Healthcare Design - August 2013 - 26

INTERIORS | 08.13

Balancing act
Designing to create a safe environment that also serves as a therapeutic retreat
can be a challenge in psychiatric facilities
By Jaques Black

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Certainly, the more comfortable and homelike the
environment, the more problematic it becomes to
make it entirely safe and free of risk. To overcome
this challenge, designers and facilities must work in
conjunction with the clinical staffers on these units and
gather input from former patients, to address the issue
of designing healthful, therapeutic spaces for patients
with psychiatric disorders. Issues to discuss with staff
include the safety of furniture items related to looping
hazards, access to staff in the nurses' station, and the
potential for self-harm when patients are in their rooms
and alone. It's also helpful to have furniture items delivered to a site and assessed by clinical staff for safety
and durability prior to purchase and installation. Items
such as door hardware, plumbing fixtures, curtain
attachments, and wardrobe construction should also
be reviewed by members of the project team before
being specified. If the project timeline and budget
allow, mockups are another option. At NewYork-Presbyterian Hospital/Westchester Division (White Plains,
N.Y.), full-scale mockups of the proposed nurses'
station are being built prior to preparation of shop
drawings and construction to allow clinical staff to see
what's planned.
Design considerations
During the design process, it's important to weigh all
the items that are part of the inpatient environment to

The Psychiatric Inpatient Unit
at NewYork-Presbyterian
Hospital/Westchester Division, houses an open nurses'
station.

Jaques Black

©2013 WALTER DUFRESNE

In 1813, Samuel Tuke wrote the following
in a description of York Retreat, an institution for insane people in York, England,
that was founded by his grandfather
William Tuke: "Many errors in the construction, as well as in the management,
of asylums for the insane appear to
arise from excessive attention to safety.
... In the construction of such places,
cure and comfort ought to be as much
considered as security."
It was true then, and it's true today. A
design approach for psychiatric facilities
focused totally on the elimination of
potential safety hazards for the patient
will lead to an environment of care that
is inhospitable, institutional, and unlivable. Designers must walk a tightrope
between the ultimate safe environment
and an environment that is therapeutic
and fosters healing.
The Facility Guidelines Institute's 2010 Guidelines
for Design and Construction of Health Care Facilities offers direction in the section "Environment of
Care for Psychiatric Hospitals" by noting that a safe
environment is critical; however, no environment can
be entirely safe and free of risk. "Patients in inpatient
psychiatric treatment facilities are considered at high
risk for suicide; the environment should avoid physical
hazards while maintaining a therapeutic environment. The built environment, no matter how well it's
designed and constructed, cannot be relied upon as
an absolute preventive measure," the guidelines state.
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Healthcare Design - August 2013

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