With over 25 years of experience in healthcare design and planning domestically and internationally, Dan Thomas knows healthcare. Today, in celebration of World Mental Health Day, we speak to him about the importance of maintaining patient humanity in the face of mental healthcare in a global pandemic.
What is the personal importance of mental healthcare to you?
DT: My personal experience with the mental healthcare system comes from my father’s diagnosis with Lewy Bodies dementia—an aggressive form of Alzheimer’s with a life expectancy of about two years after their diagnosis. When we first found out, my father woke up in the middle of the night to see people coming into his house. They started talking to him and quickly whisked him off to the doctor. After taking a CAT scan and confirming he was ill, he began taking psychiatric drugs.
In Texas, the transition from inpatient care to psychiatric care is the patient being placed in police custody and transported to a psychiatric hospital in a cop car. Obviously, this is incredibly confusing and scary for the patient. In my father’s case, he thought he was going to jail and wanted to know what he had done. Once he was placed in the psychiatric hospital, we had limited contact with him (two hours a day, only in the “activity room”). We also had little contact with his caregivers and got limited information about his treatment plan and diagnosis. After his 30 days stay, he was transferred to a nursing home for only a day, then re-admitted to an inpatient care hospital. There, in the hall outside his room, we were told he only had a few days left and had to be transferred to a palliative care facility.
Even after my father had passed, this traumatizing incident affected my family every day. I have spent all of my career creating spaces to enhance the patient and family experience in the healthcare environment. The reality is it’s not just about the space: it’s the philosophy and approach physicians and staff take to deliver care—including how they incorporate the patient and their family in major decisions regarding their care plan.
How can we better design for people with mental disabilities?
DT: Patients come to mental healthcare facilities needing help. When they first arrive, the process can be extremely demoralizing, since they are losing their entire sense of belonging and, to an extent, their sense of self. By designing small spaces where they can be alone to de-escalate or even just change their clothes in privacy, they can retain some sense of normalcy and comfort.
In [CRTKL-designed] healthcare facilities, we have implemented respite rooms for staff, patients and families. These rooms provide a low sensory environment with color therapy options for a reprieve from the chaos of a hospital. In a high-stress event like entering a behavioral health facility, everyone involved needs space to relax physically, mentally and emotionally. These respite rooms let the people involved know they are in a safe space, and that it is okay to remove themselves from the situation temporarily.
When designing behavioral health facilities, it is also essential to understand the needs of both the patient and their families. From the moment they set foot in a facility, we must map their experience and create an environment that supports their physical and emotional wellbeing. By providing natural light and incorporating colors and materials from nature, we can create a more calming environment. Furniture is equally as important. We must stay away from “institutional” furniture, like desks and chairs, because a classroom or office-like setting can be triggering. We need these spaces to be as home-like and comforting as possible. This allows the patient to have the best environment to heal in and for family and staff to feel supported throughout the process.
What are some of the most notable recent evolutions in behavioral health unit design?
DT: There have been a few major evolutions due to the pandemic. The first of these is the sub-bed unit pods. These pods offer isolation of airborne infection and higher acuity patient areas: they can be divided patients by diagnosis to allow for segregation of COVID-19 positive patients if the facility is affected. Another evolution is isolated, negative pressure-capable patient rooms. There’s been an increase in a type of HVAC system to change from negative when necessary to further isolate and prevent the spread of infection, as well as providing patient/staff safe anti-rooms to access the isolated patient rooms. A final major evolution is the addition of adequate donning and doffing areas, equipment storage and supply access. We’ve developed flexible spaces that can be converted into donning and doffing areas for PPE—like offices and lounges. We can also use those spaces to provide adequate storage for need supplies and respite areas during a pandemic outbreak.
How can people navigate some of the barriers in accessing mental health care during a pandemic?
DT: Unfortunately, the isolation of families from patients is a necessary but major barrier for patients in behavioral health facilities right now. I have high hopes that access to telemedicine and technology will help to create communication pathways to reduce that separation. This will also help provide better communication with physicians, consults and family members during their treatment so it can be a more holistic decision. This year’s World Mental Health Day is a difficult one, but it’s important to remember that we must not only prevent the spread of infection—we must also mentally and emotionally care for ourselves and the most vulnerable around us.
Dan Thomas: Dan is a Vice President in CRTKL’s Dallas office. He has more than 25 years of experience in healthcare design and planning domestically and internationally. Dan brings a wide range of knowledge of master planning, schematic design and programming. He understands the unique demands of healthcare facilities by performing extensive research in current and future state analysis, industry trends and best practices. Dan leads project teams in establishing the overall design and planning vision and works closely with the owner and end-users to reach set goals.