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Featured Article:

Why mental and behavioral health design requires unique considerations

by Viviane Chan, Unicel Architectural

What if appropriate design could help improve behavioral and mental health treatment and outcomes? 


Spoiler alert: The right design can, and already does, in facilities that have made the right investments and design choices. Recent studies have shown that excessive noise and lack of privacy can cause undue stress in behavioral health patients, while beneficial elements like natural daylight, suicide-resistant building materials, and good sightlines can dramatically improve health outcomes.  


That's vitally important, perhaps now more than ever. That’s because mental and behavioral health issues are growing problems within our society, illustrated by increased mental illness (especially among teenagers and young adults), behavioral health facility admittances, and rates of self-harm due to mental illness.


According to the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services, one in 5 U.S. adults experienced mental illness in 2018. A further one in 25 adults experienced severe mental illness. Seventeen percent of youth also experienced mental illness. Add to this that more than one in five homeless people in the U.S. have a serious mental health condition, along with nearly 40 percent of adult offenders in U.S. prisons, and a whopping 70 percent of those in the juvenile justice system.


But these numbers don't just tell a tragic human story. It's also an economic issue – across the U.S. economy, severe mental illness causes an average of $193.2 billion in lost earnings each year. Additionally, mental illness and substance abuse are involved in one in eight emergency department visits by a U.S. adult. Despite these alarming trends, the number of psychiatric beds in the U.S. keeps decreasing. "In 1955, there were an estimated 559,000 state and county psychiatric beds, or nearly 340 beds per 100,000 people," according to the Virginia-based Treatment Advocacy Center. "By early 2016, the state hospital bed population had dropped more than 96%, to 37,679 beds, or 11.7 beds per 100,000 people."


According to the Canadian Mental Health Association, the issue is just as concerning north of the border, where one in five Canadians experience mental health problems or illnesses every year. By age 40, around half of the entire population will have had a mental illness. And the Mental Health Commission of Canada estimates that close to seven million Canadians currently live with a mental illness, nearly three times those who have Type 2 Diabetes. 


Sobering numbers, to be sure, especially when one considers it's almost certain that the stress and uncertainty of the ongoing Covid-19 crisis, along with the resulting economic damage and social unrest, have likely accelerated these trends. 


Meeting the challenge: Design considerations


To meet this ongoing and growing challenge, facilities and jurisdictions across the U.S. and Canada are expanding behavioral health budgets, which have increased in more than 30 states. Michigan, for example, increased its mental and behavioral health budget by $200 million in 2019 – although some watchers said it wasn't enough to meet the "skyrocketing demand for mental health and substance abuse services" in the state. Similarly, the Canadian federal government in 2017 announced a $5-billion investment to improve access to nationwide services. The funding will roll out over the next several years. Although this is still not enough to fully tackle the problem, it’s being combined with provincial funding for various activities including replacing or upgrading aging mental health facilities.


Either way, designing and building a mental and behavioral health facility or floor isn't like designing a typical building. It's even quite different from designing a typical healthcare facility. Indeed, developing a behavioral health facility requires special considerations, including:


  1. A therapeutically enriching environment:
    1. Emphasizing patient autonomy, respect and privacy
    2. Providing visual access to nature to promote healing 
    3. Offering tranquility and calm


  1. A safe and secure environment: 
    1. Minimizing potential physical hazards 
    2. Enhancing staff visibility and engagement with patients 
    3. Using abuse-resistant and ligature-resistant materials, furnishings and fixtures 
    4. Open floor plans and good sightlines



Patient & staff safety


Because both patient and staff safety are the No. 1 concern of behavioral health facilities, special attention must be paid to this element of facility design. Patient suicide is a huge risk: A psychiatric nurse in London, U.K., for example, experiences a completed suicide every 2.5 years. But there are other potential safety issues such as falls, escapes, and aggression towards other patients or staff. 


For these reasons, staff in mental and behavioral health facilities must always have good visibility and sightlines into patient areas. Building materials such as shatterproof glass and ligature-resistant materials also need to ensure safety. A Shepley-Burfinch/Cornell survey of behavioral health professionals found that suicide resistance was the most important and effective materials-related option for ensuring patient safety.


Windows featuring cordless operation, privacy control, rounded specialty glass stops, and shatterproof glass can further reduce risk. Window systems that pass the American Architectural Manufacturers' Association (AAMA) 501.8 performance certification for resistance to human impacts (2,000 ft-lbs.) through high-impact glazing or polycarbonates are perfect in this regard.


Noise, daylight & patient privacy


Noise is also an essential factor when designing mental and behavioral health facilities. Everyone who has ever spent time in a hospital – or even just recovering at home – knows that unwanted noise is antithetical to a therapeutic environment. In this regard, noise can be a behavioral health hazard. Good design must seek to mitigate noise, no matter the facility: "Effective acoustical performance is a critical need for all types of healthcare facilities," according to Healthcare Design Magazine. "Negative impacts include elevated psychological and physiological stress levels."


The Shepley-Bulfinch/Cornell survey also found that noise control, along with healthy amounts of natural daylight, are the highest-rated environmental features by behavioral health staff. Natural lighting has well-documented health benefits, and optimizing natural daylight and temperature are important design elements. Bright artificial lights can impede rest and recovery. "Utilizing nature as a healing distraction benefits all ages of patients," according to Ashe Health Facilities Management. "By allowing the lines between interior and exterior to blur, the benefits of the outdoors can be brought inside."


Patient privacy is also vital but must be met with some nuance, since the discreet visual observation of patients is also critical – but must take place in such a way that doesn't aggravate patients or situations. A good mental and behavioral health privacy solution must also be easily adjustable, so medical staff can observe patients without being overly obtrusive.


Integrated louvers meet behavioral and mental health requirements


Integrated louvers – insulating glass units with integrated cord-free louvers – are the only solution that competently addresses all of these design requirements. High impact glazing protects against shattering and violent force: The louvers are made with hollow-chambered aluminum to provide maximum strength and maintain the blades' strictly parallel alignment. In a fully closed position, they ensure an additional safety barrier against violent impact.


Integrated louvers also offer completely adjustable vision control. When fully opened, they provide 80-per-cent visibility; when fully closed, they ensure 100-per-cent vision blocking. They can be angled to provide discreet observation by staff while preventing external views. They typically feature double glazing with a two-and-a-half-inch airspace with a Sound Transmission Class (STC) rating on par with drywall and concrete block walls, and in many cases come with ligature-resistant operators that prevent self-harm. 


Integrated louvers can also feature an AAMA 501.8 impact resistance certification for interior and exterior mental and behavioral health applications.


These building materials can further improve security through attack-resistant glazing, adaptable ligature-resistant operators, rounded stops, deep aluminum frames and specialty glass stops. They're also hermetically sealed with a contaminant-proof seal. That means integrated louvers ensure maximum hygiene, complete daylight control, and optimal thermal efficiencies, and help to moderate and maintain ideal room temperatures. 

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