‘It Is Crucial That We Send the Message That Behavioral Health Patients Are Valued.’

A Conversation with Tammy Felker, Registered Nurse and Architect, NBBJ

October 11, 2019

Partner, NBBJ

Editor’s Note: The number of people reporting behavioral health issues is on the rise, a crisis often compounded by lower-than-average funding, a lack of psychiatric beds and high occupancy rates of behavioral health facilities. This week we are posting interviews with experts in behavioral health, following an NBBJ-hosted panel discussion, to learn how different parts of the country are addressing the crisis.

 

NBBJ: You plan spaces across specialties, but you are especially focused on behavioral health facilities. Given your expertise, how should these spaces evolve?

Tammy Felker: In the past, behavioral health spaces were designed like jails and featured prison-grade materials, such as tamper-proof lighting fixtures and plumbing. As a result, these environments feel institutional and cold.

Thankfully a shift in mindset is starting to transform the industry, creating a normalized care experience so patients feel safe, but also valued. Fixtures are becoming less institutional-like, and there’s a holistic emphasis on providing warm and therapeutic spaces.

One specific area we’re investigating is the integration of circadian lighting. Regulating sleep-wake cycles is especially important to the behavioral health population for healing, and it is ripe for further study and analysis.

 

What are the most impactful changes that could be made to how behavioral health spaces are designed?

The first change is to rethink spatial density. Studies show that too  many people in a small space can increase aggression. In behavioral health centers, giving enough square footage beyond the code minimum, so everyone has their own space, can make a difference in creating a normalized environment.

Another is to provide room for physical activity, from yoga to treadmills. Research demonstrates the positive benefits of exercise on anxiety and depression. Current building codes for inpatient behavioral health units don’t require exercise areas, but as a result, they are missing a great way to support the link between lifestyle choices and behavioral health.

A third element to consider is nature integration, ideally with access to the outdoors. Design that addresses our primal connection to nature can help decrease blood pressure and the use of pain meds. Even an area for horticultural therapy and opportunities to take care of plants can help.

 

Why should investments in treatment and design go hand-in-hand?

Our spaces and places convey meaning, and it is crucial that we send the message that behavioral health patients are valued. In fact, it may be more important to have a well-designed behavioral health facility than a typical healthcare space. That’s because behavioral health patients typically spend very little time in their bedroom and are constantly interacting with staff and other patients. Meals are usually in a group setting, and there are different therapy sessions, from art to group to individual sessions. Design needs to be supportive of this treatment model.

 

What makes you hopeful when it comes to addressing the behavioral health crisis?

The first is the Affordable Care Act and healthcare parity laws that require treatment of mental illnesses just like physical illnesses — and that people can get insurance that covers behavioral healthcare. Funding to train more doctors, nurses and other staff that specialize in behavioral health is another. In Washington State, Governor Jay Inslee is proposing an initiative that puts funding in place for a new 150-bed behavioral health teaching hospital in Seattle, along with community behavioral health centers across the state.

 

Images courtesy Sean Airhart/NBBJ.

Share this:  envelope facebook twitter googleplus tumblr linkedin
Comment Follow nbbX

The More We Talk About Behavioral Health, the Better the Outcomes

A Conversation with Dr. Delaney Ruston, Filmmaker, Speaker and Stanford-Trained Physician

October 10, 2019

Planner/Healthcare Architect, NBBJ

Editor’s Note: The number of people reporting behavioral health issues is on the rise, a crisis often compounded by lower-than-average funding, a lack of psychiatric beds and high occupancy rates of behavioral health facilities. This week we are posting interviews with experts in behavioral health, following an NBBJ-hosted panel discussion, to learn how different parts of the country are addressing the crisis.

 

NBBJ: Could you tell us a bit about your upcoming documentary, Screenagers NEXT CHAPTER, about children with anxiety?

Dr. Delaney Ruston: We live in a screen-saturated world, and we’re examining how this affects teens’ emotions and communication preferences. In our film, we speak with teens about their personal stories, and talk with parents as well as schools — about what they are doing and how they can better support our teens. The film also explores my daughter’s experience with depression and my role as a parent.

A key goal of our film is to help all teens develop and build skills to thrive with hard emotions, such as stress, clinical depression and anxiety. We’re also motivated to raise awareness, to increase the national discussion surrounding teens and mental health. There are lots of interactive interventions, but it can be complicated and painful for our teens (and parents, too).

We’re so excited that this film uncovers lots of different solutions to a troubling situation. It also ramps up the science that shows why the teenage years are such an emotionally complex time. Teens are not just moody — their brains are undergoing rapid physiological changes.

 

What are the most impactful changes that could be made to how behavioral health is handled in the United States?

The first is that we could revolutionize the system to fully appreciate the magnitude of solutions available, particularly people power — our support teams, teen peer groups, school psychologists, etc. From my personal standpoint, my father with schizophrenia bonded with his case workers in such a profound way. I think we need to further contemplate and build this task force. The power of positive, supportive relationships is fundamental.

The other is integrating medical and behavioral health into one. Behavioral health is complex, and for some conditions, like depression, we need lots of mental health and social services support. To strengthen the link between the two healthcare areas, while training professionals (and paying them a living wage) as well as community members and peers, would go a long way.

 

What is an innovative approach/treatment you — or another institution, city, state, country, etc. — are working on when it comes to behavioral health treatments?

As a Fulbright fellow, I made films in India. During my time there, I spoke with and filmed mental health workers across the country and examined their peer-training system. Globally, I think the peer movement needs more funding and resources, particularly targeting college-age groups and above as mentors.

 

Traditional behavioral health facilities are seen as socially isolating or unpleasant to the senses. How should the design of behavioral health facilities transform to better serve patients (and their families and visitors) and staff?

If the right presentation and program is offered through a medical setting, the community will come. Seattle has a “birds and the bees” program, where parents come with pre-teens to discuss the impacts of puberty. It is critical we create welcoming spaces for behavioral health discussions, programs, training interfaces and more.

 

What makes you hopeful when it comes to combating the behavioral health crisis?

People are so eager to talk about these issues — and adolescents are overall being raised in environments that are more open to talking about these topics. Thankfully, this cultural mindset of greater acceptance is pulling the cover off the silence around mental health issues. It only hurts the situation by not discussing it. By seeing positive stories and showing that talking more about behavioral health leads to better outcomes, we’ll continue to benefit, as a community, in our families, and as individuals.

 

Banner image courtesy of John Durant/NBBJ.

Share this:  envelope facebook twitter googleplus tumblr linkedin
Comment Follow nbbX

Providing Integrated Care Is the Most Important Thing We Can Do for Behavioral Health

A Conversation with Dr. Gregory Miller, Chief Medical Officer, Unity Center for Behavioral Health

October 9, 2019

Planner/Healthcare Architect, NBBJ

Editor’s Note: The number of people reporting behavioral health issues is on the rise, a crisis often compounded by lower-than-average funding, a lack of psychiatric beds and high occupancy rates of behavioral health facilities. This week we are posting interviews with experts in behavioral health, following an NBBJ-hosted panel discussion, to learn how different parts of the country are addressing the crisis.

 

NBBJ: What is the most impactful change that could be made to how behavioral health is handled in the United States?

Dr. Gregory Miller: The development of a truly integrated system of care — not between behavioral health and physical health, but within behavioral health itself — is one change. Care for episodes of illness has become spread out between disparate providers, such as inpatient, partial hospitalization programs, outpatient, case management, etc. Often one team knows nothing about the real handoff information necessary to change the level of care smoothly. Delivering care from truly integrated systems would make a huge difference. In addition, community services need to be built out and invested in.

 

What is an innovative approach/treatment you — or another institution, city, state, country, etc. — are working on when it comes to behavioral health treatments?

The concept of Psychiatric Emergency Services, i.e. specialty mental health care that is immediately accessible, is an innovation that mostly benefits the severely mentally ill (SMI), a poorly-resourced population. It helps to rebalance the needs of the SMI population when community services are inadequate or poorly accessible. It should be seen as a temporary approach, providing access during a period of transition to more richly-resourced community services. When the community is adequately resourced, the need for such higher-end services will decrease.

 

Traditional behavioral health facilities are sometimes seen as socially isolating or unpleasant to the senses. How should the design of behavioral health facilities transform to better serve patients (and their families and visitors) and staff?

I like the design of progressively expanding “spheres of community.” For example, in an inpatient unit or subacute unit, the most intimate sphere of community is where one sleeps and tends to personal hygiene. Units where patient rooms are clustered internally with progressively expanding bands — such as an area for dining and group treatment, with activities that emerge into a larger sphere for consultation with providers, school service and family and visitation — tend to mimic life in the communities that we live in.

 

What makes you hopeful when it comes to combating the behavioral health crisis?

I am hopeful regarding the progression of knowledge and treatments. However, I am disappointed that care has become, over the course of my career, progressively more disintegrated and confusing. Systems do not converge to provide cohesive treatment. Patients are confused by the systems they are involved in. Providers, likewise, are confused. Hopefully this will be the next wave of progress.

 

Images courtesy Sean Airhart/NBBJ.

Share this:  envelope facebook twitter googleplus tumblr linkedin
Comment Follow nbbX
Next Page »

Follow nbbX