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Design practices contribute to stabilization unit safety

June 30, 2017

Designing a mental health facility requires special considerations to protect the safety and dignity of patients in a fragile psychiatric state as well as ensure the security of staff. Previously, designs focused on safety restricted freedom, further stigmatizing patients. Today, we recognize that providing both safety and dignity are not only possible but beneficial to the healing process.

The inpatient stabilization unit

The demand for inpatient behavioral health beds often exceeds the available supply, leaving patients who are in crisis in emergency departments for up to several days while awaiting placement. Emergency department crisis rooms are designed for immediate intervention and safe holding rather than treatment and recovery and can exacerbate an at-risk patient’s situation. One innovative way some hospitals meet the demand for behavioral health beds is by creating an inpatient stabilization unit (ISU).

The ISU provides the opportunity to begin evaluation and treatment of arriving behavioral health patients immediately. Where possible, the patient’s condition is stabilized within the unit, and the patient is released back to their community. If continued treatment is required, patients can be transitioned into a behavioral health unit within the hospital. An ISU offers a therapeutic environment for patients experiencing a behavioral health crisis, rather than just a safe holding space.

Strategic design planning

The design of facilities for behavioral health has traditionally focused on maintaining the safety of patients and caregivers. While safety remains an important design criteria, the opportunity exists to go well beyond this single focus to provide behavioral health environments which focus not only on function but also on the recovery process.

The need for a safe environment begins before admission. An enclosed sally port offers a secure entry area for patients arriving via ambulance or police cruiser not only preventing elopement but shielding patients in crisis from passersby during a trying and vulnerable point. Privacy continues with a confidential admitting unit. A corridor from admissions into the hospital provides a clean, direct circulation path to an ISU or existing unit in the hospital as well as staff offices. Patients receive a private and dignified experience, while staff benefit from an improved workflow and circulation.

The use of building information modeling (BIM), or 3D technology, can help communicate the design to all stakeholders early in the design process, allowing management and staff to fully visualize the finished project before construction begins. Design layout may be revised in real-time. The advantages of using BIM during the design process include reducing the number of costly changes during construction, enhancing communication and coordination between project team members, and reducing project delays.

Healing design considerations

In recent years, research has shown the therapeutic benefits of incorporating elements found in nature—air, water and earth—into the built environment to create a more comfortable setting that is soothing to the soul and promotes healing. By incorporating these healing design concepts, which are now expected in the design of most medical facilities, behavioral health centers can provide safe and efficient delivery of care while also conveying expectations of healing and recovery. Making a space feel less institutional reduces anxiety and contributes to a comfortable healing environment. Thoughtful color choices in soft palettes of earthy beiges, blues and greens and the use of natural materials, such as wood, generate a calming, soothing effect. Shatterproof acrylic and secure hardware allow the addition of art to foster a therapeutic atmosphere while eliminating potential self-harm materials.

Typical healthcare materials need to be durable and resistant to aggressive cleaning solutions. Behavioral healthcare facilities also require materials that can withstand abusive behaviors and can’t be weaponized. Materials and building construction must be secure with pick-proof seams, including plumbing fixtures, lighting and door screws. Tragically, each year suicide takes the lives of around 38,000 Americans, making it imperative to eliminate ligature points, which may result in self-harm or loss of life. Many standard products pose a risk in a behavioral healthcare facility, requiring the use of alternate anti-ligature fixtures and accessories to minimize the possibility of danger.

Flexible materials like vinyl flooring prevent the potential for the removal of a sharp, jagged piece, which could harm patients or staff. Softer materials also provide great acoustical benefits, reducing sound reverberations and creating a quieter, calmer place where the focus is on treatment rather than distracting sounds.

While mounted or weighted furniture is less likely to be picked up by a patient and used to cause harm, it also limits rearranging furniture to accommodate changing needs. Heavy, steel-framed furniture with tamper resistant fasteners and fabrics that resist staining and moisture penetration are a better choice, allowing flexibility while maintaining safety. Selecting durable yet attractive materials and furnishings contributes to a warm environment that focuses on hope, healing and recovery, while reducing risk.

Adding dignity with patient choices

A centralized nurse station maximizes visibility for staff security by providing direct supervision of every patient room and all common areas, while encouraging positive socialization and engagement between patients and staff. An intentional open design allows staff to react quickly during a crisis while also offering a place where staff can retreat for protection from a potentially aggressive patient.

Natural light and access to exterior views have been shown to advance healing and recovery. Clerestory windows of impact-resistant glass admit light but shield patients from passersby. By placing patient rooms around the perimeter of the ISU, patients can access nature and light as desired.

The Department of Health and Human Services (HHS) also requires that patient rooms have windows to the exterior to admit natural light. This is particularly necessary for patients in an ISU as their length of stay can last upwards of 72 hours. This length of time without daylight is unacceptable to HHS guidelines and can hinder a patient’s recovery.

Integrating healing design features gives owners and operators the opportunity to shape psychiatric healthcare by going beyond function and safety to include the dignity and respect all people deserve.

Judy L. Johnson, AIA, LEED AP, is a principal and architect at Harriman, and Peter J. Pinkerton, IIDA, NCIDQ, is an associate and senior interior designer at Harriman. The multi-disciplinary design and engineering firm has offices in Portland and Auburn, Maine; Portsmouth, N.H.; and Boston.

PHOTO CREDIT: Siri Blanchette/Bind Dog Photo Associates

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