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• W3103029405 abstract "We write in support of Stephanie Liddicoat and colleagues1Liddicoat S Badcock P Killackey E Principles for designing the built environment of mental health services.Lancet Psychiatry. 2020; 7: 915-920Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar and concur with the ideas detailed in their thoughtful description of six architectural principles that can be applied to design psychiatric institutions in order to “enhance treatment outcomes and experiences, provide benefits to families and the community, and promote community resilience”.1Liddicoat S Badcock P Killackey E Principles for designing the built environment of mental health services.Lancet Psychiatry. 2020; 7: 915-920Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar However, we would like to propose that, rather than including the lighting design of the built environment in the architectural principle of facilitating empowerment, the accumulating evidence that lighting systems substantially affect subjective wellbeing and objectively assessed prognoses makes this issue worthy of separate consideration.2Scott J Langsrud K Goulding IR Kallestad H Let there be blue-depleted light: in-patient dark therapy, circadian rhythms and length of stay.BJPsych Adv. 2020; (published online Aug 25.)https://doi.org/10.1192/bja.2020.47Crossref Scopus (1) Google Scholar As such, we propose a seventh architectural principle: create a chronobiologically informed therapeutic milieu. Liddicoat and colleagues1Liddicoat S Badcock P Killackey E Principles for designing the built environment of mental health services.Lancet Psychiatry. 2020; 7: 915-920Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar highlight that a more nature-like environment (including access to natural light) supports recovery. Indeed, Florence Nightingale described light and the rhythm of night and day as two important factors in restoring physical health. Furthermore, at least four large-scale studies in somatic and psychiatric inpatients show clinically significant effects on morbidity, medication use, length of stay, and mortality rates of different levels of daylight and artificial light exposure.2Scott J Langsrud K Goulding IR Kallestad H Let there be blue-depleted light: in-patient dark therapy, circadian rhythms and length of stay.BJPsych Adv. 2020; (published online Aug 25.)https://doi.org/10.1192/bja.2020.47Crossref Scopus (1) Google Scholar It is now understood that the inter-relationship between light, sleep–wake cycles, and health outcomes has an empirical biological basis and, in inpatients, can be linked to the spectrum of light and the timing of light exposure experienced by individuals.2Scott J Langsrud K Goulding IR Kallestad H Let there be blue-depleted light: in-patient dark therapy, circadian rhythms and length of stay.BJPsych Adv. 2020; (published online Aug 25.)https://doi.org/10.1192/bja.2020.47Crossref Scopus (1) Google Scholar In psychiatry, it is increasingly recognised that light is the most important time-giver to the human circadian system, and that circadian disruptions are a transdiagnostic feature of many severe mental disorders.3Foster RG Peirson SN Wulff K Winnebeck E Vetter C Roenneberg T Sleep and circadian rhythm disruption in social jetlag and mental illness.Prog Mol Biol Transl Sci. 2013; 119: 325-346Crossref PubMed Scopus (104) Google Scholar Although morning bright light therapy is often used in treating mood disorders,4Lam RW Levitt AJ Levitan RD et al.Efficacy of bright light treatment, fluoxetine, and the combination in patients with nonseasonal major depressive disorder: a randomized clinical trial.JAMA Psychiatry. 2016; 73: 56-63Crossref PubMed Scopus (115) Google Scholar attention is now shifting to the importance of darkness in the evening and night. Specifically, blocking short-wavelength blue light frequencies in evening light (artificial darkness) can be used to reset and stabilise the circadian rhythm in humans and to treat mental illness.2Scott J Langsrud K Goulding IR Kallestad H Let there be blue-depleted light: in-patient dark therapy, circadian rhythms and length of stay.BJPsych Adv. 2020; (published online Aug 25.)https://doi.org/10.1192/bja.2020.47Crossref Scopus (1) Google Scholar Based on these empirical observations, the first circadian lighting systems are now being tested in medical and psychiatric units (eg, NCT03788993). A new psychiatric unit in Trondheim, Norway, incorporates an evening blue-depleted light environment.2Scott J Langsrud K Goulding IR Kallestad H Let there be blue-depleted light: in-patient dark therapy, circadian rhythms and length of stay.BJPsych Adv. 2020; (published online Aug 25.)https://doi.org/10.1192/bja.2020.47Crossref Scopus (1) Google Scholar We have shown that for healthy adult volunteers, residing in this hospital light environment has a beneficial effect on the circadian system, sleep, and neurocognitive arousal over and above any benefits of usual inpatient routines.5Vethe D Scott J Engstrøm M et al.The evening light environment in hospitals can be designed to produce less disruptive effects on the circadian system and improve sleep.Sleep. 2020; (published online Sept 21.)https://doi.org/10.1093/sleep/zsaa194Crossref PubMed Scopus (3) Google Scholar This makes a chronobiologically informed lighting system a feasible and effective architectural design option that targets circadian rhythm disruptions—a core mechanism of developing and maintaining mental disorders. We declare no competing interests. Principles for designing the built environment of mental health servicesAlthough there is an increasing amount of literature on the key principles for the design of mental health services, the contribution of the built environment to outcomes for the service user is a largely neglected area. To help address this gap, we present evidence that highlights the pivotal role of evidence-based architectural design in service users’ experience of mental health services. We propose six important design principles to enhance the care of mental health service users. Drawing on research into the delivery of mental health services and best-practice approaches to their architectural design, we outline a holistic conceptual model for designing mental health services that enhance treatment outcomes and experiences, provide benefits to families and the community, and promote community resilience. Full-Text PDF" @default.
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• W3103029405 title "Chronobiologically informed inpatient milieu in psychiatric institutions" @default.
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