Healthcare Design - June/July 2021 - 38

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easily accessible or readily available, which
can help mitigate the growing need for beds.
2. Limited access and providers. Approximately
111 million people live in areas of the
country with a shortage of behavioral health
professionals, according to the Department
of Health and Human Services. This deficiency
has left individuals waiting weeks or
even months for in-person appointments,
with many finding these appointments excessively
far away or inconveniently accessed. Telemental health and
telepsychiatry address this problem by enabling providers to see more
patients in a shorter period of time, as well as potentially harmonizing
the geographical distribution of psychiatrists and psychiatric patients
in both inpatient and outpatient settings.
A SHORTAGE OF MENTAL
HEALTH PROFESSIONALS
HAS LEFT PATIENTS
WAITING WEEKS OR
MONTHS FOR IN-PERSON
APPOINTMENTS.
settings, may use these virtual solutions to
provide treatment, prescribe medication, conduct
medication management, and streamline
treatment team meetings.
If designing a room in which a mental or be3.
Stigma preventing treatment. Shame and stigma often keep people
out of treatment and prevent patients from seeking and adhering
to treatment plans. This can be especially problematic in rural areas
where privacy and anonymity are particularly challenging. Telemental
health and telepsychiatry allow patients concerned with these issues
to access care in a comfortable, private environment of their choosing
(home, office, clinic, etc.).
4. Need for primary care integration. According to the American Psychological
Association, primary care has been a setting where 70 percent
of patients are diagnosed and treated for the most common mental
health conditions, including anxiety, depression, mood, and substance
use disorders. Integration is key as many acute and chronic disorders,
such as obesity, diabetes, and chronic pain, involve health behaviors or
psychosocial issues that make primary care the optimal medical home.
With the adoption of telehealth in a primary care setting, telemental
health and telepsychiatry providers can collaborate with primary care
physicians to ensure continuity of care.
While the use of virtual care delivery acts as a protective measure, reducing
new cases of mental disorders and increasing the capacity of our behavioral
healthcare system to handle more patients, it's a change that brings
about significant impacts on facility design.
DESIGN IMPLICATIONS
Mental/behavioral health facilities typically accommodate a diverse array
of patient populations and must be able to respond to changes in demand,
workload, care objectives, and treatment technologies. Designing
for flexibility empowers a program to accommodate evolving operational
concepts like the increase in need and demand for virtual visits. A strategy
for new facilities can include universal room layouts with virtual capabilities
to use telehealth, as needed. It's important to note that if a significant
number of mental health patients are being seen virtually, especially in an
outpatient mental health environment with providers working remotely,
it could result in a potential decrease in the necessary number of physical
exam or consult rooms. Modular designs could allow rooms to be converted
to meeting or work rooms with virtual capabilities for multiuse options.
And as telemental health and telepsychiatry become more integrated
in care delivery overall, facilities throughout the continuum of care must
adapt for the long-term implications, as well. For example, spaces such
as emergency departments, hospitals and outpatient centers, primary
care offices, substance abuse centers, nursing facilities, and correctional
38
JUNE/JULY 2021
havioral health patient may be present, strategies
to provide a safe environment must be in
place. Approaches include ligature-resistant
design in areas where direct one-to-one supervision
is not possible to prevent harmful
actions patients may take toward themselves
or others and durable fixtures and equipment
that are impact and tamper resistant. The quality
of acoustics plays an important role, too.
Poor acoustic conditions can exacerbate negative
human-response effects such as irritability,
anxiety, and even lowered immune system
symptoms. Planning for quiet telemental
health and telepsychiatry spaces with acceptable
noise levels, sound absorption coefficients
for materials, and sound isolation between
rooms can all enhance the patient experience.
The infrastructure to support optimal virtual
communication must be in place, as well. Psychiatric
or psychological evaluations require a
provider to clearly identify facial expressions,
microexpressions, speech impairments, and
body language to properly evaluate certain disorders.
On the patient's side, building a positive
rapport with a mental health provider is an
important part of treatment, also requiring the
ability to read body language, hear the provider
clearly, and see facial expressions. Poor connectivity
and sound quality, lighting with harsh
shadows, camera placement that's not at eye
level, and distracting backgrounds that impact
visibility can compromise this relationship.
MORE
ONLINE:
Telehealth kiosks
within communities
can assist in
delivering virtual
care services to
those who don't
have internet access
or the necessary
hardware at home.
Read more on
this solution at
HCDmagazine.com/
telehealth-kiosks.
CONTINUED IMPORTANCE
Telemental health and telepsychiatry are playing
an important role in expanding psychiatric
care and combatting barriers to treatment that
were exacerbated by COVID-19. These services
will also be valuable tools in managing the
heightened demand for care that's anticipated
post pandemic. As the need for virtual care continues
to grow across the continuum, it's important
to consider the spatial implications of
such interventions and for design to continue
to respond to technological innovation. 
Anosha Zanjani, MArch, MSc, is a behavioral
health design specialist at HDR (Los Angeles).
She can be reached at ANOSHA.ZANJANI@
HDRINC.COM .
HCDMAGAZINE.COM
http://www.HCDmagazine.com/telehealth-kiosks http://HCDmagazine.com/telehealth-kiosks http://www.HCDMAGAZINE.COM
Healthcare Design - June/July 2021

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