​  Architecture

Designing inpatient adolescent health

DHS and space innovation lead the way

By Mark L. Hansen, AIA, and Dave Moga, AIA, NCARB, EDAC, LEED AP

s one of the leading causes of illness and disability around the world, mental illness is a widespread health challenge. Recent data from the World Health Organization reveals that approximately one in four people worldwide will suffer from a mental illness at some point in their lives. While researchers and clinical psychologists continue to dig deeper into mental illness, one thing is certain: these conditions are complex and have many causes.

People often assume that mental illness runs in families, which can be true, but genetics are only a small part of it. Mental illness encompasses a variety of disorders, from anxiety to schizophrenia, with levels of severity ranging from no impairment to mild, moderate, and severe. These disorders can occur due to a combination of factors, including a person’s environment and lifestyle. Where the patient lives and the facility in which they receive treatment can play a major role in mental health.

According to the National Alliance on Mental Illness (NAMI), young adults aged 18–25 years old have the highest prevalence of any level of mental illness at 25.8%. However, the need for mental health treatment is becoming increasingly prevalent in children and adolescents starting at very young ages. NAMI also states that one in six U.S. youth aged 6–17 experience a mental health disorder each year. Mental Health America reports that half of those who will develop mental health disorders demonstrate symptoms by age 14. The time between prenatal and early adulthood is a critical time in brain development.

Unfortunately, many of these youth—as well as adults—do not have access to facilities that meet their needs or promote recovery.

​One in six U.S. youth aged 6–17 experience a mentalhealth disorder each year.

Assessing the method of care required

Whether the result of a trauma, a chemical imbalance, genetics, learned behaviors, or a combination of factors, an appropriate network of care must be developed which, depending on severity, could deliver care through several modalities, including counseling, outpatient visits both group and private, intensive outpatient therapies, intensive short-stay care, or inpatient treatment. While it is always the goal to treat children in an outpatient setting and allow them to incorporate their treatment plan into their home setting and daily lives, for some youth that just is not the appropriate level of care.

We struggle to properly identify the early markers of mental health problems before they reach a crisis level. In the past, care regimens waited for a major event before involving mental health professionals. The goal now is a proactive attempt to identify risk markers and deliver care to stabilize or reverse the illness. Therefore, efforts are being made to provide mental health services to support and promote care appropriate to the illness—taking action swiftly at a time when illness management can occur, an approach that results in fewer rates of suicide, school drop-out, homelessness, and involvement in the juvenile justice system. The Minnesota Department of Human Services (DHS) strongly believes that screening for social, emotional, and developmental concerns is essential to early identification of mental health problems in children and youth.

Effect of the physical environment

Physical environment has a direct effect on behavior and the healing process. This has been universally substantiated and proves to be increasingly relevant as it relates to health care settings and the overall well-being of patients, family members, and health care staff. According to the National Council for Behavioral Health (NCBH), the physical environment influences mental health by altering psychosocial processes with known mental health causes. Personal control, socially supportive relationships, and restoration from stress and fatigue are all affected by properties of the built environment.

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For patients receiving care at facilities that are not appropriate to their medical needs, or in response to court-ordered care, DHS runs the Child and Adolescent Behavioral Health Services (CABHS) facility in Willmar. The program provides inpatient psychiatric hospital services in a setting for youth who need crisis stabilization, comprehensive assessment, and intensive treatment of specialized mental health problems.

When their lease was up on the existing eight-bed hospital in Willmar, DHS opted to develop a new, freestanding 18,000-square-foot inpatient facility. This new 16-bed hospital allows the state to effectively provide inpatient services to children and adolescents ranging in age from six to 18 years old. The goal of the facility is to create an environment that provides care in a dignified manner within a setting that is age-appropriate in design and provides areas for privacy, independence, and group interaction within a safe, nurturing, and enjoyable space.

To achieve the best physical space for this at-risk population, ligature-resistant fixtures—which eliminate points where a cord, rope, or bed sheet could be looped or tied—and finishes are delicately incorporated into the design concept, offering functional characteristics while providing a safe environment for both patients and staff. The new Willmar facility responds to the need for sensory stimulation that prompts feelings of safety and comfort while appealing to a large range of ages. Circular clouds with pops of color hang from the ceiling soffit in the main commons area. Lowered ceilings and a built-in bed platform in each of the private patient rooms provide a space scaled to the patient and offer the sense of feeling “nested” within the room. The patient room wings consist of three contained zones of four, four, and eight rooms, all of which are in clear sight from the central care provider station. The open floor plan creates space for one-on-one therapy sessions, group sessions, a spacious gathering area next to the care station, quiet nooks, and window seats for patients to have “alone” time with oversight provided in a dignified manner. The facility also includes a family lounge for overnight stays by parents or guardians to facilitate post-care treatment upon discharge.

​We need to continue to invest in the health and well-being of people facing mental health challenges.

The facility, which opened its doors to patients in June 2020, also includes seclusion rooms, consult rooms, a large commons area, social and dining area, day lounge, comfort sensory room, restrooms, physician offices, exterior courtyards, and a variety of other ancillary spaces.

Response to the need by other facility types

Patients with mental health concerns coupled with substance use disorders also benefit from properly designed facilities. Hennepin County is leading an effort to keep these patients out of jails and hospitals through an extensive renovation to its detox center at 1800 Chicago Ave. S. in Minneapolis. The goal is to create a one-stop-shop Triage Center that ranges in services from detox to mental health care to assisting clients seeking county services. The 13,000-square-foot space includes exam/counseling rooms, waiting areas, and staff/support spaces. The design concept was centered around the theme of “Respite in the City.” The team developed guiding principles that were referred to often during design to ensure the concept stayed true to this theme. Evidence-based design led to the selected principles, which included:

“Familiarity of Home” creates comfortable spaces that are more welcoming for people in stressful situations and offer a residential feel that works to de-stigmatize the type of space.

“Personal Safety” evokes a sense of safety to ease the anxiety of both clients and staff. The space includes a creative use of materials that enhance safety and offer sightlines to prevent personal harm.

“Person-Centric” creates a space that is focused on a person’s holistic experience as they come into the facility—not only the way we design the space, but the way the caregivers work in the space to ensure their focus is centered on the client.

“Grounded Natural Elements” that are strategically designed to pull in natural light through windows by putting client rooms in the center of the space, incorporating nature and art with soft organic forms in the architecture that resemble natural elements throughout.

“Sensory Awareness” creates an environment that is sensitive to noise and overstimulation by incorporating dimmable lights and movable furniture with thoughtful textiles. The public “Living Room” includes a bubble wall design feature. The bubbles create an organic shape and provide a soothing distraction.

The Triage Center opened to clients in September 2020. As a new archetype we are excited to see how it positively impacts the health of the community.

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More to do

In addition to the behavioral health projects currently taking shape in Minnesota, we are making progress in the ability to offer appropriate environments where dignified care is provided. Mental health care of children and adolescents is driven by the goal to treat the underlying issue, not just address the symptoms, under a treatment approach that is proactive, not passive. Favorable outcomes will continue as we are able to expand patient coverage, care services, and treatment regimens. Considerable time, research, and expertise go into the development of mental health facilities with a primary goal to provide individualized care plans in a home-like environment that is flexible, safe, and secure for both patients and staff. As a society we need to continue to invest in the health and well-being of people facing mental health challenges. We have come a long way but are continually learning the best methods for creating better care environments.

Mark L. Hansen, AIA, NCARB, LEED AP, is a Principal and Project Manager/Architect with Mohagen Hansen Architecture | Interiors.

Dave Moga, AIA, NCARB, EDAC, LEED AP, is an Architect/Project Manager for Mohagen Hansen Architecture | Interiors.