Let’s Commit More Resources to Behavioral Health

A Conversation with Dr. Curtis Wittmann, Associate Director, Acute Psychiatry, Massachusetts General Hospital

October 8, 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. Curtis Wittmann: The biggest issue currently is a lack of resources. This crosses many domains, ranging from a lack of true parity, which makes recruitment of providers more difficult; a lack of places to refer patients; inadequate inpatient and state hospital beds; and a lack of social resources and programs, which impedes our patients’ ability to engage in treatment.

An increased availability of resources, both within the mental health field and as social supports, would allow for meaningful and novel approaches to be implemented. Until then, even in relatively resource rich-environments, we don’t have enough to offer our patient
populations.

 

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

At Massachusetts General Hospital we have been redesigning our dedicated emergency psychiatry space and increasing both our capacity and attention to patient comfort. We are moving to minimize the use of inappropriate clinical space and attempting to allow for a more open design to allow more patient interactions and increased programming while patients are boarding in the emergency department.

Concurrently, we are working to initiate treatment from the point at which patients arrive to the ED and are screened by emergency medicine. Both of these initiatives are designed to decrease the amount of boarding that takes place and the length of stay for patients who are boarding.

 

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?

There is always a balance between the need for safety on the one hand, and maximizing patient comfort, freedom and environments on the other. Increasing safe open spaces to allow for connection between patients, between patients and staff, and between patients and their families and visitors is critical.

Ideally these settings would make better use of natural light or, if possible, outdoor spaces — though this is very challenging in city environments. It may be possible to create a more natural space indoors through the use of plants and more creative design.

Finally, there is increasing attention to the role of physical activity and exercise in mental well-being, and even suggestions that exercise may be an effective treatment for several mental health conditions — a creative design would work to implement increased walking space and/or a semi-dedicated space for exercise with associated programming to implement positive habits or continue them while patients are hospitalized.

 

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

I’m made hopeful when I see the response to the opioid use disorder epidemic. Although it was delayed, across the country there has been a dramatic increase in the commitment of resources to treatment and to novel programs within hospitals and communities. These resources have been a blend of government resources along with hospital and private resources.

The mental health epidemic does not have the same dramatic statistics regarding increasing death rates, but arguably it extracts an even larger price from a larger number of people. Should we be able to learn from some of the lessons of the opioid crisis — rapid access to treatment, de-stigmatization, increased recovery supports — we could have a similar impact on improving our country’s approach to behavioral health.

 

Banner image courtesy of Anton Grassl/Esto/NBBJ.

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Behavioral Health Needs Spaces Where Patients Can “Pass Storms and Glimpse a New Horizon”

A Conversation with Dr. Susan Swick, Physician in Chief and Medical Director, Ohana Montage Health

October 7, 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. Susan Swick: Psychiatric illnesses are common and treatable, often curable, but access to effective treatment remains maddeningly difficult in the United States. Yet even with effective treatments, being disease-free is not the same as being healthy. Building mental health can protect against disease and contribute to a life of meaning, with happier relationships, satisfying work and better physical health. Helping people to understand that good mental health is something each individual must develop will not only improve public health, but also diminish the stigma that remains around mental illnesses.

Finally, by helping parents to understand that mental health is something we help our children develop, rather than simply protecting them from mental illness, we contribute greater resilience in children and well-being in families. I have seen the power of these ideas at work in my patients and in my own family and am passionate about contributing to a health care system that builds health.

 

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

The physical environment in which care occurs contributes profoundly to the well-being of patients and caregivers, just as classrooms affect students. Environments create our sense of what is possible, while raising or lowering the volume of what we are hearing in the moment. Environments — including the materials, presence of natural light, fresh air and sounds — have the power to be soothing and quieting or highly stimulating and activating.

In a windowless, crowded psychiatric emergency department in NYC, I experienced the power of music to quiet agitation and comfort the lonely: a cozy office filled with art, books and overstuffed furniture created the personal, warm and reliable setting that allowed effective psychotherapy to take place. In addition, an escalating child was able to go on a walk outside with a trusted adult and was able to naturally re-regulate themselves and not require medications or restraints to do so. The setting never does all the therapeutic work, but the right setting makes it possible for the clinician and patient to do the work together.

 

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?

Behavioral health facilities are still healthcare facilities, and they must ensure safety, including infection control, prevention of suicide and everyone’s safety around agitated or aggressive patients. But they must support quality care, also. I think design for highest-quality behavioral health care should create an environment which is soothing — with, for example, lower noise levels, natural materials, neutral colors, predictability and options for retreat or privacy. At the same time, they should be inspiriting or support a sense of possibility with higher ceilings, dynamic views, fresh air and ample, diffuse, natural light.

It is critical that these spaces include the potential for agency or choice, more so when patients spend more time in them. We hope that the skills which our patients build in these spaces will remain when they return to their homes, offices and schools. Therapeutic spaces should echo the spaces our patients inhabit. But they can still be special — spaces in which to pass storms and glimpse a new horizon.

 

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

If design can serve both the passing of a storm and the promise of an open horizon, all while promoting agency, it will be an extraordinary space. When we provide care and offer education about mental fitness in spaces that everyone is delighted to be in, it destigmatizes mental illness in ways that words and statistics cannot. When we provide care in humane spaces that promote autonomy and individualism, alongside nurturing connections between patient and clinician, between family members, among colleagues, between friends, and across a community, we support mental fitness in our patients, ourselves, our colleagues and our guests.

 

Banner image courtesy D Ramey Logan/Wikipedia.

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Thriving, Not Just Surviving: Solving the Climate Crisis

A Visit to the 2019 UN Climate Action Summit

October 4, 2019

Director of Design Performance, NBBJ

I had the privilege of joining the 2019 UN Climate Action Summit in New York City earlier this fall. Amongst the many tracks at the event, my focus was on Infrastructure, Cities, and Local Action — how to bring climate solutions to bear in cities that are on the front lines of emissions, impact and action. As the creators of cities and the urban context, our profession plays an integral part of any climate crisis solution and must be actively involved in driving the world forward.

My key take-away from the summit is the broader societal success that will result when our cities transform into zero-carbon economies. Zero-carbon cities will be healthier, cleaner, more connected, more resilient, and the drivers of innovation and green economic success. They will be the places where you want your children and grandchildren to live. It’s hard to argue against that.

It is of utmost importance for the design industry to elevate the discussion around these greater societal benefits, especially in these times of disagreement over the urgency of the climate crisis. Focusing on the non-climatic benefits can drive greater change while we reap the environmental benefits. There are stories and threads for every audience — be it economic growth, resilience and security, human health, ecosystem restoration or social justice.

What can we do, as city designers, in a context where, as Ms. Maimunah Mohd Sharif, executive director of the United Nations Human Settlements Programme, said at the summit, 75% of the 2050 infrastructure has yet to be built? Here are a few ideas:

  • Bring long-term thinking to our projects. All our current buildings will be around in 2050 — are they able to make the transition and meet the 2050 goals for zero carbon?
  • Utilize full-cost, life-cycle accounting in our decision-making, bringing in the cost of carbon and societal impacts and evaluating them from construction to decommissioning.
  • Focus on the human experience — zero carbon means little if our projects aren’t wonderful places for people.
  • Focus discussions around non-carbon benefits to build stakeholder support.
  • Don’t look for a “new tech silver bullet” — the solutions we need, from heat pumps to solar and wind energy, are here, now.
  • Lead from within.*

While getting to zero carbon by 2050 is a daunting task, it is achievable. We see tremendous growth in action and commitment across the public and private sector — whether it’s Amazon’s recent Climate Pledge, New York City’s buildings’ carbon emissions law or the consortium success of the C40 Cities Initiative.

I’m bullish about our capabilities and the passion and talent across the AEC industry and beyond. Together, we can drive this exponential curve to zero carbon and enjoy a beautiful and healthy future in our cities — cities that will house 5 billion of us by 2050.

“Getting there [to zero carbon cities] will be the growth story of the 21st century.”
—Lord Nicholas Stern, London School of Economics

 

* Here are a few of the things NBBJ is doing:

  • More than a decade of commitment to the Architecture 2030 Challenge
  • Leaders who are active in their communities, from driving local code changes to serving on national and international boards and committees, including the Living Futures Institute, the AIA’s Energy Leadership Group and ASHRAE
  • Founding sponsorship of and membership in Targeting 100! with the University of Washington
  • Our Legacy Project in partnership with the Nature Conservancy

 

Banner image courtesy of Pixabay.

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