Turkish Republic Ministry of Health spatial evaluation of CMHC-community mental health centers and CMHC design criteria proposal

World Health Organization (WHO) defines mental health as "a complete wellbeing of mental and physical status", which carries a great importance for individuals, societies and countries. As a response of pursuing efforts of WHO, emphasizing the importance and encouragement of countries to include mental health in their health politics and plans, Turkish Republic Ministry of Health has launched the 'National Mental Health Action Plan' that would be valid between 2011 and 2023. Within the scope of this action plan, transition from hospital based mental healthcare system model approach through community based mental healthcare system approach for the diagnostics and treatment of severe mental disorders has been declared obligatory and urgent. However, lacking necessary resources for a direct transition to community based system, a balanced community-hospital based mental healthcare system model has been preferred to establish the new mental healthcare system in Turkey. In balanced community-hospital based mental healthcare system model, hospital based approach is preserved by psychiatric hospitals, whilst the first step into community based mental healthcare system is considered Community Mental Health Centers (CMHC). In the CMHC Regulation published in 2011 and revised in 2014, the target group of CMHCs has been defined as patients with severe mental disorders, who have been released from psychiatric hospitals after having the necessary treatment. The aim of CMHCs has been determined as registering those patients, following their daily based treatments and medication, encouraging integration of patients to the society by occupational therapies and various trainings and lastly providing patients' relatives the training and support they need. The starting point of this study is the thesis that criteria of CMHCs are crucial in terms of psychology, productivity and benefits for user groups, which are patients, patients' relatives and staff; however physical features and spatial requirements of CMHCs are not explained in a clear and detailed way in CMHC Regulation. Therefore, the objective of this study is to define the physical and spatial needs of CMHCs and eloborating with these, to generate a design criteria set for CMHC. Thus, during this study, a mixed research bethod of both quantitative nd qualitative approaches are deployed respectively accompagnied with literature review. Inıtially the existing literature has been widely reviewed for current mental healthcare systems, historical aspect and other examples. Afterwards, two CMHCs (Beylerbeyi CMHC and Sultanbeyli CMHC), which are affiliated with Erenköy Psychiatric Hospital are chosen as cases for further research in field study. Then, as quantitative phase, the numeric data regarding user groups, spatial organization and physical spatial needs are observed and analyzed. Later on, within the scope of the qualitative phase, semi-structered interviews are held with the users which are patients, patients' relatives and working staff in order to gain data about their spatial experiences, thoughts, needs and expectations. These interviews are analyzed by decoding these interviews and using content analysis method on transcripted texts. Data set derived from the content analysis that are grouped and coded and then by classifying those codes, themes are created. In conclusion, themes are evaluated and final outputs are produced as CMHC design criteria proposal. Final outputs that are derived from the study show that current CMHCs have many deficiencies about physical and spatial conditions. The main reason for these defincies are observed as the lack of adequate information in CMHC Regulation as well as the physical restrictions within the existing conditions. Deficiencies and requirements about subjects such as location, accessibility, spatial dimensions, spatial organization, illumination and noise characteristics, colors and material selections, security features etc. are all revealed from the observations, interviews and analysis under headlines as spatial organization, interior design elements and comfort conditions, spatial fittings. Finally, the thesis of "Design criteria of CMHCs are crucial in terms of psychology, productivity and benefits for user groups which are patients, patients' relatives and staff." has been confirmed through this study and a design criteria proposal has been generated to be used as a guideline for existing and further developed CMHCs.