America’s behavioral health care system often comes second to medical care in the eyes of payers, the government and even patients themselves.
That inequality can lead to shortfalls in behavioral health care delivery — including in terms of the facilities where services are offered. Criticisms range from a lack of beds to certain providers being housed within larger medical care complexes that don’t account for the specialized nature of behavioral health.
CannonDesign, an architectural firm that has received over 600 design awards from general and trade media publications — as well as a bevy of awards for their designs of behavioral health facilities — aims to help.
Founded in 1945 in Niagara Falls, New York, CannonDesign’s current flagship office is in New York City. It has more than 1,100 employees in 16 American cities and also has global locations in Toronto and Mumbai.
To date, the firm has designed more than 50 behavioral health facilities and has more than a dozen others in the works — all created especially with safety and efficiency in mind.
Its most recent facility, the Thompson Autism Center, opened up to patients earlier this month. The $9.5 million, 20,000-square-foot autism spectrum disorder (ASD) treatment complex is based in Orange, California, and operated by the Children’s Hospital of Orange County (CHOC).
The new center is filled with indirect lighting, calming colors and artwork showcasing social connections, which children with autism often struggle to form. It also features a specialized waiting room, filled with wall nooks where kids can climb in and sit when they need a break from outside stimuli, as well as exam rooms where children can receive all different types of specialty care, cutting down on the number of new unfamiliar environments associated with comprehensive treatment.
The center is also built with special attention to sound sensitivity, as loud noises can adversely impact children with ASD.
“[An] aspect that is really important is how these facilities engage with or connect with the community that it serves,” Stephanie Vito, a behavioral health architect and senior vice president at CannonDesign’s Buffalo, New York office, told Behavioral Health Business.
While the firm has its hand in the design, engineering and construction of projects across several fields, CannonDesign’s behavioral health work dates back to 1996, when it built its first mental wellness facility, Canada’s Whitby Psychiatric Hospital (now the Ontario Shores Center for Mental Health Science).
The hospital is considered important by the firm because it was designed with the intent of maximizing wellness care to patients in a way that allows them to return to their homes as soon as possible, as opposed to keeping them hospitalized on a long-term basis.
While the company’s behavioral health business was slow to take off and lagged behind general health care work at first, it has boomed in recent years.
“It’s really picked up over the last decade or two,” David Sass, a senior vice president and health care architect at CannonDesign, and a Buffalo-based colleague of Vito’s, told BHB. “Our early work… positioned us well to be prepared for that growth in behavioral health care project work and construction.”
CannonDesign is currently working on a number of behavioral health projects — up to 15 by Sass’s estimate — all of which are at various points in the design phase and are being handled out of the firm’s Buffalo office.
Most of the firm’s behavioral health projects are centered on psychiatric care, with a growing emphasis on autism services. While those projects somewhat resemble medical care complexes, the best behavioral health facilities feature a few important differences, Vito explained.
“The design process is similar in that we start to think about the patients, the staff, the users, the family and the context of the project,” Vito said. “But .. [behavioral health] patients are much more ambulatory.”
“One of the things that we see with behavioral health care is we have to balance a couple of additional factors into the design, including…a heightened sensitivity around durability and safety and security,” Sass noted.
Those kinds of nuances, in large part, haven’t always been taken into consideration in the construction and adaptation of behavioral health care facilities.
The Facility Guidelines Institute, a nonprofit that works to establish proper protocols for health care facility design and construction, published a report in 2015 addressing the implications inadequate behavioral health care facility designs can have for patients.
If designed improperly, facilities can put patients at risk. While a safe behavioral health facility is “often completely different” from a safe medical or surgical unit, the report says, there is no one gold standard for the design of behavioral health facilities.
“Decisions about design for psychiatric facilities should be thoroughly discussed with facility staff beginning during the programming phase and continuing at decision points throughout a project,” authors of the report wrote. “As well, the decisions made should be documented, including the reasons behind them, before proceeding to subsequent phases of a project.”
In other words, there’s no one size fits all solution, and behavioral health designs should vary by facility type and objectives.
CannonDesign also believes in that customizable approach, and that’s part of the reason it’s earning behavioral health acclaim.
One such facility embodying CannonDesign’s ethos is the Virginia Treatment Center for Children (VTCC) in Richmond, which opened in 2016 and holds 32 inpatient beds across its 118,800-square-feet.
VTCC has won multiple accolades for its design, including being named a finalist by FastCompany last year in its annual World Changing Ideas awards competition.
The facility, which can be expanded to hold 48 beds, is designed as a “pavilion in the park,” according to CannonDesign.
It consists of a one-story inpatient building with therapy and treatment areas and an outdoor space for recreational activities. The inpatient building is connected to a two-story administrative building that also provides outpatient services.
The campus also makes extensive use of glass to let in natural sunlight, departing from the more sterile forms of design that are traditionally seen in behavioral health architecture.
“Some design features of that facility [challenge] … norms in design and really looked to… foster a more progressive way of providing care,” Sass said. “A couple of those things are the attention to keeping … clusters of patients relatively small.”
To accomplish this, the firm designed self-contained units in the building that hold 16 beds each.
Each unit has an “activity zone” where children can engage in treatment, therapy and recreational activities. For instance, children who aren’t immediately receiving therapy at those times — or who maybe want to go read a book or play games — can go to other rooms to engage in different activities.
By keeping the patient capacity of certain spaces small, therapists can better separate children by age, gender or specific diagnosis, and maintain better order over the management and care of young patients.
“I think a well designed behavioral health hospital will allow clinicians to provide more care to their patients throughout the day,” Vito said.
CannonDesign hopes to remain busy helping providers deliver better services and care through smarter architecture going forward.
“We see a lot of facilities that are in aging infrastructure, with poorly designed plans,” Vito added. “The clinicians are constantly struggling to combat these negative conditions within the facility and spend a lot of time doing so rather than actually spending time delivering care to the patients. I think the challenge is to really work with the clinicians on their delivery models.”