Behavioral Health Look Book

Behavioral Health

IKM Thought Leadership

Behavioral Health At IKM, we have had the opportunity to improve the lives of behavioral health patients through the design of facilities that benefit society as a whole. Our behavioral health work makes up some of the most intricate and demanding projects that we have the privilege to develop. We understand that successful facilities are achieved by creating safe and caring environments that meet the complex requirements of behavioral health spaces.

The security of staff and loved ones is just as important as patient safety. Visibility and lines of sight are crucial to maintaining control of patient areas. A balance must be struck between allowing staff to be accessible to patients, and providing them a place of protection. We accomplish this by prioritizing access control in every area of the facility and providing secured areas for visitors.

Patient care and dignity are the most important factors that inform our designs. These may seem like competing issues, but they can be mutually satisfied through details like patient room doors, windows, toilets, showers, and finishes. Interiors should feel as noninstitutional as possible, while ensuring that no material can be removed as a potential instrument of harm. Furniture must be fixed to the building or too heavy to lift. Enclosed and monitored outdoor space provides natural light and promotes physical activity and patient interaction.

From the moment a patient’s behavioral health needs are identified, each individual journey of care is unique. Whether it be an Emergency Department suite, inpatient facility, or outpatient center, IKM understands the challenges that staff and patients face and how to design spaces that best support the patient journey.

Learning from Behavioral Health Data Our responsibility as designers is to create behavioral health environments that facilitate healing and learning, supporting the wellbeing of both patients and caregivers. Design of these facilities has evolved significantly alongside the progress of mental health care research. There is now more data available than ever before, and as a member of Advisory Board, IKM draws on cutting-edge resources to make informed decisions that are tailored to each behavioral health space and client.

1

Behavioral Health Patient Population Statistics show that mental health issues affect everyone, regardless of age, race, gender, and other differences. Behavioral health environments should reflect that. We strive to design spaces to accommodate the full spectrum of variations that exist within the patient population.

Of people who reported a major depressive episode within the previous year - less than 50% of young people received treatment compared to 70% for those 26+.

Gender

Underdiagnosed & Undertreated 51%

Race

*Please note the data collected is limited and doesn’t reflect all genders and race.

35%

19%

52%

Age

Hispanic / Latino /A /X

41%

17% Ages 12-17

37%

16%

Female

23% White

42%

26%

31% Ages 18-25

Percentage that Experiences Mental Illness

37%

17%

Male

21%

Black / African American

47%

25%

14% Asian / Asian American

48%

Ages 26-49

Percentage that Receives Treatment

15% Ages 50+

Evident Inequities LGBTQIA+ youth reported being harassed at school, 86% of which significantly impacted their mental health.

55%

of Veterans held in local jails report experiencing mental illness.

of Individuals couldn't get an appointment in 8% a timely manner.

Medicaid beneficiaries have a comorbid 62% of behavioral health condition.

Why Does it Matter?

Too Costly to Ignore - the cost differential per patient per month of treating patients with behavioral health diagnoses increased 27%.

Staff Storage - an estimated 45% of the U.S. population live in a mental health professional shortage area.

Reducing Stigma - 76% of Americans see mental health as important as physical health.

Design Principle Case Studies We have selected three recent IKM projects that represent our commitment to creating facilities that support the holistic wellbeing of patients and staff: William Sharpe Psychiatric Hospital 50-Bed Addition Southwood Children's Behavioral Healthcare 108-Bed Addition AHN Forbes Regional Hospital ED Behavioral Health Suite In the next pages, we will introduce six current challenges in designing successful behavioral health spaces. The above projects will illustrate examples of design strategies to address these principles: Visibility

Designing for Dignity

Staff Safety

Security

Connection to Nature

Freedom of Choice

2

Visibility The risk of violence and self-harm is a major concern in behavioral health facilities. Architecture can serve as a tool to minimize that risk by creating spaces with higher visibility for staff supervision. Open nurse stations establish clear lines of sight between staff and patients, and blind spots are reduced by eliminating corners where patients can hide.

The leading risk factors for suicide attempts include depression, substance abuse, hopelessness, and a history of trauma.

One Attempt Made Every 26.2 Seconds

Right: The nurse work station at Forbes Hospital Emergency Department allows for direct views of all patients within each secure holding room as well as the milieu space.

On Average 130 Suicides Per Day

1,204,575 Attempts Made Every Year

Staff Sight Lines Courtyards / Green Space Shared Patient Spaces Staff Spaces

Left: William Sharpe Hospital is organized to allow for complete visual control down all single-loaded patient corridors, patient spaces and integral outdoor courtyard.

Below: Southwood Children's Behavioral Healthcare nurse station protrudes into the main circulation path to allow for unobstructed views of all patient spaces within the unit.

Staff Safety Staff retention impacts the quality of patient care, but it can be a challenge when staff shortages are widespread. It’s important to create an environment where staff feel safe and supported. By integrating accessible lounges, places of respite, and paths for safe retreat away from patients, facilities are more likely to recruit and retain committed staff members.

Staff Movement Shared Patient Spaces Staff Spaces Right: The nurse station at Forbes Hospital Emergency Department is located to permit staff to safely egress from the suite without moving through a patient area.

Social Workers

Psychologists

Psychiatrists

Inadequate supply of the ‘right’ behavioral health professionals to provide timely care to all who need it.

Addiction Counselors

Projected 2030 Workforce

200,000

100,000

-40,000

Above: Separating staff from a forensic population, the nurse station at William Sharpe Hospital provides physical separation while still maintaining the ability to communicate with patients.

Left: Southwood Hospital's nurse station is centrally located to permit staff to easily access other staff-only amenities, such as lounge, respite room and offices.

Staff Movement Shared Patient Spaces Staff Spaces

Connection to Nature Access to nature is proven to have a positive impact on all types of healthcare. Traditional behavioral health facilities have sacrificed nature to create fortress-like structures focused on restricting opportunities for elopement or harm. IKM designs incorporate elements known to help patients heal, such as supervised outdoor courtyards and large windows for natural light. Interior spaces can encourage relaxation with images of nature and lighting that mimics the circadian rhythm.

Vitamin D is made naturally in the body via UVB light and interacts with nearly every cell in the body.

Strengthens Bones & Muscles

Boosts Immunity

Right: A centrally located courtyard at William Sharpe Hospital is key to capturing daylight in patient areas that typically don't have access to direct light.

Improves Mood

Reduces Inflammation

Improves Heart Function

Above: Due to limited access to natural daylight, the light fixtures in Forbes Hospital Emergency Department mimic daylight's changing color to maintain patients' circadian rhythms.

Left: Southwood Children's Behavioral Healthcare's patient corridors have custom designed wall protection graphics depicting a calming mountainous woodland.

Designing for Dignity Entering an unfamiliar behavioral health facility can be a stressful experience. By understanding the patient perspective, we can create spaces that give them dignity by addressing their emotional needs. Some patients may sit in the Emergency Department suite overnight, so reclining chairs and indirect lighting allows them the chance to rest. For long-term stays, homelike private rooms offer solace and elements of personalization give patients ownership of their space.

A home-like environment has been associated with enhanced emotional and intellectual well-being.

Lighting Design

Choice

Calming

Featured Incorporation of Dignity in Design

Right: The unique wall-washing and cove lighting in Forbes Hospital Emergency Department was chosen to eliminate harsh downlights above patients utilizing recliners during their stay.

Comfortable

Access to Daylight

Welcoming

Ventilation

Perceived Control

Visual Stimuli

Appropriate Acoustics

Home-like Feel

Left: The bedrooms at William Sharpe Hospital are designed so each patient has a space that feels their own.

Below: The exterior of Southwood Children's Behavioral Healthcare was designed to feel playful and inviting for children of all ages and have a calming effect on parents who may be experiencing anxiety when leaving their child in the facility's care.

Security

Environmental Safety Risk Assessments evaluate necessary safety and security measures for a wide spectrum of spaces.

Right: Due to the child and adolescent patient population at Southwood Children's Behavioral healthcare, each space was designed to meet the required security levels.

Intent for Self-Harm

Protecting patients and staff is the foundation of behavioral health design. Codes enforce specific requirements and needs vary from space to space depending on risk of harm. IKM has implemented intricate security measures in every facility we’ve designed. Elements to consider include security cameras, anti-elopement strategies, and interior finishes including door hardware, furniture, flooring, and more.

Level II Highly Supervised

Level IV Alone Time

Level I Staff-Only

Level III Minimally Supervised

Opportunity for Self-Harm

Level V Special Considerations

Above: William Sharpe Hospital's outdoor courtyard utilizes an anti-climb fence to prevent possible patient elopement.

Left: Security cameras are located throughout Southwood Children's Behavioral Healthcare to provide full coverage of both interior and exterior patient areas.

Security Cameras

Level III Security

Level I Security

Level IV Security

Level II Security

Level V Security

Freedom of Choice One of the first compromises a behavioral health patient experiences is lack of freedom to make their own decisions, which can contribute to anxiety and violence within a facility. Some of that freedom can be restored through strategic design. Varied seating arrangements allow social spaces to accommodate patients’ intended uses, while enclosing outdoor space within the nursing unit gives patients the freedom to access nature under the surveillance of the nurse station.

Patient behavior and time spent doing that type of activity varies by room type.

Entertainment

25% Nurse Station

Movement

45% Corridors

Right: Despite limited square footage, the Forbes Hospital Emergency Department provides flexible seating options for patients to choose the level of social interaction they desire.

Social

Task Oriented

45% Dining Area

45% Support Areas

Other

35%

Social Areas

Left: William Sharpe Hospital's patient areas are designed so patients can move freely between a variety of interior and exterior spaces.

Below: Patients at Southwood Children's Behavioral Healthcare have free access to noisier play areas and quieter nooks throughout the day.

Staff Movement

Patient Movement

Green Space

Shared Patient Spaces

Staff Spaces

The Future of Behavioral Health Design At IKM, data is integral to our process. We consult up-to-date resources to inform our behavioral health designs, as well as to evaluate where the field is heading next. As a forward-thinking firm, we create environments with the foresight and flexibility to serve not just the current patient population, but those seeking care for years to come.

Continuous learning is infused in our practices, which evolve alongside cutting-edge research. We prioritize forming a meaningful partnership with each client and sharing our expertise to make collaborative, informed decisions and deliver the solution best suited to the specific project and users. On the next pages, we will break down our insight on the latest areas of growth based on our analysis of recent data and project experience.

3

Areas of Growth The settings in which behavioral healthcare is delivered are vast. In order to support demand, most of these facility and space types will grow and evolve as we learn more about the unique and diverse needs of this patient population. IKM has identified five key areas of immediate growth that will impact behavioral health.

Psychiatric Inpatient

FGI Guidelines

Overnight Stay Less than 30 day stay Provides continuous Support

Psychiatric Residential Longer-term care Usually 90 day stay Less institutionalized feel

Psychiatric Outpatient

No overnight stay Tailored to treatment plan Provides increased flexibility

Other

Workplace Environments

Frequent and routine Full or part-time employment Wellness-oriented culture

Educational Environments

Frequent and routine School and after-school hours Active learning and development

Units in General Hospitals

Drug and Alcohol Detoxification Drug and Alcohol Rehabilitation

Nursing Home

Clinics in General Hospitals Private Practice

Community Mental Health Programs

Workout Space

Respite Rooms Quiet Rooms

Other

Psychiatric Hospitals

Psychiatric Residential Center

Other

Veterans Affairs Other

Outpatient Clinics Informal Breakout Spaces

Dedicated Quiet Workstations Classroom for Multiple Learning Modalities

Therapy Rooms

Life Skills Rooms

Counselor Rooms

Small Group Learning Rooms

Emergency Department Expansion

1 in 8

Emergency Department visits is associated with a behavioral health issue.

In a population with increasing behavioral health needs and a lack of facilities to treat them, many behavioral patients turn to Emergency Departments for care. It is increasingly important for facilities to adapt their EDs to adequately care for behavioral patients, by creating designated behavioral suites or “swing rooms” that can flex to accommodate a variety of patient types.

Community Growth Our communities are also being equipped to better serve the growing behavioral health need. Research shows that community-based healthcare helps to address disparities, like socioeconomic factors, by personalizing services and focusing resources on the specific needs of a demographic area.

27%

of the population

57%

of health spending

This is the amount of money allocated for mental health services in a recent bipartisan bill by congress. These monies will fund the expansion of school-based mental health services, further blending the sectors of education and healthcare to provide resources and spaces that are not yet widely available in educational settings.

$12.3B

Telemedicine

160M

Live in a designated psychiatrist shortage area.

Inequities in Behavioral Care Individuals with a Behavioral diagnosis account for:

Educational Settings

The stigma surrounding behavioral health prevents patients from seeking help and discourages potential staff from entering the field. Workers that do pursue behavioral health jobs often encounter low reimbursement rates that damage the incentive to stay. To provide better care and reduce total cost, the industry must start by improving care for the populations experiencing the greatest disparities and worst outcomes.

60%

Of Psychiatrists report having no openings for new patients.

With growing need and a shrinking workforce, supply and demand has an inflated impact on behavioral healthcare. Telemedicine continues to see rapid growth as it allows caregivers to reach more patients from a broader demographic. However, unchecked use of telemedicine has the potential to exacerbate inequities by catering to low-acuity, higher income users and separating from the patient continuum of care.

IKM's History with Behavioral Health Projects IKM’s experience with behavioral health projects spans the full range of care facilities and environments. We have designed for the complete patient journey, from Emergency Department suites, to inpatient and residential long-term care, to outpatient centers.

Our healthcare expertise also informs our work in the education and workplace sectors.

Behavioral health data is constantly evolving, and our designs reflect that. We are committed to continuous progress and to creating the best facilities for our clients with the most up-to-date resources available.

4

Additional Behavioral Health Projects Inpatient Chestnut Ridge Psychiatric Hospital, WVU Medicine, Renovation and Addition Forbes Hospital 40 Bed Behavioral Health Inpatient Unit Renovation Forbes Hospital Emergency Department Behavioral Health Unit Indiana Regional Medical Center Geriatric Behavioral Health Inpatient Unit Lakewood 40 Bed Inpatient Psychiatric Hospital Southwood 70 Bed Child and Adolescent Psychiatric Hospital Original Building Southwood 108 Bed New Child and Adolescent Psychiatric Hospital on Existing Campus Southwood Child and Adolescent Psychiatric Hospital Inpatient Unit Renovation UPMC Shenango Psychiatric Inpatient Unit Renovation UPMC Western Psychiatric Institute and Clinic, Multiple Projects Veteran Affairs Clarksburg, WV 10 Bed Inpatient Unit, Adaptive Reuse of Administration Area Veteran Affairs Oakland PA Emergency Department Behavioral Health Unit West Penn Hospital Behavioral Health Inpatient Unit Renovation William Sharpe 50 Bed Behavioral Health Inpatient Addition WVU Medicine Hospital Emergency Department Behavioral Health Unit Residential Southwood Child and Adolescent Psychiatric Hospital Residential Unit Adaptive Reuse of Administration Area Outpatient Penn State Health Lancaster Pediatric Behavioral Health Outpatient Care Center West Penn Hospital Postpartum Depression Outpatient Care Center Workplace Confidential Financial Client Pittsburgh Commercial Office Building Restack IKM Pittsburgh Office Confidential Financial Client - Charlotte Tenant Fit-out Confidential Financial Client - Pittsburgh Tenant Fit-out Education Avonworth School District Middle and High School Butler High School Library and Administration Renovation Chartiers Valley Intermediate and High School

Alexis Joy D’Achille Center for Perinatal Mental Health This 7,300 square foot outpatient care center serves women who are experiencing behavioral health challenges during pregnancy, postpartum, and beyond. A group therapy room with windows overlooking the adjacent park is the central focus of this specialized facility, offering a safe and comfortable space for moms to participate in bonding and stress relief activities.

VA Clarksburg Behavioral Health Unit The fourth floor of the VA Medical Center in Clarksburg, WV, was renovated to house a new ten-bed behavioral health unit. The Day Room, Group Room, and Dining Room have securable cabinetry to store technology and materials for patient activities. Staff spaces include a secured nurse station, conference room, and lounge. The unit is considered an “unlocked” space due to the integration of patient monitoring systems with door hardware.

Southwood Psychiatric Hospital Residential Unit This 2,000 square foot renovation transforms administrative offices into residential units for the Sexually Maladaptive Behaviors Program at the IKM-designed Southwood Psychiatric Hospital. Adding sixteen total beds, the patient rooms are split into two units to better serve patients and support staff. Appropriate finishes and security measures were implemented for safety, including alarms to alert staff when patients leave their beds at night

www.ikminc.com Pittsburgh Cleveland Columbus