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12-2015

A Mat Response to Deinstitutionalization

Dominic Lipuma

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A Mat Response to Deinstitutionalization

The relationship between architecture and The architectural typology of the asylum,
mental health, in regards to psychopathology, based on the Kirkbride model, reflected soci-
or mental illness, has been one of great ety’s validation (and, therefore, more serious
contention. They have been estranged since and humane treatment) of mental illness.
the age of deinstitutionalization that began However, the actual outcomes and depictions
in the 1960s, and, with this abandoment of in popular movies have shown the admirable
architectural issues, the two still have yet to intentions of the Kirkbride model, based on
be reconciled. As a result, further social issues monumental, symbolic, and hierarchical orga-
have manifested, with higher proportions of nizations of isolation, failed.
the mentally ill making up prison and home- Due to these failures of both tested and
less populations throughout the United States, proposed architectural solutions, in conjunc-
in addition to an overall lack of proper mental tion with the rise of pharmacology, a major
health treatment. According to a 2012 report shift in strategy from environmental and
by the New York State Office of Mental Health, architectural treatment to biological treatment
“Nearly 40% of adult New Yorkers with serious has taken place over the last half-century. This
mental illness did not receive mental health has left a “hole” within the field of architecture,
treatment in the past year.” The problem leaving space for a new solution to be offered
has not been solved, but rather transferred in regards to an architecture designed and
somewhere else in what has been referred to built specifically for treating psychopathology.
as “transinstitutionalization.”
An approach to architecture that also came
This thesis references the wave of new ideas out of this radical era of the 1960s was the
for architecture’s response to mental health “mat” building. Mat building involves the
during the 1960s, based on a new under- minimum organization necessary and a flex-
standing and approach to mental illness in ible, integrative typology that fosters engage-
society, with the proposals for Community ment with the community and surrounding
Mental Health Centers (CMHCs). These context in which it is located. However, in
facilities formed the architectural basis of the addition to utitlizing the mat strategy, this
Community Mental Health Act of 1963, which thesis offers a new sensitivity to a temporal
was ultimately never fulfilled, marking the experience of program. The Mat-Collective
wave of deinstitutionalization and the closing Community Mental Health Center does not
of psychiatric hospitals without these CMHCs express a hierarchical representation of power,
in place. Therefore, this thesis picks up where but rather reflects the user’s temporal experi-
the ball was dropped back then, proposing a ence as a result of an investigation of metrics,
new architectural solution based on further program, and place.
research and insight that has since taken place.

1 Advisor: ANNE MUNLY

DOMINIC S. LIPUMA

2
A MA T
R E S P ON S E
TO
DEINSTITUTIONALIZATION
 Buildings are inert objects, but our experience of them transcends
the physical realm and extends into our deepest consciousness.
Architecture, in particular, which moves beyond mere building,
strives to enhance the human condition and promote emotional
well-being through the manipulation of space, light, material,
and form.

- Elizabeth Danze and Stephen Sonnenberg, Space & Psyche, 2013

A Mat Response to
Deinstitutionalization

Dominic LiPuma
Primary Advisor: Anne Munly
Secondary Advisors: David Shanks, Tarek Rakha
Thesis Preparation
Fall 2015
Syracuse University School of Architecture
TABLE OF CONTENTS

I. Contention, Executive Summary 1

II. Institutionalization and the Evolution of the Asylum Typology 11

III. Deinstitutionalization and Community Mental Health Centers 31

IV. Mat Building - Case Studies 49

V. Summary of Characteristics and Mat Strategies 61

VI. Proposed Site - Roosevelt Island, NYC 89

VII. User Focus: Spatial Scopes 109

VIII. Precedents 123

IX. Bibliography 135

X. Appendix 139
 I. Contention,
Executive Summary

1
I. Architecture and Mental Health

The relationship between architecture and mental health, in regards to

psychopathology, or mental illness, has been one of great contention. They
have been estranged since the age of deinstitutionalization that began in the
1960s, and, with this abandoment of architectural issues, the two still have yet
to be reconciled. As a result, further social issues have manifested, with higher
proportions of the mentally ill making up prison and homeless populations
throughout the United States, in addition to an overall lack of proper mental
health treatment. According to a 2012 report by the New York State Office of
Mental Health, Nearly 40% of adult New Yorkers with serious mental illness
did not receive mental health treatment in the past year. The problem has
not been solved, but rather transferred somewhere else in what has been
referred to as transinstitutionalization.

2
 II. Re-entering the progressive conversation of the 1960s

This thesis references the wave of new ideas for architecture s response to
mental health during the 1960s, based on a new understanding and
approach to mental illness in society, with the proposals for Community
Mental Health Centers (CMHCs). These facilities formed the architectural basis
of the Community Mental Health Act of 1963, which was ultimately never
fulfilled, marking the wave of deinstitutionalization and the closing of
psychiatric hospitals without these CMHCs in place. Therefore, this thesis
picks up where the ball was dropped back then, proposing a new
architectural solution based on further research and insight that has since
taken place.

3 CONTENTION, EXECUTIVE SUMMARY

III. Architectural issues specific to the mental health typology

The architectural typology of the asylum, based on the Kirkbride model,

reflected society s validation (and, therefore, more serious and humane
treatment) of mental illness. However, the actual outcomes and depictions in
popular movies have shown the admirable intentions of the Kirkbride model,
based on monumental, symbolic, and hierarchical organizations of isolation,
failed.
Due to these failures of both tested and proposed architectural solutions, in
conjunction with the rise of pharmacology, a major shift in strategy from
environmental and architectural treatment to biological treatment has taken
place over the last half-century. This has left a hole within the field of
architecture, leaving space for a new solution to be offered in regards to an
architecture designed and built specifically for treating psychopathology.

4
 IV. Mat Building: Strategy and Typology

An approach to architecture that also came out of this radical era of the 1960s
was the mat building. Mat building involves the minimum organization
necessary and a flexible, integrative typology that fosters engagement with
the community and surrounding context in which it is located. However, in
addition to utitlizing the mat strategy, this thesis offers a new sensitivity to a
temporal experience of program. The Mat-Collective Community Mental
Health Center does not express a hierarchical representation of power, but
rather reflects the user s temporal experience as a result of an investigation of
metrics, program, and place.

5 CONTENTION, EXECUTIVE SUMMARY

 Institutionalization
Kirkbride Plan - Asylum
Isolated
Exclusive
Disengagement
Plan: New Jersey Lunatic Asylum, 1847

Deinstitutionalization
Community Mental Health Center

Outpatient

Inpatient

Day Care

Dissociation
Emergency

Consultation
& Education

Plan Diagram: CMHC Study, 1967

Mat-Collective

Integrated
Inclusive Association
Engagement

Plan: Venice Hospital, Le Corbusier, Guillermo

Julliano de la Fuente, 1964

6
 The history of the built environment s response to treating psychopathology
illustrates a discrepancy between intention and effect. Unlike the 19th
century era of institutionalization, marked by the monumentality and
isolation of old asylums, and, in response to today s failed aftermath of
deinstitutionalization, the Mat building strategy may provide an alternative
solution to the successful care and treatment of those afflicted with serious
mental illness.

The architecture of a mental health center should not symbolically or

stylistically express its institutional nature, as a means of lessening the stigma
associated with failed psychiatric hospitals. As Candilis, Josic, and Woods
describe in diagramming their Mat project, the Berlin Free University (1964),
The external expression of differences in function and nostalgia for
representative form also tend to segregate the [mental health center] into
specialized disciplines only. Therefore, We seek rather a system giving the
minimum organization necessary to an association of disciplines. The specific
natures of different functions are accommodated within a general framework
which expresses [mental health center].

Utilizing this approach, the characteristics of Mat building, when applied to

the design of a mental health center, may instill the client s sense of
autonomy, while also still maintaining safety and necessary surveillance,
based on the seriousness of the client s condition. It may provide essential
flexibility and allow room for growth, accommodating the constant flux of
patients coming in and out. The mental health clinic as Mat building may be
less oppressive on the site, offering a means of co-habitation of multiple
programs, while also providing greater opportunities for public interaction
and contextual engagement with the surrounding community.

7 CONTENTION, EXECUTIVE SUMMARY

The institutionalization of mental illness marked the recognition of
psychopathology as a valid condition deserving proper, humane care and
treatment. This was reflected in the monumental architecture of asylums,
following the Kirkbride Plan design model in the mid-19th century. State
hospitals were constructed under this model, based on the tenets of Moral
Treatment, throughout the United States. They were built in rural areas, away
from the pollution and chaotic energy of industrialized, booming city centers,
growing larger in scale to accommodate more and more patients. Yet,
despite ideal intentions, asylums acquired a negative stigma due to poor
conditions, involving overcrowding and inhumane treatment methods,
acquiring names such as madhouse and snake pit.

These issues gained greater attention in the 1960s, which marked a period of
newfound concern for and understanding of mental illness. With this societal
shift in understanding, came a new design approach reflected in proposed
Community Mental Health Center (CMHC) design studies. The Community
Mental Health Act (CMHA) of 1963 was enacted, seeking to establish
community-based care for the mentally ill through the federally-funded
construction of CMHCs across the United States. This progressive thinking in
architecture and design was also paralleled in the development of Mat
building, coined by Alison Smithson.

8
 The resulting period of deinstitutionalization, which saw the closing of state
psychiatric hospitals, reduced the asylum population from its peak in 1955 at
558,000 to just 45,000 today.1 However, the idealized intentions of the CMHA,
which marked a societal shift in the understanding and treatment of mental
illness towards community-based care, were never fully realized, mainly due
to a lack of funding. As a result of the closing of state psychiatric hospitals and
the release of patients with nowhere to go, a rise in both prison and homeless
populations of those who qualify as mentally ill has taken place. This
transinstitutionalization has not solved the problem but transferred it
somewhere else, out of sight and out of mind.

This thesis aims to pick up where the ball was dropped during this radical
period in the 1960s of unfulfilled design strategies for CMHCs, employing the
integrated Mat building design approach as a new alternative to mental
health architecture in today s context of even greater understanding in the
treatment of mental illness.

1. Segal, Andrea G; Sisti, Dominic A; Emanuel, Ezekiel J. Improving Long-term Psychiatric Care: Bring Back the
Asylum . Journal of American Medical Association (JAMA), Volume 313, Issue 3, January 20, 2015.

9 CONTENTION, EXECUTIVE SUMMARY

 The five points in common between muscle operation and an electric doorbell circuit:
1. volition: bell button, 2. motor center: battery, 3. nerve: wire, 4. motor end-plate:
interpreter, 5. muscle: clapper. Fritz Kahn, 1926

10
 II. Institutionalization and
the Evolution of the
Asylum Typology

11
“The Stone Cutter” (The Cure of Folly), Hieronymus Bosch (c. 1450-1516),
Museo del Prado, Madrid, Spain
12
 Public Hospital (for Persons of Insane and Disordered
Minds), Williamsburg, Virginia, 1770

Considered the first public building in North America devoted to

the treatment of the mentally ill.

2 story, brick masonry construction.

Contractor, Benjamin Powell, directed to provide yards for

patients to walk and take in air. A fence was placed around the
site.

24 patient cells, designed for security and isolation.

Building expanded with the adding of a female ward in 1821 and

the addition of a third story in 1841. There were 300 patients by
1859, 400 in 1883, and 450 by 1885.

13 INSTITUTIONALIZATION AND THE EVOLUTION OF THE ASYLUM TYPOLOGY

 Sanborn Map,
Williamsburg, VA,
Jan. 1904
(The hospital burned down in
1885 and was replaced by the
Eastern State Hospital shown in
the map)
Site Plan

Elevation

Plan (100 feet long)

Scale: 1’-0” = 1/32”
14
 Panopticon, Jeremy Bentham, 1791

The Industrial Revolution in England created a wave of new ideas

in building, among them Jeremy Bentham s Panopitcon.
Bentham boasted of his enlightened architectural idea, writing,
Morals reformed̶health preserved̶industry
invigorated̶instruction diffused̶public burthens
lightened̶Economy seated, as it were, upon a rock̶the
gordian knot of the poor-law not cut, but untied̶all by a simple
idea in Architecture!

However, the Panopitcon came to be known as a symbol and

model for societal control, power, and surveillance. Michel
Foucault describes this in Discipline and Punish, stating, But the
Panopticon must not be understood as a dream building: it is the
diagram of a mechanism of power reduced to its ideal form.

15 INSTITUTIONALIZATION AND THE EVOLUTION OF THE ASYLUM TYPOLOGY

(120 foot diameter)
Scale: 1’-0” = 1/16”
16
 New Jersey Lunatic Asylum, Trenton, 1847

The first public mental hospital in the state of New Jersey.

Founded by Dorothea Dix, an advocate and activist for better,

more humane treatment of the mentally ill.

Designed utilizing the model of the Kirkbride Plan: (developed

by Thomas Story Kirkbride) a linear plan with corridor wings en
echelon (staggered to allow each wing to receive ample natural
light and air). This was based on the philosophy of Moral
Treatment. The building itself was seen as part of the cure of
mental illness.

17 INSTITUTIONALIZATION AND THE EVOLUTION OF THE ASYLUM TYPOLOGY

 1/4 mile diameter

Google Earth,
Trenton, NJ

Site Plan

Elevation
Scale: 1’-0” = 1/64”

Plan (480 feet long)

Scale: 1’-0” = 1/64”
18
 St. Elizabeth s Hospital, Washington, D.C., 1852

The first federally operated psychiatric hospital in the U.S.

At one point (in the 1950s), housed over 8,000 patients and employed
4,000 people.

Design guidelines based on the Kirkbride Plan: institutional, imposing,

fortress-like, with extensive surrounding grounds.

19 INSTITUTIONALIZATION AND THE EVOLUTION OF THE ASYLUM TYPOLOGY

 Google Earth, D.C.

Site Plan

Elevation
Scale: 1’-0” = 1/64”

Plan (750 feet long)

Scale: 1’-0” = 1/128”
20
 Greystone, Morristown, New Jersey, 1872

Built to alleviate overcrowding at the New Jersey Lunatic Asylum

in Trenton.

First built to house 350 patients, but throughout its multiple

expansions it reached a peak of over 7,700 patients, suffering
severe overcrowding.

Architect: Samuel Sloan

Design guidelines based on the Kirkbride Plan, separated by

wards.

21 INSTITUTIONALIZATION AND THE EVOLUTION OF THE ASYLUM TYPOLOGY

 Google Earth,
Morristown, NJ

Site Plan

Elevation
Scale: 1’-0” = 1/32”

Plan (1,243 feet long)

Scale: 1’-0” = 1/256” 22
 Buffalo State Hospital for the Insane, Buffalo, New York,
1871

Arcitects: Henry Hobson Richardson and Frederick Law Olmsted

(designed the grounds).

Red sandstone and brick construction.

Style: Romanesque Revival

Design guidelines based on the Kirkbride Plan.

23 INSTITUTIONALIZATION AND THE EVOLUTION OF THE ASYLUM TYPOLOGY

 Google Earth,
Buffalo, NY

Site Plan

Elevation
Scale: 1’-0” = 1/64”

Plan (2,200 feet long)

Scale: 1’-0” = 1/256”
24
 1.

2.

3.

4.

5.

1. Public Hospital, Williamsburg,

Virginia, 1770
2. New Jersey Lunatic Asylum,
Trenton, 1847
3. St. Elizabeth s Hospital, Washington,
D.C., 1852
4. Greystone, Morristown, New Jersey,
1872
5. Buffalo State Hospital for the
Insane, Buffalo, New York, 1871

Scale: 1’-0” = 1/64”

25
 Overview: Growth of the Asylum Typology

1.

2.

3.

4.

5.

Scale: 1’-0” = 1/256”

26
 Critique

Failure of the Asylum Typology

What does it mean to say that a building does not work ?

1. ...if a building, regardless of purpose, collapses because of a poorly

designed structure, crushing its inhabitats, pundits agree that the
building did not work.

2. If a building is designed for a specific purpose, and that purpose can

never be fulfilled because of errors in planning, discerning observers
might reasonably agree that the building does not work.

Given that in the past three decades almost every industrialized country
has rejected the confinement of the mentally ill in large-scale buildings,
one could argue that linear plan hospitals did not work.

- Carla Yanni, The Architecture of Madness, 2007

27 INSTITUTIONALIZATION AND THE EVOLUTION OF THE ASYLUM TYPOLOGY

Photos in the Worcester State Hospital, Worcester, Massachusetss, 1949,
Herber t Gehr, Life Magazine

28
 Buffalo State Hospital, second floor interior corridor, 2008, Christopher Payne,
Asylum: Inside The Closed World Of State Mental Hospitals

29 INSTITUTIONALIZATION AND THE EVOLUTION OF THE ASYLUM TYPOLOGY

 Linear insane asylums are an extreme case of
these changing fortunes over time: considered
ideal at the time of their invention, they are now
considered nearly useless.

- Carla Yanni, The Architecture of Madness, 2007

30
 III. Deinstitutionalization and
Community Mental
Health Centers

31
32
Deinstitutionalization as a Response to Failed Asylums and
Mental Health Treatment Practices

1955: Congress passes the Mental Health Study Act

appoints Joint Commission on Mental Illness and Mental Health

1961: Commission on Mental Illness and Mental Health issues report

1963: Community Mental Health Act (CMHA) signed by President John F. Kennedy
provide grants to states for the establishment of local mental health centers, under the
National Institute of Mental Health
Community-based care: (alternative to Institutionalization) - starts wave of
Deinstitutionalization

(Only half of the proposed centers are built (none are fully funded), and no funding for
long-term operation)

1965: Adoption of Medicaid - accelerates Deinstitutionalization

1970s: Under the Reagan administration, the remaining funding for the act is transferred
to a mental health block grant for states

Present: Since the passing of the CMHA, 90% of beds devoted to mental health patients
have been cut at state hospitals. This has resulted in a dramatic rise in the percent of
mentally ill among the nursing home, prison, and homeless populations.

33 DEINSTITUTIONALIZATION AND COMMUNITY MENTAL HEALTH CENTERS

JFK signs the Community Mental Health Act of 1963, photo, Bill Allen,
Associated Press
retrieved from:
http://www.propublica.org/article/50-years-after-the-community-health-act-the-best-reporting-o
n-mental-health

34
CMHC: Strategies1

Psychiatric context implies an environment which:

1. maintains the social skills which the patient possesses

2. restores lost or damaged social skills
3. prevents the acquisition of bad or irrelevant habits while in the hospital
4. helps him to develop necessary and relevant new skills

Criteria/Guidelines for Analysis:

SITE ASSESSMENT OF PROBLEM

PROGRAM DATA Solutions

Existing Mental Health Services Chronic Patient Experience
Evaluation of Need Acute Inpatient Psychiatric Experience
Building Requirements (Teaching, Research, and Service)
Climatology Outpatients
Hospitalization
Family Study Unit
Patient Care Unit Teams
PSYCHIATRIC ORIENTATION Teaching, Research and Service and the
Patient

PSYCHIATRIC PROGRAM ARCHITECTURAL RESPONSE

1. Lacy, Bill N. Architecture for the Community Mental Health Center: Rice Design Fete III. Mental Health Materials Center, 1967.

35 DEINSTITUTIONALIZATION AND COMMUNITY MENTAL HEALTH CENTERS

 Outpatient Outpatient

Day Care
Inpatient

Day Care

Consultation
Emergency
& Education
Consultation Inpatient
& Education Emergency

A Project Could Involve Construction of a A Project Could Involve Construction of a

Single Facility for all Essential Elements of Network of Facilities for all Essential
Service Elements of Service

Outpatient
Day Care

Day Care
Inpatient

Outpatient

Consultation
& Education Emergency
Inpatient
Consultation
Emergency
& Education

A Project Could Involve Construction of a A Project Could Involve Construction of an

Single Element Within a Scattered Network Element of Service to an Existing Facility of
of Services Service

Diagrams adapted from 1967 CMHC study

36
CMHC: Architectural Response/Concepts

The Community Mental Health Center is Those most greatly

a Bridge between hospital and in need of help
community, between illness and health. require the greatest
encouragement to
seek help.

The Community
Mental Health Center
Program requirements are
is for all People.
bound to change.

The Community Mental Health Center

The mentally healthy individual is not merely should complement existing services,
free of disease; he is productive and creative. not replace them.

The Community Mental Health

Center should court associations
with other productive, social and Mental health requires opportunity for play
cultural agencies. and relaxation as a counterpoint to the
pressures and constrictions of city life.

37 DEINSTITUTIONALIZATION AND COMMUNITY MENTAL HEALTH CENTERS

 Mental illness does not There must be no walls between the mental
entirely reside in the health center and the community.
individual; a CMHC should Census Welfare

treat social problems as

well as personal illness. School Patient Cases

CMHC Barrier Community

Record Center

CMHC Integration Community

Program

7
The Community
People who need help Mental Health
need it now. Center should
enhance the
capacity of people
to experience life.
Nocturnal Architecture

24

The program must not be a

one track assembly line The community and the hospital interpenetrate in
the successful Community Mental Health Center.
Hospital Community

Physiological Sociological

Financing of the CMHC can follow a multiple

resource pattern.
Planning the form
Park and function of the
Fee Clinic
CMHC demands the Treatment
Hospital
teamwork of
Theater
architects and Administration Patient Response

Zoo
mental health
Endowment Sheltered Housing
specialists.
Nursery School
Community Building
Retreat
Relations Maintenance
Planning

Public Education
Indigent

Program Analysis
Sheltered Workshop Technology Environmental Control

Profit Enterprises Apartments

Economy
Shops
Cafe

Diagrams adapted from 1967 CMHC study

38
CMHC: Architectural Response/Concepts

Security vs. Autonomy

Globally, a third of all patients admitted for psychiatric care are involved in
violent incidents. 1 Violence and aggression is usually a response to stress, and
the architectural environment of psychiatric care facilities focus on security
contributes to patients stress, thereby paradoxically making the environment
less safe. Increasing a patient s sense of autonomy and interaction with others
reduces stress. The design of the built environment can cater to this by
providing shared spaces with moveable furniture, sound-absorbing surfaces
to reduce noise, and optimizing the amount of natural light and air in the
building.

1. Ulrich, Roger S. Designing for Calm. The New York Times, January 11, 2013.

39 DEINSTITUTIONALIZATION AND COMMUNITY MENTAL HEALTH CENTERS

Gradient: Private to Public (Bed to Community)
Multiple Scales: Individual, Group, Community

Diagram: Hierarchy of Human Association, Alison and Peter Smithson

http://canstudio.com.au/tag/alison-smithson/

Secondary, Community (Public)

Primary, Group Space
(Semi-Public) Space

Individual (Private)
Space

Community Flow

40
CMHC: Building Design Proposals

Case Study A, CMHC/metro-suburban-rural situation, David A McKinley Jr (AIA), AR Foley

(MD), 1967

41 DEINSTITUTIONALIZATION AND COMMUNITY MENTAL HEALTH CENTERS

Case Study F, CMHC/heterogeneous urban situation, William W Caudill (FAIA), Alfred
Paul Bay (MD), 1967

42
Aftermath of Deinstitutionalization - Statistics

In a recent article in the Journal of American Medical Association, titled, “Improving Long-term Psychiatric
Care: Bring Back the Asylum,” the authors state, “This was the original meaning of psychiatric “asylum” –
a protected place where safety, sanctuary, and long-term care for the mentally ill would be provided.” In
today’s failed aftermath of deinstitutionalization, they say, “It is time to build them – again.”

The asylum population in the US Given the doubling of the US population, this
peaked at 558,000 in 1955, and since represents a 95% decline, bringing the per
then a series of moves has reduced the capita public psychiatric bed count to about
number of patients in state-run mental the same as it was in 1850̶14 per 100,000
hospitals to 45,000. people.

Approximately 10 million people in Between 1998 and 2006, the number of

the U.S. have a serious mental illness. mentally ill people incarcerated in federal,
state, and local prisons and jails more than
quadrupled to 1,264,300.

Since 2006, mental-illness rates in For every $2,000 to $3,000 per year spent
some county jails have increased by on treating the mentally ill, $50,000 is saved
another 50 percent. on incarceration costs.

Prisoners with mental illness cost the Severe mental disorders cost the nation
nation an average of nearly $9 billion $193.2 billion annually in lost earnings.
a year.

Percentages of inmates with mental health problems (as of 2004)

44.8 % 56.2 % 64.2 %

Federal Prisons State Prisons Local Jails

43 DEINSTITUTIONALIZATION AND COMMUNITY MENTAL HEALTH CENTERS

Environmental Biological Treatment

Antidepressants
(in millions)

300

Prescriptions in the United States 250

200

150

100

50

0
01

02

03

04

05

06

07

08

09

10

11
20

20

20

20

20

20

20

20

20

20

20
Year

Antipsychotics
(in millions)

60

50
Prescriptions in the United States

40

30

20

10

0
01

02

03

04

05

06

07

08

09

10

11
20

20

20

20

20

20

20

20

20

20

20

Year

Source: IMS Health, a healthcare technology and information company

44
Aftermath of Deinstitutionalization - Statistics

Number of Conditions (officially-recognized disorders) listed in the Diagnostic and

Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric
Association.

350

300

250
Number of Conditions

200

150

100

50

0
DSM - I DSM - II DSM - III DSM - IV
Published in 1952 Published in 1968 Published in 1987 Published in 2000

Source: Mental Health Biomedical Research Centre, National Institute for Health
Research, U.K.

100%

80% Prescription Drugs

Hospitals

60% Physicians

Insurance Administration

40% Multi-service mental health

organizations
Other Professionals

20% Nursing Homes

0
1986 2014

45 DEINSTITUTIONALIZATION AND COMMUNITY MENTAL HEALTH CENTERS

 Global adjustment for patients diagnosed with schizophrenia
Global adjustment is a score that factors symptoms, life adjustment, and work and social functioning.
It s measured on a scale from 1-8. (The lower the score, the better the functioning).

These results represent the scores of schizophrenia patients assessed over a 15 year period by
researchers Martin Harrow and Thomas Jobe in the Chicago area, comparing patients both on and not
on antipsychotic medication.

6
Global Adjustment Factor

0
2 4.5 7.5 10 15

Patients on antipsychotic Patients not on

medication antipsychotic medication

These results suggest that those schizophrenia patients who fare better
tend to stop taking medication, or that patients who stop taking
medication tend to fare better.

Source: M. Harrow and T.H. Jobe, Factors Involved in Outcome and Recovery in
Schizophrenia Patients Not on Antipsychotic Medications: A 15-Year Multifollow-Up
Study.

46
Aftermath of Deinstitutionalization - Statistics

Change in states spending on mental health (2009-2012)

-40% to -20%

-19% to 0%

1% to 20%

21% to 40%

41% to 60%

Up to 30 percent of the
homeless population is
30 % thought to be seriously
mentally ill.
This is five times the rate of the
general population.

47 DEINSTITUTIONALIZATION AND COMMUNITY MENTAL HEALTH CENTERS

 Rates of Institutionalization (per 100,000 adults)

100%

80%

60%

40%

20%

0
1940 1950 1960 1970 1980 1990 2000

Prisons and Jails

Mental Hospitals

Combined

48
 IV. Mat Building

49
Case Studies

Centraal Beheer, 1968-72 Ysbanpaad Orphange, 1961

School & Home for HIV Orphans, 2006-7 Venice Hospital, 1964-65

50
 How to Recognise and Read Mat-Building
- Alison Smithson, 1974

Mat-building can be said to epitomise the anonymous

collective; where the functions come to enrich the
fabric, and the individual gains new freedoms of
action through a new and shuffled order, based on
interconnection, close-knit patterns of association,
and possibilities for growth, diminution, and change.

51 MAT BUILDING - CASE STUDIES

52
 Centraal Beheer, Herman Hertzberger, Apeldoorn,
Netherlands, 1968-72

Cut-away axonometric drawing, Herman Hertzberger

Aerial photo, Centraal Beheer, Aviodrome Luchtfotografie

The 9m x 9m cellular module allows for flexibility and growth of the program.
However, this singular scale results in restricitons within the building as well.

53 MAT BUILDING - CASE STUDIES

Cellular Modularity - Flexibility

Module: 9m x 9m (29.5 ft)

9m 1
person

9m

2
people

3
people

4
people

54
 Ysbaanpad Orphanage, Aldo van Eyck, Amsterdam,1961

Physical model, aerial photo

Photo, courtyard Photo from “Team 10: In Search of a Utopia of

the Present,” 2005

Built-in furniture within the plan, use of the circle for gathering spaces (social
interaction), precedent from Anasazi kiva typology. Use of different scales
for children and adolescents.

55 MAT BUILDING - CASE STUDIES

The plan blurs the boundary between
interior and exterior space.

56
 School & Home for HIV Orphans, Koji Tsutsui &
Associates, Uganda, 2006-7

Rendering, aerial view, Koji Tsutsui & Associates

Physical model, Koji Tsutsui & Associates Physical model, Koji Tsutsui & Associates

Separate program connected by interlocking roofscape.

System allows for continued expansion and spatial flexibility.

57 MAT BUILDING - CASE STUDIES

 Bedroom W.C.

Bedroom
Lecture Room
for 40 Children
“Mukwano” Space
eating Entrance Gate
playing
Office meeting
praying Lecture Room
for 40 Children
Roof
Lecture
Line
Room for Office
40
Children
Study and Play Terrace

Plan, ground level

58
 Venice Hospital, Le Corbusier, Guillermo Jullian de la
Fuente, 1964-65

Physical model, Atelier Jullian

Photomontage of Venice Hospital over the city. Model of third level patient cells
Atelier Jullian, third project, 1966

59 MAT BUILDING - CASE STUDIES

“...the psychological aspect of the spirits of the visitor plays a major therapeutic role, by creating
around the patient an atmosphere which stimulates his will to live and transforms the hospital, a
machine for healing, into a hospital for life.”1 - Le Corbusier

Strategies
Horizontal Hospital

3 Levels:

1. Ground/First Floor - Liaison with the city,

includes general services and public access
2. Second Floor - Medical Technology:
preventive care, specialties, and rehabilitation
3. Third Floor - Area of hospitalization (individual
patient rooms), visitors

Modularity:
2.96 m ( 10 ft)

3 Scales: Detail plan and section of typical patient cells, 1965

1. Unité Lit (bed unit) and for ambulatory patients

2. La Calle (the street)
3. Campiello (small square) and Le Jardin Suspendu (the hanging
garden) where patients will find all required for their convalescence
and progress in their return to society. 1

Atelier Jullian, Venice Hospital, third project, 1966; detail sections

1. Shah, Manaz. Le Corbusier s Venice Hospital Project: An Investigation into Its Structural Formulation. New
edition. Farnham, Surrey, England: Burlington, VT: Ashgate Publishing Company, 2013.

60
 V. Summary of
Characteristics

61
Mat Strategies

62
 Institutionalization
Kirkbride Plan - Asylum
Isolated
Exclusive
Disengagement
Plan: New Jersey Lunatic Asylum, 1847

Deinstitutionalization
Community Mental Health Center

Outpatient

Inpatient

Day Care

Dissociation
Emergency

Consultation
& Education

Plan Diagram: CMHC Study, 1967

Mat-Collective

Integrated
Inclusive Association
Engagement

Plan: Venice Hospital, Le Corbusier, Guillermo

Julliano de la Fuente, 1964

63 SUMMARY OF CHARACTERISTICS AND MAT STRATEGIES

Overview: Design Approach

Candilis, Josic, Woods - sketches for Berlin

Free University, 1964

“The external expression of differences in

function (are these as important as
similarities?) and nostalgia for
representative form also tend to segregate
the university into specialized disciplines
only.”

Dissociation

“We seek rather a system giving the

minimum organization necessary to an
association of disciplines. The specific
natures of different functions are
accommodated within a general framework
which expresses university.”

Association

64
 Mat-Collective - Characteristics

Mat building is...

a ...horizontal weave of programmatic and circulatory

elements, a play of solid and voids stabilized within a legible
geometric order. 1

both object and fabric: Instead of defining a distinct object,

mat-building weaves itself into the surrounding context,
creating a building that performs like a city, or transforming part
of the city into a building. 1

antifigural, antirepresentational, and antimonumental. Its job

is not to articulate or represent specified functions, but rather to
create an open field where the fullest range of possible events
might take place. 2

...porous interconnectivity, in which transitional spaces are as

important as the nodes they connect. Externally, they are loosely
bounded. Their form is governed more by the internal
connection of part to part than by any overall geometric figure.
They operate as fieldlike assemblages, condensing and
redirecting the patterns of urban life, and establishing extended
webs of connectivity both internally and externally. 2

1. Hyde, Timothy. How to Construct an Architectural Genealogy" in CASE: Le Corbusier's Venice Hospital and
the Mat-Building Revival, ed. Hashim Sarkis, Pablo Allard and Timothy Hyde. (Munich, Prestel, 2002), 104-117.
2. Allen Stan. Mat Urbanism: The Thick 2-D in CASE: Le Corbusier's Venice Hospital and the Mat-Building
Revival, ed. Hashim Sarkis, Pablo Allard and Timothy Hyde. (Munich, Prestel, 2002), 104-117.

65 SUMMARY OF CHARACTERISTICS AND MAT STRATEGIES

 Claims for Environmental Performance1

1. Mat buildings allow for greater adaptability in the use of space.

2. Mat buildings use land efficiently.

3. Mat buildings are inherently energy conserving.

4. Mat buildings reduce the overall need for transportation.

5. Mat buildings create their own microclimates.

Jourda and Perraudin Architectes, Mont-Cenis Academy, Herne. Envelope ventilation diagram.

1. Addington, Michelle; Kienzl, Nico; Intrachooto, Singh. Mat Buildings and the Environment in CASE: Le
Corbusier's Venice Hospital and the Mat-Building Revival, ed. Hashim Sarkis, Pablo Allard and Timothy Hyde.
(Munich, Prestel, 2002), 104-117.

66
 Mat Response

“Dismantling and reframing programme and composition, mat-building

envisaged architecture as a dynamic, flexible armature.”1

Having reached the hypothesis that Mat-building is most

suitable for mental health architecutre, this thesis will
analyze the characteristics and strategies that make up the
Mat typology and develop, refine, and apply them to a
design for a Mat-Collective Community Mental Health Center
on Roosevelt Island.

Through the analysis of existing mental health facilities and

their programmatic requirements and function, the goal of
this thesis is to apply the Mat building typology to this
specific program as a means to express the user s temporal
experience.

1. Calabuig, Deboram Domingo; Gomez, Raúl Castellanos; Ramos, Ana Abalos. The Strategies of
Mat-building. The Architectural Review, August 13, 2013.

67 SUMMARY OF CHARACTERISTICS AND MAT STRATEGIES

Mat Building involves 3 compositional principles:

A. Metrics
B. Program
C. Place

68
 A. Metrics

Moore Neighborhood von Neumann Neighborhood

69 SUMMARY OF CHARACTERISTICS AND MAT STRATEGIES

Cellular Automata1
Cellular automata (CA) are discrete, abstract computational systems...CA are
(typically) spatially and temporally discrete: they are composed of a finite or
denumerable set of homogeneous, simple units, the atoms or cells. At each
time unit, the cells instantiate one of a finite set of states. They evolve in
parallel at discrete time steps, following state update functions or dynamical
transition rules: the update of a cell state obtains by taking into account the
states of cells in its local neighborhood.
The mark of CA consists in their displaying complex emergent behavior.
CA are abstract, as they can be specified in purely mathematical terms and
implemented in physical structures.

Architectural Tranlsation into 3-D Space

“Application of generative form in 3-D space” “Responsive Benches - Cellular Automata Based Geometry,”
http://www.stephenwolfram.com/publications/generation-form http://www.l-e-a-d.pro/research/05-iws5/143
-a-new-kind-of-science/

1. Stanford Encyclopedia of Philosophy. http://plato.stanford.edu/entries/cellular-automata/

70
The Modulated Grid1

A mat-building is a large-scale, high-density structure organised on the basis of an

accurately modulated grid. A first look at any mat-building geometry shows a ground plan
in the form of a regular grid that constitutes the general order.

Frankfurt, Berlin and Venice have the red and blue series of Le Corbusier s Modulor in
common. In each of the three proposals just a few centimeters provide the starting point
for designing buildings hundreds of metres in size.

In addition, the Modulor series forms the module which is multiplied in both directions to
create all kinds of variations. In Frankfurt, Berlin and Kuwait half modules were also
employed. In Venice, there are few complete modules in the plan since most lack a
quadrant.

The formal construction of the Venice Hospital starts with consecutive additions: several
Unités de Lit or bed modules (based on a module of 2.96m, a Modulor dimension)
combine with several service rooms to form a Unité de Soins, or treatment module. Four
Unités de Soins and the respective corridors constitute a Unité de Bâtisse; and finally, the
hospital consists of a specific number of Unités de Bâtisse, square rooms about 60m along
each side. Le Corbusier uses a completely different procedure to form a size very similar to
the one used by his colleagues in Berlin.

Finally, the analysis of the underlying patterns in each case study revealed a complex grid
of strips forming a tartan-like fabric. Each strip can be understood to be a widened grid line
that houses a set of specific functions. This purpose-built grid is simply a framework or
fixed base upon which a volume may (or may not) be built. It is precisely this ambiguity
that enables compositional flexibility resulting in stratified and profusely perforated
buildings.

1. Calabuig, Deboram Domingo; Gomez, Raúl Castellanos; Ramos, Ana Abalos. The Strategies of
Mat-building. The Architectural Review, August 13, 2013.

71 SUMMARY OF CHARACTERISTICS AND MAT STRATEGIES

 Frankfurt Berlin Venice Kuwait Valencia

Frankfurt Berlin Venice Kuwait Valencia

Venice

Frankfurt Berlin Venice Kuwait Valencia

5 Mat Buildings: 1. Frankfurt Plan (Candilis, Josic and Woods) 2. Free University of Berlin (Candilis, Josic and Woods) 3.
Venice Hospital (Le Corbusier and Guillermo Jullian de la Fuente) 4. Kuwait - Urban Study and Demonstration
Mat-Building, 1968-72 (Alison and Peter Smithson) 5. Universitat Politècnica de València (L35)
Diagrams above adapted from article.

72
 B. Program

73 SUMMARY OF CHARACTERISTICS AND MAT STRATEGIES

Mat-Collective Community Mental Health
Center (CMHC)

74
Programming: List
3 Scales: 1. Community (Public)
Community (Public)
Space
Group Space
Individual (Private)
Space

Community Amenities Administration/Service

Day Care Reception Director s Office

Convenience Store Billing Office Psychiatrist Offices

Media Center (Forum) for Storage Therapist/Counselor Offices

meetings/research
Janitor s Closet (J.C.) Doctor Offices
presentation/film/music
I.T. Room Secretary Office
Ferry Terminal
Laundry Staff Room (Break)
Library
Social Counseling Gaurd Work Room
Public Restrooms
(Social Work)
Private/Public Restrooms
Shipping/Loading Area

Trash Area Educational

Parking Research Labs - Affiliated with Cornell

University (connection with new Tech
Outdoor Spaces
Campus) - Psychology, Environmental
(Park/Recreation)
Psychology, Sociology, Psychiatry

75 SUMMARY OF CHARACTERISTICS AND MAT STRATEGIES

 2. Group (Semi-Public) 3. Individual (Private)
Community (Public) Community (Public)
Space Space
Group Space Group Space
Individual (Private) Individual (Private)
Space Space

Group/Gathering Individual

Art Room Exam Rooms

Music Room Nurse Stations

Small Library Individual Patient Rooms

(include private restrooms,
Group Meeting -
patios/shared courtyards)
Conference

Recreation Room

Fitness Center/Gym
Patient Rooms
Storage
Group/Gathering
Kitchen Admin./Service

Dining
Community
Restrooms Ground Plane

76
Programming: Translating Corbusier s Modular
Module - Building Block

Venice Hospital - Bed Unit Module

2.96 m

1.83 m 1.13 m
2.75 m
1.35 m
1.40 m

77 SUMMARY OF CHARACTERISTICS AND MAT STRATEGIES

Bed Unit (Individual Space): 9 x 10 = 90 sf

Small Group Space: (= 5 bed units) 20 x 22.5

= 450 sf

Large Group Space: (= 8 bed units) 24 x 30

= 720 sf

Recreational Space: (= 40 bed units) 60 x 60

= 3,600 sf

Treatment Unit: 75 x 75 = 5,625 sf

Building Unit: 200 x 200 = 40,000 sf

SCALE: 1’ = 1/64”

78
Mat-Collective: Community Mental Health Center,
Roosevelt Island, NY
Program Relationship
SUMMARY
Ground Level (Public) - Community Amenities

Day Care NSF Total: 3,600 sf

Convenience Store NSF Total: 3,600 sf

Media Center NSF Total: 5,625 sf

Ferry Terminal NSF Total: 5,625 sf

Library NSF Total: 5,625 sf

Total Program Area - Ground Level (not including circulation, toilets and mechanical):

79 SUMMARY OF CHARACTERISTICS AND MAT STRATEGIES

 Public Restrooms NSF Total: Per Code.

Shipping/Loading Area NSF Total: 720 sf

Trash Area NSF Total: 720 sf

Parking NSF Total: TBD

Outdoor Spaces NSF Total: TBD

+/- 25,515 net sf

80
Mat-Collective: Community Mental Health Center,
Roosevelt Island, NY
Program Relationship
SUMMARY
Level 1 (Public) - Administration/Service, Education

Reception NSF Total: 720 sf

Billing Office NSF Total: 720 sf

Storage NSF Total: 720 sf

Janitor’s Closet NSF Total: 4 @ 90 sf

I.T. Room NSF Total: 720 sf

Laundry NSF Total: 3,600 sf

Social Counseling NSF Total: 4 @ 90 sf

Director’s Office NSF Total: 450 sf

Psychiatrist Offices NSF Total: 2 @ 90 sf

Total Program Area - Level 1 (not including circulation, toilets and mechanical):

81 SUMMARY OF CHARACTERISTICS AND MAT STRATEGIES

Therapist/Counselor Offices NSF Total: 10 @ 90 sf

Doctor Offices NSF Total: 2 @ 90 sf

Secretary Office NSF Total: 450 sf

Staff Room NSF Total: 720 sf

Guard Work Room NSF Total: 720 sf

Private/Public Restrooms NSF Total: Per code.

Research Labs NSF Total: 4 @ 720 sf

+/- 13,680 net sf

82
Mat-Collective: Community Mental Health Center,
Roosevelt Island, NY
Program Relationship
SUMMARY
Level 2 (Semi-Public)

Art Room NSF Total: 720 sf

Music Room NSF Total: 720 sf

Small Library NSF Total: 3,600 sf

Group Meeting NSF Total: 10 @ 720 sf

NSF Total: 10 @ 450 sf

Total Program Area - Level 2 (not including circulation, toilets and mechanical):

83 SUMMARY OF CHARACTERISTICS AND MAT STRATEGIES

Recreation Room NSF Total: 3,600 sf

Fitness Center/Gym NSF Total: 720 sf

Storage NSF Total: 4 @ 90 sf

Kitchen NSF Total: 720 sf

Dining NSF Total: 3,600 sf

Restrooms NSF Total: Per Code.

+/- 25,740 net sf

84
Mat-Collective: Community Mental Health Center,
Roosevelt Island, NY
Program Relationship
SUMMARY
Level 3 (Private)

Exam Rooms NSF Total: 10 @ 90 sf

Nurse Stations NSF Total: 10 @ 180 sf

Patient Rooms NSF Total: 200 @ 90 sf

Total Program Area - Level 3 (not including circulation, toilets and mechanical):

Total Program Area (not including circulation, toilets and mechanical):

Total Building Area:

85 SUMMARY OF CHARACTERISTICS AND MAT STRATEGIES

+/- 20,700 net sf

+/- 85,635 net sf

+/- 114,000 gross sf

86
Mat-Collective: Community Mental Health Center,
Roosevelt Island, NY
Program Relationship
SCALE: 1’ = 1/64”

Ground Level (Public - Community Amenities) Level 1 (Public - Admin./Service)

Level 2 (Semi-Public - Group/Gathering) Level 3 (Private - Individual Patient Rooms)

87 SUMMARY OF CHARACTERISTICS AND MAT STRATEGIES

 Level 3

Level 2

Level 1

Ground Level

SCALE: 1’ = 1/128”

88
 C. Place

VI. Proposed Site -

Roosevelt Island, NYC

89
“The Island Nobody Knows,” Cover Image, MoMA Exhibition, 1969

90
REORIENTATION
Urban Break
INTEGRATION

Why Roosevelt I
Testbed for Social Experimentation
Over the years, this bit of land just two miles long and 600 yards wide has served as a
proving ground to test civic-minded and architectural ideas proposed in a spirit of
experimentation. A quirky scrap of the city, Roosevelt Island boasts such amenities as
an underground pneumatic tube system for transporting garbage and the first
commissioned aerial tramway in the United States. In the 19th century, the island was
home to an insane asylum, an almshouse, a prison, a charity hospital, and a smallpox
hospital̶warehouses for the human unwanted, kept safely segregated from the rest
of the population by the treacherous currents of the East River.
- Angela Riechers, archpaper.com, July 2012

91
Island?

92
History of Development - Roosevelt Island Evolution

1600

Colonialism Blackwell s Island, 1686

Minnahanonck ( It s nice to Manning s son-in-law, Robert

be here, Long Island ), Blackwell, becomes owner
Canarsie Tribe
City of New York buys
Varcken Eylandt (Hog Island), 1637 Blackwell s Island, 1828
The Dutch raise hogs on the island

Manning s Island, 1666

British take control

93 PROPOSED SITE - ROOSEVELT ISLAND, NYC

 2020

Welfare Island, 1921 Johnson-Burgee Plan Roosevelt Island,

(Unfinished), 1969-1970s 2015 (present)
NY State s Urban Development
Corportation (UDC) takes a
99-year lease of the island, 1969

Roosevelt Island, 1973 Roosevelt Island,

Cornell Tech
Campus, 2017

94
 Map, 1879: Figure/Ground, Comparison of Scales - Central Park and Blackwells Island (now Roosevelt Island)

95 PROPOSED SITE - ROOSEVELT ISLAND, NYC

96
Rem Koolhaas, Zoe Zenghelis
New Welfare Island Project, 1975-76
“Rem Koolhaas, German Martinez, and Richard
Perlmutter designed New Welfare Island for the south
end of Roosevelt Island (once known as Welfare Island).
This theoretical project extended Manhattan's grid, in
this case between Fiftieth and Fifty-ninth streets, onto
the island, in a manner similar to that used for
Koolhaas's and Zenghelis's Roosevelt Island
Redevelopment competition entry. Each newly created
lot was intended to support competing
structures—formally, ideologically, and
programmatically—corresponding to what they viewed
as Manhattan's dominant characteristic. Just north of
the "travelator," a moving pavement extending to the
rivers, is a convention center. To its south, amid vacant
lots reserved for future use, are Kazimir Malevich's
"Architecton," an interior harbor housing a 1932Norman
Bel Geddes yacht, and a "Chinese" swimming pool. The
New Welfare Hotel, a city within a city, which looks
toward Manhattan, is situated at the bottom of the
island.”

(MoMA), Rem Koolhaas, Madelon Vriesendorp, Welfare Palace Hotel Project,

Roosevelt Island, New York, New York , Cutaway axonometric, 1976

“At the top of the aerial view, the Queensboro Bridge passes through a convention center, a monumental gateway to Manhattan.
Farther south, a tecton—a Suprematist device from the work of Kasimir Malevich—hovers over a streamlined Art Deco yacht
designed in 1932 by Norman Bel Geddes. At the island's tip the six towers of the New Welfare Hotel rise up opposite a wandering
fragment of Manhattan that includes Rockefeller Center and Times Square (including the proposed Sphinx Hotel, designed by
Elia and Zoe Zenghelis). The New Welfare Hotel, designed by Koolhaas, Perlmutter, and Derrick Snare, is separately rendered in
the third drawing; it is a center for dancing, dining, and general urban pleasure. Overall, Koolhaas writes, the Roosevelt Island
project is intended as a visual interpretation and resuscitation of some of the themes that made Manhattan's architecture unique;
its ability to fuse the popular with the metaphysical, the commercial with the sublime, the refined with the primitive.”

Publication excerpt from Terence Riley, ed., The Changing of the Avant-Garde: Visionary Architectural Drawings from the Howard Gilman Collection, New
York: The Museum of Modern Art, 2002, p. 145
Publication excerpt from Matilda McQuaid, ed., Envisioning Architecture: Drawings from The Museum of Modern Art, New York: The Museum of Modern
Art, 2002, p. 172

97 PROPOSED SITE - ROOSEVELT ISLAND, NYC

(MoMA), Rem Koolhaas, Zoe Zenghelis, New Welfare Island Project, Roosevelt Island, New York, NY , Aerial perspective, c. 1975-76

98
 FEMA Flood Zone - Roosevelt Island

R
IVE
R
ST
EA

0 400 1000 FEET

100-Year Floodplain
SCALE
500-Year Floodplain

99 PROPOSED SITE - ROOSEVELT ISLAND, NYC

Usable island footprint, taking into
account future flooding

Safe Zone

500-Year
Floodplain

100-Year
Floodplain

Roosevelt Island Footprint

100
 Possible Sites

Taking into consideration FEMA s study of future floodplains in conjunction

with rising sea levels, Roosevelt Island is left with a much smaller buildable
footprint.
Therefore, site selection for the Mat-Collective Community Mental Health
Center will be based on areas not at risk.

Extending Manhattan s Grid

Delirious New York, Rem Koolhaas, 1978:

Mat view:
The Grid s two-dimensional discipline also creates undreamt-of freedom for
three-dimensional anarchy. The Grid defines a new balance between
control and de-control in which the city can be at the same time ordered
and fluid, a metropolis of rigid chaos. 1

1. Hyde, Timothy. "How to Construct an Architectural Genealogy" in CASE: Le Corbusier's Venice Hospital and
the Mat-Building Revival, ed. Hashim Sarkis, Pablo Allard and Timothy Hyde. (Munich, Prestel, 2002), 104-117.

101 PROPOSED SITE - ROOSEVELT ISLAND, NYC

 N

Manhattan

Queens

Safe Zone

102
 Possible Sites - Open Spaces

EAST RIVER - WEST CHANNEL

TRAMWAY

(UNDER CONSTRUCTION) QUEENSBORO BRIDGE

EAST RIVER - EAST CHANNEL

Public Memorial Private

Public Recreation Field Waterfront Promenade
Public Park Pedestrian Pathways
Private Space, Publicly Accessible

103 PROPOSED SITE - ROOSEVELT ISLAND, NYC

 N
M A N H AT TA N

ROOSEVELT BRIDGE

QUEENS

104
 Site Location
The Mat-Collective CMHC will be located within the safe zone on
Southpoint Park, directly southwest of Cornell s proposed tech campus. This
site provides the opportunity for direct interaction and engagement within
an active urban fabric. In association with Cornell, the building will provide
educational support as a testing ground for research.

Queensboro Bridge

FDR Memorial, Louis Kahn design Site of new Cornell Tech campus Tram Station

Southpoint Park
(site location)

Southpoint
Park

Strecker
Lab

Demolition - Goldwater Memorial Hospital Proposed Cornell Tech bldgs.

Site plan diagram, Handel Architects

105 PROPOSED SITE - ROOSEVELT ISLAND, NYC

N

Safe Zone

The Octagon Coler Goldwater Hospital

Roosevelt Bridge

106
 Infrastructure: Transit

Proposed Ferry Terminal

A ferry terminal will provide infrastructural support for the Mat-Collective
CMHC, while also integrating the larger NYC community, fostering public
engagement and interaction directly on the site.

Proposed Ferry Network map diagram,

http://gothamist.com/2015/02/04/expanded_ferry_map_nyc.php

107 PROPOSED SITE - ROOSEVELT ISLAND, NYC

 N

Q102 to Astoria
27th Ave- 2nd St
Q102

T F
Roosevelt Island

RIOC

Q102

Ferry Terminal
(proposed location)

0 500 1000 feet

Roosevelt Island Red bus SCALE

Q102 Route
F Subway Line
T Tramway

108
 VII. User Focus: Spatial
Scopes

109
 Personality disorders

Paraphilic disorders

Least Severe
Neurocognitive disorders

Substance-related and addictive disorders

Disruptive, impulse-control, and conduct disorders

of Mental Disorders, Fifth Edition (DSM-5)

Mental Illness Spectrum
Gender dysphoria

Based on the Diagnostic and Statistical Manual

Sexual dysfunctions

Sleep–wake disorders

Feeding and eating disorders

Somatic symptom and related disorders

Dissociative disorders

Trauma- and stressor-related disorders

Obsessive-compulsive and related disorders

Anxiety disorders

Depressive disorders

Bipolar and related disorders

Schizophrenia spectrum and other psychotic disorders

Most Severe

110
 Spatial Scope/Activity: Institutionalized Patient

Perspective Vignettes: Film Stills from One Flew Over the Cuckoo’s Nest (1975) and Girl, Interrupted (1999)

New Jersey Lunatic Asylum, Trenton, 1847 (partial plan)

Plans
0.7
0.6
DISTANCE (MI)

0.5
0.4
0.3
0.2
0.1

Movement
ACTIVITY (DAILY ROUTINE)

SLEEP

SLEEP

SLEEP

SLEEP

SLEEP

WAKE UP

MORNING CHECKS
GET READY

B R E A K FA S T

COMMUNITY GROUP
SESSION

SESSION
THERAPY

REC ROOM
W A T C H T. V.
10
9
8
7
LEVEL OF ACTIVITY

6
5
4
3
2
1
Emotional State/Brain Activity/Awareness Level

1 2 3 4 5 6 7 8 9 10 11 12
Time (hours)
 LUNCH

13
PROCESS GROUP

14
D A I LY C H E C K- U P Oregon State Hospital

15
REC ROOM
PL AY CARDS

16
VISITATION HOUR

17
REC ROOM
Randle Patrick "Mac" McMurphy

18
DINNER

19
C LO S U R E G R O U P

20
REC ROOM

21
Harrisburg State Hospital

NIGHT MEDS
REC ROOM

22
BEDTIME
LIGHTS OUT
Susanna Kaysen

23
SLEEP
Lisa Rowe

24
SLEEP
 Spatial Scope/Activity: Institutionalized Patient

Kirkbride Model Characteristics:

Validated mental illness:

- expressed through the monumentality of the institutional, Victorian-era architecture
of the asylum
- Intention: humane treatment, new therapeutic treatments, generate changes in
public perception of mental illness (reduce stigma)

- Kirkbride Plan:
- based on tenets of “Moral Treatment”
- Linear plan
- Central administration building flanked by two wings made up of tiered wards
- hierarchical segregation of residents according to sex and symptoms of illness
- Each wing subdivided by ward
- more “excited” patients placed on lower floors, farthest from the central
administrative structure
- better behaved, more rational patients situated in the upper floors and closer to the
administrative center
- seclusion from suspected causes of illness
- patients' asylum experience more comfortable and productive by isolating
them from other patients with illnesses antagonistic to their own while still allowing fresh air,
natural light, and views of the asylum grounds from all sides of each ward
- place patients in a more natural environment away from the pollutants and
hectic energy of urban centers
- Extensive grounds with cultivated parks and farmland
- Landscaped parks served to both stimulate and calm patients' minds with natural
beauty
- Farmland served to make the asylum more self-sufficient by providing readily
available food and other farm products at a minimal cost to the state
- Patients were encouraged to help work the farms and keep the grounds
- structured occupation was meant to provide a sense of purpose and
responsibility which, it was believed, would help regulate the mind as well as improve physical
fitness
- Patients encouraged to take part in recreations, games, and entertainments which
would also engage their minds

113 USER FOCUS: SPATIAL SCOPES

 Kirkbride Model
New Jersey Lunatic Asylum, Trenton, 1847

SPATIAL SCOPE

Kitchen/Dining

Patient Room

Group Therapy Recreation

Individual Therapy

Group Therapy

Recreation

Patient Ward (Wing)

114
Spatial Scope/Activity: Ideal - Mat-Collective CMHC

Activity

SECURITY SECURITY SECURITY SEC

RESEARCH

O U T I N G

FITNESS FITNESS

ART

ENTERTAIN
MUSIC

EAT

THERAPY

EP SLEEP

1 2 3 4 5 6 7 8 9 10 11 12
Time (hours)
CURITY SECURITY SECURITY SECURITY

RESEARCH

O U T I N G O U T I N G

S FITNESS FITNESS FITNESS

MUSIC ART

NMENT ENTERTAINMENT ENTERTAINMENT

ART MUSIC

EAT EAT

THERAPY THERAPY

SLE

13 14 15 16 17 18 19 20 21 22 23 24
 Institutionalized Patient

1/4 mile
diameter

Film Still: One Flew Over the Cuckoo’s Nest, 1975 Site Plan: New Jersey Lunatic Asylum, Trenton, NJ
Deinstitutionalized Patient

Outpatient

Inpatient

Day Care

Emergency

Consultation
& Education

Plan Diagram: CMHC project proposal study Site Plan: CMHC project proposal study
Mat-Collective Patient

Candilis, Josic, Woods - Berlin Free University sketch, 1964 Site Plan: Venice Hospital, 1964

117 USER FOCUS: SPATIAL SCOPES

 SPATIAL SCOPE

Kitchen/Dining

Patient Room

Group Therapy Recreation

Individual Therapy

Group Therapy

Recreation

Patient Ward (Wing)

SECURITY SECURITY SECURITY SECURITY SECURITY SECURITY SECURITY

RESEARCH RESEARCH

O U T I N G O U T I N G O U T I N G

FITNESS FITNESS FITNESS FITNESS FITNESS

ART MUSIC ART

ENTERTAINMENT ENTERTAINMENT ENTERTAINMENT

MUSIC ART MUSIC

EAT EAT EAT

THERAPY THERAPY THERAPY

EP SLEEP SLE

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 118
Psychiatrist s Perspective: Daily Routine

Ferry Terminal [7:22 am] CMHC Entrance [7:25 am]

Patient Counseling Session [8:00 am] Meeting [10:00 am]

119 USER FOCUS: SPATIAL SCOPES

CMHC Lobby [7:26 am] Psychiatrist’s Office [7:28 am]

Lunch [12:00 pm] Lab Work, Research [2:00 pm]

120
Mat-Collective CMHC Patients - Spatial Scope Variances
1. Inpatient, Schizophrenia (high-risk)

The high-risk patient has access

within a specific zone of the
building with a higher level of
security. In accordance with his
treatment, he is slowly granted
access to other areas of the center.

CMHC building

Site Area

2. Inpatient, Bipolar Disorder (low risk)

A patient determined low-risk, after

evaluation, is permitted access to
all spaces designated for patient
use under supervision, including
those outdoors.

CMHC building

Site Area

121 USER FOCUS: SPATIAL SCOPES

3. Outpatient, Major Depressive Disorder (MDD), released from
inpatient treatment a week ago

An outpatient, recently admitted from the

center, is now back in his parent’s home, a few
miles from the center. He comes back for
counseling/therapy sessions twice a week.

CMHC building

Site Area

4. Outpatient, Bipolar Disorder, released from inpatient treatment

two years ago

An outpatient, admitted from the center two

years ago, has been living in his own
apartment, five miles from the center. He now
comes for counseling/therapy sessions once a
month to check in.

CMHC building

Site Area

122
 VIII. Precedents

123
124
Helsingor Psychiatric Hospital, JDS Architects (BIG collaboration),
Denmark, 2006

How does one combine the efficiency

of a central organization with the
freedom and autonomy of a
decentralized complex? The hospital
needs to allow control and protection
while maintaining a free and open
atmosphere. In terms of function it 3X
should be a logistically optimized
hospital, but in terms of experience it is
anything but a hospital.

- JDS Architects

Balance of Contradictions:

Decentralized/Centralized
Freedom/Control
Openness/Closure
Privacy/Sociability

Aerial photo, JDS Architects

125 PRECEDENTS
Planning Strategy

Plan diagrams, BIG Architects

Photos, JDS Architects

126
Worcester Recovery Center and Hospital, Ellenzweig Associates,
Inc. and Architecture+, Worcester, MA, opened 2012

Plan diagrams, Architecture+

127 PRECEDENTS
 Planning Strategy

Plan diagrams, Architecture+

128
Syracuse Behavioral Healthcare - Mental Health Clinic
329 N Salina St, Syracuse, NY

Exterior south facade, photo by author

Building Tour (November 10, 2015): Bill Ruckyj, Director

of Operations; Kathi Meadows, Outpatient Service
Director

129 PRECEDENTS
Group meeting room, evaluation, photo by author Second floor, admin. offices, photo by author

First floor plan, Associated Architects - Syracuse, provided by SBH

130
Patient Room Precedent
La Certosa del Galluzzo, Florence, Italy

This figure-ground diagram illustrates the

covered/enclosed spaces vs. the open spaces
in the plan. The interlocking program
juxtaposes private and public space at
multiple scales, forming a microcosm of a
city. It provides a balance of spontaneous
moments for gathering and interaction with
moments of isolation and privacy.

This planning strategy may be translated

within the Mat-Collective CMHC building,
which is also a type of city as building,
allowing for necessary social engagement at
multiple scales, in balance with both open and
closed spaces.

Le Corbusier drew inspiration from the

individual monk cells of this monastery for his
new housing solution. This housing prototype
may also serve well as precedent for the
individual patient rooms within the center.

Plan, figure-ground drawing

131 PRECEDENTS
Aerial photo, G.A. Rossi
http://www.arco-images.com/italy-tuscany-florence-certosa-monastery-aerial-images-photos/1023051.html

Le Corbusier’s sketch of a monk cell in the Certosa del Galluzzo

http://docenti.polimi.it/dalsasso/laboratorio-di-progettazion/rilievo-e-rappresentazione/le-corbusier-3.html

132
Patient Room Precedent
Nexus World Housing, OMA, Fukuoka, Japan, 1991

Aerial photo, David Ewen, flickr

“OMA’s Nexus World in Fukuoka, Japan, offers a very convincing example of a constructed hous-
ing mat. In this case, the site is split into two blocks, each with a defined perimeter. Parking and
public space is integrated into the ground floor, along with access to the living spaces above.
Instead of penetrating the site progressively from the exterior, residents reach their apartments
by passing to the interior and then up through a porous fabric of courtyards and patios. Out of a
fundamentally regular system (buildable, rational), a high degree of variation is achieved through
local adjustment, and through the activation of void spaces within the fixed fabric.”1

1. Allen, Stan. Mat Urbanism: The Thick 2-D in CASE: Le Corbusier's Venice Hospital and the Mat-Building
Revival, ed. Hashim Sarkis, Pablo Allard and Timothy Hyde. (Munich, Prestel, 2002), 118-126.

133 PRECEDENTS
Plan drawing, diagram illustrating circulation from the street and up into the individual housing units. The building is open at
the ground level, filtering the pedestrian in and up into the private residences.

Plan - second level, individual housing units (six Section diagram highlighting the flow of natural light.
variations). Juxtaposition and balance of both open and
closed spaces.

134
 IX. Bibliography

135
136
 REFERENCES

Addington, Michelle; Kienzl, Nico; Intrachooto, Singh. “Mat Buildings and the Environment” in CASE: Le Corbusier's
Venice Hospital and the Mat-Building Revival, ed. Hashim Sarkis, Pablo Allard and Timothy Hyde. (Munich,
Prestel, 2002), 66-79.

Allen, Stan. “Mat Urbanism: The Thick 2-D” in CASE: Le Corbusier's Venice Hospital and the Mat-Building Revival, ed.
Hashim Sarkis, Pablo Allard and Timothy Hyde. (Munich, Prestel, 2002), 118-126.

Comer, Ronald J. Manaz. Abnormal Psychology. Ninth Edition edition. New York, NY: Worth Publishers, 2015.

Foster, Juliet L.H. “What can Social Psychologists Learn from Architecture? The Asylum as Example”. Journal for the
Theory of Social Behaviour, Volume 44, Issue 2, June, 2014.

Foucault, Michel. Madness and Civilization: A History of Insanity in the Age of Reason. 1 edition. Vintage, 1988.
———. Discipline & Punish: The Birth of the Prison. Translated by Alan Sheridan. 2nd edition. New York: Vintage Books,
1995.

Fuente, Guillermo Jullian De la. H Ven LC: The Venice Hospital Project of Le Corbusier. Rice Univ., 1968.

Graafland, Arie. The Socius of Architecture. Rotterdam: 010 Publishers, 2000.

Grob, Gerald N. Mental Illness and American Society, 1875-1940. Princeton, N.J.: Princeton University Press, 1987.
———. Mental Institutions in America: Social Policy to 1875. New Brunswick: Transaction Publishers, 2008.

Hyde, Timothy. “How to Construct an Architectural Genealogy" in CASE: Le Corbusier's Venice Hospital and the
Mat-Building Revival, ed. Hashim Sarkis, Pablo Allard and Timothy Hyde. (Munich, Prestel, 2002), 104-117.

Lacy, Bill N. Architecture for the Community Mental Health Center: Rice Design Fete III. Mental Health Materials Center,
1967.

Lam, William M. C. Perception and Lighting as Formgivers for Architecture. 1St Edition edition. New York: McGraw-Hill
Inc.,US, 1977.

Marcussen, Lars. The Architecture of Space - The Space of Architecture. Copenhagen: Arkitektens Forlag, 2008.

Morrissey JP, Goldman HH. “Care and treatment of the mentally ill in the United States: historical developments and
reforms”. Ann Am Acad Pol Soc Sci. 1986;484(1):12-27.

Mumford, Eric. “The Emergence of Mat or Field Buildings” in CASE: Le Corbusier's Venice Hospital and the Mat-Building
Revival, ed. Hashim Sarkis, Pablo Allard and Timothy Hyde. (Munich, Prestel, 2002), 48-65.

Panero, Julius, and Martin Zelnik. Human Dimension & Interior Space: A Source Book of Design Reference Standards.
New edition edition. New York: Watson-Guptill, 1979.

Poppelreuter, Tanja. “‘Sensation of Space and Modern Architecture’: a psychology of architecture by Franz Löwitsch”. The
Journal of Architecture, Volume 17, Issue 2, 2012.

137 BIBLIOGRAPHY
Robert, Lym Glenn. Psychology of Building: How We Shape and Experience Our Structured Spaces (The Patterns of Social
Behavior Series) by Lym Glenn Robert (1980-10-01) Hardcover, n.d.

Rothman, David. The Discovery of the Asylum: Social Order and Disorder in the New Republic. Revised edition. Aldine
Transaction, 2002.
———. Conscience and Convenience: The Asylum and Its Alternatives in Progressive America. 2 edition. Aldine
Transaction, 2002.

Sarkis, Hashim, Allard Pablo. Case: Le Corbusier’s Venice Hospital and the mat building revival. Munich; New York:
Prestel Publishing, 2002.

Scull, Andrew T. Decarceration: Community Treatment and the Deviant: A Radical View. 2nd edition. New Brunswick, N.J:
Rutgers Univ Pr, 1984.
———. “Institutionalization and deinstitutionalization”. In: Pilgrim D, Rogers A, Pescosolido B, eds. The SAGE
Handbook of Mental Health and Illness. London, United Kingdom: SAGE Publications Ltd; 2011:430-452.
———. Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern
Medicine. Princeton: Princeton University Press, 2015.
———. Social Order/Mental Disorder: Anglo-American Psychiatry in Historical Perspective. Berkeley: University of
California Press, 1992.

Segal, Andrea G; Sisti, Dominic A; Emanuel, Ezekiel J. “Improving Long-term Psychiatric Care: Bring Back the Asylum”.
Journal of American Medical Association (JAMA), Volume 313, Issue 3, January 20, 2015.

Shah, Manaz. Le Corbusier’s Venice Hospital Project: An Investigation into Its Structural Formulation. New edition.
Farnham, Surrey, England: Burlington, VT: Ashgate Publishing Company, 2013.

Smithson, Alison. “How to Recognise and Read Mat-Building,” Architectural Design (AD), September 1974.

Sonnenberg, Elizabeth Danze and Stephen, and Ed. Space & Psyche. Center for American Architecture and Design, 2013.

Tomes, Nancy. A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum-Keeping, 1840-1883. First printing
edition. Cambridge Cambridgeshire; New York: Cambridge University Press, 1984.

Torrey E, Fuller D, Geller J, Jacobs C, Rogasta K. “No Room at the Inn: Trends and Consequences of Closing Public
Psychiatric Hospitals”. Arlington, VA: Treatment Advocacy Center; 2012.

Whitaker, Robert. Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in
America. 1 edition. Broadway Books, 2011.
———. Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Second Edition
edition. Basic Books, 2010.

Whyte, William H. The Social Life of Small Urban Spaces. Project for Public Spaces Inc, 2001.

Yanni, Carla. The Architecture of Madness: Insane Asylums in the United States. 1 edition. Univ of Minnesota Press, 2007.

138
 X. Appendix

139
140
New York State: Mental Health Demographics

Severe Mental Illness/Serious Emotional Disturbance Status by

Program Category

Program Category Total Clients* SMI/SED Not SMI/SED Unknown

Total 180,204 146,734 33,470 0
Emergency 4,260 3,288 972 0
CPEP Crisis Beds 7 7 0 0
CPEP Crisis Intervention 2,022 1,599 423 0
CPEP Crisis Outreach 165 136 29 0
CPEP Extended Observation Beds 93 82 11 0
Crisis Intervention 1,693 1,260 433 0
Crisis Residence 26 22 4 0
Crisis/Respite Beds 219 158 61 0
Home Based Crisis Intervention 146 123 23 0
Inpatient 11,433 11,110 323 0
Outpatient 123,762 98,053 25,709 0
Residential 31,780 31,298 482 0
Support 34,637 28,523 6,114 0

Emergency

Inpatient

Outpatient

Residential

Support

0 40,000 80,000 120,000

SMI/SED Not SMI/SED Unknown

Statistics provided by the New York State Office of Mental Health (OMH)

141 APPENDIX
 Clients Served By Program Category By Age Group

Client's Age
Program Category Total Clients* Below 18 18-64 65 And Above
Total 180,204 35,704 130,377 14,087
Emergency 4,260 841 3,246 172
CPEP Crisis Beds 7 0 7 0
CPEP Crisis Intervention 2,022 366 1,580 76
CPEP Crisis Outreach 165 24 130 11
CPEP Extended Observation Beds 93 5 81 7
Crisis Intervention 1,693 298 1,315 79
Crisis Residence 26 26 0 0
Crisis/Respite Beds 219 4 210 5
Home Based Crisis Intervention 146 145 1 0
Inpatient 11,433 1,770 8,514 1,146
Outpatient 123,762 29,666 85,062 9,021
Residential 31,780 297 28,812 2,667
Support 34,637 5,597 26,498 2,527

Emergency

Inpatient

Outpatient

Residential

Support

0 40,000 80,000 120,000

Below 18 18-64 65 And Above

142
New York State: Mental Health Demographics

Clients Served by Program Category by Race/Ethnicity

Race/ Ethnicity
Program Category Total Clients White Black Hispanic Other Multi-Racial Unknown
Total 180,204 80,747 43,831 41,982 7488 4,271 1,885
Emergency 4,260 1,688 1,282 930 170 143 47
CPEP Crisis Beds 7 1 6 0 0 0 0
CPEP Crisis Intervention 2,022 719 667 470 98 61 7
CPEP Crisis Outreach 165 57 67 27 9 3 2
CPEP Extended Observation Beds 93 36 24 18 12 3 0
Crisis Intervention 1,693 775 434 339 46 65 34
Crisis Residence 26 11 9 3 1 2 0
Crisis/Respite Beds 219 85 83 35 6 6 4
Home Based Crisis Intervention 146 47 32 55 4 8 0
Inpatient 11,433 5,282 3,415 1,890 551 270 25
Outpatient 123,762 55,696 25,657 32,420 5326 3,447 1,216
Residential 31,780 13,301 11,201 5,418 718 1,033 109
Support 34,637 16,781 9,371 5,601 1205 1,181 498

Emergency

Inpatient

Outpatient

Residential

Support

0 40,000 80,000 120,000

White Black Hispanic Other Multi-Racial

Unknown

Statistics provided by the New York State Office of Mental Health (OMH)

143 APPENDIX
New York City: Mental Health Demographics

Prevalence of serious mental illness (SMI)

among adult New Yorkers
Age
Sex
6
Household
5% 5% Income
5
Percent of adults 18+

4% 4%
4
3% 3% 3% 3%
3
2%
2

0
18-29 30-44 45-64 65+ Male Female Low Middle High

Source: 2012 NYC Community Mental Health Survey

Prevalence of chronic physical health problems and unhealthy behaviors

by serious mental illness (SMI), NYC 2012
SMI
50 46% 45% 44%
45 43% No SMI
40
35%
Percent of adults 18+

35
30 27% 28% 28%
25 22%
21%
20
15%
15 11% 12%
10
5 4%
0
Hypertension High Cholesterol 2+ chronic disease Past-year asthma Currently smokes No fruits or No physical activity
diagnoses attack vegetables in past 30 days
yesterday

Source: 2012 NYC Community Mental Health Survey

144
New York City: Mental Health Demographics

Prevalence of past-year mental health treatment

among adults with serious mental illness (SMI),
NYC 2012

Counseling
only
15%
No medication Medication
or counseling only
39% 14%
In treatment,
category Medication and
unknown counseling
1% 30%

Source: 2012 NYC Community Mental Health Survey

Numbers do not add up to 100% due to rounding

Statistics provided by the New York State Office of Mental Health (OMH)

145 APPENDIX
 Self-rated health status and access to healthcare by
serious mental illness (SMI), NYC 2012

Fair or poor 43%

health
20%

SMI
Didn’t get
needed 21% No SMI
medical care 11%
in past year

0 10 20 30 40 50
Percent of adults 18+

Source: 2012 NYC Community Mental Health Survey

Nearly 40% of adult New Yorkers with serious mental

illness did not receive mental health treatment in the
past year.

Adult New Yorkers with SMI were more than twice as

likely to report fair or poor general health as those
without SMI (43% vs. 20%).

146