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Pediatric Mental Health Crisis Needs Bold Design Strategy

Karen Freeman, AIA, ACHA
As stay-at-home orders swept the nation, children had to adapt overnight to dramatic life changes: new ways of learning, inconsistent schedules, isolation from friends and relatives.

Parental and familial stressors exacerbated these challenges with children watching their caregivers navigate job and financial instability, changes in work/life balance and, in some cases, grief and fear surrounding sickness and death. According to the CDC,
more than 140,000 U.S. children have lost a primary or secondary caregiver due to COVID, with children of color being disproportionally impacted.

Among adolescents, rates of suicidal thinking and behavior are up 25 percent from 2019. Pediatric emergency admissions for mental health issues like panic and anxiety have increased by equal measures. The situation has become so bad that three leading pediatric medical associations have now declared a national state of of emergency in children’s mental health.

Prior to the pandemic, many children had access to a safety net of teachers, counselors, coaches, mentors and religious leaders who could help observe, identify and address mounting mental health issues. But these aren’t normal times. And parents—and kids—are in desperate need of physical and social interaction.

While vaccines are beginning to give adults a taste of normalcy, minors will be among the last segment of society to fully return to normal. So how do we cope until then? And how can our future healthcare facilities help children dealing with mental health crises like the one we are experiencing today?

We can begin by focusing more on prevention and resources. Today, children experiencing mental health crises often end up in an emergency room. But ERs are ill-equipped to de-escalate the situation and provide the behavioral health services needed. The nation’s mental health treatment facilities—or the lack thereof—are also part of the problem.

Even prior to the pandemic, the U.S. lacked the facilities and resources to adequately treat mental health. With too few inpatient beds and numerous barriers to entry, the crisis can’t begin to be addressed without the clinicians and inpatient and outpatient spaces required to appropriately treat those in need.

As a first line of defense, schools can play an active role in training educators how to identify students with mental health issues and provide resources. Healthcare systems can respond by increasing access to telehealth services and publicizing behavioral health services through pediatricians, community organizations and leaders. Future mental health facilities will need to incorporate telehealth services with quiet, private spaces for clinicians. It is worth noting that there can be challenges to leveraging telemedicine to treat pediatric patients, particularly when working with children who are neurodivergent. Safe environments for in-person interaction are paramount for this patient group.

Pop-up clinics and mobile treatment centers could greatly expand access by bringing mental health services into neighborhoods and communities. Architects working on pediatric behavioral health facilities must also ensure these spaces aid in developing a child’s coping skills so they can foster the competencies to manage their diagnoses. This could include:

  • Incorporating access to nature and biophilia, which have been shown to benefit physical and mental health outcomes.
  • Providing access to natural light to promote a healthy circadian rhythm.
  • Create environments that feel more residential than institutional to help normalize treatment and make patients feel comfortable and receptive to care.
  • Ensure spaces for multi-sensory engagement and activity.
  • Provide controlled social environments within treatment centers to help children overcome feelings of isolation and foster inclusion.
  • Incorporate art and imagery that provides positive distractions.

While the pediatric mental health crisis won’t be solved overnight, the time for designing a brighter and happier future for our children begins now.

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