A New Tool in Treating Mental Illness: Building Design

The Four Percent


Residents of the Taube Pavilion in Mountain View, Calif., wake up in private rooms with views of the wooded Santa Cruz Mountains, have breakfast in airy communal spaces and can hang out in landscaped courtyards throughout the day.

It may sound like a resort, but the Taube Pavilion is a $98 million mental health facility that opened in June as part of El Camino Hospital. Designed by WRNS Studio, the 56,000-square-foot building is one in a new wave of facilities that are chipping away at outdated institutional models.

For decades, psychiatric hospitals were grim settings where patients were crowded into common rooms by day and dorms at night. But new research into the health effects of our surroundings is spurring the development of facilities that feel more residential, with welcoming entrances, smaller living units within larger buildings and a variety of gathering spaces. Nature plays a big role: Windows provide views of greenery, landscapes decorate walls, and outdoor areas give patients and staff access to fresh air and sunlight.

The new approach, promoted as healing and therapeutic, has produced environments that are more calming and supportive. And it feels particularly timely, given the surge in mental health issues created by the pandemic.

“We’ve been talking about this for a really long time,” said Mardelle McCuskey Shepley, the chair of the department of design and environmental analysis in Cornell’s College of Human Ecology. “It’s only now that it’s gaining momentum.”

Architecture and interior design firms with expertise in health care buildings have reported an increase in activity. At the design firm Architecture+ in Troy, N.Y., one or two major mental health facilities are typically in the pipeline, with total construction costs for those projects at about $250 million a year, said Francis Murdock Pitts, a principal and founding partner. Last year, the firm was working on 16 large mental health projects totaling about $1.9 billion.

His firm and others like it have medical planners on staff who help translate research into “evidence-based” designs. “This isn’t just about being warm and fuzzy,” Mr. Pitts said.

Such safety measures are crucial, but “you don’t want it to get to the point where it looks prisonlike,” said Shary Adams, a principal at HGA, a national design firm. At the same time that the built environment must be engineered to ensure safety, there is also a move to give patients some control over their surroundings. Manual thermostats allow patients to adjust the temperature in their rooms, for example, and dimmer switches let them modulate the lights.

The location of mental health facilities is changing, too. Psychiatric institutions used to be tucked away, but today they are likely to be part of hospital campuses or otherwise conveniently situated. They often combine inpatient rooms for those who need round-the-clock monitoring and areas for outpatient services, allowing patients to shift to less intensive care in the same building.

Still, not every hospital system has an angel investor, and it is more expensive to construct buildings with these new designs — private rooms alone ratchet up costs.

But advocates say the upfront expenditure may result in savings down the road, improving staff retention, for instance, because workers are less prone to burn out and have to be replaced with new employees who must be trained.

“We try to use evidence-based design to help clients make a connection to other things on their balance sheet,” said Angela Mazzi, a principal at GBBN and president of the American College of Healthcare Architects, a certifying organization. “By investing in some of these things that are not a straightforward part of the clinical space, you’re going to get different outcomes and a different kind of payback.”


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