Next Steps for Behavioral Health

Hope. It’s not a word often associated with behavioral health. But new approaches to the delivery of care and the design of facilities in which treatment occurs show promise in reversing the impact of behavioral health illnesses.

And with systems constructing more facilities for behavioral health than almost any other specialty, now is the time to combine these unique interventions with design expertise, to transform the spaces in which care is provided from cold and institutional to safe, uplifting and hopeful.

Continue reading to find out how, or download the report [PDF] here.

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Ten Design Principles for Better Behavioral Health Outcomes

While behavioral health facilities have historically elevated the need for safety above the comfort of patients, this is changing. Research shows that a calming, homelike setting with access to nature helps patients regulate emotions and, in some cases, take little or no medication. Here are ten design principles which can help balance patient and safety needs to create more therapeutic environments.

1. Design with nature.
Access to nature — via views or courtyards, walking paths and outdoor gardens — provides patients with positive distractions, which have been shown to reduce stress and improve outcomes. Daylight and fresh air also promote recovery from depression and bipolar disorders. Circadian lighting, such as tunable LEDs that mimic sunlight, may also be used to synchronize sleep and wake patterns.

2. Help patients feel at home.
In order to ease patients’ transitions into and out of a facility, a homelike setting with flexible common spaces and familiar materials should be provided. This can include wood, carpeted bedrooms, community kitchens, lounge furniture and other elements.

3. Allow a sense of control.
Giving patients more control over their environment has a calming effect. A diversity of safe spaces, controllable lighting and semi-operable windows help give patients more personal autonomy.

4. Reduce stress with quiet.
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.

5. Make care more accessible.
Integrating outpatient behavioral health services into primary care or other convenient health locations can be an effective way of making care more accessible. This can also support a multidisciplinary approach that addresses the interrelationship between behavioral and physical health issues.

6. Ensure patient privacy.
Patient privacy is a key concern, particularly in busy outpatient settings. Sound-absorbing doors, sound masking and other features can be used to prevent conversations in therapy rooms from being overheard. Entrances and waiting areas can also be designed to provide direct, secluded access to offices, safeguarding privacy.

7. Provide positive distractions.
Positive distractions which support mental wellbeing can include fitness rooms and gyms, game rooms, workshops and theaters and outdoor grounds for physical activity. These distractions may be even more important for children.

8. Offer spaces for respite.
Quiet, convenient areas for relaxation, like gardens and meditation rooms, can help patients relax and deescalate aggression. Single-patient rooms with private bathrooms can reduce stress by giving patients privacy and respite.

9. Prioritize safety …
Basic safety measures aim to ensure visibility and the physical security of patients and staff. Central nursing stations with safe, yet non-intrusive barriers, halls and rooms designed for high visibility, rooms with enhanced security and supervision, and furniture and finishes which are tamper-, impact- and ligature-resistant are all key security elements.

10. … but safe doesn’t have to mean institutional.
Passive security strategies aim to hide or minimize security features, creating a far less institutional feel. For example, nursing station barriers may be disguised as design features, and landscape elements can be used as perimeter barriers.

Q&As with Leading Experts on Behavioral Health

NBBJ spoke with several national experts on behavioral health to learn how different parts of the country are addressing the behavioral health crisis. While the statistics can be troubling, they shared new approaches to prevention and treatment that are showing promise in reversing the tide of the emergency. Read highlights from those discussions below, or link through to NBBJ’s blog for the complete conversation.

Dr. Susan Swick, Montage Health

Physician in Chief and Medical Director, Ohana Montage Health

“The physical environment in which care occurs contributes profoundly to the well-being of patients and caregivers, just as classrooms affect students. Environments create our sense of what is possible. ... The setting never does all the therapeutic work, but the right setting makes it possible for the clinician and patient to do the work together.”

Read the complete Q&A.

Dr. Curtis Wittmann, Mass General

Associate Director, Acute Psychiatry, Massachusetts General Hospital

“I’m made hopeful when I see the response to the opioid use disorder epidemic. While it was delayed in response, across the country there has been a dramatic increase in the commitment of resources to treatment and to novel programs within hospitals and communities. ... Should we be able to learn from some of the lessons of the opioid crisis — rapid access to treatment, de-stigmatization, increased recovery supports — we could have a similar impact on improving our country’s approach to behavioral health.”

Read the complete Q&A.

Dr. Gregory Miller, Unity Center

Chief Medical Officer, Unity Center for Behavioral Health

“I am hopeful regarding the progression of knowledge and treatments [even though] care has become, over the course of my career, progressively more disintegrated and confusing: Systems do not converge to provide cohesive treatment. Patients are confused by the systems they are involved in. Providers, likewise, are confused. Hopefully this will be the next wave of progress.”

Read the complete Q&A.

Dr. Delaney Ruston, Filmmaker/Physician

Filmmaker, speaker and Stanford-trained physician

“People are so eager to talk about these issues — and adolescents today are overall being raised in environments that are more open to talking about these topics. ... By seeing positive stories and showing that the more we talk about behavioral health leads to better outcomes, we’ll continue to benefit, as a community, in our families, and as individuals.”

Read the complete Q&A.

Tammy Felker, Nurse/Architect

Registered nurse and architect, NBBJ

“Our spaces and places convey meaning, and it is crucial that we send the message that behavioral health patients are valued. ... Thankfully a shift in mindset is starting to transform the industry, creating a normalized care experience so patients do feel safe but also valued.”

Read the complete Q&A.

Video: Designing Hope: Solutions to the Behavioral Health Crisis