Transitional healing

As described in Winifred Gallagher's Power of Place, “we need places that support rather than fragment our lives, places that balance the hard, standardized and cost-efficient with the natural, personal and healthful.”1

Today, a new population is being shaped as a result of the ongoing fight against terrorism. Honorable soldiers and their spouses and children are its members who are adjusting to the invisible injuries of anxiety, depression, and post traumatic stress disorder (PTSD), among others. Current treatments disconnect the soldier and the family by separating guidance, therapy, and treatment among many facilities. The top mental wellness programs that do exist are for soldiers only, and are reactive to situations and/or have limited access.

According to the U.S. Department of Veteran Affairs, successful treatment of PTSD and other war-related mental health injuries must be treated promptly. At the same time, these diagnoses must remain secure to prevent the fear of stigma from deterring treatment.

To truly succeed, the Military Healthcare System and Department of Defense must create new entities; sensitive and thoughtfully designed environments that truly promote and contribute to the wellness of body, spirit, and mind for the active-duty military family as a unit-as a soldier, spouse, child, couple, and family.

Scientific research in the last two decades established a direct link between poor health, such as anxiety, depression, high blood pressure, and an increased need for analgesic drugs, and inadequate or psychologically inappropriate physical environments.2 Healthcare today embraces this evidence-based design research and the positive impact an environment can have on patient wellness and healing.

To pave the road toward evolution in the Military Healthcare System and mental health facilities in general, a new design model of mental wellness treatment is proposed in the form of a “wholistic” environment of “transitional healing.”

Making connections and discoveries

“Transitional healing” addresses the frag-mentation of access to care and support. It incorporates evidence-based design principles of patient and family-centered care. It also bridges the stages of healing and wellness of the body, mind, and spirit of the soldiers by including and addressing the needs of their families, who are integral participants in the process. It combines people and services in a tangible, physical space that involves and connects the family in every aspect of the design to facilitate the recovery journey of the individual (soldier, spouse, and child) as well as the family unit.

Integration on a military base would address three primary barriers that impact military mental health treatment for soldiers and their families as noted by the APA Presidential Task Force on Military Deployment: availability, acceptability, and accessibility.3 Its physical presence in the community it serves could also help alleviate and eliminate stigma associated with mental wellness and healing.

On the site would be a village of pre-fabricated modules organized around a central core (courtyard), forming a holistic, non-clinical atmosphere-one that promotes humane, interactive therapy and discovery. The target users (active duty soldiers, spouses, and children) are supported through a facility that focuses on Connection and Discovery (figure 1).

Connection offers secure places to educate and prepare soldiers, spouses, and children before a deployment, or to connect during and reconnect after (figure 2). Here soldiers and spouses can learn about support programs that are offered and the potential psychological and behavioral issues that may arise. They are also given a tour of the facility and services offered to ensure healthy transitions before, during, and after a deployment or, in many cases, in between deployments. The initial environmental experiences help to form a subconscious bond of trust, easing the return when healing is truly required, especially for soldiers and families suffering from the effects of PTSD.

Discovery is a place that encourages learning, observation, and understanding, encompassing all formal therapy and counseling services for active duty soldiers, spouses, and children. It is divided into two zones:

• Discovery 1 is for soldiers only. It is a place to seek individual and group therapy as well as assessment before and after deployment with fellow comrades who understand where you are going and where you have been (figure 3).

• Discovery 2 supports the child, spouse, couple, and family.

Supporting both zones are interconnected spaces and treatment offices. Each zone has its own receptionist and Discovery 2 also includes a licensed therapist specializing in children's issues and needs.

Creating a journey to wellness

The concept of serving the military family unit in a single yet all encompassing environment is based on the principle that healing environments are, in essence, people places and that we, as individuals, are inextricably interconnected.

Organizationally (within Connection and Discovery), the spaces invite each user to journey through a transitional healing process consisting of four elements (figure 4):

1. Passages provide secure, directed pathways that connect a series of reflective areas.

2. Moments provide interludes where meditation, discovery, and insight may take place.

3. Segues transition the user from one area to the next, perhaps marking a point in the journey.

4. The series of passages, moments, and segues lead to a locus-an environment, room, or space where the work of focused healing takes place.

Each passage, segue, and moment offers a physical connection to the user. By touching, smelling, hearing, and seeing throughout and within the spaces, the haptic experience links the user to place and perhaps creates a connection to self. Sensory elements can serve as an extension of therapy and can be achieved through placement of architectural elements, such as a wall feature of carved and back lit brush tile by Braun or wall panels from Architectural Systems' Sculptured or Ecotextures collections. The hands, feet, eyes, and mind can be entertained by Jockimo's Liquid Lava Floor Tiles or Visual Reference Studio's Cypress Stool, multi-sensory seating made of thermochromatic material.

Of the more than two million soldiers returning from the wars in Iraq and Afghanistan, more than 25 percent have been diagnosed with post traumatic stress disorder (PTSD), depression, or anxiety. For many victims of PTSD, they feel isolated and no longer a full-fledged member of society, experiencing a loss of identity and sense of self.

Children and spouses may also face personal mental health issues such as depression, anxiety, anger, and aggression. The absence of their loved ones during these long periods makes it difficult to maintain family routine and, at times, meet personal needs. This creates a painful void that is eventually filled or denied so that life can continue. “For every day he was deployed in Iraq, it took that many for us as a family to readjust when he returned,” explained one military wife.

Human interaction and connection with nature is also important and is a universal desire. In a “transitional healing” environment, it is an integral component.

Like the sensorial elements, art, and play therapy inside, a sensory garden in the courtyard can be a method by which to contribute to the restoration of the mind. Movement inside and out is guided by integration of natural light and views of nature, with interludes along the way that contribute to spirit of place and spirit of belonging. They include artwork and sculptures, pools of water, a wall of inspirational quotes and poems, suspended mobiles, a stone water wall, and fireplace.

The form and movement within a “transitional healing” model embodies the facets of transition one experiences in finding a sense of self, family, and society, while linking the user to spaces that respond to demographic concerns, needs, and limitations. It focuses on the pivotal and active role of interiors as an extension of therapy, combining the functional requirements with the dynamic interplay of spatial relationships, materials and finishes, and connection to nature. It creates a personal journey for the user-a story that unfolds to uncover the next phase of life's mysteries and moments for the individual (soldier, spouse, and child), family, and community.

Heather Boylan Drew is an interior designer in Richmond, Virginia, and owner of bella DESIGNS studio. She is also an adjunct faculty member at Virginia Commonwealth University's School of the Arts Interior Design department. After more than 10 years in public relations, Heather completed her Master of Fine Arts in Interior Design from the Savannah College of Art and Design. This article is a summation of her thesis, inspired by her experiences as the daughter, sister, friend, and wife of war zone veterans.

References

1. Gallagher Winifred.(1993). The Power of Place. New York:Poseidon Press.
2. Dilani Alan, PhD.(2001). Psychosocially Supportive Design. World Hospitals and Health Services 37 (1), 20-24.
3. Psychological Needs of Military Personnel And Their Families Are Increasing, Reports APA Task Force.(2007, February 25). American Psychological Association (APA) Press Release. Retrieved June 29, 2007 from https://www.apa.org/news/press/releases/2007/02/military-health.aspx.

Behavioral Healthcare 2010 May;30(5):22-25