Healing the Mind as Well as the Body

HEALING THE MIND AS WELL AS THE BODY i nte g r a te d b ehavi o r a l he a l thc are for tre ating the whole p erson

FORECASTING TRENDS

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HEALING THE MIND

A N E S C A L AT I N G N E E D A

encompasses

stigmas surrounding mental health issues, inability

mind and body. Healthcare practitioners today

holistic

view

of

wellness

to afford treatment, and other obstacles, many of

understand that the mind/body connection is

these individuals will delay or avoid seeking the

profound, and that the health of one system can

assistance that could make their conditions more

impact all others. However, while challenges to

manageable.

healthcare access exist across the continuum of care, barriers to access for behavioral healthcare

The COVID era has amplified concerns about the

are especially pervasive. Delays in treatment can

growing need for behavioral healthcare. Though

have devastating consequences for patients, their

the long-term effects of this global health crisis

families, and their communities.

are as yet unknown, factors including stress, grief, trauma, financial insecurity, and isolation can

According to the National Institute of Mental

create or exacerbate behavioral health issues. The

Health, as of 2017 almost 20% of American

CDC reports that the most vulnerable groups for

adults are living with some form of mental

adverse impacts from stress during an outbreak

illnesses (4.5% with severe mental illness).

include vast swaths of the population: essential

Mental illnesses can range from depression and

workers, people at elevated risk for serious

anxiety to substance use disorders to psychosis,

illness, the elderly, caregivers, people impacted

with a broad spectrum of impacts to patients’ ability

economically, people with existing conditions, and

to function. With limited access to healthcare,

many others.

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shortage of beds access to urgent care

TREND FORECASTS

focus on safety

During and after the COVID crisis, the need for

access to geriatric psychiatry

expanded behavioral health services is almost certain to grow. A number of other existing and emerging trends are likely to impact behavioral healthcare and the design of related facilities for the future as well.

crisis intervention teams university mental health covid response integrative treatment co-occurrence

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HEALING THE MIND

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S H O RTAG E O F B E D S The number of available inpatient hospital beds

This decline in beds is due in large part to budget

for behavioral health patients has been declining

cutting;

precipitously for decades, with the result that bed

medication are also allowing many patients to better

shortages frequently lead to last-resort measures

manage serious mental illnesses at home. Patient

such as “hoteling” patients in the emergency room

advocacy groups have long fought for patients

until a bed opens. According to the Treatment

to be treated in the least restrictive environment

Advocacy Center, in the roughly six decades

appropriate for health and recovery, meaning

between 1955 and 2016, the number of state

that patients have more options for treatment

hospital beds decreased by 97%, even as the

outside of state hospitals. If behavioral healthcare

population and the need for services continued to

providers can intervene before patients reach a

grow. Lack of services has ripple effects impacting

crisis stage requiring inpatient hospitalization, the

every system. The Treatment Advocacy Center

impacts will be lessened for patients, families, and

also documented that more people with serious

communities. Early intervention will require the

mental illnesses were incarcerated than in state

expansion of treatment all along the continuum of

mental hospitals- by a factor of 10.

care.

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HEALING THE MIND

however,

advances

in

psychotropic

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AC C E S S TO U R G E NT C A R E To address the prevalent situation of housing behavioral health patients in the emergency room while awaiting a bed- an inefficient solution for all involved- some health systems are creating behavioral health urgent care facilities. These facilities offer 24/7 access, and patients can be triaged and recommended for a 23-hour observation period, discharged, or referred to an onsite inpatient care center (with separate facilities for pediatric and adult patients). This model relieves the burden on emergency room physicians while providing a more compassionate treatment experience for patients and their families.

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HEALING THE MIND

The World Health Organization reports 93% of mental,

93%

neurological, and substance use services have experienced service disruptions due to COVID-19. Outpatient and community based services have been most profoundly affected.

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FOCUS ON SAFETY The increased focus on patient safety by the Joint Commission, along with the “National Patient Safety Goals Effective 2020 for the Behavioral Healthcare Program” report, will have lasting impacts on patient safety in behavioral health settings.

Though

current

guidelines

exempt

residential and outpatient facilities, even in facilities for patients of lesser acuity, health systems are paying closer attention to ligature and other patient safety threats for people at their most vulnerable patients.

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HEALING THE MIND

LS3P Associate Principal Jeff Mural is a national expert in risk assessment and self harm in behavioral heatlhcare settings and presents at conferences on the differences between national behavioral health design guides.

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AC C E S S TO G E R I AT R I C P S YC H I AT RY The aging population impacts every facet of healthcare.

This

demographic

will

increase

demand for behavioral healthcare services as they age and thereby create increased demand for infrastructure. According to the American Association for Geriatric Psychiatry, “by the year 2030, there will be just one geriatric psychiatrist per 5,862 older adults with a psychiatric condition.”

As we age, our physical and brain functions change. Mental health issues, including dementia and Alzheimer’s can compound the effects of aging. Senior living facilities need to be equipped to mitigate the physical and mental health of the residents.

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HEALING THE MIND

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C R I S I S I NT E R V E NT I O N T E A M S In a mental health emergency requiring a 911 call, police are often the first to respond. An increasing number of police departments are providing Crisis Intervention Training for their officers.

Recognizing mental health crises in the moment allows officers the critical ability to de-escalate hazardous situations. Some communities have deployed crisis intervention teams which include police officers, mental health professionals, and substance abuse specialists who are trained to respond to patients in a behavioral health crisis and connect them with appropriate care. This strategy can be a life-or-death intervention, as the Treatment Advocacy Center reports that people with untreated mental illness are 16 times more likely than other populations to be involved in a fatal police shooting.

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HEALING THE MIND

U N I V E R S IT Y M E NTA L H E A LT H University behavioral health providers often struggle to keep up with demand, as young adults away from home for the first time are learning coping strategies and dealing with new stressors.

The generation currently entering college has already experienced weighty issues, if not trauma: they’ve potentially felt the effects of multiple recessions, the COVID crisis, climate change, civil unrest, and uncertainty in a rapidly changing world. As students grapple with these and other challenges while they navigate student life, they are likely to require expanded access to services.

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C OV I D RESPONSE COVID is likely to have far-reaching impacts on the way behavioral health is accessed. The demand for telehealth services is rapidly expanding, requiring new infrastructure to support this emerging modality. All healthcare facilities will need to be flexible and adaptable to accommodate evolving needs, and every architectural design must now consider healthcare impacts and behavioral health impacts as we help people cope with a changing world.

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HEALING THE MIND

The 154% increase in telehealth visits during the last week of March 2020, compared with the same period in 2019 might have been related to pandemic-related telehealth policy changes and public health guidance.

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I NT E G R AT I V E T R E AT M E NT The delay between the initial onset of symptoms and seeking treatment is often due to the stigmas which have been associated with behavioral health issues. Facilities which highlight “brain health” as a part of whole-body healthcare help to normalize treatment as part of the human experience.

Settings that provide welcoming atmospheres can reduce barriers to seeking treatment; changing the language and changing the aesthetic can create a more welcoming environment.

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HEALING THE MIND

An estimated 31.1% of U.S. adults experience any anxiety disorder at some time in their lives.

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C O-O C C U R R E N C E Behavioral health issues, don’t always occur in isolation.

Comorbidities with other health or environmental issuessubstance abuse, socioeconomic stressors, family trauma, and the unexpected demands of responding to COVID-19, are common. Addressing the needs of the whole patient, including providing resources for managing coinciding conditions which complicate behavioral health conditions, is an essential part of the treatment process.

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HEALING THE MIND

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SPECIALIZED EXPERTISE

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HEALING THE MIND

GUILFORD COUNTY ADULT CRISIS & BEHAVIORAL HEALTH URGENT CARE CONE HEALTH G re ensb o ro , NC

NEW CONSTRUCTION

SIZE 37,000 GSF

Guilford County developed a vacant property

LS3P

in Greensboro, NC to create a new mental

planning, programming, and design for the

health center comprising a Peer Center,

architect of record, TFF Architects. This new

Outpatient Center, a 16-chair Behavioral

facility will be operated by Cone Health and

Health Urgent Care, and a 16-bed Adult Facility

provide a state-of-the-art safe and therapeutic

Based Crisis Center. This facility will provide

environment for mental health treatment. It is

integrated acute and behavioral healthcare

being constructed at the same time as a child

and functions as a better alternative to an

and adolescent facility by Sandhills Center on

emergency department for urgent mental

an adjacent site.

provided

behavioral

healthcare

health crises. The Facility Based Crisis Center will be licensed by the NC Division of Health Service Regulation.

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HEALING THE MIND

SANDHILLS CENTER CHILD & ADOLESCENT FBC G re ensb o ro , NC

NEW CONSTRUCTION

SIZE 16,000 GSF

Three entities – Cone Health, Guilford

Sandhills Center has developed a 16-bed

County, and Sandhills Center – formed

child and adolescent FBC center on these

a

to

co-located sites. Alexander Youth Network

expanding behavioral healthcare services

is contracted by Sandhills Center to provide

in the community. Working with healthcare

services.

unique

providers

partnership

Cone

Health

dedicated

and

Alexander

Youth Network, and with input from North Carolina’s Department of Health and Human Services, and architecture firms LS3P and TFF Architects, the team envisioned the Guilford County Crisis Center: a place where children, adolescents, and adults could come to receive walk-in care, residential treatment, and outpatient services.

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HEALING THE MIND

WAKEBROOK MENTAL HEALTH & SUBSTANCE USE DISORDER FACILITIES WAKE COUNTY R a le i g h , N C

MULTIPHASE NEW

Over the course of nine years, LS3P designed

non-institutional setting. The owner and

CONSTRUCTION &

and

the

designers collaborated to incorporate best

behavioral health WakeBrook campus by

practices for mental health care treatment

completing two standalone buildings and the

facilities in the design, with the ultimate goal

most recent addition to the Substance Use

of providing spaces with tranquility, familiarity,

SIZE

Disorder Unit. The restructuring of mental

and dignity for recovery and healing. Each

68,200 GSF

health services delivery by the State of North

building has a service court and one main

Carolina resulted in gaps between service

entry for visitors, staff, and patients.

RENOVATION

administered

construction

for

providers for the full range of patients. This facility fills those gaps in the mental health continuum of care for the citizens of Wake County, and delivers services in a welcoming,

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HEALING THE MIND

MODERN MINDS MUSC C h arle sto n, S C

UPFIT

SIZE 3,400 GSF

This innovative mental health and wellness

The design features a soothing environment

center provides treatment for adults who

to reduce stress and remove the stigma

are struggling with mental wellness, as

of receiving mental health services. LS3P

well as those who are seeking growth in

provided schematic planning, construction

their personal and professional lives. The

documents, and interior design, including

renovation includes check-in and waiting

structural finishes, furniture, and artwork.

areas, a private waiting area, consult rooms, a group therapy room, an observation room, and both private and open offices.

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HEALING THE MIND

CHARLESTON COUNTY SOCIAL SERVICES HUB DEPARTMENT OF ALCOHOL & OTHER DRUG ABUSE SERVICES C h arle sto n, S C

NEW CONSTRUCTION

SIZE 171,690 GSF

Charleston County’s Social Services Hub

& Vital Records, and also outpatient and

will serve as a central location with multiple

inpatient treatment areas for the Department

community service outreach departments

of Alcohol and Other Drug Abuse Services.

co-located

The

These include residential treatment facilities,

design aesthetic embodies the values of

an opioid treatment program, a daycare for

“community,” incorporating guiding principles

residents’ children, and a residential crisis

to develop a civic facility focused on the

stabilization unit. With the diverse activities

common good through a human-centric

planned in the building, the design aspires

approach. The facility provides space for the

to create an environment that embraces

Department of Social Services, Department

second chances, inspires recovery, and lifts

of Health & Human Services, Department

the human spirit.

within

one

“home.”

of Health & Environmental Control Clinics

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HEALING THE MIND

FLORENCE CRITTENTON SERVICES OF NORTH CAROLINA C h arlo tte, N C

NEW CONSTRUCTION

SIZE 38,000 GSF

This new residential facility provides a

An efficient “H” shaped single-story design

welcoming, supportive facility for young

provides living areas, gathering spaces,

single mothers with services and counseling

amenities, and security features for residents

to help guide the personal growth of each

and staff. The entry opens to a reception

individual. Within the facility, each program

area and family living space with adjacent

has its own dedicated wing with comfortable

conference rooms and administrative suite.

rooms for each young mother and baby to

The connector area of the design contains the

bond, shared activity spaces and play areas,

shared amenity spaces such as a relaxation

colorful residential lounges, common areas,

lounge, learning/computer lab, classrooms,

and kitchen spaces for socializing.

fitness and activity spaces, and art room.

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JEFF MURAL

AIA, EDAC

Be h av i o ra l He a lth Archite ct jeffmural@ls3p.com 919.829.2700 (direct) 919.418.6212 (cell)

Associate Principal Jeff Mural brings over 20 years

Jeff spent six years a Project Manger for the New

of experience on a wide variety of healthcare,

York State Office of Mental Health Statewide /

master planning, educational, and institutional

Campus Planning project, and was instrumental

projects. His specialty is in behavioral healthcare,

in developing the Patient Safety Standards for

for which he has planned or designed over 1.7

the NYS Office of Mental Health, which has been

million square feet on projects from South Carolina

used widely across the country*. Jeff brings the

to Ontario.

experience to LS3P and provides unique insight on how to design safe and empathetic spaces for patients.

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HEALING THE MIND

*completed under prior affiliation

LS3P + Jeff Mural have planned or designed 2.6+ Million SF & 2,100+ Beds for Behavioral Health Clients

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W I L LY S C H L E I N He a lthc a re Pr a ctic e L e a der willyschlein@ls3p.com 864.272.1250 (direct) 864.361.1420 (cell)

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HEALING THE MIND

AIA, NCA RB, LEED AP

OUR TEAM IS GROWING Our team of experts brings extensive knowledge, substantial experience, and a passion for health care design to your project. We enjoy the process of design. Our team offers a collective synergy between the broad individual talents of our designers, planners, and architects.

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