Low scent, fragrances in Mental Health Unit Design
Low Scent, Fragrances in Mental Health Unit Design
This blog will outline the rationale for a low scent environment in Mental Health Units and offer recommendations with respect to the design of these environments.
People admitted to Mental Health inpatient Units present with a wide range of mental health disorders including schizophrenia, Borderline Personality Disorder, Post Traumatic Stress Disorder and Autism Spectrum Disorder. It is now understood that people with these diagnoses experience a higher rate of sensory sensitivities and other sensory processing challenges compared to the general population (Stromberg et al).
The prevalence of fragrance sensitivities were investigated in the United States, United kingdom, Australia and Sweden by Steinemann (2019) and results included:
· 75.8% of Autistics are sensitive to fragrances
· 26% of the general population report being diagnosed with asthma/asthma like conditions and 57.8% are also fragrance sensitive.
Scents that were particularly problematic included:
· Air fresheners and deodorisers (54.8%)
· Being in a room with recently cleaned products (53.8%)
· Being near someone wearing a fragranced product (56.5%)
There was a range of adverse health effects associated with fragranced product exposures for chemically sensitive individuals and this included:
· Respiratory problems (50.2%)
· Mucosal symptoms (39.4%)
· Migraine headaches (36.9%)
· Asthma attacks (25.2%)
Scent was identified as a barrier to engaging in occupations including:
· 37.4% are unable or reluctant to use public restrooms that have an air freshener, deodoriser or scented product.
· 51% enter a business but then leave as quickly as possible due to a fragranced product
· 9% of the general population has lost work days or lost a job in the past year due to illness from fragranced product exposure in the workplace
· 60% of students in one study had a physical reaction including headaches, shortness of breath, or a rash after being exposed to fragranced products. Additionally, 41% noted their reactions to fragranced products impacted their ability to concentrate on studying and taking exams. (Lee, 2019)
Healthcare
· 51.45% of the general population would prefer that healthcare facilities and healthcare professionals are fragrance free.
· 77.2% of Autistics would prefer fragrance free healthcare.
PTSD:
Herz (2021) found that odors may be the most incapacitating triggers for PTSD because:
“ (1) odors are invisible and there is often no way to prepare for or anticipate the possibility of exposure;
(2) odors evoke more emotional and evocative memories than other sensory stimuli
(3) odors are processed in the area of the brain where emotions, emotional memories, and associations are processed (the amygdala-hippocampal complex and orbitofrontal cortex), which comprises the same neural circuitry as PTSD due to their direct connection to the neural network of emotion, odors can instantly elicit affective responses and associations prior to and without cognitive appraisal That is, at-risk individuals are vulnerable to traumatic odor-triggered memories; odor processing inherently elicits highly emotionally charged memories; and, due to the automaticity of odor-evoked memories, encountering an odor associated with trauma can sideswipe cognitively prepared coping responses.
In addition to being highly insidious triggers, odors often play a central role in PTSD episodes. For example, in a report of 100 refugees who were seen at a psychiatric clinic, 45 percent reported experiencing an odor-triggered panic attack within the preceding month [51]. Odor cues can also trigger particularly negative flashbacks.”
Sensory Modulation Brisbane recommends that Mental Health Units respond to the needs of people with sensory sensitivities and trauma triggers to scents by implementing sensory modulation techniques and Universal Health Design features such as:
· Availability of Nil Odor, Stink Balm or other odor reducing strategies to provide an option for people to decrease a scent that they do not like.
· Providing personally preferred scent input eg options for different soaps, little containers with cotton balls and scent on it.
· Low scent cleaning , laundry and bathroom products
· No aromatherapy diffusers, incense etc
· Scents to be considered as a possible contributor for distress and agitation.
· Problem solving to address scents that are identified as problematic by people on the ward
· Designing spaces to separate the food areas to keep food scents in one location.
· Consideration of separate eating areas or other strategies for people with scent sensitivities or triggers or who need lower scent levels in order to comfortably eat.
· Healthcare professionals to wear low scent personal products.
· Air purifiers, plants
· Open windows and outdoor areas
· Completing a personal safety plan to identify useful and problematic scents
Further information on this topic is available on the On demand course:
References:
S. Herz R. Olfactory Virtual Reality: A New Frontier in the Treatment and Prevention of Posttraumatic Stress Disorder. Brain Sciences. 2021; 11(8):1070. https://doi.org/10.3390/brainsci11081070
Lee, R., Westmoreland, D., Maju, M., Apolloni, A., Bullock, H., Wang, A., & Sidhu, S. (2019, November). Assessing the Prevalence of Chemical Sensitivities to Fragranced Products Among Undergraduate Students & Its Impact on Educational Experiences. In APHA's 2019 Annual Meeting and Expo (Nov. 2-Nov. 6). APHA.
Sensory Modulation Resource Manual
Steinemann, A. International prevalence of chemical sensitivity, co-prevalences with asthma and autism, and effects from fragranced consumer products. Air Qual Atmos Health 12, 519–527 (2019). https://doi.org/10.1007/s11869-019-00672-1
https://link.springer.com/article/10.1007/s11869-019-00672-1
Steinemann, A. The fragranced products phenomenon: air quality and health, science and policy. Air Qual Atmos Health 14, 235–243 (2021). https://doi.org/10.1007/s11869-020-00928-1
https://link.springer.com/article/10.1007/s11869-020-00928-1#citeas
Maria Strömberg, Lina Liman, Peter Bang, and Kajsa Igelström.Experiences of Sensory Overload and Communication Barriers by Autistic Adults in Health Care Settings.Autism in Adulthood.Mar 2022.66-75.http://doi.org/10.1089/aut.2020.0074
https://www.abc.net.au/news/2023-01-09/too-many-smelly-candles-here-s-how-scents-impact-the-air-quality/101823806