With the goal of treating people with mental illnesses having moved from institutionalization to rehabilitation in the community, the mental healthcare landscape has transformed during the past 40 years. As the profession has evolved, designers of treatment facilities have endeavored to keep pace, seeking an alternative to the isolated rooms and dark corridors of the past.
The emergence of sustainable design—green” buildings that promote healthy indoor environments while limiting natural resource consumption—represents a new common ground for architects and mental healthcare professionals. The synergy between sustainable design and the mission of behavioral healthcare organizations is clear:
Improved indoor air quality and greater access to natural light create an ideal healing environment.
Operational savings through energy efficiency and water conservation free up monies for enhanced patient and staff amenities.
Efforts to protect the health of the environment directly reflect and impact efforts to improve the health of people.
With the benefits of going green now widely recognized, the challenge becomes implementing a system to guide the design of sustainable facilities. To meet this challenge, the U.S. Green Building Council has created the LEED (Leadership in Energy and Environmental Design) Green Building Rating System. LEED is a recognized benchmark for the design, construction, and operation of high-performance green buildings. LEED promotes a “whole building” approach to sustainability by recognizing performance in five key areas:
Sustainable site development
Indoor environmental quality
The LEED rating system awards points for specific strategies integrated into the building and/or achieved outcomes. The LEED certification level is awarded based on the total score earned. Platinum is the highest designation, followed by Gold, Silver, and Certified. The Southeast Regional Treatment Center (SERTC), an inpatient mental health facility in Madison, Indiana, recently achieved LEED certification.
Building 13 is one of two new residential facilities constructed on SERTC's campus.
The Activities Building underwent significant renovation to accommodate modern treatment demands.
Leadership From the Top
SERTC is situated on a 650-acre campus overlooking the Ohio River. In 2001, state officials decided that SERTC, originally built in 1904, needed to be updated to support state-of-the-art treatment and therapy for inpatients with serious mental illnesses and/or developmental disabilities throughout an 18-county region. A primary goal of the project was to create an operationally efficient, functionally flexible campus that would serve the state's needs for 50 years.
Our firm, HOK, previously had designed Evansville State Hospital (another of Indiana's five psychiatric treatment centers) with a variety of sustainable elements. Chief among these was an exterior composed of autoclaved aerated concrete, a product manufactured using fly ash residue from the burning of coal in power plants. At the time, this represented the largest, most extensive use of this recycled product within an institutional facility in the United States.
Motivated by the Evansville project's success and a desire to “green” government operations, the state (under the leadership of Susan Williams, then executive director of the Indiana State Office Building Commission) mandated that SERTC be redesigned to achieve LEED certification. This leadership from the top set in motion an integrated design process from the outset and proved instrumental in meeting project goals.
A Greener Campus
The redesigned SERTC combines new and renovated historic buildings. Although the original brick buildings were beautiful on the outside, years of neglect had left the interiors virtually unusable for modern treatment demands. As a result, some state officials favored all new construction on a “greenfield” site. Other officials, together with the project team and the SERTC staff, proposed conserving as much of the historic site as possible without limiting functionality.
The ultimate solution was to renovate three of five “bluff” buildings overlooking the Ohio River to ensure that both treatment modalities and historic preservation requirements were met. Two residential buildings had to be demolished, but were rebuilt on-site, to maximize efficiency and effective patient care.
The overall design concept is tied directly to SERTC's mission to rehabilitate clients so that they might lead full, rewarding lives independently in the community. To that end, the daily regimen at SERTC mimics community living. Clients sleep in rooms (home), head to the community rooms (neighborhood) to do laundry and other basic activities, and then go to the central area (main street) for education and socialization. This treatment program determined SERTC's overall architectural form.
Sustainability is incorporated into patients' daily activities, including learning how to separate and recycle waste products. In addition, silverware has replaced the use of plastic utensils. Measures such as these are intended to help prepare patients for their future life off campus as much as possible while also reducing the solid waste created on-site.
Aiming for Sustainability
The project team actively monitored the LEED checklist and informed the state of essential points throughout the process. Indoor air quality standards, environmental controls, and the use of nontoxic materials were required by Indiana healthcare facility guidelines and provided built-in LEED points. Modern healthcare design trends, such as increased daylighting, also contributed to a higher score. Yet to achieve LEED certification, additional measures and approaches were required:
A construction waste management program diverted approximately 80% of construction waste from landfills. For example, we reused bricks and roof tiles from demolished buildings, which also made the new buildings visually compatible with the original structures.
Efficient windows and optimal insulation in the walls improved the “thermal envelope” of the century-old buildings.
An optimized HVAC system increased patient comfort and overall efficiency.
A computer energy model was used to fine tune the mechanical systems and building management systems to monitor performance.
Bicycle racks and shower facilities for those biking to the site were incorporated.
Implementing these features demanded a great deal of perseverance and resolve. The exterior walls, for example, required constant attention to optimize performance. The project team analyzed the walls' thermal properties to determine the most effective thickness and insulation. The results were applied to practical considerations such as the project's budget and compatibility with the design. This resulted in an affordable, appropriate building envelope boasting optimal efficiency.
Access to natural light and views received similar attention. In the older buildings we added skylights, clerestory windows, and highly fenestrated hallways to introduce natural light to public spaces. Shading devices and obscured glass were added in private areas to prevent excessive glare.
The key to successful implementation of green measures was integration across all disciplines. For example, architectural conditions in the design were tested with energy models from engineers, with the costs of implementing them determined by the contractor. This approach led to buildings sustainable at their core and not just “greenwashed,” i.e., standard buildings with outwardly green elements tacked on. This past January, three buildings on the SERTC campus became LEED certified: the two new residential facilities designed by HOK and a major renovation of an activities center designed by RATIO Architects, Inc.
Despite a limited budget, we achieved LEED certification and met all other project requirements. With mandated standards from the client, commitment from the project team, and an integrated design approach, we believe any project can meet high environmental, aesthetic, and operational goals on time and within budget.
SERTC was the first LEED project for everyone on the project team. As with a first attempt at any enterprise, the process was not always smooth and required fine tuning throughout. Despite these growing pains, everyone involved believes it was well worth the effort. In subsequent projects, team members have found the LEED process to be much smoother and easier to implement. We suggest hiring a LEED consultant to map out the process for a firm striving to achieve LEED certification for the first time.
Objections to pursuing a sustainable design—most often budget related—can appear reasonable at first. Yet when we take a step back, we soon realize that it is something we simply have to do. With the treatment of people with mental illnesses having progressed so dramatically in recent years, it is time for mental health facilities to catch up. The LEED system offers a reliable guide for helping to make this happen.
David Buckley, AIA, LEED AP, is a Senior Project Designer in the St. Louis office of HOK, a global architectural firm.
Brian Smyth, AIA, LEED AP, is a Project Manager in HOK's St. Louis office.