MARDELLE SHEPLEY: So I'd like to welcome everyone again. And many of you I had a chance to speak with last night. So a few of you were arriving just now. But you're going have the opportunity to introduce yourself to everyone.
Just a few brief discussion of notes I have about what we're going to talk about today. And one of the things I said last night is we are going to be as flexible as humanly possible in terms of how we're going to conduct this discussion. Because this is really a sharing of ideas more than-- whether we call an educational session, in the sense that somebody stops, stands in the front, tells you about some very specific topic, and you move on. We are wanting to embrace everyone who is participating as part of problem-solving in this issue of trying to provide better mental and behavioral health facility design.
Now I know that there are individuals here that are not designers. And we purposely went after that, to try and have people in different capacities. We are aware-- people in the design field are fully aware-- that to create a good experience in one of these settings, inpatient or outpatient or a transitionary setting, it's really the individuals who are providing the care and the nature of the program that's there that is the most important piece of this. But we look at design and the physical environment as a means of allowing these things to take place, or affording these things to take place.
So that is the context that we find ourselves in. And as I was involving people in this process, I purposely tried to work from millennials to people in their 70s. so that we would have multiple generations represented, different kinds of perspectives. I have people who are designers, people who are clinicians, people who are administrators of programs. So I think that we're going to get a lot of different views, and hopefully many of you are just meeting one another for the first time because of the transdisciplinary nature of what we're working on.
So you all have your program in front of you. And there are other items in there. There are a couple of papers that address a current research project with which I was involved.
And then there's also-- inside your packet, you'll see there's a survey that we're getting ready to distribute. If we have time, we'll actually have you try and do a little bit of the survey to see if you have any advice you can provide about it. Because this is the end of the pilot session, and we're hoping to put that forward.
And where morning lays out, as soon as I relinquish the podium, I'm going to ask each person to talk about who they are, a little bit of their background, and what they're interested in now. So this is not the time to be shy. This is the time to share with people what your journey getting here, why you think you might be sitting at this table, and what you're doing right now that might be of interest to people.
So as far as I'm concerned, after this, I plan to talk about the research project that's described in those two papers. And I will truncate-- somehow we got-- let me get back here-- I will talk a little bit about my research project if we have time. But I'm really more interested in hearing what you have to say. And you do have this written format to walk away with and read later to find out about that.
So we are planning on being completely fluid. If we find ourselves on this great adventuresome place, we're just going to go with it and change the schedule as we go along. The only thing that we have to do is take a group photo at some point.
So what I'll do is, I'll just say a couple of words about myself. And then I already warned Samir that she was going to be the first victim as we go around the table to talk about her background. So my background, for those of you who don't know me, is I'm a health care architect. And I was in practice for many years.
And then I wound up going to teach at a university. And I stayed in school long enough to study research methods. So that put me out in the world to be able to collect data as part of the design process. And I was at Texas A&M for many years. They have a very large health design and research program. And then I was romanced away to Ithaca, New York, to Cornell University.
Which has been-- and I've said this to many people, so I'm going to say this joke. And all my friends were retiring and moving south, and I took a new job and went north. So it's forced me to use my brain and meet new people and change my perspectives and learn how people in hospitality look at the world and how their interests relate to mine. And it's just been overall just a-- I've been blessed with the opportunity, to tell you the truth.
In my area right now, I've done a lot of different things in health care design research. But right now, I'm looking at the mental and behavioral health, and trying to figure out what we need to do next. So I think that's briefer than I'd like you to be. So starting with Samira, Samira, why don't you tell the group about your background?
SAMIRA PASHA: Good morning, everyone. I am an architect by training and profession. I met Mardelle at Texas A&M University. She was actually-- and that was my introduction to research. I remember when I was at A&M, I was interested in looking at the relationship between design and human behavior.
And then the research program that A&M had at that time was mostly focused on health care. So that was my way of getting into healthcare. My dissertation topic was focused on healing environments for children. I looked at three different children's hospitals and the way their garden spaces were designed and how different children and staff and patients and well children used those spaces, and then come up with design guidelines for design of future spaces. I think that shaped my interest into finding practical guidelines for designers to be able to use research in a meaningful way, in a way that's meaningful to them.
So after graduation, I went back to practice. And I worked for almost six years as an architect in various firms, mostly as a health care architect. It was a very interesting experience for me to see how research is perceived by practitioners and how they find it useful and not useful.
Just recently, so actually the Cumming Group actually placed me. I've just had a change of jobs recently. Cumming Group placed me in Kaiser Permanente, the national facility services as a design manager. So they're expecting expansions in the Northeast area. So they're looking into making their facility services stronger.
And during all these years, I think it was great that we stayed in touch. My job really did not entail a lot of research during these years, but Mardelle and I just recently finished a book on design for mental and behavioral health, and that was actually my introduction to bringing my knowledge about design for mental health up to speed.
In my current job, I think it's good to see that Kaiser does a little bit of integration of care. So it was interesting to see that they have the outpatient clinics with the mental health needs in mind. But I'm still learning. I think there's a lot for me to learn there.
MARDELLE SHEPLEY: Thanks, Samira. Jim?
JIM HUNT: Hello, I'm Jim Hunt. Excuse me. I like to say I'm a recovering architect. [INAUDIBLE].
About-- almost 40 years ago, now, I was part of the design team for a replacement hospital for the Menninger Clinic. And at the end of that project, they kept me around as their Director of Facilities, which is a position I held for about 20 years. And that kind of gave me a day to day insight on what it takes to make these things work. And I often say that if every architect had to live with their project for 20 years, they might do a few things differently. I know I did.
So I'm now retired. And I have a consulting company that consults with psychiatric hospitals and architects designing all over the United States and Canada. And I've been keeping very busy lately. But that's a good thing. There's been a lot of interest and a lot of construction going on. So have a lot of projects in the works.
AUDIENCE: Doesn't sound like you retired.
I'm three times retired. And my wife keeps asking me what part of retirement I don't understand.
I've now charted the course. In two years' length, I'm going to be much more retired than I am now.
AUDIENCE: You hope.
JIM HUNT: I have said that before, so--
PENNY MILLS: Good morning. I'm Penny Mills. I'm the Executive Vice President and CEO of the American Society of Addiction Medicine, which is a professional society representing physicians and other clinicians who specialize in caring for patients with addiction. I'll probably, in the course of the day, be advocating for something ASAM has stood for for many years, called the ASAM criteria, which represents assuring patients get a full continuum of care, and that they move across that continuum based on their needs and assuring that, I think, facility design reflects the principles of the ASAM criteria.
I've been in health care my whole career. I'm proud to say I attended the business school here. I was in the Sloan program in the business school. And I still feel very affiliated with Sloan-- with the Johnson School. My first job after I finished graduate school here at Cornell was managing the psychiatric and substance abuse services at United Health Services in Binghamton, New York. So that was my first exposure to what is now finally being called behavioral health.
After I left Binghamton, I did a lot of consulting work in policy and hospital consulting in the DC area. And I always say the best accident of my life was I moved into medical society management. So I actually worked for the American College of Cardiology for 15 years.
Then I went back into health policy when the Affordable Care Act was moving through Congress the first time out, and spent the past year fighting to keep it. But then I missed medical society work, and got approached about the opportunity with ASAM, and have been there now for seven years. So it's been a terrific experience for me, because it really has pulled together everything I've ever done in my career, from my experience in hospital management, policy work, et cetera.
I'm also going to bring a perspective here today as a parent. I have a son who started struggling with depression at age 11. Went in and out of multiple inpatient and outpatient treatment programs for both mental health and addiction services throughout his young years, adolescent years and adult years. So I think I'll also bring a patient and family perspective to today's discussions as well.
BRIAN GIEBINK: Testing My name is Brian Giebink. I'm one of the millennials in the room, so my history is quite brief.
BRIAN GIEBINK: I work for HDR. I went to school at the University of Kansas. Received a Master's Degree in Architecture. So now I'm an architect.
When I was in school, my last year in school, I took a health care design course with Frank Zilm. I'm sure some of you recognize the name, very, very fantastic person, and very influential. And he really kind of guided me into the health care field in architecture. So I wasn't specifically in behavioral health at first.
Once I got into health care and got into HDR, I had a couple of really good mentors who were involved in behavioral health projects and they really came to me and said, Brian, we need some help. We just can't do this all. Because they saw this tidal wave of behavioral health projects coming this way. So I certainly said absolutely. I'd love to help you out.
And then, since then, I've really learned that I have a true passion for behavioral and mental health. I don't see another in health care that has quite the need that we have today. One in five people have a mental illness. There's an incredible stigma with behavioral health care, and I feel like architecture is one of the many ways that we can solve that.
SHEILA BOSCH: Hi. I am Sheila Bosch. I've had many careers. I'm not a millennial.
SHEILA BOSCH: I started out as a high school science teacher. Then I worked as an environmental scientist for the Army at Aberdeen Proving Ground in Baltimore. And then I went back to school to get my PhD at Georgia Tech. Some of you probably know Craig Zimring there. I studied with Craig, and continued to work there after I finished my PhD for a couple of years.
And then moved to Tampa to work as the Director of Research for Gresham Smith and partners, which does a lot of health care design and was there eight years. And heard about a position at University of Florida, I was kind of missing academia. So this is my third year at the University of Florida. And I love it, but it's really intense. And I feel like I'm getting another PhD.
SHEILA BOSCH: I've learned more in the past two and a half years than in a long time. I did recently-- I got to work on a project with the VA in Tennessee Valley Health System VA, as they were renovating an inpatient and outpatient unit there. And wrote a paper with a colleague of mine, Lisa Platt. And we developed a framework, actually, for sort of looking at different kind of compartments of how one might want to look at design for mental behavioral health.
FRANK PITTS: My name is Frank Pitts. I'm an architect. I'm the founding principle of architecture+ in Troy, New York. I worked as a recreational therapist with emotionally disturbed adolescents while I was putting myself through college. And I did my thesis on environments for kids like that and have continuously worked in the field since then.
We've worked in 35 states and provinces, probably a couple other countries beyond Canada. And at this point, it's over 300 projects, over 20,000 beds. Really, really, really committed to change, I've seen change.
Our involvement in projects is generally schematic design and design development with interiors. We partner almost always, when we're away from home with other firms. So we've worked with some of the firms that are here.
The things that are really interesting to us at the moment, driving things, are the implications of continuums of care; and integration of care at a particular setting; scale, which I'll talk about; the personal, the private, the comfortable; early diagnosis and treatment, which I think is a topic that is going to dramatically change what we do; reduction of aggression and violence; Rogers' paper has had a significant impact; safety, culture, and stigma.
And we need another term for millennials, my daughter, Annalisa, tells me. And if you're into equity, diversity and inclusion, I'm Annalisa's dad. And my wife, Debbie, is a graduate of the program here in environmental psychology. So I did marry an environmental psychologist.
LYNNE WILSON ORR: Good morning. I'm Lynne Wilson Orr. I think I'm here to bring the Canadian perspective, because I don't think there are any other Canadians in the room, not that we all wear maple leaves or anything. But I have degrees in both interior design and architecture. I have taught those subjects at a variety of Canadian universities.
But my primary role is as a partner in a large firm of health care architects in Toronto. And you may know that we purchase and design health care differently in various provinces in Canada than what we did in the past. So they are done through a public-private P3. I'm so used to saying P3 I forget what it stands for. It's a partnership between the public and the private.
And basically, we are mortgaging our future if you look at what our governments are doing. And it has changed the way we practice considerably. So we work on projects across Canada, primarily. We do some work in Europe. But it's primarily Canadian. And we do a lot of mental health care projects.
My particular interest has been with child adolescent mental health, and I've done a number of projects like that. As someone else said, I bring both a professional and my personal life to this, because both of my children have had issues with reactive attachment disorder, anxiety disorders. And while they are fully functioning adults, the process of providing mental health care for children and teenagers is something that is very deficient in Canada. It probably is here as well.
And our public system has not caught up to the needs that there are for children. What we're seeing in our health care practice is an increasing dual diagnosis, in teenagers in particular, and the struggles that mental health facilities are having. And then, across our practice, we do a lot of work with indigenous people and in the Arctic. And we're seeing that whole dynamic is changing fairly dramatically.
So we did a project not too long ago that is a correctional facility. Because we're seeing a crossover between behavioral health and correctional facilities. And thank heavens our governments are starting, in Canada, to realize that they need to look at who the population is and start to provide them with care rather than just incarceration.
But one of the most recent facilities we've done is up in Rankin Inlet in the Northwest Territories, which is very far north. And there, the facility is designed to be a healing facility in addition to being correctional, to the point where one of the aspects that is incorporated in the healing is allowing and encouraging the patients, inmates to hunt for their own food. So if you can imagine a correctional institution where you hand your inmates a gun and say, go get dinner. It has turned out to be an incredibly positive environment for the inmates there.
It has expanded into the community, and it is now making the food blogs across the world. Because the chef that is there is working with fresh seal, fresh polar bear, whale, ptarmigan, anything that the inmates can bring back for meals. So we're starting to see some really interesting things happening within our system.
And one of the things I hope to learn from this today is I sit on our National Standards Board, which is in the process of revising our health care standards. So it's called CSA Z8000, and we're looking at how we can provide a more inclusive environment in terms of mental health care. So hopefully I can hear some things today that will help us with that process.
AUDIENCE: What is reactive attachment syndrome?
LYNNE WILSON ORR: Essentially, it is children who have been adopted who have indiscriminatory trust. In some cases, inability to make connections or they overmake connections with the specific members of their family. So it's really related to adoption issues. It can start with a child as early as a couple of weeks or it may start when they are older than that. But it's a very challenging situation for them and for their families.
LYNNE WILSON ORR: It's been interesting.
AUDIENCE: I'm [INAUDIBLE]. I work with the Institute, and I'm writing a report on this conference.
SAMANTHA GREENBERG: Hi, everyone. My name is Sammi. I'm honored to be here today. And also a proud Cornellian. I graduated in 2010, so also a millennial But really passionate about this space. I believe I'm here as part of the no space arena.
I live in San Francisco. I work at a Series A start up. We help individuals reduce their anxiety, depression through our engaging mobile app. We also have a body image and stress program.
We take cognitive behavioral therapy and mindfulness and break it down to bite sized pieces for individuals to use on their mobile phone. We pair everyone with a coach, and it's to guide them through our program and make them motivated to complete the program. Ultimately, we want our users to gain the skills they need to manage their mental health.
We typically work with those with mild to moderate symptoms. We know that 80% of mental health is provided, actually, over primary care. So we are trying to be integrated to primary care settings as well as an employer benefit.
My background, prior to where I am now, is I was working in HR and financial services in Manhattan. Got to really understand what employers are offering to employees. But had personal experiences with the health care industry where I could wait months or weeks to see a doctor. Had access to great health insurance, but it really didn't matter when I actually went to the doctor. I could be waiting hours to actually see a doctor.
So I transitioned my career. Went to business school in order to provide health care online. And have since worked at about five or six mental health companies. Doctor on Demand, where we provide a telemedicine service and services for both mental health and primary care medicine.
And have realized that mental health is by far the most inaccessible health cares around. 55% of our country lives in mental health deserts, which is why I'm really passionate about what we do at Lantern. I am on particularly the sales side, business development side. And yeah, I'm really excited to be here today.
ELISABETH PERREAULT: Good morning. I'm Elisabeth Perreault. I am with CannonDesign. My career spans just over 18 years, 16 of which have been at CannonDesign. I lead the Western New York health practice.
And for over a decade, I really focused my career on health care design and planning. And I've spent the bulk of that time really focusing on what I like to think of are the people who kind of slip through the cracks of the health care system. So designing and planning environments for persons with behavioral health issues, geriatrics, persons with intellectual and developmental disabilities, and the people who really can't necessarily effectively manage their own care without a support team.
So I've designed, over the last 10 years, and planned over thousands of beds, facilities, and millions of square feet. And really worked from strategic master planning at the systems level, down to small renovations of units and safety net hospitals. I've worked with the full range of providers, from provincial Canadian health care systems to federal government systems here, state, county, the private sector, and community health organizations as well.
I tend to prefer working with safety net hospitals and community hospitals that are really, truly struggling today. And I think that we can really actually provide the most amount of help versus working, maybe, with some of the larger academic centers, which we also work with at [INAUDIBLE] design, which is fun. So I think that's about it for me.
MIKE MCKAY: Good morning, everyone. My name is Mike McKay. I'm Vice President of Architecture at ERDMAN. ERDMAN-- we're probably, maybe the lone design builder here today. So I'll be bringing that kind of master builder perspective.
To Jim's point earlier, it's interesting to be involved in the process from not only the planning and design, but to the build and then the occupancy thereafter. And the warranty process that builders often are stuck with, have to live with once a project is done in helping the owners live in that facility and operate that facility. So I very much enjoy that side of our business.
Also at ERDMAN on the architecture side, since we're an integrated practice, we have advisory services, strategic planning, architecture design, engineering, all of those disciplines involved. We run an integrated thought leadership studio. And it's in that studio where we like to begin exploration through knowledge and research. It's where we've gotten to know people like Mardelle and others in the industry on the research side of this business, where we bring that research into our practice and like to ask questions and challenge our design teams.
Some of the information I'm sharing with you today are some of those questions. I would like to ask questions, we may not have the answers. It's an interesting dilemma, I like to say, that architects face, because there's a lot of pressure and an onus in this health care industry for us to be the expert and know it all.
And I still liken architecture to-- it's very much a practice. And you learn every day. And you learn from the projects that you do. And hopefully, you're working for and with clients that are letting the entire team learn.
And you know when you get done that you have things that you haven't done so well that you need to come back and fix, or you do lessons learned, and you try to involve that in the next process. So I always look at it as a continuum of learning. So I very much enjoy sessions like this where we can come together, especially across multiple generations and multiple disciplines, and tell our stories and learn from each other, and put things out there as ideas. So I'm looking forward to today, and hope to share and live and learn from everyone here. Thank you.
NIANNE VANFLEET: I am Nianne VanFleet, Director of Operations at Cornell Health. Used to be Gannett Health Services for those of you who are Cornell folks. We recently changed our name and our building. I've been at Cornell going on 36 years as a community health nurse with a master's degree in nursing administration and on the senior leadership team at Cornell Health for a number of years.
We spent a lot of time envisioning what the renovation and build would be of our building. I spent a lot of time on things like [INAUDIBLE] University Health and our volunteer program, hearing from students and learning that what parents many times hope will happen is that the student packs everything but their mental health and physical health problems. Doesn't happen-- in their suitcases and baggage come the things that they had all along. And we, in a college health model actually deal with the full continuum of whatever they are bringing. And sometimes things that home wasn't even aware of. And we're helping them to deal with that. And that's a very important piece of college health.
In our new building, we envisioned, with our previous Executive Director Dr. Janet Corson-Rikert, a building where we would have integrated health care across the spectrum. You would come in the door, and you would be seen as a whole person. Now for students who are here, we may not be there yet. And I'd love to hear what your experiences have been. I take feedback all the time.
But we are working towards making it seamless. If you come in for a gastrointestinal problem and the clinician can't find anything physically wrong, we have behavioral health consultants embedded in our medical services. We have, right down the hall, on the same unit, our counseling service. So that our providers go back and forth seamlessly consulting with each other, which hasn't happened in the past for us.
And it's an exciting change professionally for them, but it didn't come without some growing pains and a lot of work to get everybody comfortable with each other. And I spent an inordinate amount of time as the end user project manager for our project, making sure I tried to fit the needs of the counselors and the medical staff and the users of our service, where our penetration has just passed 20% for mental health. So at any given time in a year, 20% of our students are using our services, over 110,000 visits combined at Cornell Health.
So our door is swinging freely, and we want to keep access at our highest opportunity for everyone. So you come in, and you sit in a waiting room, and you check in with staff, who check you in for all kinds of visits. You're not labeled at the check in. You're not labeled by the waiting room. You go through a door, and get the service that you need. And if it's not what you thought it was, you're transitioned to where you need to be.
So we're working on that, and there's been a lot of growth. I'm happy to be part of this, but I'm not sure I fit in with everybody in academics. It's been a great journey for 36 years, and I love the students.
ROHIT VERMA: Thank you. Good morning, everyone. My name is Rohit Verma. I'm a millennial who has aged quite rapidly.
ROHIT VERMA: I was thinking about that. Actually, my daughter, who just graduated from Cornell, she said I'm not cool enough to have all the latest apps like Snapchat and some other stuff. I have accepted my place in the world.
ROHIT VERMA: Along with Mardelle and Brooke, I had the pleasure of getting the Cornell Institute for Healthy Futures initiated two years ago. So let me welcome you on behalf of these few. I've had a chance to say hello to a few people yesterday, but some people are here this morning, so welcome.
In terms of my own background and interests, I have been here at Cornell for 12 years now, in the School of Hotel Administration. I teach classes. I go-- I have a couple of administrative roles right now. So I'm useless as a researcher or teacher. But I used to teach. I taught classes in service operations management and quality management. And a lot of topics which you will discuss today links to that, but not directly.
So this is a completely new area for me. Most of my own research has been on what you'd call service designe in the business school. So that may be different from what architects call service design or other disciplines call it. In our case, basically, we're looking at the intersection between the service processes, which we offer [INAUDIBLE] facility, and see how the space and the steps in the process, and [INAUDIBLE] of customers interact with each other to find a better way to deliver whatever we are doing.
And in that role, we try to identify how people [INAUDIBLE], or the recipients of the service, how they make their choices. And try to link it with whatever the operations are deployed or can deliver. And this may mean facilities design, it maybe led to work design for the individuals, or the process steps, if you will.
A couple of projects which I'm involved in right now, mostly through collaborators and PhD students, they are the ones who are doing all the work. I am just happy to be part of group right now. One very exciting project is on looking at the big issues in health care. And we have started tracking surveys in the state of New York and also nationally now, where we're asking randomly selected consumers, demographically balanced across the country or the state, to identify which are some of the big issues from their perspective in health care, the role of technology, and so on. So that's one big project.
The other big project we're looking at is the hospitality side, where we are looking at the role of health and wellness in the hospitality sector. Is there a consumer willing to pay for those services? And does it enhance satisfaction and experience and so on? And finally, last one, we just got a new PhD student. Alexis, can you just say hello?
She brand new, two months in. Right? Two months in.
ALEXIS: Yeah, two.
ROHIT VERMA: Two months in. And Alexis is interested in looking at the patient experience and the related aspects. So that will be a new area to work on. Welcome.
JIM SPELMAN: I'm Jim Spelman. My disclaimer, I suppose, is that I figure the only reason I'm in this room is that Mardelle Shepley and I are both in love, maddeningly in love with the same man, with the emphasis under maddeningly. Ben is one of my dearest friends.
And Ben and I met when we were both engineering students here at Cornell many years ago. He continued to be an engineer, and designs remarkably beautiful post and beam wooden structures across America. I dropped out of engineering, and probably should have headed toward architecture, which is what both my wife and I think I would have been best suited for. But instead, ended up at the [INAUDIBLE] college in social psychology.
And I've lived my whole lifetime in the trenches of these beautiful buildings that you create. So I think it's something of an honor to be in this room. I'm a clinician. I'm not a builder.
Although I am-- I knocked down a perfectly good house and reconstructed it. [INAUDIBLE]. But I didn't put my own [INAUDIBLE]. So I know something about what it feels like to create spaces that are vital for their task, in this case to love and support my family. And actually, another aside, last couple nights I've spent with a very dear friend, another college Cornell graduate in Corning. His wife is the present curator and director of the Corning Art Museum.
And any architects in the room who have not seen that Thomas Phifer-designed new wing should definitely do so. Carole White, with whom I stayed, was a principle in creating that space from the perspective of the director and curatorship. The task at hand was to take the contemporary collection of the most remarkable class artwork and display it property in a setting. So that-- so I've had these conversations over this last-- tense conversations in the last 24 hours about how does architecture impact the task at hand.
So I come to this as a clinician. This is what I do. And in that respect, I feel like I'm a fish out of water here.
MARDELLE SHEPLEY: Say a little more about your job as a clinician. Where are you working as a clinician?
JIM SPELMAN: I worked a moment in that state of the art facility. It was created six years ago. It's a rehab outside of Boston, Massachusetts in the town of Quincy. We created it. We created the unit. I was actually in on the design and construction of it. I was there from the stud walls up.
And the task at hand was to create a unit that was going to be able to treat, in a satellite setting, outside of a more discreet hospital, the most difficult patients to treat in the Commonwealth of Massachusetts. The ones who get stuck for a week or 10 days or sometimes three weeks in an emergency room because nobody wants to take these people in. So the task is huge, and frankly, we were up for the challenge.
I have watched in many ways what has happened in that environment. Barely a day went by in that first year, year and a half, when I wouldn't turn to somebody who was intent on knocking the computer terminals off the nursing station that was not protected but looked [INAUDIBLE]. Looked at them, squarely in the eye, and say, you know, this is a respectful environment, and we've done everything we can to create a healing space for you. Will you at least meet me halfway here and not bust up my computers? And remarkably, the most difficult patients to treat responded to that, and did, and do respond to the environments that you create.
On the other hand, and I'm speaking too long, but I'm here to tell you that, from the point of view of a clinician, and there are so several of us in the room, the system by which we provide mental health care in America is broken, tragically broken. And many of the things-- I think to myself that there are two questions that I could answer to you that you've probably been puzzling over if you don't know the answers already.
The first one is, how is it that a patient's so highly suicidal that they need the kind of stripped down, well-thought out facility can be discharged three or four days later to the-- safe and sound-- to the world of kitchen knives and high bridges and pharmaceutical shelves. How does that happen? I can tell you how that happens, but that would take the rest of the morning.
The other question I think I can answer is, why is it that highly suicidal patients seem to choose hospitals in which to create [INAUDIBLE]? Why does that happen? And that begs a different question, which, is it possible, is it possible that in this world where we strip down the doors and have to have special doorknobs and configurations for doors themselves, and where we expect that somebody is going to not just knock on the door, but open a door to make sure that you're not hanging yourself in the toilet or in the shower-- whether we do, despite our best efforts, whether we create an environment where the real issue of safety has to be understood now as a particular sense of safety or healing that we provide for clients, so much as it is the safety of the clients for whom you built? Which is to say that against the fear of litigation, [INAUDIBLE]. So there you have it.
We'll get back to that later on.
JIM SPELMAN: [INAUDIBLE] My wife tells me I just need to shut up because I go on.
But clearly, the undercurrent here for me is this is the work I do. These are the trenches I chose to live in, and I'm delighted that you make such beautiful spaces. There's no question about it.
But it's also the case that these are-- particularly the mentally ill-- these are dispossessed. And it's a complicated equation. Because some people are there because they really need to be there. And some people are there because they've run out of their welfare check, and they're looking for the six or seven days that I can provide them until the new check comes in.
And some people are there to get drugs as well as to try to get rid-- get free from themselves-- these are complicated, very complicated equations. And this is not the place where that will get meted out, I suppose. But to the degree that I can speak to that, I'm here. Thank you.
MARY TABACCHI: I'm Mary Tabacchi. I've been at Cornell since 1972. I think I've been here longer than that. At any rate, I finally retired. So I'm now Professor Emeritus, which means I can do fun stuff like this and less time in the classroom.
My background is in biochemical nutrition. I graduated MS and PhD from Purdue University. I came here to teach in that field, and interestingly, I ended up in the hospitality school, which has been my blessing, OK. It's been wonderful. All my other colleagues are studying rat enzymes or something. And I'm over here where the excitement is, but anyway.
I taught the first corporate wellness class here many years ago, started it. I taught the first spa development class. Because what happened is, I was the only academic in the hospitality world that had some kind of science background. So when people would call the school for help with their developing wellness or spa center, the administration would send them to me.
And, of course, I knew nothing. So I thought, I'd better learn. So I was actually funded to teach the first course by someone in my field who was a great mentor-- who was not from the University, but who gave the money to make sure I got this going.
I'm a fitness nut. I have been my whole life. As a biochemical nutritionist, I get all that together. I really feel strongly that there's so much we can do to help people who are-- that you so passionately speak about, if we can figure out a way. And I'm very passionate about what we can do to slow or mitigate the progression of emotional, behavioral problems early on in life. Not childhood, but I mean, can we get people to be more mindful?
I can tell you what that is in four different ways, OK? But you don't want to hear it right now. OK. Or how can we get people to do more to raise their spirits, their seratonin level. And this new molecule called anandamide if you've ever dealt with [INAUDIBLE], they talk about anandas being [INAUDIBLE].
So anyway-- but nonetheless, I had an interesting adventure recently. In March, I went to a opiate in Qatar. I went to a place to talk about opiate addiction. I wasn't the expert in opiate addiction. I was a person who was supposed to speak about wellness and [INAUDIBLE], or putting off development of addiction.
It turns out we can be addicted to a lot of things. I know that. You guys know that. And that the opiate center is there naturally.
At any rate, the neurobiologist tolerated me and asked me to come. Qatar was quite interesting, because they're next door to Afghanistan. And all these-- you know, it's a wealthy country. And honestly, some of these people who are so wealthy-- I mean, this expands. This mental illness, mental addiction, whatever, starts with people who don't have any money to people who are really fascinatingly rich.
And so I was there. And he was showing me the architecture they have for healing, and how they have to have privacy for the higher ups who might be part of an elite family, let's put it that way, OK? So at any rate, I went there to suggest ways to work with people who weren't quite in the state that you find them from a suicidal standpoint.
And I really talked about addiction in the sense of all the things. I mean, you could be addicted to exercise. You could be addicted to surgery, God forbid. OK? You could be addicted to a whole host of things, and some of this does work on that opiate receptor in the brain.
And so that was really quite fascinating. The neurobiologist kind of liked my idea of can you substitute quote, a healthy addiction for a less healthy addiction. And I don't know, it's like the first time they thought of it. And they went, oh, really? Then they questioned me a lot and I thought, oh, I'm in really deep trouble.
But anyway, I kind of represent this side of this situation as preventive and ameliorating. I'm not so-- I mean, I am interested. But that's not my forte. My forte is not like yours. I don't have the training to do that. Or I'm not a designer obviously, OK?
But my real forte is looking at prevention. And sometimes I say, once you get a patient in a clinical setting, it's sick care. And I'd like to go to preventive health care. So that's my frame of thought. And I'll tell you about anything else you want to know later. Naomi?
NAOMI SACHS: Hi. I'm Naomi Sachs. And I am a new post-doc here at Cornell, working mostly with Mardelle in the Department of Design and Environmental Analysis. Just got my PhD from Texas A&M University in architecture. I have a background in landscape architecture from UC Berkeley.
And so my PhD in architecture was kind of a Trojan horse, infiltrating the architecture with landscape architecture. My dissertation focused on developing a standardized toolkit for evaluating gardens in health care facilities. So it was very specific.
And At the same time, I'm interested, kind of like you, Mary, in what we call salutogenic environments. So from the small scale of a healing garden in a health care facility to looking at city planning and how the greater environment can facilitate health and well-being.
MARY TABACCHI: Green spaces.
NAOMI SACHS: Green spaces, exactly. And some of the research that Mardelle and I are working on has to do with that more large scale. When I was a MLA student at Berkeley, one of the reasons I went to Berkeley was to work with Clare Cooper Marcus, who I most recently wrote a book with called Therapeutic Landscapes. Well, when I was a student there, she asked me to write the chapter on psychiatric hospitals for her first book, Healing Gardens. And that was a terrific opportunity.
I know mental health is a stigma, so I'm going out on a limb to say that I have also been a patient, and have struggled with depression since about 14-years-old.
MARY TABACCHI: Wow.
NAOMI SACHS: And so it was good to be able to bring that perspective. Then also, with our book, Therapeutic Landscapes, we wrote chapters on spaces for specific populations, including mental and behavioral health, and veterans and wounded warriors. And I am co-editor of Health Environments Research and Design Journal, and we're always looking for articles to publish for peer review. And several other people here have published in HERD.
And we're also looking for good reviewers. So please approach me if you're interested in being a reviewer and/or a writer for HERD. And I think that's it.
BROOKE HOLLIS: Through? Thanks, Naomi. Hi, everyone. So I'm Brooke Hollis. And so pleased to have you all here. What a wonderful group of professionals and people who provide so many different perspectives. It's really great to be involved.
So I just happened to come back, Lynne, from Nova Scotia last night. I had a wonderful place. I had a-- my flight was cancelled, and then there was delays. I got back at one in the morning. Not what I expected. I thought I was going to be at the reception last night. But anyway, so you'll excuse me if I'm a little bleary eyed today.
So I've always been interested in this kind of intersection between management and design and facility planning. So I kind of fumbled my way into finding this combination over the years and ultimately ended up getting an MBA and Sloan certificate in health administration here. Started in the architecture school here, ran out of money, and then later finished a Master of Architecture and Design at Washington University in St. Louis.
So I've always been interested in this combo. Brian, I actually hired Frank Zilm for his first project on his own firm at the University of Cincinnati Medical Center when I was Director of Planning there almost 40 years ago. It's hard to believe. But he actually is a guest lecturer remotely in my class every year.
I teach a class on facility planning for managers and entrepreneurs. Kind of because a lot of hospital people get into running projects, and have absolutely no idea about design and how it all works. So it's kind of to give them the tools to be better communicators and clients for architects and other designers.
So my career started out more traditionally. I was first working at a number of hospitals at the University of Cincinnati and a couple of other places, more bridging this facility planning and management side. Then I had the opportunity to become an entrepreneur, working to develop specialty clinics, a durable medical equipment company, and contract services for hospitals. And learned a lot about a lot of interesting things and kind of combining these two areas.
But unfortunately, some of my partners ended up having financial problems. So I learned about preparing for and ultimately finding partners and spinning off parts of the business and ultimately selling. And so the next part of my career after looking at other entrepreneurial opportunities was becoming a partner in a merger and acquisition advisory firm for professional services firms in health technology and other things. And did that for about 10 years with one person, and then set up my own firm.
But all the way, I was an active volunteer at Cornell, and was involved with Penny and a great group of people, running the alumni association at one point. I got this opportunity to come back to Cornell, so here I am. Kind of started as a part-time gig. I commuted from Hartford, Connecticut and now I've move up here, and I've been here for quite a number of years and have had the wonderful opportunity to collaborate with a lot of people.
And along the way, got to know Mardelle and Rohit, setting up this institute together. And then Julie is back here, Julie [INAUDIBLE] with the Sloan program, great colleague. I've got a great team of people I get to work with over there. This group is a great example of why it's so exciting to be back on campus and to be able to be part of all these kinds of things. So welcome, everyone. Thank you.
TAMMY THOMPSON: Hi. I'm Tammy Thompson. I consider myself to be a patient first. I was born with a chronic illness that requires regular maintenance and management just to try to stay healthy. And so during my undergrad years at Georgia Tech in architecture, I was also learning a great deal about health care. Because I had the majority of my health concerns and problems at that time.
And so I sort of naturally moved into health care. My first job was with a health care design firm. And went into just learning about, more so gravitated towards the user side. I have a master's degree in architecture and became a licensed architect about 10, 12 years ago. And again, really gravitate towards the user side of health care design.
I started the Institute for Patient-Centered Design in 2010, and we thought it would be a great way, sort of aside from my regular job to help to communicate the needs of patients and families to those in the health care realm. And at the time to time, my sister was very much supportive of this idea. And wanted to-- we thought this would be a great way, in addition to many of my other colleagues, to help to educate those on not just what we thought from a design standpoint, not even what clinicians needed, which also is extremely important, but to introduce the patient perspective into this discussion. I didn't realize at the time that I would lose her later that year. And so it has been my mission since that time to really drive home the mission of the patient in the design process.
So I have continued to have a sort of a regular behind the scenes job, and the Institute for Patient-Centered Design is really an organization that's almost 100% volunteer led. I have many friends, which I consider the Institute's family in this room. I have worked closely with experts like Jim Hunt and Mardelle Shepley.
And she actually encouraged me to step out of my comfort zone for the behavioral health piece. And which she promised me that if I did, she would support it, and she has.
So a number of years ago, I started learning about behavioral health, with the introduction of the design competition that the Institute hosted to find an ideal patient-centered design project. And with that project, we have taken it in a lot of different directions. We are currently working on the installation of a mock up, the Institute's fourth mock up. This one is going to be-- going to reside at Heather's facility. And we'll have a lot of input from the PA and their patient advisory team and staff there.
I most recently joined on staff at the Medical University of South Carolina. And it has been a wonderful experience so far. I've moved from design to teaching over at SCAD for a period of time, and now I'm at the Medical University of South Carolina.
And my first two months at this organization has been all about learning about the needs of the patients, families, and staff in the pediatric facility. So it has been a rewarding experience to actually go to every unit and shadow every unit over the past two months. And I have learned, oh my goodness, so much in just the past two months from seeing current state of patient care in a pediatric facility. We are working for the transition into our new facility, which will happen in two years. And my role is to sort of gather all of the teams and plan that transition in terms of operational improvements and also the move itself.
So I am very pleased to be here. I have sort of a new interest now in the implications of behavioral health on the health care delivery process. And what I have seen so far and what I have learned in this new role, I see a definite, strong connection, and that we need to be very much aware of safety concerns and what we can do from a behavioral health standpoint to help the entire patient population.
HEATHER SHANGOLD: Hi, everybody. My name is Heather Shangold. I am the local Recovery Coordinator and Psychologist for VA New Jersey Health Care System.
The local recovery coordinator is an odd title. And basically, my job is mostly, as the administrator, I work in mental health to make sure that we are patient-centered and strength-based in our approaches to mental health care. And I also do a little bit of clinical work as well. And as part of my job, I try to make sure that our system is really working with the veterans to make it an empowering opportunity for them to regain their health and their mental health, and try to educate people about stigma and how that does impact treatment and care.
I started my mental health career in-- I worked at a social service agency in Manhattan, actually. I was the Director for Patient and Educational Services. So our population was people with dual diagnosis, people with severe and persistent mental health conditions, such as schizophrenia, bipolar disorder, major depressive disorder. And the work that I did in vocational counseling was a job first model. And then our agencies became a housing first model.
And so I actually have seen recovery in action. I've seen people, who you might think are the least likely to succeed because of their diagnosis, actually, they succeed and thrive. And so I've seen the impact of actually believing in people and hope and how that does change somebody's ability to thrive. And as a professional, that is my job in the VA, to make sure that everybody believes that recovery is possible, and that people can grow and thrive as long as we give them the tools.
And we've had this discussion about what prevents suicide-- care, Care prevents suicide. But having care in an environmentally friendly, in a place that is not stigmatizing, ensures that the care is possible. So I'm on a lot of committees within the VA to make sure that we have a balance between safety and care, because a lot of times, people are afraid of what happens with behavioral health. People-- there's still a stigma out there, so it's a challenging balance. So I'm happy to be here.
SERENE CHEN: I'm Serene Chen. I bring the physician perspective to the group. I'm an emergency medicine doctor. I currently work at Oakland. The official title of the place is Alaveda County Health System. And the hospital I work in is Highland.
And our population that we serve is one of the biggest ones in the Bay area. And it's one of the biggest counties in California. And it has a tremendous amount of unmet needs, not just in medical, but also psychological, behavioral and social services, various places.
And you can imagine the emergency department is really-- we're open 24/7/365 so we're the place people go to when they have nowhere else to turn. We are, indeed, a safety net hospital and a level one trauma center. And you can imagine the facility requirements that we have, from going to patients who are actively bleeding and exsanguinating is what we call it, losing their lives that way, or slowly losing their lives, decompensating over the course of decades.
I think there's a tremendous amount of need. There's a tremendous amount of, also, optimism though, and potential. There's just so much work to be done in this area that I'm very, very reassured to hear about all these big themes that we've been talking about, you know? Social justice, patient dignity, and these design decisions that you guys make confirm and underscore for everyone in the room that it makes a huge difference 10 years, 20 years, 30 years down the line.
And I think about these-- my work, every shift is affected by these. So, so many of the decisions you make or may not have made makes a huge difference to me. The other thing was, if you are all curious about the work I do and a little bit of-- get a snippet of what we do in the emergency department, there is a documentary made a couple years ago called The Waiting Room that specifically features my work place.
I think this would be a good time to also just maybe sheepishly reveal that I am also on the older end of the millennial group. And so these themes about operations, how to bring healing environment to every environment, not just a mental health facility, will be stuck with me for decades to come.
KAYVAN MADANI-NEJAD: Good morning, everyone. I guess I'm the last. My name is Kayvan Madani. I'll be quick. I work with the VA central office, the VA and in Washington, DC. I'm an architect.
My career-- I've been designing mostly mental health and geriatric facilities. I still do that. Every facility that is designed in the VA, basically, has to comply with the design guide that we create. And also I work with local designers to make sure that those designs are in compliance with what we create. I met Mardelle, maybe in the late '90s, she was the chair of my dissertation.
And I focus on the emotional effect of space on folks, and specifically architectural form. And let's see-- I'm also part of suicide prevention at VA, a suicide prevention group. Every day 20 veterans commit suicide, which is much higher than the national rate. We're trying to see, at least on my end, how we can reduce that rate, at least, with [INAUDIBLE] environments and what kind of effects that has on it.
Let's see-- one of my passions is integration of primary care and mental health. I believe that mental health is primary care. At least, in the VA, we have 40% of the patients shared between primary care and mental health, outpatient mental health. So that's a big number.
And in general, mental health has always been the stepchild of health care. And there's a stigma associated with that. So how can we address that issue with design, with buildings. And I think integration is also another key issue in that department.
As a side gig, I do space architecture. I'm also an aerospace engineer. I'm always intrigued with how people spend time in space in 20 square feet and not murdering each other in the long term. So I do a lot of-- not a lot, but some research with that and design some prototypes. I've worked with NASA on that. So that's what I do.
MARDELLE SHEPLEY: So I am going to-- that's all right-- so I wanted to make something clear. As I heard people talk about who they were, and sort of people that are non-designers, sort of apologize, I'm not a designer, people in the design field-- there are conferences we can go to and just hang out with designers. We want to intermingle with people that are running these facilities, that are administrating these facilities, that are working in these facilities. So for us, you know, we are honoring your presence.
And I looked around the room, about half of you are not designers. So this is a part of this brave new world. We stop thinking about ourselves as being individual silos. We want to think of us as being together in this situation.
And we need-- the designers need to learn from you, and as you are-- seem to be open to learning about the designers' perspectives on things. And we all, we live in the physical environment. So we have to deal with that every day. So please carry that with you, no apologies. You know, it's great to have this integration of perspectives.
So what I like to do is, I told you, I'm going to make this fluid. I was going to talk about this research project I've been. Involved with I'm going to skip over that to get closer to our schedule, and come back to this at some point. And I want to start with what's listed in your agenda as the recent mental and behavioral health design projects.
So I invited, just for the sort of fun pictures, I invited-- let me get through the first one so you don't look at my work-- some of the individuals representing firms in the country, or who are participating now, to talk about their work just briefly. We said give us five slides and say a little bit about it. And so Brian, I think you are first up in terms of talking about what you folks are up to.
BRIAN GIEBINK: OK. Well, thank you, Mardelle. Again, my name is Brian Giebink. I'm with HDR. A little bit about HDR. We're an international architecture and design firm. So I thought it would be appropriate to share our international behavioral health work that we've done.
We've done over 100 behavioral health projects or components of projects, if it's a hospital with a behavioral health component, large, small, outpatient clinics, and then inpatient units. We've done hospitals with 200 beds, down to 24 beds, that type of thing. So we've really seen the whole gamut.
So the first one we want to show you is actually in Saudi Arabia. It's a 200 bed psych nursing home. The really unique thing about this project, I think, was the culture, the complete difference in culture. That, and the really unlimited budget-- so on this project-- which, right here in the United States, we don't see that very often.
This project, we were involved from the conceptual and planning phase, we did all the programming and planning. And then we did sort of a conceptual design development. We didn't really get into drawing specific details. But we started thinking about the space and what it looks like in elevation, in colors and materials, and things like that.
The cultural implications, obviously, you can see in the design elements. A lot of these shapes and features you see may not even be accepted here. They may be deemed to be abstract or inappropriate for people in the behavioral setting. But they're actually very comforting to people in Saudi Arabia, because that's what they're familiar with. We're creating a home-like environment for them.
It's probably enough on that project. We'll move on. The next one, Western State Hospital, it's a very interesting project in Staunton, Virginia. We actually worked with CannonDesign. We did the initial design concept, and they came in, designed, finished it out with the construction documentation and CA.
This project, Western State Hospital, actually has a very storied history. You know, pre-Civil War era hospital, moved to this site in 1941. But before that, they really had sort of the whole experience of behavioral health care. They looked at treatment options such as sterilization and lobotomies, the ECT treatment, you know. They did really the whole gamut.
And even looked at farming. You mentioned hunting. They didn't specifically do hunting, but they did farming. They found that patients were actually much more calm when they were out in the environment, actually farming and gardening their own food.
This one, Valleyview Mental Health Building, this was a P3 competition. And Lynne, I read your bio. I think you also had this in your bio as well as a competition in Canada for a P3 project. This one is on Native American land, or First Nations land for the Canadians.
And again, we really tried to incorporate a lot of that art work and those features into it. They were very adamant that we incorporated those design elements that were appropriate for them. And again, it's some of these abstract forms or some of these forms in shapes that we may feel uncomfortable with. But it's First Nations land. And those kids that use that facility are very comfortable with those.
So this facility actually had five different types of treatment. It's really a residence more than a hospital. It wasn't a medical facility. It was a residence for anyone from the ages of seven to 18. And then there actually was one unit for adults, mentally challenged adults.
And then this one, I know some of us in the room are way too familiar with this project at this point. This is the mock up that Tammy was talking about a little bit ago. This is a mock up-- we participated in a design competition, a behavioral health design competition in 2015, hosted by the Institute for Patient-Centered Design at the health care design conference.
And we were voted on to have the best design. And so we moved forward and did a mock up. We presented a cardboard mock up at the Innovation Summit in SCAD last May. Was it May-- last May. And then at that point, it really started to gain traction. The VA really started to get interest in this project and wanted to build a mock up of it, full scale with real materials at the VA in Lyons, New Jersey.
So we're currently in the process. I'd say some of us are too familiar with it. Tammy is working on it, Mardelle, Naomi has had a hand in it. Who else in this room? Jim, obviously, huge help--
BRIAN GIEBINK: --and it's-- oh, yeah, thank you. It's been a tremendous honor to work with all of you on this project and a real privilege to learn and get the insights from everybody as we go through this project. So it's a learning experience for us, and it's a learning experience, hopefully, for the VA. And when it's built, as Tammy mentioned, we're going to have focus groups and we're really going to learn is this the ideal patient room. What can we do to make it better? Does it work?
It incorporates things such as a digital art work display. We know patients like to have control and choice in their environments, and art work is also very significant in in-patient care and recovery, so giving the patients a choice with this digital artwork display, what art work they're actually looking at. We know scenes of nature are very important. But what type of scene of nature? Are they more comfortable with a beach scene or with a forest scene, and giving them the choice and the opportunity to do that. And I think that's it for my project.
MARDELLE SHEPLEY: Would you punch up the next slide, so we know who's next? All right. Thank you, Brian.
BRIAN GIEBINK: Yep.
MIKE MCKAY: So Mardelle asked us to send a few slides. I think I sent, like, 43.
So we whittled it down. But when we did so, I'm not sure if I know which ones we ended up with. So we'll go on the journey together. Let's see. What, that's back.
So a couple of case studies. Bulle Rock is one. And this is literally still on the boards for us at ERDMAN. We're working with a client in Havre de Grace, Maryland, on a new medical campus project, of which behavioral health, mental health, inpatient and outpatient, is part of the program. And it's part of the first phase, so the renderings that you're seeing are of the entire development, which is going to be mixed use, ambulatory in nature.
They're really trying to approach a hospital presence in this community by replacing an older, outdated facility with a newer one, strategically, within the system, relocating beds and consolidating as part of that on this site, their behavioral inpatient program, while also consolidating a large outpatient program. One of the interesting things that we're working on-- and it's in the middle of Maryland's CON process, so those of you that are familiar with that can understand how cumbersome and detailed, and I like to approach it as a wonderful learning opportunity-- but one of the things that we are working with with the client is trying to combine outpatient behavioral health with inpatient behavioral health in an emergency department, freestanding emergency department setting, while trying to show them that we comply with the legislative requirements that Maryland has come up with for this freestanding medical facility. And it's interesting because the authorities having jurisdiction are trying to take the behavioral health components, which in our world, in our understanding, in our programmatic requirements want to be connected to but separate from the emergency department. So we can get those patients diagnosed, put them into a crisis center out of the ED environment proper, but connected to those experts.
Maryland wants to put all of that in the ED requirements. So they're looking at this saying, this is all emergency department. It's, therefore, too big. Help us understand. So wonderful opportunity to help educate authorities having jurisdiction, complicated in that we're trying to take them on this journey and then also teach them about some of the components of mental and behavioral health.
So a couple of the floor plan diagrams that we have-- so the previous sketch, this is phase one. It's the freestanding medical facility, which is on the first floor walk in on the parking lot level that you see here. Behavioral health inpatient, then, is on the lower level, down the hill. It kind of cascades down the hill and out the back of the facility, if you will, so that we could put the inpatient environment kind of into its own world, if you will, with the patients having access to outdoors and nature and be away from the hustle and bustle of the freestanding medical facility.
They're also contemplating a medical office facility on this site, which would be the integrated primary care, behavioral health, some of those other components, such as wellness, as well on this campus. So this is the freestanding medical facility diagram, which is comprised of a freestanding ED observation suite that can flex up and down and also provide that inpatient presence that Havre de Grace is really wanting to maintain. They're afraid of losing their hospital and their hospital services within the community. It has a diagnostic and treatment platform and some administrative space.
The letter B in the upper left-hand corner is the Crisis Center component, which patients are presented by emergency vehicle through the sally port in the rear of the facility by ambulance or police car, they can be taken into that corner of the building which is supposed to be their home within this ED, away from that. So it provides a nice environment where they can go through the diagnostic process and be out of that emergency department. Unless they need the medical care or trauma care, they can be in that space.
From there, if they are admitted, they go directly downstairs and into this inpatient behavioral health unit. And here, we're exploring the idea, and these are just space diagrams for now, but we're exploring the idea of small households in inpatient behavioral health, trying to break down the scale. Heard some of those comments around the table in introductions.
I think that's one of the largest problems facing health care. And as an architect in this space, I think we contribute more to that concern than we are solving it. I really think we need to break these facilities down, make them smaller. Because the larger they are, the less homelike they can be, no matter what we try to do. We try to do these design interventions to make it feel more residential in human scale. And the fact of the matter is we're designing these buildings around process and operations and not around patient experience from a patient perspective.
So we're asking a lot of questions of our client in this, and they're wanting to go on the journey with us. We did the behavioral health competition that Brian mentioned. And in that, we were proposing the small household neighborhood. It's not reflected yet in these space diagrams, but we're getting there.
We're trying to take a 40 bed facility that they originally wanted in a typical race track inpatient type of environment, and break it down into three households. Where the households could scale or swing between each other, where all of the services and support services are off stage, stealth services, if you will. So that the inpatient environment, those bedrooms that the patients are living in and their living space is completely separate from services. So all of that's coming and going behind the scenes. And the living environment, the environment of care, is owned by the patients.
We're also looking at design strategies in this where they can go inside and outside without having to have staff intervention or control to do that. So they're allowed to explore and be in the outdoors when they want to be, and inside, all under staff supervision and control, of course, but the ability to move in and out and all around within the facility at will. Again, trying to restore the notion of home and self-control within these spaces.
Another one that's related to this is Cordileras. Our company had the opportunity-- this is a project that's underway in San Mateo County, California. HGA was the lead architect that established the original concept for the County of San Mateo. The County then chose to explore a design build delivery for this a year ago. And our company was one of several that were invited to the table to do some planning and try to get the project moving forward through a design build opportunity.
That process didn't come to fruition. They are very challenged with a lot of program on a limited site, a very complex and difficult site. But I think a wonderful opportunity here that is going to have ramifications in the impatient world for behavioral health moving forward. They've pulled that project back and are now going back out, soliciting architects through a design, bid, build delivery method, so we'll see where it goes.
But I wanted to share some of the concepts that we were involved with, because I think there's some merit here. It's a mental health recovery program as well as an adult residential facility program. So the mental health recovery program are the buildings on the left-hand side of the screen. Literally small households, 16 residents max, they're taking advantage of a waiver in the Cal Med program to allow for these to be individually licensed and true small households, with the adult residential facility, then, across the valley on the other side.
So the small household we begin exploring. And this was the concept that we brought to the Institute for Patient-Centered Design, a little iteration of that. By putting the patient rooms, literally, a household of 16, a mix between private and semi-private, but with shared space and a controlled outdoor space in the center there. So patients and residents, if you will, of this household, are free to move in and out at will under supervision, with all of the services then off stage at the lower part of the screen, with staff and services coming and going off stage, if you will.
We were looking at versions of this to shorten it, so it could literally sit on the site. The County site for this is on the San Andreas fault. It's in the valley. There's a lot of nature. There's some bog turtles and other wildlife that are going to be involved in this project when it does come to fruition. And so we were looking at opportunities to set this as gingerly on that site as possible. But in doing so, maximizing daylight and views and access to that outdoors, which I think is entirely warranted.
The building across the valley from it is the adult residential facility. So when you start to take a larger program and break it up into smaller components, you need to still accommodate campus functions and support facilities. So a lot of that was moved over to this facility in terms of a campus wide gathering space, in terms of administrative offices, amenities spaces like the art studios and learning spaces. And then above that are the living spaces, the adult residential facility itself.
But here again, we're exploring the idea of small households. And separating what originally they had programmed as one entire floor of residential units, breaking it into two smaller households that could share a living space. And in doing so, allowing them flexibility in terms of management and census, moving patients, or operating patients from one side to the other and giving them a lot of flexibility in the facility.
The rooms are canted in the way that they are, because again, some of the evidence that our group was bringing to bear on the competition about orientation and views. We wanted these rooms, since we were on a tight site, to have sight lines not across at other rooms, but up and down the valley and of nature. So that in these rooms, the idea is that I can't sit in there and see my neighbor necessarily, or see my neighbor across the way.
So try to take into account all of that. So those are a couple of projects that are on the boards for us at ERDMAN. And we'll go from there.
ELISABETH PERREAULT: This advances?
ELISABETH PERREAULT: OK. I can do this here. So I did keep it to five slides. I could probably spend about an hour on any one of these projects. But I'm going to kind of just give a really high level overview just of a few of the projects that I've recently, personally completed.
So the first one I wanted to talk about was the Juravinski Centre for Integrated Health Care. This one is in Hamilton, Ontario. It is one of the P3 projects. We saw this design through design development, construction document, CA, and then even some post-occupancy evaluations.
It is a 305 bed adult psychiatric facility that includes 850,000 square feet. It's both inpatient and outpatient, and it also includes a medical clinic with full diagnostic and imaging capabilities for the community. So that whole idea of really getting rid of the stigma of mental illness is about putting that community clinic right in the facility.
Also part of the outpatient program is this is a academic medical center. They are affiliated with McMaster. So we actually moved the entire psychology department for McMaster University into this facility. So it's located here. It includes geriatric units. And it includes, basically, mood disorders, schizophrenia.
It includes medium and minimum secure forensic facilities or units in here. And some of the things we really looked to do here, this whole unit or facility is designed based on a layered level of security. So there is an access control system throughout this facility that every patient has their own proximity bands, essentially. And they're individually programmed to each patient in terms of where they are in their recovery, so that they're able to move throughout the facility freely.
So when you first start, maybe initially, you're on unit. The unit has its own on unit therapy spaces and outdoor access. And then, as you kind of progress throughout, you are able to kind of move throughout the facility freely.
Waypoint Centre for Mental Health Care, up in Penetanguishene, Georgian Bay, this is another one that was part of a P3 process. This one is a maximum secure forensic facility. This one is 120 beds. It actually has 144, because there's a 24 bed swing unit that allows them to do any kind of renovations or repairs without actually ever moving a unit, because it's maximum secure forensic.
And this one-- what's really interesting about this one is it was a-- well, first off, it's maximum secure forensic. It serves most of Canada, frankly. So it's [INAUDIBLE] area is huge, and there are very, very few facilities like this across the country.
And it was moving from a 1938 brick facility that was essentially a prison. This was a skeleton key facility where they had the skeleton keys and bars, barred doors that you would move throughout the facility. So we were taking patients who, literally, their average length of stay is 20 plus years. They live in this facility for the most part. So taking them from a very prison-like environment and applying all of what we know in terms of best practices and evidence-based design to give them a therapeutic environment, including open nurses station.
So we're very proud of this facility, because it's working. So we were able to move these patients from basically a prison-like environment. And we found, post-occupancy, that really only 5% of the patient population needed a more secure environment. So what we're doing is taking basically more of a seclusion suite area on those units. And we're hardening it a little bit, and taking out some of the detailing because of that 5%. But 95% of the patients are really functioning quite well and doing much, much better in this type of environment.
And back to the Canadian hunting points, they actually have an ice rink in this facility. So they moved from outdoors. But they moved from a prison to allowing the patients who are essentially living here to play hockey with ice skates. And everyone's behaving quite well.
AUDIENCE: That's wonderful.
ELISABETH PERREAULT: The next facility is the Virginia Commonwealth University, Virginia Treatment Center for Children. This is a children and adolescent facility. It is under construction and will be completed in about a month. So it's a 32 bed, inpatient facility, two 16 bed units, and there's also outpatient services here.
Basically, what was interesting about this client-- well, first it's an academic medical center. So they're incredibly progressive with their care model. So they use a collaborative, problem solving approach to care. So they have a hands off policy for dealing with the children and adolescents.
They also serve a very wide range. So they treat patients from 6-years-old to 18-years-old. Now the difference when you deal with a child and an adolescent, is there a huge difference between a 12-year-old and a 14-year-old and a 6-year-old and an 8-year-old. So the challenge here is really to divide the facility up in very small pods so that you are able to kind of passively separate the appropriate kinds of age ranges.
Also, in the units here-- oh, it's not the best image-- one nice thing about this is that there is no nurse station. So basically, what we have is we called it, the nurse station, an architecture of authority. So it's basically a divider between patient and provider and staff.
And so instead of doing that, we have a central area that's shared with electronic health records. No one needs to sit behind a station and chart any longer. Everyone is using mobile tablets. Panasonic makes a really nice one you can drop and drop kick.
So basically, you still do need that single point of awareness in the unit. So at night you can sit and supervise passively. So we made that an interactive space. So it's not a-- this is the nurses' space. This is in a non-patient space. And it has a combined area in the center of the unit.
AUDIENCE: Do they make 2 16 bed sections so they can get Medicare reimbursement?
ELISABETH PERREAULT: No, it worked with their-- typically, the way we divide up units is we sit down with a clinical group, and it's back to their own staffing model. So--
AUDIENCE: And that's not a way to get around the IMB exclusion?
ELISABETH PERREAULT: I don't think so.
AUDIENCE: The IMB doesn't apply to kids.
ELISABETH PERREAULT: Yes, so basically, it's two 16 bed units with, I think it's two six bed pods and four bed pods within that unit. And then the last-- oh, this isn't the last project.
The second to last project I wanted to talk about, just so you see the range of what I've done, this is Sinai Health System, Holy Cross Hospital. This is actually a safety net in a hospital, where we renovated empty floors in the Chicago area to create a inpatient unit and on that floor. We're also doing a crisis stabilization unit, which is under construction. This one opened, maybe about six months ago or so.
And basically, we were able to convert-- it's one of those older, 1950s hospital towers. And we were able to really create a state of the art environment the. Interesting thing about this is we typically do patient and family focus groups when we design things. And this area of Chicago has a real wide variety of different race, different ethnicities, and different groups of individuals.
So when we talk about color, color is very subjective, right, so especially culturally. So different colors mean different things to different cultures, so we pulled in a focus group for the interiors. And we had, I think, five different color schemes.
And the client was really adamant that their community was going to want this one color scheme. And nope, they didn't. They actually liked the one we offered, [INAUDIBLE] which was the green and the blue scheme. So it was an interesting way to develop this.
We also did focus groups for the art work. This is obviously at Chicago. It's on Lake Michigan. And so we have a water theme and did a lot of work on what made them [INAUDIBLE].
And then finally, the last piece I wanted to show. This is The Golisano Center for Community Health in Niagara Falls. It recently opened. The reason why I wanted to show this is because I'm also very passionate about the integration of primary care and behavioral health.
So I spent a lot of time focusing now at the system level of how do we integrate behavioral health throughout the health care continuum? Health care in general is moving to more multi-disciplinary care teams. And one of the biggest hurdles we see today is really access to behavioral health services and the stigma behind it.
So this is a very unique project, where a safety net hospital really looked at their community. Which has-- 49% of that community have developmental disabilities. It's a very, very challenging demographic. And they took a look at, basically, the community's health assessments and who were the people who were ending up in the emergency department, who were clogging up the system, and who were unable to really manage their own care.
They decided to proactively create a community center that's a combination of an integrated behavioral health and primary care clinic. It has the Child Advocacy Center of Niagara County. It has Rivershore, Inc., which is a social service network for persons with intellectual and developmental disabilities, among other social services, to really start focusing on the social determinants of health care. So it has the care management programs for Niagara County in it.
And it's been incredibly successful. It actually has a physical corridor that links back to the emergency department. And [INAUDIBLE] does not allow you to have somebody present at the emergency department and you say, no, you go down here. But you can self-select, right?
So basically, what they're finding is that they have and extended hours primary care clinic linked to the emergency department. And patients are actually self-selecting to go to the primary care clinic and then get linked into primary care medical home network versus going to the emergency department when they are not-- it's not emergent. So it's a very successful project. And we're starting to see more health care systems look at that more proactively. Thank you.
FRANK PITTS: So Elisabeth did a great job about talking about Juravinski Pavilion. This was a P3 project. We were the compliance architect. We did the indicative design. The thing I would say about this project that was spectacular-- and I'm not going to explain the projects, I'm just going to talk about themes-- was they had this brilliant idea that if you co-locate your primary imaging facilities and a whole bunch of somatic medicine outpatient facilities, including women's care, in a single building with behavioral health, mental health, what would happen? What would happen to the question of stigma?
This is Worcester Recovery Center and Hospital. And the theme here has to do with, first of all, a continuum-- inpatient unit, houses, a local treatment mall, a neighborhood that's connected to the houses, a downtown that everyone looks at that has the singular [INAUDIBLE]. This was meant to increase participation in off unit treatment mall programs by putting the mall within the standard control of direct care staff. And the inpatient unit is broken into four apartments or subclusters, not because they're more homelike, but because the social science is around small group dynamics drive this idea.
This is also two hospitals, an adult hospital and a children's hospital. We're seeing a fair amount of this happening. Where they share facilities and they share services, but have separate entrances and identities. It saved $20 million to do this in terms of capital costs. It saved them about $2 million a year in operating costs.
And this is a view of a wonderful student center at a major university-- and it's not. That's the public space in a tertiary care safety net public hospital. It's all about assaulting notions of stigma and creating environments that talk about a different kind of reality. This is at the Vermont Psychiatric Hospital.
SPEAKER 8: I love that.
FRANK PITTS: It's a safe room that is wonderful to be in, just a very simple thing. It's nice to be by the window. It's about comfort and familiarity. It's very safe. It's very secure. And we've won an international interior design award. Nobody gets international interior design awards to make psychiatry.
It's about places in between, same hospital. It's a place at the end of a hall where a patient can be, can be with themselves. Can see what's going on in the rest of the unit, and make decisions about what's next, who's next.
This is one of the most interesting bets that I'm seeing happening in the country. This is Nationwide Children's. We've worked for five of the top 10 children's hospitals in the country the last couple of years. And I've not seen anybody make this bet before.
It's an integrated mental health service that involves everything from crisis care, transitional living units, extended observation beds, outpatient care, inpatient care, a treatment facility for autism kids, a completely vertically integrated facility, much like the Juravinski building. It is the wave of the future, I think, in urban areas for mental health.
AUDIENCE: What's this project called?
FRANK PITTS: This is the Big Lots Behavioral Pavilion. We should talk about the different distinction. My Canadian colleagues and I say mental health a whole hell of a lot more than it happens in America, and there's a reason for that.
The challenge here, if you think about the form factor of Worcester, where everything is seeking light and stretching out like a finger, the challenge here was to locate on a campus that had a great deal of medical facilities and be a part of that, as opposed to being out in the country someplace where you could spread out. We had a very, very tight site. And the challenge was, how do you figure out how to do an inpatient unit on a very tight site that has these same qualities that we have when you extend your hand like a finger.
And then, culture is something that has been teaching us an awful lot. This is a competition that, alas, we did not win. MAP won this one. [WHISPERS] Damn them!
But it's [INAUDIBLE]. The idea here was to figure out a way of organizing inpatient units and a whole hospital where the inpatient units were organized around courtyards that are a familiar form. And the courtyards form-- the courtyards and buildings form neighborhoods and relationships that are [INAUDIBLE], but at the same time deal with the extraordinary and extreme segregation that needs to happen between patient types.
And that was a huge driver of this project, now completed, in Riyadh, a National Guard Hospital. Where everything that drove it were these notions of who can mix, who cannot mix, who can be seen, who cannot be seen, very different ideas about how you organize a hospital. And it's really lovely to work overseas to get to see what cultural impacts are. I want you to talk later about this notion of safety and what happens in Europe, and why it happens, and what the differences are.
NAOMI SACHS: Hello again. Thank you. OK. I wanted to start with this slide, going back to Brian and the farming. The access to nature, which is what I focus on and have been focusing on for a long time. And I forgot to mention that I'm also the founding director of the Therapeutic Landscapes Network, which provides information and education and, hopefully, inspiration about all kinds of different landscapes for health.
And so this idea of access to nature in health care is not a new idea. Well, I mean, long, long ago, that's kind of all we had, right? And so even in the 18th century and 19th century, there was something called the moral treatment. Which was this idea of taking people out of their chains and tied to their beds and getting them outside and being respected.
And part of that was getting people, really, outside, exercising, talking with each other, farming, gardening. And like much of health care, that changed in the sort of mid-20th century, and we went to this big hospital environment. And we got more and more separated from the outdoor space. And it was felt like we didn't really need access to nature, that it could all be handled with drugs and lobotomies and stuff like that.
So in general with health care, part of the reason that nature is so important is that it is normalizing. It's something that's familiar to people in an environment that is very alien and frightening to people, and where people have given up so much physical and emotional control, whether they want to or not. And so having either visual and/or physical access to nature is something that feels like home. This is Rosecrance Healing Garden at an adolescent treatment center. And this is open to, actually, the whole community as well as all of the patients.
They're not allowed-- the patients are not allowed to go outside by themselves. They're always accompanied by a staff member, which means that this can be open to the community. And they do walking and treatment outside.
There are several rituals that people engage in throughout their treatment. So it's become a very successful facility and is amazing that it's an adolescent treatment center that's also open to the community. So anyone can just go take a walk there if they want to, speaking of getting rid of that stigma.
I think Juravinski wins the prize of being mentioned most times. And so one thing that we talk about in health care in general, but I think especially in mental and behavioral health, is visual access to nature, depending on the level of acuity and also the weather. Whether it's the heat in Texas or the cold in Ithaca, New York, we can't always go outside. But we can always have that connection, and of course, natural light, which is incredibly important for people with dementia and where the circadian rhythms are off. We really need to provide visual access to nature.
And then active interaction with nature-- so not just seeing a beautiful scene or walking and experiencing being outside, but also gardening, and people getting their hands dirty. And actually, with mental and behavioral health, we have less of the concern about people being immunocompromised, which is something for a cancer facility, for example. That there would be some danger and some real health concerns with someone getting their hands dirty.
But with most behavioral health, that is not as much of a concern. And so whether it's the process of getting a seed and planting it and growing it and taking care of something and really having control of something-- and then, perhaps, if it's a radish, getting to eat it, that's very exciting for people-- or just weeding. And it's also a very community-oriented, so there's a real social aspect as well that has been found to be beneficial.
Since we're supposed to be talking about new projects, this is a brand new project. Has anyone been to this project in Bethesda?
NAOMI SACHS: So this is the Green Road Project. It's one of six, five or six projects, that was funded by the TKF Foundation, also called Open Spaces, Sacred Places. And they've given $6 million for projects to do both the build and then research about it. And this is at the Walter Reed National Military Medical Center, and Fred Foote is kind of the fire soul behind this.
And I decided not to put the plan on there. But if you Google the Green Road Project, Bethesda, you can see the wonderful plan that they've developed. And it's basically a ravine and a stream that connects the Fisher Houses, which is where the veterans and wounded warriors and their families stay, and then the NICoE, which is The National Intrepid Center for Excellence. And this one is specifically for wounded warriors with traumatic brain injury and PTSD.
And so this is the Green Road that connects the Fisher Houses and the NICoE. And they're using it as both a passive space and also a therapeutic space. So I'm happy to talk more with people about that if you like. Thank you.
LYNNE WILSON ORR: I'm going to be interested to see what slides come up here. Because like Mike, I sent more slides than was asked for. Because I wasn't quite sure what the other presenters would be coming forth with, and I wanted to give Mardelle the opportunity to, perhaps, balance out with different examples of different sizes and types. So let's see what we have here.
So Oakville Trafalgar is, again, a P3 hospital. It is 1.5 million square feet. It was completed about a year, year and a half ago. And one full floor of the hospital is adult and child adolescent mental health.
It is a hospital that, while it was done under the P3 process, Oakville is a city that feels that they are more entitled to higher quality health care than perhaps some other areas of Ontario are. So when the [INAUDIBLE], which is what we call the documents that are put together that describe the design that must be provided, when that was put together, it advocated for patients and families to increase the level of design within the space, to increase the sizes of spaces, and also to move to a single room model of care. So it is one of very few hospitals in Ontario that is 100% single room.
We do not have the same requirements in terms of HIPAA for privacy that you do in the United States. Our single room model is driven by infection prevention and control. We do, obviously, have privacy concerns and privacy legislation. But it's not to the extreme.
We tend to be a less litigious population in Canada. I don't think we've figured out we can be litigious. It's not something that you see to the same degree. So it is. I'm quite happy to be Canadian some days.
And I'm not trying to be negative. It's just a fact that our staffing levels are much lower than they are in the United States. Our ratios of patients to staff is completely different. And it doesn't translate well if you don't understand that into design.
So this is one of the outpatient waiting areas within the mental health unit. This is a typical design. My first degree was in interior design, so that tends to be the area that I'm more involved with. And we are working towards creating environments that are both safer, but more interesting, more normalized for our mental health patients.
So that if you walked into this particular waiting room, you would not know that it is mental health specific, because it is designed in the same manner as all of the waiting rooms within the hospital. So just two different shots of it. Some areas have fireplaces within them. It's a hospital that has more than 300 wall mounted monitors telling you everything you want to know about the hospital. And that's extremely important in terms of how we provide care.
Mardelle made a comment last night about who got lost on their way to find this room. We're finding that so much money was being spent and hidden within operational budgets for way finding within hospitals, that most of our hospitals are moving towards the use of digital information to assist patients with their journey through the hospital. So this is something that's becoming much more common.
This is another area, just in that same-- this is the entrance to the emergency department. But it includes a large mental health component in this area. And there was a concern, during the original design phase for this, about the use of fireplaces in these areas. But we've found is that there are very safe elements that are available where you will not burn your hands.
And the interesting thing since this opened, is we had anticipated that the fireplaces would be used in the winter time, in the fall, in the winter, in the spring. Patients will come in, see this, and ask to have it turned on, even when it's 90 degrees outside. There's a comfort factor for them that they get from this. So these are found in all of the units within the hospital.
And then this is one of the care stations. We have moved to systems care furniture. We very rarely use constructed mill work nursing stations, even within our mental health areas. So they are all designed on that psychosocial model of care, such that you have-- and this is not actually one of the mental health units. It's one of the other units.
But it's a similar aesthetic that's used, such that the private work that needs to be done by caregivers without being overheard by patients is done in a private area behind this very public area where patients and families are welcome to interact with the caregivers. So it is that aspect of openness, connectedness that we are looking for in the design of the facilities that we create. And we see this whether it is a forensic mental health unit, a child adolescent unit, or some of the emergency departments.
We have enormous problems within our mental health system in Canada in terms of the treatment of indigenous people. In some of our cities, our population in Winnipeg, Regina, some of our Western Canadian cities, 25% of the city population are indigenous people. And because we have not provided them with the standard of care on the reservations and in some of the smaller centers where they live, they are gravitating towards the city. So we are seeing large numbers of them becoming users of our mental health services within the hospitals.
But our large cities, all of our cities, actually, are extremely diverse. So what we've found one of the challenges is is recognizing the number of cultures. And Brian showed that image of Valleyview. And the fact that there was a strong intent on the part of the health authority to recognize the indigenous teens and children.
But that facility is actually designed for 250 different diverse cultures, because it brings children and adolescents from all across the province of BC. And that is typical of what we do. So this idea of incorporating culture into our environments is very challenging. Whether it is culture, whether it is color, whether it is visual images, it has to be something that is respectful of a wide variety of people, because our cities are changing.
And you go into a neighborhood, and it's been East Asian for many years, and it's changing, and now it's a Somali neighborhood. So that it's very diverse, very changeable. And we're finding that reflecting that in our health care system is very challenging. And as a result, some of what we do may look somewhat neutral, because we cannot reflect all of the cultures that are there. We need to be respectful of anyone who comes there.
And then this is the main entry lobby. This is the gas fireplace. It's probably one of the few places we'll ever get to do something like that again, because of Oakville and the amount of money that they were able to raise. Because we are a public health care system, but a lot of the, shall we say niceties, the artwork, the furniture, the improved materials that are used, are funded by the local neighborhood. So that varies from one community to another.
So one of our challenges as architects is to not make it look like it varies between the communities. And that is hugely challenging. And then this is just the main entry to the hospital.
So when you design something this big, and for Canada this is very large, we've only done a couple of projects bigger than this, at 1.5 million square feet for a community hospital, you can imagine that that becomes an issue in terms of finding land that is available, finding access points for people. Because we are very much based on a public transportation system. So it is a hospital that was in a downtown neighborhood and had to be relocated into the suburbs. So all of those became factors that became part of the design process.
And with a P3 process, as Frank said, you're given an indicative design. And the challenge is always, do you follow that design, or do you improve on that design? And this was an opportunity for us to improve on that design. And then, this is the main drop off. Well, you gave me more than five!
MARDELLE SHEPLEY: We thought you were going to truncate it. And that's all right.
LYNNE WILSON ORR: OK. We'll stop with that.
MARDELLE SHEPLEY: All right.
LYNNE WILSON ORR: OK.
MARDELLE SHEPLEY: Thank you.
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The Cornell Institute for Healthy Futures hosted its first roundtable on Mental and Behavioral Health Design on October 15-16, 2017. The event brought together clinical practitioners, designers and architects, and design researchers to focus on identifying the most pressing issues associated with improving the quality of mental health services and facility designs.
With a steadily growing population of adults in the United States reporting serious psychological distress, CIHF aimed to identify critical issues with industry experts. The roundtable provided informative discussion and presentations on the current status of mental health programs and facilities, recent research on design, the impediments architects, designers, and health management are facing, and opportunities to develop successful designs and programs.