2021 HCD Expo: Finding The Right Balance In Behavioral Health Design

Many healthcare facilities have aging mental and behavioral health facilities that are in need of safety upgrades, according to Melanie Baumhover, principal, BWBR (St. Paul, Minn.), during the presentation, “Renovating Occupied Inpatient Mental/Behavioral Health Units for Safety, Experience,” at the 2021 HCD Expo, held Oct. 23-26 in Cleveland. “Mental/behavioral health has been a challenge in our country for decades, and with the COVID-19 pandemic, the needs are greater than ever before,” she said.

As facilities look to renovate their existing health units to meet this growing demand, Baumhover, along with Jarett Anderson, project manager at BWBR; Paul Sims, facilities project manager at Mayo Clinic (Rochester, Minn.); and Steve Rasmusson, senior construction manager at Mayo Clinic, discussed that projects should look not only to address safety issues, using existing industry guidelines, but also use an approach that considers how design can support the therapeutic and wellness needs of patients and staff.

“We believe that the best facilities use those guidelines and standards as a baseline, and on top of those build a human-centered facility that allows patients and staff to have better interactions, which supports the work of the clinicians as they endeavor to help their patients heal,” Baumhover said.

This approach also looks at how the environment can be used to reduce patient stress levels that often result in staff injuries. Baumhover noted that some existing facilities can look more like a prison than a hospital. “When patients feel they are being punished, or that they and others around them can’t be trusted, they are less able to focus on the work of healing,” she said. “Some of that stigma can be overcome with a healing environment that focuses on daylight, nature, movement, appropriate choice, and control of the individual’s self. We tend to focus on what they can’t have or can’t do. We need to switch to focus on what they can do, what they can have, and how they can move forward.”

As an example, the speakers shared a case study of Mayo Clinic St. Marys campus in Rochester, Minn., and the renovation of four inpatient behavioral health units, which included child/adolescent, depression, geriatric, and acute units.

Before the project began, Mayo Clinic conducted an environmental risk assessment and found risks related to ligature points, concealment, and possible ways that materials in the space could be weaponized, Sims said.

“The goal was to reduce the ligature risks present in the units and, while doing so, provide not only minimum safety measures, but also improve the supportive tools and environment available to patients to bring the facility in line with the Mayo Clinic’s primary value, where the needs of the patient come first,” Baumhover said.

While space elements, including the unit footprint, circulation pattern, or basic layout of the patient bedrooms or bathrooms, could not be changed, the project team did add sensory rooms to each of the four units, with touch-sensitive technology to help patients self-regulate, including videos, games and guided meditation, yoga, nature videos, and patient-controlled color-change room lighting.

In the bedrooms, the design team added televisions with staff-controlled content, which will be able access to patient education similar to the videos in the sensory rooms that patients can watch in the comfort of their own space. “When patients are shown tools on the unit that they can take home and use when they find themselves deregulating, it gives them the skills to live differently into the future,” Baumhover said.

When selecting furniture for a project, the speakers noted that too often furniture is selected solely because it is ligature resistant and challenging to throw at staff, rather than for the ways it can supports the overall needs of the intended user. For the Mayo Clinic project, the team worked closely with clinical staff to select pieces that were aesthetically pleasing, ligature resistant, and appropriate for the physical and emotional needs of their patients. For example, in the adolescent unit, the furniture needs to be fun and fit the unique ways kids sit while still feeling respectful to the older kids who can be sensitive to being treated like a child. “Those pieces would not have been appropriate for the geriatric population, who have differing needs,” Baumhover said.

“While considering in place renovations of your mental/behavioral health facilities, be sure you are looking not only at providing minimum measures of patient safety, but looking for ways to support the social and emotional needs of patients and staff,” Baumhover said.

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