The impact of design elements on behavioral health

There’s a heightened interest in behavioral health care lately, says Rebecca Kleinbaum Sanders, AIA, NCARB, health care principal, HGA. “It’s finally getting attention,” she says. “Being able to provide the facilities that go along with it is important, and I’m excited to see that happening.”

Researchers are working to ensure that those facilities are designed to meet behavioral health patients’ unique needs. Eve Edelstein, EDAC, assoc. AIA, FAAA, recently was appointed Research Fellow in Neuro-Architecture at Perkins+Will. In this role, Edelstein will be drawing on her background in architecture, neurology and anthropology to help initiate and report on research studies about behavioral health facilities. This is an extension of her work as a faculty member in the Academy of Neuroscience for Architecture at the NewSchool of Architecture & Design, San Diego, and as president of design and research firm Innovative Design Science (iDS), also located in San Diego.

Edelstein notes that existing facility standards, even sustainability guidelines that consider human outcomes, often do not specifically address cognitive impact. “That’s very much a focus that we’re trying to bring in,” she says. “In the same way that medicine uses translational science, we’re thinking in terms of translational design. What do the clinical, medical and psychosocial data tell us that we can translate into design concepts?”

As part of the American Institute of Architects Design and Health Research Consortium, established this year, researchers at the NewSchool and iDS are working to identify specific relationships between components of the built environment and measurable aspects of human response. Areas of study include, for example, how different types of lighting change the experience of a space. Edelstein says the research team will work with designers to determine how to embody their recommendations into guidelines for facility design.

“Design is about the kind of questions you ask,” says John Haymaker, AIA, LEED AP, director of research, Perkins+Will.

Creating mindful space

Safety and comfort are two main goals of any behavioral health care design project. Hunt says, “We’ve learned over time that those two don’t have to be an either/or situation. We can provide both within the same environment, but it takes a different way of looking at it than what’s been typically done in medical institutions.”

Hunt also consulted on the design of the new Cherry Hospital, a state-run psychiatric facility in Goldsboro, N.C. The project’s architect of record, the Freelon Group, Research Triangle Park, N.C., is now part of architecture and design firm Perkins+Will. North Carolina Department of Health & Human Services spokesperson Olivia James says patient and staff safety was considered in all design decisions at Cherry Hospital — including materials, furnishings, circulation routes and use of space. For example, anti-ligature door hinges, handles and locking mechanisms are installed in all patient areas to prevent self-harm. “Many of these anti-ligature devices were not on the market until just a couple of years ago, and they were produced in response to the need by psychiatric hospitals,” James says.

These products confer a high level of safety without an institutional appearance, says Hunt. “It’s the direction all health care needs to go,” he adds.

Cherry Hospital’s main off-unit activity zone is organized as a therapy mall with classrooms, courtyards, a library, medical clinic and laboratory, gymnasium, group therapy and dining space. Located on the second level, the therapy mall is just one floor away, by elevator or stairs, from the rest of the building. James says that this is an improvement over the hospital’s previous campus, where staff members routinely had to transport patients between buildings. “This one up/one down concept allows a much safer transition of patients to and from the mall activities,” she says.

Common design elements throughout the facility include high ceilings, vandal-resistant light fixtures, durable finishes and furnishings, and natural light. “Natural light is a key design element,” James says. “All areas have utilized natural light to open spaces and make them less confining.”

Transparency and light also are key to the design of the Comprehensive Behavioral Health Center at Kingsbrook Jewish Medical Center, New York City, designed by the Behavioral Healthcare Architecture Group. At this facility, interior glazing to the corridor gives rooms a feeling of openness, making them more comfortable spaces to inhabit, says William N. Bernstein, AIA, LEED AP, co-founder, Behavioral Healthcare Architecture Group. Hunt notes that largely in response to recent hurricanes, the glass industry has developed products that are high-strength and perfectly clear, well-suited to use in behavioral health care. “There’s a lot of effort to create a safe environment and create a really appealing environment at the same time,” Bernstein says.

Solid, secured, natural-wood furnishings add to the appeal of patient rooms at Kingsbrook. Built-in benches provide a spot for patients to sit and read, or for counselors to sit, rather than on the bed, when seeing patients in their rooms.