A New Tool to Treat Mental Illness: Building Design

Residents of the Taube Lodge in Mountain View, Calif. Wake up to private rooms with views of the forested Santa Cruz Mountains, have breakfast in spacious common areas, and can relax in furnished courtyards throughout. the day.

It might sound like a beach resort, but the Taube Pavilion is a $ 98 million mental health facility that opened in June as part of El Camino Hospital. Designed by WRNS Studio, the 56,000 square foot building is part of a new wave of facilities that are destroying outdated institutional models.

For decades, mental hospitals have been grim environments where patients were crammed into common wards by day and dormitories by night. But new research into the health effects of our environment is spurring the development of facilities that feel more residential, with welcoming entrances, smaller living units in larger buildings, and a variety of gathering spaces. Nature plays a big role: windows offer a view of the greenery, landscapes decorate the walls and outdoor spaces allow patients and staff to access fresh air and sunlight.

The new approach, touted as curative and therapeutic, produced more calming and supportive environments. And it seems particularly timely, given the surge in mental health problems created by the pandemic.

“We’ve been talking about this for a very long time,” said Mardelle McCuskey Shepley, director of the environmental design and analysis department at Cornell’s College of Human Ecology. “It’s only now that it’s gaining momentum.”

Even before the pandemic, the number of Americans affected by mental illness was at a new high. One in five adults suffered from depression, bipolar disorder, schizophrenia, post-traumatic stress disorder or some other illness, according to the National Institute of Mental Health. Rates were significantly higher for adolescents (about 50 percent) and young adults (about 30 percent).

Almost a year after the start of the pandemic, more people are suffering. Young adults and blacks and Latinos of all ages report increased levels of anxiety, depression, and substance abuse, according to a Centers for Disease Control and Prevention survey. A recent Gallup poll showed Americans rated their mental health as “worse than it has ever been in the past two decades.”

The demand for treatment has skyrocketed and the construction of mental health facilities has overtaken that of other specialist hospitals. Last year, 40% of hospitals specializing in construction were psychiatric hospitals and behavioral health centers, according to the American Society for Health Care Engineering.

Architecture and interior design firms with expertise in healthcare buildings reported an increase in activity. At design firm Architecture + in Troy, New York, one or two large mental health facilities are usually in the works, with total construction costs for these projects of around $ 250 million per year, Francis Murdock Pitts said. , a main and founding partner. Last year, the company was working on 16 major mental health projects totaling around $ 1.9 billion.

His practice and others like him have medical planners on staff who help translate research into “evidence-based” designs. “It’s not just about being warm and fuzzy,” Pitts said.

For example, exposure to nature has been shown to lower cortisol levels, a measure of stress. Adding healing gardens and other green spaces can help soothe restless patients and give staff a place to unwind.

Research specific to mental health care settings also comes into play. Studies have shown that reducing clutter by providing private rooms and multiple common spaces can reduce stress and aggression for patients and employees. Noise reduction – by removing unnecessary beeps from medical equipment, for example – can also help. If patients are less stressed, they can make faster and longer-lasting progress during treatment, experts say.

But because mental health issues vary widely, there is no one-size-fits-all solution. And safety – for patients and staff – remains paramount.

Codes and guidelines refined over many years have sought to eliminate features of rooms that patients have used to injure themselves and others. Window glazing is made from polycarbonate compounds to reduce breakage. The doors hang on quick-release hinges to allow staff to enter a room if a patient is barricaded there. The plumbing and other fixtures were designed to avoid the possibility of hanging or strangling.

Such security measures are crucial, but “you don’t want it to get to the point where it looks like a prison,” said Shary Adams, director of HGA, a national design firm. At the same time that the built environment must be designed to ensure safety, there is also a process to give patients some control over their environment. Manual thermostats allow patients to adjust the temperature in their room, for example, and dimmers allow them to modulate lights.

The location of mental health facilities is also changing. Previously, psychiatric institutions were nested, but today they are probably part of hospital campuses or are otherwise well located. They often combine inpatient rooms for those who need 24-hour monitoring and areas for outpatient services, allowing patients to move to less intensive care in the same building.

A state-of-the-art youth center in Monterey, Calif., Illustrates the new approach. Montage Health, a nonprofit supplier, opened the 55,600 square foot building in November.

Named Ohana, a Hawaiian word for an extended family concept, the facility will offer young patients psychiatric treatment, sometimes involving their parents and siblings. Care early in life is crucial, as half of lifelong mental illnesses present at age 15 and 75% at age 24, said Dr Susan Swick, Ohana’s chief medical officer.

She asked the architects of the NBBJ for a design that would own some of the wonder of a children’s museum or public library – “a place you walk into that gives you a sense of possibility,” she said. .

The building will wrap around beautiful old oak trees on the sloping site overlooking a green valley. It will house inpatient wards, an outpatient treatment wing, several classrooms and a variety of spaces for group and individual therapy.

The land will provide spaces for yoga and informal gatherings. The paths will be lined with cedars and pines, rosemary and lavender – plants whose scents activate “natural killer” cells that can boost immunity, said Richard Dallam, managing partner of NBBJ and leader of the corporate health care practice.

“It’s not just pretty; it’s useful, ”he added.

With its curves and curves, Ohana looks like a complicated building to erect, but it is constructed with cross-laminated timber in modules that can be assembled off-site, reducing costs and speeding up construction. Its price: $ 50 million, which is covered by a donation of $ 106 million which will also fund clinical services.

Yet not all hospital systems have an angel investor and it is more expensive to construct buildings with these new designs – private rooms alone add to the costs.

But advocates say the upfront expense can result in savings down the road, improving staff retention, for example, because workers are less prone to burnout and need to be replaced with new employees who need to be trained.

“We try to use evidence-based design to help clients relate to other items on their balance sheet,” said Angela Mazzi, director at GBBN and president of the American College of Healthcare Architects, a certification organization. “By investing in some of these things that are not a simple part of the clinical space, you will get different results and a different kind of return on your investment.”