Healthcare Design - November 2017 - 111

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A CAREFUL RESPONSE

There are 10 major drivers influencing new design
solutions for mental healthcare environments
By Francis Murdock Pitts

URING THE PAST 10 years, there's been a dramatic and
accelerating change in both the number and the nature of behavioral healthcare construction projects.
Where once the majority of projects consisted of either the renovation of inpatient units at general hospitals, the occasional outpatient clinic, and the even
more occasional replacement of a large and outdated state hospital, today we're seeing small and large
freestanding specialty hospitals, new mental health units, and integrated outpatient treatment centers being built in cities across the country.
There are 10 major drivers causing this evolution that design and construction professionals should consider.
1 . G R O W I N G C A P I TA L I N V E S T M E N T

In 2015, mental illness and substance abuse disorders were leading contributors to disease burden in the U.S., or the total societal costs associated with disease, according to an article in the Journal of the American Medical Association.
Research correlates this trend with a lack of treatment or delayed treatment of
mental illness. Clinical and epidemiological studies conducted over the past
decade have concluded that early diagnosis and treatment of mental illness
can change the course of care and dramatically improve outcomes, influencing
investments now being made in new facilities to support those efforts.

ing stigma is a key part of decreasing the time between the onset of symptoms and the initiation
of treatment. While design alone can't eliminate
these negative associations, designers are increasingly providing an experience that combats
traditional preconceptions by creating environments as similar to their equivalents outside facility walls as possible, such as in-hospital schools,
living areas, and amenity spaces. Designers can
further diminish stigma by avoiding institutional
finishes, materials, and layouts.
4 . I N C R E A S I N G A C T I V E T R E AT M E N T
MODELS

Long-term inpatient care has moved from medical and custodial models to one involving active
treatment that's focused on assisting patients
in gaining the skills they need to achieve their
individual life goals. This new care model is fundamentally based on providing environmental
supports such as smaller and more customizable
spaces in lieu of purpose-built activity workshops and arts-and-crafts rooms that marked an
older generation of psychiatric hospitals. This
care model also requires the involvement of peer
counselors and care teams that include multiple
disciplines, resulting in an increased need for office, counseling, and meeting spaces to accommodate those teams as well as individual and group
therapy sessions.
5 . C R E AT I N G E D A L T E R N AT I V E S

Mental illness frequently manifests itself before adulthood. Considering this
and the above regarding the importance of early diagnosis and treatment,
providers are making significant investments in child and adolescent psychiatry facilities. For example, the Marcus Autism Center in Atlanta is pioneering a treatment approach for the most challenging patients that offers
intensive day hospital programming in lieu of the more traditional extended
inpatient stay, finding that lessons learned and applied with children in both
the home and treatment setting are more effective, and affordable, in the
long term. There's also a current emphasis placed on offering a wider range
of on-site services than traditionally provided. For example, Big Lots Behavioral Health Pavilion, which is under construction at Nationwide Children's
Hospital in Columbus, Ohio, will provide a day hospital for intensive outpatient treatment, outpatient clinics focused on specific illnesses, inpatient
beds, and an observation space. This approach allows patients to be placed in
the setting that's most appropriate for their needs while providing clinicians
and researchers with access to a diversity of treatment tools.

Hospital emergency departments (EDs) have been
overburdened in recent years by a growing volume
of hard-to-place mentally ill patients, leading to increased investment in mental health crisis care as
an adjunct to emergency care or as a substitute via
freestanding psychiatric EDs. It's also not unusual to see alternatives like transitional living units
or 72-hour assessment beds provided in conjunction with these EDs, allowing clinicians to
avoid admitting patients to inpatient care. Medical clearance (physical exams that establish that
there's no prioritized comorbid medical issues
present) and triaging comorbid physical ailments
are a critical driver of the location, organization,
and staffing of psychiatric EDs, with some hospitals collocating mental health and general medicine triage capabilities at the ED entrance, while
others push psychiatric services downstream
after medical clearance has been established.

3. REDUCING STIGMA

6 . I M P R O V I N G PAT I E N T S A F E T Y

2 . R E S P O N D I N G T O C H I L D R E N ' S M E N TA L H E A L T H

Much of the untreated mental illness in this country can be traced to patients
and families who don't want to present evidence of a problem by seeking
treatment. The mental health community has long understood that reduc-

The Joint Commission issued a formal Sentinel Event Notice in 1998 that called attention
to the range of environmental features patients

NOVEMBER 2017

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Healthcare Design - November 2017

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