After 25 years of practicing psychiatry in the Cayman Islands, Dr. Marc Lockhart recognized a critical gap in local mental health care: the lack of an inpatient psychiatric facility. In some cases, patients were kept on a hospital ward, while in acute cases, patients were held in prisons. Those who needed longer-term care were sent to Jamaica. “That was extremely upsetting,” says Lockhart. “We needed our own facility to care for those with mental illness.”
Witnessing psychiatric patients assist in relief efforts after Hurricane Ivan in 2004 gave Lockhart an appreciation for the healing power of purpose and community. He envisioned a mental health facility that would harness that power and researched facilities around the world. He found inspiration in the care farm model, which utilizes farming and agricultural activities to improve well-being through purposeful social interaction. This model has been used to foster community and healing among a variety of populations, including mental health patients.
Lockhart imagined leveraging a similar concept on the island, where nature would play a key role. “We live in an environment where we have sunshine 300 days a year,” he says. “Let’s take advantage of that. Let’s use the healing power of nature to act as a therapeutic vehicle.”
The project received funding from the Cayman Government Ministry of Health & Culture to deliver a residential facility for patients 18 years and older. Featuring a village-like atmosphere with multiple cottages in an agricultural area in the interior of the island, the Poinciana Rehabilitation Centre opened in December 2024.
Harmonizing with the rural setting
Designed by Montgomery Sisam Architects (Toronto) in association with local firm DDL Studio (Cayman Islands), the project represents the Cayman Islands’ first purpose-built, government-run mental health treatment facility.
However, the village layout of Poinciana today began with a more traditional idea. When the request for proposal opened, the plan called for one building, according to Enda McDonagh, principal at Montgomery Sisam Architects. The firm had completed successful projects in urban locations where apartment-style settings allowed patients to connect in common areas. Here, however, they sought a solution that would sit more comfortably within the scale of nearby houses, integrating thoughtfully with the rural context through a series of multiple smaller buildings.
“We knew that was going to be a budget driver,” says McDonagh. One building would have been more cost-efficient, but it would not have achieved the aims Lockhart had for the center, nor would it have harmonized with the setting.
Through discussions with Lockhart and various user groups, such as nursing and operations staff, the architects determined the programmatic needs of the facility and then strategized the types of spaces to house them. These spaces, such as a commercial kitchen, pharmacy, workshops, classrooms, and homes, emerged as the components of a village, explains McDonagh.
Village model for behavioral health
The goal of the design was to create locations for interaction among staff and residents—the term used instead of “patients.” This focus on community drove the idea for a village-like layout for the new facility, which pairs domestic-scale residential buildings with larger programmatic buildings to meet the needs of all users.
The Poinciana campus comprises a central hub with three buildings housing administrative, clinical, and meeting spaces. This “village square” is encompassed on one side with three clusters of three residential cottages each. The various buildings are connected by intersecting paths, enabling residents to naturally encounter each other and enjoy the natural setting as they walk the campus.
“There are ways you interact with people and places that make something a village,” says McDonagh. For example, residents go to the main buildings to eat in the cafeteria, visit the activity centers, or participate in vocational training in the woodshop.
Additionally, the facility incorporates seating areas in the reception building to welcome visitors, who can also enjoy the coffee shop and, in the future, a gift shop managed by the residents—all part of the village square. Also within the central hub, a small library includes computer stations for residents’ use, allowing them a level of independence, says Marcia Mullings-Thompson, director at Poinciana Rehabilitation Centre.
All spaces and programs were chosen with the aim of preparing patients to return to society with functional skills. “We wanted to break that revolving door cycle,” says Lockhart. “That was the key focus of design.”
Integrating nature with facility design
Modeled on the traditional Cayman cottage-style home, the residential cottages feature pitched roofs, local stone, and sand gardens to blend with local architecture, while the color palette highlights natural hues such as terracotta, ochre, and blue that honor the earth, sun, and sky, according to the project team. Additionally, the use of multiple colors aids in wayfinding, minimizing the need for signage.
To promote resident independence, privacy, and dignity, each residential cottage accommodates six private rooms as well as a kitchen, laundry room, and sitting area for group programming.
The surrounding landscape and nature informed the design as much as the local architecture. The project team visited a botanic park and sought advice from an island nursery on local flora. As a result, the buildings are placed around existing trees, and the property features gardens and orchards tended by residents, recalling the care farm model that had initially inspired the facility.
“The integration into the natural landscape is the great success of this,” says McDonagh. “No matter what room you are in in the whole facility, you are not looking into another building but into the landscape.”
Carrie Whitney is a freelance writer based in Atlanta and can be reached at [email protected].
Poinciana Rehabilitation Centre project details
Location: Grand Cayman, Cayman Islands
Official Project Name: Poinciana Rehabilitation Centre
Project completion date: December 2024
Owner: Cayman Islands Government
Total building area: 43,500 sq. ft.
Total construction cost: $24 million
Cost/sq. ft.: Not disclosed
Architect: Montgomery Sisam Architects
Local architect: DDL Studio
Interior designer/FF&E: DDL Studio and Montgomery Sisam
General contractor: The Phoenix Group, AAA, and RWE
Engineer: Read Consulting (civil), LEA & Reed Consulting (structural), MCW (mechanical and electrical), Aspyr (IT and data security), DDL Studio (costing)
Project details are provided by the design team and not vetted by Healthcare Design.
