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The evolution of behavioral healthcare facilities and emerging trends

August 25, 2014
by Megan Combs
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Designing new behavioral healthcare facilities is about patient dignity, said Perkins+Will architect Kevin Turner at an Aug. 25 presentation at the Behavioral Healthcare Leadership Summit (BHLS), which is part of the National Conference on Addiction Disorders. The session was presented in conjunction with architect and consultant Jim Hunt. 
"We want this to be a place where people aren't ashamed to go for treatment," Turner said. "People have fears of these facilities because of what they've seen on TV or in movies. You should feel comfortable leaving your loved one there for care. (The facility) needs to be designed so that they feel appropriately dignified being there.
Hunt and Turner started their presentation with a history of where behavioral healthcare started. Hunt said the earliest known "lunatic hospital" was built in 872 in Cairo, Egypt. By the Middle Ages, mental health patients were taken to towers, monasteries and madhouses. Some of these were attached to hospitals.
"The concept was the get the mentally ill away from the rest of society," Hunt said. "They weren't getting any treatment."
Then Panopticons were built, Hunt said. These buildings were circular and had a big tower in the middle. Patients were told guards were in the tower watching them, but patients couldn't see into the tower. 
"You can imagine how oppressive it was," Hunt said. "They were built well into the 20th century. This idea took a long time to die."
In 1848, behavioral health advocate Dorothea Dix began complaining to North Carolina state legislators about the lack of hospital beds for the mentally ill. She was tired of seeing these patients being sent to jail or courthouses without getting proper treatment, Hunt said.
At around the same time, Thomas Story Kirkbride was the first architect to come up with a design concept that helped the mentally ill get better. He created a system of buildings, with one central building, where patients started at the back and worked their way forward in the system.
"It was a very unique, modern and revolutionary design concept," Hunt said. Today, Oregon State Hospital and Greystone Park in New Jersey are examples of this design.
Today, Turner and Hunt are working on rebuilding Broughton Hospital in Morgantown, North Carolina. The hospital was built in response to Dorothea Dix's complaint about the lack of hospital beds for the mentally ill. The cost of renovating the existing building was around $400 million. Starting from the ground up was closer to $140 million.
The new Broughton Hospital has a main building and six units that branch off a main hallway. On one side of the building are three patient room buildings that are three stories high. The other half of the building is what Turner called a "treatment mall."
"The point of the treatment mall is to get the patients on the right medication so they're stable enough to go somewhere that is less expensive for continuing care," Turner said. "Patients go and have breakfast, attend classes to stay engaged to be monitored for behavior, then they go back to unit and spend afternoon there. The get a sense of going somewhere, and a sense of stimulation."
Another trend Hunt and Turner see is finding the proper balance between staff safety and weighing against need having patients feel in control of their healing experience. 
"It's important that staff isn't too overbearing and that the patients feel like they're in control of their life and their healing," they said.
Today 89.3 million Americans live in mental health professional shortage areas, Turner said. 
"This is going to get worse and not better," Turner said. "We have a low number of students choosing this field in medical school. We're losing seasoned professionals to retirement and we're not replacing them fast enough."
Are you designing a new treatment facility? What methods or ideas are you using to help the patients feel in control of their recovery?