From the Design Quarterly: Design drivers for a new behavioral and mental health facility
January 24, 2020
January 24, 2020
How goals like “veterans first” shaped the design for a new VA building supporting a patient-centered recovery model
This article first appeared as “Design drivers for mental health” in the Stantec Design Quarterly, Issue 08.
More than 1.7 million veterans received treatment in a Veterans Affairs (VA) mental health specialty program in 2018, making it one of the largest providers of mental health care services in the United States. The VA takes a patient-centered recovery model approach to mental health care with four major dimensions: health, home, purpose, and community.
At the VA Puget Sound Health Care System’s new Mental Health and Research Building (MH&R), Stantec, working in collaboration with associate architect The Design Partnership, thoughtfully applied design features that support this care model for mental and behavior health in the physical environment. Five goals—Veterans First; Safety and Security; The Building as a Tool for Care, Learning, and Research; Flexibility and Adaptability; Sustainability and Energy Reduction—guided our design.
VA Puget Sound Health Care System’s new Mental Health and Research Building (MH&R) expands all VA Puget Sound’s outpatient mental health care services, from medication management and psychosocial case management to dialectical behavior therapy and evidence-based individual, family and group psychotherapy. It offers treatments for addiction, self-harm, anxiety, depression, anger management, memory issues, relationship problems, and difficulties in reintegrating in the community. MH&R offers methadone treatment for opioid addiction. Brought together, this array of treatment options offers a comprehensive, holistic approach to behavioral health for veterans.
Creating a supportive environment for such a wide population of users is a challenge but if we put people first, it can be quite simple. But, how do we put people first?
By planning for variety and dignity
Behavioral health treatment requires a variety of spaces—so the building includes large classrooms and group rooms in the front of the house areas, and smaller PTSD clinic group rooms on the second floor as well as a variety of occupational therapy type spaces in more private settings.
We sought to create a facility that would honor veterans and provide a dignified setting for care. To that end, we gave the center a strong architectural identity within a welcoming campus. Upon arrival, visitors are greeted by a new landscaped entrance plaza and a glowing wood wall just inside the MH&R building’s façade.
Through connections to nature and daylight
Evidence-based design tells us that daylight is important to well-being and views of nature can positively impact mental health. At the VA Puget Sound, daylight and views are even more important. The building’s hilltop setting provides stunning views of the surrounding area. For consultation and exam rooms, those views help mitigate feelings of stress, anxiety, and claustrophobia in VA clients. Daylit spaces, offering views of nature from inside, and access to green spaces help occupants to connect with the beautiful outdoors. Two large, open-air courtyards cut through the building to bring daylight, natural ventilation, and outdoor views to the heart of the building. Almost all occupied rooms have direct access to daylight. Covered by a skylight, the winter garden offers daylight for more offices and consultation rooms and provides a large function space.
For behavioral health services, it is important to make the facility as welcoming as possible to reduce the chance of intimidation and missed visits. And, because the VA serves a patient population with many elderly and disabled vets, it must be highly accessible. We wove elder-friendly features into the design, looked for opportunities to shorten travel distances, and included intuitive wayfinding elements. Those features help reduce stress for all patients and staff.
We changed the location of the MH&R from the original remit in order to create a new entrance plaza serving the existing hospital, the new MH&R building, and the new parking garage with a clear, intuitive visual progression from the public road, onto the site, and to the new arrival point.
The new building and parking structure work in concert with the existing hospital to frame the entrance plaza, embrace the visitor, and offer distinctive entrances into each of the buildings. The lower levels of the parking structure extend under the entrance plaza to bring accessible parking right up to the existing hospital entrance, minimizing travel distances. At each level, the elevator lobbies provide views to the outdoors to the south and into the winter garden on the north, thereby reorienting visitors as they step off the elevators.
The design also makes it easy to get around the building. The building circulation wraps around and flows, with no dead-ends or places where occupants can feel cornered or lost. The consultation rooms are also designed for the safety and security of the providers and for the comfort of their clients.
Behavioral health benefits from peer support, so while the building features many off-stage and quiet areas, it also includes zones that are public and heavily trafficked. A concourse or “main street” at each level provides vets with direct access to the large group rooms and leads to the quieter “neighborhoods” of individual counseling and exam rooms. Lounge spaces along the main streets provide opportunities for vets to meet and chat with their compatriots.
Promoting accessibility, calm colors, privacy
The MH&R building’s opiate-substitution treatment clinic is accessible in early morning hours to allow for patients to access treatment directly even when the building is otherwise closed.
The interior spaces are covered with a rich palette of varied materials, cool colors, and fine-to-medium textures to foster a calming environment. Room doors alternate along the hallway, so doors do not directly face each other. This reduces cross-corridor sound transmission and increases privacy.
Creating a supportive environment for such a wide population of users is a challenge but if we put people first, it can be quite simple.
The Puget Sound VA is an instrument for care, but also a tool for research. The Puget Sound VA is a critical center for the study of PTSD and head injuries from blasts, a study which has taken on increased urgency as veterans returned from Iraq and Afghanistan with improvised explosive device (IED) injuries.
The new facility consolidates most of its research programs into one central location. This enhances collaboration and the VA’s ability to explore fields such as lower-limb prosthetic design and engineering, Alzheimer’s disease and PTSD, rehabilitative medicine, suicide prevention, and oncology. Researchers here are using 3D printing to efficiently produce custom-fit prosthetics and protective insoles for diabetic patients.
We configured MH&R with spaces to support telemedicine for veterans who have difficulty reaching the facility due to travel distance or limited mobility. Telemedicine also gives off-site veterans access to therapies such as yoga.
A 120-square-foot room is the basic building block for the bulk of the program elements of MH&R—offices, exam rooms, consultation spaces—and the structural grid is tailored to this block. A simple, regular layout of these rooms, positioned consistently in the floorplan, makes the building highly adaptable. Spaces can be easily converted in the future. Many support rooms are also sized at 120 SF or multiples of 120 SF. For example, the copy rooms and team rooms can each be easily subdivided into two offices or exam rooms, and a 380-SF room of workstations could be split into three 120-SF rooms.
The MH&R was designed to LEED standards, reflecting the VA's commitment to resiliency, energy stewardship, and healthy spaces. We employed design strategies such as solar shading, operable windows and daylighting, intensive green roofs, rainwater harvesting, access to outdoor spaces and interior gardens, and natural ventilation.
We used passive systems first, active systems second—taking advantage of the thermal penetration and daylight available through the design. Occupants enjoy a pleasant view of green roofs when looking down to lower levels. Radiant floors heat and cool the public spaces, providing thermal comfort and energy efficiency. Six massive sculptural rock formations selected from local stone were set in landscaped planting beds in the central winter garden to connect to the regional setting.
The strategies employed at the MH&R facility are universal; they are elements of thoughtful human-centric design. We challenge you to incorporate these tenets into your next human-centered project whether that is for health, education, or workplace clients.