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Addressing Mental Health Needs With Crisis Stabilization Units

Jeff Goodale, AIA, ACA, and Virginia Pankey, AIA
As society emerges from the worst of the pandemic, psychiatrists, psychologists and healthcare professionals are caring for a new wave of patients with mental health issues worsened by isolation and deferred treatment.

A recent survey from the U.S. Centers for Disease Control and Prevention showed that more than 38 percent of respondents reported symptoms of anxiety or depression. Emergency visits for suicide attempts and overdoses rose by more than 25 percent in the last year. And even in the states with the most mental health resources, more than 38 percent of those struggling don’t receive treatment. Our healthcare and justice systems are the frontlines for caring for those with mental health issues. Crisis stabilization units play a critical role.

In this Q+A, Virginia Pankey, a senior medical planner with HOK’s Healthcare practice, and Jeff Goodale, director of Justice, talk about designing these spaces to meet the distinct needs of behavioral health patients and their families.

What is the purpose of the crisis stabilization unit in behavioral health design?

Virginia Pankey (VP): The crisis center is for individuals experiencing a mental health emergency. Just like if someone has a heart attack, sometimes people have emergency psychiatric needs and they need a safe place to be treated.

Jeff Goodale (JG): They often aren’t voluntarily admitting themselves. Family or others take the patient there because of some kind of crisis. Very often, there is some kind of triggering event that led to the intervention. The crisis stabilization unit meets the needs of these patients with specialized care.

COVID-19 has had an impact on the need for crisis services. Can you talk about the pressures facing the healthcare system in the wake of the pandemic?

VP: We’ve all seen the statistics showing that the number of people with mental health issues has shot up in the last 18 months. The stress and isolation associated with the pandemic exacerbated those issues. People often treat physical ailments quickly. If you’re struggling to walk, you would take yourself to a doctor or emergency department after a fairly short time. But the same is not the case for mental health issues. Even if your anxiety is impacting your work or family life, you might still be tempted to push through rather than seek treatment. During the height of the pandemic, many were scared to visit an emergency room and clinicians didn’t have as much availability to care for mental health patients. These factors all had a negative impact on overall mental health and wellness.

JG: I work with many in law enforcement and those associated with our healthcare systems. I’ve repeatedly heard that they are getting more calls than ever to respond to drug overdoses, domestic abuse, suicide calls and more. These issues are often connected to mental health.

What are the key design elements of a crisis stabilization unit?

VP: Programatically, these units are similar to traditional emergency departments. But there is greater sensitivity to privacy, noise and promoting calming, deescalating spaces. These units typically include a smaller arrival space, traditional exam rooms for intake and accessible quiet rooms near the entry that can provide comfort to someone experiencing an episode. A kitchenette is available to patients and visitors. A comfortable waiting space with minimal stimuli also is key. An open nurse’s station helps minimize paranoia and anxiety. Seclusion rooms can give additional privacy when someone is experiencing a traumatic episode.

JG: Use of glass in a nurse’s station or other space sets up a hierarchy. The staff is in a position of power. So removing glass when possible can avoid making patients feel like they are in a subordinate position. It helps patients feel some control over their space and themselves. It helps them feel like they can talk one-on-one to clinicians and providers.

Materials, lighting and acoustics are also important. Patients should have lighting systems they can control. Carpet and ceiling selections should minimize and absorb noise. Selecting furnishings and materials without patterns can reduce stimulation. Natural materials elevate the space and make it feel less like a mental health facility.

Behavioral health clinicians experience great pressure. Which design strategies promote rest and security?

JG: Staff need their own, removed place close to patients. It could be as simple as a well-designed break area. It could be a private office space. It could be a patio or outdoor area that offers access to daylight and biophilic design elements. Amenities should be focused on reducing stress and providing moments of respite.

How have crisis stabilization units and behavioral health facilities evolved over the last decade? 

JG: One of the most notable changes is avoiding isolation. Isolation can be incredibly damaging to patients. Even in forensic mental health facilities, we think about facilitating gathering safely in groups with clinical staff. This creates a more normalized environment and promotes socialization. We’ve also taken steps to soften the design of these spaces, avoiding materials that promote an institutionalized look and feel while providing patients with the benefits of daylight, biophilic design and control of their space when possible.

VP: In addition to the move away from isolation, clinicians on crisis stabilization units are well-trained in quickly caring for patients presenting with a mental health crisis, which didn’t used to be the case. When mental health patients come into a general emergency department, they are 40 percent more likely to end up as inpatients than someone with an acute medical condition. And with a longer average length of stay for behavioral health patients and a limited number of beds and staff, we have a real shortage on our hands. These crisis stabilization units are becoming much more common and are important to alleviating pressure on a hospital’s emergency department while providing patients with better care.

What does the future hold for behavioral health design?

VP: We will see an increase in behavioral health facilities and these spaces will be prioritized as a critical component of the continuum of care. I hope we see more community centers and community-based care options designed for outpatient behavioral health services.

JG: The resources available to the community will broaden. Some services, like police stations, will also become more community-centered. The Village of Oswego Police Headquarters sets a great standard. The client prioritized community access and transparency. These spaces should be viewed as a safe place to access needed services or get pointed in the right direction. I expect we will also see more social services-based crisis intervention teams who are trained in deescalation and can look at things through a different lens.

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