Architects work closely with behavioral health providers to meet the unique needs of their patient population, whether that’s giving a patient confined to an inpatient setting the ability to access outdoor space or including a daycare at a substance use disorder (SUD) facility.
“A lot of trauma-informed design principles come into play,” Stephen Parker, a behavioral health planner at Stantec, told Behavioral Health Business. “So giving patients autonomy, voice and choice throughout the process [is important], so that they have dignity going into the campus or facility.”
Stantec is an architectural, construction management engineering firm headquartered in Edmonton, Canada.
Design can be crucial in how patients interact with staff, spend time and, ultimately, recover. Modern behavioral health facilities now prioritize designing with patients’ autonomy, cultural competency, co-location, community spaces and outdoor space in mind.
Many architects are working with behavioral health providers to give patients more autonomy over their space.
“If a patient can see their role and have agency in their treatment plan, then they’re more likely to adhere to it and see it through,” Parker said. “So to give them ownership and agency in that process is to give them choices and not simply dictate to them in their treatment plan, what’s going to happen to them. They become an active participant.”
That could be something as simple as giving patients the ability to open and close their blinds without asking the nurse to do it for them. This allows patients to regulate their sleep as they see fit, which could significantly impact their stress levels.
More facilities are also looking at giving patients a private or semi-private room. This, too, offers patients the ability to have ownership over their space.
Environmental psychologists have found that including social support, control and integrating nature into design can help reduce stress.
Many behavioral health facilities are also looking to give patients the autonomy of deciding where to spend their time, including providing options for social spaces.
“We’ve tried to figure out ways to incorporate social interaction in the amenities spaces that we’re designing,” Blima Ehrentreu, founder and CEO of The Designers Group, told BHB. “Even in our recreation rooms, we’ve gotten creative in designing different furniture layouts and bringing in technology so that people could, let’s say, interact together but not necessarily be sitting right near each other.”
The Designer Group is focused on designing interior spaces for residential, commercial, hospitality and health care projects.
Social spaces can also play an important role in behavioral health recovery and making patients feel safe and accepted.
“When you go into one of our outpatient clinics, they’re designed in a very purposeful way that gives us the experience of belonging,” Alex Stavros, CEO of Embark Behavioral Health, told BHB. “It’s the colors; it’s the furniture that makes it feel welcome, that makes it feel bright, that makes it feel accepting. And all that design is the bright light and natural light coming in. All of those design aspects are intentional, align with our culture, with our core values, with our treatment approach, and create an environment that can lead to healing and an environment where you feel accepted.”
Chandler, Arizona-based Embark provides a network of outpatient centers and residential programs for mental health treatment for preteens, teens and young adults. Earlier this year, private equity firm Consonance Capital Partners invested in the provider, giving it a controlling stake in the company.
In addition to social spaces, many behavioral health operators prioritize outdoor space at their facilities.
For example, Parker worked with a large academic medical center to create garden courtyards off their psychiatric units, allowing patients to decide if they would like to access the outdoors.
“It’s designed with psych-safe features,” Parker said. “So it limits the risk for individuals in crisis who are still under observation, but gives them the ability to self regulate by choosing to go outside and socialize, and so on.”
It’s not just psychiatric facilities prioritizing outdoor spaces. Ehrentreu noted that many substance use disorder treatment centers are also incorporating outdoor-indoor areas into their model. Being in nature can provide a calming effect, she noted.
“There’s a lot of indoor-outdoor spaces,” Ehrentreu said. “For people who can’t get out as much, we’re trying to mimic that and bring biophilia into the design. And we’ve definitely seen the benefit of vitamin D sunlight and just overall people are really enjoying the option to be able to go outside, and if they cannot go outside also bring the outdoors to people.”
Culturally responsive design
Cultural competency is a core part of designing for specific communities. For example, Parker has helped design substance use disorder facilities for indigenous communities in North America.
“Truly looking at addressing specific cultural touch points through designing around care culture would be my big takeaway,” Parker said. “Because I have to understand my bias when I come into a project and [understand] the providers, patients and stakeholders.”
Instead of separating the individual seeking care from the community, this facility can bring the entire family onto the campus. That way, providers can help address generational trauma and keep patients part of the community.
In terms of design, it means that the facility needs to include a daycare for children and areas dedicated to the community, such as a traditional crafting room and a ceremony space. In addition, the space needs to include clinical spaces for outpatient counseling, group therapy and intake.
In addition to community spaces, many providers are co-locating different levels of behavioral health treatment on one campus and integrating physical health.
Blima noted that she has been working on a special needs community center that offers several physical and behavioral health offerings.
“There’s a day habilitation program, as well as an urgent care component where there’s doctors’ offices, therapists, as well as a dentist,” Ehrentreu said. “So it’s really giving the people in that community the ability to be able to come in and have all their needs taken care of.”
This one-stop-shop type of treatment center often means co-locating several different stakeholders on one campus.
“Instead of having an individual coming off scheduled detox … and experiencing homelessness, and sending them to a shelter … and their treatment facility is on the other side of town, [the idea] is to co-located services into what we call a recovery campus,” Parker said. “That’s kind of interesting because there isn’t one facility that owns that scope of services.”
These campuses can often include many providers from different parts of the community. In terms of design, it can mean creating several spaces for vastly different uses. For example, these co-located recovery campuses can include behavioral health services, recreation spaces, preventive care offerings, nutritional support programs and housing.
“Sometimes, we’re literally in the programming discussions because the organization that would run this doesn’t exist,” Parker said.