CONCEPTUAL FICTION

The modern understanding of medicine accepts the human being as a whole physically, spiritually and socially. The organs, systems that make up the organism, the physical aspect of the human being; mental and emotional abilities, feelings and thoughts felt in the face of events; and its relations with the environment and society in which it lives constitute its social aspect. In general, the individual continues his life in intense interaction with himself, his family, his immediate environment, the society he lives in and the job he works in, in the time period he lives and in changing places. When the balance and harmony in these relationships are disturbed, mental health problems arise. (Çiçekoğlu P. Duran S.; 2018)

All of the studies carried out to help individuals overcome their mental problems and to regain their social roles lost due to illness are included in community mental health services. These services around the world;  It is offered in three different models as hospital-based model, community-based model and community & hospital balanced model. (Çiçekoğlu P. Duran S.; 2018)

The hospital-based model is the oldest and traditional model used in the treatment and care of patients with mental health problems in the world. During this period, warehouse hospitals called “Asylum” were established in Europe and America. These hospitals are established outside the city and have an average of 1500-2000 bed capacity. 3 The understanding that “patients can only be treated if they are removed from the environment they live in” has a great impact on the establishment and dissemination of these hospitals.

It has been discussed since the 1950s that mental hospitals were overcrowded, that mental patients were ill-treated and tortured there, and that being isolated from the society for a long time harmed patients as much as mental illness.

The community-based model is the model in which treatment and care services are provided in the patient's own environment instead of traditional hospitals. The main goals of this model are to prevent hospitalization of mental health patients and to ensure that patients reach a level where they can live without the need for others with minimal support. The community-based mental health model is a form of service that attaches importance to the personal and human rights of mental health patients, and supports caregiving to patients where they live, rather than in crowded, isolated hospitals. In this model, stigmatization of mental health patients decreases and access to health services becomes easier. In summary, in the community-based mental health model, the patient is treated in the clinic for a certain period of time, and his treatment and care is continued in the community he lives in after discharge. Family and social support given to the patient and alternative treatment methods make the treatment of mental disorders more effective.

The hospital-based or community-based model alone is not sufficient for the treatment and care of severe mental health patients. For this reason, it is necessary to create a mixed model by carefully examining the beneficial aspects of these two models at the point of delivery of mental health services. The issues to be considered in the balance model are that the services offered are close to the living environment, the duration of hospitalization is reduced as much as possible, and the budget allocated for mental health is transferred to community-based services instead of hospitals.  There is a worldwide desire to provide treatment and care to mental health patients within the framework of a community-based service model, to close mental hospitals and to treat patients without hospitalization. However, due to the nature of mental illnesses, hospitalization is inevitable in some cases. Having no one to care for the patient, the patient is a danger to himself and the society, the patient needs to be protected from the society and himself, the patient does not cooperate in the treatment, the patient is diagnosed appropriately, the use of high-risk drugs g [u1]  is required.

The community-based model, which aims to completely close mental hospitals and spread psychiatric inpatient services throughout the country, has a high cost, especially in terms of human resources. Considering the socio-economic conditions of our country and the structure of the health system, and when it is calculated that it will take many years to complete the deficiencies in terms of human resources, it is seen that the most appropriate model is the community-hospital balance model. In this model, which is still being implemented in England, psychiatric hospitals were protected by reducing them to 200 beds or less, and a community mental health system was also established (Ministry of Health, 2011).

Mental health services, like other health services, are classified into three groups as preventive, curative and rehabilitative services. Although mental health services are classified separately in this way, they are services that affect, develop and complement each other. Objectives of mental health services; It can be listed as ensuring that the individual is happy, harmonious and successful in the society and environment in which he lives, to prevent mental disorders and diseases, that is, to protect the individual and society from mental diseases, and to reintegrate people into society by treating mental diseases (Köknel, 2000: 5).

Mental hospitals are places where mental patients perform all their vital and social activities. Patients have access to the bedroom to sleep, a personal area where they can rest and be quiet, access to the toilet and shower in private conditions, hygienic eating areas for eating and drinking, common spaces that will enable them to communicate with other people when they want, natural light, scenery and a safe place where they can meet with visitors. They need space, peaceful courtyards where they can move in the open air.

Erenköy Psychiatric Hospital, which was converted from a sanatorium to a mental hospital in 1977, started to serve 260 inpatients and 1700 outpatients in an area of 97 decares in the city.

Public context-Relation to the city

When the current use of Erenköy Spirit and Nerve Hospital is examined, it is striking that the potentials of the area are not sufficiently evaluated.

The project land is in the north with Bayar Street; It is bounded on the east by Şemsettin Günaltay (Minibus Street) and Okur Street, which connects Bayar Street and İnönü Streets. Likewise, the internal connection road within the land, which has the potential to provide convenience to the people living in the vicinity, in reaching the Bayar street, which extends in the south-north direction and cuts the land vertically; It cannot be used because the door on the Bayar street side is disabled.

In psychology, the individual's awareness of the feelings, thoughts and behaviors that make him/her himself is called "insight". We can say that the way to meet the "self" within oneself and to dissolve the boundaries of oneself is through insight. One of the main goals of the therapeutic relationship is to enable the person to form this "insight" and to look at himself from the inside. Sometimes a person is isolated from himself, meeting with oneself with this insight can be considered the first step of dissolution and healing.

We care about insight because the awareness that one's own insight will bring to oneself is the first step of society's self-awareness. This awareness is imperative to get to a better point.

Erenköy Mental and Neurological Diseases campus is also isolated in the city it belongs to due to its function and physical conditions. It can be understood that the buildings carrying some functions of a campus should remain isolated from the city due to the nature of the function. However, Erenköy Psychiatric Hospital campus was isolated from the city as a whole.  We think that the only point where the New Mental and Nervous Diseases Campus meets the city should not be the borders of the building blocks. For this reason, we have designed a street where the campus overlaps with the city and the boundaries between it melt, forming the mortar between the two. We named this street “insight street”. 

The meeting of the city with itself within itself is important for all public buildings. We believe that this street will dissolve the borders between the two by creating an insight into this part of the city that belongs to it but has remained isolated until now, and this will be for the benefit of both parties.

When the physical conditions of the hospital are examined, it is interesting that the city is a breathing point with 3000 trees. Although the pine tree type trees that dominate the vegetative landscape of the area and especially the pine area create a peaceful recovery area for mental and nervous patients, they cannot be used directly by all patients. At the same time, the tree texture covering almost the whole of the 97000m² land covers a rather large area compared to the park areas on the Anatolian side, but it cannot be used by the citizens.

However, the high walls that separate very clear boundaries with the city make the Psychiatric Hospital equivalent to a prison; It creates a frightening and frightening effect for those living in the surrounding area. While this situation creates prejudice against mental hospitals for outsiders, it disconnects those inside from the real world. However, mental illness should be evaluated and treated like any other illness.

On the ground floors of Bayar Street, the dominant commercial axis is divided by the high walls of the Mental and Nerve Hospital.

All these problems when starting the project; needs program, the dominant landscape and the potentials of the area

Considering today's possibilities, it has been evaluated by putting them on top of each other.

At the end of the evaluation, it was decided to divide the project area into 3 zones. It has been observed that the average tree height is 16m, and it is accepted as a principle not to exceed this height when planning the building heights.

It was decided not to interfere with 3011 trees in the area, but due to the intensity of the requested program, it was decided to move 108 trees to suitable spaces within the project area.

​

​