Historical and current construction of psychiatric hospitals

At the beginning of the 19th century, institutional care for the insane was established by the various German states. At first, the separation of curable and incurable patients influenced psychiatric care and the construction of hospitals. The combination of care and cure in one hospital in Illenau was a turning point in institutional care. Contradictory tendencies characterized the second half of the 19th century: the integration with general medicine in the cities, on the one hand, the social separation and cure in the seclusion of the countryside, on the other. The characteristic psychiatric construction in different countries was influenced by individual architects. The following building styles were dominant: in England, panoptic architecture; in the United States, linear staggered structures; in France, the ''carres isoles''; and in Germany, the structure of blocks with cross-axes. At the end of the 19th century, the system of pavilions was internationally accepted; occupational therapy and mental care in the countryside were introduced. From the First World War until the end of the 1960s, a standstill in psychiatric buildings was noted in Germany, and institutional care came under increasing criticism. There was a reorientation from the middle of the 1970s as a result of more effective therapeutic possibilities. A variety of complementary institutions, outpatient and partly inpatient therapies, which were recommended by the ''Psychiatrie-Enquete'', started to be realized. Smaller units and different models of integration of psychiatric care, such as building the hospital next to a general hospital or psychiatric wards within a general hospital, became relevant criteria for planning the construction of psychiatric hospitals, as did the integration into the community and the city. Principles of organization like the construction of a communicative quiet inner room, or grading the rooms from public to private, were structurally integrated. Specific structural requirements for the construction and design of psychiatric hospitals should be evaluated in more detail by post-occupancy methods.