COVID-19’s effect on mental health, future design

Amy Dvorak, AIA Associate

White males account for a whopping 73% of deaths by suicide over the past 14 years according to the Colorado Violent Death Reporting System. The staggering correlation between those numbers and this community: 70% of AIA Colorado members are white men.

Amidst the COVID-19 pandemic, which has come with record-high layoffs and isolation – and worse, the loss of loved ones – mental health services are needed now more than ever, particularly among the built environment. Yet in the peak of social distancing, mental health care facilities are having to adapt to contain the virus spread, while also meeting increased demands and taking into account considerations for future facility design.

“For patients and clients, we have the benefit of outpatient teams as part of our system,” said Kim Boe, executive vice president of West Springs Hospital in Grand Junction. The recently built hospital is part of a larger network, Mind Springs Health, which has virtually converted all therapy appointments and group sessions. But for inpatient care, technology isn’t an option. That’s where design comes in.

Robyn Linstrom, AIA, a senior associate at Davis Partnership Architects, was among the team that helped design flexible and secure spaces for West Springs that have become beneficial amidst the pandemic.

“For patient rooms, we designed with a level of flexibility so that they can section them off,” said Linstrom. “The intent in the original design, and for patient milieu, was that you could segment a few people or segment adolescents.” Already, that’s been put to use during the outbreak. While there have been no positive cases at West Springs Hospital, at the time of press, six patients presented as symptomatic with COVID-19. The course of action in these instances is to isolate patients while tests are pending – a weeklong process at the moment.

However, for patients who have not reported symptoms, operating under the state guidelines for social distancing is near impossible for effective treatment outcomes. “Psychiatric hospitals are about milieus and groups and not isolating,” said Boe. “We work hard with patients on social distancing, but they are together. We have to provide this psychiatric approach.”

To contain the virus spread, West Springs’ environmental services team cleans walls day and night. As part of the design process, those units and housekeeping were strategically placed close to patient rooms, which has further helped the hospital reduce the spread. “We have not mandated social distancing with patients. We are cleaning like never before and are trying to still provide the psychiatric hospital care patients need.”

While utilizing the flex space and isolating adolescents with symptoms worked temporarily, the escalation in COVID-19 cases warranted the need to convert an adjacent building for quarantining. And treating the symptoms alongside mental health issues is no small task. “Mental health, that’s what we have expertise in,” said Boe. “When patients come to us, they are already struggling. The world doesn’t make sense. It’s terrifying when one’s own mental health system is at its height and then asking them to put on a mask. It’s scary.”

For further virus prevention, a separate staff entrance is now doubling as a wellness checkpoint. There, staff must have their temperatures checked along with receiving an alcohol spritz to eradicate contaminants. Locker rooms allow them to change clothing and contain shoes that may be carrying virus particles instead of bringing them home. “Having one, single point of entry for staff has been instrumental in managing the creep of the virus and keeping staff healthy,” said Boe.

However, the fear and stress of the pandemic is taking its toll on them, as well.

“The piece I am seeing is an increase in staff’s anxiety,” said Boe. “They are coming into work and are understandably concerned. They are primarily reassured, because we’ve put so many stop guards in place. However, we will run out of personal protective equipment. That is the anxiety piece.” At West Springs, Linstrom incorporated colored light therapy that soothes, artwork and respite rooms for “staff to calm down and have few moments,” she said.

And while the hospital was not designed with pandemic preparedness in mind, it was for patients to feel well and be treated well, despite the circumstances. “Often, psychiatric hospitals are sterile and institutional,” said Linstrom. “The whole intent for West Springs was to build a sanctuary. A lot of thought went into how we do that to maintain dignity and a sense of control and environment.”

To inform that design, the Davis team met with previous patients to help identify elements that made them feel safer and heal faster. “Because we took that time, this building works,” said Boe. “We can respond to pandemics and agitated patients, and we can respond to extraordinarily depressed patients and keep suicidal patients safe and make a difference.”

Ultimately, the shift for architects and health care facilities is toward designing for the next pandemic. While that typically hasn’t made the program of requirements, it may soon be as clients aim to close gaps made clear by the COVID-19 pandemic.

“It makes us all think more about this,” said Linstrom, who has already received requests for makeshift and temporary spaces, mainly sleeping areas for physicians and people on the front lines. “The key is putting in flexibility in design, to be able to accommodate things as they come,” she said. “Who knows if we’ll be in the same situation, but we need to be designing buildings that can flex with the times.”[/vc_column_text][/vc_column][/vc_row]