Designing for behavioral health: Balancing privacy and safety

In December 2014, the Huffington Post UK posted an article and accompanying cartoon which satirizes our society’s prevailing misunderstanding of mental health, which is the trivialization and dismissal of such suffering. From our choice descriptors to our “helpful” advice, we are usually way off target in eradicating the stigma of mental health.

As our government attacks the stigma—by expanding access and insurance coverage, providing job training incentives, and integrating the services into the primary care world—the next big opportunity to improve care delivery lies within designers’ hands.

What power do we have to alter the situation? The power of thoughtful solutions that provide a design spotlight, dignity and support. To get at those needs, a designer only needs empathy.

Take a moment to consider when you have felt a dip in your mental health; it doesn’t take much—stress at work, the end of a relationship, the onset of a physical illness. There are many moments in life when our mental health is compromised. Drawing on those experiences can be the foundation for thoughtful, supportive design.

Head Healthy Advances

The connection between our minds and our bodies cannot be overstated. Mental health issues cause physical health issues, and vice versa. The Advisory Board recently noted that “70% of primary care visits result from psychosocial issues, but most primary care providers and care teams are poorly equipped to address these underlying causes.” The key: greater integration of care.

Fusing physical care with mental care is a key component to positive change. Community Health Centers (CHCs) and Health Maintenance Organizations (HMOs) have incorporated mental healthcare into their core care programs—essentially a pre-cursor to the Affordable Care Act’s (ACA) medical home, a place where patients can seek support for all of their care needs by practitioners who work as a single team, addressing symptoms and creating a care strategy alongside the patient.

With the growth of medical homes, providers nationwide will adjust their service platforms to include all health needs. The medical home within an integrated care model is, in essence, space that brings a variety of practitioners together to collaborate.

The variety of workspaces needed within a corporate setting are not too far off from the healthcare environment: space for private consultation for sensitive issues, heads-down focus space for individual work and collaboration space between a variety of disciplines. Gensler understands these needs through our Workplace Performance Inventory (WPI®) research.

In 2013, we found workers needed space that was supportive of the following four tasks to better perform: focus, collaborate, learn and socialize. Both staff and patients have requirements in each of these categories: quiet reflection and meditative focus space, collaboration space for group therapy, space supportive of learning about a condition as well as ways to manage it, and—equally important—socialization space for further normalization.

An additional step of providing care is “insuring” patients can pay for their care. Insurers—for the first time—are required to cover mental health treatments to the same degree that they cover physical health treatments, after the federal government instituted new enforcement rules associated with the 2008 Mental Health Parity and Addiction Equity Act.

Along with those of the ACA, these new rules are expected to bring mental health services to 62 million Americans, says former Health and Human Services Secretary Kathleen Sebelius. And in early 2014, the White House answered the question of supply and demand: $115 billion was secured for the training of a new workforce to treat these services. It is time to build! With an additional $50 million dedicated to construction, expansion or improvement of mental health facilities, organizations have the opportunity to build the safe spaces that are needed.

While mental health facilities no longer conjure up images of the horror film "Insane Asylum," mental health facilities leave a great gap in healing environments: they are far from embracing an evidence-based approach and evoking a hospitable, homey feel like that of many new hospitals. Too many facilities are more closely related to an incarceration environment: everything bolted down and tamperproof, Fort-Knox style nursing stations and furniture that is neither comfortable nor flexible.

Privacy and safety will remain cornerstones every mental health facility. The challenge for designers is balancing the two: giving a patient privacy to reflect while ensuring they are safe from themselves or each other. The details of this work take research; typical building elements from door hinges to lay-in ceiling tile can contribute to an unsafe environment if specified incorrectly.

We as designers will need to step up to the challenge with invisible and passive safety measures interwoven with flexibility and comfort. As designers, our oath is to protect the health, safety and welfare of the public—all of the public, especially the most vulnerable. This action is not only for personal safety but for greater societal health as well.

Into Action

Gensler is currently working with Family Matters of Greater Washington to incorporate these elements into their satellite mental health clinics planned for the D.C. metro area. The socialization and collaboration components are front and center in Family Matters’ core services to seniors: providing group education classes to seniors on staying connected in a digital age and actively fighting isolation and depression. These services are co-located with their individual therapy programs allowing for overlap with all of their patient base: children to seniors in hopes of creating a greater sense of community.

Alternately, Gensler’s design work with Children’s National Health System highlights the integration of their renowned behavioral pediatric programs with their renowned specialty physical health programs. Their newest Regional Outpatient Center planned for the D.C. metro area is designed with a singular waiting space to serve all patients with varying stimuli zones to provide the ultimate choice and control in the waiting experience. Patients and families will not only be able to choose where they want to wait, but how they want to function while waiting.

We believe this is just the beginning of how we can further drive our design success and research into the mental health environment. To learn expand our mental health understanding further, the Gensler D.C. office will be hosting a Think Tank in 2015. This event will focus on the future needs of both the industry and the patient as we invite practitioners, leadership and patients to continue the conversation alongside us and together, take a stand against the stigma of mental health.

We have for far too long dissected the head from the body in our cultural views and our healthcare delivery system. Be on the lookout for Part Two of this post that will include our Think Tank discoveries on how to bring the design of mental health spaces back in-line to a healthy society.

About the Author: Jamie Huffcut is a Regional Health & Wellness Practice Area Leader at Gensler. She leads design teams in utilizing data and translating operational objectives into effective and supportive care delivery spaces. Jamie’s career has focused on research and evidence-based design, specifically on the impact of the built environment on human health: physical, emotional, and mental. Contact her at jamie_huffcut@gensler.com.