In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.
Joseph Doherty is a principal at FCA (Philadelphia). Here, he shares his thoughts on designing for behavioral health facilities and the importance design plays in patient care.
1. Fundamentals of behavioral health design
I recently read “On the Construction, Organization and General Arrangements of Hospitals for the Insane” by Dr. Thomas S. Kirkbride, published in 1854. Even back then, Kirkbride saw the positive effects of natural light and fresh air on the health of patients. Though the treatment of mental illnesses has changed, the benefits of some of the basic tenets of design, such as high ceilings, natural light, and ventilation, that we believe in today were known more than 150 years ago. Many of the standard amenities in his book are features we continue to design into behavioral health spaces today.
2. Spaces to reduce patient stress
Creating behavioral health spaces that help reduce patient stress is a constantly evolving challenge. Historically, low reimbursements have driven facilities to reduce patient activity space to the code minimums. Typically, Facility Guideline Institute’s Guidelines for Design and Construction require a minimum of one noisy activity area for patient socialization and entertainment, and one quiet activity area for more solitary activities such as reading. We’ve received feedback from our clients saying that positive impacts on patient behavior have been observed from having multiple activity areas of each type. Providing patients with various options allows them to assert some control over their daily routines, which can help eliminate conflict between patients by giving them space and allowing them to avoid unnecessary interactions with each other.
3. Staff safety
Staff safety is an important aspect of every behavioral health project, leading to discussions with the staff and administration about open versus closed team stations. The goal is to create a physical separation between staff and patients without creating a barrier that obstructs care. Creative solutions such as angled transaction tops or frameless polycarbonate separators are often employed. In cases where the patient population requires floor-to-ceiling separation, it’s important to make the separation unobtrusive so that patients feel they have connectivity to the staff and caregivers can still see and hear what’s going on in the patient areas. For example, providing gaps between the sheets of polycarbonate set into the team station can effectively provide the staff with the ability to hear what’s happening in the unit and proactively intervene, if needed.
4. Reducing stigma
Designers can help reduce the stigma and stress associated with behavioral health facilities through material and color choice. For example, using natural materials like wood typically seen in private residences can help reduce patients’ stress by giving them a familiar homelike setting. Additionally, color has been shown to have benefits to patients’ emotional state that can lead to improved outcomes. Based on this research, hospitals have shifted the choices of finishes from traditionally institutional colors and materials such as mint green or beige tile to more residential and hospitality-oriented materials and colors, including earth tones and durable faux wood flooring.
5. Creating flexibility
Most behavioral health providers have been forced to do more with less money and space over the years due to dwindling reimbursement. Building flexibility into the design can help facilities overcome this challenge and designers need to understand the utilization of spaces and build rooms that can perform double-duty appropriately without lengthy setup and breakdown. For example, understanding how often a group therapy space or activity room is used can eliminate the need for duplicate square footage for a therapy space. Another technique for building flexibility is the creation of swing space between units or wings for flex beds or shared support. Strategically placed cross-corridor doors can let behavioral health units with different patient types or acuity levels grow into the flex space as needed, maximizing occupancy but keeping the populations separated.