Over the past 15 years, research has demonstrated the importance of physical spaces and their impact on people’s moods and ability to work, heal, or learn. Substance use disorder (SUD) facility designers are increasingly turning to “evidence-based design” to support patients better.
While evidence-based behavioral health care has been in vogue for decades, evidence-based approaches to SUD facility design are a slightly more recent phenomenon. Evidence-based design approaches can not only help designers and providers “speak the same language,” but they can also promote a greater return on investment.
Thoughtful design choices with a basis in evidence are imperative when treating patients with behavioral health conditions, according to Scott Holmes, behavioral health environment network facilitator for the Center for Health Design.
“SUD and mental health patients are somewhat unique from other health care populations in that they are often socially marginalized and stigmatized,” Holmes said. “So you need to have that in mind.”
The Center for Health Design is a Concord, California-based non-profit organization dedicated to design research, education and advocacy. The organization’s members include architects, interior designers, health care executives and health care professionals.
Evidence-based design can help address problems associated with stigma and marginalization. One evidence-based tactic requires architects to be conscious of density, Holmes said, which can significantly impact a patient’s anxiety levels. He identified two types of density: social and spatial.
Social density is the number of people in a particular space.
“Sometimes that goes at odds with the care philosophy,” Holmes said. “A lot of times for substance use, you’re trying to create this sense of community … but we also have to be aware that we might need some smaller public spaces where folks [can go.] It may be just a little smaller seating alcove for two or three people versus 20 people at once.”
Spatial density is an individual’s “sphere of personal space,” or an imaginary bubble surrounding a person, which they may prefer to keep as a buffer between themselves and another person. People with post-traumatic stress disorder (PTSD) may have a larger bubble than others, which evidence-based designers should be aware of, Homles said.
Brian Giebink, a registered architect and behavioral health practice leader at HDR, has been accredited and certified in evidence-based design and says it helps providers and designers “speak the same language.”
Headquartered in Omaha, Nebraska, HDR is an employee-owned professional services firm specializing in architecture, engineering, environmental and construction services. The company has more than 200 offices in 15 countries with more than 12,000 employees worldwide.
Evidence-based design has also led Giebink to focus on trauma-informed design to support trauma-informed care models.
“Trauma-informed care is an approach to care that’s not asking a patient what’s wrong with you, it’s asking what happened to you,” Giebink told Addiction Treatment Business. “Trauma-informed design is really about creating spaces that promote supportive relationships, empower patients, promote dignity and prevent retraumatization.”
To create safe spaces geared towards patient well-being and healing processes, designers can look for ways to provide control and choice for patients who may lose a sense of autonomy through treatment.
Options for patients to personalize their individual spaces can promote this sense of freedom. For example, patients can choose the color of the lighting in the rooms or control artwork through a digital display. Even having choices of where to sit in a room can be helpful.
“If you go to an addiction treatment center, you might see patient bedrooms with their beds fixed or bolted to the floor,” Giebink said. “That’s not necessarily supporting trauma-informed design. It’s probably going in the wrong direction and increasing stress and anxiety because you’re losing that control, choice and sense of agency.”
Even before beginning the design process, designers must understand their target population.
Demographics like age, relationship status and family status can all impact design choices. In addition to demographics, it is critical to understand the provider’s care model. Providers sometimes delay communicating exactly what their care model is to designers, Holmes said, because the design and construction process can be so lengthy.
“They figure they have plenty of time, but understanding that care model is integral to creating a successful design because the facility, the built environment, can support whatever that model wants to be,” Holmes said.
Some design choices can help reduce anxiety among patients with SUD. Commonly used techniques include incorporating green and blue colors, adding natural light and including access to outdoor areas.
Barge Design Solutions Barge Design Solutions“Outdoor spaces, exemplified by healing gardens like one of our recent projects at the Siskin Rehab Hospital in Chattanooga, TN, are also pivotal for mental recovery,” Matthew Griffith, vice president and director of health care division at Barge Design Solutions.
Nashville, Tennessee-based Barge Design Solutions is an engineering and architecture services firm with over 15 locations across six states.
A facility’s location might make incorporating outdoor space impossible. For example, the building may be located on a busy street. In this circumstance, a designer may “supplement” nature through nature-themed artwork.
A facility on a busy street may also create problems with privacy, which is crucial for SUD populations. While large windows can offer natural light, you may risk making patients feel “on display,” Holmes said.
While keeping privacy in mind is important, another trend intends to foster a sense of community while maximizing efficiency. “Recovery villages,” which involve dorm-style housing with associated treatment offices, are becoming increasingly common.
“This shift is a response to the shortage of behavioral health beds, marking a positive evolution in healthcare that can be expected to become more prevalent in [2024] and beyond,” Griffith said.
Looking forward, providers and designers must focus on a whole-person approach to health, Giebink said.
“We need to be thinking about more than just substance use treatment,” he said. “It’s not just about substance use. … It’s about your whole health. … It starts to destigmatize the condition and break down barriers.”
