by Briana Manfrass, EDAC, Managing Principal
One in six people experiencing homelessness in Oregon are living with a serious mental illness (NAMI, 2021), and according to data collected from the 2023 Point-in-Time count, Oregon has the second-highest rate of unsheltered homelessness. As Oregonians, we know that the homelessness problem is complex, with the primary factors being a shortage of housing supply and inadequate access to behavioral health services. This multi-faceted problem needs to be addressed with multi-faceted solutions, including housing, outpatient services, and residential treatment facilities.
The Restructuring of Residential Treatment
In recent years, a significant and transformative trend has reshaped the landscape of the healthcare industry –the emphasis on treating individuals at various stages of mental health disorders with a continuum of care model that destigmatizes behavioral healthcare. Some of us remember the American mental asylums or have at least seen them depicted in modern media. By the mid-20th century, mental asylums had become associated with overcrowding, poor living conditions, and inhumane treatment and were eventually discontinued to focus mental health care resources on community-based care solutions – primarily outpatient care. Oregon’s large psychiatric facilities and residential care facilities began shutting down in the late 1980s with the plan to replace these institutions with smaller, localized facilities. However, the new facilities never came and instead, Oregon has seen many people with serious mental illness forced into homelessness (Zielinski, 2023). The rise in homelessness and untreated mental health needs has refocused how we address healthcare, and more state funding is being allocated to developing behavioral health facilities across Oregon. While funding is paramount, there are additional obstacles to overcome once a project is funded, including land acquisition, rising construction costs, and staffing.
Models of Care
Residential behavioral health facilities play a crucial role in supporting individuals facing mental health challenges by providing a structured and therapeutic environment. Various models of care exist within each patient’s journey to well-being, each tailored to meet the unique needs of the individual.
Crisis Stabilization Facilities (CSF) are specialized healthcare settings designed to provide immediate and intensive short-term care for individuals experiencing a mental health crisis, diverting services from the jail or emergency room. These facilities play a crucial role in the continuum of care by offering timely interventions to stabilize individuals, address acute symptoms, and prevent further escalation. CSFs enable early interventions, preventing the exacerbation of issues and alleviating the strain on other public services. The architectural features of CSFs include a building layout that focuses on the separation of public and private services and separate entrances and intake rooms for adults, children, and those transported by law enforcement.
Residential Treatment Facility (RTF) refers to a specialized residential setting where individuals receive intensive therapeutic treatment for emotional and behavioral health conditions. These facilities provide a structured and supportive environment, often involving a combination of therapy, education, and other services to address a patient’s needs as they learn to re-integrate into their community. The architectural features of RTFs include residential-grade appliances and fixtures, therapy space, and free egress from the building.
Secure Residential Treatment Facilities (SRTF) are specialized types of residential treatment facilities designed to provide a secure and highly structured environment for individuals who require aid and assistance due to behavioral, mental health, or legal considerations. The term ‘secure’ indicates that the facility has measures in place to ensure the safety and containment of residents, often due to concerns of self-harm or harm to others. This level of oversight allows for immediate intervention in case of emergencies or crises. The architectural features of SRTFs include anti-ligature and antivandal fixtures and finishes, open sightlines and/or cameras for staff to monitor, and security throughout the facility to control when people enter and exit the building.
Substance Use Disorder Treatment Facility (SUD) refers to a residential facility designed to provide services for individuals detoxing from substance use disorder and/or addiction. These facilities play a crucial role in addressing the complex needs of individuals affected by substance use disorders, offering a range of services aimed at assessment, intervention, treatment, and support throughout the recovery process. These facilities tend to have fewer security and safety measures as individuals are typically not likely to harm themselves or others. The architectural features of SUD facilities include residential-grade appliances and fixtures, group therapy spaces, free egress from the building, and childcare centers.
According to the National Institute on Drug Abuse, 37.9% of the nearly 20 million persons with substance use disorders also suffer from a mental condition, otherwise known as a dual diagnosis. Potential treatment of a dual diagnosis (i.e., schizophrenia and substance use disorder) should be considered in the design of any facilities providing residential behavioral health treatment.
From Asylums to Healing Spaces
The design of residential treatment facilities plays a crucial role in fostering healing and well-being. As our understanding of behavioral health continues to broaden, there is a remarkable shift in interior and architectural design standards and trends for behavioral health facilities – moving away from the stark and institutionalized settings reminiscent of the early 1900s mental asylums. The dated asylums, with large, foreboding structures and minimal consideration for the well-being of patients, were designed more for containment than treatment, contributing to a stigmatized and dehumanizing environment that also made it more challenging to re-integrate into their local communities. Architects and designers now recognize the importance of creating spaces that promote health, focusing on elements that contribute to a sense of safety, comfort, and community. Key modern design trends include:
Warm and Welcoming Spaces. Modern designs prioritize warm and inviting atmospheres, steering away from the cold and clinical aesthetics of the past. Soft color palettes, natural lighting, and comfortable furnishings contribute to a homier feel, fostering a sense of ease and relaxation for residents. The goal is to provide a sense of home and normalcy, so each location may differ in design aesthetic. Sensory considerations are integral to modern designs, with attention to lighting, acoustics, and tactile elements. Incorporating soothing colors, soft textures, and adjustable lighting (color tuning) allows for the creation of environments that support various therapeutic modalities for individual client needs.
Biophilic Design. This design approach is proven to reduce stress and anxiety and promote overall well-being. Biophilic design principles integrate natural elements such as plants, sunlight, and natural materials to create environments that connect individuals with nature. This is often done with imagery, murals, artwork or faux plantings to reduce maintenance while providing a connection to natural elements.
Community-Focused Spaces. Modern facilities emphasize communal spaces that encourage social interaction and a sense of community. Shared areas like lounges, kitchens, and outdoor spaces are designed to facilitate positive social connections among residents, while still providing areas for privacy in smaller individual spaces scattered throughout the facility. Additionally, the integration of community- and culturally-specific artwork can foster a sense of connection to the greater community.
Privacy and Personalization. Recognizing the individual needs of each resident and understanding that social interactions can be overwhelming at times, modern designs prioritize personal space and opportunities for customization. Private rooms are designed to be comfortable and functional, allowing residents to personalize their living spaces within therapeutic guidelines with designated spaces for personal artwork and individual lighting control. Smaller, intimate spaces are created within proximity to larger community spaces, allowing patients to dictate their level of participation depending on their comfort level.
Outdoor Recreation. Many modern therapies leverage a connection to nature and regular exercise in the healing process. In modern residential treatment facilities, this can include integrated walking paths with distance markers, outdoor sports areas (basketball court, outdoor gym, disc golf course, pickleball court, and more), community gardens, and water features and often provide clients an opportunity to enjoy an activity that resembles life at home.
Safety and Security. Safety and security for staff and patients is a primary concern at behavioral health facilities. In early design, the focus was on security with locked doors and padded rooms to limit the patient and staff interaction. Today’s facilities promote safety and security while honoring dignity and choice. Design often incorporates open sightlines and security features that are discreet to limit client fears and past traumas.
As the trend of merging behavioral health and residential care continues to gain momentum, it is clear a more comprehensive and integrated approach to healthcare is on the horizon. This transformative shift holds the potential to improve patient outcomes, reduce the stigma surrounding mental health, and create a more efficient and cost-effective healthcare system. The support of policy and funding for the built spaces and staffing for residential behavioral health facilities is paramount to the overall well-being of our communities. As providers and policymakers embrace this trend, the future of healthcare looks promising, with a focus on holistic well-being that encompasses both mind and body.
If you are curious about how you can implement some of these design principles within your facility or want to talk about healthcare design solutions, reach out by clicking this link – Contact
Printed in the Cascade Business News on September 19, 2023
Briana is an Evidence-Based Design (EBD) certified professional. She bases decisions about the built environment on credible research to achieve the best possible outcomes. With more than 17 years of experience designing healthcare environments, she thrives on working with her clients to explore unique design ideas and integrate proven design solutions. Briana is a firm owner and actively involved in the Central Oregon community, currently serving on the Bend Development Advisory Board. Briana@parch.biz or 541.388.9897 x22