Mental Health and Addictions Centre, St. John’s, Newfoundland
After 170 years, Waterford Hospital in St. John’s, Newfoundland, was operating in an outdated facility with an antiquated model of care where mental illness was heavily stigmatized and hidden away behind imposing brick walls. When provincial health authority Newfoundland and Labrador (NL) Health Services decided to replace the 1850s-era facility, project leaders knew that simply erecting a new building wouldn’t be enough. The entire philosophy of care had to undergo a fundamental transformation.
Opened in spring 2025, the new Mental Health and Addictions Centre (MHAC) in St. John’s achieves this vision by bringing behavioral health treatment out into the open. Designed by B+H Architects (Toronto), the 240,000-square-foot facility embraces a recovery-focused, person-centered model. To help change the community mindset around mental health, the design team focused on creating a secure environment that feels open and welcoming for inpatient and outpatient services. “It was really important to us to break down that division between hospital and community,” says Allison Winter, regional director for mental health and addiction services at NL Health Services and senior systems transformation consultant for the project.
Bridging inpatient, outpatient services with a therapeutic mall
The 6-story MHAC is organized with outpatient services, including a pharmacy and psychiatry and psychology offices, on the first floor. Floors 1-4 house 102 private inpatient beds distributed across designated adult acute, geriatric, and forensic units. Additionally, the fifth floor provides a hostel for families visiting patients, topped by a mechanical penthouse.
To bridge the transition between inpatient and outpatient services, the project team introduced a “therapeutic mall” strategy for services. Concentrated on the facility’s second floor, this zone incorporates everyday life activities directly into the patient care journey.
Along this corridor, patients can shop for clothes, get a haircut at the salon, grow plants in a horticulture studio, practice musical instruments, and create art. “It’s the therapeutic heart of the facility, where patients, staff, and visitors can interact in a safe way that mirrors everyday interactions, like on a Main Street, and build their skills, autonomy, and confidence,” says Michele Cohen, healthcare principal at B+H Architects.\
Balancing security and patient independence in the design
Providing patients with dignity and a sense of independence required a careful balance with the principles of harm reduction and security. The design team implemented a hierarchy of safety features to ensure the environment remains therapeutic yet secure. “It’s all very controlled,” says David Stavros, senior design principal at B+H Architects. “Patient access is continuously managed based on required level of care and personalized risk assessments.” This is facilitated through designated patient elevators and corridors, sally-port entrances and exits in the forensic unit, and wearable patient armbands that serve as secure room keys while tracking location within the facility.
Because of this tiered security approach, the therapy mall is utilized strategically rather than indiscriminately. “It’s a graduated, purposeful part of the clinical care,” Cohen says. “At the early stages of their treatment, patients can access those services only when accompanied by staff.”
As patients progress in their recovery journeys and gain independence, they are granted unsupervised access to the therapy spaces on Main Street, monitored by staff at nurses’ stations. Eventually, patients may also be cleared to access the first-floor outpatient and public spaces independently. “It’s ultimately the staff’s decision, but the patient also has a say in how ready they are to be integrated into these spaces,” Cohen says. “They have some freedom to go at their own pace as they feel comfortable. I think that’s what is so unique about this facility.”
Mental Health and Addictions Centre project details
Location: St. John’s, Newfoundland and Labrador, Canada
Completion date: October 2024
Owner: Government of Newfoundland and Labrador, Eastern Regional Health Authority
Total building area: 240,000 sq. ft.
Total construction cost: $240.9 million
Cost/sq. ft.: $1,004/sq. ft.
Architect: B+H Architects, John Hearn Architects
Consortium: Avalon Healthcare Partnership (Plenary Americas, Marco/Cahill Mental Health Partnership, B+H, and Cahill Facility Management Ltd.)
Interior designer: B+H Architects
Engineer: Smith + Anderson
Design-Builder: Marco/Cahill Mental Health Partnership
Developer & Equity Investor: Plenary Americas
Facility Management Services: Cahill Facility Management Ltd.
Sustainability Consultant: Footprint
Certification: LEED Gold
Project details are provided by the design team and not vetted by Healthcare Design.
