Environment Can Help, But it Can’t Cure

The following post was originally featured in Behavioral Healthcare  and may be seen here.

Bio:

James M. Hunt, AIA, is a practicing architect and facility management professional with over 30 years of experience. He is a registered architect, holds a certificate from the National Council of Architectural Registration, and served as director of facilities management for the Menninger Clinic for 20 years.

Now, Jim is president of Behavioral Health Facility Consulting, LLC, an organization that works with psychiatric hospitals and behavioral health facilities with improving patient and staff safety. He consults with hospitals and architects on the design of both new construction and remodeling projects.

Jim is also the co-author of the “Design Guide for the Built Environment of Behavioral Health Facilities” that is published electronically on the website of the National Association of Psychiatric Health Systems and is also available here. It has been updated 12 times since its original posting in 2003.

Article:

There has been a lot written over the years, mainly by architects and interior designers about how properly designed environments can cure patients with either physical or mental illnesses. Much of this has been under the banner of “Evidence Based Design”. If examined carefully, much of what is represented as “evidence” may be questionable. The facilities studied are not laboratory situations and the ability to control variables and repeat studies for validation are minimal, at best.

Buildings cannot provide treatment. Only human beings can provide treatment. Placing a patient with a broken leg in the absolute ideal environment will not set the bone. Similarly, providing the best possible space for a psychotic or suicidal behavioral healthcare patient will not resolve their issues.

Does the environment make a difference in recovery time for either of these patients? Definitely. If a medical patient is calm, comfortable and well rested it is conceivable that their recuperation will proceed well. The same can probably be said for patients with mental illnesses.

The difference may be that the environment may actually cause a behavioral health patient’s condition to get worse. If a patient who is suffering from depression and low self-esteem is admitted to a facility that looks and feels like a prison, it is very possible that their condition will become worse and make them more resistant to the treatment that is offered to them. A patient who is experiencing a manic episode and is brought to a typical hospital emergency department with its bright lights, overhead paging and bustle of activity may find it very difficult to tolerate the environment and their symptoms may escalate.

Many standard features of general hospitals that almost literally scream “institution” or “hospital” are not necessary in behavioral healthcare facilities and serve to greatly increase the negative character of the environment. Items as simple as 2’x4’ fluorescent light fixtures, overhead paging, call lights and lay-in ceilings are good examples.

Paddle style door handles, bedpan washers, wall-hung lavatories, call lights, electrically adjustable medical beds, light fixtures directly over the beds and over-bed tables are just a few examples. All of these can either be eliminated completely, or replaced with vandal-resistant products that look much more like items you and I have in our homes.

Colors and finish materials also can contribute significantly to a less-institutional environment. There are large number of studies regarding which colors are best to use in these environments. A few years ago, a client asked me to send them some color studies for their review. I was careful to send them a variety of studies. For every one that said that blue was the best, I sent them two that said blue should never be used, and so forth for all of the recommended colors. In my opinion, if we are trying to make these facilities look more “typically residential” we should use the colors that are in vogue now and use them on surfaces that will be renewed periodically such as wall paint, upholstery fabric, etc.

Noise control is also very important to providing a calming environment.  Conversations, foot traffic, overhead paging, phone conversations, mechanical noise, alarms, doors opening and closing are all contributing factors.  Flooring may be one of the most important and effective ways to address noise.  Carpeting is not as prevalent now as it was a few years ago in either hospitals or residences.  It is a great material to use for noise reduction of both impact sound and ambient noise.  It also tends to have less institutional character.  Hardwood flooring is very popular now in both residences and hospitals.  There are some very good cushioned sheet vinyl flooring products now available which can provide the appearance of wood flooring along with some reduction of both impact and ambient noise.

In conclusion, architecture cannot heal either medical or mental patients.  It can certainly exacerbate mental patients; condition and make them more difficult to treat and extend their recovery time.  Only human intervention can actually provide treatment and actively bring about a cure for the patients’ illness.