Design for Mental and Behavioral Health / Edition 1

by Mardelle McCuskey Shepley, Samira Pasha

Overview

Studies confirm that the physical environment influences health outcomes, emotional state, preference, satisfaction and orientation, but very little research has focused on mental and behavioural health settings. This book summarizes design principles and design research for individuals who are intending to design new mental and behavioural health facilities and those wishing to evaluate the quality of their existing facilities. The authors discuss mental and behavioural health systems, design guidelines, design research and existing standards, and provide examples of best practice. As behavioural and mental health populations vary in their needs, the primary focus is limited to environments that support acute care, outpatient and emergency care, residential care, veterans, pediatric patients, and the treatment of chemical dependency.

Product Details

ISBN-13:	9781138126367
Publisher:	Taylor & Francis
Publication date:	05/16/2017
Pages:	282
Product dimensions:	7.40(w) x 9.60(h) x 0.60(d)

About the Author

Mardelle McCuskey Shepley, M.Arch., M.A., D.Arch., EDAC, FAIA, FACHA, LEED BD+C is a professor in the Department of Design & Environmental Analysis and associate director of the Healthy Futures Institute at Cornell University. Dr. Shepley has authored/co-authored five books, most recently Design for Critical Care (2009), Health Facility Evaluation for Design Practitioners (2010) and Design for Pediatric and Neonatal Critical Care (2014). To enhance the link between research and practice, Dr. Shepley has worked in professional practice, full-time and part-time, for 25 years. She is founder of ART+Science, design research consultants.

Samira Pasha, M.Arch., Ph.D., AIA, LSSGB, EDAC, LEED BD+C, is an architect and researcher at CallisonRTKL, Washington DC. As part of the healthcare studio team, her work includes programming, planning, and evaluation of healthcare environments ranging from small unit renovations to health campus master plans, including domestic and international projects. Since 2012 Samira has been involved with NCARB intern think tank, AIAS, and District Architecture Center (DAC) as an advocate for integrating research into practice of architecture.

Table of Contents

List of figures xi

Acknowledgements xv

Introduction xvii

Part 1 Mental and behavioral health context 1

1 Mental and behavioral health history and context 3

1.1 Historical perspective 3

1.1.1 History of psychiatric care 3

1.1.2 History of psychiatric facilities 3

1.1.3 Post-nineteenth-century history of legislation 7

1.2 Challenges to mental and behavioral health research and design 10

1.2.1 Variety of settings 10

1.2.2 Variety of diagnoses 10

1.3 Global issues 12

1.3.1 North American context 12

1.3.2 European context 13

1.3.3 Middle Eastern context 13

1.3.4 Asian context 14

1.3.5 Central and South American context 14

1.3.6 African context 14

1.3.7 General international challenges 15

1.3.7.1 Impact of natural disasters and emergency situations on care providers 15

1.3.7.2 Scarcity of resources and economic instability 15

1.3.7.3 War, conflicts, and human rights violations 15

1.3.7.4 Forced displacement and migration 15

1.4 Mental and behavioral health context summary 16

2 General design considerations 21

2.1 Theories behind psychiatric facility design 22

2.1.1 Anthroposophy 22

2.1.2 Evidence-based design and research-informed design 22

2.1.3 Generative design 23

2.1.4 Planetree and the Institute for Patient-Centered Design 23

2.1.5 Salutogenic design 25

2.1.6 Specialist versus generalist 25

2.2 Planning and programming considerations 26

2.3 Transdisciplinary collaboration 26

2.4 Design considerations 27

2.5 Environmental psychology issues 28

2.5.1 Personal space and density 28

2.5.2 Choice and control 29

2.5.3 Sensory considerations 30

2.5.4 Spatial clarity and organization 31

2.5.5 Comfortable and homelike surroundings 31

2.5.6 High-quality, well-maintained environment 32

2.5.7 Positive distraction 33

2.5.8 Social interaction 34

2.5.9 Access to nature and daylight 35

2.5.10 Safety 36

2.5.11 Supervision 37

2.6 Specific setting issues 38

2.6.1 Inpatient common areas, inpatient parent spaces, and overall recommendations 38

2.6.2 Outpatient settings 40

2.6.3 Staff spaces 40

2.6.4 Finishes, furniture, and equipment 40

2.7 Site and building envelope and configuration 42

2.8 Case studies 43

2.8.1 Dandenong Hospital 43

2.8.2 Psychiatric hospital in Slagelse 48

2.8.3 Southwest Centre for Forensic Mental Health Care 52

2.8.4 Vermont Psychiatric Care Hospital 57

Part 2 The settings 67

3 Outpatient facilities 69

3.1 Introduction to outpatient facilities 69

3.1.1 History of outpatient psychiatric care 69

3.1.2 Data regarding the outpatient psychiatric population 70

3.2 Characteristics of outpatient psychiatric facilities 72

3.2.1 Frequency and duration of visitations 72

3.2.2 Number of psychiatric outpatient facilities 73

3.3 Outpatient psychiatric facility design 74

3.3.1 Research on ambulatory psychiatric care design 74

3.3.2 Outpatient psychiatric care design recommendations and features 75

3.3.2.1 Fountain House 76

3.3.2.2 Service Integration 76

3.3.2.3 Design strategies 77

3.4 Case study 79

3.4.1 The Peter B. Lewis and Adam Lewis Wellness Center 79

4 Emergency psychiatric facilities 87

4.1 Introduction to emergency facilities 87

4.1.1 History of psychiatric emergency care in the United States 87

4.1.2 Data regarding the psychiatric emergency population 87

4.2 Characteristics of emergency psychiatric facilities 91

4.2.1 Frequency and duration of visitations 91

4.2.2 Number of emergency facilities 93

4.3 Emergency psychiatric facility design 94

4.3.1 Research on emergency psychiatric care design 94

4.3.1.1 Dedicated spaces 94

4.3.1.2 Regional services 94

4.3.1.3 Collocation 94

4.3.2 Emergency psychiatric care design recommendations and features 95

4.3.2.1 General recommendations 95

4.3.2.2 Entry 96

4.3.2.3 Waiting areas 96

4.3.2.4 Assessment rooms 97

4.3.2.5 Seclusion rooms 98

4.3.2.6 Public and private space 98

4.4 Case studies 99

4.4.1 Behavioral Healthcare Center of Excellence - Erie County Medical Center 99

4.4.2 Emergency Department at Kings County Behavioral Health Center 102

5 Substance use disorder treatment settings 107

5.1 Introduction 107

5.1.1 History of facilities for treatment of substance use disorders in the United States 107

5.1.2 Characteristics and needs of substance use disorder patients 107

5.2 Characteristics of facilities for persons with substance use disorders 110

5.3 Research on facilities for persons with substance use disorders 112

5.4 Substance use disorder facility design goals 115

5.4.1 Inpatient environments 115

5.4.2 Outpatient environments 116

5.5 Case studies 118

5.5.1 Margaret and Charles Juravinksi Centre for Integrated Care 118

5.5.2 Worcester Recovery Center and Hospital 121

6 Mental health facilities for veterans of war 129

6.1 Introduction 129

6.1.1 History of mental and behavioral health facilities for veterans in the United States 129

6.1.2 Data regarding war veterans population 130

6.1.3 Characteristics and needs of war veterans 131

6.2 Characteristics of residential mental health facilities for war veterans 133

6.2.1 Length of stay 134

6.2.2 Average daily census 135

6.2.3 Number of beds and facilities 136

6.3 Research on mental and behavioral health facilities for war veterans 136

6.4 Design goals for facilities for war veterans 140

6.4.1 Inpatient environments 140

6.4.2 Outpatient environments 142

6.5 Case study 145

6.5.1 Acute Inpatient Psychiatric Replacement Facility Palo Alto, Veterans Affairs 145

7 Child and adolescent psychiatric care 151

7.1 Introduction 151

7.1.1 History of child and adolescent care in the United States 151

7.1.2 Data regarding the pediatric psychiatric population 152

7.1.3 Characteristics and needs of children 154

7.2 Characteristics of residential pediatric mental healthcare facilities 154

7.2.1 Length of stay 155

7.2.2 Average daily census 156

7.2.3 Number of beds and facilities 156

7.3 Characteristics of outpatient and emergency room pediatric mental healthcare facilities 158

7.3.1 Pediatric outpatient data 158

7.3.2 Pediatric emergency department data 160

7.4 Pediatric inpatient, outpatient and emergency room design goals 160

7.4.1 Pediatric inpatient environments 160

7.4.1.1 Research on pediatric inpatient design 160

7.4.1.2 Pediatric inpatient design recommendations and features 161

7.4.2 Pediatric outpatient environments 165

7.4.3 Pediatric emergency department environments 165

7.5 Case studies 166

7.5.1 Mary Graham Children's Shelter 166

7.5.2 Placer County Children's Emergency Shelter 171

8 Mental and behavioral health community residential settings 179

8.1 Introduction 179

8.1.1 History of residential facilities in the United States 179

8.1.2 Data regarding residential facility population 180

8.2 Characteristics of residential facilities 181

8.2.1 Types of programs and settings 181

8.2.2 Number of facilities and participation rates 182

8.3 Mental and behavioral health design goals 185

8.3.1 Recommendations by designers 186

8.3.2 Psychological factors influencing the effectiveness of community facilities 187

8.4 Case studies 188

8.4.1 The Next Door 188

8.4.2 Tiny Homes at the Farm at Penny Lane 193

Part 3 The research 199

9 The role of the physical environment in mental and behavioral health research 201

9.1 History and status of research 201

9.2 Methodology for literature review 201

9.3 Challenges to data collection involving patients 202

9.4 Behavioral health facility evaluation tools 203

9.5 Linking research to design 205

9.5.1 Strong evidence and emerging evidence 205

9.5.2 Studies requiring additional corroboration 207

9.6 Research summary 208

9.6.1 Physical environment and social behavior 209

9.6.2 Pre- and post-occupancy evaluations 212

9.6.2.1 Multiple facility studies 213

9.6.2.2 Satisfaction 213

9.6.2.3 Staff behavior 215

9.6.3 Harmful behavior and stress 215

9.6.3.1 Suicide 216

9.6.3.2 Stress 216

9.6.3.3 Pathological behavior 216

9.6.3.4 Aggression and violence 217

9.6.3.5 Issues regarding smoking 218

9.7 Trends 219

Part 4 Guidelines and future directions 229

10 Guidelines 231

10.1 Introduction 231

10.2 Organizations providing standards and guidelines 231

10.2.1 Australasian Health Infrastructure Alliance & New South Wales Health 232

10.2.2 Canadian Standards Association 232

10.2.3 Military Health Services System (MHSS): Department of Defense 232

10.2.4 Facility Guidelines Institute (FGI) and the American Institute of Architects 233

10.2.5 National Association of Psychiatric Health Systems 234

10.2.6 New York State Office of Mental Health 234

10.2.7 Royal College of Psychiatrists 234

10.2.8 Veterans Affairs 235

10.3 Challenges to development of guidelines and standards 240

10.4 Differences between guidelines and standards 241

10.5 Guideline research agenda 241

11 Conclusion 245

11.1 Where we've been 245

11.2 Where we're headed 246

11.2.1 Transitions in mental and behavioral health practice 246

11.2.2 Trends in behavioral health environments 247

Glossary 251

Index 253