Sacramento County, like much of the country, faces a challenge in the care of patients with behavioral health issues—there is a distinct shortage of psychiatric facilities. As a result, a growing number of behavioral health patients are heading to local emergency departments (ED) to be seen when they are in crisis. However, these facilities are not equipped to meet their specific healthcare needs.

Patients with behavioral health issues require additional resources; additional nursing, security, and specially trained individuals. Not only are these resources not available to them in an ED situation, they may be diverting the use of resources available to patients with physical ailments in an already overcrowded ED environment. In addition to adding to the amount of people the ED must see in a day, these patients were placed in the ED waiting room before being seen for treatment. This waiting room can be loud and crowded—a bad environment for someone who is in crisis and suffering from behavioral health issues. All of this creates the potential for a situation in which they could be a harm to themselves or others.

To directly address this issue, Mercy San Juan Medical Center has built a new crisis stabilization unit (CSU), Dignity Outpatient Behavioral Health, in a 3,200 s.f. modular building located outside the campus’ existing emergency department.

The CSU will help patients in this situation by providing a space close to the hospital that offers counseling and psychiatric care. Patients arriving at the ED will first be seen by the emergency team to ensure that they are medically stable. Following this, they will be escorted over to the CSU for a psychiatric evaluation. This process reduces the number of patients that the ED puts on psychiatric hold by providing a middle level of care for patients.

More importantly, the CSU offers a safe, comfortable space for patients who are unable to function due to any psychiatric difficulties, or drug- or alcohol-related issues. With this in mind, our design intent for the Dignity Outpatient Behavioral Health facility as a project was to promote a therapeutic patient experience.

Our design and research teams worked together to create specific goals based upon Evidence-Based Design that we would incorporate into the design of this facility:

Home-like environment. A familiar environment can help to make patients feel safe, thereby allowing them to feel comfortable and more open to the healing process. For our concept, we centered our design around the American River, a local, natural feature that was nearby the clinic. We incorporated the river in artwork throughout the space. Most notably, the back wall of the Common Room, which is covered by a 40-foot wall graphic. The graphic depicts the river bathed in rays of sunlight which create different hues of color in the water.

Access to nature. Both physical and visual access to nature have proven to foster recovery in behavioral health patients. Visual access reduces stress, creates a positive distraction, and can lift spirits to instill hope. Physical access, via an outdoor space for patients, provides a sense of separation from treatments spaces within the facility.

We used the artwork throughout the facility to provide “visual access to nature.” Sky Factory panels in the Common Room have images of trees that reach towards the clouds and sky. Combine that with the large wall graphic of the American River (as mentioned above) and patients feel like they are taking in the sunshine while riverside.

To compliment this, the 3Form panels in the waiting room have a texture that resembles water. This biophilic design, informed by nature, allows textures and shapes to relay the relaxed sensation one feels when outdoors. In staff spaces, we used photographs of beaches and calming spaces to give workstations a similar sense of calm.

Additionally, an outdoor space for patients offers the opportunity to get some fresh air while at the clinic. This courtyard is covered in greenery and has benches for patients to sit as they enjoy a space away from treatment areas.

A sense of control and choice. We all need to be able to exercise choice and control, particularly when our health status is challenged. Patients with a sense of control over their environment are typically shown to have reduced or eliminated stress. Patients who do not have that sense of autonomy are likely to feel more anger and aggression.

To aid with this, we installed six blue and six gray recliners for patients to relax in the Common Room. This allows not only the selection of where they would like to sit, but the choice of color as well. Giving them that much needed sense of control.

Thoughtful lighting design. Light impacts human health and performance through a variety of highly important factors. Proper lighting controls the circadian system and sleep/wake cycles; improves mood; reduces depression; reduces stress; lessens agitation; and lessens pain perception.

There are several types of lighting fixtures throughout the facility’s common area. At night this allows the staff to turn light off over the recliners (for patient comfort), but still have a well-lit nurse station and visibility for staff via a cove light located around the perimeter of the room.

The previously mentioned Sky Factory panels provide natural light for both patients and staff, as do five windows on the back wall of the Common Room.

Minimized noise. High levels of sound have negative physical and psychological effects on patients. It can disrupt sleep, increase stress, and decrease patients’ confidence in the competence of their clinical caregivers. Throughout the space, we used acoustical ceiling tile instead of a gyp ceiling to help with noise reduction. By using 4’ x 4’ ceiling tiles we were able to reduce the amount of grid used thus increasing the coverage.

Honoring privacy and dignity. Control over privacy can lead to healthy social interactions and peer support that are instrumental in the success of treatment. We incorporated this into the design while keeping in mind the safety of the patients and staff members. In addition to the space provided by the outdoor courtyard, a semi-private room next to the nurse station with one recliner in it allows patients to feel “separated” from the main Common Room. To ensure safety, this room has a cased opening rather than a door so that staff can keep an eye on the patient.

The number of CSUs continues to grow nationwide. Through this type of Evidence Based Design research and patient-centric care, there’s hope that this successful new MSJ facility will act as the catalyst to meet and spur further growth to meet the need for behavioral health crisis facilities that exists in Sacramento County.