Kristin Ledet
Kristin Ledet
September 16, 2019

5 Takeaways From HORIZON Houston Event on Mental Health & Wellness

Kristin Ledet
Kristin Ledet

We were thrilled to host our Houston office’s inaugural HORIZON event, “A Deeper Look at Mental and Behavioral Health & Wellness in Texas,” in late August. The discussion explored numerous topics including the lack of architectural guidelines for mental health facilities in Texas, the unique challenges in designing spaces for adults, children and college students, best practices, and ideas for creating spaces for patients and staff that are inspiring, safe and dignified. It proved a thorough and informative discussion.

The audience featured local health, education and business leaders, along with designers and real estate professionals. We were fortunate to have an incredible panel with leaders and experts from UT Health Harris County Psychiatric Center, Texas Health & Human Services, Texas Children’s Hospital, University of Houston and CannonDesign. The event showcased strong interest in the future of mental health in Texas and beyond. Here’s a look at five key takeaways from the Houston event.

1. Safety is No. 1 priority
The main priority for every behavioral health institution is safety for both patients and staff. Most patients who are staying in a mental health facility can be risks to themselves or others, and care spaces need to be designed with that in mind. But most administrators don’t want their facilities feeling institutional. “In some of the designs of our new hospitals, we’ve had to be very creative in thinking through what can be used to cause harm to yourself,” said Mike Maples, Deputy Executive Commissioner for Texas Health & Human Services. “But you also want it to be a healing environment, you don’t want it to be like a cell. How do you balance those things?

“We looked at the types of behavioral health patients are coming into our facility who would inflict harm to themselves or others in the pediatric setting, those who ingest items,” said Rene Kacal, Facilities Project Manager, Texas Children’s Hospital. “Then we look around the room and see what we could do to minimize that risk.”

2. Access for all is crucial
A large part of the mental health crisis occurring today in the United States is access to care. Waiting lists for mental health facilities are lengthy, as both state-funded and private facilities do not have the capacity to meet the demand for their services. Gaps in the continuum of care from counselors to supportive housing also make access and avoiding readmission difficult.

“Having access when you are in your most desperate hour, when you may be a parent with a child in crisis, the last thing you want to hear is there’s a 200-person waiting list,” said Maples. “How can I make the most efficient use of my beds? How do I provide a healing environment with services that make people well as quickly as possible, isn’t a dreary place where people don’t get better, where staff want to work and families are comfortable bringing their loved ones there? As we sit down to design new hospitals that’s really been the focus.”

Universities are also confronting capacity issues, and are using group therapy as a potential solution. “Universities are quite proud when every year they can increase their population, but sadly when they increase by 1 percent, the need for mental health also increases,” said Floyd Robinson, former Associate Vice President for Student Affairs, Health and Wellness, University of Houston. “In higher education we have to become very mindful of spaces we develop to accommodate the increase.”

3. Design should respond to patient and staff needs

The behavioral health facilities being built today are keeping in mind the needs of two populations: patients and staff. Patients need to be in a space where they can truly heal, and staff needs to feel like their surroundings can facilitate that care.

“The environments we create for mental health patients truly do impact their care,” said Tim Rommel, Director of our Behavioral Health Practice. “We use the term ‘therapeutic platform’ which is not only the built environment but the space around that built environment. Does everyone have access to the outside, (where you can) feel the wind, rain on your cheek; things that we take for granted but someone in a restricted environment might not have access to.”

He adds that as the design impacts patients and staff first and foremost, these spaces are also benefiting the community at large and helping to destigmatize mental health institutions. “We’ve had clients who have said we’re a community asset. We’ve got a gym that patients use but they don’t use it all the time. We’ve got conference rooms but not used all the time. What if we were to open those up to the community and bring the community in. We’ve got clients where the Boy Scouts meet at the mental health hospital, or the sports league is using the gym. This can help reduce stigma related to mental health today and into the future.”

4. Research needed on design’s influence on patient outcomes
Healthcare facilities rely on patient outcomes data to receive funding and reimbursement for services. Our panelists agreed that stronger research into how design influences patient outcomes would be helpful when it comes to renovating or building new behavioral health facilities.

“If we can fund more research on the intersection of design and outcomes, it would have a huge impact,” said Stephen Glazier, Chief Operating Officer of UTHealth Harris County Psychiatric Center. “Then you could have something anyone can use as they’re developing guidelines and deciding how they’re going to build buildings to give real evidence-based ideas about what does and doesn’t work. Really well-done research carries a lot more weight than our anecdotal stories.”

Glazier said he’s seen how things such as lighting, colors, and different spatial layouts can lower stress levels and aggression. He said providing multiple seating options has given patients the control to sit by themselves or with others. He added that concrete data of the benefits of these design choices would inform how behavioral health facilities evolve.

5. College students are demanding resources
With an increasing percentage of college students being treated for a mental health issues – about 34 percent in 2018 compared with 19 percent in 2007 – these students are in turn demanding the resources they need. University leadership is noticing. More than 80 percent of university executives say mental health is a bigger priority on campus than it was three years ago, according to a report by the American Council on Education.

Colleen McKenna, Director of our Sports, Recreation and Wellness Practice, said the younger generations expect to have access to behavioral health services around the clock. “This is the Netflix world… they expect to be able to meet with a counselor 24/7, but college counseling offices have traditionally been open between the hours of 8 and 5. What happens if a student has a crisis at midnight on a Friday? If there are no services, they’re slipping through the cracks. Students are aware of this, demanding what they need, and I expect their voices to get louder and louder.”

Learn more about HORIZON >