As I write this, I am working from home, self-isolated to do my part to flatten the curve during the COVID-19 outbreak. Hopefully that is all over when you read this. Giving up things like going to a coffee house or restaurant has me thinking about what makes us want to go there in the first place. You would think we would prefer the quiet and privacy of our home to a loud space filled with strangers, but we don’t. We love to go to bars, restaurants, coffee shops and other gathering places. All those various venues that are crowded, loud and generally inconvenient in a lot of ways provide us with a very timely lesson in group dynamics.
Despite what is commonly assumed, people don’t naturally descend to the most convenient, the quietest or the most comfortable. People are energized by being around other people. But the gathering places that are successful understand that there must be rules.
One of the truly unique aspects of behavioral healthcare is the patients are ambulatory. Because of that, they will fully inhabit the spaces in which they are being treated. It is a mistake to think of their gathering time as just a safety concern. So much of group space design is based around how to engage and control the group. It is essential that we look at the types of spaces where we choose to be around a crowd, to understand how to design for folks who are forced to be around a crowd.
So, here are a few rules to live by.
- Arrange furniture to create opportunities for intimate conversations or larger groups. We all need social interaction. It is the human condition. Behavioral healthcare patients are no different. General group dynamics show that any group of more than eight will break into smaller groups. If the participants are cognitively or socially impaired, that number is probably lower. So, it is easy to say that arranging 16 chairs in a room all facing a TV (or in a circle on the walls) is not going to result in a therapeutic environment during non-group therapy times. Think of how your living room is arranged and offer patients the same opportunities. Also create other spaces where patients can gather to talk, play games or just read. Even being by yourself in a larger group can be better for patients than being alone in their room.
- Arrange furniture for easy flow. A little extra room around seating areas can go a long way. Patients who are sensitive may feel fear or strong reactions to others walking too close to their personal space. If nothing else, 16 to 24 people sharing a space can get chippy with each other under any circumstances. Give them room to walk around. This also helps staff to circulate within the space while patients are interacting without interfering with those interactions.
- Provide plenty of seats. This isn’t a parking lot. You need more than one per person. If you have a unit with 16 to 18 patients, you really need 30-40 seats. This allows for patients to have a choice of where they sit and who they sit near (or don’t sit near). Nobody wants to be the last one seated with only one chair left. Think of it this way: How much anxiety do you feel when you read the phrase, “move your feet, lose your seat”? Psychiatric patients don’t need that stress.
Design psychiatric group spaces like you would design other spaces. If it is a dining area, look at restaurant design. If it is play area, look at entertainment design. If it is a seating area, look at coffee house design. If you are still struggling, think about how you wish your living room was designed the day ALL of your relatives (and your spouse’s relatives) show up for Thanksgiving.
And no, you can’t hide in your bedroom until they are gone!
