Residents of the Taube Pavilion in Mountain View, California, wake up in private rooms with views of the wooded Santa Cruz Mountains, have breakfast in airy common areas and can hang out in landscaped courtyards throughout the day.
It may sound like a resort, but the Taube Pavilion is a $ 98 million mental health institution that opened in June as part of El Camino Hospital. The 56,000-square-foot building was designed by WRNS Studio and is one in a new wave of facilities that are shutting down outdated institutional models.
Psychiatric hospitals have been grim environments for decades where patients were crammed into ordinary rooms and dormitories at night during the day. But new research on the health effects of our environment is leading to the development of more residential facilities, with welcoming entrances, smaller living units in larger buildings and a variety of meeting rooms. Nature plays a big role: windows offer a view of greenery, landscapes adorn walls and outdoor areas give patients and staff access to fresh air and sunlight.
The new approach, which is being promoted as curative and therapeutic, has created calming and supportive environments. And it feels particularly timely, given the increase in mental health issues caused by the pandemic.
“We’ve been talking about this for a very long time,” said Mardelle McCuskey Shepley, chair of the department of design and environmental analysis at Cornell’s College of Human Ecology. “It’s only now gaining momentum.”
Even before the pandemic, the number of Americans affected by mental illness was at a new high. According to the National Institute of Mental Health, one in five adults has experienced depression, bipolar disorder, schizophrenia, post-traumatic stress disorder or some other illness. The rates were significantly higher for adolescents (about 50 percent) and young adults (about 30 percent).
Almost a year into the pandemic more people are suffering. Young adults and black and Latino people of all ages report increased levels of anxiety, depression and substance abuse, according to a survey by the Centers for Disease Control and Prevention. A recent Gallup poll found that Americans felt their mental health was “worse than it has been at any point in the past two decades.”
The demand for treatment has skyrocketed, and the establishment of mental health facilities is better than that of other specialist hospitals. Last year, 40 percent of the specialty hospitals under construction were psychiatric hospitals and behavioral health centers, according to the American Society for Health Care Engineering.
Architecture and interior design firms with expertise in healthcare buildings have reported an increase in activity. Francis Murdock Pitts, a principal and founding partner, says Francis Murdock Pitts at the design firm Architecture + in Troy, NY, usually has one or two major mental health facilities in the pipeline. Last year, the firm worked on 16 major mental health projects totaling $ 1.9 billion.
His firm and others have medical planners who help staff translate research into ‘evidence-based’ designs. “It’s not just about hot and fuzzy,” he said. Pitts said.
For example, exposure to nature has been shown to lower cortisol levels, a degree of stress. Adding healing gardens and other vegetables can help soothe uncomfortable patients and provide a place for staff to decompress.
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Research specifically for mental health care institutions is also relevant. Studies have shown that reducing pressure by providing private rooms and multiple common spaces can reduce stress and aggression. Reducing noise – for example, removing unnecessary squeaks from medical equipment – can also help. If patients are less stressed, they can make faster and more lasting progress during treatment, experts say.
But because mental health issues are very different, there is no one-size-fits-all design solution. And safety – for both patients and staff – remains important.
Codes and guidelines that have been in place over many years have sought to eliminate room features that patients have used to harm themselves and others. Window glass is made of polycarbonate joints to reduce breakage. Doors are hung on quick release hinges to allow staff into a room when a patient is locked up. Plumbing and other accessories are designed to prevent the possibility of hanging or strangulation.
Such security measures are crucial, but ‘you do not want it to get to a point where it looks like a prison,’ says Shary Adams, a principal at HGA, a national design firm. At the same time that the built environment needs to be designed to ensure safety, there is also an effort to give patients some control over their environment. Manual thermostats allow patients to adjust the temperature in their rooms, and through dowmer switches they can modulate the lights.
The location of mental health facilities is also changing. Psychiatric institutions used to be hidden, but today they are probably part of hospital campuses or otherwise located. They often combine inpatient rooms for those who need 24-hour monitoring and areas for outpatient services, allowing patients in the same building to switch to less intensive care.
A modern youth center in Monterey, California, illustrates the new approach. Montage Health, a nonprofit provider, broke ground on the 55,600-square-foot building in November.
The name Ohana, a Hawaiian word for an extended concept of family, provides young patients with psychiatric treatment that sometimes involves their parents and siblings. Care early in life is crucial because half of all mental illnesses are by 15 years and 75 percent by 24 years old, said dr. Susan Swick, doctor in Ohana, said.
She asked architects at NBBJ for a design that would contain the wonder of a children’s museum or a public library – “a place where you walk in that gives you the possibility of rising possibility,” she said.
The building will be surrounded by beautiful old oaks on the sloping grounds overlooking a green valley. It contains inpatient rooms, an outpatient wing, several classrooms, and a variety of groups for group and individual therapy.
The site will provide areas for yoga and informal gatherings. Roads will be lined with cedars and pines, rosemary and lavender – plants whose scents activate ‘natural killer cells’ that can boost immunity, said Richard Dallam, a managing partner of NBBJ and a leader in the firm’s healthcare practice.
‘It’s not just beautiful; it is purposeful, ”he added.
With its whips and curves, Ohana looks like an intricate building to erect, but it is built with cross-laminated wood in modules that can be assembled from the site, reducing costs and speeding up construction. The prize: $ 50 million, covered by a $ 106 million donation that will also provide funds for clinical services.
Yet not every hospital system has an angel investor, and it is more expensive to build buildings with these new designs – private rooms alone increase costs.
Advocates say, however, that the upfront spending could lead to savings on the road, which could improve staff retention, for example because workers are less likely to burn out and need to be replaced with new employees who need to be trained.
“We try to use evidence-based design to help clients connect with other things on their balance sheet,” said Angela Mazzi, a principal at GBBN and president of the American College of Healthcare Architects, a certifying organization. said. “By investing in some of these things that are not a simple part of the clinical space, you will get different outcomes and a different payback.”