A well-designed healthcare environment is essential for successful treatment. This is especially true for the millions of vulnerable Americans utilizing behavioral healthcare and addiction treatment facilities. These spaces must be designed with treatment of the whole patient in mind. We adhere to a number of protocols that have proven to be effective in the design of this type of environment.
Case studies referenced in this discussion include a rehabilitation facility for Community Mental Health Affiliates (CMHA), New Britain, CT; Yale Child Study Center (YCSC), New Haven, CT; headquarters for nonprofit provider Continuum of Care, New Haven, CT; Cornell Scott-Hill Health Center in New Haven, West Haven, and Ansonia, CT; and while not strictly related to behavior health, the Ronald McDonald House of Connecticut, in New Haven.
Engagement in the Process
Involving a suitably wide constituency in the design process provides valuable input as well as community enthusiasm and energy for the project. It is imperative that we gain an understanding of who will inhabit the finished space, since a good design cannot come solely from the architectural practitioners. This collaborative process ideally involves stakeholders including administrators, care providers, the communities they serve, and the design team. A key goal of the engagement process is to collectively develop a project charter, and ultimately an inspiring vision of the final space.
The organization’s staff should propose participants for the engagement process, as they will have insight as to who will be most helpful. But the project team must be sure they include a cross-section of users: those who know the programs well and others with alternate perspectives that can be just as valuable, and members of various age groups, genders, and backgrounds. The Svigals + Partners has conducted numerous workshops with mental health and addiction clientele, as well as facility users transitioning into the community following incarceration.
Inviting the greater community into the engagement process can be helpful in more ways than one. It allows community members to share their input on the design as well as become advocates for a facility of this type, often stigmatized with issues of desirability and perceived safety.
According to Patti Walker, president of Continuum of Care, providers value a commitment to collaboration and engagement, noting that the process “resulted in a building that truly feels like home for us.”
Layout and Space Arrangement
Since individuals are unique and react differently to various paths of treatment, behavioral health and addiction facilities should be designed to support multiple methods of care. This means among other things providing a variety of spaces, such as open and semi-private areas sensitive to the various needs of different users and moods, an approach applied to the recently completed facility for Yale Child Study Center. For example, convertible spaces that serve as meeting areas one day, can be used for treatment on another. In social settings, clients benefit by manipulating furniture and having the ability to control their environment.
Similarly, the new layout for the CMHA rehabilitation and vocational facility includes activity rooms, a reading area, fitness space, and a full kitchen where meals are prepared and served by members, who also operate and patronize a small retail counter. The layout reinforces the program’s mission, to instill habits that increase independence and successful community functioning.
Facility layouts should generally support a sense of control and understanding, with residential-scaled stairs and cohesive circulation to reduce any sense of feeling disconnected or disoriented. Utilizing color motifs related wall finishes and flooring can support wayfinding. Where possible, windows at end of corridors, as used at a Ronald McDonald House in New Haven, provide both cues for orientation and natural light. Access to secure outdoor space also supports health aims. As examples, both the multipurpose space at CMHA and the cafeteria at behavioral health provider Cornell Scott-Hill Health Center provide access to the outdoors for fresh air and socializing. Just as it is important for members of these communities to know they have support and friendships, they also must have suitable places to nurture those relationships.
Design and Aesthetics
Evidence-based studies suggest that architecture and design can have the power to relax patients, make them more receptive to treatment, and elicit positive behavioral responses. This is especially true of biophilic design, in which approaches and elements reinforce connections to the natural environment. This was a primary focus for the new facility for Yale Child Study Center, where staff and caregivers serve children of varying ages and behavioral needs and their families. Themes, patterns, integrated artwork and wayfinding elements are inspired by nature, including wood-finished spaces and a palette of colors and finishes that subtly evoke the natural world. In the waiting room, a ceiling installation of white curvilinear acoustic panels hung below a blue ceiling suggests the sky, while a more overt gesture is a full-height tree sculpture of brown and green wood veneer and laminate wrapping a structural column. Linda C. Mayes, MD, Arnold Gesell Professor of Child Psychiatry, Pediatrics, and Psychology, and chair of the CSC, says it is great to see the excited look on children’s faces as they walk through the doors of the new space. “I think it’s the respect they feel by the beauty of it. It doesn’t feel traditionally medical. It feels welcoming and caring.”
Furthermore, these nature-themed and biophilic design elements tend to require less maintenance as facility occupants treat them better. This raises the importance of durable materials and finishes which are valuable for behavioral health settings but need to avoid an institutional sensibility that can contribute to negative patterns. Color and lighting are two valuable tools in this regard: Finish colors should be enlivening and warm, but not dramatic or high in contrast. Natural colors such as blues and greens work well, balanced with wood tones, as employed by CMHA and Ronald McDonald House. Lighting fixtures should avoid institutional solutions in favor of warmer illumination more closely associated with residential design.
Similar to the benefits of biophilia, applied and integrated artwork can elevate the function and feeling of a behavioral health space. Artwork, including sculpture and murals integrated into the overall design, is a powerful way to bring behavioral health facilities a positive distraction, as well as lending warmth and a recognizable identity to the facility.
Providing an added level of thought and consideration, the double-height entry at the Yale Child Study Center presents a colorful, overhead sculptural installation depicting a shimmering school of fish, curated by the art consultant Nancy Samotis, of Art for Healing Environments. The sculpture introduces the facility’s biophilic theme and encourages use of the stairs instead of an elevator. For the Ronald McDonald House of Connecticut, a theme of families led to the application of figurative elements to the building exterior, which is visible to occupants and visitors from various areas of the facility.
The pre-design engagement process will often inform the choice of artwork. Working with Continuum of Care’s clients, these discussions revealed how the organization helps clients become integrated into their communities. The provider’s logo was formerly a house with circles. However, during the engagement process the team heard stories about what Continuum means to its clients. These stories were translated into hand-drawn sketches by Svigals + Partners architect and artist Marissa Mead depicting home and community themes. Ultimately, the design was adopted as the organization’s new logo and laser-cut into aluminum panels that were applied to the building’s exterior, a welcoming image of domestic comfort and interconnectedness.
Doug Lovegren, AIA, is an Associate Principal and Project Manager with Svigals + Partners, New Haven, Connecticut. Doug joined Svigals + Partners in 1998 as a graduate of The College of Architecture & Urban Studies at Virginia Tech in Blacksburg, Virginia.