It was Mother Teresa who said that the biggest disease of our generation will not be Leprosy or Tuberculosis, but mental health in the west. Nothing could’ve ushered it more swiftly to the forefront than the current pandemic, and not just in the west but worldwide!
According to a report published by Mental Health America, 19% (47.1 million) of people in the U.S. are living with a mental health condition, a 1.5 million increase over last year’s report. The past year has seen a 90% increase in telehealth, 40% increase in IOP/ambulatory care and a 10% increase in brick-and-mortar facilities of behavioral health cases. According to a FAIR Health “white paper”, mental health claims essentially doubled as a percentage of all medical claims for individuals age 13-18 in March (+97%) and April (+103.5%) of 2020 compared with the same periods a year earlier. Medical claims overall fell by about half during that time. If there is a silver lining, our younger generation has normalized talking about mental health and substance abuse and adjusting behaviors to address the condition.
While design of all healthcare facilities is key to delivery of care, design has the power to influence attitudes towards mental health. More than any other area of patient care delivery, mental health faces the dichotomy of providing care and the safety of staff delivering that care. The design community has dived headlong into finding ways to provide dignity of care through passive security measures. The clinicians’ first line of response is not security but de-escalation. To that end, replacing bullet-proof glass with discreet activation buttons to call for support, and physical badge alarms to bring professional care quickly and easily to the case has become commonplace.
Design of behavioral health facilities has seen a shift from us versus them mentality, to more of a home-like concept. Gathering around a “kitchen table” concept where there is no front or back, or us versus them approach. The model of care is moving closer towards an Apple Store type decentralized model providing increased sense of safety, improved access, and imparting a sense of socializing (and social distancing) while providing the care.
At a recent virtual webinar addressing this concept of delivery of care, an attendee challenged the safety aspect of this method. It was reassuring to hear a healthcare professional unmute his microphone and speak about working at a recently completed behavioral health facility that was designed to follow this type of open concept and a year into it, he saw a reduced incidence of agitation-related actions/reactions.
Outdoor connection is another key component in the delivery of behavioral health care. It’s proven that access and exposure to nature not only makes one feel better emotionally, but it also contributes to physical wellbeing by reducing blood pressure, alleviating muscle tension, regulating the heart rate, and the production of stress hormones. Providing opportunities for access to nature at multiple levels in the built environment in the way of design is illustrated at the NeuroDiagnostic Institute in Indianapolis – locating building volumes to create interstitial outdoor terraces that not only provide that access to nature at every level but mitigate chances of injury by creating a stepped back massing that reduces the impact of injury from height.
The Centers for Medicare & Medicaid Services (CMS) published the revised anti ligature standards in 2017 that provides standards for every area used by patients. The American Society for Health Care Engineering advises the 3-prong approach of identify, observe, and remove. The emphasis being that if there is an option of providing 1-on-1 observation of at-risk patients, the only hazards that need to be removed is anything that can be used quickly to inflict harm.
Of course, there are exceptions to the rule such as with privacy laws or facilities that are not equipped to provide the 1:1 care. It is about humanizing the built environment, providing light and augmenting the ambience of the space through design, the use of constantly evolving products and furnishings with the goal of restoring human dignity. It’s about constantly reinventing ourselves as a design community to provide a space that supports healing and recovery.
To conclude with a quote from Mother Teresa – ‘It’s not about how much you do, but how much love you put into what you do that counts.’
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