Well, today we have Brian giving architect and leader of HDR Behavioral Health Practice.

He introduces current research and design trends to improve safety, patient satisfaction and staff retention for behavioral science and HDR.

He's also a member of and FTI topical focused on making policy and he has received national recognition for all of his contributions to our field and to this state.

So thank you so much, Brian, for joining us.

I'm gonna invite you to the podium.

All right.

Thank you, Brian.

Thank you.

Thank you.

Very, very happy to be here.

And share a little bit about what I do in mental health care.

This is a mental health care is a topic that I'm very passionate about.

And as the leader of our studio, I get to be involved in many projects.

I want to share a little bit with you about what we're doing and what we're learning and as the National a national leader in health care, HDR has identified a number of what we refer to as silent killers.

These are issues that are significantly impacting the health and well-being of people in our communities and our society.

And these are issues that aren't often talked about.

They're not always at the top of mind.

Some of these are getting better, but it's it's been a challenge.

And so these these are what we are seeing as as some of the top issues and equitable solutions climate change, obesity, loneliness and mental health.

These are all significant challenges that are impacting both our life span and our health span.

And if not addressed, we reach a tipping point where it really significantly reduces our quality of life as life span is simple.

That's really the number of years that you're alive from From birth until death health span is taking into account the number of years during your life in which you are healthy.

So poor, poor care or not, addressing certain conditions could lead to a lower quality of life and could potentially reduce health span.

So let's look at some of these issues and see how it's impacting our our health span and lifespan.

Some new research that's that's just coming out suggests that climate change is actually reducing lifespan by six months to a year and it has significant health spend impact as well.

We know that, of course, with the natural disasters, there could be physical injuries, but there's also poor air pollution associated with that.

And there's also mental and physical.

There's also mental mental health conditions arising from that.

Depression, anxiety, climate change, anxiety is now being diagnosed.

We think about obesity, potential loss of life of ten years from this issue.

And the health span impact is equally significant.

Designing buildings or spaces or infrastructure, or even even government solutions to problems if they're not considering equitable solutions, could lead to significant health impacts and reduce our lifespan.

Wealthy men, for example, they're 15 years longer than the poorest men.

Wealthy women live ten years longer than the poorest women.

The health spend impact is significant as well.

Lower incomes experience higher levels of disability.

Minority and lower income populations have poorer conditions.

Social determinants of health.

And of course, we all know that the public health crisis on loneliness is at the top of mind today.

Potential loss of life of 15 years from from that average life span and the health impact is significant as the health span impact is significant as well.

We're looking at issues such as physical issues, heart disease and chronic diseases, as well as anxiety and depression that arise from this public health crisis.

And then lastly, mental illness can have a very serious impact, if not addressed.

Loss of life of up to 25 years compared to the average life expectancy.

The health span impact is significant as well.

We're looking at at lower self-confidence, lower self-esteem, unable to perform daily tasks.

Mental illness is a really a big challenge in our society, and all of these are affecting both our health and our well-being and our physical today.

And I want to talk about mental health and what we're doing at HDR and how we're thinking about mental health to address improve health span and lifespan.

Like many of you in the room, I'm still a student and in every encounter I have with every with a clinician and a user group meeting, working with a furniture manufacturer or a product manufacturer for something in a behavioral health space, meeting with a family member, somebody with lived experience.

There's always something new to uncover about behavioral health care.

And what I'm what I'm noticing is in all of these encounters, there's a common thread that we can actually trace back centuries that revealed itself in treatment approaches and design solutions that date back hundreds of years.

It's so critical to positive health outcomes that it can really be easily overlooked.

And that common thread is about building connections.

The health care sector has long focused on using design to improve engagement between patients and clinicians.

But mental health care is really slow to catch up, and in some cases it regresses due to staffing challenges or because of safety concerns.

But it's also so much more than just patient to caregiver.

When we think about connections, connections really aid in one's progress towards recovery.

So we're really going to look at connecting with people, connecting with community and connecting with purpose.

So we think about connecting with people.

What does that mean?

It's about companionship, accountability, building relationships.

Loneliness and social isolation are are on the rise in that lack of human connection can really impact both our health and our mental health in very significant ways.

Today, where we have busy lives, where we're trying to balance social or social lives or school, our work.

We're trying to to still devote time to hobbies.

And that can be really demanding and taxing.

We're trying to to develop time to self-care.

And oftentimes we we lose our personal connection with others that personal connection can really fall by the wayside.

But by connecting with others, we can actually start to improve mental health care because we know that looking at the longest in-depth longitudinal study on human life, good relationships are the number one predictor of health and happiness.

We're social creatures.

Humans are social creatures, right?

We have we're wired to see connection with connection with others.

And these connections allow us to share interests and feel a sense of belonging and security.

Social connection improves a patient's response to treatment.

It builds trust, builds relationship.

It builds a sense of security and build a sense of belonging.

It can promote engagement.

Connecting with others can establish a support network.

It can strengthen the continued continuity of care, the follow up care, so a patient knows who they're going to meet with when they leave the facility.

As architects and designers and researchers, we have a very important role to play in building relationships at all levels.

Mental health design.

We build spaces to connect patients to other patients.

We build spaces to connect patients to family, connecting family to staff, and even connecting patients to staff, because the right setting makes it possible for the clinician and the patient to do the work together.

And I think a really good example of connecting patients to staff, this can be done in many ways.

But I think the most obvious example, something that many of us are probably aware of is when you think about the care team station, the nurse station in a behavioral health setting, are we creating spaces, environments, design solutions that connect others, or are we creating barriers between patients and staff?

At the Behavioral Health and Wellness Center in Omaha, we got rid of the care team station.

So we don't we don't want a care team station.

We don't want the barrier.

And so the care team station is pushed out of out of the picture.

It's in the back behind that window and in its place instead of a desk.

We have a conversation opportunity.

We have a coffee table and chairs where patients can interact with others and a place where where staff can interact with patients and connect on a more personal level.

At Radius, a residential treatment center in Omaha, there's no dedicated staff space.

The staff are intermixed with the patients and they're connected and they're building relationships.

There's movement and interactions that are fluid and dynamic throughout.

This allows us operate those really important opportunities for connection at the same facility.

We also provide those opportunities outside.

We know that some physical movement, being in the sunshine, being outdoors can really help others open up, throwing a ball around all of these activities are ways to help connect to people.

Then, of course, we need to think about family members connecting with potentially a child or a loved one.

That's in a mental health facility.

Are we creating spaces that are comfortable and welcoming and disarming, or are we creating barriers?

We need to think very carefully about providing the right spaces for these connections to happen.

And then lastly, of course, we need to think about staff.

We need to be sure that we're giving staff the spaces that they need, giving them quality real estate in the building with good views, not letting them be an afterthought.

Oftentimes staff spaces are are an afterthought of of filling a functional need.

We really need to be giving them that quality real estate that allows them to to feel like they're like they belong, to feel empowered and to feel like they're there.

Leadership supports what they do and so giving them good views and in and that that connection to nature can be very important.

It also promotes interdisciplinary collaboration.

If staff are drawn to a space, they're able to connect with others in a mental health care interdisciplinary collaboration is so important learning how mental, mental and physical health working together.

So secondly, looking at connecting with community.

And this is all about connecting the public to mental health, and it's about communities embracing mental health.

Communities that are better connected to mental health have better outcomes, supports reintegration into the community.

It strengthens the community, strengthens community support, and it strengthens community mental health.

And I think most importantly, it destigmatize this mental illness because stigma can be the single greatest barrier to recovery.

I want to share a couple of examples of how community connection works or what it might look like.

A few years ago, the community of Hampton, Virginia, had access to health care.

It had access to behavioral health care, but that behavioral health care was fragmented.

There were some services, but they weren't well connected.

And one of one of the biggest pieces missing was a place for patients, adults and children to go when they're in when they're in a mental health crisis.

And the the the current state at the time was to bring them to the emergency department.

So now they're boarding in the emergency department, which can be very costly for the health system.

And the patients aren't healing in the appropriate environment.

Law enforcement might pick up somebody and not know where to take them.

So either they go to the emergency department or go to jail.

But Riverside Mental Health and Recovery Center recognized this challenge in the community, and they worked with a number of community stakeholders, bringing everybody together to do that, to create something that was the first of its kind in the state, the very first psychiatric emergency department in the state of Virginia.

And you can see it took an Army.

It takes, you know, the Department of Health, public public support patients and families, law enforcement, everybody came together to solve this problem.

So now fast forward to 2023, and the result is a psychiatric ed that's embedded within the community.

It's not a large, shiny, really tall building.

It's something that fits within the urban fabric of that community.

And it's part of the community and it gives people hope.

It gives people confidence that they have a place to go if they're in crisis.

And it gives parents comfort in knowing that they have a place to bring their child, where they where their child will receive the appropriate care.

It's really an obvious solution.

But it takes it takes a lot of community support to do this and the community embraces it.

Another example is focal point in Chicago.

Focal Point is a great example of how we're bringing everything people need to the community in a way that uplifts the community and the people and has both a health and an economic impact.

It's bringing so many things to the community in this development.

Health care is the anchor, but community is at its heart.

It's providing so many other services beyond just health care.

It's breaking barriers.

It's blurring the lines between community health and mental health.

It has education, vacation, retail, has a daycare, has a gym, it has a performance center.

It's really about whole health and whole family care extending out into the community.

So then third, lastly, connecting with purpose.

We know that the Substance Abuse and Mental Health Services Administration includes purpose as one of the four dimensions of mental health recovery.

It's such an important aspect to remember.

The most basic definition of the word purpose is reason for existence.

So instead of or instead of asking what's wrong with you, we should really be asking, What do you want to do?

Because I guarantee you almost every single person receiving health care or mental health care doesn't actually want to be there.

They want to be doing something bigger.

They want to be doing something different.

So we need to help them identify how patients identify what it is they want to do and give them opportunities to do it or to improve so that they can do those things.

Finding purpose improves outcomes.

It helps rise above basic thoughts of survival, and it helps patients move towards recovery and healing.

It establishes goals and gives patients hope.

I think a really great story that that I think really, really resonates with me is during the design process of one of the hospitals we were designing a couple of years ago, we had listening sessions with people with lived experience and one of the patients who had been in and out of care for a number of years came up to the listening session and he sat down with us and he told us a story.

He said, When I first started treatment, there was the groundskeeper, his name was Charlie, and the groundskeeper Charlie would take patients for a walk around the grounds and occasionally they would stop and they would they would participate in activities like woodworking or building a birdhouse or painting a birdhouse.

And then Charlie retired, but the patient had still been coming back occasionally for treatment, and he noticed that he was missing something.

And then at the end of the story, he said, all I wanted to do was paint a birdhouse.

That was his purpose, that gave him purpose and meaning.

And so the result of that was for us to create a hospital that was all about the the the idea of purpose creating purpose and connecting to purpose and moving through space in ways that allows you to experience different, different opportunities and different activities.

A lot of outdoor space, allowing patients to connect with nature and to move around and to participate in those activities, such as painting birdhouses.

Another great example of this is at Healing Spirit House in just outside of Vancouver in Canada.

Healing Spirit House is built on First Nations land and First Nations land in in the region.

And because of that connection to that first nation nation, they have a very, very deep connection with woodworking as part of their culture.

And so providing opportunities, providing that opportunity to connect with purpose through woodworking was very important to them.

Purpose can look different to everybody.

Purpose could mean painting, it could mean drawing, it could mean art.

Purpose could also be physical activity, could be competition.

It could be perfecting that jump shot.

There's a lot of different ways that people experience, purpose and find purpose.

Purpose could mean getting a could mean graduating from high school, could mean getting a college degree.

And we can as as architects and designers, we can create those places to inspire people to find their purpose and inspire them to recovery.

And lastly, for some, connecting with purpose might mean connecting to one's deep inner self through meditation.

It could also be spiritual purpose and developing a meaningful connection with something bigger than oneself.

So in conclusion, we've really spent a majority of the time talking about mental health and but we need to keep in mind that there are other silent killers.

It's more than just mental health care.

The built environment is a catalyst to address these challenges, whether they're physical or mental.

In my work, I strive to build meaningful connections and remove stigma around mental health to improve the quality of life, to improve healthspan and lifespan.

And you all can, too.

And your career is as well.

We need to give mental health the same consideration as these other serious health conditions, because in the end, mental health is the same as any other medical condition.

So thanks for your attention, Annie.

Do you have any questions to students.

Staff and students on.

Okay.

Hey.

Lecturing today?

Yeah.

my question, I guess, is a little bit also regarding the course so much you specifically the spacing issue with an adjacent seat in the community space and we could talk for in the unit and Roxanna mentioned that there's something physical barriers that we could do that are not walls that could allow our patients not feel institutionalized.

And also this statement that you're talking about.

So what are some methods, That you've been exposed to, to integrate those two spaces?

Yeah.

Well, safety is always a top priority.

And mental health care.

We cannot overlook that.

And and we have to remember that as as we're talking about blurring the lines and connecting community, that we still need physical, we still need barriers, we still need a secure perimeter.

But there are ways that you can start to to integrate.

For example, at Hillsboro Hospital, that spiritual space that that it's intended to to flex as both a community space and a patient space.

There's a café that allows patients if if they're as they're starting to recover and demonstrate ability to to function in an in the community, they can actually start to work at that cafe without leaving the the hospital.

Right.

Without leaving the building.

And the community has drawn in to use the café and to participate.

There's also a gym that allows some of those lines to be blurred.

And so it's, you know, I think a lot of it too, you mentioned the café, the idea of third places, places where you can go and connect with others are perfect opportunities for patients to use and the community to start to use.

Those communities are drawn to third places, to those cafes.

Coffee shops could be, could be a gym, different different things where they're able to really, really connect.

And and so I think that that's kind of how we've we've started to address blurring the lines.

So I into your question or do you have some idea maybe you have some idea as to.

Following the environments such as where there are potential hazards, strike patients can be hurt themselves to harm themselves or others.

How do you basically accommodate safety?

How do you make it a safe environment while engaging people, you know?

Yes, a.

Psychiatric unit and.

Yeah, yeah.

So a lot of it a lot of it comes down to how they're going to operationalize the space, how how what patients can use the space, at what times and when can community use it.

Are there opportunities for certain patients to start to interact with with the community?

And it's a challenge that we're still trying to continue to solve because there's such an important there's this need for connection and need for building relationships with the community.

without sacrificing safety.

Right?

So, so there's, it's, it's a challenge we're continuing to work through and a lot of it is it's, it really is operational it's it's are these patients appropriate.

And then there's of course there's the physical equipment and things like that.

And that really comes down to can we move the equipment out of the way?

Can it be put into a storage room, for example, when when certain patients are using it, or are certain patients only allowed to use certain spaces and then eventually hopefully be able to to have more privileges as they progress their healing journey?

Okay.

I have a question in regards to I guess we're on the topic, so I'll just kind of expand on that, having that connection with the community and again mentioned the strategy of having to replace.

But in one of the examples you have provided, you see that now that there is this place of when you're in a crisis or you're getting to that point, you have a place where you know you can go right?

Instead of, you know.

The typical work.

Where it's not really clear.

So my question was what strategies are being done in Texas?

I know you're not you're not based on that.

You're kind of all over the place.

In order to address this need that we have to kind of be more aware as a community of where to go.

Yeah.

Well, I don't know if I can speak specifically to Texas.

I do know that that the state is is putting a lot of funding into improving behavioral and mental health care in the state.

So that's a huge step in the right direction.

It's the funding building new state hospitals and really looking at how to improve access to care and access to care come in a number of different things.

But that would improve those those crisis centers or psychiatric emergency departments throughout the country.

We're seeing I mentioned the one in Virginia was the first of its kind in the state of Virginia, a freestanding psychiatric emergency department.

We're starting to see those more and more, but we're also seeing crisis centers, community centers and other types of spaces that aren't designated as an emergency department, but still available for for people to that are in crisis.

Two to go.

Nine, eight, eight is the new emergency.

It's it's been around for a number of years.

But instead of calling 911, if you're in a mental health crisis, you call nine, eight, eight.

And that should work anywhere in the country.

And you should be connected to somebody who can help you, whether it's you or you're calling for a loved one.

So that's another sort of non architectural solution, but it's a really good one because then that would start to connect people to the right place.

The problem is people oftentimes don't know where to go, so they end up in an emergency department, which is really the worst place for somebody in a mental health crisis to be.

It's chaotic, it's loud, there's often no windows.

You're stuck in a room by yourself.

So that's.

Yeah.

And the second question, yeah, I really think I don't think mental health we think of like the different types of technologies in terms of like the hospitals and what have you.

But I was curious, what have you seen in terms of other areas or sectors such as like education?

Is there any changes that they're trying to do to address mental health?

Because, you know, there's a lot of situations where we see that things are not really being tracked or what have you.

So are there any changes that we've seen?

Just out of curiosity?

Yeah, do you have some examples of different are you thinking like education settings.

Or education in other settings?

Sure, absolutely.

Well, I can speak a little bit to education as a starting point there.

Schools are now often they're really K through 12 schools.

Let's say.

They're are really looking at providing psychiatric professionals on site.

Right.

Social workers and somebody to talk to beyond just your standard school counselor.

And there's a lot of thought that's going into how do we design buildings in schools in a way to destigmatize that?

You don't want to be seen as a kid going down the hallway to the to the social workers office.

Right?

And so there are some design considerations that go along with that.

Higher education is I think every university is trying to address this issue.

It is a big challenge.

It's a big concern.

And a lot of that comes comes to providing providing that support similar to the K-12 spaces.

But it's also about think about wellness centers a little bit differently.

Instead of, you know, traditionally recreation centers, right?

You go you play basketball, you go play ping pong, whatever you're going to do there and lift weights.

But really, it's about wellness.

It's about promoting all this.

It's about having opportunities to connect with others.

It's about having meditation space, yoga spaces, just cafes, places where you can be well and be connecting with others.

And so that's a really, really I think we're seeing that grow tremendously in the education space.

And it's you know, it's in homes as well.

It's in school, it's in, you know, community areas, it's in grocery stores.

We're starting to see Walmart's trying to trying to tackle this and things like that with not just the Minuteclinics.

Right.

I think Target has the minuteclinics, but but, you know, it's mental health care as well.

So it's.

Yeah, great question.

And I sure that.

You can do.

Work on so.

Yeah so I had a question mind specific just to one of the projects that you had your presentation because you said it starts spaces like when you create a stash, basically you crack a barrier or you create like a place for them to mix with the patient.

And I think it was in one of the projects where, like you said, they got rid of like the typical like desk move, like glass on top of it.

They put it behind like it was still there and appeared to still be there just behind like a full glass wall right now.

And so, like, how would you recommend like what kind of strategies would you recommend?

And then creating that space where they get to mix with the patients.

But it's not just the room that's now behind them, right?

Yeah, Patients seeing how they just watch it.

Yeah.

Right.

That's a very, very good question and thanks for noticing that and calling it out maybe to answer your first question first about staff, the staff dedicated staff need their own space to get away.

They need a space to to connect with other staff to decompress.

It's a very being in a mental health environment is very, very demanding on staff.

And so having a dedicated space, that's that's where they would be disconnected from, from patients and from others, but still able to connect with each other.

Regarding the second question about the care team desk and removing the care team desk and putting it behind a glass enclosure, and the idea behind that is that you're encouraging staff to be out with the patients because as soon as you into to mix with the patients, as soon as you put a desk out there, that's where staff are going to sit.

It's almost like they you know, they're and that's just that's just out of both habit and it's just kind of human nature.

You want to you want to be where you're comfortable, Right?

And so by removing that, staff are able to then find comfort in being out in the middle.

You and it doesn't work everywhere.

This isn't I'm not not trying to suggest it is one or the other.

Every we have this conversation almost daily with with our our clients.

There are there are times and opportunities where you want a fully enclosed nurse station with glass barriers and then there are other opportunities where maybe you're comfortable without that barrier.

And it really comes down to understanding the client's needs and how they're planning to operate.

But it's something that we need to be talking more about and not just assuming that there is, okay, this is a mental health space that we're going to put a barrier and we're going to put it right in the center of the unit so that everybody can can watch what's happening there.

Go ahead.

Just following that.

Yeah.

In that particular case, yeah.

We haven't yet, but we will.

Yeah.

Yes it is.

Yeah.

See how the staff actually received it.

Right.

Using the space and.

You're exactly right.

And that's, that's the next step is trying to and we've, we've, we have a lot of anecdotal evidence about how it works but we haven't yet done a true post occupancy on on these spaces and that's that's critical because we we do need to know more about the research that supports it.

What we're finding through the anecdotal evidence is that everybody's doing it differently.

We meet with a number of different organizations and they they all say, well, we're doing it this way and it works and we love it.

But even within the organization, you talk to two different people and one loves it, one hates it, right?

So there's there's a lot of don't say controversy, but there's a lot of ongoing.

And we're still, I think, as an industry trying to find the right balance.

But ultimately, I do think it's it it's different for everybody.

There's probably never going to be a one size fits all solution.

And the main challenge, I guess, exist around the staff.

Perception is actually different from patients perception of care as it relates to the design, then how would you conciliate that?

That's something that's working for the staff.

Not working.

Exactly.

Exactly right.

Right.

I think that the takeaway here at the heart is are we building connections or are we creating barriers?

And in trying to to really, really keep that idea of connection at the forefront, Great value.

So thank you for being here.

Thanks for being here.

I have two questions.

If you have time for the first two, there are some physical characteristics.

Good spaces for measure.

Physical characteristics of good spaces, for connections, for connections to other people.

So I think it's it's about comfort.

It's about creating spaces that are inviting so that that can be I don't know how deep of a rabbit hole you want to go here, but it could be color, it could be lighting.

Can you control the lighting?

And I think it's if we're creating spaces for people to connect, it's opportunities, It's choice.

It's not just here's your table and chairs, Go connect over here.

It's similar to the radius project.

I could probably flip back to where you have one one large space where people are connected, but you have so many different ways to connect, so many different seating opportunities or activities.

Some people might connect better playing a game of foosball while others might connect better.

Sitting on a on a bench style seating, others might connect better in a yoga room.

It really just depends.

But the idea of choice and giving, letting people choose and have control over what's right for them and less people don't do well when they're forced to do something.

Okay, it's your second question.

Yeah.

In the present time where groups users about to move seats around and rearrange seats the way they want it.

Exactly.

They've given that type of flexibility.

Yes, exactly.

So there's there's obviously none of the furniture in this image is bolted down.

You can see it's all it's all designed for for mental health and behavioral health settings, but none of it's bolted down.

They can move furniture, they can move the couch and they can kind of create what they want to create certain obviously, you know, that this is not movable.

Right.

The the bleachers style seating.

But again, there's there's so many ways you can use just the bleacher style seating.

You can lounge on it, sit on it, you can have a couple of people, you can do a presentation.

Right.

So there's all of this flexibility built in to this space that it really helps.

But then I think also drawing, you know, it's a great question, How do you draw people to that space?

I mentioned it being inviting and welcoming.

Daylight is is a great way to do that.

And people are generally pretty attracted to a view or to natural light.

So.

Okay, thank you.

The second question is kind of related to what you were talking about earlier, about these patients might want to be somewhere else, different activities.

So I wanted to ask what are some common activities that these people desire and that are also ones that can be brought in.

Every is different.

So I don't know that I can give you a specific answer, but it's about, again, providing flexibility and control and choice and what activities might bring people purpose.

Of course, there's there's music, you know, some of these are ones music, music therapy, there's art, outdoor spaces to be physically active and physically fit.

But really creating those those opportunities for for staff to understand and support the patient in their, their, their purpose, in their goal rather than just, you're here, okay, we're going to give you a medication.

We're going to we're going to take care of you while you're here.

How can staff actually help them get to where they want to go ultimately?

And then obviously, we're not going to build a mountain and let somebody climb up to the top of a mountain on a in a behavioral health hospital.

But staff can start to do things to support that physical wellness, physical activity and being mentally fit to accomplish that task.

But really understanding what their goals are really motivates the patients to to to want to succeed and be back out in the community.

Great questions and other questions.

Okay, if there are no more questions.

But I love the discussion.

Thank you so much again, Brian, for joining us.

Thank you.

Thank you.

And it would be great if we could get one picture.