metamorphosis
Tr a n s f o r m i n g l i v e s t h r o u g h n a t u r e ' s b e a u t y
A Rehabilitation Center for Psychiatric Healing
marissa wilson | senior thesis | 2014
design goal . . . . To create an ultimate
healing environment for those who are
suffering from depression and other mental disorders. This facility not only focuses on the design of the interior space, but also brings nature’s
healing powers into the facility through biophilic design, horticulture therapy and therapeutic gardens. This will encourage patients, staff and family members to become more involved with nature around them while they are there. Most importantly, the patient’s
recovery
process will be faster and will transform their lives into the happiness they once felt.
DESIGN CONCEPT concept word :
sophrosyne [n] a healthy state of mind, characterized by self- control, moderation, and a deep understanding of one’s true self, and resulting in true happiness.
design concept :
metamorphosis [n] the process of transformation from an
immature form to an adult form in two or more distinct stages.
DESIGN CONNECTION
The word sophrosyne describes what the facility hopes to acheive with each patient. In order to do this, they may have to go through a
major transformation of themselves so they can gain their happiness and freedom once again; similar to how a butterfly goes through the process of
metamorphosis. A butterfly garden is the central focus of one of the three the courtyards, which will provide inspiration for patients during their stay. The design is based on the natural colors and materials found in nature’s beauty.
key words :
antidepressants: This drug influences the function of the brain neurotransmitters – serotonin and norepinephrine, or monoamines. They begin to take effect by slowly changing the brain cells/neurons chemical messenger pathways to rework the way the genes in the brain are being processed. anxiety: Research has shown that depression almost always exists in combination with anxiety disorders consisting of panic disorder, obsessive compulsive disorder, post-traumatic stress disorder, social phobia or generalized anxiety disorder. biophilic design: Based on the theory of ‘biophilia’ which contends that human health and well-being has a biologically based need to affiliate with nature. http://archinect.com/sustainabilityMonster/biophilic-design bipolarDdepressive disorder: a separate disease from depression, but it shares some of the features of Major Depressive Disorder such as sadness, loss, passing mood states, a person’s ability to function. cognitive-behavioral therapy (CBT): Changes patients negative thinking habits and behavior. dysthymic depression: Less severe but a more chronic form of depression that suffers from major depressive episodes. This disorder is diagnosed when depression persist for at least two years in adults, one year in children and adolescents and they have at least 2 depressive symptoms electroconvulsive treatments: This form of therapy produces a seizure in the brain while being under basic anesthesia by applying electrical stimulation to the brain through electrodes placed on the scalp. hormonal Iimbalance: Persons suffering from depression have a hormonal imbalance of the hypothalamic- pituitary – adrenal (HPA) axis. This hormonal system is responsible for the body’s response to stress and is often overactive in those with depression.
interpersonal Ttherapy (IPT): Helps to change and work through difficult personal relationships that have contributed to depression – used to treat dysthymia. major depressive disorder: Symptoms of depressive disorder include; constant sad mood, loss of interest or pleasure in activities that were once enjoyed, change in appetite or body weight, difficulty sleeping or over sleeping, physical slowing or agitation, loss of energy, feelings of worthiness or inappropriate guilt, difficulty thinking or concentrating, and recurrent thoughts of suicide. If a person has five or more of these in a two-week period, they are classified as having Major Depressive Disorder (MMD) psychotherapy: This treatment works by changing the way the brain functions. Using the process of learning, in which the brain forms new connections between the nerve cells in the brain is the core of psychotherapy treatment. stress: Highly linked to the onset of depression. Psychosocial and environmental stressors are identified as risk factors for depression. Environmental stressors interacting with these defective genes produce a higher risk for developing depression therapeutic gardens: Rich foliage, flowers, water features, nature sounds and visible wildlife – birds. This type of therapy is used today in rehabilitative, vocational and community settings. It can help patients learn new skills or to help regain them again by improving memory, cognitive abilities, task initiation, language skills and socialization. It also promotes physical activity because it strengthens certain muscles, enhances coordination, balance and endurance and teaches patients how to work independently, problem solve and follow directions. trauma: when a person suffers from a loss, especially of a family member or close friend, this can trigger the onset of depression in an individual. Individuals who have developed post-traumatic stress disorder (PTSD) from an event that either caused physical harm or threatened them in some way are more likely to have depressive disorder as well. unipolar depressiveDdisorder: when these episodes of depression reoccur throughout a person’s lifetime.
history of depression :
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designing for depression
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Depression is one of the most common medical conditions that people suffer from. If affects as many as one out of ten adults during some point of their lives. Many may not even be aware that they have this disease, which means that they never receive treatment. Over 80% of those who have symptoms are not being properly treated, and this number increases 20% yearly. This disease affects those of all ages, but mainly those who are between the ages of 45-64, and also affects women more than men. There are many causes that trigger depression that can also interrupt other factors of their daily lives (“Depression Statistics, 2012�). However, there are a variety of treatment methods to overcome this this disorder with the right help, one can learn to be happy again and live their life to their fullest potential. The goal is to design a rehabilitation facility for those suffering from depression by utilizing the design discoveries of today; both scientific and aesthetically through nature, that have shown a greater improvement for those suffering from this disorder. Those who are depressed need a facility that is not only successful in changing the outlook of their life, but through a holistic healing process in the most beneficial and greatest ways possible, which have been shown to improve not only their lives, but the lives of their loved ones. Studies have shown that Biophilic design and one’s own human biome have numerous beneficial effects on the healing process of depressed patients. New scientific studies have been reporting that examining ones own microbiota (bacteria) on their human body can help find new approaches to prevention and treatment of depression and many other diseases (Foster & McVey, 2013). New brain imaging technologies have allowed for further research of this disorder and has given scientists and doctors a better understanding of how depressive disorder affects a person. Many medical treatments have been developed, but using the simple healing powers of nature might be the most beneficial treatment of them all.
Biophilic design involves bringing nature into a built environment, but also includes working with nature in the outdoor environment. Giving patients the ability to take care of something allows them to feel like they are wanted, which is especially important and exactly what these patients need. Having this opportunity to integrate nature into the space not only comforts and relaxes them, but has also shown a greater improvement with their healing process. Getting patients involved with nature outside can provide many activities such as gardening, or creating a garden sculpture, depending on what soothes them and allows them to feel like they are taking part in something. Educating patients about the environment first, may help them to understand and contribute more once they have recovered. They can share and continue what they have learned about the environment in hopes to keep contributing once released from the facility. One of the main goals of the facility is that an ultimate holistic healing rehab facility for those suffering with depression will be created. The design will incorporate nature in both the interior and exteriors of the facility to encourage healing and involvement with the environment around us. Creating programs that educate the patients about the environment will hopefully have an impact on them to share what they learned with the community around them. Those in the nearby community and those who drive by will notice the garden and unique atmosphere of the facility and will hopefully take interest for their own area of living to contribute to the environment as well.
The overall purpose of the facility is to help those suffering from depression to have a holistic healing by recovering faster, learning about the importance of their being as a human, reacting with nature and the environment around them and to educate them through the numerous programs the facility will provide. Educating those about the environment we live in, and showing them what they can do to contribute is very important for the future of our threatened environment today. First, learning about depression and the different types, symptoms and causes will help to gain an ultimate understanding of how it affects a person and will allow for new discoveries of the disease.
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depression defined
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Depression is a serious mental health illness that affects many people’s lives at some point in their lifetime. It can be severe or mild, or may not even affect them directly, but rather indirectly through someone they love (Hunter, 2013). The most fearsome result of depression is suicide. Suicide not only affects one’s self, but other individuals, families and society. In order for this to not happen, recognizing this disorder earlier and having effective treatments as well as prevention methods are the most critical priorities for healing depression. The National Institute of Mental Health (NIMH) is the worlds leading mental health biomedical organization that conducts and supports research on the causes, diagnosis, prevention and treatment of depression in the United States. They have, and are still conducting many studies and researching more how depression affects the human brain, and with new technologies they are discovering and understanding more what exactly depression is (Hunter, 2013). Depression is a disorder of the brain based on past evidence from neuroscience, genetic studies and clinical investigations. Brain imaging technologies reveal that the neural circuits responsible for a person’s moods that involve thinking, sleeping, appetite and behavior do not function properly in a person with depressive disorder. Neurotransmitters, which are chemicals in the brain that are used by nerve cells to communicate messages, can get out of balance. A person’s genes can affect their risk for depression as well as many environmental factors. Brain chemistry studies and examining antidepressants continue the development of new and improved medical psychotherapy treatments (Hunter, 2013). The National Institute of Mental Health has been conducting research on scientific disciplines of molecular and cellular biology, genetics, epidemiology and cognitive and behavioral science to gain a better understanding of these factors that influence the brains function and behavior. Basic and clinical scientists are working together to translate discoveries and knowledge into clinically relevant questions and targets of research for design opportunities and more effective treatments (Hunter, 2013).
symptoms
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Symptoms of depressive disorder include; constant sad mood, loss of interest or pleasure in activities that were once enjoyed, change in appetite or body weight, difficulty sleeping or over sleeping, physical slowing or agitation, loss of energy, feelings of worthiness or inappropriate guilt, difficulty thinking or concentrating, and recurrent thoughts of suicide. If a person has five or more of these in a two-week period, they are classified as having Major Depressive Disorder (MMD) (Hunter, 2013). Many patients who have thyroid problems, other endocrinopathies, medication side effects, malignancy and neurologic disorders are at a greater risk for developing depression. Many patients who have a complicated history are more inclined to develop depression (Aina & Susman, 2006). There are three other types of depression. They include, Unipolar Major Depression, Dysthymic Depression and then an alternate form is Bipolar Disorder (Hunter, 2013). Unipolar depressive disorder is when these episodes of depression reoccur throughout a person’s lifetime. Dysthymic disorder is a less severe but a more chronic form of depression that suffers from major depressive episodes. This disorder is diagnosed when depression persist for at least two years in adults, one year in children and adolescents and they have at least 2 depressive symptoms. Bipolar disorder is a separate disease from depression, but it shares some of the features of MMD (Hunter, 2013). The emotional experiences of depression – sadness, loss, passing mood states, can strongly interfere with a person’s ability to function. A recent study from World Health Organization and World Bank found that unipolar depression is the leading cause of disability in the United States and worldwide. Depression is such a complex disease because of the variety of symptoms, course of the illness and response to treatments that people respond to. This causes a challenge for researchers, doctors and scientists to fully understand what depression is and how to successfully treat this disorder. Scientists have made many recent discoveries and advances in research technology that have helped them understand the biology and physiology of depression and its different forms to help them identify effective treatments for each individual based on their symptoms (Hunter, 2013).
medical treatments
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One of the most challenging problems in those with depression is a patient being refractory towards treatment, in other words, hard to treat. Refractory is a term most often used that means resistant to process, stubborn and disobedient. Only 80 percent of people respond positively to treatment. However, of these people many do not have complete or lasting improvement and harmful or unsuccessful side affects are common. One of the main goals being worked on by the NIMH is to develop more effective treatments for all and for those who are treatment-refractory and to have very few side effects from the treatments (Hunter, 2013).
One form of treatment is antidepressants. This drug influences the function of the brain neurotransmitters – serotonin and norepinephrine, or monoamines. Antidepressants take several weeks to become effective or show results. Based on research, antidepressants begin to take effect by slowly changing the brain cells/neurons chemical messenger pathways to rework the way the genes in the brain are being processed. Older forms of antidepressants– TCA tricyclic antidepressants and MAOIs monoamine oxidase inhibitors affect neurotransmitters at the same time. These medications are difficult to tolerate because of side effect and many dietary restrictions. SSRIs- Selective Serotonin Reuptake Inhibitors have few side effects and are easier for patients to take. All these are effecting in relieving depression but individuals will respond differently to each drug (Hunter, 2013). However, antidepressants are linked to the activation of increasing the risk of a deeply depressed patient to carry out their suicidal plan (Aina & Susman, 2006). Understanding the mechanisms that go on within the cells and the long-term changes in neuronal function that is made by the antidepressants or other psychotropic drugs during the presence of an illness is crucial. Understanding how the brain works with antidepressants can help the development for future medications with fewer side effects that can reduce the time of the first dose and the body’s response to it. Based on the patient’s diagnosis of which type of depression they have determines the medication they are prescribed. For biological processes, NIMH researchers are learning how each antidepressant reacts with the various types of depression so they can learn how the brain biologically responds.
Combinations of two medications may be used most effectively to treat depression because they either enhance the therapeutic action or reduce the side effects. However, there is little research done on doing this for psychiatrists to know exactly what combinations to prescribe. NIMH is currently examining this combination therapy to expand their clinical research to further explore and develop combination treatment inventions. If depression is left untreated it can lead to frequent outbreak episodes that usually become more severe overtime (Hunter, 2013). Another available treatment is Psychotherapy. It works by changing the way the brain functions. Using the process of learning, in which the brain forms new connections between the nerve cells in the brain is the core of psychotherapy treatment. According to NIMH, cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are two forms of psychotherapy that have shown to help alleviate depression. CBT changes patients negative thinking habits and behavior while IPT helps to change and work through difficult personal relationships that have contributed to depression – used to treat dysthymia. Psychotherapy CBT treatment may be enough for treating children and adolescents, but if the depression is more severe, recurrent or psychotic then medication may be prescribed. For adults, antidepressants are usually combined with psychotherapy for further relief. Studies have shown that adults who get IPT and take antidepressants for at least three years are less likely to have a relapse. For mild depression, CBT or IPT is enough treatment according to many studies (Hunter, 2013).
medical treatments
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Electroconvulsive treatments are another form of depression therapy (ECT). It is the most effective, but most disapproved treatments for depression. Eighty to ninety percent of people improve drastically with ECT. This form of therapy produces a seizure in the brain while being under basic anesthesia by applying electrical stimulation to the brain through electrodes placed on the scalp. Repeated treatments of this are done. The electricity placement on the electrodes is what impacts the degree of depression relief and results in how severe the side effects may be. However, memory loss and other cognitive problems may occur but are short-term side effects. There have been some long- term side effects, but they have advanced much further in modern techniques that have shown a strong reduction in these problematic side effects. High rate of relapse after procedures are not an issue. NIMH is working on a study following up with patients who have received this treatment comparing different medication treatments and medication and maintenance ECT. Having results will help guide follow-up treatment plans for ECT future procedures (Hunter, 2013). Some people believe there are remedies for treating depression including herbals such as hypercium or St. Johns wort that are said to have antidepressant effects. A study was done by the National Institutes of Health that tested how effective St. Johns wort was. 340 people took either an SSRI, St. Johns wort or a placebo. The results came out that it had no effectiveness on the patient just like taking a placebo. However, studies in Europe argue that hypericum extracts have positive effects in the treatment of depression based on their studies that were conducted (Hunter, 2013)
Many genetics research studies have contributed to the understanding of depressive disorder.
NIMH states that genes play a very critical role in exposure to depression as well as many other mental disorders. Over the years, searching for a single defective gene that is the cause for each mental illness has led to a realization that not just one gene is responsible, but rather multiple genes acting together are the source. These defective genes reacting with other environmental factors and developmental events create a higher risk for psychiatric disorders. Identifying these genes has been very difficult for scientists. However, with new technologies, identifying one’s human genome (DNA) can lead to new discoveries associated with psychiatric diseases (Hunter, 2013). One way for scientists and doctors to fully understand this disorder is by using brain imaging studies. With new technology advancements, scientists and doctors can examine more clearly the brains of depressed patients and normal healthy patients. It is called functional magnetic resonance imaging, or fMRI. It is a safe noninvasive medical procedure that allows scientists to view the brain’s structure and how it functions at the same time. This medical advancement will allow for scientists to develop more effective treatments for better outcomes based on the data they can now gather and analyze. Brain imaging allows for microscopic abnormalities to be found of the brain’s structure and function that are accountable for producing mental disorders. Brain imaging can assist in early diagnosis and determining which type of depression or other mental disorders one has, allowing scientists to develop new treatments (Hunter, 2013). Recognizing the hormonal imbalance in those with depression can help determine which type they have. Persons suffering from depression have a hormonal imbalance of the hypothalamic- pituitary – adrenal (HPA) axis. This hormonal system is responsible for the body’s response to stress and is often overactive in those with depression. NIMH specialists are investigating if this hormonal imbalance is responsible for the development of this medical illness
causes
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The hypothalamus of the brain manages the release of hormones throughout the body. When a threat to a person’s physical or psychological well-being is created, the body increases the production of a hormone called corticotrophin releasing factor (CRF). When this CRF hormone is high it leads to secretion by the pituitary and adrenal glands and prepares the body for taking defensive action. These defense actions include reduced appetite, decreased sex drive and heightened alertness, and it is believed by NMIH researchers that this overactive hormone is linked to the basis of depression. Treatment for improving depressive symptoms for those with high CRF levels usually consist of antidepressant drugs or ECT. Scientists are inspecting how these hormonal findings relate and how they work with the genetics research and monoamine studies (Hunter, 2013). Stress is highly linked to the onset of depression. Psychosocial and environmental stressors are identified as risk factors for depression. NIMH says that when a person suffers from a loss, especially of a family member or close friend, this can trigger the onset of depression in an individual. According to genetics research, environmental stressors interacting with these defective genes produce a higher risk for developing depression. Recurrent episodes of depression can be triggered by traumatic life events, for some however, other may have episodes without any known triggers. According to NIMH, social isolation and life deprivation in early childhood can cause permanent changes in how the brain functions leading to depressive symptoms (Hunter, 2013). Stress is not only the cause of depression; anxiety disorders also play a major role in the onset of depression. In those who develop depression and anxiety, 72% worry, 62% have psychic anxiety 42% have somatic anxiety and 29% suffer from panic attacks (Aina & Susman, 2006). Research has shown that depression almost always exists in combination with anxiety disorders consisting of panic disorder, obsessive compulsive disorder, post-traumatic stress disorder, social phobia or generalized anxiety disorder (Hunter, 2013).
Anxiety and depression are comorbid with one another, meaning they are related to one another and are generally present at the same time along with psychiatric disorders (Aina & Susman, 2006). It is very important that both of these illnesses be diagnosed and treated. For those suffering from depression and panic disorder, suicide is at a high risk according to many studies. Panic disorder is unexpected and repeated episodes of intense fear and physical symptoms, chest pain, dizziness and shortness of breath. Individuals who have developed post-traumatic stress disorder (PTSD) from an event that either caused physical harm or threatened them in some way are more likely to have depressive disorder as well. More than 40% of patients with PTSD who were tested one month and again at four months after a traumatic event had affected them also had depression (Hunter 2013). Depression can also co-exist with other illnesses. Depression also is linked to other long-standing chronic medical conditions including cardiovascular disease and diabetes mellitus (Aina & Susman, 2006). Strokes and cancer can be comorbid with depression and can increase the chance for physical illness, disability and can even lead to early death. Depression as a physical illness is often not identified and therefore untreated, which in turn makes it hard to find treatment for these other medical illnesses. NMIH believes that diagnosing these patients early and providing them with proper treatment will improve their whole health outcome. A large scale survey from NIMH collected and analyzed data that discovered those with major depression are more than four times at risk to suffer from a heart attack over a twelve to thirteen year follow-up time span. Even those who might have had mild depression were twice as likely to suffer from a heart attack. Whether or not depression treatment also helps reduce heart attacks is currently being further researched (Hunter, 2013).
causes
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More women are connected to developing depression than men based on many contributing factors. Almost double the amount of women (12%) then men (7%) experience depression at some point in their lives. As many as 20% of women have at least one episode of depression at some point throughout their life that should be treated. It is known that depression is common for women during menopause, but in fact the childbearing years have a higher risk for developing the disorder. NIMH are studying the causes of depression in women as well as the treatment processes and focusing on life stressful moments that affect women and provoke recurrent episodes. Abnormal hormones have been a cause for depression in women especially those associated with the mood swings and physical symptoms of premenstrual syndrome. Those who experience PMS can be treated for it by taking medication that overpower the function of the ovaries, turning off the sex hormones estrogen and progesterone. Researchers are investigating what makes some women vulnerable to PMS and others not by studying the genetics, hormonal imbalances, mood disorders and serotonin function. Depression can occur in women after childbirth and is called postpartum depression. Abnormal hormonal shifts are responsible for causing psychosocial stress in vulnerable new mothers (Hunter, 2013). Depressive disorder can also occur in children and adolescents. Studies have shown that 2.5% of children and 8.3% of adolescents suffer from depressive disorder in the United States. Many facts have determined that depression is more common in those born in more recent decades. When depression begins in early years it often persists, reoccurs and continues into adulthood years, which in turn may produce a more severe case of depression in their adult life. With children and adolescents, it is important to diagnose and treat their depression to avoid further issues with academic, social, emotional and behavioral functioning so they can live up to their full potential. It is harder to diagnose children suffering from depression because their symptoms are harder to notice and understand.
There are very few studies of depression in younger patients, therefore it is harder to diagnose and treat them safely without harming their developing brain. Brain imaging of children and adolescents with depression is being done by NIMH to learn more about brain development and what happens to the brain’s functioning during a mental illness. Over the past few years, suicide has increased amongst young people and was the third leading cause of death in 15-24 year olds and the fourth leading cause in 10-14 year olds in 2009. Methods are being developed to help treat young individuals with mental disorders to prevent suicide; evaluating suicidal thinking could be the key start to prevention. According to NIMH, fluoxetine an SSRI medication was the safest treatment for children and adolescents with depression. Developing psychotherapy treatments for children that are more effective are in the process of being studied as well as newer antidepressants have shown positive outcomes. TCAs – tricyclic antidepressants have shown to be ineffective in treating children and young adults (Hunter, 2013). Those who are over the age of 65 are also at risk for developing depression. Between one and two percent of the elderly who do not live in nursing homes or other community organizations suffer from major depressive disorder and two percent have dysthymia. Major depressive disorder is not part of the normal stage of aging and because it is typically a recurrent disorder, preventing relapse episodes is important in elder patients. Antidepressant medication and psychotherapy can be used to help treat the elderly who have depression. Thirteen to twenty- seven percent of older adults have depression symptoms that do not fall under the major depressive disorder or dysthymia category but are associated with the chance of major depression, physical disability, medical illness and high use of health services. Subclinical depression is when there are noticeable depression symptoms but there are not enough to be considered of major depressive depression symptoms. Among the elderly, suicide is more common for them than any other age group (Hunter, 2013). About one in ten patients with depression attempt suicide and 70% of those are because of depression, while anxiety plays a role in suicide attempts as well (Aina & Susman, 2006). Based on studies from NIMH, elderly who committed suicide had major depressive disorder or had some other mental or substance abuse problem. Suicide committed by white males who are 85 and older was almost six times the U.S. national rate, 65 per 100,000, in 2009 (Hunter, 2013).
biophilic design
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Biophilic design is one form of treatment that does not involve medications, but rather the natural healing elements of the environment.
(Heerwagen) “Contact with nature is a basic human need: not a cultural amenity, not an individual preference, but a universal primary need. Just as we need healthy food and regular exercise to flourish, we need ongoing connections with the natural world.” – E.O. Wilson (Page 39).
We can connect with nature through numerous ways such as gardening, walking in a park, playing in water, watching animals outside and can enjoy the beauty of flowers. Experiencing nature leaves a mark in our minds, our behavioral patterns and our physiological functioning. How we pay attention and respond to the environment is explained in the biophilia hypothesis: as species, we are powerfully responsive to nature’s forms, processes and patterns. Using the knowledge we have gained over time about nature, we can produce overall health and wellness through the environments we create. Work, home, and public spaces can become more relaxing, productive, harmonious, inclusive and can provide more security, belonging with the sense of nature added to them. In order to fully understand nature’s effect on people, we need to look back to when humans depended on nature and its natural landscape for resources such as water, sunlight, animal and vegetables for food, building materials, shelter, vistas and fire for human survival. Each one of these resources had many purposes that humans depended on including the sun’s warmth and light, shelter provided by trees, flowers and vegetation for food, materials and medicines. Rivers and watering holes were the main source for life, they provided drinking, bathing, fish and other animal resource for food as well as a way to travel was on water (Heerwagen).
Linking nature to human health and well-being means that it can offer healing opportunities for depressive disorder. (Heerwagen) “Nature is beneficial to all, regardless of age, gender, race or ethnicity and it should be available to all, not just those who can afford to live on the edges of parks and open spaces.” “Connection to nature on a daily basis reinforces the values of respect and care for the environment that are necessities for sustainable communities” (Page 40). Areas with rich nature filled with trees, flowers, vegetation, water and pathways to open to amazing views stimulate relaxation and enjoyment so it is important to maintain these areas so they are not filled with dying plants etc.Nature can create positive experiences in homes, offices, backyards and common spaces. Combining both the local natural environment with cultural expressions creates a sense of place, which is very important to the success of biophilic design (Heerwagen). According to research studies, improved moods and reduced stress are the most reliable benefits of being in contact with nature. Contact with nature can be visual or multi-sensory or through active engagement – walking, running, gardening, or passively through only viewing it. Based on studies done by Ulrich, the testing of sickly patients with who had windows with nature view verses those who had windows with brick wall views were done, the patients with nature views had a faster recovery process and used less medication while being hospitalized. From over 10 years of conducting studies, research shows that patients who are exposed to natural scenes during their stay at any facility showed to have the greatest reduction in physiological stress and mood enhancement (Heerwagen). Sunlight plays a big role in the recovery process of depression. People prefer daylight environments and it is a proven fact that natural daylight improves health and psychological functioning when compared to electric lighting. Daylight affects the body’s circadian rhythm, moods, neurological health and alertness.
nature
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Research shows that patients in bright rooms recover dramatically faster from illness, have lower pain levels, take less analgesics and stay in the hospital fewer days that patients in poorly lit rooms that have no views of sunlight. Integrating sunlight into the space can have many positive affects and also incorporating outdoor activity can benefit patients greatly (Heerwagen). Nature is not just an attraction to natural elements, but also from our desire for aesthetically pleasing and appealing natural settings. Filling places with positive emotional experiences of enjoyment, pleasure, interest, fascination and wonder is the goal of Biophilic design. Biophilic design has not yet been set into any certain standards or guidelines, but it has become a phenomena people are interested in especially the sustainability factor of it. Many of those who live in urban environments do not get the opportunity to live and interact with nature; however, there are many ways to incorporate nature in these urban environments. Having live nature is always more preferable, but designing with the qualities and features of nature in a space can create an atmosphere similar to one with real nature attributes (Heerwagen). Large trees can attract people to be outdoors, which in turn can encourage them to get to know the community around them developing relationships. Studies have shown that children who constantly play outdoors are less likely to develop Attention Deficit Hyperactivity Disorder. Providing “green time� for children can serve as their medication or behavioral therapies without actual medical treatment. From data gathered, research has found that those who live near green spaces filled with gardens and neighborhood parks have better health profiles compared to people who live far from green areas. More research is being done evaluating the relationships, particularly stress reduction, emotional restoration, physical activity and social integration (Heerwagon).
Children who play in natural environments at home, school or camp have shown great improvements for social, emotional and cognitive development. Nature inspired props – flowers, stones, sticks, water- can stimulate imagination in children when they play (Heerwagen). (Heerwagen). “Nature provides both the platform and the objects for play. It encourages exploration and building among older children which aids orientation and wayfinding, group decision-making, knowledge of how to respond to changing contexts and improved problem solving” (Page 47). The biophilic template can provide many options for designing interior spaces, which include: Heraclitean motion: (Heerwagen) “Nature is always on the move. Sun, clouds, water, trees, leaves, grasses, all move to their own rhythms with the help of wind” (Page 48). Heraclitean motion is a soft movement pattern that always changes yet always stays the same and is associated with safety. The movement of trees, grasses, a light breeze, fish in an aquarium, light and shade patterns are all examples of Heraclitean motion. Storms and dramatic changes in light are sudden and erratic changes in motion that can be associated with danger. Change and resilience: Birth, death and regeneration are all cycles of natural habitats. Natural spaces can provide extraordinary signs of the ability to recover quickly. (Heerwagen) “The use of recycled elements and the natural aging of materials can create this impression of resilience in built environments” (Page 48). Variations on a theme: Trees, flowers, animals, shells all show variation and similarity in shape and appearance from their growth patterns. Nicholas Humphrey explains this occurrence as “rhyming” and believes that it is the foundation for aesthetic appreciation, which involves understanding sensory experience and the objects and features of the environment. He also states,
nature's healing powers
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He also states, (Heerwagen) “Beautiful structures in nature and art are those which facilitate the task of classification by presenting evidence of the taxonomic relationships between things in a way which is informative and easy to grasp” (Page 49). Designers should use this concept of “rhyming” from nature when designing spaces as well as using sensory conditions to form circulation and wayfinding in interior spaces using color and patterns that provide a smooth transition from outdoors to the indoors (Heerwagen). Discovered complexity: Sensory exploration involves the desire to explore the complex design of a living organism, space or object. Spaces that are too complex are hard to understand, but just the right level of complexity can intrigue one to explore and learn about a space. Successfully combining these two can produce a space that engages sensory systems and comprehension of the simplistic complexity (Heerwagen). Multi-sensory: Natural habitats are filled with sensory elements including sight, sound, touch, taste and odor that communicate information to humans as well as fire, water and sun. Emotion centered design – Japanese practice of Kansei engineering – links between sensory perception and emotional responses to artifacts and to specific features of products (Heerwagen). Transformability: What children need to play is “unused space and loose parts.” Children will use whatever they find outdoors - leaves, rocks, sand, water, branches, flowers – motivate imaginative play. Transformability and multi-use are greatly considered in the design world, but are rarely executed (Heerwagen).
Contact with gardens, whether it being passive or active can help provide psychological, emotional and social benefits. They can provide an area to overcome stress, a place to escape to and can improve moods (Heerwagen). Horticulture Therapy is the practice of using plant and gardens for human healing and rehabilitation. It is a rather new interest, but is ancient in practice (Horticulture, 2012). Horticulture therapy can provide comfort in clinical settings and nursing homes. Rich foliage, flowers, water features, nature sounds and visible wildlife – birds. Improves emotional functioning and lowers stress. Viewing projected scenes of nature and urban images while on a treadmill - “Green exercise�- tested the physiological and psychological results of patients. All of the patients who were tested scored high in physiological results and those who viewed scenes filled with nature landscapes showed higher self esteem results than those who viewed urban images (Heerwagen). Success with taking care of plants can provide depressed patients with the feeling of being wanted, which is exactly what they need (Horticulture, 2012). The therapeutic qualities of garden environments have been documented as far back as the ancient times. The Father of American Psychiatry, Dr. Benjamin Rush was the first to discover the positive benefits of working in a garden for those with mental illnesses. This type of therapy is used today in rehabilitative, vocational and community settings. It can help patients learn new skills or to help regain them again by improving memory, cognitive abilities, task initiation, language skills and socialization. It also promotes physical activity because it strengthens certain muscles, enhances coordination, balance and endurance and teaches patients how to work independently, problem solve and follow directions (Heerwagen). Nature does not threaten or discriminate against anyone, therefore anyone can plant a garden that will respond to their love and care (Horticulture, 2012).
therapeutic gardens
]
]
The American Society of Landscape Architects have professional specialists that design therapeutic gardens. A therapeutic garden is plant-dominated and is designed to encourage either active or passive interaction with the environment and its healing elements of nature. There are different types of therapeutic gardens, which are healing gardens, enabling gardens, rehabilitation gardens and restorative gardens. Horticulture therapists work with landscape designers to create these healing gardens. A therapeutic garden typically consists of numerous entrances connected to nature-filled pathways that are full of plant beds and flowerpots that were picked to our liking of senses of color, texture and smell. However, therapeutic gardens alone will not provide an ultimate healing process without incorporating therapeutic programs (AHTA, 1995). Some characteristics of therapeutic gardens that increase frequency in healthcare settings and consist of plant-dominated landscapes are: Scheduled and programmed activities: classes for routine garden duties and activities that bring in the community – faculty staff, families of clients, patients, residents and in some cases nearby community residents. Features modified to improve accessibility: Garden elements, features and equipment should be carefully selected to provide to best accessible places, activities and experiences imaginable. Creating this experience gives patients opportunities to learn and perform tasks to keep the garden in shape, which enhances their horticulture experience and provides them with responsibilities while enjoying Mother Nature and all of its beauty Well-defined Perimeters: The edges of gardens are identified through special zones and activities that direct the focus within the garden itself.
A profusion of plants and people/plant interactions: Gardens that are planned, intensive outdoor environments in which renewal, horticulture education, therapy and social interactions are incorporated into the plant-dominated spaces and pathways that promote four seasons of sensory stimulation (AHTA, 1995). Benign and supportive conditions: The garden should create a sense of safety, security and comfort for those experiencing it. Avoidance of harmful herbicides, fertilizers, and insecticides should be controlled. Shade and other protective structures along with the plants offer comfort and are an escape for the garden user. Universal design: These therapeutic gardens should be accessible to anyone of any condition of all ages. These gardens stimulate many senses including memory, hearing, touch, smell and maybe even taste. Therapeutic gardens allow for a variety of people/plant interactions and experiences possible. Recognizable placemaking: These gardens are simplistic and easily understood places. Garden patterns and experiences enhance the experience of each unique feature it has. Placemaking is a strategy that is important in landscape design dealing with relation to plants, comfort and independence experienced by the user (AHTA, 1995). Another form of therapy is through patients expressing themselves through art (AHTA, 1995).
creative art therapy
]
]
Creative art therapy is offered as a method of healing depressive disorder in many hospitals, outpatient centers and private practices. Art therapy allows depressed patients to get in touch with their feelings and gives them the opportunity to express themselves to others so they can figure out how to further their treatment. Art therapy provides the patient with the opportunity to evaluate themselves and create an analysis of their work and achievements (Dalley, 1979). Anyone can take part in this type of therapy no matter if they do not have a talent for it. It is in fact harder for artists to take part in this therapy because they are more judgmental of the artwork they produce. The American Art Therapy Association was established in 1969 and has continued to train therapists in art and therapy for years. Routa Segal, an art therapist in New York, stated: (Illiades, 2012) “For someone with depression, it can be a way of breaking through some of the barriers that may be blocking psychotherapy. Every time you create art, you are taking a picture in time. Like a snapshot from a dream, it can reveal what you need to know, and it’s yours to keep.” Creative therapy can be performed in groups, with couples or families or just with the individual and the therapist. The overall goal of this therapy is to express yourself and to learn how you feel about yourself (Illiades, 2012). The procedure of creating this artwork consists of how the piece makes them feel, how it reflects their feelings and how it relates to the current situation of the patient. (Dalley, 1979). Giving patients the opportunity to learn about themselves will provide better treatment and will allow the therapist to understand, and determine how and what treatment strategies the patient needs. Segal’s thought on this type of therapy are, (Illiades, 2012) “Creative art therapy is a journey of finding out who you are, where you are, what you have, and what you need to get where you want to be in life.”
Art therapy includes drawing, painting, sculpting, dance or movement therapy, drama therapy- storytelling, acting, improvisation, and music therapy – listening or playing and writing music. These different art therapy approaches provide a healing power for the mind and body due the release of chemicals in the brain that help fight depression. Art therapy can enhance one’s sense of well-being because it helps fight depression as well as anxiety at the same time (Illiades, 2012). A disturbed psychotic patient stated, (Dalley, 1979) “Painting helps to ease the strains inside me. It makes me more contented. Painting helps me express a surge of power.” Art therapy enables me to become less tense; it enables me to express feelings and helps problems to surface.” (Pg. 263)
Art therapy is so effective at improving the lives of depressed patients because the patient creates their own physical work and can then visualize what the think about themselves, allowing them to evaluate negative aspects they would like to change personally. Expressing and creating themselves in a way that is not judgmental can eliminate negativity associated with depression. Group therapy allows and encourages patients to connect with those dealing with the same issues around them because they are able to let go of their emotions and can bond with others building trust with them (Illiades, 2012). Providing a supportive environment allows the patient to explore a different path other than the one they were choosing (Dalley, 1979). ¬¬ Researching further precedent studies, other unique forms of therapy have become popular treatment as well. Sometimes this depends on the geographical area and what it has healing powers it has to naturally offer. Sierra Tucsan in Arizona is one of the best rehabilitation facilities in the United States.
precident analysis :
sierra tucsan : Founded in 1983, Sierra Tucsan has been succeeding in healing the lives of those suffering from alcoholism, drug addictions, depression, anxiety, trauma, eating disorders, sexual and love addiction, chronic pain and many other disorders. They are known for their extremely supportive staff, unique and effective therapies, as well as the 160 acres of nature it is set on. The Santa Catalina Mountains and the desert mounds offer a stunning view for the patients that create an environment of peace, beauty and hope for a healthy future for those seeking help (Sierra Tucsan, 2013). Sierra Tucsan is recognized as a Special Hospital and a Behavioral Health Residential Treatment Center and are accredited as leaders in the treatment of addictions, behavioral disorders and chronic pain. Each patient is given an individual treatment plan to follow with therapies that will benefit him or her most. Whether these unique therapies are through the equine facilities, a challenge course, climbing wall, fitness center, walking trails, or a labyrinth, many opportunistic healing therapies are provided. The elements of nature also inspire the healing of the patient through the mountains, desert landscape, water fountain features and wildlife animals a holistic approach to healing is embodied in each patient (See figure 6). The facility’s chef, registered dietitians and fitness specialists guide the patients to live a nutritious and healthy lifestyle by educating them on balanced meal choices using the American Diabetes Association Exchange Lists (See figure 7). The rooms are semi-private with full beds and feature a hotel-like design to make patients feel more at home and comfortable (Sierra Tucsan, 2013)
sierra tucsan : Thousands of lives have been changed through Sierra Tucsan’s holistic treatment approach for addictions and behavioral health disorders by following their Sierra Model. This model states that, “This bio-psycho- social- spiritual approach recognizes that all of us exist as mind, body, spirit and emotions, representing our commitment to treat the whole person.� It is a twelve-step philosophy with traditional, experimental and integrative medical and psychiatric services. Western and Eastern medicine practices are used to provide patients an ultimate healing result. Family healing is also important at Sierra Tucsan; through their family program they extend their treatment methods to allow for a complete recovery (Sierra Tucsan, 2013). There are a wide variety of therapy types at Sierra Tucsan which include: Creative Arts/Expression therapy Equine-assisted therapy Experimental therapy Grief and Spirituality therapy Somatic experiencing
Adventure therapy Climbing wall Chiropractic therapy Cognitive Behavioral therapy Shiatsu therapy
Individual therapy Integrative therapy Massage therapy Qi Gong therapy Reiki therapy
Along with this variety of powerful treatment methods offered, clinical experts and staff have the ability to cater to each one of the patients needs in order to give them their greatest support to help break them from their disease or addiction (Sierra Tucsan, 2013). These services include: Twelve-Step philosophy with multiple on-site and off-site meetings Group Process & Individual Therapy Dialectical Behavior Therapy (DBT) Skills Training Psychodrama Eye Movement Desensitization & Reprocessing (EMDR) Psychopharmacology Nutritional & Fitness Consultations Therapeutic & Recreational Activities Program, e.g., Challenge Biofeedback Meditation Nutraceuticals (vitamin and herbal supplements) Integrative Therapies, e.g., Acupuncture, Chiropractic, Massage Family Program included in each person’s treatment program. Aquatic Therapy Demo Kitchen for Eating Disorder patients Couple’s Workshops
sierra tucsan : Combined with the other therapies above, patients and their families truly know that Sierra Tucsan is there to fully give their maximum attention to the healing process of their patients. This would be impossible if they did not have a variety of experts and specialists on their staff, who are available 24/7 (Sierra Tucsan, 2013). The multidisciplinary treatment team includes a full time medical and psychiatric staff, specialists, certified addiction specialists, psychologists, master’s level therapists, eating disorder specialists, registered dietitians, therapeutic activity and fitness specialists, exercise physiologists and licensed integrative therapy practitioners. Each patient is given a multidisciplinary core treatment team, which include a medical provider, unit therapist, family therapist and in some cases a registered dietitian and an exercise psychologist, or a grief/spiritual therapist and many other considering the patients individual needs. Once they are fully treated for their disease or addiction, they are released from Sierra Tucsan with the faith and hope of the staff that they will not relapse in their future. Sierra Tucsan has a Continuing Care Plan provides patients with continuous check-ins after they have been released as well as family members. This call or email happens as one week, one month, three months, six months and a year after their release. There are also alumni support services offered (Sierra Tucsan, 2013).
user & needs :
US states with highest rates of depression in adults: OK, AR, TN, LA, MS, AL WV
121 million worldwide suffer from depression out of 7+ billion people
ethnicity: African-American
4%
Hispanics
4%
Whites
3.1%
Others
4.3%
usually suffer from: obesity heart disease stroke sleep disorder unemployed divorced
gender: Over 80% do not seek treatment, these numbers increase by 20% yearly 1/10 Americans will suffer from depression during their lifetime 1 in 10 women will develop depression after having a baby Women are twice as likely to develop depression than men
age :
in- patients: –
2.8%
4.6%
18-24
45-64
admitted to hospital because of depressive disorder seeking treatment and at least one overnight stay
out- patients:
admitted to hospital but does not require overnight stay (released, but still needs assistance)
staff: multidisciplinary team:
Administrative Directors Medical Directors Psychiatrists Nursing Director Director for Eating Disorders Registered Dietitian Assistant Directors Program Director Primary Therapist Psychdramatist (trauma) Equine-Assisted Psychotherapist Therapeutic & Recreational Activities Program Residential Therapist Family Program Coordinator Family Therapist Director of Behavioral Medicine Psychology Manager/Staff Training Director Clinical Trainer Consultant- in- Training EMDR Therapist (Eye Movement Desensitization and Reprocessing) Continuing Care Counselor Sexual Compulsivity Therapist (Sex addiction) Naturopathic Physician/Integrative Medicine Consultant Senior Alumni Coordinator Regional Clinical Manager Clinical Outreach Specialist
goals & objectives safety & security:
Design a facility that creates an interior and exterior environment that balances the operational, technical and physical safety and security needs for all users, focusing strongly on the patients being treated.
comfortability:
Design a facility that provides an atmoshpere that creates a sense of physical and psychological ease through the materiality and products used in the spaces.
visability:
Design the facility to allow views of nature to be seen from every room as well as providing visual contact for staff to easily see patients in all areas of the building.
codes : Department of Veterans Affairs Office of Construction & Facilities Management Design Guide December 2010 Mental Health Facilities
design guide : 2010 mental health facilities SECTION 2 Pg 36: general trends Pg 39: design reccomendations Flexibility Efficiency Patient needs Risk reduction Entries/exit Patient behavioral incidents Reducing patient/staff injuries Reducing patient/staff stress SECTION 3 Pg 45 Home-like design Open and bright layout Pod-like design without long corridors No blind corners Areas can be blocked off after hours Visual and physical access to nature Secure outdoor spaces Healing gardens Access to light Acoustic control Artwork Furniture, fixtures and equipment should be safe Patient room clusters Open nursing stations Inviting reception area Clear signage – large letters
Pg 49-5 Floorplans and diagrams
Inpatient entrance/reception – secure vestibule
Patient room – ADA – bariatric - room features pg 53 Patient beds – mounted on floor- rounded edges Desks- built in w/ writing area and shelving Chairs – rounded edges, not easily dismantled Clothing storage – open shelves with containers Marker boards Lighting – 2x2 or recessed – over bed lighting- night light Vents on ceiling Windows – double glaze – 4” max opening – integral blinds Patient bedroom doors – out swinging – anti ligature hardware Patient Bathroom Nurse call button 2x2 ceramic floor Drain in floor (slope)? Doors- out swinging top-pressure sensitive alarm- door w/ slope top – sliding door Toilets – no exposed piping – push button flusher Lavatories- solid surface material w/ integral sink – no piping – sensor faucet Shower- stainless steel – dual head – solid surface panels and pans – if use curtains have proper plastic clips or Velcro that fall off w 4lbs weight Mirror- stainless steel rim – no shelf Toilet paper dispenser- soft spindle Grad bars- welded horizontal plate on bottom of bar to prevent anchor point Clothing hooks- collapse w/ 4lbs of weight Shower/floor drains- security screws Paper towel dispenser- recessed Soap dispensers – wall-mounted w/ sloped top – or recessed
Patient activity areas pg 68 Living room/dayroom Dining room Therapy room Group/family rooms Quiet room Secure outdoor spaces Lighting- recessed or surface mounted w/ vandal resistant fixtures No sharp wall, furniture or fixture edges Finishes/furniture should be durable and easily cleaned/maintained All wall-mounted objects should be flush w/ wall – security screws Access to storage rooms to prevent storage in corridor Computer or other equip. used by patients in rooms that can be locked Chairs should have arms for elderly patients Address glare issues from sunlight Corridor areas Handrails/wallprotection - wood Corner guards – round edges Panels – wood Living/dayroom Open and enclosed spaces Furnished Visible from entry Closed area for TV and louder activities Sofas and chairs secure and unbreakable No lamps or coffee tables other loose accessories Long Sofas and primarily single chairs Rounded furniture edges Stain resistant fabrics – easily cleaned – withstand abuse/punctures Residential style furniture Flat-screen TVs in a niche with cords less than 12” and not accessible to patients Bookcases should be built in with fixed shelves
Dining Room Closed or open Heavy tables to prevent throwing Pedestal type tables Group therapy rooms Used for scheduled programs and when staff is present Heavy-duty commercial furniture that cannot be easily thrown or damaged (VA EOC Design Work Group) Video conferencing may be used- specialized lighting, acoustics, finishes Auxiliary lighting an diffuse front lighting – window shades/full blackout One wall in room should have sound absorbing material Acoustical ceiling tiles Away from outside noises Solid colors in medium tones Nursing stations Blend in to interior- smaller, more integrated and open Computer tablets/comps on wheel be included for patient file/charting Can have glass on countertop for semiprivate area – 18” Bedrooms and patient activity areas should be viewed from nurse stations These areas are for maintaining patient confidentiality through computers Technology and equip. hardware should be safe from patient harm Should promote physical reaction with patients and staff Large space behind nurse station should be avoided Circular or linear approach Outdoor courtyards pg 76 Direct but secure access Designed with three principles in mind: Located within the unit and be visible by staff from nursing station Enclosed to discourage patients to escape Designed with landscape and hardscape features that do not support self-harm or assaultive behavior Outdoor areas should be accessible from each inpatient unit Should include walking pathways and a garden
Security and safety: Enclosure height of 14 feet recommended- material that prevents climbing If any exit doors or gates – should be strong enough to withstand force and have an alarm that can communicate to staff if an emergency occurs. Trees within the area should not allow for climbing over a wall or fence and low enough so patient cannot hide behind No rocks, gravel or dirt or any material that can be used as a weapon No toxic plants or materials should be used Space should be well lit- fixtures with tamper resistant enclosures- light poles should be avoided in the middle of space. Surveillance cameras installed high up Outdoor furniture should be anchored or too heavy to lift Furniture should not be adjacent to fence or wall to prevent escape Any elevated porches should have railing or be screened Tamper resistant screws on devices Women patient rooms Women’s rooms as well as geriatric (elderly) rooms should be located in a separate unit than men’s rooms as well as a separate dayroom Mixed gender unit bathrooms should have door locks Geriatric rooms should have higher lighting levels The Mental Health Residential Rehabilitation Treatment Program (MH RRTP) 20% bedrooms per facility – ADA 10% Spaces pg 95 Therapy rooms have acoustic control 2 separate waiting areas? for patients withdrawing and those who are entering Communication center for waiting/reception Receptionist, office supplies, copy/print, file room, storage Ample lighting – natural light whenever possible 6’ corridors for 2 wheelchairs Classroom/group rooms that seat 30? Kitchen for teaching patients how to cook healthy meals Dining- Commercial kitchen Large multi-purpose rooms for family therapy sessions
Exam/treatment rooms Occupational therapy rooms Art room Computer/internet access room Quiet or sensory modulation room Storage rooms Restrooms for staff – patients separate Offices/cubicles- coordinator, director, counselors, psychiatrist, psychologist, advanced practice psychiatric nurse, peer support technician, occupational therapist, peer support specialist, social worker, vocational rehabilitation specialist, rehabilitation technician positions Staff lounge Staff lockers
SECTION 4 Codes and Standards: International Building Code (IBC) including International Mechanical and Plumbing Codes National Fire Protection Association (NFPA) 101 Life Safety Code (see notes below) NFPA National Fire Codes with the exception of NFPA 5000 and NFPA 900 Occupational, Safety and Health Administration (OSHA) standards. VA Seismic Design Requirements, H-18-8 National Standard Plumbing Code (NSPC). Safety Code for Elevators and Escalators A 17.1, published by American Society of Mechanical Engineers (ASME) ASME Boiler and Pressure Vessel Code ASME Code for Pressure Piping Uniform Federal Accessibility Standards (UFAS), including VA Supplement Barrier Free Design Guide Building Code Requirements for Reinforced Concrete (ACI 318), published by the American Concrete Institute. Manual of Steel Construction, Load and Resistance Factor Design Specifications for Structural Steel Buildings, published by the American Institute of Steel Construction (AISC). Energy Policy Act of 2005 (EPAct). DOE Interim Final Rule: Energy Conservation Standards for New Federal,
Commercial and Multi-Family High-Rise Residential Buildings and New Low-Rise Residential Buildings, 10 CFR Parts 433, 434 and 435. Federal Leadership in High Performance and Sustainable Buildings: Memorandum of Understanding (MOU) Executive Order 13423: Strengthening Federal Environmental, Energy, Transportation Management. The Provisions for Construction and Safety Signs, stated in General Requirements Section 01010 of the VA Master Construction Specification. Ventilation for Acceptable Indoor Air Quality – ASHRAE Standard 62.1- 2007, published by the American Society of Heating, Refrigerating and Air- Conditioning Engineers, Inc. Safety Standard for Refrigeration Systems – ASHRAE Standard 15- 2007, published by the American Society of Heating, Refrigerating and Air- Conditioning Engineers, Inc. Greening the Government through Leadership in Environmental Management – Executive Order 13148. Design Guide for Humidity Control in Commercial and Institutional Buildings; 2001, published by the American Society of Heating, Refrigerating and Air- Conditioning Engineers, Inc. The Joint Commission (TJC) Environment of Care Emergency Management and Life Safety Standards
Pg 107 United States Green Building Council (USGBC) Leadership in Energy and Environmental Design (LEED) Project Certification – current version. HIPAA Life Safety Systems Emergency egress Disaster planning Emergency response Site Guidelines Site area Site geometry Local zoning – roadways, parking aisles, neighboring buildings Topography – trees, streams, rocks etc. Regional and climatic factors Utilities Other site characteristics
Single- story facility, village-like style with courtyards Completed site should include: Landscaped features Setbacks and buffers Adequate parking for staff and visitors – AIA – spots for each staff member and 1.5 per patient bed Safe, attractive circulation for pedestrians from parking areas Access for emergency vehicles Utility and service areas Inpatient exterior spaces - courtyards Covered entry Signage- wayfinding Factors of zoning: Lot Occupancy Number of Stories Parking Green Space Historic District F.A.R. Setbacks Use Groups Site Signage/wayfinding Directional Traffic (one-way) Restrictions Parking Deliveries Patient Entry Entrance to Site Entrance to Facility Service Areas: Loading docks Shipping/receiving areas Trash areas Vehicular turnaround roadways Service ramps
Landscaping Gardens Vegetation Patient and staff safety/security overview pg 120 Staff and Service areas where patients are not allowed. Counseling rooms, examination rooms, group therapy, multipurpose and interview rooms where patients are highly supervised and not left alone for periods of time. Corridors, dayrooms and dining areas- where patients may spend time with minimal supervision Patient Rooms (semi-private and private) and Patient Toilets- where patients spend a great deal of time alone with minimal or no supervision. Admissions rooms and seclusion rooms- where staff interacts with newly admitted patients that present unknown potential risks and/or where patients might be in a highly agitated condition. In Level 4 and 5 spaces nothing in the space, to the fullest extent possible, should facilitate use as an anchor point, weapon, or projectile. In addition to utilizing appropriate finishes, devices and fixtures, the plan of the facility, particularly inpatient facilities, should allow direct, ongoing observation of patient areas by staff while allowing patients as much freedom as possible to move about independently within the unit or facility. Technology should be used to support the staff’s ability to maintain safety and security for both patients and staff. However, technology should not be used as a replacement for on-going, informal staff observation and interaction with patients. PAGE 123 – Interior Design Lighting Acoustics Finishes Graphics/wayfinding Furnishings
Interior Finishes: Flooring – resilient tile, ceramic/porcelain, carpet Base – rubber or matching to tile Wall finishes- paint (eggshell) and vinyl wall coverings (on non-exterior walls) High impact Paneling and trim Corner guards and other wall protection Acoustic wall panels 9-10foot Ceiling – painted gypsum board, acoustic tile/plaster Aesthetic value Therapeutic attributes Maintainability Durability Affordability Infection Control Sustainability Safety/Security Flammability / Flame Spread Compliance Wall-mounted items Artwork Corner mirrors Bulletin/marker boards Exit signs, door steps, telephones Alcohol hand cleaning dispensers HVAC Energy economic analysis Energy conservation Exterior design conditions Indoor design conditions Supply air requirements Outdoor air requirements Exhaust air requirements Noise criteria Seismic requirements
Plumbing fixtures Toilet Shower Lavatories Floor drains Water coolers Electrical Electrical requirements Public utility requirements Seismic restraints Electrical system characteristics Emergency power Lighting Receptacles Conduits Conductors Fire alarm system Communications Telephone Information system Video-conferencing Nurse call Television Public address – paging of staff Duress alarm – wireless alarm Waste management Medical waste General waste Recycling Solid linen
Transportation Patient transport Staff Records Specimens Pharmaceuticals Material Linen Sterile supplies Food
spatial requirements & adjacencies:
spatial diagrams
spatial requirements administration areas
patient bedrooms
patient activity areas
waiting room/reception
300
dining room/serving line
700/235
single patient bedroom
150
public restroom
65
kitchen/training kitchen/storage
400/290/120
bathroom
65
living room/day room
675
double patient bedroom
230
communication center print/copy/mail
60-80
lounge
560
bathroom
65
supplies
60-80
classroom/computer room
300/225
bariatric patient bedroom
180
storage
60
occupational therapy room
300
bathroom
75
offices
100-180
treatment room
150
director
180
quiet room
225
small
120
seclusion room
225
large
150
art studio
500
staff lounge
260
yoga/exercise studio
700
staff break
340
fitness gym
900
staff conference
150-300
recreational gym
5,040
staff restrooms/showers
65/25
storage
60-150
staff lockers
2.5
restroom
65
exam room/consult room
120
nurse station
300
workroom
120
medicine/dispense
150
220
team room
greenspace
site analysis :
the arboretum 500 Alumni Drive Lexington, KY 40503
sun patterns Ssouth
Building
west
east
Snorth
schematic diagrams :
STAFF
PATIENT BEDROOMS
PATIENT SOCIAL ACTIVITIES
NORTH
STAFF SUN
PATIENT BEDROOMS
WEST
EAST
PATIENT SOCIAL ACTIVITIES
SOUTH
gardens :
courtyards & butterfly garden BUTTERFLY GARDEN PICNIC TABLES BENCHES GAZEBO TERRACES PATHWAYS GARDENS SMALL POND
flowers & plants for butterflies
NEW ENGLAND ASTER
JOE-PYE WEED
ORNAMENTAL CABBAGE
GOLDENROD
PARSLEY
DILL
BUTTERFLY BUSH
GLOBE AMARANTH
floorplan :
graphic floorplan CONF.
WAIT
CON EXM EXM
M
R BD
RR
L.OFF
SOFF BUTTERFLY GARDEN
SOFF
STR
L.OFF D.OFF FILE P/C SP
SP
1BD
RRMM * * B B 11
M
2
1BD
RM
1BD
F.
OF
M
R BD
RM
R 1BD
OC. RR THRPY
SOFF
.
T.R
LOUNGE
P/C
1BDRM
NURSES STA.
STAFF
WORK RM TEAM RM MED. DISP. RM
BREAK/ LOUNGE LOCKERS
RR/S RR/S
QUIET
CLASSRM/ COMP.
SOFF
2
RM
L.OFF
L.OFF STR SECL.
ART STUDIO
LIVING/ DAYROOM
RR
OFF. 1BDRM 1BDRM 2BDRM
T.R. 1B
DINING
DR
LDY TRAING KIT.
1B*RM 1B*RM 1BDRM 2BDRM
KITCHEN STG.
M 1B
OF
T.R
.
*R
F.
M
1B
6’
1B
DR
DR
M
1B
M
DR
DR
RECREATIONAL GYM STR FITNESS GYM
YOGA/ EXERCISE
2B
M
2B
DR
M
M
CONF.
WAIT
CON EXM EXM
RM
RR
RM
L.OFF
SOFF BUTTERFLY GARDEN
SOFF
STR
L.OFF D.OFF FILE P/C SP
SP
1BD
RRMM * * B B 11
M
2
1BD
RM
1BD
F.
OF
M
R BD
RM
R 1BD
OC. RR THRPY
SOFF
.
T.R
LOUNGE
P/C
1BDRM
NURSES STA.
STAFF
WORK RM TEAM RM MED. DISP. RM
BREAK/ LOUNGE LOCKERS
RR/S RR/S
QUIET
CLASSRM/ COMP.
SOFF
D 2B
L.OFF
L.OFF STR SECL.
ART STUDIO
LIVING/ DAYROOM
RR
OFF. 1BDRM 1BDRM 2BDRM
T.R. 1B
DINING
DR
LDY TRAING KIT.
1B*RM 1B*RM 1BDRM 2BDRM
KITCHEN STG.
M 1B
OF
T.R
.
*R
F.
M
1B
6’
1B
DR
DR
M
1B
M
DR
DR
RECREATIONAL GYM STR FITNESS GYM
YOGA/ EXERCISE
2B
M
2B
DR
M
M
floorplans : FILES
LIVING/DAYROOM
NURSES STATION TEAM RM
COURTYARD COURTYARD
DINING ROOM
RR WAITING RM FOOD COUNTER RECEPTION DESK TRAINING KITCHEN
KITCHEN
D SINGLE ADA
MEDICINE/ TREATMENT RM
BARIATRIC PATIENT BEDROOM WING
DOUBLE ADA YOGA/EXERCISE
design inspiration:
[
color
]
[
]
nature design
sketches :
logo
patient bedroom
nurses station
yoga & meditation
waiting room & reception desk
courtyard
renderings :
waiting room
living, dining, nurses station
nurses station
dining room
yoga & meditation
single patient bedroom
sources:
sources
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References: Board of directors: American Horticulture Therapy Association. Therapeutic Garden Characteristics. (1995): 1. http://ahta.org/sites/default/files/attached_documents/TherapeuticGardenChracteristic_0. pdf In text: (AHTA, 1995) Dalley , T., Hons B.A, & Dip, A.T. (1979). Art therapy in psychiatric treatment: An illustrated case study. Art Psychotherapy, 6, 257-265. http://www.sciencedirect.com/science/article/pii/0090909279900541 In text (Dalley, Hons, Dip, 1979) Foster , JA, and Neufeld KA McVey. Gut-brain axis: how the microbiome influences anxiety and depression..� PubMed.gov. 36.5 (2013): http://www.ncbi.nlm.nih.gov/pubmed/23384445 In text: (Foster , & McVey, 2013 ) Hunter, J. (2013, Oct 9). Research on depression. http://psychcentral.com/disorders/depressionresearch.htm In text (Hunter, 2013) Heerwagen, J. Biophilia, Health, and Well-being, 39-57 http://www.terrapinbrightgreen.com/downloads/ Heerwagen%20-%20Restorative%20Commons.pdf In text: (Heerwagen)
Illiades, C. (2012). The healing power of creative therapy for depression. Manuscript submitted for publication, , Available from Everyday Health . http://www.everydayhealth.com/health-report/major- depression/creative-therapies.aspx In text: (Illiades, 2012) Sierra Tucsan. (2013). http://sierratucson.crchealth.com/ In text (Sierra Tucsan, 2013) Unhappiness by the Numbers: 2012 Depression Statisitcs (Nov 5 2012) http://www.healthline.com/health/depression/statistics-infographic In text (Statistics, 2012) What is Horticulture Therapy? (2012, Dec 17). http://aesop.rutgers.edu/~horttherapy/whatis.html In text (Horticulture, 2012) Yemi, A. & Susman J.L. (2006). Understanding Comorbidity with Depression and Anxiety Disorders. Journal of the American Osteopathic Association. 106.5 1-6. http://www.jaoa.org/content/106/5_ suppl_2/S9.full.pdf html In text (Aina & Susman, 2006)
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Dalley , T., Hons B.A, & Dip, A.T. (1979). Art therapy in psychiatric treatment: An illustrated case study. Art Psychotherapy, 6, 257-265. http://www.sciencedirect.com/science/article/pii/0090909279900541 In text (Dalley, Hons, Dip, 1979) Gensler. Scottsdale healthcare thompson peak hospital healing garden. http://m.gensler.com/project/ scottsdale-healthcare-thompson-peak-hospital-healing-garden?market=health-wellness In text ( Gensler) Mayo Clinic. (2013, July 13). Positron emission tomography (pet) scan. http://www.mayoclinic.com/health/medical/IM00356 In text (Mayo Clinic) Nbbj: Perkins & Will (2012, June 6). http://www.nbbj.com/news/2012/6/6/nbbj-sweeps-healthcare-designs- 12th-annual-architectural-interior-design-showcase/ In text (Perkins & Will) Sierra Tucsan. (2013). http://sierratucson.crchealth.com/ In text (Sierra Tucsan, 2013)
thank you!
marissa wilson | senior thesis | 2014