Recently I had the opportunity to host a panel alongside GBBN’s Angela Mazzi for the American College of Healthcare Architects (ACHA) Master Series 2.0 on the topic of Behavioral Health Trends and Facility Impacts.  The subject matter experts we discussed the topic with were:

  • Frank Pitts FAIA, FACHA-, architecture+
  • Mardelle Shepley FAIA, FACHA, Janet and Gordon Lankton Professor, Department of Human Centered Design, Director, Cornell Institute for Healthy Futures
  • Hilary Bales AIA, ACHA, EDAC, Principal, Page

Our discussion was thought-provoking and informative, and I wanted to share a few things that piqued my interest from the conversation.

What are some recent trends in the research and design of mental and behavioral health facilities?

Much of the push for behavioral healthcare is outside the traditional behavioral health facility.  Community centers, schools, and mobile crisis units provide behavioral healthcare to communities and provide care to patients earlier.

Investment in outpatient treatment, intensive outpatient programs, and day programs is also increasing.  Frank shared that there is a higher level of post-discharge compliance when an inpatient gets to go to an outpatient setting before being discharged.  As a result, it is common for inpatient facilities to include outpatient programming.

Finally, over the past decade, the construction of psychiatric emergency departments has been incorporated into hospital campuses more frequently.  Separating unique patient types increases throughput, improves patient experience, and reduces caregiver stress.  Specialized units align the core competencies of staff to patients, reducing the amount caregivers need to flex during their shifts.  Separation of patient populations also allows customization to align the care environment for specific needs based on evidence-based design.

Why are behavioral health buildings suddenly so expensive, what can we do about it, and how can facilities plan for success?

Construction costs have escalated for several years, and behavioral health facilities are not immune.  Behavioral health facilities must also maintain ligature-resistant spaces, meaning fixtures and finishes are more costly than their non-ligature-resistant counterparts.  The durability of building materials also increases in the behavioral health setting, adding more cost over common construction materials.

The best way to curb increased material costs is to create a very detailed risk assessment that pinpoints exactly where the enhanced finishes and fixtures are necessary for patient and staff safety.  By focusing on areas that need a high degree of safety or protection, one can avoid overdesigning the level of finish.

Another durable way cost savings can plan for success early is by creating flexibility in the built environment.  Designing adaptable spaces that can be used for more than one activity decreases the overall size of the building, which is the best way to lower construction costs.  Similarly, using outdoor spaces to extend the patient care milieu can create value in the built environment by leveraging code-required spaces for more than one use.

What strategies can facilities use to make behavioral health hospitals flexible for treating different patient types (diagnosis and age)?

To increase flexibility, facilities can aggregate therapeutic spaces like group rooms and activity spaces so that they are accessible to different patient populations, which reduces space duplication.  The “treatment mall care model” congregates unique treatment spaces such as gyms and exercise facilities in a central location and makes access a privilege incorporated into a patient’s treatment plan.

The trade-off for a shared room approach is that patients must move from one environment to another.  Depending on the patient population, this type of patient movement could introduce security or staffing challenges, which must be addressed.

Flexibility can also be gained from creating multiple ways for patients to experience a single space.  Rather than letting the room type dictate what functions or activities take place, let the space be a canvas for people to create the type of space they need.  Allowing patients and staff to reimagine the use of space, the building can become a part of the care toolkit rather than being something they are fighting against.

How do we design for staff in the behavioral health setting?

Mardelle shared from her research that inpatients and staff often see the same things as important: safety.  However, the perception of what constitutes a safe environment can be different.  One key difference is the time staff and patients experience the building.  Staff are in the building for an extended period, day in and day out, while patient stays are more episodic, typically between one week and one month.

We seek environmental transitions, and the more accustomed we are to an environment, the more it can impact how it is interpreted.  Buildings should provide flexibility of experiences within the building for staff who will grow more accustomed to the environment over time.  One way to do this is to provide ample access to the outdoors, both physically and visually.  Transitions happen naturally in outdoor environments, with seasonal creating an enriching compass that makes people feel more comfortable.

What environmental features have been identified as most important to patients and staff?

Because patients live most of the day with other patients, providing as much choice as possible is important.  These options do not need to be new space types – they can exist in the “in-between” spaces that naturally occur in buildings. For instance, some patients prefer to be near a caregiver to observe, feel secure, or get to know them better, while others prefer more independence.

Regarding staff, beyond the safety of the environment, Mardelle’s research saw staff rank the importance of different environmental qualities, including:

  1. Well maintained environment
  2. Visual access to nature
  3. Attractiveness and aesthetics
  4. Deinstitutionalized environment
  5. Orderly and organized environment.

The patient’s family is an often-overlooked group in the behavioral health setting, especially in adolescent or pediatric units.  One space type that can help ease the transition of patients going home is an overnight setting where families can spend the night in the hospital with their child, with caregivers nearby to help if necessary.

The evolving behavioral health facility design trends reflect a commitment to holistic care and recognize that the healing process extends beyond medical treatments to include the physical spaces where care is provided. Visiting any medical facility can be a stressful experience. Coupled with the stigma associated with behavioral health, visiting a behavioral health facility can feel especially intimidating. These facilities must provide a functional and safe place for providers and patients while also being warm and aesthetically pleasing. Achieving this balance is challenging but, when done right, can put patients at ease and support their goals and well-being.

Daniel Perschbacher, AIA, ACHA, Assoc. DBIA, IISE Lean Green Belt

Principal in Charge

As principal in charge in HMC’s San Diego Healthcare studio, Daniel serves the firm’s healthcare client base and works to expand the firm’s healthcare reach in the San Diego region. He has over 19 years of experience in healthcare architecture spanning nearly every project type and delivery method. He is passionate about applying Lean principles to the architecture and construction delivery process. Daniel believes that healthcare design, more than any other project type, wraps around communities and provides space for their most joyous and difficult moments.

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