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Perspectives on Behavioral Health: Elevating Design Beyond the Trends

Welcome to a new Q & A series designed to uncover what behavioral health really means within secure justice facilities, including the current and future trends in design, the crossover with healthcare, the shared focus we have with our clients and partners, and the best way forward. The greatest challenges to behavioral health for secure environments continue to be access to care and continuity of care. With the closing of mental hospitals as part of a “de-institutionalization” program in the U.S., our corrections and detention facilities have often taken their place. This means those most at risk for behavioral health issues are often detained and confined. This in turn impacts operations and facility design for corrections and detention facilities.

We’re dedicated to championing healthy communities by helping our clients and partners plan, program and design their facilities to achieve their goals. This means we must first explore and understand what is happening in our communities, including the issues and challenges, effective and therapeutic design, and the evolving solutions. In our first Q & A of the series, Greg Cook shares his informed perspective, based on his years of experience designing a broad range of facilities, with a specialty in justice. Here we're featuring Brian Giebink, a project architect working primarily on healthcare projects, sharing his perspective on behavioral health design within hospitals and health facilities.

Q: How long have you been in the health field and when did you become focused on behavioral health design within hospitals/health facilities? What do you find most interesting about behavioral health projects?

BG: I joined the HDR team seven years ago and have been involved in the planning, design and documentation of health projects almost exclusively, with the exception of a few education and federal projects. I've always been interested in health design because of the strong connection the built environment has on the health and well-being of its occupants, as well as the complexity of projects and the challenges. Behavioral health is of growing interest to me for those exact reasons. I can't think of another building typology where the design, down to the smallest details, has a more significant impact on the health and well-being of its occupants. I'm continually drawn to the unique challenges our clients face to provide better, safer, more effective care and how the built environment can influence those outcomes.

Q: How do you define behavioral health in the health market?

BG: That's a tricky question because it depends who you ask, and in which country. Generally accepted in the United States, "behavioral health" is often used as an all-encompassing term to mean anything relating to mental health or substance use or addiction disorders in children and adults of all ages. Care for mental and behavioral health patients occurs across a range of services along a continuum of care, including education, prevention, treatment, and recovery, and in a variety of settings ranging from community support to acute inpatient care. Statistically, one in five people experience mental illness so all health settings, whether specific to behavioral health or not, need to be equipped to respond to mental and behavioral needs. In many cases we see crossover in patients with a co-occurring diagnosis of a mental health and a substance use disorder or a dual diagnosis of mental health and developmental disability. So while the behavioral health "term" is broad, we often need to find design solutions that safely and appropriately address needs of both behavioral and mental health patients.

Q: What design trends do you see developing in the design response for behavioral health within hospital / health facility environments?

BG: As a society, we have come a long way in the design of behavioral health facilities in recent years. We’ve recognized the need to change the way we address mental health, erase the stigma associated with it, and improve the way care is delivered. Nature has been widely accepted as a therapeutic tool in the design of behavioral health facilities. We're also starting to understand the importance of de-institutionalizing behavioral health facilities by creating normalized environments that are nurturing and therapeutic to help patients cope with their illness beyond their release from the health facility. Additionally, we are seeing more emphasis placed on patient dignity and respect, by empowering patients to take active ownership of their healing journey and becoming partners in their care. Safety and security for patients, visitors and staff has always played an important role in behavioral health design, but as the industry evolves, we are developing better, safer solutions to prevent injury or self-harm. Similarly, we are designing solutions that strategically balance active and passive surveillance which builds trust and promotes autonomy. While I'm encouraged by these trends, we still have a long way to go. Too many people with mental illness are either not receiving treatment or receiving inadequate treatment across the continuum of care.

Q: How can we, as designers, support the mission and the focus of a facility designed around behavioral health or mental health?

BG: We must continue to elevate our designs above and beyond the promising trends we are seeing in behavioral health care — to create affordable, effective solutions that meet the growing need of behavioral healthcare in our communities. We need to continually ask ourselves ‘what's next?’ in behavioral and mental healthcare, rather than simply repeating what has already been done. We also need to actively contribute to the growing body of research available by approaching each design as an opportunity to inform the next one. Most importantly, we need to work together. Behavioral and mental healthcare is a global issue that needs a collective response from: designers, builders, manufacturers, health executives, providers, patients, families, communities and governments to reshape policy and design to improve outcomes in behavioral healthcare.