A chubby bronze bird perches on the roof of a bright orange building at the Alder Hey children’s hospital, craning its neck to keep tabs on all who enter. On a bench nearby, a smaller bird looks up, its wings tentatively spread, as though plucking up the courage to join its mother on the roof. Two more cartoonish creatures are engaged in conversation above the entrance canopy, perhaps mimicking some of the family discussions happening down below.
It is a disarmingly cheerful entry to a place where most visitors arrive in acute distress, as the new home for young people’s mental health services in the region. The £20m project brings services together that were formerly scattered around Liverpool in a disjointed muddle of converted buildings, giving them a new base on the main hospital site, as part of Alder Hey’s expansive parkland campus. Designed by Cullinan Studio, with artworks by Lucy Casson, the new centre points to a welcome alternative to the usual dreary hospital template of anonymous sheds housing wipe-clean, windowless corridors. It floats on the edge of the park like a rusty steel ship moored in a dry dock, enclosing a pair of light-flooded courtyards, with warm wooden interiors and thoughtful details throughout.
“It’s part of the NHS’s wider drive to treat mental health with the same level of importance as physical health,” says Lisa Cooper, Alder Hey’s director of mental health services. The need could not be more stark. Since the pandemic, the number of young people seeking mental health support has reached a record high, with 1.4m school-age children requesting NHS help last year – a dramatic increase of 76% since 2019. Eating disorders have rocketed, thriving in the social isolation of lockdown, while anxiety and self-harm have also been on the rise, often triggered by the pressure of having to catch up with missed school time.
“Our young people usually come with multiple diagnoses,” says clinical lead, Andrea O’Donnell. “It could be an eating disorder like anorexia, in addition to OCD [obsessive compulsive disorder], with autism on top. They are complex, layered mixes.”
In the previous facility, children were ushered into a low-ceilinged waiting room, with plastic seats facing each other in an intimidating square, a welcome that couldn’t be more off-putting. Now, they enter the new Catkin Centre into a space where a great wooden cone bursts through the ceiling, bringing light into the open foyer. The structure has benches and seating nooks built in, while deep window sills offer places to perch – doing away with the usual seats in serried rows or arranged around the edge, common to most NHS waiting rooms.
From here, consultation and clinical rooms are arranged in clusters around a U-shaped courtyard, with smaller “sub-wait” lobby spaces for each trio of rooms. The architects’ drawings show these as alluring spaces, lined with upholstered cubbyholes, but they have become distinctly more workmanlike affairs in the contractor-led building process – something that is sadly a recurring theme throughout.
The building next door, known as Sunflower House, is a higher-security inpatient facility, home to 12 bedrooms, where children aged between nine and 13 with more challenging mental health needs stay for an average of nine months. It takes a similar two-storey courtyard form, with timber-lined corridors facing on to a planted central space – equipped with a giant xylophone and spherical water feature – and bedrooms arranged around the edge on the upper level, each with a deep bay window. The nurses’ office occupies a prime viewing spot, positioned like a panopticon at the end of the courtyard, so they can easily survey the whole scene. Open lounge spaces project into the courtyard, although it turns out most of the kids prefer to sit on the deep window sills, where they can look out, but also feel protected.
“We found that children tend to seek small spaces within big spaces,” says Roddy Langmuir, practice leader at Cullinan Studio. “The bay windows are designed so you can climb into them, while all the sills are deep enough to sit on, and feel a connection with the outside.”
During the design consultation, one child drew a sketch showing little private pods arranged on what look like umbilical cords extending from a central oval. “Not linear shaped like a normal hospital,” said the accompanying note. “Different seating areas built in,” said another. Both became driving principles of the design. “They all wanted ‘getaway space’,” says Langmuir, “somewhere to feel out of the public eye, but also be able to see what’s going on.”
Children who feel too anxious to join classroom sessions downstairs can watch from the safe distance of an upstairs window sill, then they might come down to the courtyard to join a table tennis game, and eventually find themselves feeling comfortable at a desk. Multiple routes help soften the psychological barriers to entry.
Such progression is aided by a multimedia “immersion room”, where various scenes of the outside world can be simulated by interactive projections on the walls. One minute we’re standing in a busy pedestrian shopping precinct in Liverpool (which feels more overwhelming than the real thing), the next an airport terminal, then a calming underwater scene, where fish swim in shoals across the floor, and the swipe of a hand conjures bubbles across the wall. Real-life classrooms can also be simulated, even down to where the child will be sitting, to help acclimatise them back into the feeling of being at school.
The school canteen might be a comedown after time spent here. The consultation process determined that, above all else, the kids wanted to eat in an American diner. So that’s what they’ve got. It is washed in a Miami colour scheme, with minty walls, lilac banquettes, 1950s decals covering the walls, and a diner-style menu.
The pastel palette continues elsewhere, in the vinyl upholstery covering the heavyweight anti-ligature furniture, and in the sloping architraves around the doors, designed so nothing can be tied or hung from them. The door handles are solid and also can’t be tied on to, while the cupboards have sloping tops. “Our challenge was to break through the institutional coding,” says Langmuir, “while having to use all the certified fixtures and fittings.”
They have mostly succeeded, although there are places where the vision hasn’t quite found its way into reality. As is often the case, the NHS trust chose a “design and build” procurement route, whereby the builder rather than the architect is in charge, appointing contractor Galliford Try to oversee the project. The company boasts that it “refined the design, delivering £5m savings,” but it seems that some of the joy was squeezed out in the process.
The original wooden window mullions around the courtyard are now metal, creating a more harsh, officey feel, while the once-pitched bedroom ceilings have been flattened, making them feel more institutional. The cross-laminated timber walls feature gaps and cracks that look hastily filled, while suspended ceilings now hang where the timber would once have been exposed, and the vinyl floors are mismatched in places. Clunky glass balustrades add to the catalogue-chosen air. These might sound like small details, but they make a difference – and it’s particularly galling when compared to the much more slickly finished research institute next door, the preserve not of patients, but staff and visiting academics.
Thankfully, Cullinan Studio’s primary design moves are strong enough to have survived most of the cost-cutting, but NHS procurement needs a rethink if it is to achieve the quality its patients deserve.
• In the UK, the youth suicide charity Papyrus can be contacted on 0800 068 4141 or email pat@papyrus-uk.org, and in the UK and Ireland Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is at 988 or chat for support. You can also text HOME to 741741 to connect with a crisis text line counselor. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
