Hospital design experts Ryan Hullinger and Sarah Markovitz discuss how health systems should start rethinking physical spaces so they are well-equipped to provide patients with the behavioral health support they need.
The past year forced healthcare and design professionals to quickly reimagine hospitals in order to meet the influx of patients with Covid-19. But far less attention has been paid to the shadow behavioral health pandemic. That’s why healthcare systems should start planning now to integrate best practices in design so the physical spaces are well-equipped to provide patients with the support they need.
While the coronavirus pandemic has taken an unprecedented physical toll on millions, the resulting social isolation, economic uncertainty and other context-related stressors have also led to a dramatic increase in behavioral conditions including depression, anxiety, isolation, PTSD, eating disorders and substance abuse, as well as rising levels of self-harm and suicidal ideation. This can be seen across nearly every segment of American society, but it’s especially pronounced among children and young people, BIPOC persons, essential and frontline workers, caregivers, and those with preexisting psychiatric conditions.
Reimagine behavioral health design to plan for patient surges
When providers, architects and builders collaborate to respond to rapidly evolving healthcare needs, a lot can happen. Look no further than the Covid-19 crisis, where we quickly built field hospitals, triage tents, drive-through testing and vaccination facilities. Just as we’ve worked to meet the surge in demand for physical care, we now need to ask ourselves, how will healthcare design teams proactively respond to the pending surge in behavioral healthcare need?
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One idea is to adapt the flexible field hospital approach that allowed us to significantly expand care capacity at the height of the pandemic for use in behavioral health care delivery. By leveraging the latest innovations in pre-fabricated and ‘pop up’ architecture, we could deploy community-responsive and integrated behavioral health clinics in and near schools, workplaces, retail spaces and places of worship. This approach is flexible, scalable and transportable, giving us an opportunity to expand behavioral healthcare access in underserved communities – both in low income urban areas and in rural areas that often don’t have access to specialty care.
And there are opportunities to design these surge spaces in a way that addresses the other major behavioral health challenge – a shortage of qualified practitioners and specialists – through design layouts that maximize caregiver sightlines and by integrating advancements in telehealth with in-person, physical support space. This reimagination of behavioral healthcare ‘surge’ spaces gives us an opportunity to redesign the experience – destigmatizing treatment, bringing it closer to where people live and work and removing as many barriers as possible.
Rethink emergency room space
A sobering trend over the course of the pandemic has been an uptick in suicidal ideation, attempted suicide and self-harm requiring emergency mental health treatment.
According to a recent report from the CDC, ”through most of 2020, the proportion of pediatric emergency admissions for mental problems, like panic and anxiety, was up by 24 percent for young children and 31 percent for adolescents compared to the previous year.” Hospitals from Philadelphia to Anchorage are reporting their concerns over the rise in patients of all ages coming to the emergency department for urgent behavioral health support.
But traditional emergency departments were not designed to care for behavioral health patients well. They often lack appropriate dedicated space and because of inefficiencies, can be more expensive as well. This insufficient behavioral health bed capacity can mean that patients can spend days waiting for placement in a proper care environment.
Healthcare organizations like Nationwide Children’s Hospital in Columbus, Ohio, are working to fill the gap. Nationwide Children’s opened a new nine-story pavilion just before the pandemic in 2020 that includes a dedicated psychiatric crisis department. This functions like an emergency room, but it was designed from the ground up for children experiencing a mental or behavioral health crisis. As well as a youth crisis stabilization unit, in which treatment is provided by a multi-disciplinary behavioral health team consisting of a care coordinator, clinicians, psychiatrists, nurses, and specialists in family support and therapeutic recreation – all working together to address the core needs of pediatric patients.
Seeing this amplified need, Massachusetts General Hospital worked with design and construction teams to expedite the completion of a new behavioral health emergency department during the pandemic. Recognizing that behavioral health patients were both a bottleneck in the emergency department and that their experience was sub-optimal, they built a separate section where patients can be cared for appropriately while waiting for bed placement, allowing them to begin treatment with trained staff, rest privately, and if they are able, to leave their private, safe rooms and socialize in a small lounge space overseen by nursing staff.
What is good for patients is good for providers
Beyond serving the industry with better capacity to deal with behavioral health surge events, there is also the issue of longer-term care. Even before the pandemic, designers and behavioral health administrators were working together to guide a sea change in the look, feel and approach of treatment spaces such as residential care programs – one that is a vast departure from the cold and clinical environments we typically associate with mental health institutions. And these shifts have proven even more critical in the pandemic.
Employee burnout within behavioral health fields was alarmingly high before 2020 (at a rate of up to 40%). This past year has magnified the challenges for our frontline workers facing the current mental health epidemic; staff who themselves are dealing with stress, isolation from loved ones, increased patient load, concerns about getting sick, and often having to act as surrogate family members for their patients.
Design strategies responsive to the latest research on the impact of our physical environment on the brain can improve well-being and outcomes for both patients and for the staff guiding their recovery.
Designing with nature: Incorporating views or courtyards, walking paths and outdoor gardens — has been shown to reduce stress and improve patient outcomes. Daylight and fresh air also promote recovery from depression and bipolar disorders.
Bringing in amenities allowing for active engagement: At both the Big Lots Behavioral Health Pavilion at Nationwide Children’s Hospital and Ohana Montage Health in Monterey, CA, amenities like centralized gyms and sporting facilities and gardens for growing fruit and vegetables help reduce stress and elevate a sense of competency and control
Minimize noise where possible: Care should be taken to minimize ambient noise, as doing so has been shown to decrease stress levels. This can be accomplished through material and layout considerations, such as placing seclusion rooms or other potentially noisy spaces outside the main corridors, dayrooms and therapy areas.
Focus on lighting: Poor sleep quality is associated with a slew of behavioral health issues Integrate best practices in lighting healthcare settings for optimal well-being. These strategies include the use of daylighting wherever possible, allowing for high light levels in the early part of the day, and shifting color temperature, table-mounted lighting and dimming lights to low levels in the couple of hours before bedtime.
While the prevalence of mental and behavioral health challenges has existed in society long before the pandemic and will exist well-after, the past year has cast an intense spotlight on our need to create appropriate space for treatment and care. This requires balancing short and long-term thinking and planning – developing immediate design solutions to scale-up care while investing in expanding access and care in communities in a way that normalizes care.
If you or someone you know is thinking about suicide, please call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or text the Crisis Text Line at 741-741.