one way of going about it and much the same way that some people are hypersensitive or hypersensitive. They can seek to be very cloistered and want the sense of coziness that you get from sitting in your own space or cloister corner or seating niche or others who really want wide open spaces. They want to see everyone coming at them. They want to understand they have a lot of room for movement and escape and refuge. And so there's a number of different sort of modes of thoughts that kind of exercise empathy as a muscle, and that takes you through those scenarios to get you out of your comfort zone and realize where your own bias is coming from, and then how to then design for those groups but not necessarily for, but with.

[00:23:01] Challenges and Solutions in Mental Health Design

[00:23:01] Sola DaSilva: In your work with psychiatrists, patients, other clinicians, what's the biggest complaint that you've gotten from these user groups about the spaces that they work in and occupy? 

[00:23:14] Stephen Parker: Ooh, just one? I mean, I think there is a functional and aesthetic kind of responses. It doesn't look nice. It feels prison like. It looks institutional. It looks like I don't want to be here because I don't want to be here. Why would I want to be here? Why would I want to treat someone here? Why would I take my family member to a place I don't want to be? Then there's like functionally, that goes back to like, how do you feel valued in this space? Do you feel valued if you have no sense of value? Right? I occasionally, and I don't know why I get this, but, oh, we don't want to make it too nice. They'll stay. They being the patients or those individuals who might be experiencing homelessness or might be contending with addiction. And that's a unique response I've gotten more than once about don't make it too nice. Thanks as a complaint to making it better. Then functionally there are things like it's so loud. It's so harsh. I can't hear myself think. I can overhear someone else talking about me. I can overhear someone else, talking about someone else's crisis and, or struggles. And that can escalate the situation as well. So you've got to think about that functional friction that can also be overcome with design. So we hear that quite a bit. um, very harsh lighting. I don't know what it is nowadays, but every place seems as if it's got so much lighting, it's hurts I wish I had more outdoor space and oftentimes mental health facilities don't think about like in the pandemic, the value of having a yard or a balcony to decompress and engage nature. Why don't we categorize that in code? Why do we still regulate people to also share bedrooms and behavioral mental health spaces? Things like that, that just seem really fundamental as complaints. Again, it goes back to the value sets that organization aspiring to really project and serve with the policies that dictate what they can and can't do and the monetary and fiscal environment that either will allow them to build and sustain the kind of model of care and the care culture they're aspiring for. 

[00:25:36] The Role of Design Advocacy

[00:25:36] Sola DaSilva: As a designer, I sometimes feel that the tools at our disposal are somewhat limited to respond to some of the challenges that we're facing in society today, you know, including public health crisis, you know, poverty, discrimination, housing crisis. And so my question to you is, do you think that your work is enough? Do you think that you're able to meet the needs that we're currently faced with today? I know it's a tough question, but.

[00:26:08] Stephen Parker: Oh yeah. Design is the manifestation or the end of the tail in a lot of cases of like, we need to get to a point to enclose a space with four walls and a function. Whereas if the services that were provided would prevent, let's say that crisis in the first place is what a lot of providers wish for. That they didn't have to take care of someone in that setting. I will say crisis centers in particular are intended to divert from worse settings, jails, emergency departments, places that just aren't well suited for it, for an individual in crisis, both as a built environment and as the clinical service. There's a burgeoning understanding that these issues are never in isolation. And I think the communities that I look to as examples are the ones that have found really clever ways of amalgamating resources and understanding that this shared collective vision for addressing youth mental health or children who might be drummed out of, let's say, the systems of care that exist out there, whether it be health, incarcineal or social, or educational. I think it was when I was in the Netherlands, it was a broken child is a very expensive adult. So obviously it's preventing that at all stages of life, allowing access to that care, that there's an understanding and overcoming that stigma to having people acknowledge that they need it, sooner rather than later I think is a huge part of it. I like to think that also for the organizations I volunteer with and engage with is to think about and influence policy. 

[00:27:38] We simply don't have to design. We can advocate by design. We can be design advocates and say that we are designing at this worst end case, but we would love to design for that intermediate step or that preventional step. Is it in the classroom? Is it The fact that you provided affordable housing that lifts people out of poverty. Is it that you've overcome food deserts any other sort of social determinants of health as well that we all have play a role in our communities. Is it going and showing up the zoning board and saying, yes, I would like additional housing options so that my neighbors don't always have to look like me, but they can aspire to be whoever they want to be. I don't have to be exclusionary and who is my neighbor, because I think that makes a richer environment for any number of things and makes me more empathetic to these different perspectives in life. Oftentimes that's the breakdown of a lot of facilities is like, how do you break down authority dynamics of an us versus them in society writ large. I'm not an anthropologist or a social scientist but from a design standpoint, is it lowering social density? Is it making sure that when you do interact with someone hoping to serve you, that you don't create friction and function. That you provide the ability for someone to autonomously take care of themselves in a space without having to knock on a window or ask someone for these things that we may take for granted. Can you open my windows so I don't get the sunlight in? Can I get a drink of water? Things of that nature. But if I don't have a policy that dictates I can do that or not, if I don't have a fiscal ability in a capital planning study, if I don't see it in an RFP or brief, I can't design for certain things. I think that's one aspect of just knowledge sharing is that we can all do better. I'm still learning. Everyone's still learning. Shoot that out there in the world. Design is one aspect of overcoming stigma and addressing these societal ills. Policy is another aspect of it that we can also play a role as design advocates. 

[00:29:32] Sola DaSilva: I really liked the term design advocate because it encompasses, the technical side of design and the administrative things that you have to do as an, as an architect. 

[00:29:42] Conclusion: Finding Serenity in Design

[00:29:42] Sola DaSilva: But there's also all the emotional things that you have to take into consideration, like you'd mentioned, dignity, self-worth and that probably requires going a little bit beyond the building code or what the design brief is, it's kind of taking an additional step and I want to end the podcast on that note and I just want to thank you so much for your time and for all of the information and wisdom that you've shared. So the question I ask, all of my guests, is, what's your third place? It could be anything. It could be virtual, but, what's your third place?

[00:30:19] Stephen Parker: There's this little creek near where we live. That's one reason why we picked this neighborhood and many other things. And during the pandemic, it was kind of our escape. We could walk off the path and be surrounded by nature, the flow and sound of water. I grew up on the beach. I grew up near water and, um, something really comforting about that, that the world around you is still flowing and moving forward, even when you think that you're not. Maybe your own life is not really moving forward the way you want. And I think there's something to be said for me I find that very serene and comforting.

[00:30:52] Sola DaSilva: Thank you for listening to this episode of Third Space. Be sure to like, subscribe, and share. I'd love to hear your thoughts. Send me emails, DMs. Adios, friends. Until next time.