The Veteran's Administration (VA), recognizing the potential influence that nurturing interior environments may have on patient well–being, has been designing and constructing mental health settings intended to calm, restore, and revive. Unfortunately, limited research investigates the links between the interior environment and mental health outcomes that can be used for guiding the design for these facilities. This paper seeks to provide a framework for designing person–centered mental health interiors that would be supportive of human factors for a healthcare organization's clinical and operational staff as well as Veterans. The framework is intended to assist healthcare providers in achieving mental health aims through thoughtful, evidence–based, person–centered design. Based on a review of the literature and case study investigations of three VA acute inpatient mental health units in the United States, the framework is comprised of six domains: Involve, Protect, Engage, Comfort, Personalize, and Sustain. These domains, informed by existing credible research and best practices, were vetted through post–hoc analysis of qualitative data gathered from interviews, focus groups, and/or listening sessions conducted with the three sites. The resultant Framework for Designing Person–Centered Mental Health Interiors for Veterans, developed based on the data and methodologies used in conducting this study, is meant as a complementary resource for informing future research, planning, design, and operation of acute inpatient mental health spaces. The research team's aim was to develop an accessible set of evidence–based environmental planning considerations to aid in the prioritization and development of person–centered mental health environments.
Get full access to this article
View all access options for this article.
References
1.
AndesM., & ShattellM. M. (2006). An exploration of the meanings of space and place in acute psychiatric care. Issues in Mental Health Nursing, 27(6), 699–707. doi: 10.1080/01612840600643057.
2.
BagianJ. P. (2012). Health care and patient safety: The failure of traditional approaches—How human factors and ergonomics can and must help. Human Factors and Ergonomics in Manufacturing & Service Industries, 22(1), 1–6. doi: 10.1002/hfm.20261.
3.
BeerM. D., PereiraS. M., & PatonC. (2001). Physical Environment. Psychiatric intensive care (pp.294–303). London: Greenwich Medical Media. Retrieved January 11, 2016 from https://searchworks.stanford.edu/view/8241284.
4.
BlanchardB. S., & FabryckyW. J. (2011). Systems engineering and analysis (5th ed.). Upper Saddle River, NJ: Prentice–Hall.
5.
BoschS., PlattL.S., NelsonC., & Burgtorf. (2015). Person–centered mental health facility design: Is it worth the investment? Proceedings from the 2015 Planetree Annual Conference, Boston, MA.
6.
BrokerM., RohrichtF., & PriebeS. (1995). Initial assessment of hospital treatment by patients with paranoid schizophrenia: A predictor of outcome. Psychiatry Research, 58(1), 77–81.
BrownB., RutherfordP., & CrawfordP. (2015). The role of noise in clinical environments with particular reference to mental health care: A narrative review. International Journal of Nursing Studies, 52(9), 1514–1524. doi: 10.1016/j.ijnurstu.2015.04.020.
9.
CarayonP., WetterneckT. B., Rivera–RodriguezA. J., HundtA. S., HoonakkerP., HoldenR., . (2014). Human factors systems approach to healthcare quality and patient safety. Applied Ergonomics, 45(1), 14–25. doi: 10.1016/j.apergo.2013.04.023.
10.
CarrV. L., SangiorgiD., BüscherM., JungingerS., & CooperR. (2011). Integrating evidence-based design and experience-based approaches in healthcare service design. Health Environments Research & Design Journal (HERD), 4(4), 12–33. doi: 10.1177/193758671100400403.
11.
CarterR., & PlattL. S. (2013). Chapter 7: Healing environment: Architecture and design conducive to health. In FramptonS., CharmelP. & GuastelloS. (Eds.), Putting patients first: Best practices in patient centered care (Vol. 3). San Francisco, CA: Jossey–Bass.
12.
ChassinM. R., & LoebJ. M. (2013). High–reliability health care: Getting there from here. The Milbank Quarterly, 91(3), 459–490. doi: 10.1111/1468-0009.12023.
13.
ChaudhuryH., MahmoodA., & ValenteM. (2005). Advantages and disadvantages of single–versus multiple–occupancy rooms in acute care environments: A review and analysis of the literature. Environment and Behavior, 37(6), 760–786. doi: 10.1177/0013916504272658.
14.
CheshireW. P.Jr. (2015). Multitasking and the neuroethics of distraction. Ethics & Medicine, 31(1), 19.
ClarkC., HeadJ., & StansfeldS. A. (2013). Longitudinal effects of aircraft noise exposure on children's health and cognition: A six–year follow–up of the UK RANCH cohort. Journal of Environmental Psychology, 35, 1–9. doi: 10.1016/j.jenvp.2013.03.002.
17.
CostelloA. B., & OsborneJ. W. (2005). Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment, Research & Evaluation, 10(1), 1–9.
18.
DaykinN., ByrneE., SoteriouT., & O'ConnorS. (2008). Review: The impact of art, design and environment in mental healthcare: A systematic review of the literature. The Journal of the Royal Society for the Promotion of Health, 128(2), 85–94. doi: 10.1177/1466424007087806.
19.
DixR., & WilliamsK. (1990). Psychiatric intensive care units a design for living. Psychiatric Bulletin, 20(9), 1990–1992. doi: 10.1192/pb.20.9.527.
20.
DobrohotoffJ. T., & Llewellyn–JonesR. H. (2011). Psychogeriatric inpatient unit design: A literature review. International Psychogeriatrics/IPA, 23(2), 174–189. doi: 10.1017/S1041610210002097.
21.
DvoskinJ. A., RadomskiS. J., BennettC., OlinJ. A., HawkinsR. L., DotsonL. A., . (2002). Architectural design of a secure forensic state psychiatric hospital. Behavioral Sciences & the Law, 20(5), 481–493. doi: 10.1002/bsl.506.
22.
EdwardsJ., & HultsM. S. (1970). “Open” nursing stations on psychiatric wards. Perspectives in Mental Health Interiors for Veterans Psychiatric Care, 8(5), 209–217. doi: 10.1111/j.1744-6163.1970.tb01521.x.
23.
EvansD. (2003a). Hierarchy of evidence: A framework for ranking evidence evaluating healthcare interventions. Journal of Clinical Nursing, 12(1), 77–84. doi: 10.1046/j.1365-2702.2003.00662.x.
24.
EvansG. (2003b). The built environment and mental health. Journal of Urban Health, 80(4), 536–555.
25.
FarringtonJ. (2012). A rose by this or any other name. Performance Improvement Quarterly, 25(1), 27–34. doi: 10.1002/piq.20136.
26.
ForoughiC., WernerN., NelsonE., & Boehm–DavisD. (2014). Do interruptions affect quality of work?Human Factors: The Journal of the Human Factors and Ergonomics Society, 56(7), 1262–1271.
27.
GolembiewskiJ. A. (2010). Start making sense: Applying a salutogenic model to architectural design for psychiatric care. Facilities, 28(3/4), 100–117. doi: 10.1108/02632771011023096.
28.
GrossR., SassonY., ZarhyM., & ZoharJ. (1998). Healing environment in psychiatric hospital design. General Hospital Psychiatry, 20(2), 108–114. doi: 10.1016/S0163-8343(98)00007-3.
29.
GulakM. B. (1991). Architectural guidelines for state psychiatric hospitals. Hospital & Community Psychiatry, 42(7), 705–707. doi: 10.1176/ps.42.7.705.
30.
HartigT. (1993). Nature experience in transactional perspective. Landscape and Urban Planning, 25(1), 17–36. doi: 10.1016/0169-2046(93)90120-3.
31.
Healing Design Integration (2015). 4 N: Mental health inpatient unit ideation session analysis. Clemson, SC: Wingler.
32.
HendrickH., & KleinerB. M. (2001). Macroergonomics: An introduction to work system design. Human Factors and Ergonomics Society: Santa Monica, CA.
33.
HoldenR., CarayonP., GursesA., HoonakkerP., HundtA., OzokA., . (2013). SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics, 56(11), 1669–1686.
34.
HuntJ., & SineD. (2012). Design guide for the built environment of behavioral health facilities. Washington, DC: National Association of Psychiatric Health Systems.
35.
IlozorB. D., & KellyD. J. (2012). Building information modeling and integrated project delivery in the commercial construction industry: A conceptual study. Journal of Engineering, Project, and Production Management, 2(1), 23–36.
JohnsonC., BushR., HarmanJ., BolinJ., HudnallG., & NguyenA. (2015). Variation in utilization of health care services for rural VA enrollees with mental health–related diagnoses. The Journal of Rural Health, 31(3), 244–253.
39.
JosephA., & UlrichR. (2007). Sound control for improved outcomes in healthcare settings. Concord, CA: The Center for Health Design.
40.
KarlinB. E., & ZeissR. A. (2006). Best practices: Environmental and therapeutic issues in psychiatric hospital design: Toward best practices. Psychiatr Servives, 57. doi: 10.1176/appi.ps.57.10.1376.
41.
KesslerR. C., Aguilar–GaxiolaS., AlonsoJ., ChatterjiS., LeeS., OrmelJ., . (2009). The global burden of mental disorders: An update from the WHO World Mental Health (WMH) surveys. Epidemiologia e psichiatria sociale, 18(1), 23–33.
42.
KimD., LeeJ. H., & HaM. (2014). Exploring perceptions of designers and medical staff in South Korea about design elements for the elder–friendly hospital. Journal of Interior Design, 39(4), 15–32. doi: 10.1111/joid.12034.
43.
KumarS., & NgB. (2001). Crowding and violence on psychiatric wards: Explanatory models. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 46(5), 433–437. doi: 10.1177/070674370104600509.
44.
LeeY.–Y., & LinJ. L. (2010). Do patient autonomy preferences matter? Linking patient–centered care to patient–physician relationships and health outcomes. Social Science & Medicine, 71(10), 1811–1818. doi: 10.1016/j.socscimed.2010.08.008.
45.
LiS. Y. W., MagrabiF., & CoieraE. (2012). A systematic review of the psychological literature on interruption and its patient safety implications. Journal of the American Medical Informatics Association, 19(1), 6–12. doi: 10.1136/amiajnl-2010-000024.
46.
LuY., & ZimringC. (2012). Can intensive care staff see their patients? An improved visibility analysis methodology. Environment and Behavior, 44(6), 861–876. doi: 10.1177/0013916511405314.
47.
MaloneE. B., & DelingerB. A. (2011). Furniture design features and healthcare outcomes. Concord, CA: The Center for Health Design.
48.
MazuchR., & StephenR. (2005). Creating healing environments: Humanistic architecture and therapeutic design. Journal of Public Mental Health, 4(4), 48–52. doi: 10.1108/17465729200500031.
49.
MillsP. D., KingL. A., WattsB. V., & HemphillR. R. (2013). Inpatient suicide on mental health units in Veterans Affairs (VA) hospitals: Avoiding environmental hazards. General Hospital Psychiatry, 35(5), 528–536. doi: 10.1016/j.genhosppsych.2013.03.021.
50.
MourshedM., & ZhaoY. (2012). Healthcare providers’ perception of design factors related to physical environments in hospitals. Journal of Environmental Psychology, 32(4), 362–370. doi: 10.1016/j.jenvp.2012.06.004.
MyersB. L., & BadiaP. (1995). Changes in circadian rhythms and sleep quality with aging: Mechanisms and interventions. Neuroscience and Biobehavioral Reviews, 19(4), 553–571.
53.
National Council of Behavioral Health (2012). Meeting the behavioral health needs of veterans of Operation Enduring Freedom and Operation Iraqi Freedom. Washington, DC.
54.
National Research Council (2012). Treatment for posttraumatic stress disorder in military and veteran populations: Initial assessment. Washington, DC.
55.
Olson–MaddenJ. H., HomaifarB. Y., HostetterT. A., MatarazzoB. B., HugginsJ., ForsterJ. E., . (2014). Validating the traumatic brain injury–4 screening measure for veterans seeking mental health treatment with psychiatric inpatient and outpatient service utilization data. Archives of Physical Medicine and Rehabilitation, 95(5), 925–929.
56.
O'TooleT., Conde–MartelP., GibbonA., HanusaJ., & FineL. (2003). Health care of homeless veterans. Journal of General Internal Medicine, 18(11), 929–933.
57.
PerkinsE., ProsserH., RileyD., & WhittingtonR. (2012). Physical restraint in a therapeutic setting; a necessary evil?International Journal of Law and Psychiatry, 35(1), 43–49. doi: 10.1016/j.ijlp.2011.11.008.
58.
PolacekM. J., AllenD. E., Damin–MossR. S., SchwartzA. J. A., SharpD., ShattellM., . (2015). Engagement as an element of safe inpatient psychiatric environments. Journal of the American Psychiatric Nurses Association, 21(3), 181–190. doi: 10.1177/1078390315593107.
59.
PriebeS., & BrökerM. (1999). Prediction of hospitalizations by schizophrenia patients assessment of treatment: An expanded study. Journal of Psychiatric Research, 33(2), 113–119. doi: 10.1016/S0022-3956(98)00037-5.
60.
RodriguesS., KlineA., SawhL., SmelsonD., O'ConnorK., . (2013). Childhood experiences and demographic characteristics of homeless veterans with co–occurring mental health and substance use disorders in MISSION. Comprehensive Psychiatry, 54(1), E9.
61.
RossbergJ. I., & FriisS. (2004). Patients’ and staff's perceptions of the psychiatric ward environment. Psychiatric Services, 55(7), 798–803. Retrieved December 15, 2015, doi: 10.1176/appi.ps.55.7.798.
SchweitzerM., GilpinL., & FramptonS. (2004). Healing spaces: Elements of environmental design that make an impact on health. Journal of Alternative and Complementary Medicine, 10(Suppl 1), S71–S83.
64.
ShepleyM., GerbiR., WatsonA., ImgrundS., & Sagha–ZadehR. (2012). The impact of daylight and views on ICU patients and staff. HERD: Health Environments Research & Design Journal, 5(2), 46–60.
Substance Abuse and Mental Health Services Administration. (2012). Behavioral health issues among Afghanistan and Iraq U.S. war veterans. In Brief, 7(1).
69.
TamuzM., & HarrisonM. (2006). Improving patient safety in hospitals: Contributions of high–reliability theory and normal accident theory. Health Services Research, 41(4p2), 1654–1676.
70.
TapakD. M. (2012). Don't speak about us without us: Design considerations and recommendations for inpatient mental health environments for children and adolescents. Unpublished master's thesis, University of Manitoba, Winnipeg, Canada.
71.
TirlingtonR. G. (2004). Facility profile. Creating a planetree inpatient psychiatric unit. Health Facilities Management, 17(6), 12–13.
72.
TownleyG., KloosB., & WrightP. A. (2009). Understanding the experience of place: Expanding methods to conceptualize and measure community integration of persons with serious mental illness. Health & Place, 15(2), 520–531. doi: 10.1016/j.healthplace.2008.08.011.
UlrichR. (1999). Effects of interior design on wellness. Journal of Health Care Interior Design, 3, 97–107.
75.
UlrichR. S., BerryL. L., QuanX., & ParishJ. T. (2010). A conceptual framework for the domain of evidence–based design. Health Environments Research & Design Journal, 4(1), 95–114. doi: 10.1177/193758671000400107.
76.
UlrichR., QuanX., ZimringC., JosephA., & ChoudharyR. (2004). The role of the physical environment in the hospital of the 21st century: A once–in–a–lifetime opportunity. Concord, CA: The Center for Health Design.
77.
U.S. Department of Veterans Affairs (2014a). Mental health facilities design guide. Washington, DC.
78.
U.S. Department of Veterans Affairs (2014b). Environmental programs service mental health guide. Washington, DC.
79.
U.S. Department of Veterans Affairs (2015). Mental Health Environment of Care Checklist. Washington, DC.
80.
VaalerA. E., MorkenG., & LinakerO. M. (2005). Effects of different interior decorations in the seclusion area of a psychiatric acute ward. Nordic Journal of Psychiatry, 59(1), 19–24. doi: 10.1080/08039480510018887.
81.
van der SchaafP. S., DusseldorpE., KeuningF. M., JanssenW. A., & NoorthoornE. O. (2013). Impact of the physical environment of psychiatric wards on the use of seclusion. The British Journal of Psychiatry, 202(2), 142–149. doi: 10.1192/bjp.bp.112.118422.
82.
VincentE., BattistoD., & GrimesL. (2010). The effects of presence and influence in nature images in a simulated hospital patient room. Health Environments Research & Design Journal, 3(3), 56–69. doi: 10.1177/193758671000300307.
83.
WattsB. V., Young–XuY., MillsP. D., DeRosierJ. M., KempJ., ShinerB., . (2012). Examination of the effectiveness of the Mental Health Environment of Care Checklist in reducing suicide on inpatient mental health units. Archives of General Psychiatry, 69(6), 588–592. doi: 10.1001/archgenpsychiatry.2011.1514.
84.
WestbrookJ. I., CoieraE., DunsmuirW. T. M., BrownB. M., KelkN., PaoloniR., . (2010). The impact of interruptions on clinical task completion. Quality & Safety in Health Care, 19(4), 284–289. doi: 10.1136/qshc.2009.039255.
85.
WhiteheadC. C., PolskyR. H., CrookshankC., & FikE. (1984). Objective and subjective evaluation of psychiatric ward redesign. The American Journal of Psychiatry, 141(5), 639–644. doi: 10.1176/ajp.141.5.639.
86.
WilsonM. R., SothN., & RobakR. (1992). Managing disturbed behavior by architectural changes. Residential Treatment for Children & Youth, 10(2), 63–74. doi: 10.1300/J007v10n02_07.
