In the chapter on Psychiatric Care Units in the Journal of Health Care Interior Design, authors Tama M. Duffy, ASID of Ellerbe Becket and Barbara Huelat ASID made the point that “A growing awareness of the real nature of mental illness helps us realize that not all mental health problems require the same type of treatment, therapy and physical environments.” The authors explore the three basic types of healthcare facilities for treating mental health disorders: state/teaching hospitals, private/community hospitals, and specialty facilities. State/teaching hospitals typically provide ‘comprehensive, multi-disciplinary program of tertiary-level patient care, clinical research, professional education and community outreach programs . . . within major university medical centers’.
Duffy and Huelat explain that private/community hospitals are typically investor-owned or not-for-profit freestanding hospitals that may include both a hospital and residential treatment facility and which often promote increasing levels of patient independence. The design criteria differ from that of a hospital, and the facilities often tend to be devoted exclusively to the treatment of mental illness. Specialty facilities might ‘focus on specific disorders such as eating disorders, substance abuse . . . [and] . . . dual addictive disorders. [These] facilities have the greatest success creating smaller, unique homelike centers to treat mental illness.’ The authors name Hazelden as an example.
Research shows that prevention, community outreach, outpatient, substance-abuse, EAP and self-help programs are growing in importance. Since the advent of The Affordable Care Act, and within the past 3 years, we’ve seen more assertive community treatment, the emergence of the health home concept with wrap-around customer focused care- including mental health. Increasingly, the emerging model of care extends to include in-home visits by caseworkers to keep children with their biological parents, and seniors in their homes rather than being moved to residential care centers.
The authors note, ‘The trend in psychiatric facilities has been to treat acute-care patients as outpatients [or] on a short term basis (under three weeks) at a community hospital.’ Pomegranate’s acute hospital stay is typically a week for crisis stabilization when a teen is a danger to self or others. The authors state that, ‘Long term care patients may be confined from 90 days to a period of years.’ A typical longer term treatment stay at Pomegranate is 3-6 months- more like a semester away at college.
‘One of the primary roles of the physical mental health care setting is to serve as a background for and assist in the recovery process. . . One primary goal of mental health facilities is to provide a setting that helps normalize and stabilize life.’ One specialty hospital Duffy and Huelat interviewed stated its primary objective that: ‘Treatment and rehabilitation are best achieved for most patients in a non-institutional, non-threatening environment where the patient is involved in an intensive treatment program- breakfast through bedtime.” The authors added, “The variety of treatments available makes the entire issue of mental health treatment unique and different from that of a medical/surgical hospital.” To that purpose, the Pomegranate facility includes classrooms on each residential unit, day room, game room, quiet spaces, family visiting areas, therapy team room, cafeteria, courtyard, therapist offices and gym. “Many times the gymnasium can be divided into separate areas to accommodate aerobics, volleyball and basketball,” the authors said. All those activities and more take place in the gym at Pomegranate.
One of the design issues is that, ‘Products must be tamper-proof and indestructible; diffusers and light fixtures must have tamperproof screws that require special tools to remove; products must be recessed and free of sharp edges; light fixture lenses must be fireproof; and no fixtures may be made of glass. Bathroom fixtures must be selected with concern: Toilets must have recessed flush valves; plumbing pipes extending into the room should be covered; shower heads should be recessed . . . outlets must be grounded-fault circuit-interrupted outlets; and fail-safe touch controls should be installed. . . . Mental health facility managers struggle to do everything possible to make environments as safe and durable as possible. However, the safety/security area is the biggest budget item,’ according to design authors Duffy and Huelat.
Facilities director John Hedrick said not only regular maintenance proceeds on daily, weekly and monthly schedules, but that includes life safety, repair and replacement considerations as well. ‘That’s all in a day’s work as there are building codes and standards to meet, and those of all the accrediting agencies as well,’ he adds. Because ‘Clinical evidence suggests that sensory deprivation may be one of the greatest mental disturbances in the built environment,’ Pomegranate has made strides in working to add murals, colorful bedding and upholstery and upgrade and update the flooring and finishes through-out the facility.
As the authors state, the goal is ‘creation of a warm, friendly, non-institutional environment; however, finishes can also be the greatest problem for maintenance staff. Institutional-looking finishes may be preferable to ripped or permanently soiled wall coverings, hole-riddled textured ceilings and raveled and permanently stained floor covering, such as carpeting. . . . ‘This is certainly an ongoing concern for any facility management team who know from personal experience the authors are right that, ‘residential-quality products are inappropriate for a highly abused psychiatric facility. . . . patient behavior varies according to patient conditions, requiring radically different design solutions.’
The designers explain that to create a homey ambiance, ‘Many facility designs incorporate as much wood as possible. . . Designers should create a variety of textures within a facility to provide visual relief as well as recognizable landmarks.’ CEO Angela Nickell and the entire facilities team are working to integrate the newer with the newest, as smoothly as possible, as the latest expansion construction continues.
Links to videos on the current Pomegranate facility:
[photo credit: Pomegranate adds another mural room with ocean view; this time to its therapy/family meeting rooms with more to come. Other murals include forest, dock with beach view, and cosmos which offer up a sense of the vastness outside one’s self.]