Healthcare Design - October 2015 - 44

in february 2014, St. Joseph's Healthcare Hamilton
opened the Margaret and Charles Juravinski Centre
for Integrated Healthcare in Hamilton, Ontario.
The project was impressive for its size alone, with
850,000 square feet and more than 300 psychiatric
beds, as the provider brought all of its mental health
and addiction services together under one roof in a
modern and comfortable setting.
But it stood out for another reason, as well: During the renovation, the operator decided to add an
ambulatory care center with diagnostic, imaging, and
outpatient medical services.
The project captures a trend beginning to emerge
across North America. New behavioral healthcare
clinics, emergency room crisis centers, and freestanding facilities are being built, while older, existing
wings are getting the green light for renovation and
expansion. Together, these projects illustrate how far
mental healthcare has come from its days tucked into
faraway hospital units or in institutionalized facilities,
as well as its growing role in a more integrated care
approach.
Tim Rommel, a principal with Cannon Design and
leader of the firm's national behavioral design group
(Buffalo, N.Y.), says his firm has about a dozen
new freestanding
behavioral health
hospitals on the
design boards right
now. "If you asked
me 10 years ago
would we ever get
to that point, I would
have laughed at you," he says. "Two years ago, we
opened 1,500 psychiatric beds in one year. That's a
huge number of beds being added to the system."
So what's driving this growth? For one, there's
more awareness of mental health and more open
discussions about the need for treatment. People
also have greater access to insurance coverage,
which has fueled greater demand.
Heather Treib, director of operations, hospitalbased services, at Pine Rest Christian Mental Health
Services in Grand Rapids, Mich., says her freestanding facility houses seven inpatient units and has
expanded significantly in the past five years. The reason, she says, isn't because there are more mentally
ill patients but because of several new or expanded
healthcare programs, including Medicaid expansion,
healthcare reform, and the Mental Health Parity and
Addiction Equity Act of 2008, which mandates that
medical insurance providers cover behavioral healthcare at the same level as physical healthcare. "A lot
of people can get benefits now to cover behavioral
healthcare services," she says.

New projects illustrate how far
mental healthcare has come from
its days tucked into faraway hospital
units or in institutionalized facilities.

HCDmagazine.com 10.15

State
While demand has risen, industry professionals
say reimbursement rates have not, meaning the
incentive to build cost-effective facilities is everpresent. Providers have also seen lengths of stay
decrease, while the availability of outpatient behavioral healthcare services has grown. That means
providers are designing more short-term care facilities that are serving the most acute mental health
patients.
Jim Hunt, president of Behavioral Health Facility

Consulting (Topeka, Kan.), says penalties for readmissions is another reason why more care providers are
addressing their behavioral healthcare services. "It's
been a revolving-door process for a number of years,
where insurance companies would only allow seven-,
five-, or three-day stays. They'd discharge them after
that time and [the patients] would turn around and
come back the next day or week. They're in and out,
in and out, but they're not in long enough to really get
a handle on what's going on," he says. "Providers are
incentivized now to try to solve the problem."
The challenge for designers, architects, and
operators is to find cost-effective solutions that
meet facilities' high safety and security needs while
still providing an environment where a patient can
stabilize and receive treatment. "If we can make that
a more efficient process, then we've helped that
provider either treat more individuals or made it more
economical for them to provide care," Rommel says.
Evolution of care environments
In this new chapter of behavioral healthcare design,
Don Thomas, principal at BWBR (St. Paul, Minn.),
says he's seeing the emergence of freestanding or
hospital-based assessment centers, or crisis stabilization units, where clinicians can have more time
to observe and understand patients' needs before
admitting them into a specific program. "What they're
finding is that sometimes they would put people in
the wrong place," he says, such as placing someone
with an addiction issue in a high-acuity treatment
center.
Dedicated psychiatric EDs that are designed to
address the safety needs of someone in mental crisis
have also become more popular in the last 10 years,
says Cannon Design's Rommel. "In an emergency
room in an acute care environment, you have lots of
equipment and tools that can be very dangerous,"

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Healthcare Design - October 2015

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