In the United States, it is estimated that 68 percent of adults with mental illness have at least one concurrent medical condition and 29 percent of people with medical conditions have a mental health behavioral disorder, according to a 2011 Health Policy Brief By the Robert Wood Johnson Foundation. Since access by the general population to services is often limited by availability, financial constraints, or stigma, these overall numbers may be underestimated.
This can be both health and behavioral ill health, the simultaneous presence of two or more illnesses involving both mental health and medical conditions, due to causation, environmental risk factors, or even coincidence. 2008 Report In the American Journal of Medicine Dr. Wayne Caton addressed the comorbidity of type 2 diabetes and depression, noting that each condition can affect the other.
For example, depression has a direct negative effect on glucose metabolism and may increase insulin resistance and thus increase the risk of developing type 2 diabetes. Likewise, there is a constant demand for attention to type 2 diabetes, including monitoring symptoms and maintaining diets and exercises. Sports, can lead to depressive states.
For many, the comorbidity of medical and behavioral health is not a single episode, but a lifelong affliction. As people live longer and the stigma about mental health diminishes, there will only be more cases of patients seeking mental health care with an underlying medical condition, or vice versa.
Successful healthcare organizations will be those that take care of the whole person with facilities designed to support patients, their families, and employees, while keeping in mind the populations they serve. For example, a space for veterans dealing with PTSD and cardiovascular health might be different from that for a family caring for their autistic child with feeding problems. While some people with PTSD may benefit from calming spaces with calm colors and natural, ambient sounds, others with severe autism may prefer bright colors and strange noises.
With such a large pool of patients and possible conditions, the best opportunity for healthcare design is to create safe spaces for the largest number of people possible. This starts with understanding and mitigating potential risks to the population and preparing the environment to accommodate the best level of care with resilience and adaptation. It also includes meeting the needs of employees so that they can protect their health, safety and well-being while caring for others.
In an inpatient environment, units dedicated to caring for those who need the highest standard of medical care – called Medical Psychiatry Units (MPU) – make sure that the psychological care of patients is not delayed while treating their acute medical needs. These facilities are designed like behavioral health units with ligature-resistant fittings and tamper-resistant finishes. Unlike typical medical units, they also look at program spaces such as group rooms, staff and patient areas to interact and are provided with specialist physicians or multidisciplinary teams of medical and mental care providers who can provide appropriate care to each patient.
For both inpatient and outpatient settings, implementing comprehensive design strategies, such as access to fresh air, views and daylight, can be beneficial to many. These architectural components, including skylights, windows or doors, can be tailored in such a way as to prevent patient concealment or reduce the risk of mooring or escaping as occupants continue to benefit.
Additional strategies include using on-stage / off-stage configurations that hide support functions from patients, and which can help reduce patient anxiety or distress and protect staff. However, it should be noted that this solution may also increase the total area of the unit. Path marking symbols instead of words can help those with dyslexia as well as those with language barriers, while becoming part of the organization’s graphic branding.
Organizations have an incentive to address mental health comorbidity across the continuum of care because it directly affects the bottom line. 2020 Report From the Health Information and Analysis Center, I found that inpatient stays for this population are on average over a day and a half and readmission rates are roughly twice as high as those without diagnosed ALS. Child re-admission rates are three times higher.
Successful disease design associated with medical and behavioral health is limited to humanizing space in a way that respects the dignity of every person seeking care. As designers, we can help by advocating for design that embraces humanity, promotes safety, and helps remove the stigma of mental health while creating thoughtful and beautiful spaces.
Jenny Sistnik, AIA, ACHA, EDAC, NCARB, is Medical Planner, Designer, and Architect at ZGF Architects (Portland, Oregon). She can be reached at [email protected].