A New Device in Treating Psychological Sickness: Constructing Design

A New Tool in Treating Mental Illness: Building Design

Residents of the Pigeon Pavilion in Mountain View, California wake up in private rooms with views of the forested Santa Cruz Mountains, have breakfast in airy communal spaces, and relax in landscaped courtyards throughout the day.

It might sound like a resort, but the Pigeon Pavilion is a $ 98 million mental health facility that opened in June as part of El Camino Hospital. The 56,000-square-foot building was designed by WRNS Studio and is part of a new wave of facilities that dwarfs outdated institutional models.

Psychiatric hospitals have been a grim environment for decades, with patients being pushed into common rooms during the day and dormitories at night. However, new research into the health effects of our surroundings is driving the development of facilities that feel more homely, with inviting entrances, smaller units in larger buildings, and a variety of meeting rooms. Nature plays a major role: Windows offer a view of the greenery, landscapes adorn walls and outdoor areas offer patients and staff access to fresh air and sunlight.

The new approach promoted as healing and therapeutic has resulted in environments that are more calming and supportive. And it feels especially timely, given the rise in mental health problems caused by the pandemic.

"We talked about it for a long time," said Mardelle McCuskey Shepley, chair of the design and environmental analysis department at Cornell's College of Human Ecology. "Only now is it gaining momentum."

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

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

The demand for treatments has increased, and the construction of mental health facilities has outpaced the construction of other specialist hospitals. Last year, according to the American Society for Health Care Engineering, 40 percent of specialty hospitals under construction were psychiatric hospitals and behavioral health centers.

Architecture and interior design firms with expertise in healthcare buildings have reported an increase in activity. Architecture + design firm in Troy, New York typically has a major mental health facility or two in the pipeline. The total construction cost for these projects is approximately $ 250 million per year, said Francis Murdock Pitts, principal and founding partner. Over the past year, the company worked on 16 major mental health projects totaling approximately $ 1.9 billion.

His company and others who like it have medical planners on their staff to help translate research into "evidence-based" designs. "This is not all about being warm and hazy," said Pitts.

For example, exposure to nature has been shown to lower cortisol levels, a measure of stress. Adding medicinal gardens and other greenery can help calm agitated patients and give staff a place to decompress.

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Research specifically related to mental health care also comes into play. Studies have shown that reducing the crowd by providing private rooms and multiple common areas can reduce stress and aggression from patients and staff. Noise reduction – such as the unnecessary beeping of medical equipment – can also help. When patients are less stressed, they can make faster and more sustained progress during treatment, experts say.

However, because mental health problems vary widely, there is no one-size-fits-all design solution. And safety – for both patients and staff – continues to come first.

Codes and guidelines refined over many years have sought to remove spatial features that patients have used to harm themselves and others. Window glazing is made from polycarbonate compounds to reduce breakage. The doors are hung on quick release hinges so that staff can enter a room if a patient is barricaded. Plumbing and other fixtures are designed to prevent the possibility of hanging or strangling.

Such security measures are vital, but "you don't want them to get to where they look like a prison," said Shary Adams, principal at HGA, a national design firm. While the built environment must be designed to ensure safety, there is also a measure to give patients some control over their surroundings. For example, patients can use manual thermostats to set the temperature in their rooms, and dimmer switches can be used to modulate the light.

The location of the psychiatric facilities is also changing. Psychiatric facilities used to be hidden, now they are likely part of hospital grounds or otherwise conveniently located. They often combine inpatient rooms for those in need of 24/7 monitoring and areas for outpatient services so patients can move to less intensive care in the same building.

A state-of-the-art center for young people in Monterey, California illustrates the new approach. Montage Health, a non-profit provider, laid the foundation stone for the 55,600 square meter building in November.

The facility, called Ohana, a Hawaiian word for an expanded family concept, will provide young patients with psychiatric treatment, sometimes involving their parents and siblings. Early care is crucial as half of all lifelong mental illnesses occur by age 15 and 75 percent by age 24, said Dr. Susan Swick, Ohana Senior Consultant.

She asked NBBJ architects to come up with a design that contained the wonder of a children's museum or public library – "a place you walk makes you feel like you have the opportunity".

The building will wrap itself around beautiful old oak trees on the hillside overlooking a green valley. It will house inpatient rooms, an outpatient treatment wing, several classrooms and a large number of rooms for group and individual therapies.

The grounds offer areas for yoga and informal gatherings. The paths are lined with cedar and pine, rosemary and lavender – plants whose scents activate "natural killer cells" that can boost immunity, said Richard Dallam, managing partner at NBBJ and head of the company's health practice.

"It's not just pretty; it's functional," he added.

With its swoops and turns, Ohana looks like a complicated building to construct, but it's constructed from cross-laminated timber in modules that can be assembled off-site, reducing costs and speeding up construction. Its price tag: $ 50 million, which is covered by a $ 106 million donation that also provides funding for clinical services.

Still, not every hospital system has an angel investor, and buildings with these new designs are more expensive – private rooms alone add to the cost.

Proponents say, however, that upfront spending can lead to savings later and improve employee retention, for example because employees are less prone to burnout and need to be replaced with new employees who need training.

"We try to use evidence-based design to help clients connect to other things on their balance sheet," said Angela Mazzi, director at GBBN and president of the American College of Healthcare Architects, a certification organization. "If you invest in some of these things that aren't just part of the clinical field, you get different results and a different kind of payback."


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