Residents of the Taube Pavilion in Mountain View, California, wake up in private rooms overlooking the tree-lined Santa Cruz Mountains, have breakfast in airy common spaces and can have fun in garden patios throughout the day.
It may sound like a resort, but the Taube Pavilion is a $ 98 million mental health center that opened in June as part of El Camino Hospital. Designed by WRNS Studio, the 56,000-square-foot building is one in a new wave of facilities that are getting rid of outdated institutional models.
For decades, psychiatric hospitals have been gloomy environments, where patients huddled in common rooms during the day and dorms at night. But new research on the health effects of our surroundings is spurring the development of facilities that look more residential, with welcoming entrances, smaller residential units in larger buildings and a variety of meeting spaces. Nature plays a big role: the windows offer views of the vegetation, the landscapes decorate the walls and the outside areas give patients and staff access to fresh air and sunlight.
The new approach, promoted as curative and therapeutic, produced more calming and conducive environments. And it seems particularly timely, given the increase in mental health problems created by the pandemic.
“We’ve talked about this for a long time,” said Mardelle McCuskey Shepley, head of the design and environmental analysis department at Cornell’s College of Human Ecology. “It is only now that it is gaining momentum.”
Even before the pandemic, the number of Americans affected by mental illness reached a new peak. One in five adults experienced depression, bipolar disorder, schizophrenia, post-traumatic stress disorder or some other illness, according to the National Institute of Mental Health. The rates were significantly higher for teenagers (about 50 percent) and young adults (about 30 percent).
Almost a year after the pandemic began, more people are suffering. Young adults and black and Latino people of all ages are reporting high levels of anxiety, depression and substance abuse, according to a survey by the Center for Disease Control and Prevention. A recent Gallup poll showed that Americans thought their mental health was “worse than at any time in the past two decades”.
The demand for treatment has skyrocketed and the construction of mental health facilities has surpassed that of other specialized hospitals. Last year, 40% of hospitals specializing in construction were psychiatric hospitals and behavioral health centers, according to the American Society for Health Care Engineering.
Architecture and interior design firms with experience in healthcare buildings reported an increase in activity. At the Architecture + design firm in Troy, NY, one or two major mental health facilities are typically in preparation, with total construction costs for these projects at about $ 250 million a year, said Francis Murdock Pitts, director and partner founder. Last year, the company was working on 16 major mental health projects, totaling about $ 1.9 billion.
Her company and others like her have medical planners on staff who help translate the research into “evidence-based” designs. “It’s not just about being warm and confused,” said Pitts.
For example, exposure to nature has been shown to reduce cortisol levels, a measure of stress. Adding curative gardens and other plants can help calm agitated patients and give employees a place to decompress.
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Specific research for mental health environments is also entering the picture. Studies have shown that reducing crowding by providing private rooms and several common spaces can reduce stress and aggression for patients and staff. Reducing noise – by eliminating unnecessary beeps from medical equipment, for example – can also help. If patients are less stressed, they can make faster and more lasting progress during treatment, experts say.
But because mental health problems vary widely, there is no design solution that works for everyone. And safety – for patients and staff – remains paramount.
Codes and guidelines adjusted over many years have sought to eliminate bedroom resources that patients use to harm themselves and others. Window glass is made of polycarbonate compounds to reduce breakage. The doors are hung on quick-release hinges to allow staff to enter the room if a patient is blocked. Plumbing and other accessories are designed to avoid the possibility of hanging or strangulation.
These security measures are crucial, but “you don’t want it to get to the point where it looks like a prison,” said Shary Adams, director of HGA, a national design company. While the built environment must be designed to ensure safety, there is also a movement to give patients some control over their surroundings. Manual thermostats allow patients to adjust the temperature in their rooms, for example, and dimmer switches allow them to modulate the lights.
The location of mental health facilities is also changing. Psychiatric institutions used to be hidden, but today they are probably part of hospital campuses or conveniently located. They often combine inpatient rooms for those who need 24-hour monitoring and areas for outpatient services, allowing patients to switch to less intensive care in the same building.
A modern youth center in Monterey, California, exemplifies the new approach. Montage Health, a nonprofit provider, opened construction on a 55,600-square-foot building in November.
Called Ohana, a Hawaiian word for an expanded concept of family, the facility will provide young patients with psychiatric treatment that sometimes involves their parents and siblings. Early life care is crucial because half of all mental illnesses throughout life occur at age 15 and 75 percent at age 24, said Dr. Susan Swick, Ohana’s chief physician.
She asked NBBJ architects for a project that had some of the wonders of a children’s museum or public library – “a place you enter that gives you a sense of growing possibility,” she said.
The building will surround beautiful old oak trees on the sloping site overlooking a green valley. It will house inpatient rooms, an outpatient treatment wing, several classrooms and a variety of spaces for individual and group therapy.
The site will provide areas for yoga and informal gatherings. The paths will be lined with cedars and pines, rosemary and lavender – plants whose aromas activate “natural killer” cells that can strengthen immunity, said Richard Dallam, managing partner at NBBJ and leader of the company’s health practice.
“It is not just beautiful; it is purposeful ”, he added.
With its twists and turns, Ohana looks like a complicated building to erect, but it is being built with cross-laminated wood in modules that can be assembled off-site, reducing costs and speeding up construction. Its price: $ 50 million, which is being covered by a $ 106 million grant that will also provide funds for clinical services.
Still, not every hospital system has an angel investor, and it is more expensive to build buildings with these new projects – private rooms alone increase costs.
But advocates say that upfront spending could result in savings in the future, improving staff retention, for example, because workers are less likely to burn and need to be replaced by new employees who must be trained.
“We try to use evidence-based design to help customers make a connection to other things on their balance sheets,” said Angela Mazzi, director of GBBN and president of the American College of Healthcare Architects, a certifying organization. “By investing in some of these things that are not a direct part of the clinical space, you will get different results and a different type of return.”