Adult medium secure services

These services provide a safe, therapeutic environment for those who may be a serious danger to themselves and others. Their aim is to promote positive patient outcomes enabling either transferral to low secure services or a return to the community. To achieve this, the following must be considered

  • The safety and security of patients and staff
  • The provision of an appropriate therapeutic environment
  • The protection of the public

The maintenance and design of the built environment have been closely linked to patient recovery, while the provision of a safe and secure environment for patients, staff and visitors is intrinsic to the delivery of the care itself.

Key principles

  • Create a safe environment for staff, patients and visitors. Patients must feel safe to engage with their therapeutic care
  • Create an environment which supports the therapeutic care of the patients, enabling them to engage in a variety of activities to facilitate a return to the community
  • Create an environment which maintains the integrity of the service and promotes integration into the community

Guide to design

Research is being carried out continually to identify best practice in design, but there are some key principles on which key stakeholders and designers agree.  This is intended as brief overview of the subject and does not constitute definitive guidelines. The product recommendations below do not constitute an exhaustive list and we would always recommend that you consult your Altro Consultant on specific project requirements.

Top tips for design in all areas

  • Create an environment which feels comfortable and non-threatening, reduces stress and contributes to conflict avoidance between staff and patients
  • Design an environment which is safe and minimises risk
  • Design a therapeutic environment, taking into account the need for acoustic reduction, the avoidance of crowds, requirements for good natural light and ventilation
  • Design a homely environment that is suitable for extended lengths of stays, with a range of communal areas for quiet time / therapy / education / leisure / visits
  • Optimise the use of inspirational design to create interesting areas which do not compromise the requirement for functional secure health facilities
  • Create an environment which supports the development of relational security
  • Allow for the provision of a low stimulus environment
  • Facilitate visibility, access and safe movement around the built environment
  • Minimise the potential for fixtures and fittings to be used as weapons against others, barriers or for self-harm, including ligature, or for them to be used to conceal contraband
  • Design a quiet environment in which noisy service areas, such as de-escalation suites, delivery bays and laundries, are soundproofed with acoustic flooring and located away from bedrooms
  • Prevent and control the spread of infection and contamination
  • Specify finishes which enable easy cleaning, maintenance and hygiene. A well maintained environment delivers a caring message to the patients, their families and the staff, promoting patient recovery and enhancing staff morale
  • Facilitate patient observation, while maintaining a balance between privacy and observation
  • Provide a welcoming environment and positive first impression, which remains suitable for healthcare with facilities for visitors
  • Place high importance on life cycle costs and long-term development needs, to future-proof current areas to allow for expansion and flexibility of function
  • Avoid products with a woven fibre backing, such as on some carpets, as it can be used as a ligature

Bedrooms/ wards

  • Avoid a sterile, hospital look, create a homely feel to aid sleep and reduce anxiety
  • Areas should be bright, maximising the perception of space
  • Flooring should be impervious and fully bonded to the substrate
  • Bedrooms should include an ensuite bathroom
  • Design should preserve the patient's privacy and dignity, while allowing staff observation

Product recommendations: Altro Suprema II, Altro Wood Safety, Altro Whiterock wall cladding, Altro resins on walls and floors

Bathrooms/ shower rooms

  • Eliminate any self-harm or ligature points
  • Flooring should be impervious and fully bonded to the substrate
  • Ensure that the flooring is slip-resistant from edge to edge, effectively sealed around walls and splashbacks, affording protection for both the patients and staff, who may or may not be wearing footwear, when moving about in areas that could be simultaneously wet and dry in patches
  • Ensure the safety flooring offers the latest in PUR cleaning technologies to maintain cleanliness and hygiene, promoting effective infection control
  • Avoid flooring and walling that are clinical in appearance. Specify products that create a homely feel

Product recommendations: Altro Aquarius safety flooring combined with Altro Whiterock wall cladding

Dining rooms

  • Use slip-resistant flooring in eating areas where there is the risk of spillages
  • Specify an acoustic underlay or acoustic flooring to reduce noise in areas where the clatter of food trolleys can significantly contribute to ambient noise levels and patient distress

Product recommendations: Altro Suprema II, Altro Wood Safety, Altro Whiterock wall cladding

Kitchens/ ward serveries

  • Design should allow patient participation in appropriate kitchen tasks, while permitting staff observation
  • Flooring and walling should be impervious and fully bonded to the substrate to maintain hygiene
  • Welded joints will aid hygiene and the maintenance of cleanliness

Product recommendations: Altro Stronghold 30, Altro resins, Altro Whiterock wall cladding

Lounges/ education/ leisure areas

  • Flooring and walling should be impervious and fully bonded to the substrate
  • Design flooring and walling to aid relaxation and reduce anxiety
  • Use slip-resistant flooring in areas where there is the risk of spillages
  • Specify flooring which affords sufficient flexibility of function to enable the space to be subdivided for activities
  • Welded joints will aid hygiene and the maintenance of cleanliness

Product recommendations: Altro Suprema II, Altro Walkway Plus, Altro Timbersafe II, Altro Whiterock wall cladding

De-escalation areas

  • Create a calming, low-stimulus space for patients with muted and restful colours
  • Install durable, hard-wearing, slip-resistant, seamless flooring which can withstand picking and other forms of attack

Product recommendations: Altro resins on floors and walls, eg Altro TB Screed, Altro Multiscreed Naturals, Altro Mosaic and AltroScreed Quartz, bespoke solutions available (conditions apply, please ask your Altro Consultant)

Seclusion suite

  • Create a calming, low-stimulus space to manage highly disturbed patients with ensuite facilities
  • All fixtures and fittings must significantly reduce the risk of patient self-harm by being anti-pick and seamless

Product recommendations: Altro resins on floors and walls, eg Altro TB Screed, Altro Multiscreed Naturals, Altro Mosaic and AltroScreed Quartz, bespoke solutions available (conditions apply, please ask your Altro Consultant)

Treatment rooms

  • These areas may be used for emergency treatments or for the administration of medicine and therefore may be prone to liquid / powder spillages. Ensure the flooring is slip resistant for staff and patient safety
  • Create a relaxed ambience through design to promote calm behaviour

Product recommendation: Altro Suprema II, Altro Whiterock wall cladding

Corridors/ circulation areas

  • Incorporate way finding into the overall design to facilitate access and manage flow to key patient areas
  • Flooring should be impervious and fully bonded to the substrate
  • If spillages are a concern, from patients / staff carrying liquids etc, or from patients who may suffer from incontinence, install slip-resistant safety flooring offering the latest in PUR cleaning technologies to maintain cleanliness and hygiene

Product recommendations: Altro Suprema II, Altro Wood Safety, Altro Walkway Plus, Altro Whiterock wall cladding

Reception areas

  • Create a welcoming, good first impression to reduce anxiety and make people feel at home
  • Design in ease of orientation to other key areas in the building

Product recommendations: Altro Suprema II, Altro Walkway Plus, Altro Wood Safety, Altro Whiterock wall cladding

Visiting suites

  • Create a welcoming environment with a comfortable, bright atmosphere
  • Allow for staff observations
  • Promote staff, patient and visitor safety

Product recommendations: Altro Suprema II, Altro Wood Safety, Altro Whiterock wall cladding

Skirting boards

  • In patient areas under intermittent observation coved flooring provides optimum safety
  • In patient areas under constant observation hardwood skirting boards or equivalent may be installed

Product recommendations: coved Altro safety flooring or walls/floors seamless Altro resins

Doorsets

  • Allow staff observation as required
  • Allow for integrated blinds
  • Construction should prevent dismantling / removal of individual parts / breaking to be used for harm or as barriers
  • Design and installation should prevent ligature, finger-trapping, escape, hiding
  • Allow a two-way swing to prevent patients blocking entry 
  • Colour co-ordinate with the design scheme for a calming effect

Product recommendations: Altro Whiterock Doorsets