KMD has developed a design philosophy responsive to changes in the delivery of care for behavioral health services since 1963.
It was then that Ellis Kaplan and Herbert McLaughlin, the founders of the firm collaborated with two psychiatrists to conduct research to be published in the book, “Programming, Planning and Design for the Community Mental Health Center.” The study was funded by a grant from the National Institutes of Health (NIH) and thus KMD Architects was born. The book, also published by the NIH, was a guide to implement the goals set forth by the Kennedy Administration’s Mental Health Act of 1963. It created an entirely new way of approaching the design and planning of behavioral health facilities. The premise was based on the theory that providing integrated open space varied in plan and section—building architecture itself could have a positive therapeutic effect on patients’ psychiatric well-being. Also, creating outdoor space for patient use without compromising security often results in such spaces becoming the focal point of the facility.
KMD put this premise to the test when designing the Marin Community Mental Health Center in the mid-1960s. This approach created a new paradigm and contravened the planning conventions dominating mental health architecture up to that time. Two post-occupancy evaluations at Marin Community Mental Health Center validated the concept. Over 90 percent of the staff responding to an independently administrated questionnaire agreed this was the best designed community mental health center in which they had worked.
Our staff continues to strive to design behavioral health facilities so that use of outdoor space and abundant natural light by patients can be maximized without compromising security. Courtyards are located in highly visible areas and often become focal points of the facilities. In the years since the Marin project, KMD has designed and constructed more than eighty (80) behavioral health related projects and has achieved an international reputation in the design of state-of-the-art behavioral health facilities.
Our design philosophy has evolved over the years in response to new methodologies for mental health care delivery. Facilities designed from 1963 until 1980 emphasized long patient stays within an environment conducive to behavior modification and rehabilitation. Whereas our earliest projects led the profession during an era of long inpatient stays to achieve behavior modification, we have adjusted our design philosophy in response to the development of new isotropic drugs.
However, the model of care of which we are proponents and one that is supported by the ACA allows patients an opportunity to live within a structured, hotel-like environment of an intensive outpatient program wherein they can take a longer time to rehabilitate before reentering the community. Patients are supported by a structured program of behavior modification during evenings and weekends, under the supervision of staff. Staff will support their individual medication regimens and instill a sense of responsibility and participation through programs that may be extended well after their periods of Rehabilitation and Structured Living within structured housing.
This sea change to augment—and in some cases replace—state institutions with new community-based programs and facilities is still evident today in contemporary rehabilitative facilities. Recent projects by KMD for the States of Washington and Hawaii, the California Veterans Department and the Half-Way Home portion of the Al Amal Hospital in Dubai, provide the ideal supportive environment for structured living as a transition before returning to the community at large. Hence, KMD Architects have adjusted our design philosophy to reflect such new approaches to the delivery of rehabilitative behavioral medicine, as well as care for substance abuse.
Today’s goals and facilities support rehabilitation within small group, residential settings of 16 patients, followed by an indeterminate stay within the Supportive Housing program and facility. As a firm, KMD has current experience designing several similar facilities for county behavioral health organizations and regional clients within the State of Washington. They range from 16 bed residential facilities for evaluation and treatment to a 120-bed behavioral health hospital in Tacoma, Washington, sponsored by two large hospital systems serving the South Puget Sound area.
This facility, the Wellfound Behavioral Health Hospital, provides comprehensive services including a crisis stabilization unit, outpatient clinic, intensive outpatient program, partial hospitalization program and inpatient units of varying acuity levels. In order to meet such programmatic needs, KMD has evolved a variety of architectural solutions from new construction through the repurposing of an abandoned, rural hospital in the underserved southwest region of the state, as well as renovating and expanding a portion of an underutilized Juvenile Justice Facility in Snohomish County for Behavioral Health.
In each case KMD has provided settings conducive to rehabilitation for acutely ill mental health patients, as well as structured and supportive housing as they transition into the community.
As organizations compete for funding for constructing facilities and delivering care at a competitive cost, one consideration with the greatest impact on construction cost is the provision for all private versus all semi-private patient rooms.
The all private room model simplifies bed assignment in mixed gender units, avoids roommate conflicts and provides a quieter environment. However, space requirements per patient for single rooms with toilets requires 45% more area than an all semi-private model housing the same number of patients. Additionally, the cost of operating and maintaining a larger all-private room facility will result in higher costs over the life of the building. Consequently, a majority of the for-profit providers construct facilities with all or mostly semi-private patient rooms. There are also some clinicians who believe that semi-private rooms provide greater safety since they eliminate the one area where a patient is left alone for an extended period of time.
The philosophy at KMD recognizes the clinical benefits of the all private model as well as the cost benefits of the semi-private model. Providing a mix of the two can result in patient feelings of inequities and we have found a solution to be designing some patient units of all private rooms, generally for patients of higher acuity, and some units of all semi-private units.
Creating outdoor space for patient use without compromising security often results in such spaces becoming the focal point of the facility.
One of the hallmarks of mental health facilities is to create a serene environment with outdoor spaces for the residents. When a site offers a natural existing environment that is not available to urban sites, it is our goal to incorporate, as much as possible, appropriately landscaped outdoor activity areas and views of gardens into the design.
As new treatment methods for behavioral health have evolved, so too has KMD’s design philosophy for behavioral health facilities to support and enhance the latest models of care. With larger institutions increasingly being supplemented by smaller facilities that are more residential in nature, the stigma of mental health treatment continues to diminish. Mental Health continues to become integrated with other basic healthcare services as part of the philosophy of treating the whole patient. This change has caused millions to seek treatment they previously may have avoided, resulting in a healthier population.
©kmd architects 2019
To learn more about KMD’s Behavioral Health Care practice contact Chris Rubright.
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