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Top 10 Designs to Rethink in Your BH Facility

November 20, 2013
by Megan Rozsa
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James Hunt started his Healthcare Design Conference session on Monday by saying that if you're running your behavioral health facility on the principle of "that's the way we've always done it," it's time to change.
 
Hunt was a speaker at the Healthcare Design Conference in Orlando, FL, on Monday.
 
His session was titled "10 Things You Know That Just Ain't So," paraphrasing a quote by Satchel Paige that is along the same lines: "It's not what you don't know that hurts you, it's what you 'know' that just ain't so."
 
"Behavioral health (BH) rooms are different from general hospitals because what works in one won't work in the other," Hunt said. "General hospital patients spend most of their time in their room, where BH patients don't."
 
He outlined 10 things that he says professionals think they know about the design of a BH facility -- all things that should be changed and improved. 
 
1. Design models aren't one solution fits all.
"People ask me 'What's the ideal design?'" Hunt said. "It takes a discussion to learn about the population. I think the longer the length of the patient's stay the more diverse you can be with design."
 
2. Suicide assessments are not reliable.
"A VA study from 2012 says all suicide assessment tools currently in use are not reliable," Hunt said. "If we rely on some kind of assessment to separate suicidal patients from nonsuicidal patients, we're walking a dangerous path."
 
3. Instead of having a few safe rooms, design them all to be safe rooms.
"So what if you have four safe rooms and five suicidal patients?" Hunt asks. "We need to let the building do what the building can do to free up the staff to take care of patients."
 
4. Fifteen-minute checks do not prevent suicide.
"Patients learn how to time the checks and staffing patterns," Hunt said. A way several patients have committed suicide in a short amount of time is by anoxia, Hunt added. Patients tie something around their next to cut blood-flow to the brain and lean forward to create tension. In four to five minutes, they're dead.
 
5. One-on-one observation is not a sure thing.
"Patients can overpower the watcher, or in one case from a jail, still kill themselves," Hunt said. He explained one woman in a jail cell was watched by her husband overnight, and she still managed to kill herself. She took a roll of toilet paper with her to bed and stuffed pieces in her nose and mouth. 
"I think electronic surveillance could work, but it gives us a false sense of security," Hunt said. "It's only good if someone is watching."
 
6. Adding staff doesn't work. 
"It's expensive and in the long run doesn't really improve treatment," Hunt said. "Design a building that can help you work with less staff."
 
7. Corridor doors aren't always foolproof.
"Patients have figured out how to make these doors dangerous," Hunt said. "Doors are the leading attachment point for suicide." 
 
8. Barricading is an issue. 
"Anchor your furniture to the floor so patients can't move them in front of the door," Hunt said. "Make it so that your doors swing a certain way so that patients can't hide behind them."
 
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Hi James. Yes I am in agreement with your design aspects. Since I work as a design engineer I recommend as a door component digital doors that open via a swipe. Costs more but alleviates the frustration of having key entry. Secondly key entry to patient doors is highly annoying due to the noise factor. And as for showers I recommend no doors and definitely no shower curtains. I would like to see psych units as high tech and futuristic in design as possibly can be. I myself have over the course of ten years helped design three psych units in Australia and one in the usa. Now colleagues and I are designing a behavioural unit in the usa to rehabilitate and educate people with behavioural disorders. I've been trying to make the units more welcoming and therapeutic and with programs to alter behaviour that is problematic, enhance therapeutic programs. I very much like the idea of sensory rooms. These rooms are particularly good for self harm victims. Perhaps in the coming months or year our paths will cross again. Good day.

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Megan Combs

Associate Editor of Reader Engagement

Megan Combs

@VendomeHCMedia

www.vendomegrp.com