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Home > Design Guidance > Building Types > Health Care Facilities > Psychiatric Facility

by Robert F. Carr NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM) Revised by the WBDG Health Care Subcommittee Last updated: 12-30-2010

The range o f psychiatric facilities includes psychiatric ho spitals, psychiatric and neuro -psychiatric nursing units o f general ho spitals, facilities fo r the psychiatric medically infirm, gero psychiatric units, alco ho l and drug addictio n treatment facilities (bo th inpatient and o utpatient), mental health clinics, day ho spitals, day treatment centers, and o thers.

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Psychiatric Facility

OVERVIEW

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RELAT ED RESO URCE PAGES

Achieving Sustainable Site Design through Low Impact Development Practices Aesthetic Challenges

Within This Page Overview Building Attributes

Aesthetic Opportunities

Emerging Issues

Air Barrier Systems in Buildings

Relevant Codes and Standards

Air Decontamination

Major Resources

In additio n to inpatient nursing units, psychiatric ho spitals include their asso ciated diagno stic and treatment areas, as well as the necessary dietetic, supply, ho usekeeping, and administrative spaces co mmo n to all ho spitals.

They do no t generally include the co mplex and high-tech diagno stic and treatment areas o f general ho spitals.

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Psychiatric ho spitals may include o utpatient psychiatric areas. These areas sho uld be lo cated o n a direct path fro m the lo bby, and circulatio n paths o f the o utpatients sho uld be separated fro m the paths o f the mo re acutely ill inpatients. Teaching ho spitals will also include spaces fo r training and educatio n, and o ften spaces fo r research studies.

The mental health clinic is the basic o utpatient unit, pro viding an interface between inpatient care and the co mmunity. As such, it pro vides preventative care, primary care, and aftercare. The clinic may also serve as a site fo r research and fo r training o f mental health pro fessio nals o n all aspects o f o utpatient treatment o f mental health pro blems.

A substance abuse clinic pro vides o utpatient care PDFmyURL.com

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and treatment o f alco ho l and/o r drug-dependent patients no lo nger needing inpatient care. In a ho spital, it sho uld be so lo cated that its patients do no t need to travel thro ugh o ther parts o f the ho spital.

Psychiatric Facility, VAMC Augusta, GA

The day ho spital has no beds, but is typically lo cated within o r adjacent to a ho spital. It o ffers to tal ho spital psychiatric services fo r acutely ill patients witho ut remo ving them fro m the family and co mmunity.

The day treatment center pro vides a suppo rtive learning enviro nment away fro m a ho spital in which patients having chro nic difficulties with co mmunity adjustment and o ther psycho -so cial pro blems may receive help. Such patients have o ften had lo ng perio ds o f ho spitalizatio n, and need co ntinuing mo nito ring o f their general health and medicatio n needs.

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BUILDING AT T RIBUT ES Ef f iciency and Cost - Ef f ect iveness The design o f a successful psychiatric facility sho uld: Pro mo te staff efficiency by minimizing distance o f necessary travel between frequently used spaces Allo w easy visual supervisio n o f patients by limited staff. Nurse statio ns o n inpatient units sho uld be designed to pro vide maximum visibility o f patient areas.

Include all needed spaces, but no redundant o nes. This requires careful pre-design pro gramming.

Fo r inpatient units, pro vide a central meeting area o r living ro o m fo r staff and patients and pro vide smaller ro o ms where patients can visit with their families Make efficient use o f space by lo cating suppo rt spaces so that they may be shared by adjacent functio nal areas, and by making prudent use o f multi-purpo se spaces

Therapeut ic Environment The character o f the immediate surro undings can have a pro fo und affect o n the psyche o f a psychiatric patient. The New Yo rk Psychiatric Institute repo rts a dramatic dro p in the number o f patients who need to be restrained since o ccupying their new facility with its bright o pen spaces.

Every effo rt sho uld be made to create a therapeutic enviro nment by: Using familiar and no n-institutio nal materials with cheerful and varied co lo rs and textures, keeping in mind that so me co lo rs and patterns are inappro priate and can diso rient o lder impaired patients, o r agitate patients and staff. See also VA Interio r Design Manual .

Admitting ample natural light wherever po ssible.

Pro viding a windo w fo r every patient bed, and views o f the o utdo o rs fro m o ther spaces wherever po ssible. Views o f nature can be resto rative.

Pro viding inpatients with direct and easy access to co ntro lled o utdo o r areas PDFmyURL.com

Pro viding adequate separatio n and so und insulatio n to prevent co nfidential but lo ud co nversatio n fro m traveling beyo nd co nsulting o ffices and gro up therapy ro o ms.

Giving each patient as much aco ustic privacy as po ssible—fro m no ises o f o ther patients, to ilet no ises, mechanical no ises, etc.

Giving each patient as much visual privacy, and co ntro l o ver it, as is co nsistent with the need fo r supervisio n.

Giving each inpatient the ability to co ntro l his immediate enviro nment as much as po ssible, i.e. lighting, radio , TV, etc.

Pro viding co mputer statio ns fo r patient use when patient pro file and treatment pro gram allo w.

Designing features to assist patient o rientatio n, such as direct and o bvio us travel paths, key lo catio ns fo r clo cks and calendars, avo idance o f glare, and avo idance o f unusual co nfiguratio ns and excessive co rrido r lengths.

Designing a "way-finding" pro cess into every pro ject. A patient's sense o f co mpetence is enco uraged by making spaces easy to find, identify, and use witho ut asking fo r help. Co lo r, texture, and pattern, as well as artwo rk and signage, can all give cues. (Fo r a guide to clear signage, see VA Signage Design Guide ).

Pro viding exercise equipment fo r patient use where appro priate fo r the pro gram o f care.

Pro viding access to kitchen facilities, preferably o n the unit, where snacks o r meals can be prepared by patients, when patient pro file allo ws.

Cleanliness Psychiatric facilities sho uld be easy to clean and maintain. This is facilitated by: Appro priate, durable finishes fo r each functio nal space Pro per detailing o f such features as do o rframes, casewo rk, and finish transitio ns to avo id dirtcatching and hard-to -clean crevices and jo ints Adequate and appro priately lo cated ho usekeeping spaces Inco rpo rating O&M practices that stress indo o r enviro nmental quality (IEQ)

Aest het ics

Gero- Psychiatric Facility, VAMC Salem, VA

Aesthetics is clo sely related to creating a therapeutic enviro nment. It is also a majo r facto r in a facility's public image and is thus an impo rtant marketing to o l fo r patients and staff. Aesthetic co nsideratio ns include: Use o f new lighting systems, high perfo rmance glazing, increased use o f natural light, natural materials, and co lo rs Use o f (so o thing, no t exciting) artwo rk Attentio n to details, pro po rtio ns, co lo r, and scale PDFmyURL.com

Bright and o pen public and co ngregate spaces Co mfo rtable and intimately scaled nursing units and o ffices Co mpatibility o f exterio r design with surro undings

Securit y and Saf et y The po tential suicide o f patients is a special co ncern o f psychiatric facilities. The facility must no t unwittingly create o ppo rtunities fo r suicide. Design to address this and o ther safety and security issues includes: Plumbing, electrical, and mechanical devices designed to be tamper-pro o f Use o f breakaway sho wer-ro ds and bars, no clo thes ho o ks Eliminatio n o f all jumping o ppo rtunities Co ntro l o f entrances and exits by staff Pro visio n fo r patient bedro o m do o rs to be o pened by staff in case o f emergency Laminated glass fo r windo ws in inpatient units Fiber-reinfo rced gypsum bo ard fo r walls Special features in seclusio n ro o ms to eliminate all o ppo rtunities fo r self-injury, including o utward o pening do o r with no inside hardware Careful co nsideratio n o f appro priate lo catio ns fo r grab bars and handrails. Where they must be used in unsupervised spaces, and patient pro file justifies extra care, special designs are available that preclude their use fo r self-injury.

Eliminate the use o f do o r kno bs and handles So lid material specified ceilings

Sust ainabilit y Psychiatric facilities are public buildings that may have a significant impact o n the enviro nment and eco no my o f the surro unding co mmunity. As facilities built fo r "caring", it is appro priate that this caring appro ach extend to the larger wo rld as well, and that they be built and o perated "sustainably".

Sectio n 1.2 o f VA's HVAC Design Manual is a go o d example o f health care facility energy co nservatio n standards that meet EPAct 20 0 5 (PDF 1.3 MB, 550 p g s ) and Executive Order 13423 requirements. The Energy Independence and Security Act o f 20 0 7 (EISA) (PDF 740 KB, 310 p g s ) pro vides additio nal requirements fo r energy co nservatio n. Also see LEED's (Leadership in Energy and Enviro nmental Design) USGBC LEED fo r Healthcare .

Relat ed Issues The HIPAA (Health Insurance Po rtability and Accessibility Act o f 19 9 6 ) regulatio ns address security and privacy o f "pro tected health info rmatio n" (PHI). These regulatio ns put emphasis o n aco ustic and visual privacy, and may affect lo catio n and layo ut o f wo rkstatio ns that handle medical reco rds and o ther patient info rmatio n, paper and electro nic, as well as patient acco mmo datio ns."

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EMERGING ISSUES There is a co ntinuing shift to o utpatient psychiatric care as new and mo re effective drugs are develo ped fo r the classic psychiatric co nditio ns. Many o f the ho meless in o ur urban areas are ex-psychiatric inpatients who receive little o r no fo llo w-up o utpatient care. There is a large unmet need fo r suppo rtive ho using and/o r treatment facilities fo r them.

There is also a great need fo r effective treatment o f drug addictio n and alco ho lism, particularly amo ng the po o r. This issue is also related to ho melessness.

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RELEVANT CODES AND STANDARDS Health care facilities are amo ng the mo st regulated o f all building types. Like o ther buildings, they must fo llo w the lo cal and/o r state general building co des. Ho wever, federal buildings o n federal pro perty generally need no t co mply with state and lo cal co des, but fo llo w federal regulatio ns. To be licensed by the state, design must co mply with the individual state licensing regulatio ns. Many states ado pt the AIA Guidelines for Design and Construction of Hospitals and Health Care Facilities, as a reso urce, and thus that vo lume o ften has regulato ry status.

State and lo cal building co des are based o n the mo del Internatio nal Building Co de (IBC). Federal agencies are usually in co mpliance with the IBC except NFPA 10 1 (Life Safety Co de), NFPA 70 (Natio nal Electric Co de), and Architectural Barriers Act Accessibility Guidelines (ABAAG) o r Unifo rm Federal Accessibility Standards (UFAS) takes precedence."

Facilities which treat patients who are reimbursed under Medicare must also meet federal standards, and to be accredited, they must meet standards o f the Jo int Co mmissio n o n the Accreditatio n o f Healthcare Organizatio ns (JCAHO). Generally, the federal go vernment and JCAHO refer to the Natio nal Fire Pro tectio n Asso ciatio n (NFPA) mo del fire co des, including Standards fo r Health Care Facilities (NFPA 9 9 ) and the Life Safety Co de (NFPA 10 1).

The American with Disabilities Act ( ADA) applies to all public facilities and greatly the building design with its general and specific accessibility requirements. The Architectural Barriers Act Accessibility Guidelines (ABAAG) o r the Unifo rm Federal Accessibility Standards (UFAS) apply to federal and federally funded facilities. The technical requirements do no t differ greatly fro m the ADA requirements. See WBDG Accessible.

Federal agencies that build and o perate psychiatric facilities have develo ped detailed standards fo r the pro gramming, design, and co nstructio n o f their facilities. Many o f these standards are applicable to the design o f no n-go vernmental facilities as well. Amo ng them are: Department o f Veterans Affairs(VA), Office o f Co nstructio n & Facilities Management Technical Info rmatio n Library co ntains many guides and standards, including: Design Manuals o f technical requirements, equipment lists, master specificatio ns, ro o m PDFmyURL.com

finishes, space planning criteria, and standard details.

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MAJOR RESOURCES WBDG Federal Mandate Executive Order 13423 Technical Guidance Products and Systems Building Envelo pe Design Guide

Websit es See WBDG Health Care Facilities fo r generic health care facilities websites

Publicat ions Design Considerations for Mental Health Facilities by AIA Co mmittee o n Architecture fo r Health. Washingto n, DC: AIA Press, 19 9 3.

Design Details for Health: Making the Most of Design's Healing Potential, 2nd Edition by Cynthia A. Leibro ck and Debra Harris. New Yo rk: Jo hn Wiley & So ns, Inc., 20 11.—Inno vative design so lutio ns in key areas such as lighting, aco ustics, co lo r, and finishes Psychiatric Services —Jo urnal o f the American Psychiatric Asso ciatio n primarily fo cused o n treatment o f mental illnesses, but carrying o ccasio nal articles dealing with facilities.

UFC 4-510-01 Design: Medical Military Facilities See WBDG Health Care Facilities fo r generic health care facilities publicatio ns BACK TO TO P

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