An exploration of versatility in design

During the medical equipment planning process, we are frequently encountering a new trend:  the potential for one of the rooms to be designed for use in behavioral health situations.  According to CDC, more than 50% of Americans will be diagnosed with a mental illness or disorder at some point in their lifetime and 1 in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression.  With these numbers, it is no wonder that the topic comes up regarding medical facility design.

The concept of enabling a traditional inpatient unit to meet the needs of a wider population is an intriguing one.  Patients don’t always fall into a single category and may need a special combination of care.  If you consider patients with multiple conditions, such as an ortho rehab patient who has Traumatic Brain Injury (TBI), a cardiac patient who has PTSD, or any of a multitude of comorbidities that could occur, you start to see the need for flexibility in design.

A major problem with this concept is the dichotomy between a standard inpatient room and a behavioral health space.  Everything from door hardware and casework style to window treatments and medical equipment must be addressed.  Since standardization across a unit is key to efficient workflow, a decision must be made regarding the extent of the differences of a behavioral health room.  If the room is to be usable within the unit’s primary function, there is only so far you can go towards behavioral health design.

Behavioral health design decisions should be based on several criteria.  The most important item is patient and provider safety.  This is a commonly recognized topic, with anti-ligature fixtures and furniture being prevalent on the market.  However, due to clinical patient care needs, medical equipment can rarely be made ligature-free.  The VA, in their Mental Health Facilities Design Guide, states that bariatric and disabled with physical or medical conditions compromising basic living activities should generally be treated in a medical or med-psych setting.  This is largely due to the near impossibility of creating an anti-ligature environment for patients that require IV pumps, ceiling mounted patient lifts, or any number of other equipment.

Patient well-being is also an important consideration.  Recent trends in behavioral health design have moved towards transparency and comfort, with the goal of de-stigmatization and creating environments that promote healing.

Observation

Observation is an important consideration for a behavioral health room.  If the room is set up for 1:1 observation, many of our clients have determined that the FF&E does not need to be completely anti-ligature.  Instead, patients’ safety is monitored through direct observation by caregivers as part of the room design.  This could be as simple as a work alcove in the hallway with a window into the room (already common on inpatient floors) or transparent doors with direct-line-of-view from the caregiver station.  In the UCHealth AIP2 Clinical Observation Unit, security cameras were installed near the televisions for remote observation. The article “Applying Behavioral Health Design Strategies to the ED Environment” goes into some detail regarding the difference observation can make in behavioral health design requirements.

Layout

The layout of the room should be considered early in the design phase.  Locations of casework, outlets, televisions, and other non-movable objects need to be determined so that safety concerns can be addressed.  Safety features such as roller doors should be designed based on what is going to be behind them.  If only a headwall with outlets, flowmeters, and suction regulators will be hidden behind the door, it can be very shallow.  However, it will have to be much deeper if the plan is to have wall-mounted equipment, such as physiology monitors, behind the door.

Hardware

This is an important consideration for a behavioral health room.  Everything must be considered.  Behavioral Health Facility Consulting released a white paper entitled “Behavioral Health Design Guide“.  It is a thorough paper addressing the built environment for adult inpatient behavioral health facilities.  Once the observation method has been determined, the matrix that is presented in the document can be used to determine which level of risk your space falls into. This determination can then be used throughout the design process.

Furniture

Furniture choices are key when it comes to patient well-being.  There are multitudes of designs options that will work in a variety of situations, but they all lay somewhere between what you would expect to see in a standard inpatient room and traditional behavioral health furniture.  Designing to your unit’s purpose will determine where on that spectrum you end up.  Even with changing design trends, a dedicated behavioral health unit has very different needs from an ortho room designed for patients with TBI. The observation decisions discussed earlier in the article will have a considerable impact on your furniture selections.  The article “5 Ways Design is Transforming Behavioral Healthcare” offers insight into other important design topics to address.

Stay tuned for the next section of this post, where we will explore the issues relating to medical equipment planning in behavioral health design.

Laura LeTang

Medical Equipment Planner

laura@maiaplanning.com

Maia Consulting, LLC