HEALING THE MIND AS WELL AS THE BODY i nte g r a te d b ehavi o r a l he a l thc are for tre ating the whole p erson
FORECASTING TRENDS
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HEALING THE MIND
A N E S C A L AT I N G N E E D A
encompasses
stigmas surrounding mental health issues, inability
mind and body. Healthcare practitioners today
holistic
view
of
wellness
to afford treatment, and other obstacles, many of
understand that the mind/body connection is
these individuals will delay or avoid seeking the
profound, and that the health of one system can
assistance that could make their conditions more
impact all others. However, while challenges to
manageable.
healthcare access exist across the continuum of care, barriers to access for behavioral healthcare
The COVID era has amplified concerns about the
are especially pervasive. Delays in treatment can
growing need for behavioral healthcare. Though
have devastating consequences for patients, their
the long-term effects of this global health crisis
families, and their communities.
are as yet unknown, factors including stress, grief, trauma, financial insecurity, and isolation can
According to the National Institute of Mental
create or exacerbate behavioral health issues. The
Health, as of 2017 almost 20% of American
CDC reports that the most vulnerable groups for
adults are living with some form of mental
adverse impacts from stress during an outbreak
illnesses (4.5% with severe mental illness).
include vast swaths of the population: essential
Mental illnesses can range from depression and
workers, people at elevated risk for serious
anxiety to substance use disorders to psychosis,
illness, the elderly, caregivers, people impacted
with a broad spectrum of impacts to patients’ ability
economically, people with existing conditions, and
to function. With limited access to healthcare,
many others.
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shortage of beds access to urgent care
TREND FORECASTS
focus on safety
During and after the COVID crisis, the need for
access to geriatric psychiatry
expanded behavioral health services is almost certain to grow. A number of other existing and emerging trends are likely to impact behavioral healthcare and the design of related facilities for the future as well.
crisis intervention teams university mental health covid response integrative treatment co-occurrence
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HEALING THE MIND
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S H O RTAG E O F B E D S The number of available inpatient hospital beds
This decline in beds is due in large part to budget
for behavioral health patients has been declining
cutting;
precipitously for decades, with the result that bed
medication are also allowing many patients to better
shortages frequently lead to last-resort measures
manage serious mental illnesses at home. Patient
such as “hoteling” patients in the emergency room
advocacy groups have long fought for patients
until a bed opens. According to the Treatment
to be treated in the least restrictive environment
Advocacy Center, in the roughly six decades
appropriate for health and recovery, meaning
between 1955 and 2016, the number of state
that patients have more options for treatment
hospital beds decreased by 97%, even as the
outside of state hospitals. If behavioral healthcare
population and the need for services continued to
providers can intervene before patients reach a
grow. Lack of services has ripple effects impacting
crisis stage requiring inpatient hospitalization, the
every system. The Treatment Advocacy Center
impacts will be lessened for patients, families, and
also documented that more people with serious
communities. Early intervention will require the
mental illnesses were incarcerated than in state
expansion of treatment all along the continuum of
mental hospitals- by a factor of 10.
care.
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HEALING THE MIND
however,
advances
in
psychotropic
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AC C E S S TO U R G E NT C A R E To address the prevalent situation of housing behavioral health patients in the emergency room while awaiting a bed- an inefficient solution for all involved- some health systems are creating behavioral health urgent care facilities. These facilities offer 24/7 access, and patients can be triaged and recommended for a 23-hour observation period, discharged, or referred to an onsite inpatient care center (with separate facilities for pediatric and adult patients). This model relieves the burden on emergency room physicians while providing a more compassionate treatment experience for patients and their families.
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HEALING THE MIND
The World Health Organization reports 93% of mental,
93%
neurological, and substance use services have experienced service disruptions due to COVID-19. Outpatient and community based services have been most profoundly affected.
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FOCUS ON SAFETY The increased focus on patient safety by the Joint Commission, along with the “National Patient Safety Goals Effective 2020 for the Behavioral Healthcare Program” report, will have lasting impacts on patient safety in behavioral health settings.
Though
current
guidelines
exempt
residential and outpatient facilities, even in facilities for patients of lesser acuity, health systems are paying closer attention to ligature and other patient safety threats for people at their most vulnerable patients.
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HEALING THE MIND
LS3P Associate Principal Jeff Mural is a national expert in risk assessment and self harm in behavioral heatlhcare settings and presents at conferences on the differences between national behavioral health design guides.
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AC C E S S TO G E R I AT R I C P S YC H I AT RY The aging population impacts every facet of healthcare.
This
demographic
will
increase
demand for behavioral healthcare services as they age and thereby create increased demand for infrastructure. According to the American Association for Geriatric Psychiatry, “by the year 2030, there will be just one geriatric psychiatrist per 5,862 older adults with a psychiatric condition.” As we age, our physical and brain functions change. Mental health issues, including dementia and Alzheimer’s can compound the effects of aging. Senior living facilities need to be equipped to mitigate the physical and mental health of the residents.
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HEALING THE MIND
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C R I S I S I NT E R V E NT I O N T E A M S In a mental health emergency requiring a 911 call, police are often the first to respond. An increasing number of police departments are providing Crisis Intervention Training for their officers. Recognizing mental health crises in the moment allows officers the critical ability to de-escalate hazardous situations. Some communities have deployed crisis intervention teams which include police officers, mental health professionals, and substance abuse specialists who are trained to respond to patients in a behavioral health crisis and connect them with appropriate care. This strategy can be a life-or-death intervention, as the Treatment Advocacy Center reports that people with untreated mental illness are 16 times more likely than other populations to be involved in a fatal police shooting.
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HEALING THE MIND
U N I V E R S IT Y M E NTA L H E A LT H University behavioral health providers often struggle to keep up with demand, as young adults away from home for the first time are learning coping strategies and dealing with new stressors. The generation currently entering college has already experienced weighty issues, if not trauma: they’ve potentially felt the effects of multiple recessions, the COVID crisis, climate change, civil unrest, and uncertainty in a rapidly changing world. As students grapple with these and other challenges while they navigate student life, they are likely to require expanded access to services.
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C OV I D RESPONSE COVID is likely to have far-reaching impacts on the way behavioral health is accessed. The demand for telehealth services is rapidly expanding, requiring new infrastructure to support this emerging modality. All healthcare facilities will need to be flexible and adaptable to accommodate evolving needs, and every architectural design must now consider healthcare impacts and behavioral health impacts as we help people cope with a changing world.
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HEALING THE MIND
The 154% increase in telehealth visits during the last week of March 2020, compared with the same period in 2019 might have been related to pandemic-related telehealth policy changes and public health guidance.
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I NT E G R AT I V E T R E AT M E NT The delay between the initial onset of symptoms and seeking treatment is often due to the stigmas which have been associated with behavioral health issues. Facilities which highlight “brain health” as a part of whole-body healthcare help to normalize treatment as part of the human experience. Settings that provide welcoming atmospheres can reduce barriers to seeking treatment; changing the language and changing the aesthetic can create a more welcoming environment.
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HEALING THE MIND
An estimated 31.1% of U.S. adults experience any anxiety disorder at some time in their lives.
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C O-O C C U R R E N C E Behavioral health issues, don’t always occur in isolation. Comorbidities with other health or environmental issuessubstance abuse, socioeconomic stressors, family trauma, and the unexpected demands of responding to COVID-19, are common. Addressing the needs of the whole patient, including providing resources for managing coinciding conditions which complicate behavioral health conditions, is an essential part of the treatment process.
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HEALING THE MIND
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HEALING THE MIND
SPECIALIZED EXPERTISE
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HEALING THE MIND
GUILFORD COUNTY ADULT CRISIS & BEHAVIORAL HEALTH URGENT CARE CONE HEALTH G re ensb o ro , NC
NEW CONSTRUCTION
SIZE 37,000 GSF
Guilford County developed a vacant property
LS3P
in Greensboro, NC to create a new mental
planning, programming, and design for the
health center comprising a Peer Center,
architect of record, TFF Architects. This new
Outpatient Center, a 16-chair Behavioral
facility will be operated by Cone Health and
Health Urgent Care, and a 16-bed Adult Facility
provide a state-of-the-art safe and therapeutic
Based Crisis Center. This facility will provide
environment for mental health treatment. It is
integrated acute and behavioral healthcare
being constructed at the same time as a child
and functions as a better alternative to an
and adolescent facility by Sandhills Center on
emergency department for urgent mental
an adjacent site.
provided
behavioral
healthcare
health crises. The Facility Based Crisis Center will be licensed by the NC Division of Health Service Regulation.
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HEALING THE MIND
SANDHILLS CENTER CHILD & ADOLESCENT FBC G re ensb o ro , NC
NEW CONSTRUCTION
SIZE 16,000 GSF
Three entities – Cone Health, Guilford
Sandhills Center has developed a 16-bed
County, and Sandhills Center – formed
child and adolescent FBC center on these
a
to
co-located sites. Alexander Youth Network
expanding behavioral healthcare services
is contracted by Sandhills Center to provide
in the community. Working with healthcare
services.
unique
providers
partnership
Cone
Health
dedicated
and
Alexander
Youth Network, and with input from North Carolina’s Department of Health and Human Services, and architecture firms LS3P and TFF Architects, the team envisioned the Guilford County Crisis Center: a place where children, adolescents, and adults could come to receive walk-in care, residential treatment, and outpatient services.
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HEALING THE MIND
WAKEBROOK MENTAL HEALTH & SUBSTANCE USE DISORDER FACILITIES WAKE COUNTY R a le i g h , N C
MULTIPHASE NEW
Over the course of nine years, LS3P designed
non-institutional setting. The owner and
CONSTRUCTION &
and
the
designers collaborated to incorporate best
behavioral health WakeBrook campus by
practices for mental health care treatment
completing two standalone buildings and the
facilities in the design, with the ultimate goal
most recent addition to the Substance Use
of providing spaces with tranquility, familiarity,
SIZE
Disorder Unit. The restructuring of mental
and dignity for recovery and healing. Each
68,200 GSF
health services delivery by the State of North
building has a service court and one main
Carolina resulted in gaps between service
entry for visitors, staff, and patients.
RENOVATION
administered
construction
for
providers for the full range of patients. This facility fills those gaps in the mental health continuum of care for the citizens of Wake County, and delivers services in a welcoming,
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HEALING THE MIND
MODERN MINDS MUSC C h arle sto n, S C
UPFIT
SIZE 3,400 GSF
This innovative mental health and wellness
The design features a soothing environment
center provides treatment for adults who
to reduce stress and remove the stigma
are struggling with mental wellness, as
of receiving mental health services. LS3P
well as those who are seeking growth in
provided schematic planning, construction
their personal and professional lives. The
documents, and interior design, including
renovation includes check-in and waiting
structural finishes, furniture, and artwork.
areas, a private waiting area, consult rooms, a group therapy room, an observation room, and both private and open offices.
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HEALING THE MIND
CHARLESTON COUNTY SOCIAL SERVICES HUB DEPARTMENT OF ALCOHOL & OTHER DRUG ABUSE SERVICES C h arle sto n, S C
NEW CONSTRUCTION
SIZE 171,690 GSF
Charleston County’s Social Services Hub
& Vital Records, and also outpatient and
will serve as a central location with multiple
inpatient treatment areas for the Department
community service outreach departments
of Alcohol and Other Drug Abuse Services.
co-located
The
These include residential treatment facilities,
design aesthetic embodies the values of
an opioid treatment program, a daycare for
“community,” incorporating guiding principles
residents’ children, and a residential crisis
to develop a civic facility focused on the
stabilization unit. With the diverse activities
common good through a human-centric
planned in the building, the design aspires
approach. The facility provides space for the
to create an environment that embraces
Department of Social Services, Department
second chances, inspires recovery, and lifts
of Health & Human Services, Department
the human spirit.
within
one
“home.”
of Health & Environmental Control Clinics
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HEALING THE MIND
FLORENCE CRITTENTON SERVICES OF NORTH CAROLINA C h arlo tte, N C
NEW CONSTRUCTION
SIZE 38,000 GSF
This new residential facility provides a
An efficient “H” shaped single-story design
welcoming, supportive facility for young
provides living areas, gathering spaces,
single mothers with services and counseling
amenities, and security features for residents
to help guide the personal growth of each
and staff. The entry opens to a reception
individual. Within the facility, each program
area and family living space with adjacent
has its own dedicated wing with comfortable
conference rooms and administrative suite.
rooms for each young mother and baby to
The connector area of the design contains the
bond, shared activity spaces and play areas,
shared amenity spaces such as a relaxation
colorful residential lounges, common areas,
lounge, learning/computer lab, classrooms,
and kitchen spaces for socializing.
fitness and activity spaces, and art room.
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JEFF MURAL
AIA, EDAC
Be h av i o ra l He a lth Archite ct jeffmural@ls3p.com 919.829.2700 (direct) 919.418.6212 (cell)
Associate Principal Jeff Mural brings over 20 years
Jeff spent six years a Project Manger for the New
of experience on a wide variety of healthcare,
York State Office of Mental Health Statewide /
master planning, educational, and institutional
Campus Planning project, and was instrumental
projects. His specialty is in behavioral healthcare,
in developing the Patient Safety Standards for
for which he has planned or designed over 1.7
the NYS Office of Mental Health, which has been
million square feet on projects from South Carolina
used widely across the country*. Jeff brings the
to Ontario.
experience to LS3P and provides unique insight on how to design safe and empathetic spaces for patients.
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HEALING THE MIND
*completed under prior affiliation
LS3P + Jeff Mural have planned or designed 2.6+ Million SF & 2,100+ Beds for Behavioral Health Clients
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W I L LY S C H L E I N He a lthc a re Pr a ctic e L e a der willyschlein@ls3p.com 864.272.1250 (direct) 864.361.1420 (cell)
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HEALING THE MIND
AIA, NCA RB, LEED AP
OUR TEAM IS GROWING Our team of experts brings extensive knowledge, substantial experience, and a passion for health care design to your project. We enjoy the process of design. Our team offers a collective synergy between the broad individual talents of our designers, planners, and architects.
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