In the past 60 years, we have seen dramatic changes in the design of behavioral health facilities, from the sterile environments depicted in science-fiction movies in the 1960s to now near spa-like environments that contribute to a sense of dignity and hope for patients. Each year feels like our industry is pushing the envelope further for these challenging environments.
I have been fortunate to witness this same sterile to spa-like evolution within the general healthcare industry over the past 25 years, and I believe now is the moment in time we can really make great strides for behavioral health facility design. At Davis Partnership Architects, we collaborate with behavioral health clients around the nation, and in doing so, have identified five leading trends in behavioral health facility design that we expect to continue into the next decade. With the recent and unprecedented experiences of COVID-19, how we address infection control in our healthcare industry will be forever on our minds, but we must not lose sight of these following items that are so important to the psychological health, safety and well-being of the individuals who occupy the spaces of mental health and treatment.
- Lighting. Lighting acts as a subtle, subconscious cue for the general population. It's an even more powerful cue for behavioral health patients. Clear, well organized lighting without glare, flicker or noise is crucial to minimize distraction and repetitive behaviors. Traditional overhead 2x4 and 2x2 lighting in the behavioral health environment not only feels more institutional, but direct overhead lighting can feel uncomfortable and be agitating to a patient. Research in the medical and scientific communities demonstrates lighting's profound neurological impact. Optimized lighting, including the infusion of daylighting, has been proven to support normalized sleep cycles and immune function, and reduce symptoms of mental illness.
- Flexibility in design for the future. The needs of behavioral health facilities are constantly changing as they adapt to swings in client volumes, patient acuity and trends. One of our recent projects, West Springs Hospital at Mind Springs Health, is a 48-bed behavioral health facility, expandable up to 64 beds for future patient populations. Patient unit design accommodates how units function now as well as accommodating the future expansion. Swing rooms were provided in between units so that they can be used where needed depending on volume and milieu needs. These types of decisions made early in the design will help extend the life of a facility.
- Choice and control. With evidence-based design, we have found multiple opportunities to enhance recovery though choice and control. Sensory rooms where patients can adjust and control their own light levels and colors to help decompress to bring that small sense of control has shown positive results to help their recovery process. At West Springs Hospital, this color light therapy was also provided in staff respite rooms. So, they too can re-energize during their breaks. This has been greatly received, and as a small investment, has had considerable positive impacts to both patients and staff alike.
- Safety and security. Successful behavioral health design is finding the proper balance between patient/staff safety and having patients feel welcome and in control of their healing experience. The buildings need to provide a calm reinforcement to the dignity and hope of the patient. Additionally, as noted above through the incorporation of staff respite rooms, we are seeing an increased focus and emphasis on the health, safety and welfare of the staff caring for patients. Behavioral healthcare comes with increased stress to staff when faced with escalated events threatening their own safety. Consideration to planning that allows staff to be integrated into the unit for patient care and engagement, with the ability to recede quickly in the presence of a threat, allows staff to continue to be effective in therapy.
- Courtyards. Creating opportunities for patients to go outside and get some fresh air is extremely important for behavioral health environments to aid in the healing and therapeutic process, and even more so now with COVID as we gravitate naturally to getting outside into the open. An outdoor garden can provide a place of respite, a sanctuary of sorts, through a stress-free and nurturing environment. The biology of humans is rooted in nature. It is familiar to us, and that can provide comfort and support general well-being. Outdoor environments can be incorporated into the design in a variety of ways. We, however, have found that providing an internal courtyard located directly adjacent to the patient unit is very beneficial. This allows natural light into the unit and provides staff visual access to patients while empowering patient choice and control to decompress in an open outdoor area. When creating safe, non-threatening spaces, it is important to be mindful to mitigate the negative aspects of climate (extreme sun, wind, precipitation). Also, considerations to visual and sound buffering along with living plants can promote relaxation and restoration from mental and emotional fatigue for patients, families, and staff. Courtyards can also be located off dining and activity areas to provide a variety of programs and zones for the patient to actively and positively engage in their own recovery. These include more active areas, such as a basketball court, to quieter spaces like small group therapy seating areas and horticulture therapy planting beds.
Wendi Ekborg, AIA, LEED AP, is principal of Davis Partnership Architects.