Designing Psychiatric Units for the Geriatric Population
Imagine designing a geriatric mental health unit where there's a waiting list of nurses who want to work there.
That's what happened after Mercy Health's Saint Mary's psychiatric unit underwent a redesign in Grand Rapids, Mich. Panelists James Hunt, Carrie Mull and Laurie Placinski explained the design process at a Roundtable Discussion session at the Healthcare Design Conference on Nov. 16 in San Diego.
The unit opened two years ago and operations managers are in the process of gathering data to build a case study. The old unit was on the eighth floor of a nine-story tower. When designers came in to talk about remodeling the space, everyone determined that it wasn't a conducive workplace for staff or patients. Nothing could be done to change it, so they relocated the facility to a different Mercy building in the area.
Hunt, an AIA member and president of Behavioral Health Facility Consulting LLC, said the facility dealt with patients who oftentimes had coexisting disorders. It operated as a psych unit first and a medical unit second. This is what drove the dynamic of the new design.
Mull, BSN, RN, RN-BS, and manager of the psych unit has been there for the past 20 years. She had lots of ideas to bring to the table for the new unit, but she also gathered ideas from anyone who works on the unit, families and the community.
"The existing unit was designed like a very typical psych unit," said Placinski, IIDA, LEED AP, EDAC, Progressive AE. "It wasn't designed for that population."
Staff was crammed in to small work areas, there were several dark areas, ligature points and the environment had a negative impact on patients, Mull said. Patient rooms were semi-private.
"There was nowhere for patients to get away," Mull said. "They had no options and their dignity was taken away. It was very easy for staff to congregate away from patients because it was difficult to be with them because of the design of the unit."
The new unit was designed 40 percent larger, features natural light and also appeals to younger (than 60) patients as well.
"We wanted to create and design a space that made it easy for staff and patients to do the right thing," Mull said. "A jail-like atmosphere would be safe, but if you design a jail, you'll have more aggressive behavior."
In the new design, Mull and Placinski looked at adding risk reduction, more safety features and external spaces. They wanted a therapeutic, enriching environment with a quiet place for patients that was also more helpful for staff.
"We wanted to take care of the staff and minimize fatigue," Mull said. "We had spent a lot of time wasting time. We had to run and get supplies that were far away from the patient, so in this design we wanted to put the supplies at the staff's fingertips."
When it came to interior design aspects, Mull had to fight for the patients and what she thought they deserved, televisions in each room for example.
"I asked, why couldn't they have a TV," Mull said. "People argued the patients would stay in their rooms all day and watch it. So we set up some parameters around when they could watch and when they had to socialize."
In the two years the unit has been open, Mull said they haven't had a problem with the televisions.
Other positive outcomes include:
- Reduction in aggressive patient behavior
- Elimination of restraints
- Lowest staff turnover rate in the whole hospital system
- Reduced fall risk
- Increased staff engagement (36 percent actively engaged, which is the highest in the system)
"Our fall rate is five per 1,000 patient days, and it's decreasing," Mull said. "Most of our falls were happening in the bathroom because staff had to leave the patients to get supplies. Now that the supplies are there, it doesn't happen."