James Hunt started his Healthcare Design Conference session on Monday by saying that if you're running your behavioral health facility on the principle of "that's the way we've always done it," it's time to change.
 
His session was titled "10 Things You Know That Just Ain't So," paraphrasing a quote by Satchel Paige that is along the same lines: "It's not what you don't know that hurts you, it's what you 'know' that just ain't so."
 
"Behavioral health (BH) rooms are different from general hospitals because what works in one won't work in the other," Hunt said. "General hospital patients spend most of their time in their room, where BH patients don't."
 
He outlined 10 things that he says professionals think they know about the design of a BH facility -- all things that should be changed and improved. 
 
1. Design models aren't one solution fits all.
"People ask me 'What's the ideal design?'" Hunt said. "It takes a discussion to learn about the population. I think the longer the length of the patient's stay the more diverse you can be with design."
 
2. Suicide assessments are not reliable.
"A VA study from 2012 says all suicide assessment tools currently in use are not reliable," Hunt said. "If we rely on some kind of assessment to separate suicidal patients from nonsuicidal patients, we're walking a dangerous path."
 
3. Instead of having a few safe rooms, design them all to be safe rooms.
"So what if you have four safe rooms and five suicidal patients?" Hunt asks. "We need to let the building do what the building can do to free up the staff to take care of patients."
 
4. Fifteen-minute checks do not prevent suicide.
"Patients learn how to time the checks and staffing patterns," Hunt said. A way several patients have committed suicide in a short amount of time is by anoxia, Hunt added. Patients tie something around their next to cut blood-flow to the brain and lean forward to create tension. In four to five minutes, they're dead.
 
5. One-on-one observation is not a sure thing.
"Patients can overpower the watcher, or in one case from a jail, still kill themselves," Hunt said. He explained one woman in a jail cell was watched by her husband overnight, and she still managed to kill herself. She took a roll of toilet paper with her to bed and stuffed pieces in her nose and mouth. 
"I think electronic surveillance could work, but it gives us a false sense of security," Hunt said. "It's only good if someone is watching."
 
6. Adding staff doesn't work. 
"It's expensive and in the long run doesn't really improve treatment," Hunt said. "Design a building that can help you work with less staff."
 
7. Corridor doors aren't always foolproof.
"Patients have figured out how to make these doors dangerous," Hunt said. "Doors are the leading attachment point for suicide." 
 
8. Barricading is an issue. 
"Anchor your furniture to the floor so patients can't move them in front of the door," Hunt said. "Make it so that your doors swing a certain way so that patients can't hide behind them."
 
9. There is no safe zone.
"The 18-inches from the floor safe zone is not safe," Hunt said. "Anoxia can be done from any point on the floor."
 
10. Avoid curtains.
"Breakaway curtains don't always work as planned," Hunt said. "Patients can obtain a large amount of fabric, and it's usually not breatheable and they suffocate."
For shower curtains, Hunt recommends using foam doors or not having doors at all. 
 
Hunt closed his session by asking everyone to challenge what they know, start a dialogue and most importantly listen to each other.
 
Do you agree with Hunt's assessment of the things on this list? Tell me in the comments.