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Compassionate containment? Balancing technical safety and therapy in the design of psychiatric wards

Curtis, S.E.; Gesler, W.; Wood, V.J.; Spenser, I.; Mason, J.; Close, H.; Reilly, J.

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W. Gesler

V.J. Wood

I. Spenser

J. Mason

H. Close

J. Reilly


This paper contributes to the international literature examining design of inpatient settings for mental health care. Theoretically, it elaborates the connections between conceptual frameworks from different strands of literature relating to therapeutic landscapes, social control and the social construction of risk. It does so through a discussion of the substantive example of research to evaluate the design of a purpose built inpatient psychiatric health care facility, opened in 2010 as part of the National Health Service (NHS) in England. Findings are reported from interviews or discussion groups with staff, patients and their family and friends. This paper demonstrates a strong, and often critical awareness among members of staff and other participants about how responsibilities for risk governance of ‘persons’ are exercised through ‘technical safety’ measures and the implications for therapeutic settings. Our participants often emphasised how responsibility for technical safety was being invested in the physical infrastructure of certain ‘places’ within the hospital where risks are seen to be ‘located’. This illuminates how the spatial dimensions of social constructions of risk are incorporated into understandings about therapeutic landscapes. There were also more subtle implications, partly relating to ‘Panopticist’ theories about how the institution uses technical safety to supervise its own mechanisms, through the observation of staff behaviour as well as patients and visitors. Furthermore, staff seemed to feel that in relying on technical safety measures they were, to a degree, divesting themselves of human responsibility for risks they are required to manage. However, their critical assessment showed their concerns about how this might conflict with a more therapeutic approach and they contemplated ways that they might be able to engage more effectively with patients without the imposition of technical safety measures. These findings advance our thinking about the construction of therapeutic landscapes in theory and in practice.

Journal Article Type Article
Publication Date Nov 1, 2013
Deposit Date Jun 14, 2013
Publicly Available Date Jan 10, 2014
Journal Social science and medicine
Print ISSN 0277-9536
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 97
Pages 201-209
Keywords England, Psychiatric hospitals, Mental health care, Hospital design, Risk governance, Technical safety, Surveillance, Therapeutic landscapes.
Public URL


Accepted Journal Article (483 Kb)

Copyright Statement
NOTICE: this is the author’s version of a work that was accepted for publication in Social science & medicine. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Social science & medicine, 97, 2013, 10.1016/j.socscimed.2013.06.015

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