departures level floor plan
Co Diagnosis: An Interdisciplinary Examination of Designing for Co-diagnosed Medical and Behavioral Health Inpatients St. Louis, Missouri
Currently in the U.S., approximately 16 million people (7%
designing an inpatient acute unit for patients who need
rooms at the Barnes Jewish Hospital (BJH)/ Washington
innovative, unconventional design approaches to caring for
Students engaged with key stakeholders and subject matter
of the population) cope with major depression; 42 million
to be hospitalized for medical conditions and also have
University Medical Campus in order to pilot this concept of
co-diagnosed patients.
experts through tours, lectures and a charette. Working
people (18%) live with severe anxiety; and 8.5 million people
behavioral health diagnosis.
providing a ‘safe unit’ for co-diagnosed patients.
(3.8%) live with advanced diseases such as schizophrenia or bipolar personality disorder. While there is long standing history and research around
Welcome!
‘safe unit’ environment. Posters of concepts and ideas were
Research and design investigation must be undertaken in
Through the Center for Health, Research and Design (?) at
was open to 16 undergraduate and graduate students in
designed and presented as students were challenged to
order to better understand the challenges and opportunities
Washington University, BJC HealthCare and the Sam Fox
architecture, landscape architecture, urban design, art and
propose innovative design concepts for this unprecedented
of caring for co-diagnosed patients.
School of Design and Visual Arts at Washington University
visual communications. Students met at both BJH Hospital
approach to patient care.
in St. Louis will be engaging an interdisciplinary group
Barnes Jewish Hospital at the Washington University Medical
of students to examine the design problem and propose
Campus and the Sam Fox School of Design and Visual Arts.
the design for psychiatric units and for medical units individually, there is currently no precedent for specifically
in small teams, students proposed concepts for a healthy This course ran over the course of a long weekend and
BJC HealthCare will be renovating an existing unit of patient
St. Louis State Hospital
185
During Civil War Dr. Smith (Superintendent of Fulton State Hosptial) sends telegram to St. Louis county commissioner describing the pillaging by the confederate guerillas and tells the city to come and retrieve their patients. Dr. Taussig arranges for 80 patients to be transferred from Fulton to St. Vincents Insane Asylum, 9th Street and Geyer Avenue. With one Union Soldier, he seeks out to retreive patients.
mid 1840s Dorthea Dix visits and impresses St. Louis Representatives of the importance of the mental health movement; St. Louis joins Mental Health Movement
Upon arrival, he becomes aware that conditions are far worse than origianally described. Patients are without blankets, clothes, provisions and shelter. He rescues 250 mental patients from Fulton and Confederate controlled area. Patients were numbered, assigned a wagon, and procedded to sing songs and shout as they were all on their way to a picnic. The shear volume of the caravan discouraged confederate troops to attack the group so all arrived safely.
1846/47
1880s
Patients hardly left their quarters
1926
St. Louis citizens would dress up and attend dances at the Insane Asylum with patients in attendence
Overcrowded facilities and the lack of community support for the moral treatment led to a decline in perception of the facility and it’s patients
next overflow crisis - temporarily met by another building program but the addition only included an attendants quarter, and an addition of a cafeteria and auditorium
Patients were smiling, happy and interacting with society outside the walls of the asylum
Country Court approtions $50,000 for the purchase of ground for St. Louis County Insane Asylum on the old Kemper College grounds. New facility seeked to accomendate 150 patients and not exceed $50,000.
1847 Kemper College dies of financial malunitrition + sold alone with 129 acres to St. Louis County
1864 St. Louis County Architect William Rumbold commissioned to design St. Louis County Insane Asylum. St. Louis County Hospital was part of architectural pair with the old Court House ar 4th + Market Street.
St. Louis’s first solution for a mental health facility was a poor farm on the Main Kemper Building and land. At the time a better than average haven for indigent poor inlcuding senile, mentally deficient, physically handicapped, incurably alcoholic and mentally ill
April 1864 - Plans are approved
St. Louis’s Poor Farm quickly becomes overcrowded and plans were set in motion to provide a decent home for mentally ill exclusively
To save money, bricks were made on site, recycling rain water was important for suppplying the power house and facility, advanced ventilation system, and included a gas plant on site for gas lights
December 1864 - Cornerstone laying ceremony
Asylum now had 215 patients, 65 more patients that origianlly desinged for
1960s 1932
1895-1904
1870s common treatment of the time included the moral treatment
1934
no additional beds were planned for
To alieviate overcrowded conditions, patients were sent to Fulton, Farmington or the Poor House
St. Louis Community proud of their hospital, first two decades of asylum coincided with high public concern for mentally ill
1930s
additional funds provided for new construction + renovation to accomendate 2,000 patients and 300 employees
Daily Schedule of Patient
1907
1930s
activities included dancing, music, reading, swinging, playing the piano, walking in the grove, and moderate labor around the building
City purchases 20 additional acres for new construction of 8 additional wings and a seperate building for the power house and kitchen
the hospital did have porches where patients spent many hours but they were so close to the public street that patients were often subjected to the annoyance of curiosity seekers
1909
City & County negotiate their seperation, The St. Louis Sanitarium is renamed to the St. Louis City Institution
1860
1930s
Additions included bowling alleys, a box-ball alley, two billard tables, the purchase of a moving picture machine, and a vehicle for 20 people so they could take daily drives around the parks and country side
1876
1880
1900
Patient population for the first time in a century shows a downward trend and hospital began to explore the frontier of psychology
basic requests included: - new building/additional wings for patients - isolation pavilion for tuberculosis insane - additional solariums to provide recreation space
1905/06
These activities left patients joyous and smiling, delusions often forgotten
Missouri Institute of Psychiatry officially identifies with medical school of the University of Missouri
solariums were installed in the wards in buildings C, E, I and H
1900s
VIP tours given of the St. Louis Insane Asylum to visitors of the city, mostly european because the facility was considered ahead of its time + “nothingto-hide” liberalism mentality of the time
Missouri Institute of Psychiatry built between Rumbolds Hospital and Rumbolds hopsital building (Kohler building later demolished)
additional buildings requested to increase total bed capacity by 537 for general medical illness and tuberculosis
Dr. Runge institutes the beginnings of laboratory work, extended the new concept of psychiatric clinics, pre-admission perfonal histories of patients for their clinical records, and new approaches to occupational therapy
1863
Representative Dr. Williams J, McElhiney sent to visit most advanced Dorthea Dix approved hospital in New Jersey + New Hampshire while Fulton State Hospital was in planning
1840
1890s
so overcrowded that recreation spaces had to be converted into sleeping spaces survery of floor space identified 50 sq. ft. per patient and could only accomodate 2,370 patients
1920
1960
1940 1937
mid 1850s Taussig sent to retrieve 80 mental patients that bad been transferred from the country poor house to Fulton Hospital back to St. Louis
1850s St. Louis’s mental health movement lead by many German-American immigrants bringing the european approach to mental health care to the area Main leaders of St. Louis’s Moevement Judge John H. Fisse + Dr. William Taussig
1910 “every mental hospital of the time was like a bath tub with more water flowing in through the faucets than was going out through the drain. No matter how the tub might be enlarged, its next overflow was just a matter of time”
March 1, 1869 - Facility opens to accomendate 150 patients
1851 First public hospital for mental patients in Missouri opens - Fulton State Hospital in the heart of “Little Dixie”
April 23, 1869 - 129 Male and Female patients are moved from Fulton to St. Louis; 40 moved from the Poor House totaling 169 residents
1864 Four story wings and a five story central section with a dome. The wings housed dormitories, wards, and bathrooms. Central section of each floor included recreation + occupational therapy facilities such as sewing and music rooms. The hospital director’s apartment was on the second floor in the central core. 1860s Dorthea Dix continues crusade to do away with fetters + dungeons in asylums. Europe has similar humanitarianusm reform movement occuring, lead by Pinel+ Tuke
1864-1869 Construction of hospital 1861-1865 Civil War 1847-1857 Dred Scott Case
history of the st louis state hospital independent study, emily johnson co-diagnosis workshop photos at bjc healthcare / washington univeristy medical campus (bottom left) and sam fox school (bottom right)
late 19th Century Psychiatry reaches a plateau - lacked new theories & methods of treatment
1950s
Electroconvulsive Therapy electroconvulsive therapy used on the first human to treat mental illness
psychiatric drug thorazine + new tranquilizer reinforced confidence of effectiveness of outpatient psychiatric treatment facilities
1935 Lobotomy - Antnio Egas Moniz performs the first human lobotomy the severing of neural connextions between the brains frontal cortex for mental patients
1948 The City Sanitarium becomes the St. Louis State Hospital and transferred to the State of Missouri 1940
1931
total patients in residence: 3,844 patients
building k, 3 stories, originally housed manic patients, but transformed into a receiving hospital to house patients until definite diagnosis was made
1940s
1958
new psychiatric theories + techniques begin to appear that could possible achieve a patient discharge rate matching admission but then WWII hits which took psychiatrists away from home while the in-patient population continued to climb
State of Missouri adopted a mental health program designed to bring the hospital new advancing sciences
1931 total bed capacity: 2,185 patients total patients in residence: 3,374 patients
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Sofa/ Chair
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EXISTING PLAN AND ANALYSIS
CURRENT VIEWS
Sofa/ Chair
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Screen
Door (with window)
Wall
PROPOSED PLAN
PROPOSED VIEWS
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INTERZONE CO-DIAGNOSIS MASTER CLASS Sheng Li, Xinyao Li, Sheng Li
existing conditions analyis, sheng li, xinyao li, damon xiang
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INTERZONE CO-DIAGNOSIS MASTER CLASS Sheng Li, Xinyao Li, Sheng Li
design proposal, sheng li, xinyao li, damon xiang
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d control ess
Exterior Planters
net lock
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2
ply cart
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ck cart
pment
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Nurse’s Station with planter and art work
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Communal Space
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Built-In Head Board
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1. Communal Space 2. Nurse’s Station 3. Visitor’s Pantry 4. Pantry 5. Soiled Utility 6. Med Room 7. Clean Storage 8. Low Stim Room 9. Therapy Room 10. Therapy Room 11. Office 12. Staff Breakroom 13. Visitor’s Lockers 14. Visitor Lobby 15. Security
1/8” = 1’
Low Stim Room
card control access
magnet lock
supply cart
1/8” = 1’ design proposal, josephine hsu, teresa lu, marty pimentel, nina clemente
Therapy Room shock cart
breath
co-diagnosis 5200
5200 is a unit located in Barnes-Jewish Hospital Rand Johnson’s fifth floor and proposed to be renovated to serve the acute medical needs of patients that also have behavioral issues. Such patients cannot be safely accommodated in traditional medical units, yet psychiatric units do not have the necessary medical equipment to treat them.
a new path
• Patients lacking a destination in their paths cause them to walk one monotonous path over and over • Patients crave going outside, though it is against medical advice: lack of autonomy and engagement; unstimulated and isolated, potentially exacerbating their abnormal behaviors • There are multiple “realms” in operation in the unit: the administration of medical treatment, the patients’ mental spaces, and the outside world. These realms are intermixed and often collide in the halls, disrupting flows
current room
current corridor
outside world
The Breath layout reimagines the circulation of patients and staff. The ouside world, patients’ community, and medical treatment realms are reogranized concentrically to better the patients’ mental wellness and the nurses’ safety. This design creates a space for the patients to live in a collective environment while still allowing nurses to have efficient transport and escape routes from room to room via an interior corridor. Rooms are centralized and facing outword, with secondary interior doors. Curved designs support a soothing atmosphere.
model
nurses station
common area music touchpoint
patients’ community
med corridor
common area
open-air greenhouse
south view
looping communal corridor
patient room window
corridor
design proposal, dayong hu, victoria xu, mingyang he, wenxi du
enclosed service elevators
clean and soiled utilities, pantry, med
low-stimulation rooms
medical treatment
design proposals, co-diagnosis workshop models