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Beyond the blueprints

March 1, 2008
by Dennis Curl, LEED AP
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A construction manager adds a valuable perspective to the design team

Psychiatric healthcare facilities are changing in both purpose and design. Gone are the days of locking up patients in an institution and forgetting about them. Today's psychiatric facilities are designed, built, and managed with the intent of rehabilitating patients so that they can return to society and function successfully.

As a result, new and renovated psychiatric hospitals are employing a community-design approach. Residential units are connected to a “neighborhood,” which then connects to a larger “downtown” area. There are common treatment areas but individual living quarters so patients are gradually exposed to more social opportunities as they move throughout the facility.

The language used to describe these spaces is changing from “hallway” to “street,” “unit” to “house,” and “ward” to “neighborhood” to reinforce a normalized environment. For example, at Worcester Psychiatric Hospital in Massachusetts the plan for the new facility (currently in the design stages) is to allow patients and staff to interact in a variety of settings throughout the facility to encourage individual growth and development.

The saint elizabeths construction site

The Saint Elizabeths construction site. Photos courtesy of Gilbane Building Company

The new psychiatric hospital being built on the Saint Elizabeths' campus in Washington, D.C., follows a similar design concept. Designed by Einhorn Yaffee Prescott Architecture and being constructed by Gilbane Building Company, the new hospital will integrate residential, treatment, and educational areas in an environment that reflects outside world experiences to better prepare patients for a return to the community. Patient treatment will take place in “malls” to encourage socialization.

At Greystone Park Psychiatric Hospital in Morris Plains, New Jersey, patients also receive their care in treatment malls. The 400-bed hospital, completed in October 2007, features on-site cottages that can house up to 60 patients to prepare them for the transition to more independent living.

It's on Paper—Now What?

Psychiatric hospital projects demand a particularly sensitive understanding of patient, staff, and visitor needs, both from a design standpoint but also during construction. Owners can get the most benefit by involving the construction manager (CM) early in the design process to ensure that everyone on the project team is aware of the design and field construction standards for this type of an environment.

The CM looks at the project from a different angle, particularly when it comes to the cost impact of the neighborhood concept. For instance, most new psychiatric hospitals use residential-style finishes as opposed to the traditional institutional finishes in order to improve patients' quality of life and to mirror real-life experiences. Those finishes will impact the budget, however, and it's important for owners to recognize how their decisions will affect the bottom line.

In addition, the modular structure of the neighborhood design, with residential clusters around downtown areas or treatment malls, can contribute to escalated costs over traditional healthcare buildings. Facilities using the neighborhood concept have greater exterior wall area as opposed to a typical hospital, which is more rectangular-shaped and has several floors. Single-patient rooms, which are becoming the standard for new healthcare facilities and aid in making patients feel more independent, also increase the amount of area needed per patient and add to the cost.

Thus, it comes down to what a good CM can bring to the table during the construction process for these unique facilities. Most owners will build only one psychiatric hospital in their careers, so they don't typically have a history to reference. The CM can bring that history to the design and planning process, along with answers to the day-to-day questions about running the construction project, such as: What do we need to think about? What have we forgotten? How will we protect patients during construction?

Safety and Security

When building a psychiatric hospital, particularly an addition to an occupied area, safety and security are paramount both for patients and the construction team. Construction tolerances for completeness, detailing, and cleanliness are a lot more stringent when building these facilities.

For example, at Saint Elizabeths one important requirement was that the walls be sealed all the way up to the underside of the slab above, to prevent access to the room and cross-talk from one room to the next. Sealing the walls meant that there would be limited accessibility to the wall cavity should a problem arise in the future, so extra care had to be taken to keep the wall cavity as clean as possible during construction. (On a typical construction site, debris can get into the wall cavity, and because of the decomposition of debris, there is a potential for mold—hence the reason for extra precautions.)

Since the new Saint Elizabeths includes a civil hospital and a forensic hospital in one building, workers have to follow the security measures used for working in a prison. Although the new building is not connected to existing structures, it is on the same site. Therefore, the team has to record anything brought onto the site in the morning and make sure it is taken off the site or securely stored at the end of the workday.