EDs for behavioral health patients on the rise

According to Kevin Turner, AIA, LEED AP, principal, Perkins+Will, his firm has seen a substantial increase in inquiries about behavioral health projects this year. Although the exact reasons for this are unclear, Turner says it could be related to mental health funding changes related to the Affordable Care Act or the new focus on accountable care organizations. “What I tell clients frequently is that mental health may not always make you money, but it will always save you money,” Turner says. He notes, as an example, the increased cost of treating patients with both chronic illness and serious mental health issues.

A third possible driver is emergency department (ED) utilization. “We are hearing directly from our clients that their throughput and efficiency in the emergency department is horrifically bad, specifically because they’re having trouble with the number of people presenting at the ED with serious mental illness,” Turner says.

To help manage this situation, providers are looking at creating EDs expressly for behavioral health patients. These projects are taking a variety of forms. Turner reports that one Perkins+Will client is planning to relocate departments above the hospital’s existing ED to create space for a behavioral health ED. Another client wants to build an appendage onto an existing ED to be used as a behavioral health ED, and a third client is planning to move behavioral health beds out of the existing hospital into a new facility just for behavioral health, which will include an ED. “We’re finding a lot of interesting solutions,” Turner says. “A lot of people are seeing the need for that kind of serious treatment facility in the hospital.”

“Emergency departments all over the country are being overrun with psychiatric patients due to hospitals closing,” says James M. Hunt, AIA, Behavioral Healthcare Architecture Group. Hunt notes that patients with no other diagnosis besides mental illness don’t belong in trauma beds and can be disruptive to ED workflow. “So there’s a lot of interest right now, nationally, about trying to develop better ways of dealing with these patients than taking them to a regular emergency room,” he says. Solutions that Hunt has seen include freestanding behavioral health EDs, converting rooms in an existing ED to be used for both behavioral health or typical ED triage, and creating a separate area adjacent to an existing ED for behavioral health use. The Behavioral Healthcare Architecture Group has behavioral health ED projects in the planning stages in New York and Connecticut. Another project in Missouri involved creating a freestanding behavioral health facility on the campus of a general acute care hospital.

“People are starting to realize that behavioral health patients are different from the other emergency patients coming in, and they should have an area that is special for them,” says Rebecca Kleinbaum Sanders, AIA, NCARB, health care principal, HGA.

Continuum of care

Rebecca Kleinbaum Sanders, AIA, NCARB, health care principal in the Minneapolis office of architecture, engineering and planning firm HGA, remarks that there is a continuum of care in behavioral health, just as in general health care. Patients may require an emergency department or crisis center, acute care, residential care or a day treatment center, depending on their needs. “It’s important to think of all the different settings,” says Kleinbaum Sanders. Different settings entail different treatment environments and levels of patient observation.

Hazelden Plymouth (Minn.), is an addiction treatment center operated by the Hazelden Betty Ford Foundation. The center provides a variety of residential and outpatient services for patients age 12 to 25, as well as family programs. In the entrance lobby, regional limestone and cherry wood give a sense of stability and warmth. The treatment spaces include art and music therapy rooms and a gymnasium with a climbing wall, all intended to keep patients engaged and actively learning to interact with others. The residential area has a living room, quiet lounge and snack area for group activities. Individual sleeping areas are separated by half-height walls.

Hope House, Martinez, Calif., a 16-bed, short-term residential treatment facility operated by mental health service provider Telecare Corp., is meant to serve as an alternative to inpatient hospitalization in times of crisis or as a step-down, transitional living environment. According to Kleinbaum Sanders, the facility is designed to give people room to grow and develop toward integrating into the community. The facility has single and double bedrooms. Areas like the group kitchen give people a place to learn and practice life skills.

The ultimate goal

Hunt stresses that while the patient-caregiver relationship is the most important aspect of recovery, design can play a significant role.

“A building’s not going to heal anybody,” he says. “But you can put patients in a space that makes them worse. You can take a patient who is suffering from depression and put them in a facility that makes them feel like they’re being punished for being ill. And if we give them an environment that makes them feel that way when they come in, we’re going to deepen that depression. We’ll make them more difficult to treat.”

The ultimate goal in the design of behavioral health facilities is to make patients feel at ease, comfortable and receptive to treatment. “If we can accomplish that, I think we’ve done our job very well,” Hunt says.

Amy Eagle is a freelance writer based in Homewood, Ill., who specializes in health care-related topics. She is a regular contributor to Health Facilities Management.