Approximately 1 in 4 of the 2.4 million Iraq and Afghanistan war veterans are diagnosed with posttraumatic stress disorder, substance abuse or both. (http://projects.perkinswill.com/files/PosttraumaticUnderstanding_2014.pdf) This means that within the group of most recent veterans 600,000 have been diagnosed with PTSD and/or substance abuse. While it is certainly important that resources exist for veterans health and quality of living, the impact of these programs is inhibited when the physical space ignores the implications of military training and experience. Those working with veterans have heard of veterans avoiding specific buildings “even if it meant skipping important appointments, because they found the spaces unnerving.” (http://articles.chicagotribune.com/2013-07-05/news/ct-met-ptsd-design-20130705_1_ptsd-clinic-post-traumatic-stress-disorder)
These spaces should be humanizing. Privacy and respect should be embodied throughout spaces intended for veteran use whether it be designing for the scale of the body, providing individual bathrooms or using materials that are familiar rather than cold and foreign. War is incredibly dehumanizing, making any opportunity to eliminate intimidating or uncomfortable spaces essential. These spaces should also give as sense of empowerment whenever able which can easily manifest in flexible spaces. The ability to make small decisions in a space can have a much larger impact on sense of control. By being able to open a window, move a chair or adjust lighting veterans are able to reduce anxiety and increase their sense of authority over their lives.
Other small moves in design can decrease unnecessary stress and triggers by reducing the cognitive load of occupying space. (http://blog.perkinswill.com/posttraumatic-understanding/) A door that is unclear in the direction it swings or a handle that is difficult to use can be a small source of stress that inhibits comfort and is a negative distraction from the pursuit of health. Insulation and sound-reducing windows can also play a strong role in sound reduction from busy streets that can be triggers for those with PTSD. Other easy to overlook elements such as natural light, allowing pets in live-in programs, providing smoking space and proximity to nature have a huge impact on stress reduction.
The urban battlefield and military training present the most radical implications in the articulation of space designed for veterans. One part avoiding obvious triggers, one part attention to lines of sight and visibility, the shared habits and experiences of those with military experience points towards training handbooks as a design resource. The most recent war veterans are more likely to experience a traumatic or particularly stressful event in a city, and because of this an environment that shares a sensory element with the streets of Baghdad for example (see image above) is likely to be a trigger for veterans using or moving through the space. In military training you learn the importance of establishing a dominant position with a given space, habits which can inform a veteran’s method of encountering space. This includes 1) facing towards openings in space 2) back towards secured area such as a corner with no windows 3) minimizing “fields of fire” or areas where you are exposed or gunfire could originate 4) high vantage point to reduce threat from above. (http://projects.perkinswill.com/files/PosttraumaticUnderstanding_2014.pdf )
Designers should stride to provide privacy and security while retaining opportunities for swift exit and eliminating the feeling of being trapped.
Many of these design moves are inexpensive and a matter of thoughtfulness in design, material choice and sourcing. Spatial decisions informed by stress reduction and military experience have a long-term impact on the effectiveness of programs and resources that target the health and well-being of veterans.