CREJ

April 2018 — Health Care Properties Quarterly — Page 15 www.crej.com B ehavioral health is a signifi- cant topic in the health care industry today and an increas- ingly important discussion among providers, the public and designers. Approximately 20 percent of the U.S. population experiences some type of mental health issue and in Colo- rado the number is approximately 25 percent. In a recent report by Mental Health America, “The State of Mental Health in America 2018,” Colorado ranks in the bottom 10, which indi- cates a higher prevalence of mental illness and lower rates of access to care for both adults and youth. In addition to lack of access, other barriers to care include cost and stig- ma. Mental health issues encompass a wide range of illnesses, including schizophrenia, bipolar disorder, depres- sion, post-traumatic stress disorder, obsessive-compulsive disorder, per- sonality disorders, panic disorder and others, making diagnosis and treat- ment often a complicated and lengthy process. Today, there are many opportunities to improve mental health services, and there is good news in Colorado. Behavioral health is beginning to be integrated into primary care, the use of tele-health is providing access to care in rural areas, the state has a goal of increasing the number of community health centers, and there is less stigma so more people are seeking care. Facilities for diagnosing and treat- ing mental health patients require very specific programming and design, especially as we begin to look at the mental well-being of patients and work to destigmatize behavioral health.There are a wide variety of facilities, including private offices, out- patient centers and inpatient hospitals, dedicated to mental health patients and each requires a spe- cific design solution to meet the needs of providers, patients and their families. There are a number of specific design strategies and considerations for inpatient facili- tates that promote safety and mental well-being: • Patient-safe environments that look and feel like any other area with built-in precautions • Collaborative care teams of fami- lies, clinicians and patients • Mediating the inpatient to outpa- tient experience (group therapy, access to providers, use of technology) • Flexible and adaptive spaces – mul- tipurpose yet meaningful • Access to the exterior, daylight and nature • Importance of patient participation and sense of dignity and ownership • Anti-ligature precautions Also specific to inpatient facilities, important programming elements typically include: • Improving the reception and entry sequence for visitors • Intake areas with exam rooms • Patient rooms; general and seclu- sion • Therapy rooms • Life skills rooms (washer/dryer, kitchen) • Dining area and multipurpose rooms • Patient interac- tion/day rooms • Access to exte- rior recreation • Physician/staff work areas Anti-ligature precautions are an increasingly important ele- ment for behavioral health facilities that encourage patient wellness, healing and suicide preven- tion.These precau- tions must be considered in every aspect of the design. The Centers for Medicare and Medicaid Services andThe Joint Commission have very specific requirements for behavioral health care facilities, and surveys are rigorous. Anti-ligature strategies include: • Treatment of every surface and device as a potential hazard for patients • Eliminating reveals that can be used to conceal contraband • Removing items such as batteries, exposed door closers, window treat- ments to make each space patient- safe, yet still have the comforts of home • Rounding of corners to reduce source of injury • Identifying design elements such as curtains, door handles and ther- mostats to make sure that all items release upon applied weight • Eliminate any projections • Placement of door hinges on the exposed side of doors where staff are supervising • Release mechanisms on all doors so staff can always access patients • Utilize tamper-proof fasteners at every location from drawers and doors to sinks and cabinets Our firm completed a project that encompassed many of these design strategies and programming elements at MedStar Franklin Square Medical Center Adolescent and Adult Behav- ioral Health Units.The design features include a shared arrival experience to create a sense of presence of the units to the hospital. Separation of adoles- cent and adult patient care spaces are necessary to promote patient-safe environments and control interde- partmental interaction. Patient com- fort rooms and de-escalation spaces allow patients/residents the ability to self-sooth without staff interference. Common rooms are a shared space for therapy, meals, art and recreation to promote community. A combination of double- and single-occupant patient rooms promotes interaction in patients who need socialization and still pro- vides privacy for patients who need more seclusion and meditative time. As a renovation, it was critical to look at every location with a fastener and existing condition to ensure patient safety. As behavioral health integrates into primary care, the number of communi- ty health centers grows and the stigma decreases, we will see more facilities being designed. Patient care and safety are the leading priorities, and design solutions tailored to the specific needs of the patients, their families, the staff and community are essential. s Importance of behavioral health care facility design Design Mary Morissette, FAIA, LEED AP Principal, Hord Coplan Macht Jamie Norwood, AIA, EDAC, LEED AP BD+CA Senior associate, Hord Coplan Macht