I was honored to participate in the roundtable discussions that concluded the 2012 Behavioral Healthcare Design for Health and Human Services Showcase. And, did I get an education—a fascinating three-hour debate about what a dozen projects say about the practice of architecture and the practice of behavioral health. The debate explored a great diversity of projects, including:
- Large-scale psychiatric hospital construction and renovations
- Renovations and additions to institutions and organizations serving adults and children
- Construction and remodeling of residential mental health, addiction treatment, and long-term dementia care facilities.
- New multi-purpose community “crisis centers” that provide 23-hour crisis stabilization, jail diversion and sobering services, short term hospitalizations and addiction treatment programs.
While four of this year’s projects earned special recognition from our judges, all 12 projects displayed in the Showcase (which can be viewed here in the digital issue) were selected on their merits from a wider field of entries based on the scores and opinions of the judges. Interestingly, while one of two projects with the largest budgets was honored, all other honors went to projects with considerably smaller budgets. So, regardless of size or budget, each project has lessons to share and a story to tell. To jump directly to each project, click on the corresponding link found to the right.
Citations of Merit
Northwestern Memorial Hospital, Stone Institute of Psychiatry (Chicago)
St. Joseph's Healthcare Hamilton, West 5th Campus (Hamilton, ON)
Lutherwood Children's Mental Health Centre (Waterloo, ON)
Lewis Wellness Center at Fountain House (New York)
Ottawa Withdrawal Management Centre (Ottawa, ON)
Cumberland Hospital for Children & Adolescents (New Kent, Va.)
Baycare Health System St. Joseph's Hospital Recovery Center (Tampa, Fla.)
Caritas (Slippery Rock Township, Pa.)
Santa Cruz Behavioral Health (Santa Cruz, Calif.)
The Meadows, Universal Health Care Systems of Delaware Inc. (Centre Hall, Pa.)
Oregon State Hospital (Salem, Ore.)
Minnesota Veterans Home-Fergus Falls (Fergus Falls, Minn.)
Note that our judges recognized that a facility’s purpose often imposes significant constraints on its design. In the words of one, “We don’t want to judge a forensic/detox facility in the same way we do a psychiatric hospital.” Indeed. To the intoxicant diverted from jail and the cop who is spared hours of booking and court time, even the spartan confines of a public sobering facility take on a beauty of their own.
The staff of Behavioral Healthcare magazine thanks our jury’s five distinguished panelists:
Gayle Anthony, EDAC, LEED AP, is a consultant with nearly 20 years of experience in the planning and design of inpatient and outpatient behavioral health facilities, acute-care hospitals and academic medical centers in the U.S. and abroad. She is founder and president of Healthcare Space Planning Consultants, LLC (Memphis, Tenn.), a consulting firm specializing in space programming, design and layouts for healthcare construction and renovation projects.
Howard Gershon, FACHE, is a founding principal with New Heights Group (Santa Fe, N.M.). He offers more than 35 years of experience as a healthcare consultant, specializing in strategic planning, market research, program development and facility development for behavioral health providers throughout the United States.
James M. Hunt, AIA, is president of Behavioral Health Facility Consulting, LLC (Topeka, Kan.), and a practicing architect. Co-author of the Design Guide for the Built Environment of Behavioral Health Facilities, he works with architects, psychiatric hospitals, and behavioral health facilities to improve safety. He served as served as director of facilities management at the Menninger Clinic for 20 years.
Jason Nordling, AIA. In more than a decade at BWBR (Minneapolis, Minn.), Nordling has forged relationships with major health care systems including Avera Health and Fairview Health Services. His experience with behavioral health facility design includes the groundbreaking Avera Behavioral Health Center in Sioux Falls, S.D., and the Gundersen Lutheran Health System Behavioral Health Center in La Crosse, Wis.
Gail Sterling, FIIDA, AAHID, is a principal and the Director of Interiors with WHR Architects (Houston), where she specializes in healthcare projects that utilize evidence-based design. Her expertise in interior design includes master plan development; interior finishes, furniture specification and selection; architectural and interior design; and preparation of construction documents.
Design Showcase highlights
Psychiatric hospital construction and renovation projects include HOK Architects’ $11.4 million conversion/remodel/renovation of Northwestern Memorial Hospital’s Stone Institute of Psychiatry in Chicago, which transformed an available hospital building to this new use.
The roots of this project’s Citation of Merit are found in its “comprehensive pre-design planning and collaboration with patients, families, and staff” which resulted in “a huge improvement in flow and finishes,” a “lean and efficient flow and circulation,” and “great daylighting and access to scenes of nature,” highlighted not only by plenty of windows, but also a simulated cloudscape on the ceiling of one of the Institute’s day rooms.
A big budget psychiatric hospital project that earned a Citation of Merit was Cannon Design’s concept for the new St. Joseph Healthcare’s new, 204-bed inpatient/outpatient mental health facility in Hamilton, Ontario. This $280 million, in-process project was praised for its attractive and welcoming exterior, a design that reflects a growing trend of behavioral health facilities that boldly and proudly express their role and value in the community.
Judges were impressed by its integration of natural courtyards and daylight, its arrangement of “onstage” (patient-facing) and “offstage” (service/business) corridors, and its “great swing bed zone between units,” a feature that will help the facility deal with wide swings in patient census.
The growing diversity of behavioral health services and needs are reflected in two projects that earned the Showcase’s Honorable Mention. Stantec Architecture linked old and new in a $5.2 million effort to “rebuild the heart” of Lutherwood Children’s Mental Health Centre in Waterloo, Ontario, Canada, with spaces to welcome the public and support a new generation of treatment and wellness services.
And, Elskop Scholz wowed the judges with its $1.5 million renovation of the Lewis Wellness Center at Fountain House in New York City, which offered “a stunning before and after transformation of high-rise space,” a “fresh color palette,” and a “clean, warm, simplicity” to engage both body and mind.
Racing to keep pace with changing needs
Another key realization was that, for all their training and expertise, our judges and their fellow architects, designers and consultants, are racing to keep pace with the with the practical challenges of our fast-changing field. One major challenge began years ago and continues today: Many states are closing large, aging, and costly psychiatric hospitals, only to find that more of their dwindling number of beds are occupied by forensic patients.
Only a relative handful of states are electing to reconcept and remodel aging state facilities to meet the latest needs.
These state-level challenges translate into changing concerns at the region, county, or community level as the designers and owners of behavioral health facilities today find that they’re dealing with:
- a higher acuity of patients—stable or “in-crisis” patients dealing with mental health, addictions or acute intoxication, co-occurring disorders, the impacts of trauma, or dementia.
- a broader diversity of patients—adult men and women, adolescents, boys and girls, military personnel, or individuals in the justice or juvenile justice systems.
- a need for more doorways to and from treatment—a welcoming “front door” for voluntary admissions or diversions from the local ER; a secure back door (often called a “sally port”) for jail diversion or juvenile justice cases; and an “exit” door for all to aftercare in their home or community.
- a growing desire for wellness—either as a means of prevention or a means of sustaining recovery for those who’ve received treatment.
Appreciating design in new ways
If it is axiomatic that “form follows function,” than it follows that the challenges confronting architects and designers are ever more complex, demanding new approaches and solutions. It also follows that, in order to appreciate the varied beauty of such work, those who pay for it and benefit from it must learn to appreciate its beauty in more varied and subtle ways.
Beyond a pleasing façade and welcoming public spaces, how does the work support healing processes, keep vulnerable people safe, help sustain better outcomes, and solve social or community problems?
How does it inspire, integrate with, and invite the surrounding locale to rethink the stigma of behavioral health treatment and accept the real, local need for these services? How does it contribute, and what does it save—in lives, in dollars, in human potential—for individuals and for the larger community?
Getting the project right—right up front
According to our judges, the success of a behavioral health facility project proceeds directly from the ability of the project’s creator to listen broadly and carefully to all stakeholders. “It is all about the conversation up front. That is the only way to avoid backtracking [on project requirements],” said one.
In the past, this meant listening to funders, practitioners, and facility staff. Today, however, it also means hearing the voices of service recipients themselves, and their family members, throughout the design process. One panelist thought it wise to get project input by walking in the shoes of a patient: “I’d suggest that the architectural manager and lead designer for any project spend a night or two on the unit.”
Another asserted, “You’ve got to have the balance. You’ve got to be able to shift from [hearing] staff concerns to getting the input of patients and families, whose feelings and needs often place them at odds with staff.” Getting this balance right is essential to avoiding problems with patient care and staff turnover because, as the judge explained, staff-related concerns “own the lifecycle cost of a project.”
And, a final word of hope for those who aspire to lofty service goals despite modest budgets: “Studies prove that you can achieve high quality without high cost,” stated a panelist, adding that great designs and treatment environments “show respect” for service recipients, “a respect that is likely to be returned.”