In this episode of Laying the Foundation, we delve into the fascinating world of healthcare design with architect Adam Wheelock. Discover how thoughtfully designed spaces can positively impact the mental and emotional well-being of patients. From creating calming environments to fostering healing, Adam shares insights into the transformative power of design in behavioral health.
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Episode Transcript
Skyler: Welcome to another episode of laying the foundation.
Skyler: Welcome everybody to another episode of the laying the foundation podcast. I'm your host Skylar and today joining me for the first time on the podcast, technically speaking, uh, Adam Wheelock, Adam, welcome to the show. Thank you for having me. Absolutely. Adam is one of our amazing architects over here at our Sioux city office.
Skyler: And I said technically because you were in kind of a pre episode that we are like a pre recording.
Adam: I remember that
Skyler: Yeah, yeah, and that was before I kind of jumped in and took over things So I didn't get to uh, I couldn't even find the file. So i'm not sure who had it Whatever the case we're here now. So, um, so today we're talking about behavioral health now, first of all As somebody kind of on the marketing side, I don't always get to hear about all the stuff that you guys are working on and don't always know these terminologies and things like that.
Skyler: What is behavioral health? What does that even mean? What, what is, how do we use that?
Adam: Behavioral health? Um, I don't know. It could be defined a couple of different ways. I think the one that probably rises to the top is It's people seeking health care for intellectual challenges, um, some mental health, uh, some long term mental health, and some short term.
Adam: Okay. But yeah, um, I would say it's, uh, people seeking health care for those reasons.
Skyler: For the, for the mind, and for, you know, that kind of area of things. Yes. And then the development of kind of behavior aspects, things kind of within that, encompassed in that. Okay. Um, so first of all, how has, so what, what do we work, what kind of projects or what kind of areas within a project might kind of directly relate to behavioral health?
Skyler: Like what are we working on that, that tends to pull a lot from behavioral health and the concepts behind it?
Adam: Sure. Um, I would say if you're working on a healthcare related project, You have to think about behavioral health. Behavioral health has definitely expanded a lot in our culture in the recent years.
Adam: Lots of different reasons, but People are now seeking help from the healthcare community to help manage and deal with those challenges that they're experiencing. It is affecting just about every aspect of healthcare. There is sure everything from outpatient clinic visits to inpatient. Um, uh, the vast majority of where we experience it is when we do, when we help out our healthcare partners, our hospitals, our clinics.
Adam: Um, people are coming for their visits for a physical related issue and they're also presenting with a behavioral health issue as well.
Skyler: Okay. Okay. And those two, I mean, obviously usually that pairs together, right? Like just because I come in with like a broken leg or something like that, there's other elements of it.
Skyler: And they're experiencing some trauma because of it. Yes. Absolutely. Okay. Understood. Understood. So are we seeing these kind of manifest physically as. Like therapy spaces or what does that kind of look like?
Adam: Um, it depends a little bit. Uh, there are the, the spectrum of behavioral health, uh, goes from one pole to the other.
Adam: Sure. Uh, some behavioral health is, um, you know, long term, uh, such as, um, Clinical depression, for example, people experience this for long periods of time, right? Sometimes they seek out Medical attention for this and sometimes they don't
right
Adam: sometimes they try to self treat Um, and then ultimately when they finally do present at a health care facility, you know, that assessment has to be made um Some patients are non violent Some patients are only a threat to themselves.
Adam: Sure, and some patients are violent and a threat to others And so it really depends on which patient presents and the challenge that health care facilities are met with is you just don't know. Right. Until you've spent time with this patient to know, are they a threat to themselves? Are they a threat to others?
Adam: Some people are obvious. They come in. They're very agitated. They might already have. run in with the police. And so we know that they're a danger to others. Um, some are simply, you know, considering hurting themselves. And so they're really only a danger to themselves. And, uh, the, the healthcare system is still trying to figure out exactly how to best help, uh, these patients.
Adam: Um, and so they're, they're met with a real challenge. And so as, um, healthcare, as healthcare designers. We are trying to give them more tools. To help them assess quicker. Yeah, and then to help room that person effectively based on their assessment when they come in. Got it. I would say, you know, there's roughly 25 million Americans that don't have health insurance.
Adam: And so Their primary care provider is the emergency department or the ED right ER for some yeah
Yeah,
Adam: and so the ED is where we're trying to provide the maximum amount of tools Because some people come to the ED and they're a danger to themselves, right? And so we have to have tools and spaces for those patients So that the health care provider can manage their condition effectively Um, there are also, uh, behavioral health patients that are brought to the ED by a law enforcement person, um, because they are experiencing physical trauma, but they are also experiencing some behavioral health issues that likely are a danger to others.
Adam: And so what kind of space do they need compared to the space that Someone is only a danger to themselves. Right. Um, so maybe those spaces are similar. Maybe they're not. Sure. Um, A big difference here would be, uh, let's say someone comes in with, uh, experiencing, uh, depression episode. They're a danger to themselves.
Adam: They're considering hurting themselves. Um, do we put them in a hardened room that, uh, looks very clinical?
Right.
Adam: Uh, probably not the best fit for that patient. No, yeah. A room that is warm and inviting and that fosters healing and fosters a calming Um environment is probably a better room Uh, unfortunately the materials that we associate with healing And calming are often soft, right?
Adam: Right. And so it's a challenge Uh, is the room, let's say we only get to build two of these rooms in a small renovation project. It's all the owner has the money for. So what two rooms do you build, you know? It's so hard to make that decision. Do you build this warm, soft, calming room for the people that are experiencing, you know, a depression episode?
Adam: Yeah. Uh, that'd be great. This would be a perfect room for them, you know? Um, is that room safe for someone that is clearly trying to cause Right. No, definitely not the same room. This room needs to be much more robust, uh, needs to be harder surfaces, surfaces that can't be damaged. Um, one common trick for people that are held against their will, is they like to break pieces off of finishes in the room and swallow them.
Adam: And because that then presents a trauma risk, and now they get to get out of their room that they're being held in, and they get to go to a different room that then a healthcare provider can help them with their now physical condition, and it gives them more opportunities escape the system or Uh, just simply get let out of the room that they're being held in right?
Adam: And so obviously you can see the differences between a room that's hardened right and a room that's more what i'll call Healing. Yes And so these you know, there is no happy medium, unfortunately. Yeah, uh, and oftentimes the health care providers are You know given this decision as to how many of these rooms do they build and which ones do they build?
Adam: Hopefully they get, uh, you know, they're well funded and they can build the right spaces for the patients that they're, they're trying to help.
Skyler: Absolutely. And that's, that's always kind of the, the tricky side of things, right? Is the budget, of course, and that kind of limits what you're able to do. And hopefully you've got maybe some statistics saying, you know, we've had.
Skyler: More patients that kind of lean towards this, but at the same time, it's kind of hard to predict that.
Adam: Yeah. Um, obviously they're trying to predict the future, which is really a challenge for everyone. Well, of course, um, they do often have, um, let's say you're an emergency department at a, you know, a medium sized hospital.
Adam: Uh, they have a lot of patient visits, statistics. And so they know how many patients are coming in and presenting with this versus that,
right?
Adam: Their biggest challenge now is that. Lots of these patients are presenting where they have a, a serious physical issue that the, let's say, the trauma team or the nursing staff or the physician staff, Needs to treat immediately.
Adam: Right, right. But then they also have this behavioral health issue that likely is long term that prevents them from let's say being left alone in a typical exam room.
Right.
Adam: Because maybe there are sharp instruments inside drawers. Maybe there's just simple supplies or Anything that they can get their hands on to then do further damage to either themselves or others And so, typical ED rooms, I would say, have lots of these things, you know.
Adam: They have, uh, things that are attached with cords. They have, um, uh, drawers that are easily opened. They have, um, things inside the room like coat hooks or things of that nature. Um, cabinet pulls that can easily be used as a ligature securing system where if a person is a danger to themselves, they cannot be left alone in a room like this.
Adam: Um, and so, uh, I would say the healthcare system and the designers that work for them are learning. Um, they're experimenting with new products. Um, luckily there are manufacturers out there that are starting to develop new products that are very helpful. Um, they're also trying to strike that balance. Can we make this product, um, and put it in a room where a person can be left alone for short periods, relatively safely, um, but it still looks healing, you know, it still has that, that nurturing and healing feel to it.
Adam: And luckily, like I said, there are vendors out there that are starting to go and develop lines like this. And it's really making our jobs easier. Oh, absolutely.
Skyler: Yeah. So when you say lines like this and products like this, what, I mean, what kind of specific things are we talking? Um, material? Sure. Okay.
Adam: Yeah. So let's say, um, let's say we're talking about the ed again. And you have a patient that comes in, um, they, uh, they've been involved in an accident. They have a traumatic injury and so they're being treated by the healthcare staff.
Adam: And they're put in a room, in an ED exam room. Obviously the care provider can't be in there every moment that they're in that room. Right. There's a time where they get room tipped. They're moving between other patients. And so they get left alone. Um, if that person is dealing with a. Um, uh, mental health crisis at that moment, they may have thoughts of harming themselves.
Adam: Yeah. And so they could use things at their disposal to harm themselves. And so the biggest one we try to eliminate is ligature risk. And so, for example, uh, the cabinets in the exam room. These cabinets probably hold, I don't know, linens for the table, um, maybe some supplies like, um, you know, some gauze or bandages or things of that nature.
Adam: Maybe some testing supplies. But if you imagine, that loop of a handle that you grasp at can support probably a considerable amount of weight. And so if you had something to loop through that, It presents a ligature risk,
Skyler: right?
Adam: And so what if that hardware, that handle were designed differently? To where now, it's only a curved lip that's on the bottom of the cabinet.
Adam: Now, there's no way to loop anything through it, there's no way to have anything support any vertical or horizontal weight. And so, just the design feature, even though it goes unnoticed to let's say the average patient. Right. It will obviously improve the, or improve the, um, ligature risk danger, reduce the ligature risk danger.
Adam: Um, same thing with, let's say door handles, uh, door handles on the inside of the room. Um, a typical door handle is maybe a round knob or maybe it's a kind of a hook shaped lever. Um, door handles can easily be redesigned. To stay flush with the actual door panel. And so they can still be moved and it's still a lever.
Adam: Still meets, um, Americans with Disabilities, uh, grasp requirements and, but still doesn't have anywhere that things can be looped through it. Right. Um, let's say a typical exam room. You want to provide the patient with a lot of privacy, but sometimes you want to be able to monitor that patient relatively easily.
Adam: Um, so let's say sometimes there's a window in the door, and you want Um, if you, the patient wants a little privacy, lots of times there's either a curtain or a blind on the inside of the room so they can turn that little rod and close it off. Well, if we're trying to keep a close eye on this patient. Um, anything with strings or cords that hang from above present a danger.
Adam: Yeah. They present a ligature risk. And so a lot of companies are now developing window kits for doors or for walls that have the blind actually trapped between the two panes of glass.
Oh, okay. So now
Adam: there's just a little knob that you turn to close the blinds. Right. Okay. And that knob often is also on the outside, so the caregiver, if they don't want that to be closed or want to just peek in.
Adam: They can turn that knob from the outside with a rope without opening that door. Peek in on the patient. They're still safe. Turn it back closed for their privacy. Absolutely.
Skyler: Wow. That's amazing. Sure. And then of course, it keeps them from being able to handle any of that. And wow, that's crazy. Okay. So yeah, definitely a lot of steps forward, which is great, which is great to know that that is.
Skyler: It is great to know that there are providers out there trying to make our jobs easier. Yes, absolutely. Easier, and then better, obviously, experience for keeping people safe. Absolutely. In difficult times. Stressful times, and times when, as you've mentioned before, you know, mental stress is, you know, Maybe manipulating a little bit of your decision making to some extent.
Skyler: So, wow. Um, as far as, and you mentioned this kind of at the beginning with the sort of healthcare system in our country and things like that, that are kind of trying to figure out how to handle things. Where are we at with the movement and the progression on that? Are, do we have, cause you mentioned like ADA, we have ADA regulations to help with people with disabilities to ensure that they have access to things like they should.
Skyler: Um, but for this behavioral health side, where are they at? And as far as trying to create policies for, for healthcare facilities to follow in order to help with the very diverse, um,
Adam: Sure. Um, I would say the state of New York has developed a guideline, um, to help, um, I would say design professionals, uh, and for that matter, healthcare facilities to, um, to illustrate where risks are, right.
Adam: And to provide either a product or a solution that helps mitigate that risk. Um, that guide is becoming very popular amongst design professionals. To my knowledge at this point, uh, it is not involved, uh, or has not been made into an adoptable code at this point. Um, the biggest challenge obviously is for healthcare providers and especially the facilities where that healthcare is provided at.
Adam: Um, if you go to, um, a mid sized community and visit any one of their hospitals, you will find that they're providing patient care. In buildings that are some brand new, uh, some built in the nineties, some built in the eighties. Um, we have a healthcare provider here in town that has a building that was built in 1917.
Adam: Wow. Okay. And there is still some patient care happening in that building really. And so you can quickly realize the challenges where if we were to build a brand new emergency department for a hospital. We would take all these aspects into consideration and it would fit the style of healthcare that's being provided now and fit the patient type that's being presented at this healthcare provider, right?
Adam: Um, the building that was built in the eighties or seventies or sixties or beyond. Um, that was obviously built for the type of healthcare being provided then. Right. And so, finding ways to retrofit those older buildings to provide better care or the best possible care, um, is our challenge. Right. And so, again, we are, over time, developing better strategies on how to provide rooms that are more flexible.
Adam: Um, so that when they have an influx of this type of patient, they can handle it. And then when they have an influx of a different kind of patient, they That room still works for both right? Right. That makes a lot of sense. I would say um the bigger health care providers are More are well funded right?
Adam: They have made bigger strides in this area Um small rural health care facilities They are definitely struggling Not because they don't know not because they aren't great health care providers You It's just because the funding is absolutely
Skyler: yeah It's frustrating to know exactly what you need to to take that next step and to offer better care But not being able to because of limited budget and limited, uh finance definitely a challenge But it's good that this information is out there I mean, I think even just this podcast discussing it is helping to kind of get the awareness out there but Um, obviously important that people recognize that behavioral health is a huge element to providing good health care and It needs to be something that is prioritized.
Adam: Sure. Yeah Uh, I hope this help. I hope this podcast helps somebody if it helps a single person or makes uh, one space slightly Better for a patient type.
Skyler: That would be great. Absolutely Is there anything that I haven't we haven't talked about or anything that you want to mention before? You We take off in the, in the topic of behavioral health.
Skyler: Um, obviously lots of points to, we could discuss it further, but, uh, this has been a good start. Okay. Awesome. Well, we'll definitely save that for, uh, for a future part two, part three, who knows how far it can go, but whatever the case, Adam, thank you so much for sitting down and sharing your expertise within healthcare design.
Skyler: And explaining kind of a little bit about what behavioral health is and giving so much information within what that looks like because like I said coming in I didn't know what that even meant. Like what what exactly is that? So I appreciate you, uh sharing your expertise and uh with me and with with our listeners Absolutely.
Skyler: If you'd like to find out more about the Laying the Foundation podcast, you can head over to any podcast streaming platform such as Spotify, iTunes, Google podcasts, and others. You can also find out more about CMBA Architects through social media, such as Facebook, LinkedIn, Twitter, and Instagram.
Skyler: Additionally, you can head over to the CMBA website at cmbaarchitects. com If you're an architecture or design professional or an intern looking for an internship within those fields, please be sure to check out our website and click on the careers tab to find out more about what opportunities we offer.
Skyler: This has been another episode of the Laying the Foundation podcast. We'll see you next time.
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September 19, 2024