by Jason Costello and John Fowler
According to the National Institute of Mental Health, behavioral and mental health (BMH) conditions affect one in five adults in the United States each year, yet only 41% of adults in the U.S. with a mental health condition received mental health services in the past year. As the stigma of mental illness begins to lessen, the need for access to behavioral healthcare treatment will only continue to grow. Recognizing that often outpatient behavioral health facilities are not medical facilities, and shouldn’t be designed as such, healthcare designers are designing therapeutic environments that ensure patient safety and promote psychological wellness and healing.
Research and emerging evidence compiled by The Center for Health Design suggests that certain design features are important for BMH treatment facilities and can relieve stress, create calm, and facilitate healing. Behavioral healthcare settings today often feature a comfortable, home-like environment with access to daylight and views of nature, enhanced noise control and visual privacy, and supportive spaces that promote patient security, autonomy, and positive distraction. BMH facilities are also being designed with efficient floor plans, multi-functional spaces, and alternative workplace designs to improve space utilization and reduce waste.
The design of the built environment can impact a patient’s real and perceived quality of care. A study in the Journal of Environmental Psychology found that the design and conditions in doctors’ waiting rooms influenced perceptions of the quality of care delivered by the doctors associated with those spaces. In behavioral health facilities, natural materials and daylighting are used to offer a calming, hospitality-feel to the reception area. If a clinical program requires security, it is often provided by plain-clothes officers with a dual job function to promote a more welcoming environment from the moment patients enter the clinic.
The programming of a behavioral health facility centers around consult rooms, the primary clinical spaces of an outpatient care environment. Their design should create a neutral, residential look while utilizing commercial materials and products. Details are subtle yet critical, such as no-trip area rugs and comfortable chairs. The selection of carpet and luxury vinyl tile (LVT) surround supports the look of a living room but with a level walking surface suitable for a healthcare environment. Visual privacy may be controlled by motorized shades that limit visibility yet allow daylight to enter the space. Sound masking solutions should be implemented to protect patient confidentiality.
Some facilities are deviating from the private office model in favor of a free address, open work setting with unassigned and shared therapy spaces. This planning model is more efficient for clinics whose providers see patients at multiple locations, leaving their vacant offices unusable to others. The integration of room scheduling software, online for clinicians and at digital signs strategically located at consult room entries, can help to improve space utilization and room booking for clinicians in a free address workplace.
Group therapy is a key programmatic element in today’s behavioral health treatment plans, but can be underutilized in an outpatient program. Facilities should be designed for multi-use flexibility to improve space utilization. Moveable partitions between large group therapy rooms can enable configuration for a variety of additional uses, as long as acoustical privacy at the partition (particularly above ceiling) is addressed to ensure HIPPA compliance for speech privacy.
Behavioral healthcare is shifting toward treatment of the whole person as clinicians recognize that exercise and nutrition are key contributors to mental wellness. Facilities are expanding their program offerings by adding nontraditional treatment spaces for fitness, yoga, meditation, and art/music therapies and demonstration kitchens to teach dietary health and wellness. These activities may require dedicated spaces or share multipurpose rooms. Defining these space requirements early in the design process is important to reduce the sound and vibration impact on adjacent patient and staff areas.
With an increased focus on overall wellness in behavioral healthcare as well as emerging approaches to treatment, BMH facilities require a clear clinical vision for today and a flexible design for change in the future.
Jason Costello, AIA, EDAC, LEED AP, is associate principal and partner, and John Fowler, AIA, EDAC, LEED AP, is associate principal and associate partner at Margulies Perruzzi.