“[Bellevue Hospital Psychiatric Ward] is a place of challenges, redemption, and surprising joy where tough hardworking doctors and staff fight to care for and keep safe a population that many would like to forget.” Memoir Summary; Sometimes Amazing Things Happen; Elizabeth Ford, MD.
At the beginning of my career, I was an intern at a large Architecture and Engineering firm in New York City. There, I began learning about the role design plays in caring for the complex needs of behavioral health patients. While patients in behavioral health centers arrive with differing afflictions, they share a common need to be treated well. From an architect’s perspective, this means that good design in a behavioral health center should generate an environment of dignity, respect, social support and independence. Most importantly, the space should be safe and aesthetically pleasing in a way that allows patient to feel that the success of their treatment is important to the team that cares for them.
In the early 2000s, I joined a team of Architects to design a Behavioral Health Adult Center in the Bronx, New York City. Our conversations, internally and with our client, focused on abandoning institutional conventions and creating a healing environment that humanized patients.
The facility we designed provided both dignity and respect by employing strategies to: reduce the stress of patients, make the facility a place where family and friends would feel comfortable, increase patient independence, and promote patient participation.
Reducing the Stress of Patients
A behavioral health center can reduce the stress of patients by providing environmental accommodations for various needs. A successful behavioral health center provides a variety of options for social interaction or quiet individual reflection. Single patient rooms supply the patient with dignity through privacy and by providing a place for individual reflection. Individual seating, grouped seating, activity tables and other program spaces located in a widened corridor are features that offer differing levels of social interaction depending on a patient’s preferences or needs. Good acoustical design is paramount to reducing stress in such open social spaces. Varied ceiling heights and materials help to keep sound from traveling too easily through open areas.
Another stress-reducing benefit to programs located in a widened corridor is visibility for patients and providers. This means easy wayfinding as open spaces help to keep the patient oriented. It would be increasingly helpful if the patient could personalize the doors of their bedrooms or activity rooms they frequent with drawings they made or pictures they like.
Smart lighting strategies can reduce the stress of the patient. A patient should have lighting choices for various activities. Dimmable lights and task lighting are safe and efficient ways to provide choice and reduce stress. Abundant daylight, views to nature and physical access to outdoor areas can also create calm.
A Place Where Family and Friends Feel Comfortable
It would be easy to feel uneasy while visiting a friend or family member in a behavioral health center. Warm and residential-like finishes can make a facility comfortable and inviting for guests. Options and choices can also set visitors at ease; architects could provide private visiting rooms and correctly-sized group rooms for shared activities.
Promoting Patient Participation
A behavioral health center can promote patient participation by providing various programs and activities for the patient to choose from. A model apartment is a place where a patient could practice skills of daily living. A salon, where a patient could have their hair cut or learn grooming techniques, promotes dignity and independence. A classroom, library, computer room, music room and art room provide creative outlets and learning opportunities. A gymnasium with a weight room and yoga room offer places to exercise or have larger social gatherings. A spiritual center is a place for patients to meditate or worship as they wish. A consignment shop run by the patients in the facility could have a reward system built into it where patients earn means of trade for healthy behavior. Finally, a central dining space and commissary could provide options for eating and socializing.
Offering a wide variety of programs that appeal to a patient’s preferences can increase patient participation. All the suggestions I listed above will reduce stress, promote healthy behavior, teach skills for independent living and give patients opportunities to choose how to spend their unscheduled time. These effects promote independence and dignity by preparing patients for life outside of the behavioral health center.
Designing for Behavioral Health is Inspiring
“The barriers to relieving suffering can be overwhelming and the rewards can seem few and far between. I have come to see my success as a doctor not by how well I treat mental illness but by how well I respect and honor my patients’ humanity, no matter where they are or what they have done.” Author’s Note; Sometimes Amazing Things Happen; Elizabeth Ford, MD.
I do not have the incredible and challenging opportunity to interact with patients of this population as a doctor or provider. I have tremendous respect for those who do. My experiences in working with these compassionate, talented women and men have helped me to understand and develop compassion for the complex needs of their patients. As an architect it is my task to use thoughtful design strategies and to provide the right environment for the treatment of their patients. It is humbling and inspiring to design a healing environment where patients can begin to find relief for their suffering and success in their journey toward mental health.
-Written by Rebecca Weidler, AIA, NCARB
