Thesis Research

the UNspoken disaster the ISSUE

Proposal Nationally Locally Location of Clinics Social Injustice

the RESEARCH

Changing Role Influence of Space Study Findings Healing Design Design’s Affect on the Brain Recovery Artwork

the SITE & CONTEXT

Site Selection Traffic Diagrams Neighborhood Businesses Demographics Walkability Observations & Photographs Climate Conditions

the PROGRAM

Project Vision User Groups Program Spaces Community Partners

the CASE STUDIES

Pima County Crisis Response Center Avera Behavioral Healthcare

1

Proposal P ortland C ommu n i t y

Mental Wellness Center

In America, one in four adults suffer from a diagnosable mental disorder in a given year. Of these, approximately 14.8 million are suffering from major depressive disorder, the leading cause of disability in the US for ages 15-44. In the battle for health, happiness, and social justice, we are failing a large sector of our population that struggle with mental illness. Not only are the numbers overwhelming, but also the challenge of social acceptance. Public stigma has shamed those with mental health issues, creating both an unwillingness to seek help and, in many cases, a lack of access. Mental health patients can experience discrimination in employment, housing, medical care, and social relationships. This human failure is not only affecting the everyday lives of individual sufferers, but is deteriorating the quality of our cities, Portland included.

In 2005, Multnomah County accounted for 17% of all suicides in Oregon, a state that ranks 14th for the highest suicide rate in the nation ("Community Health Assessment Quarterly: Suicide in Multnomah County"). Furthermore, the Portland Police Department is struggling with a reputation of injustice towards mentally ill offenders. A column in The Oregonian on Sept 16 of this year relates the results of a 14-month investigation by the U.S. Department of Justice that cites Portland police engage in “a pattern or practice of unnecessary or unreasonable force during interactions with people who have or are perceived to have mental illness.” (Duin) This social injustice has been met with continued cries of reform from mental health advocates in the region after several controversial deaths at the hands of police brutality.

Nationally, mental health issues are cited as the cause for nearly half of the homeless population, a situation that also burdens Portland’s streets. (Westberg) Instead of addressing this critical health issue, our society has continued to ignore the problem and further a culture of scorn and intolerance. Several studies indicate that the stigma associated with mental illness has not improved over the last 50 years. In fact, in a replication of a 1957 study, attitudes toward those with severe mental illness actually became more negative. (Mayville, and Penn 242) While the public’s literacy about mental disorders has shown clear improvement, attitudes remain unchanged at best; views towards persons with schizophrenia have deteriorated. (Schomerus, Schwahn, Holzinger, Corrigan, Grabe, Carta, and et al 448) This negative public perception has a lasting affect on peoples’ willingness to seek mental health. In the United States, 20% of respondents state they “probably or definitely would not seek treatment if they had serious emotional problems.” Additionally, one-half of people surveyed stated, “they would be embarrassed if their friends knew about their use of mental health services”. (Jagdeo, Cox, Stein, and Sareen 757)

2 the ISSUE

All of these factors have culminated into what many experts are calling a national mental health crisis. Not only is the lack of medical insurance on the rise, but also those suffering from mental illness have a dramatically increased rate of uninsured. Of those with insurance, many plans either do not cover medical treatment or provide much more limited plans. Approximately 8.5 million Americans with serious mental illness go without minimally adequate treatment each year (Wang). To put this in perspective, that is more than double Oregon’s state population. As a society, we have failed to make mental health a priority - we have failed to provide access to services, we have failed to provide understanding, and we are failing to ensure social justice.

Can architecture address this throbbing issue? My vision for architecture is to positively affect the way people live. I believe the built environment has a profound impact on the everyday lives of its users and seek to further investigate this intimate relationship. Through the development of a community mental health facility program, I will explore the affects of the built environment on the psychological well being of its users. More specifically, critical attention will be paid to the design of natural light penetration, user relationship to the natural environment, and the development of ‘safe’ spaces as these aspects present a particular challenge in the Pacific Northwest climate. To be considered in the building design are three strategies described in research for changing public attitude and reducing stigma: 1.

Education about misconceptions regarding sever mental illness 2.

Promoting contact between member of the community and persons with severe mental illness 3.

Changing negative attitudes and behavior directly through value self-confrontation

(Mayville, and Penn 242) Research on facilities with similar goals around the country has provided an example to the types of services and programs that could be offered locally. Mental Health Community Centers, Inc. clarifies, “a return to the community does not always mean returning to an active life.

Without appropriate services, social isolation, unemployment, boredom, depression, and even delinquency can occur. MHCC’s community based drop-in centers meet a critical need for direct, non-medical support services, activities, and programs designed to reduce and prevent the need for hospitalization.” (“Mental Health Community Centers, Inc”) A community center for mental wellness could serve as the first point of contact with sufferers. For example, a mother of four struggling with depression is much more likely to seek help from an open and casual environment rather than an institution or psychiatric facility. Additionally, including program elements that allow for all members of the community (those with mental illness as well as those without) to interact will help promote positive awareness. The building’s adjacency to a public exterior area could become a space for the building to reach out to the general public. A gradation of services creates the opportunity for users to move within the program as they heal. Creating an iconic building to address these issues increases awareness and allows services to flourish in this community. By fighting for the mental wellness of Portland’s citizens, we are fighting for the health of the city as a greater whole.

3

the ISSUE

Nationally

Prevalence of Illness

Estimated # of millions of Americans affected

44 M

mental illness heart disease

23 M

diabetes 13 M cancer 9.8 M (“Mental Healthcare Reform”)

8.5 million

# individuals with serious mental illness in the US who do

not receive minimally adequate treatment each year (Wang)

+

less than 1 in 6

# of people with serious mental illness who received treatment that could be considered minimally adequate (Wang)

4 the ISSUE

(more than double Oregon’s population of 3.8 M)

Nationally

5-6 million

# of workers between the ages of 16 and 54 who lose, fail to seek, or cannot find employment as a consequence of mental illness

Percent of Patients Uninsured United States 1993-2009

people with frequent 22.6% of mental distress people with frequent 17.7% of physical distress

16.6%

of people with neither mental / physical distress

(Preidt)

Prevalence of Violence

drug abuse alcohol abuse 24.6% schizophrenia

depression

34.7%

12.7% 11.7%

(Mayville)

5 the ISSUE

Locally

Number of Suicides in Oregon each year

566

2008

641

2009

670

2010

Number of Calls

!

to Oregon Partnership’s Suicide Lifeline

2008

11,303 19,016

2010

Oregon Suicide Rate vs. National Average

national avg

35% Oregon’s suicide rate is 35% higher than the national average

6

(Bernstein)

the ISSUE

The map illustrates a lack of services in the downtown region, as well as a tendency to push mental health facilities to the “edges” of town (as seen by the prevalence of outer east & north community mental health programs).

Portland Location of Mental Health Clinics

Community Mental Health Programs (for all income levels)

Lifeworks NW

Cascadia Behavioral Healthcare Men’s Resource Center Lifeworks NW Project Quest Integrative Heath Center Empowerment Initiatives

Cascadia Lifeworks NW

Cascadia

Mental Health Programs

Project Quest

(excluding individual practitioners) Lifeworks NW

Empowerment Initiatives Cascadia Cascadia

Portland Psychotherapy Morrison Child & Family Services Legacy Emanuel Hospital and Health Center ProtoCall Services, Inc. Alliance Counseling Center Crisis Assessment and Treatment Center Pacific Northwest Psychotherapy Opening to Life Pathways Transitions Psychological Center Dual Diagnosis Anonymous of Oregon Portland Psychology Clinic Trillium Family Services A Better Way Counseling Center Basic Mindfulness Portland LLC Neurohealth Associates LLP Flanders Clinic Advanced Neurofeedback Clinic Evergreen Clinic Caremark Behavioral Health Services

7 the ISSUE

Social Injustice in

Portland Police Dept’s treatment of the mentally ill

U.S. Department of Justice Report - 2012 14-month investigation confirmed that Portland police engage (present tense) in "a pattern or practice of unnecessary or unreasonable force during interactions with people who have or are perceived to have mental illness." (Duin)

May 14, 2010 Acting Sgt. Mathew Delenikos, responding to a report that an Old Town irregular was spitting on cars, pepper-sprayed Aaron Ferguson then fired his Taser four times when Ferguson refused to be handcuffed.

August 15, 2010 Officer Joshua Sparks four times fired his Taser at a naked and unarmed diabetic undergoing a medical emergency.

Report specifies that Portland Police... ...too frequently use a higher level of force than necessary against people suffering from mental illness; ...use Taser stun guns when their use is unnecessary or fire repeated Taser shocks against individuals that are unwarranted; and ...use a higher level of force than justified for low-level offenses.

(Bernstein)

May 15, 2011 Officer Richard Storm punched Fausto Brambila-Naranjo seven to 10 times in the face when BrambilaNaranjo, who'd been standing in the rain for more than an hour, kicked at Storm and missed.

Suggested Reforms: pair more officers with mental health experts. As the Department of Justice makes clear, cops are often the first and only responders when there are gaping holes in the state’s mental-health safety net.

(Jung)

(Duin)

8 the ISSUE

Crisis Intervention Avg cost per week

Hospital

$14,700

Jail Cascadia

$1,323 $382 ("Cascadia Behavioral Healthcare")

The Portland Plan

Vision for future development Goal 3: Healthy Connected City “Prioritize human and environmental health and safety. Our future decisions must consider impacts on human health, public safety and overall environmental health and prioritize actions to reduce disparities and inequities.”

Portland promotes healthful living as part of future planning, however, the specific goals of the plan are limited to physical wellness. Mental wellness is again overlooked in this case.

("Portland Plan”)

9 the ISSUE

Changing Role of

Mental Health Facilities Past

Building Form

Avg amount of time spent in a mental-health hospital has decreased from 10 years to seven days

“Fit in” to the community in regards to size, appearance, culture, context

Self-contained facilities, untouched by the culture of the communities they served

Create grounds for innovative, community based, interactive therapy

“imprison” the mentally ill, “warehousing” of patients created a dependency on the mental health system Typically located outside the community, separate from family, friends, and outside world

Present Community-based services Tend to be decentralized, small in scale, sensitive to local culture and needs Encourage regular contact with “the outside world” to avoid dependency and regression Successfully treat many on an outpatient basis Emphasis on preventative mental healthcare (accessibility, education, recognition of early signs, etc) Location and human atmosphere encourage citizens to seek education, advice, or treatment.

(Wilson)

10

Educate and encourage the community to participate in order to avoid problems with stigma Provide vistas, views to connect with the outside, sunlight Flexible spaces to accommodate continual development of treatment methods (Wilson)

Strategies for reducing stigma:

1.

Education about misconceptions regarding

severe mental illness 2.

Promoting contact between member of the

community and persons with severe mental illness 3.

Changing negative attitudes and behavior

directly through value self-confrontation (Mayville, and Penn)

the RESEARCH

Influence of Space on mental wellness Four possible ways of influence: 1.

2.

3.

4.

As a source of stress As an influence over social networks & support Through symbolic effects and social labeling Through the action of the planning process itself

Lack of contact with nature

“Biophilia�

Robert Ulrich study: Gallbladder surgery in Penssylvania Hospital View of nature from room vs. view of brick wall outside of window Nature: more likely to recover quickly, less likely to need pain meds.

Nature: blood pressure reduced, skin conductance declines, etc. (in consecutive studies)

vs

Environmental stressors

heat, weather (lack of sunlight), air pollution, noise

Social stressor

crowding, fear of crime Dormitory Study 1977: Corridor design promoted excessive, unwanted, and uncontrolled

interaction between neighbors Residents showed more withdrawal which inhibited group formation Withdrawal extended past dormitory into interactions with strangers

in general

vs

(Halpern)

11 the RESEARCH

Study Findings Environmental Stress-

Project Implications

Patients hospitalized for severe depression recover more quickly in sunny versus dimly lit rooms. (Evans, 541)

Natural sunlight

“Laboratory and field studies have demonstrated that exposure to natural elements (trees, water, landscapes) replenishes cognitive energy” (Evans, 545)

Healing gardens Views to nature

“People feel better and have better mental health when they can control their surroundings” otherwise a sense of helplessness can pervade. (Evans, 544)

User controlled passive sys Flexible furniture arrangements

Noise can increase irritability & aggression and decrease the likely of helping others in need of assistance; Interferes with communication.

(Evans, 545)

Range of spaces (quiet, loud) Acoustic treatments

Architectural features that support “fascination, curiosity, and involuntary attention” encourage recovery from mental fatigue (views of nature, fireplace, fountains, aquariums, animals, paintings) (Evans, 546)

Include supporting arch elements (fireplace, fountain)

“Public housing residents living adjacent to natural outdoor areas report better adjustment to their living environment, feel safer, and have more positive affect than others from the same housing development living near outdoor spaces devoid of nature” (Evans, 546)

Public outdoor space must include nature

A study of 80 university students interviewed individually in either a dim or a brightly lit counseling room demonstrated that dim settings created a more relaxed environment. Students in the dimly lit room viewed the counselor more positively and shared more information about themselves than those counseled in the brighter room did. (Anthes)

Soft lighting in counseling rooms

12 the RESEARCH

Project Implications

Social Stressors “Developments with larger numbers of dwellings tend to have a more negative impact on patterns of neighboring: the larger the number of dwellings in a development, the lower the number of neighbors that are known and the lower the level of attachment to the community.”

(Halpern, 121)

Limit the # of units Create social gathering pts Allow for private & semiprivate spaces

“People living close by can be a positive source of friendship and support but, given their proximity, there is a very real risk that the neighbors will end up as a permanent source of stress, especially if the option of avoiding them is not available.” (Halpern, 130)

Minimize the # of units per entry walkway

1976 study found that “the design of (external) public spaces in housing projects had significant influences on residents’ socializing behavior, and suggested that many of the faults of larger projects could be attributed to the design of their public space (particularly their inability to support functional activities).” (Halpern, 126)

Support spaces that house functional activities

Living above the 5th floor disconnects the residents from the street.

Limits social observation of the street (safer) and disconnection harms the mental health of residents. (Lopez)

Keep housing units within 5 stories of ground level

Patients with their own rooms are better adjusted and more socially engaged. The more individuals a psychiatric patient shares a bedroom with, the greater the amount of social withdrawal. (Evans, 539)

Individual units

In hospitals, carpet increases the amount of time patients’ friends and families spend visiting, according to a 2000 study. (Anthes)

Carpet in visiting areas

Clear sightlines

13 the RESEARCH

Healing Design

the influence of Feng Shui & Bioclimatic Design

Feng Shui It urges natural harmony and a feeling of security for the users.

Chinese ancients believed that a design must follow the natural setting and characteristics of the site to maximize the benefit and harmony offered by nature.

The principles advocate living in harmony with the earth’s environment and its energy lines so that there is a proper balance between the forces of nature.

Feng Shui example in building design “Si He Yane, which means four-sided closed courtyard, occurs in the big cities of China where residents need more security and have less access to the natural environment. In addition to using proper direction, Si He Yane also utilizes the window design and material selection in order to have better interaction with natural energy. The windows facing the interior courtyard are larger than the windows on the exterior walls, which makes the interior space gain more sunlight from the courtyard. Moreover, the exterior walls made by local thermal mass materials are thick enough to preserve adequate latent heat energy and block the winter wind from the north. The dark color also helps to absorb solar energy.�

(Wei)

Achieving the balance between Ying Chi and Yang Chi for human comfort is the central thought.

(Wei)

14 the RESEARCH

Healing Design

Feng Shui Philosophy

Social Support Patient Control Positive Distractions Influence of Nature

Bioclimatic Design Ecological Design Environmental Psychology

Bioclimatic design

Human comfort influenced by nature

aims to establish a better indoor environment by taking advantage of nature

“Following the natural rule, wind and sun direction, topography and vegetation analysis, the main notion of Feng Shui building form is to create good Chi, utilize natural power and make people feel secure. These goals are aligned with modern healing design objectives of providing, social support, patient control, positive distractions and the influence of nature.�

four major climatic factors: air temperature, solar radiation, air movement and relative humidity Using these natural sources to enhance the well-being of humans in the built environment is the greatest concern in bioclimatic design (Wei)

(Wei)

15 the RESEARCH

Design’s Affect on the

brain

Jonas Salk

Stifled by his dark basement laboratory in Pittsburgh in the 1950s, Jonas Salk traveled to Italy to gain inspiration amid a 13th century monastery. It is while wondering in sunlit cloistered courtyards that Salk’s inspiration for the polio vaccine took hold. From this experience, he came to believe so strongly in a setting’s ability to influence the mind that he teamed up with architect Louis Kahn to build the Salk Institute on the shore of La Jolla, California. Today, this scientific facility stimulates breakthroughs and encourages creativity.

(Anthes)

16 the RESEARCH

RECENT STUDIES

The growth of the brain sciences in the late 20th century gave the field a new arsenal of technologies, tools and theories.

Study: Affect of room’s ceiling height (2007) Professor Joan Meyers-Levy, Univ of Minnesota 100 people randomly assigned to 2 rooms (8ft or 10ft ceilings) Participants asked to group sports from a list into

categories of their choosing Taller Ceiling: more abstract thinking Shorter Ceiling: more concrete groupings “Ceiling height affects the way you process information,” Meyers-Levy says. “You’re focusing on the specific details in the lower-ceiling condition.”

Study: Affects of supplemental lighting (2008) Netherlands Institute for Neuroscience 12 assisted-living facilities: 6 installed supplemental lighting (approx 1,000 lux) 6 remained at dimmer lighting (approx 300 lux) Tested over 3.5 years (every 6 months) Bright light: reduced symptoms of depression by 19% (& showed 5% less cognitive decline) (Anthes)

Well-designed special care units for Alzheimer’s patients reduced anxiety, aggression, social withdrawal, depression and psychosis, according to a 2003 study

by Zeisel and his colleagues. And school design can account for between 10 and 15 percent of variation in elementary school students’ scores on a standardized test of reading and math skills, suggests a 2001 report by investigators at the University of Georgia.

“Because of advances in neuroscience, we can begin measuring the effects of the environment at a finer level of detail than we have before,” U.C.S.D.’s Edelstein says.

“We can understand the environment better, we can understand our responses better, and we can correlate them to the outcomes. I just get chills when I think about it.”

(Anthes)

17 the RESEARCH

Secure Community Design Mahlum’s 8 Strategies

1. Allow varied/multiple levels of access for public areas.

2. Consider scale when configuring shared living quarters.

3. Visual access throughout the building enhances autonomy.

4. Clarify wayfinding.

5. Alcoves allow residents to retreat from larger group situations.

6. Flexibility within communal spaces stimulates and encourages a variety of uses.

7. Abundant daylight and views to the outdoors promote wellness.

8. Clear sightlines allow parents to supervise their children without being in the same physical space.

In shelters, choosing when to interact and with whom is an essential component of self determination. Residents appreciate the ability to see who is in a communal space before entering it. Interior windows or cutouts and open sight lines can accomplish this. At the same time clear visual access supports people who may be deaf, hearing impaired or use sign language to communicate.

Views to the exterior stimulate a feeling of connectedness to the world and beyond, and provide natural daylighting. We have learned to employ transparency with a high level of intentionality, such that a balance is maintained between openness and transparency with privacy and enclosure.

18

(Quirk, “The 8 Things...”)

(Quirk, “Post Tramatic Design”)

the RESEARCH

An easy-to-navigate environment is particularly important for people who are anxious, depressed, or in crisis. Clear vistas and visual connections between all elements of the school also result in easy wayfinding. Research shows that ease of orientation can dramatically reduce anxiety levels

“Focusing on the buildings relationship to and transparency from the surrounding community is critical to the design process. At a time when public resources are limited, we recognize that public facilities must by necessity support a wide and diverse range of user groups. Clear identity and way finding, easy access for community use and service, the ability to secure select portions of the campus when community functions are occurring, and beautiful design all play an important role in ensuring an effective and successful community learning center.”

“Letting security and rules define the space results in environments that fail in their mission of healing and empowerment.”

19 the RESEARCH

Recovery Artwork paintings, sculpture, poetry, dance Goal of the of the project:

“To help women become empowered and express themselves in some of the challenges they’re going through.”

“So many times there are not words for what they’re going through. It [gives them] a different way to express themselves.

It challenges them to not be totally verbal all the time and to really get in touch with their mind, body, and spirit.”

-Timberline Knolls Residential Treatment Center (Lemont, Illinois)

Opens up dialogue with the public “A place to start this discussion, and to provide education and help for those who may need it.”

-Timberline Knolls Residential Treatment Center (Lemont, Illinois)

“It really does put a human face on what we do. We don’t just process numbers, we really are about people.”

-Sigma House Recovery Center (Missouri)

Artist: Ellen Anderson Title: “Hopeful” “A former competitive swimmer and lifeguard, i find it ironic that i wish to drown myself. and a small part of me is reaching for help and holding out hope that things may be better one day.”

(Brys)

20 the RESEARCH

Artist: Anonymous Title: “Beauty out of Darkness”

Artist: Motomi Rudoff Title: “Peeling to the Honest”

“Turning something beautiful out of darkness and making cutting something wonderful.”

“From isolation to finding your inner child. I needed to be honest even if it looked scary.”

21 the RESEARCH

Site Selection

Access

-proximity to downtown Portland -within 2 blocks of 2 max lines -located along bike lane streets -near high automobile traffic street

Urban

-infill -community anchor -public gathering point -spur economic growth

Visibility

-first point of contact (mental healthcare) -promote healthy urban living -incrased awareness -icon for community

22 the SITE & CONTEXT

PEARL

OLD TOWN

DOWNTOWN

Burnside

Burnside

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Bike Lanes

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MAX Lines

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Vehicular Traffic

24 the SITE & CONTEXT

Morr iso Bridg n e

SITE

25 the SITE & CONTEXT

Neighborhood y

Businesses

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Luggage Repair Shop Asian Restaurant Travel Agency Vintage Shop Nail Salon Lebanese Restaurant Huber’s Cafe

26

V

3rd

Printing Services Multnomah Health Dept.

Bridal Shop Key Bank Everest College Cafe

k

ton

Outdoor Store Piercing Shop Exotic Dancers Deli/Grocer Used Bookstore

park

Indian Restaurant Health Centers of UWS Starbucks Night Club

Mother’s Bistro Real Estate Office

food

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Multnomah County Office Legal Office Downtown Grocery Leather shop Hair Salon Printing Services Church of Scientology

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the SITE & CONTEXT

Empty lot Cafe/Food Services Shops Vacancy

Single Female 25.4% Black 5.3% Native American 2.6% Native Islander 0.7%

Single Male 19.2%

Asian 11.4%

Single Mother w/kids 5.4%

Other 2.2%

Families w/kids 4.8%

Hispanic 5.6%

Single Father w/kids 4.7%

White 77.9%

Families w/out kids 40.4%

RACIAL DISTRIBUTION

HOUSEHOLDS Under 5 1% 12.7% 64 & Older

5 to 17 1.1%

18 to 21 28.7% 28.8% 40 to 64

DEMOGRAPHICS

22 to 39 27.6%

Downtown Neighborhood Portland, OR

AGE DISTRIBUTION

27 the SITE & CONTEXT

Neighborhood Walkability Walk Score Site: 100 (means daily errands do not require a car) Downtown neighborhood of Portland: 96 Site transit score of 92 (45 nearby routes: 38 bus, 7 rail)

20 Minute Neighborhood 92 (0ut of 100) Factors: availability of grocery stores and other commercial services, impact on pedestrian access (sidewalks, street connectivity, topography)

28 the SITE & CONTEXT

Neighborhood

Observations

In-depth neighborhood studies took place surrounding the site on SW Stark St. between SW 4th Ave and SW 3rd Ave in Portland, Oregon. In general, observations were limited to one street in either direction. The site is currently used for parking and is covered with asphalt paving. Located in the greater downtown neighborhood of Portland, census data for 2010 provides baseline knowledge of the area. The quantitative data confirms several inferences gathered from observation: the area has very little family/children use, working-men are the majority user group, and Caucasian is the predominate race.

Qualitative observation provides a fuller understanding of the specific blocks. Many of the street level storefronts were vacant and for lease. A significant number of upper story units also touted “for lease” signs. Of the storefronts occupied, there is little noticeable effort to connect to street life; tinted windows, solid walls, and minimal signage closed out the indoor activity. One exception would be the used bookstore on the corner of SW3rd and SW Stark. Book racks fill the entrance alcove just off the sidewalk and create a place to linger. This is noticeable the location I most often saw people browsing instead of hurrying on their way.

The area appeared to have adequate infrastructure; bike racks, pay phones, and drinking fountains could be noticed along the street. Street parking was easy to come by most of the time and allowed for 90 minutes of pay-to-park. A very well marked and wide bike lane runs west on SW Oak Street. The other surrounding streets lacked bike lanes but would not have been unusable by bikers in non-peak hours. Several of the streets were tree-lined and had ‘historic’ light posts.

The city’s max lines all run within several blocks of the specified site and enhance the district’s connectivity. There are a couple below ground and above ground parking garages in the vicinity. Several of the buildings are in the process of undergoing improvements/remodels, which provides an image of revitalization and ‘hope’ for the community. Historic facades add character and a sense of place.

The people populating the streets seemed to be on their way from point A to point B, meaning there was less a sense of wandering, lingering, socializing, window-shopping. Many pedestrians carried backpacks, but few had shopping bags. For the most part, people passed by in pairs or as individuals (noticeable lack of groups). Smoking was not uncommon and perhaps even more prevalent than other street corners in Portland. Each time I visited, I noticed wheelchair users as well (some days, several), which seemed more frequent than elsewhere in Portland. I encountered several ‘bums’ on the street that appeared to be homeless, but their presence did not feel threatening.

29 the SITE & CONTEXT

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30 the SITE & CONTEXT

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31 the SITE & CONTEXT

Street Life

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32 the SITE & CONTEXT

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Challenges

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33 the SITE & CONTEXT

Portland City Code

Zone: Central Commercial (CX) Overlay D Central Commercial Zone

The Central Commercial (CX) zone is intended to provide for commercial development within Portland's most urban and intense areas. A broad range of uses is allowed to reflect Portland's role as a commercial, cultural and governmental center. Development is intended to be very intense with high building coverage, large buildings, and buildings placed close together. Development is intended to be pedestrian-oriented with a strong emphasis on a safe and attractive streetscape.

Design (d) Overlay Zone

The Design Overlay Zone promotes the conservation, enhancement, and continued vitality of areas of the City with special scenic, architectural, or cultural value. This is achieved through the creation of design districts and applying the Design Overlay Zone as part of community planning projects, development of design guidelines for each district, and by requiring design review or compliance with the Community Design Standards. In addition, design review or compliance with the Community Design Standards ensures that certain types of infill development will be compatible with the neighborhood and enhance the area.

34

Design Basics Maximum FAR: 4 to 1 Maximum Height: 75ft Min. Building setback: 0 Building coverage: no limit Min. Landscaped area: none Ground Floor Window Stds Apply (33.130.215.B.) Pedestrian Requirements: Yes (see 33.130.240) Required parking: none required

Windows General standard. The windows must be at least 50 percent of the length and 25 percent of the ground level wall area. Ground level wall areas include all exterior wall areas up to 9 feet above the finished grade. The requirement does not apply to the walls of residential units, and does not apply to the walls of parking structures when set back at least 5 feet and landscaped to at least the L2 standard.

Standard. Windows must cover at least 15 percent of the area of street-facing facades above the ground level wall areas. This requirement is in addition to any required ground floor windows. Ground level wall areas include all exterior wall areas up to 9 feet above the finished grade.

Qualifying window features. Required window areas must be either windows that allow views into working areas or lobbies, pedestrian entrances, or display windows set into the wall. Display cases attached to the outside wall do not qualify. The bottom of the windows must be no more than 4 feet above the adjacent exterior grade.

Building Line Standards

The building must extend to the street lot line along at least 75 percent of the lot line; or b. The building must extend to within 12 feet of the street lot line for 75 percent of the lot line. Except in the South Waterfront Subdistrict, the space between the building and the street lot line must be designed as an extension of the sidewalk and committed to active uses such as sidewalk cafes, vendor's stands, or developed as "stopping places."

Map 510-6: Requried Building Lines

35

Climatic Conditions

Winter Winds

Summer Winds

Location: Portland/Hillsboro Period of Record: Nov 2011-Mar 2012 Calm: 49.5% Avg Speed: 3.7 mph

Location: Portland/Hillsboro Period of Record: April 2012-Oct 2012 Calm: 42.0% Avg Speed: 4.0 mph

(“Iowa Environmental Mesonet”)

36 the SITE & CONTEXT

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("climatemps.com")

SAD (Seasonal Affective Disorder)

is a form of depression that occurs in reaction to the amount of exposure to daylight. Less daylight = more sadness, fatigue, clinical depression. (Evans, 541)

37 the SITE & CONTEXT

Project Vision:

Education. Advocacy. Service.

EDUCATION

Community Outreach: Art Gallery Exhibition Presentations & Lectures

Extended Learning: Classes / Workshops Career Development Awareness Training

ADVOCACY

Community Focused: Addressing Public Policy Awareness campaigns Political lobbying

Education programs create a platform for community discussion and serve as a tool for dissolving public stigma. The art gallery will display work (anonymously or otherwise) as a means of expression for the artist and with an aim of understanding for the public. Display also validates the individual and creates a sense of community involvement and self-worth.

A museum-style exhibition will also replace mis-conceptions with knowledge as a device for breaking down stereotypes. This, along with presentations and public speakers, will help create a mood of informed awareness and bring issues of mental health to light.

The extended learning component disseminates practical information and develops life skills to promote holistic well-being in Portland. This serves to help individuals transition from the mental healthcare system into the demands of everyday life. The programs also create an opportunity for citizens to learn how to support people in their lives that suffer from mental illness.

Advocacy seeks action in developing a better community atmosphere for patients & their families. These programs aim at affecting public policy, insurance companies, federal funding, and community awareness. Portland encourages social justice and this component provides an important expression of the city’s dedication to issue.

Organization of movement

38 the PROGRAM

SERVICE

Community Focused: Group Therapy Art Therapy Stress Management Conflict Management Meditation & Self-Healing Practices

These programs aim to increase public interaction with the Center while serving as an asset for promoting mental wellness within the community. By integrating varied levels of care, the program can become a place where ALL community members can seek support, a sense of well-being, and empowerment. Encouraging preventative care, the Center offers stress management counseling, conflict management sessions, and selfhealing strategies (such as medication, yoga, art therapy).

Resource Management

Clinical: Individual Therapy (psychological & psychiatric) Crisis Management Prescription Management Pharmacy

Housing: Transitional Housing (short term duration) Supportive Housing (integrated)

Serving as a ’home base’ for mental health treatment, the clinic offers crisis management to evaluate in-coming patients and guide their healing process. In addition to the Center’s innovative treatment programming, the clinic provides individual psychological therapy as well as psychiatric care for prescription management. As the face of mental health care in Portland, the Center can guide individuals to specific resources as a way to utilize unique programs throughout the city. This creates a linked network of mental wellness services and supporters, strengthening the system as a whole by unifying the scattered parts.

Transitional housing near supportive programming allows for shared resources and helps create a sense of community around the center. By integrating the supportive housing (for individuals with stable & treated mental illness) with public housing, the sense of engagement and community is further enforced.

39 the PROGRAM

User Groups: Mental Healthcare Consumer (acute)

Individuals in need of crisis management help will have direct access to clinical treatment.

Mental Healthcare Consumer (chronic)

Continued treatment will be provided through the clinic, as well as access to support resources through educational and community treatment programs. Transitional and long-term support housing is available to consumers with extreme needs.

education

Mental Healthcare Consumer (non-diagnosed)

Support services, group counseling, art therapy, stress management, educational resources, etc. are openly available to individuals experiencing daily struggles but lacking a medical diagnosis.

advocacy

Family Member

Educational and group sessions help family members make adjustments to support the treatment of loved-ones. Fueled by personal experience, avenues for involvement in the policies of the mental health system allow family members to have a voice.

service

Community Member

Education and public outreach (gallery, lectures, exhibitions) aim at raising public awareness and breaking down barriers of mental health stigma.

Mental Health Advocate

For individuals promoting change and social justice in Portland and the nation, avenues for action are available.

40 the PROGRAM

PUBLIC AREAS Exhibition space Lecture/meeting hall art gallery art therapy classrooms mediation room advocacy office

Program

CLINIC ADMINISTRATION Reception desk waiting room triage room offices staff room gerneral storage billing department

PUBLIC AREAS

CLINICAL FACILITIES individual counseling rooms group therapy rooms nurse’s station staff lounge

SUPPORTIVE HOUSING CLINIC ADMIN.

PSYCHIATRIC CARE individual counseling rooms pharmacy crisis management room CLINIC FACILITIES PSYCHIATRIC CARE

SUPPORTIVE HOUSING inidividual units case worker offices housing admin offic general storage group community rooms group service kitchen

41 the PROGRAM

Community Partners PSU Community Psychology

Greg Townley, PhD Assistant Professor, Applied Social & Community Psychology Dr. Townley specializes in Community Psychology with emphasis on the following: The impact of social, psychological, and environmental factors on community

participation and inclusion of individuals with psychiatric disabilities Community mental health and recovery from psychiatric disability Homelessness and housing interventions Sense of community theory and measurement The interplay of culture, sense of community, and well-being ("College of Liberal Arts & Sciences: Department of Psychology")

Cascadia Behavioral Healthcare Jim Hlava

Toured Facilities: Center for Student Health & Counseling Portland State University Psychological & Psychiatric services for PSU students Royal Palm Hotel Services: Transitional housing for homeless individuals suffering from a diagnosed mental disorder Blanchet House Short-term housing for homeless males (clean & sober), community soup kitchen (staffed by residents)

VP Housing & Homeless Services

Mr. Hlava directs the supportive housing programs for mentally ill individuals. Through personal accounts, he has helped illustrate the potentials for community based mental healthcare as well as some challenges faced in dealing with the general community. As a whole, Cascadia is “a major nonprofit healthcare provider in Oregon for mental health and addiction treatment services. [They] also provide supported housing and permanent housing to more than 600 individuals. Cascadia is unique in providing a full continuum of services to children, families, adults and older adults.� ("Cascadia Behavioral Healthcare")

Individual Care Giver Daniel Feller

Professional Care Giver

Mr. Feller provides care to individuals in the greater Portland area dealing with physical, mental, or age related difficulties. In personal interviews, he was able to provide valuable first hand perspective as well as relate client needs and service requirements. Mr. Feller has extensive experience with Single Room Occupancy housing buildings (SRO) and public resource programs in Portland.

42 the PROGRAM

The Royal Palm Case Study: Portland "Coming to the Royal Palm has really changed my life around quite a bit," explained resident Terry Noble.

"We just want people to know that we're not crazy-crazy."

One of the lowest barriers for admision among transitional housing programs in Portland area Admits homeless individuals diagnosed with “severe and persistent mental illness�

Maximum stay: 24 months Currently houses 50 residents Provides a sense of community, group support meetings, residential counselors, etc.

Includes a drop-in center, 24/7 on-site staffing, meals, medical services, case management, and medication support.

Encourages progress towards a healthier, more independent lifestyle Funded by federal government Run by Cascadia Behavioral Healthcare

NW Flanders Street

43 the CASE STUDIES

Pima County

Crisis Response Center Location: Tuscon, Arizona Year: 2011 Design Team: Cannon Design Area: 60,000+ sf Funding: $18 million CRC & $36 million Behavioral

Health Pavilion at University Physicians

Hospital, voter-approved bonds

Views of the Community 1. Mentally ill people shouldn’t be in jail “People understand that those who are mentally ill don’t belong in jail and that it makes sense to get people care in the right setting... this would save precious law enforcement resources.”

2. Those in psychiatric crisis should not be in hospital ERs, either.

“Since a significant number of the mentally ill are also uninsured or homeless, caring for them in a crisis response center could cut hospital expenses for uncompensated care. And, that is a problem in nearly every community.”

3. Our community can do better - and it should.

“There was a feeling that, as a community, [having this center] would really raise the bar on the quality of life in Tucson.”

Pima County Crisis Response Center (1), new Behavioral Health Pavilion (2), & existing UPH Hospital (Grantham)

44 the CASE STUDIES

Facility meets a range of needs: Divert many psychiatric emergency or crisis cases from emergency departments at hospitals Divert adults from jail and juveniles from the detention system into care Combine multiple medical disciplines Engage consumers and families as part of the workforce Provide crisis psychiatric care (with or without medical benefits) and them reintroduce patients back into the community (integrated and effectively)

Program 1. Two points of entry: public “front door” and secure “sally port” (for detainees) adult treatment & family/pediatric treatment (with separate waiting rooms) 2. 23-hour observation/triage areas 3. Short-term adult residential treatment 4. Adult short-term sub-acute treatment area (3 to 5 days) spacious day room, nurses’ station (floor-wide visibility), 15 patient rooms, open-air deck 5. Telecommunications center 6. Administrative, staff, and provider spaces 7. An adjacent sobering/detox facility (Cilento)

(Grantham)

45 the CASE STUDIES

(Cilento)

46 the CASE STUDIES

First 6 months of operation: Crisis line calls received: 61,154 total (8,736 monthly avg) Adults served: 4,918 total (703 monthly avg) Youth served: 776 total (111 monthly avg) “The building’s orientation, indigenous landscaping, locally produced building materials with high recycling content, and careful glazing strategies bolster the concept of creating a holistic healing environment.”

(Cilento)

(Cilento)

47 the CASE STUDIES

Avera Behavioral Health Center Location: Sioux Falls, S.D. Year: 2006 Design Team: BWBR Architects Program: 130,000 sf hospital & medical office Funding: $32 million Specialized units: profound mental illness (adult), general adult, senior, adolescent, & children

Building features

Supportive interaction

Large, unique-designed day areas Lots of skylights and windows Open nursing stations Transitional seating areas near patient rooms Special use of color, natural accents, and specially selected art work Public (“on-stage”) and private (“off-stage”) corridors flanking patient support areas

Rooms boarder on open community areas instead of long corridors. These rooms include a threshold that allows patients to enter the space at their own pace.

“patients find the space safe, comfortable, and empowering” The 130,000 sq. ft. building includes: 85,000 square feet of hospital space, 36,000 square feet of medical offices, and 9,700 sq. ft. link/shared lobby.

Open design (nurses’ station) is not only safe, but it is more peaceful and conducive for patients healing and staff working “Wedge” design encourages patients, and families/ visitors, to congregate away from nursing stations (Dahl, Thomas, and Holmes )

48 the CASE STUDIES

Setting the right tone Attractive exterior welcoming foyer, and prominent place in the community Open design empowers patients (walk through the unit, get their own beverages/snacks, sit where they find comfortable) Lack of “institutional feel” makes interactions between patients and staff better Two-story light court & waterfall create a tone of beauty and serenity Two corridors separate in-patient areas from public & daily support services (respect patient privacy and dignity)

(Dahl, Thomas, and Holmes )

“...A giant step forward for patient care and for community perceptions about behavioral health care”

49 the CASE STUDIES

Arlington Free Clinic

Location: Arlington, Virginia Year: 2009 Design Team: Perkins+Will Area: 8,500 sf LEED Gold Funding: Built entirely from donations, the free clinic was created to reflect the client’s goals of respect, dignity and inspiration.

CONCEPT

A simple flower provided the design concept. The concept illustrated the importance of a stable core and the beauty in the organic nature of the petals. This "core" engaged the four essential elements of AFC: welcome, support, community and treat (clinic).

Through research that included interviews, questionnaires, observation and daylight studies, all the aspects of the project focused on creating a healing environment that was affordable and maintainable.

(Shepley, Day, Huffcut, and Pasha)

50 the CASE STUDIES

The flexible conference/education space, the center element of the plan, supports board meetings, patient education and community events and is partitioned by curved sliding doors.

The project integrates evidencebased design strategies (EBD) and Leadership in Energy and Environmental Design (LEED). It is the first free clinic in Virginia and the first health care space in Arlington County to receive LEED certification. All design elements, including the pattern language and lighting, serve to shape an environment designed to restore health and inspire healing.

51 the CASE STUDIES

Healthcare Interior Study

Design Team: Perkins+Will Jamie C. Huffcut (designer on the firm’s healtchare team)

Seating layout. Three distinct activity zones are defined by elliptical shapes, dropped ceilings, color, and distinct seating layouts.

Corridors were shaped to discourage an institutional feel; expanding upwards, increasing opportunity for light penetration with clerestory windows. The clerestory further helps define circulation and lounge boundaries. A design solution of clearly delineated spaces avoids ambiguity of function and, therefore, ambiguity of action for occupants. Built-in seating and encircling walls within private nooks create safe levels of seclusion

52 the CASE STUDIES

All interviewees requested individual “calm down� spaces with detailed, realistic imagery. EBD research suggests privacy as a stress reducer and imagery, such as art and murals, as a positive distraction for patients.

Cool colors of blue and purple were preferred by all participants. Numerous studies associate cool colors with feelings of calm.11 Residents disliked strong primary colors, children's toys, and small-scale furnishings.

A desire for improved daylight was apparent. Daylight serves as a connection to nature and, therefore, a distraction from the difficulties of treatment.12

Isolated seating final rendering.

Private seating niches with built-in furniture create calming spaces for a safe level of seclusion.

Images with varied seating options and arrangements were highly regarded. More seating options offer patients more choice and control of the environment.

Males favored seating focused around the television demonstrating the adolescent desire to connect to peers through media and peer observation to further identity development.

(Huffcut)

53 the CASE STUDIES

the

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