My world is Behavioral Healthcare. As a result, I spend a lot of time talking about safety. How do we eliminate ligature points, sharp corners or hiding spots? These are a really important part of the job, but today I want to talk about another safety idea that I think is also very important.
Safety considerations are based on the understanding that some patients will, as a result of their disease engage in aggressive acts against others or attempt to harm themselves. This is the fundamental criteria of an inpatient psychiatric admission: The patient is a danger to themselves or others. What doesn’t get talked about as much is how much the physical environment increases patient agitations leading to aggressive acts that are not the direct result of their disease.
I often try to explain this phenomenon with the Thanksgiving metaphor. Imagine you have 16 of your spouse’s relatives in your house, all day for Thanksgiving. There isn’t enough room; there aren’t enough seats; and the acoustics can’t handle all these people arguing about whatever families argue about. You can’t go to your room for a moment of calm. How agitated would you get?
Or try to imagine that whole group after dinner with only one TV and everyone arguing about what to watch. If you are starting to think you might hit someone, you can start to understand what a patient’s life is like in many inpatient facilities. I think I would be pretty difficult to deal with even without an underlying Mental Illness.
When we imagine a new or renovated facility, we need to start by evaluating the very real human eXperience of the place. The physical environment should at least achieve the Hippocratic ideal and do no harm. And yet, I tour facility after facility that expects 18 strangers with disorders that have behavioral symptoms to share a single large room with chairs arranged in a U facing a TV. Really?
My premise is that Good Design is a safety feature. Sure, we can design a wall that is durable enough to withstand a patient punching it, but how do we protect the patient from breaking their hand? Our job as BH consultants is to invest the time and effort into truly thinking about how each patient will experience the space and designing to reduce agitation rather than increase it. There are so many subtle ways we can impact design decisions to improve the therapeutic value of a space, but it all starts with a whole team commitment.
Think back to that Thanksgiving scenario and try to imagine what type of space would make that experience better. Now imagine yourself in that scenario for a week and let’s have compassion on the patients living this experience. A patient in crisis experiences a great deal of fear and agitation. With the right team in place and the right commitment to designing an appropriate space, we can allow those patients to also experience dignity and I think your clinical team with agree, that leads to better outcomes.
