Providing treatment for children and adolescents who are experiencing psychiatric crisis is at once challenging and rewarding. It’s heartbreaking to see young children in desperate need of psychiatric attention, and designers are acutely aware of the toll this illness takes on their parents. Our goal is to support the providers by designing inpatient units and outpatient clincs that are supportive of the healing that needs to take place there. It isn’t enough just to keep these patients safe from harm (as important as that is). It is essential that we create therapeutic environments carefully tuned to the needs of these age groups.
With numerous children’s and adolescent units under our belts, we have learned some important rules about designing for this population.
Children need to play. Anyone with kids knows that you can’t give them a room full of chairs and ask them to sit still until the next organized activity. Regardless of any psychiatric crisis, that is just too much to ask. The space we design for these patients should encourage play and activity in a safe and appropriate way. It is also important to provide a variety of options, from quiet reading to active sports time.
Children need to be in a peer group that isn’t threatening. Creating smaller units or dividing units into pods can help to limit the peer group and allow providers to place kids in the most appropriate setting. Age appropriateness is also important. A young child may be intimidated by a teenager, especially if the teenager is experiencing crisis that results in inappropriate behavior. As designers, we can’t just think about segregated units. How will the common spaces be shared? Is there enough gym space to be divided up amongst all of the units without mixing misaligned groups in the same space? What about outdoor time? Is it better to have one larger play area, or to divide it into smaller separate areas?
Children aren’t adolescents and vice versa. There is a tendency to lump anyone under 18 in the realm of “pediatrics.” The reality is that a 17-year-old has more in common with an adult than with a 7-year-old. As designers, we face an interesting challenge. We know that the best environment for any child is the one finely tuned to their demographic. We also know the best environment for the business needs of the hospital is flexible and can serve multiple needs. Our job is to bridge that gap and to find a way to design spaces that can be used by any age group or gender, while still tuning each space to the needs of its programmed population as much as possible.
It is a devastating experience to be the parent of a child in psychiatric crisis. No parent wants to watch their child suffer, but for a parent to fear for their child’s safety while at home—or worse, to be in fear of their child—is more than many parents can bear. So many parents are both physically and mentally exhausted by the time they reach the point of admitting their child to an inpatient facility. The design of the building and spaces needs to give them hope for their child, themselves and their future.
As designers, the most important thing we need to understand is our users. There are important differences between pediatric and adult outpatient services: The patients are kids, and they bring parents with them!