In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.

Nurse-architect Tammy Felker is a healthcare planner and architect at NBBJ (Seattle), focusing on planning the next generation of behavioral health facilities. Here, she discusses using design to destigmatize care, uplift the patient and provider experience, and increase mental wellness.

  1. Help patients feel at ease and welcome

An overarching goal in the treatment of mental illness is to destigmatize the diagnosis, treatment, and experience. As architects, planners, and designers, we want to normalize the environment and experience and make it feel comfortable and familiar. Many people have negative images of a behavioral health facility (see movies like One Flew Over the Cuckoo’s Nest) and are reluctant to seek treatment. These places shouldn’t have a scary or punitive appearance. Instead, a positive and therapeutic environment can help decrease barriers to seeking care. For example, using wood, tile and other materials that have a residential look gives a homelike quality that’s less institutional and supportive.

  1. Allow a sense of control

Many behavioral health patients are not admitted voluntarily and have lost that autonomy and self-determination. Therefore, it’s important that the environment provide options and choice as appropriate. Simple features such as operable windows or control of the music in a quiet room can provide customization. A patient’s ability to regulate their personal space and interactions with others is also key, from offering flexible seating to movable chairs that support different-sized social interactions. It’s critical to give patients ways to practice making good choices and learn to self-regulate their behaviors in a supportive environment.

  1. Reduce stress with respite spaces

It’s stressful to be admitted to a hospital for any reason, and especially so to a behavioral health facility. Providing spaces for respite and quiet for both patients and staff, such as a soothing place to retreat if the environment is overwhelming, is beneficial. We should minimize extraneous stimuli, both visual and acoustic, as we all react to overstimulation with a stress response. One approach is to utilize sound-absorbing materials where possible and appropriate. Don’t forget about visual clutter: Offer storage for supplies and materials to keep the unit orderly and tidy. Furthermore, provide adequate space for people to regulate their interactions with others, as excessive social density is a stressor, as well.

  1. Provide positive distractions

Many studies have shown that regular exercise contributes to good mental health and management of depression. Including spaces for physical fitness can help patients establish healthy patterns of behavior that can be utilized after discharge. Art and horticultural therapy are also proven activities that support mental well-being. Art can allow patients to express emotions and feelings in a healthy and appropriate way, while a connection to nature and the outdoors speaks to our primal origins and biophilia.

  1. Prioritize safety

It’s difficult and potentially dangerous to have facilities maintenance staff on the behavioral health unit with their cart and tools doing repairs as a result of patients acting out against the building. When spaces get damaged and they’re not repaired, it can send a message to patients and their families that they’re not valued or important—nor is the patient unit. Therefore, making the facility durable and maintainable is important. Employ familiar materials in novel ways, such as a special type of dense plywood that has a higher quality of finish, which gives it a warm and familiar look while being extremely durable. Medium density fiberboard can also be routed to create interesting patterns and textures in a material that’s extremely abuse-resistant.

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