Trends and Best Practices in Behavioral Health Environments

In the United States, It is estimated that 18.6% of the population currently suffers from at least one type of mental illness.1 With greater numbers of people gaining the means and motivation to access treatment for their conditions, the current supply of behavioral health providers and facilities is falling short of demand. Additionally, as care has evolved and become more efficient, often outmoded facilities are hard-pressed to deliver the best, most cost-effective care. This document seeks to outline the trends and best practices to create environments that meet these challenges.

Beyond the pervasive rates of mental illness in the population, healthcare reform is enabling greater numbers of people to access care. According to the Centers for Medicare & Medicaid Services, 50% of Medicaid enrollees have a mental health diagnosis. With an expected 62 million people gaining insurance coverage, demand will reach a tipping point.1 Many communities already struggle with capacity to provide care and a large number of patients are crowding emergency rooms where they are treated for mental illness less effectively and at a greater expense.

Mental illness has also proven to make the overall cost of a person’s healthcare much more expensive. Substance Abuse and Mental Health Services Administration (SAMHSA) data from its National Survey on Drug Use and Health (NSDUH) – 2013 indicates people with mental illness are more likely to have chronic health conditions such as high blood pressure, asthma, diabetes, heart disease, and stroke than those without mental illness. For those with diabetes, the cost of treating this health condition is as much as four times higher when a co-occurring condition such as depression or alcohol addiction is untreated.1 Mental illness prevention, early detection, and effective treatment are key in lowering the overall cost of healthcare, so much so that special provisions have been written into the Affordable Care Act to facilitate access to behavioral health services.

It has become widely accepted among providers and architects that the design of healthcare facilities can affect patient outcomes. In recent years, a number of academic studies have focused on the relationship between specific building design elements and positive outcomes for patients. Using these findings, architects can take an evidence-based approach to building behavioral health facilities and thus support patients’ psychological and physical needs.

Another design element evidenced to reach these same goals is the use of private patient rooms and even private bathrooms. These rooms obviously address the desire for patient privacy, but beyond that have been found to improve patient engagement in care and lessen withdrawal when compared to rooms accommodating multiple patients.⁷

When shifting focus to the larger inpatient unit, flexible census units allow for rooms to be transitioned between different treatment services to accommodate fluctuating patient censuses. Examples are the creation of additional space for geropsychiatric (elder) care or segregation between genders. This also allows care to be more cost-effective because the provider is not overcommitting their resources for one service in an integrated facility if the census falls.

In addition to flexible beds, units can be designed with a neighborhood concept in mind. This helps create a more homelike environment, with groups of patients sharing activity and dining spaces, and often participating in therapy together. Providing the majority of services in one “household” or “neighborhood” allows care to be normalized and for patients to feel more participatory in their treatment, which can shorten stays and improve outcomes.

One final trend that should be accounted for is the design of technology-enabled spaces. The Centers for Medicare and Medicaid Services and other groups have advocated for increased use and funding of technology in behavioral healthcare, including incentivizing meaningful use of electronic medical records (EMRs). The Behavioral Health IT (BHIT) Coalition has stated:

“To appropriately care for patients with severe mental illness and co-morbidities, they assert, there must be tight care coordination and communication between the behavioral health provider, primary care provider and medical specialists to keep the patient from cycling in and out of intensive care. Behavioral health providers are as critical, if not more so, to a ‘healthy exchange’ and ‘safety network’ as any of the other organizations receiving funding.”²

Within specific episodes of treatment, technology-enabled spaces improve communication between staff and with patients about their treatment. Additionally, they allow for improved patient observation and security.

Meeting current and future demand for behavioral health treatment benefits the community at large. Not only are issues able to be addressed and improve overall health and prosperity, but the cost of delivering healthcare can be better controlled when patients are not crowding emergency rooms and are receiving better monitoring and more efficient care. Up-to-date, flexible ambulatory and behavioral facilities can serve surrounding communities as models for population health and a patient-centered design model in the continuum of care.