Ohana Center For Child And Adolescent Behavioral Health, Monterey, California

Benefiting from a gift of nearly $106 million from philanthropist Roberta “Bertie” Bialek Elliott (Warren Buffett’s sister), the Ohana Center for Child and Adolescent Behavioral Health was poised for attention even before breaking ground along a serene hillside in Monterey, Calif. Owner Montage Health wanted something unique for the design of its new facility, which would provide innovative outpatient care and interventional programs with a family-centered focus.

For inspiration, designers from NBBJ’s Los Angeles office spent two days on the site even before the firm had won the job, hanging out under the oaks and wandering the grounds at different hours of the day, sketching. After getting hired, they worked closely with Montage leadership; Ohana’s newly hired executive director, Dr. Susan Swick; and a neuroscientist to rethink what a mental health building could be.

“It’s a beautiful site, with a lovely view across the valley to another hillside,” says Jonathan Ward, firmwide design leader and design partner at NBBJ. “Connecting to nature is something that optimizes brain function, and we wanted to integrate that throughout the whole care process.”

The 55,600-square-foot campus, which opened in November 2023, features curving walls of glass and mass timber, stepped terraces, winding paths, and aromatic gardens. But the connection to nature is just the beginning. “Ohana” is a Hawaiian term meaning “extended family,” and that concept, combined with transparency and a sense of learning and discovery, embodies the center’s philosophy.

“We want this building to be a place that sparks curiosity for everyone in our community,” Swick says. “We really thought about the way it’s designed, with private and public spaces, including a family resource area and conference center. There’s nothing to be ashamed of here. Shame is the enemy.”

Ohana’s built-in support

The first-line approach to therapy at Ohana, Swick says, is to help children and adolescents learn new skills to manage strong feelings, impulses, and interpersonal relationships.

“It requires tolerating a lot of failure and discomfort,” she explains, “but fortunately, kids—more than adults—are wired to be super-curious about novelty and staying with something new in the pursuit of mastery.”

The facility is designed to “activate” that curiosity and instill a sense of anticipation rather than fear of the unknown. For example, Swick says, “almost the entire building is marked by curved hallways. So you’re perpetually sort of thinking about what’s around the bend.”

Gently curving walls, Ward adds, work against the institutional, cold, and hard-edged stereotype of mental health facilities. “We learned through our research that hard-edge forms are perceived as threatening deep down in the brain,” he says. The curves work in concert with other design elements meant to convey honesty and transparency, supporting Swick’s “nothing to hide” philosophy. Walls of windows everywhere offer not only extraordinary views of nature, but sight lines to other areas of the campus, allowing patients and visitors to stay oriented and reminding them they’re part of a community.

The interior architecture reveals the natural expression of materials. “We didn’t plaster everything over with drywall,” Ward says. “The structural purposes aren’t hidden. A column is a column, the ceiling is a ceiling.” For example, following the project’s simplified materiality approach, the timber ceilings and columns throughout the facility are left exposed, supporting the idea of transparency and honesty.

A community art program with works from more than 160 contributors pervades the facility and includes commissioned pieces by visual artists, poets, and student photographers. The variety of artworks, abstract and figurative, is another way to spark curiosity, but the pieces can also play a more direct role in treatment.

“When you’re in a space where you’re ruminating or worrying, seeing something vivid, unexpected, or colorful can draw you out of your head,” Swick says. “Even if it’s just for a moment, that can be enough.” Therapists will also use the hallway art—as well as a looping path in the outside courtyard—to get restless patients up and about, giving them something to respond to and discuss.

Campus lay-out

The serpentine building coils around a large, walkable courtyard and an outbuilding with a gym and cafeteria. Spaces are organized around the severity of patients’ conditions, with the most public and lowest-acuity areas on the top floor and the highest-acuity residential program at the base. The middle floor contains therapy spaces.

The Ohana campus incorporates day programs, individual and family therapy services, group therapies, music and recreational facilities, and a 16-bed, short-term-stay residential unit. It’s not a high-acuity locked facility; there are no involuntary patients.

From the main lobby at the top level of Ohana, patients and visitors can look out across the courtyard and into open-air hallways and clinic waiting rooms. “It looks a little bit like an ant farm, where you can see people moving through different parts of the building,” Swick says.

Prioritizing safety and privacy

Still, safety and privacy considerations needed to be balanced against the otherwise open and transparent ethos. “We did a very detailed diagram of the entire building with the staff there,” says Daphne Corona, senior associate and project manager, NBBJ. “Looking at the licensing requirements, our best practices, and Montage Health’s practices, we diagrammed the safety features in every single space, then did a lot of cardboard mock-ups and testing.”

The short-term residential unit is sited in a way that provides added privacy and has its own entrance and courtyard (not visible from the lobby); Swick describes the atmosphere as more of a retreat.

Throughout the facility, windows in treatment areas and some of the meeting spaces are frosted glass. “We’ve created spaces where we’re not forcing people to be more exposed than they’re ready for,” Swick says. “The message we want to deliver is: There’s nothing to be ashamed of, but we’re happy to walk alongside you at your pace.”

Keeping caregivers healthy

As important as it was for the building to support the therapeutic programming and emotional needs of patients, it was equally critical for its design to boost cognitive skills and well-being for the center’s clinicians and staff.

To that end, the ample daylight and access to nature serve staff and patients alike; other design elements, like triple-sound-insulated “chill rooms” (as Swick calls them) with dimmable lighting and calming artwork, are available to staff as well as patients who may need them to take a break.

Dedicated staff areas also include spacious, private patios on the top level of the building, looking out over the courtyard and beyond. “It’s a chance to get fresh air and sunshine with other staff, but there’s also plenty of space so you can take a solitary break, listening to headphones or reading a book,” Swick says.

Dr. John Medina, a developmental molecular biologist and NBBJ research fellow, worked with NBBJ on the initial planning to consider design elements such as these that could improve executive function—a skillset that helps people control behaviors and other cognitive abilities. “He challenged us to invert the design focus,” Ward says. “Usually, you put your energy into the patient, but Dr. Medina asked us to focus on the caregivers, which then leads to an even better space for the patients.”

Community outreach

Swick is pleased at how much interest Ohana Center for Child and Adolescent Behavioral Health has gotten from families and the greater community. “There’s been a great sense of curiosity and enthusiasm,” she says. “The building has created a feeling of ownership and pride that is itself very destigmatizing.” She adds that more than 200 local residents have expressed interest in volunteering.

It’s exactly what Swick and the design team hoped to achieve. “For a child to do what they need to do, they often need the support of family around them,” she says. “But for the family to do what they need to do, they need to be connected to a supportive community.”

Kristin D. Zeit is a contributing editor at Healthcare Design and can be reached at [email protected].

 

Ohana Center for Child and Adolescent Behavioral Health project details

Location: Monterey, Calif.
Completion date: November 2023
Owner: Montage Health
Total building area: 55,600 sq. ft.
Total construction cost: Not disclosed
Cost/sq. ft.: Not disclosed
Architect: NBBJ
Interior designer: NBBJ
General contractor: South Bay Construction
Engineers: Integral Group (MEP), Fast + Epp (structural), Whitson Engineers (civil)
Art consultant: Susan Krane
Carpet/flooring: Shaw Contract, Bentley, Nanimarquina, Chilewich
Doors/locks/hardware: Ives, Schlage, LCN
Fabric/textiles: Carnegie, Maharam, DesignTex, Knoll Textiles, Kvadrat, Geiger
Furniture—seating/casegoods: Steelcase, Coalesse, Keilhauer, Andreu World, Pineapple, Bernheardt, Bolia, Hightower, Buzzi Space, Watson, Viccarbe, Muuto, Diversified Woodcraft, Stylex, RS Barcelona, Hay, Janus et Cie, Naughtone, Davis, Herman Miller
Lighting: Tom Dixon, Alphabet, Finelite, Zero, Kirlin, Visa
Surfaces—solid/other: Corian, Plexwood
Wallcoverings: Carnegie

Project details are provided by the design team and not vetted by Healthcare Design.