Designing for: Crisis Centers with Stephen Parker/Robyn Linstrom (Season 5, Episode 4)

Transcript:

Designing for: Crisis Centers   (Season 5, Episode 4)
Guests: Stephen Parker & Robyn Linstrom of Stantec

(Music / Open)

Janet: In this series we will be discussing specific examples of design techniques that make a positive difference for people living with certain human conditions.

Carolyn: The more a designer understands the client and or the community the more effective and respectful the design will be.

(Music / Intro)

Janet: Welcome to Inclusive Designers Podcast, I am your host, Janet Roche…

Carolyn: and I am your moderator, Carolyn Robbins…

Janet: We have another amazing episode for our listeners today.

Carolyn: And a very timely hot topic which may present challenges for designers.

Janet: Right? There is an enormous increase in the amount of people seeking help for mental healthcare today, and with it, a rise in the need for Crisis Center facilities to take the overwhelming burden off of local Emergency Rooms.

Carolyn: We realized how important this issue really is, and that we had to do an episode on it.

Janet: These centers need to reduce the stigma, and taking evidence-based research into consideration can do just that. It’s those things we tend not to think of when people are in crisis that can make a huge difference.

Carolyn: Luckily, we found two very knowledgeable experts in this field, Stephen Parker & Robyn Linstrom from Stantec. Let me tell you a little more about them…

Stephen Parker- is a Behavioral and Mental Health Planner. His projects range from community-scale recovery centers to expansive mental health campuses— using dignity-driven design research for communities in crisis— with work ranging from China, India, Kenya and across the US & Canada.

Janet: As a mental health design subject matter expert, Stephen believes strongly in advocating by design for humanity at its most vulnerable, elevating communities in crisis and serving those that suffer in silence.

Carolyn: And we are also delighted that Robyn Linstrom is joining us. She is a healthcare architect and senior associate at Stantec, with a passion for behavioral health and designing for healing environments. She believes that the built environment can be a partner in supporting healing. According to her bio, Robyn is focused on changing design from the institutional to a more therapeutic environment. This challenge drives the work she does.

Janet: I love that her goal as a behavioral health specialist is to de-stigmatize facilities— with design that provides an environment of hope, dignity, and support.

Carolyn: And speaking of support, if you or someone you know is having mental health issues and needs help, know that it is available – you can call 1-800-273-8255 or simply dial 988.

Janet: And here’s a little pro tip for you—to help with any anxiety try sitting with your feet on the floor and focus on your breathing. That can help calm you. Or- take a drink of water and just focus on how your body feels. These are grounding techniques that can be used anytime, anywhere.

Carolyn: Sometimes, that may be all that is needed, but if not, it’s so vital for someone in crisis to get more help.

Janet: And ideally, they will be able to get it in a facility that has taken all the right steps in the design phase.

Carolyn: Sounds like it’s time to hear from our guests…

Janet: Yes, and these two truly know what it takes to design a good mental health crisis center.

Carolyn: and with that, here is our interview with Stephen Parker & Robyn Linstrom…

(Music / Interview)

Janet: Welcome to Inclusive Designers. I am your host Janet Roche and today I have Steven Parker, as one of our guests. Hi Steven.

Stephen: Hello Janet. Great to be here.

Janet: Thank you. And we also have Robyn Linstrom. Hi Robyn.

Robyn: Hi Janet. Nice to see you.

Janet: Thank you. Well, listen, I’m quite excited about this episode because it’s such an intricate balance of design and human behavior when we’re talking about crisis centers. Is there a starting point for you guys? Like is there something that right off the bat, you have to know to do designing for some sort of crisis center.

Stephen:  Yeah, I’ll, I’ll start off here. I’m sure Robyn can, uh, embellish…

Robyn: Yeah.

Janet: Everybody just jump right on in. It’s all good.

Stephen: So, uh, crisis centers is an interesting subspecialty in mental behavioral health design. It’s not kind of your run of the mill inpatient psychiatric facilities. It is not outpatient. And it’s intended in terms of helping the continuum of care, as the name suggests, in crisis, individuals that are emerging in crisis.

And so to divert individuals from overburdened emergency departments or worse, law enforcement settings, and diverting them to this kind of third place, is actually the third leg in the stool of the 988 system, if you will. So part of that, just to give you the context of it, is that 988, which was a, kind of like the crisis hotline that subsumed all of the suicide prevention hotlines across the country. Some place to call, someone to come get you, and some place to go. (Janet: right).

So they’re less than a day of stay, so less than 24 hours, much like emergency departments. (Janet: huh). and every community is different. So you’re, when you ask, you know, what makes them different than anything else, is that there’s typically a ‘no wrong door’ policy.

You don’t know who’s going to walk through the door and in what crisis they’re in. (Janet: right). Is it addiction? Is it withdrawal? Is it acute psychosis? Is it a child or adult on the spectrum who is escalating? You really don’t know. (Janet: right). An individual who was formerly unhoused for a long period of time. So I think that’s what kind of makes it fairly different than what you might see in other mental behavioral health settings.

And every community is dealing with that a little bit differently. And I think that’s one thing that trauma informed design principles really has a key factor in informing those very community specific needs to avoid coercion and help individuals in crisis in a humane and safe way.

Janet: Yeah, the community specific is such a big part of all of this, isn’t it. Robyn, I see you, you’re nodding your head. So…

Robyn: Yeah, absolutely. You know, I guess what I’d add to that as well, and Stephen sort of touched on it a little bit was just that, having these crisis centers now is a location and a place for first responders to take people, right? So when you start to see people on the street that are clearly in behavioral health or mental crisis, normally would go to either the E.D. or jail, right? (Janet: right). Which neither of which are appropriate place for them to be.

So the emergence of these crisis centers is really a wonderful place to get the help that they need in that immediate crisis that’s happening. So, you know, when you start to say, ‘what do we look at as designers when we’re looking at these facilities,’ that access is a huge piece of it, right? (Janet: right).

And that understanding of who’s coming to it and how they can get there. Because it can be a first responder. It could be an ambulance. It could be a walk in. And really distinguishing those different pieces and how somebody is going to enter the facility, in terms of their treatment and how they’re going to receive that treatment is key and important to understand as we start to look at these facilities and how we lay them out and design them.

Janet: Okay. So now my head is spinning. (Robyn: chuckle). All right. So I wasn’t expecting those kinds of answers, but they’re great. (Stephen: uh-huh). You know it’s also that attitude of looking at how are they coming to this facility, right? My assumption is that most places have like the walk-in ambulance, police, type of vehicles or ways to get to the facility. Am I understanding that correctly? I would assume most of them, correct?

Stephen: So, um, that’s the interesting thing about it. Different communities have slightly different needs. A standalone crisis center, and they go by crisis receiving center, crisis response center, crisis intervention center. (Robyn: stabilization unit, yup). Find the derivation of the name and acronym that comes with it, because we have a wonderful patchwork of a healthcare system.

And so what’s interesting there is that they can be independently standalone which is really helpful for rural and suburban settings where you don’t have a major medical center with which to attach this facility to or otherwise triage from emergency department from. (Janet: right).

So if it’s, let’s say, again, I’m part of the continuum of care; that law enforcement is aware; that there are crisis mobilization teams; that there are crisis centers that are getting calls and routing those calls for individuals in crisis to these centers; and that, you know, they take walk-ins and referrals. So there’s a multitude of paths. So it’s about that accessibility that Robyn mentioned. And the fact that these are triaged to be medically stable.

So if an EMT or an ambulance picks them up and they’re clear, medically stable; if they find themselves emerging in an emergency department and they’re clear, medically stable, but have this emerging crisis diagnosis or psychiatric need, and they’re diverted from that overburdened E.D. which is, you know, think about last time you went into an E.D. The national average is, what, 8-to-10 hours of wait time? (Janet: yeah). And for psychiatric needs and consults, it’s 3-times that. (Janet: wow).

So, imagine spending a day or longer, or in some cases for pediatric, youth, or ‘Geropsych’ needs, so specific patient populations where you need a consult beyond, like, kind of general adult, you could be there days. Or weeks. Because you’re not just waiting for the consult itself, but the bed to open up. And so a crisis stabilization is kind of very interesting is that you find the opportunity to put these facilities in a much more accessible location in a broad number of community settings outside of those major medical centers, if needed.

You can also attach them to those facilities. um, you see them in psychiatric EVs, there are empath units associated with major medical centers. (Janet: right). But also the fact that since they have a ‘no wrong door’ policy most of the time, that intake, that kind of first handoff between— and a warm handoff, as we like to call it— what is the experience of someone in psychosis being dropped off of this facility?

Is it because the EMT and the law enforcement officer have been trained and kind of integrate well with the facility staff to have that warm handoff? And that the first sign is not law enforcement entrance, but first responder entrance. (Janet: right, right). Because you can imagine the community connotation of an individual taken to a facility that has that sign on it, and what they’re expecting next. And I think that’s a trauma-informed principle is ‘nothing about me without me’. And so letting them know what’s happening to them next is very, very important. (Janet: agreed). (Robyn: yup).

Janet: You know, it’s also the Trauma-informed Design lens involved. I mean, and it’s also goes into everything from dignity to self-empowerment. It gets rid of the stigma, you know, to a large degree. (Stephen: uh-huh). So Robyn, did you want to join in? It looks like you were getting ready to say something and then I popped in. (Stephen: chuckles).

Robyn: No, absolutely. I, you know, I get excited about these conversations for sure. And I mean…

Janet: … who doesn’t Robyn, who does not get excited about these conversations (both laugh).

Robyn: …but you know what Steven is saying too, it’s also about acceptance of the individual coming in, right? It’s about creating this environment that allows them to come in and accept that treatment to get out of that crisis that they’re in.

You know, I have done a crisis facility and we went back and did kind of a one year, you know, retrospective, if you will, of how is the building working and how is it functioning? And one of the key takeaways I took from it was, in this kind of crisis piece, this particular facility served a lot of those experiencing homelessness, right? And that trust is not there. And that feeling of coercion of having to do things is huge, right?

And so they talked about how there are people that come and maybe they’re there for an hour. And they don’t know, they don’t trust you. They don’t know, you know what I mean? And they leave.  (Janet: hmm). But then come back and next time they’re there for maybe 2- or 3-hours, right? And so it’s really about creating these environments that allow people to build up that trust in order to receive the treatment that they need.

Janet: Right. So what would you do for something like that? How do you create that through design? I mean, I think it’s also seeing the same people and knowing that ‘we’re here for you, come back when you’re ready’ type of deal. (Robyn: um-hmm). But also how do you as designers design for that type of, you’re trying to gain their trust, right? (Robyn: right). Because that’s another Trauma-informed Design principle, trustworthiness. (Robyn: yup, and transparency, right). and transparency. (Stephen: uh-huh).

Robyn: I think that’s a lot of it in the built environment, right, as being able to see where are you going? What’s happening to me next?  Just having that environment that really meets people wherever they are, right? So somebody might feel the need for feeling safer in a smaller space. Someone else might want to see it kind of more transparent and open and be able to see everything that’s happening around them.

So it’s understanding the clients that might be using this facility and trying to kind of react to those environments, and providing those different types of spaces so that each individual can find what is comfortable for them.  (Janet: right), (Stephen: yeah).

Janet: Go ahead. Go ahead, Steven.

Stephen: Yeah, I mean, so we’re always trying to harmonize risk and recovery, or safety and serenity, if you will, in those spaces. (Janet: right). So they give the individual choice in the organization trust. Because, you know, you need good lines of sight for staff, but that’s good lines of sight also for those individuals in crisis so they understand where they are and kind of fit in the context. And they don’t, you know, have a feeling of entrapment and coercion and confinement. And avoid re-traumatization through the spaces that you may be forcing them to choose from if they’re given a choice.

And so I think voice and choice is really important to Robyn’s point is that the seating arrangement, so they can self-reflect safely, that they can choose to engage one-on-one, or they can socialize in larger gatherings, and every variety and spectrum in between, right?

So I think that’s a key part of it in terms of laying out the space. Because it’s, it’s a lot of nuances that are also very culturally specific. As Murat mentioned, an unhoused community, or those experiencing specific addiction types, whether it be an opioid, specifically fentanyl, alcoholism, so forth and so on. And so there’s, you know, different acuities and different needs that you really need to listen to the community and kind of hone in on.

Janet: Right. You know, it was interesting. I’ve been very excited to interview the two of you. And I think that designing for crisis centers and mental health and all of that through design, like it’s such an important part. And I was doing a lot of thinking about how I usually just do kind of riff, but I really want it to make sure I hit all the notes.

So I was thinking that we kind of walk through the, the front door, so to speak, (Stephen: sure). We go and we think about what that space might look like, you know. and I know we’re looking at it in terms of depends, right? It depends on the community, depends on what kind of crisis center it is, that type of deal. But maybe we can blend all those. I wonder if walking through the front door isn’t a bad place to start.

Stephen: I’ll let Robyn, unless she wants me to do it. I’m happy to walk, do a day in the life of and kind of walk through the flow.

Robyn: Yeah, we can, and we could even tag team Steven if you want, (Steven: sure, yeah). You know, I mean, I think it’s kind of coming into that space that maybe not the first thing you hit is a security or safety, or you know, it’s coming into much more of a welcoming space. (Janet: yeah). I think it’s about creating different types of environments, right? Maybe there’s an area that’s kind of a seating waiting area that’s more open.

You’re going to have smaller rooms, consult type of rooms (Janet: right), where you can have those kinds of one-on-one conversations, and where a clinician can really start to understand ‘what is this individual dealing with?’ and, kind of, ‘where are the traumas and the crisis coming from?’ to have that space. We often have spaces where we can bring in family members (Janet: yeah), (Stephen: uh-huh), because sometimes the family is part of that trauma or trying to kind of understand how that all plays into it. (Janet: right).

So it’s really to me about designing these different types of spaces. We often have what we call quiet rooms or calming rooms. (Janet: right). Sometimes they’re sensory type of rooms, right? So we can start to look at different, depending on, again, what the clients that are being served there.

You know, I had a facility where it was children, and they had these calming rooms that had different themes, right? (Stephen: uh-huh). One was just a room of ‘stuffies’ (Janet: chuckles). And that’s helped comfort children. That they could just go into this room. They could self-regulate. (Janet: right). A space that they can feel comfortable in, right?

I’ve done in adult facilities, color light therapy is a huge piece of it. Being able to go into a space and change that color of the room to what feels right for you at that moment. (Janet: right). Again, to kind of help self-regulate.

So it’s about creating all of these kinds of spaces that people are allowed to choose. And I think when you first walk in the door, there’s going to be sort of that assessment piece, right. That’s going to have to happen. (Stephen: uh-huh). But once you get through that piece, it’s really about creating this environment that allows people to find where they feel the best and able to have the conversations to kind of get themselves through that crisis with the, you know, trained folks that can help them. (Janet: right).

Stephen: And I think that gets to Robyn’s point of, if that is the initial intake assessment and evaluation that’s a key part of the crisis care model is that you’re not waiting for that immediate assessment to understand what is the best path for you moving forward. (Janet: yup).

So whether it’s that first responder entrance where they kind of take you through that intake and assessment space, they’ve kind of figured out, you know, ‘Hey, do you have anything on you that can hurt yourself or others?’ You know, ‘What was the circumstances of which you were found?’ and ‘Who brought you in?’ ‘Who called?’ ‘Did you call yourself?’ (Janet: right).

And getting all of that kind of download between staff. Oftentimes, you know, if it’s an individual that’s unhoused, ‘Where did all their personal belongings go?’ right? (Janet: yeah). And so there’s some kinds of security around literally all of their earthly possessions. (Robyn: um-hmm). You know, ‘Who’s taking care of that?’ ‘Where’s it going?’ (Janet: yeah). Not just chain of custody, but just the sense of security around my sense of belonging and the belongings I have, right?

Robyn: Do I have access to it, right? (Stephen: yup).

Janet: Well, that’s huge, right? (Robyn: uh-huh). (Stephen: um-hmm). To your point, it could just like be the clothes on their back and whatever they have in their bag, right? (Robyn: yup). They want to be able to keep their eyeballs on it all the time, right? (Robyn: yup).

Stephen: If they have a service animal, ‘Where is that pet going to be taken?’ You know, so accommodating even kennels in some cases. Or if they’re on the other end of the spectrum, oftentimes we kind of see facilities set up with four department types.

So you might see mental health urgent care, where you can do walk ins and referrals, where you have that kind of counseling and consult either individual or family. The crisis stabilization unit itself. So typically it’s a big living room style with a staff station and a variety of those other spaces Robyn mentioned that allow people to do one on one consult group therapy. (Janet: right).

Family counseling, sensory spaces, nourishment, as well as like hygiene and other things, but a variety of spaces within the living room environment. So that way when it’s typically recliners, so that boy, if they’re there for 23-and-a-half hours or so, you know, they can fully recline, get some rest. They may come in in the middle of the night.

But they also might have a more social space where, you know, we’re doing a youth crisis unit where, hey, the big topic is the video games, you know, (Janet: yeah). ‘Who’s playing what and where?’ because that’s how they relax for example. (Janet: right).

And then other components of the program could be a transitional outpatient program. So they’ve gone on their observation for that amount of time, and it’s realized that their medication is stabilized or otherwise their treatment plan, which, they’ve engaged with, and with providers, have established some sort of therapeutic alliance about what their next steps are happening to them.

Okay, we can discharge them into an outpatient or transitional program. (Janet: yeah). And that can be a day hospital, you know, sort of like a very half to full day group therapy sessions and other therapy modalities that can be accommodated in the facility. And then if it’s deemed during that observation period in the crisis unit, they need to be admitted to a longer length of stay, 3-to-5 days, 7 days longer, depending on what the facility needs.

So sub-acute units, so inpatient beds, being accommodated and therefore having kind of an inpatient setting. But you can see there that you have something of the spectrum of continuum of care within one facility, possibly, urgent care walk in; the crisis stabilization unit that has its own intake for those folks that come in hot in crisis; the transitions program for outpatient care; and then if they need to be elevated to a higher level of care, sub-acute, inpatient. That’s a lot.

Janet: Yeah, there’s a lot to digest there, but I’m wondering though, in your opinion, and maybe this is stuff that you’ve also done in post occupancy reviews or what have you, you know, is there like a sweet spot for the amount of beds? And for different types of timing that, you know, a couple of days versus like a week or so? Should designers be looking to try to fit in, say like 6 beds or say 12 beds, if it’s 7, you know what I mean, is there something along those lines?

Stephen: You want to talk about a sweet spot, Robyn? (all laugh).

Janet: Yeah, sweet spot. Is it true? I, I got to think it might be, right?

Robyn: Yeah, I think there is. I think some of that sweet spot really relies to on the staffing (Stephen: uh-huh), and sort of that staffing model. (Janet: right). Some of it is tied to licensure components, right? (Janet: sure). I often see— and Steven, you can see if you agree— but you know, that 12-to-16 beds is usually kind of that sweet spot. (Stephen: yeah). In terms of the staffing, it’s usually 8-to-1. So kind of that 16 gives you kind of 2 within there. But that seems to be manageable from the clients as well as, as the staff and the people coming in.

I think you see the kind of crisis assessment piece. As Stephen said, there’s different ways you kind of come into that initial intake assessment area, right? (Janet: correct). And then oftentimes you might have an observation area that’s sort of that less than 24-hour kind of piece. And then sometimes you move into a longer-term crisis, right? Sort of that 2-to-5 day stay until you can really understand where someone might need to be, whether it’s an outpatient, whether it’s inpatient, whether it’s additional kind of services. (Janet: hmm).

Stephen: And I think, even with 16 beds for just kind of making staffing work is that you try to lower the social density in those settings as much as possible, right? So the variety of spaces in the therapy and kind of programming and functionality you can imbue into it. So that way you’re not sort of confining a mass of people, if you will. Yeah. If you’re in a living room style crisis unit or in the subacute unit with 16 beds.

If you’ve ever had a roommate, or a sibling in my case, (Janet: chuckles), you kind of know that usually your pain points around bathrooms (Janet: yes!), and personal belongings and food. (Janet: preach). (Robyn: chuckles). So, what is your sense of personal space and belonging? Like how do you feel like you own a sense of space and some personalization if that’s the case in the subacute unit?

So how do we break that up so you’re not dealing with 16 personalities, but you’re dealing with 3, or 4, or 5, so that we can kind of lower that social density. You know, from evidence-based design research that you lower the number of incidents that lower that social density is less friction with individuals that gets back to widening corridors and creating more buffer space. Because also a lot of these spacers intended to lower the barriers between patient and provider as well. (Janet: yeah).

So the idea that you’re not creating authority dynamics of ‘us versus them’ as much. (Janet: yeah). So a ‘being out in the milieu’ as we call it. So I think particularly for crisis, a lot of providers push a peer model. So peer specialists are individuals that have gone through crisis, gone through recovery, and then have clinical training to help other individuals in crisis.

So you have someone or multiple someone’s on staff (Janet: right), that have gone through what you’ve gone through, similar age and so forth and so on. So that you can start building that trust, which is a two-way street between the organization and the individual. And it really comes down to a staff member having positive engagement and rapport.

Is that coming down to, they have a nutrition station outside in the milieu area, and they have access to it, and they don’t have to tap on the glass every time they want a drink of water, right? (Janet: right). So what are the things that help the providers not create friction points with patients because they can see a patient as a human being. And provider can be seen as a human being in the same way.

Janet: As opposed to like, maybe behind the glass, you know, the pulling back of the glass, ‘what do you want?’ You know, like, ‘I just want some more water, please.’ Right? (Robyn: uh-huh). Something along those lines. Well, you gave me a lot to unpack there as well.

You guys keep throwing out all these nuggets, which is just fantastic for designers, like, things to think about when designing crisis centers. And it’s interesting to me, the first grant we got in Trauma-informed Design was to do it for schools and we found that kids were most dysregulated in the hallways.

I mean, we knew like gyms, cafeterias, right, but it’s really the hallways, and then you only have to do is think about your own experience in school and be like, ‘Oh, right. They were.’ you know what I mean, they terribly were. (Stephen:  um-hmm). So it’s giving people their space in the hallway. So I appreciate both of those nuggets of information there.

Were there any kind of like big takeaways when you first started to do all these behavioral health centers? You know, I know that this is your job, you came into it, but was there any time that you thought to yourself, like, ‘Holy moly, why didn’t I know that, why didn’t I think of that, like, why haven’t we been doing this all along’ or along those lines?

Stephen: Yeah, I’ll let Robyn take that first one away.

Robyn: Sure. It sounds odd, but my biggest nugget when I first started doing these types of facilities was really how simple, (chuckles), the solutions can be. I think as designers, we want to be innovative. So I guess I would say, you know, I’ve started my career, I’ve always focused it in healthcare design but started kind of more in the physical health world.

And one of the things that we do is we always meet with the users of the space, right? Which is typically our nurses, our doctors, the facilities people, to really understand how they’re using the space. And when I started doing behavioral and mental health facilities that peer support that Stephen talked about is such a key piece of it and that lived experience.

And so that voice started coming into those user group meetings, right? And as designers, we’re always trying to be innovative. We’re trying to really look at how can we do something different. And I learned in talking with the peer group, how simple the solution can really be. (Janet: right). And that it’s really just about exactly what Stephen said of, ‘How do we widen the corridors so that we’re not brushing against each other as kids and poking each other and causing those friction points’ right? (Janet: friction points, right).

I mean, we had a peer group that, you know, they come in with some lofty goals. ‘We want a swimming pool’ right? Some of the things that are probably not going to happen in the facility. (Stephen: chuckles). But the simple things like, ‘I just want to get a drink of water without having to ask somebody for it.’ And as designers, well, how can we do that?

You know, from a safety perspective, drinking fountains can cause safety issues, right? (Janet: sure). There’s ligature risks and concerns. (Janet: right). But as a team, we came together and said, ‘this is something so simple that we can do. How do we do it safely?’ Right? (Janet: right). And so you have those conversations.

So I guess for me, those kinds of little nuggets are those little, smaller things is what I’ve really learned as a designer, to hear the voices and what’s really important to them oftentimes is something very simple that we can do.

Janet: Isn’t that true though? I’m so happy you said that too, because sometimes it seems like a pretty simple solution right there in front of you.

Robyn: And sometimes we make it complicated, right? (laughs). (Steven: yeah). (Janet: exactly). Yeah.

Janet: Funny. Steven what, like what’s been some of your takeaways?

Stephen: (laughs). Yeah, I would echo Robyn’s points, that’s for sure. Lived experience, I think, is very important. I serve as a board member for the Design and Mental Health Network in the United Kingdom. And they’re expanding to North America, and a big proponent of their platform is this lived experience. But that’s not just stakeholder groups kind of in that design process, it’s more holistic.

And so we see this in other parts of the world where they inform the model of care, (Janet: right). Like before the building is ever programmed. They inform the design process for how the building takes form and kind of manifest organizational goals. (Janet: right). But also, in their operations.

And so I, that’s what I like about crisis centers in particular is that as a subspecialty within mental behavioral health, it’s kind of this unique manifestation of where lived experience is becoming much more manifest. I find that engaging and worthwhile. (Janet: yeah).

I will say having a parent who’s a psychiatric patient, the kind of role of family and visitation and maintaining or forging social connections is so critical for some people’s recovery (Janet: right). And the traumatization of the individual going through crisis just ripples through families and their support networks.

So you have secondhand trauma that really needs to also account for that visitor comfort and ability to see someone in crisis and make it through crisis. So you’re also not thinking about just the individual who may be exhibiting self-harm or addiction or harm to others, but you know, how are you healing this greater community and this greater family, this greater context, by treating the individual in a much more holistic and humane facility that we’re designing.

Janet: It’s such an important part, isn’t that? I mean, to piggyback on what you said, you know, I too have had a family member that ended up in some sort of psychiatric facility. It was older, so it was bad, like really bad.

You know, like the windows with like the wires in them and stuff like that, you know what I’m talking about, right? (Robyn: uh-huh). You know, it has like the chicken coop kind of wiring. (Robyn: yup, yup). (Stephen: absolutely). Yeah, it was, I think it was early ways so that it wasn’t able to like, be broken, and then, right? (Robyn: Yeah, yup. Fire ratings, and…), Right? (Robyn: yeah). Fire, all that other stuff.

Robyn: Newer technology has improved that for sure.

Janet:  … has improved that tremendously, thank God. (Stephen: yeah). you know, but as the family member coming through, that was, I mean, I’m not allowed to say exactly because we don’t swear on this show, but it was a holy ‘beep’ kind of moment for me. (Robyn: laughs). And I just remember feeling uncomfortable.

You know, at the end of the day, I mean, it was an addiction problem, not a psychiatric problem, but they needed to put him somewhere. So that was sort of what was going on. And I just remember, besides saying, ‘holy boop,’ that it was very, it was just, it was horrifying.

And, you know, and if you’re going through that type of crisis and to be in those types of spaces, again, I know we’ve changed quite a bit since these days, but there’s still a lot of them out there that seem to be a-okay with the built environment that is not conducive to healing whatsoever.

Robyn: The built environment should support that healing, right? And it traditionally has not. (Janet: That’s our plan, right?) Yeah, hopefully we’re changing that, right? (Janet: yeah). And it’s, you can see where it came from because there’s this level of safety that we’re trying to be conscious of, of people in this facility is that may want to self-harm or, you know, harm others. (Janet: right).

And so there’s that safety level that has to be there, but how do we do it better, right? (Janet: exactly). How do we infuse it with an environment that is supportive, that allows people to receive that healing and treatment that they need. (Janet: right). Because the environments we had previously just didn’t, unfortunately. (Janet: yeah).

Stephen: And they can help or hinder, right? (Robyn: absolutely). So, I mean, it’s not neutral. And I think that the growing societal awareness around mental health has really kind of catalyzed this conversation in the last few years. (Janet: yeah).

But there’s still a lot of stigma because of ignorance, even just people using the products and just as an applique, not really understanding they can really either enhance or hinder the care that’s there. (Janet: right), and the feeling of humanity and dignity and empowerment and agency. (Janet: yeah), for patients and the safety of staff.

I’ll give a shout out to the manufacturers for providing a lot better options in recent years, (Janet: yeah), but Robyn and I especially do a lot of risk assessments of existing facilities where it was just, ‘Oh, we knew it was tested and we just used it,’ but not how it was used or how it was supposed to be installed or, you know, the feeling when someone is locked in a room, and they count every bolt and nut and screw and fastener, (Janet: right).

Janet: Yeah, it reminds me of being in church, but that’s another story. I always try to count how many crosses, (Robyn: laughs, I do the same thing, count the ceiling tiles, yes). So I’m not equating the 2, I’m just saying like, that’s how I get through church. So… (Robyn: yeah), but yeah, I mean, it, it’s changed quite a bit, and I’m glad we’re looking at that. (Robyn: yeah).

I had so many questions and then I had to do the church joke. (Robyn: laughs). So my apologies. We talked about so much and this has been just terrific. So I want to know, when you’re designing, are there things that designers kind of need to think about?

Is there something that is a crossbreed between walk-in services and has like a bit of a residential program, right, it’s sort of a mixed program, I guess, some sort of hybrid? Is there a way that you look at that differently than maybe just like a walk-in?

Stephen: Every community is a little different, I will say. We’re seeing a lot more blending and fusing of programs. (Janet: yup). And, uh, I know Robyn’s worked on some projects out her way in the west that can speak to those.

One that comes to mind, up in the far north of Canada is a recovery center that’s for a very specific indigenous community. (Janet: yeah). And so their approach to care for flow acuity is to address generational trauma and fetal alcohol syndrome. So a very specific community needs, and they do that in an inpatient setting.

So they’ll take entire family units, and kinship cohorts in for inpatient care for generational trauma and treatment. (Janet: right). So that’s very unique. And, very specific to the cultural context (Janet: yeah), dealing with addiction for that specific cohort of mother, baby. Or in the case of mother dealing with addiction of alcoholism and a much older child dealing with the developmental disorders from having fetal alcohol syndrome is a very interesting family comorbidity in a way. (Janet: right). And how they deal with that within a very specific cultural context that has a spiritual lens to it.

A very unique rural and isolated part of the world, that, you know, is very humbling to us that get to work on those projects. But they blend housing; they blend childcare; they blend counseling, both for family and individuals; they blend ceremonial and spiritual spaces, and a variety of therapies that are very unique to that context that you don’t see anywhere else. (Janet: yeah).

And so that’s one community’s response of like blending these things together instead of having disparate programs and facilities that don’t really treat the individual, much less the family or the community holistically. So those are some things that we’ve come across. We’ve had the opportunity to work on across Stantec that we’ve really enjoyed. And then Robyn’s had some similar experiences out west.

Janet: Right. I just want to remind our listeners that you can go to InclusiveDesigners.com, because I want to promote that facility that you’re talking about in Alaska, because it’s so unique and I think the pictures are pretty wild. And we will have all of that, plus other references on our reference page.

But so I didn’t mean to interrupt you, Robyn. So I seem to be doing that a lot today. So my apologies.

Robyn: (laughs). No, all good, no. You know, I would say in terms of kind of the hybrid, I feel like these facilities in general are kind of all hybrids. And I think the biggest piece to me is about flexibility, right? (Janet: yeah). And how we design the spaces.

You know, when we’re talking, someone’s coming in in crisis, if it’s substance use, they say substance use is a disease of isolation, right? It’s people that have isolated themselves. And being in a facility with potentially a roommate may be what they need as part of their treatment and their healing process, right? (Janet: hmm) versus oftentimes we’ve heard that those experiencing homelessness will choose to be on the street, (Janet: yeah), because a shelter has been a traumatizing environment for them, right? (Stephen: hmm). (Janet: right, wow).

And so that more wanting the sense of isolation and that security and safety for themselves, they might want a room that’s just an individual room, right? So when we’re looking at these types of facilities, it’s really about how do we design in that flexibility (Janet: right), to really be able to meet whoever comes into the facility where they’re at, (Janet: right), if that makes sense.

Janet: Oh, I was just going to say so well said Robyn. So yeah, you’re, you’re, you hit it right on the head. And so thank you for answering that question. And I still can’t remember what the other question was before I did the church joke, (Robyn: chuckles), but so I can jump into my next question, which is about staffing. Like I know for myself as a designer, if you’re not paying attention to the staff, if you’re not taking care of the staff, I’m not taking the job.

Because our mentality is if the staff isn’t able to find a place to be regulated and be able to bring down their own stress levels, then you can put it in a beautiful place, and have all the bells and whistles and all the finest of the finest. But if that staff is just like going off the charts, it doesn’t matter, right?

Stephen: Oh, absolutely. It’s huge. (Janet: yeah). (Robyn: huge). We’ve had the opportunity to help master plan for entire health systems, provinces and states, their mental behavioral health facilities. And so what we have come across that almost every state is deficient in thousands of beds in some cases. But even the beds they have, they don’t have the staff to staff them. (Janet: yeah).

So thinking about recruitment, retention, how to mitigate burnout. (Janet: yes), And so a lot of, you know, thinking about the mental wellbeing as well as the mental health of staff and patients, how do you give them some level of parity of patient spaces to staff space. You know, is the break room embedded into the facility with no light, or have you given them some glazing in the perimeter? Have you given them an outdoor space to kind of decompress, (Janet: right),

Even just looking at wellness rooms with the same sort of sensory lens that we take for the calming areas or other neurodiverse considerations that we have for these unique patient populations are just as beneficial to individuals on 12-hour shifts in very emotionally charged behavioral health units, right? (Janet: yeah). That they need to decompress from.

So it’s when we do observation, it’s not just the step study of between the meds room and the care desk. It is, you know, how far off to the break room does it take to kind of feel like you’ve gone away from quote unquote, the space that is causing your stress and your spike in cortisol level, right? (Janet: yeah).

So, I think that’s a big part of why we are looking at, you know, how to use these facilities as not just to create great deference. I think that goes to pay for staff, the recruitment of staff.

Janet: You’re so right. I have another story for you. So, I went to boarding school and we had a dining hall, and the dining hall was just awful. You couldn’t get a good chef in there to go work the facility because they’re like, I can’t work with this. So they would get like these terrible chefs. So they had a terrible kitchen with a terrible chef. And then somebody gave some money and then all of a sudden, they had a brand-new building and then all the chefs came running. So it’s along those lines, right?

Stephen: Absolutely. Yeah. And I like to think that, you know, we can do a lot with very little. We find that the reimbursements for mental health facilities are typically less. So there is still a lack of parity in the health system and that mental health is health and they should treat it with the same deference. (Janet: right). I think that goes to pay for staff, the recruitment of staff, and the investment in these facilities. But if you look at the capital costs versus one year of operational costs, yeah, you’ve saved a little bit up front, by picking a little bit lower finish or fixture or things of that nature when long term you’re increasing your staff retention because you’ve invested in the spaces that reflect the value you have in your staff, right? (Janet: yeah, right).

Robyn: Yeah. I mean, I think that staff retention is so important and so key in these facilities that can be very, as Stephen said, emotionally charged. Right? And I think one of the key things that we need to focus on is making sure we have dedicated space for staff. (Janet: correct). We’re always pushed and crunched on square footages and costs.

And the first thing to go is always the staff support, right? And we have to really fight for that. (Janet: don’t worry about it, they’ll be fine, right?). Yup, yup. And it can be, again, it goes back to that simple solution thing, right? I mean, it doesn’t have to be the Taj Mahal of spaces, right? But it has to be spaces that are purposeful for staff, (Janet: right).

We had a facility that I worked on where we had these sort of ‘quiet rooms’ on each of the units for the patients that had this kind of color light therapy. And we ended up doing the same thing for the staff.

It was a small room with just a chair, but it had this color light therapy in it. And we did kind of post occupancy surveys with the staff, 100-percent of the staff said that it was incredibly helpful for them. Both from an emotional standpoint of having a place to go to just decompress, but also, you know, we have to remember that these staff often in these inpatient facilities are on 24-7 in these crisis facilities. They’re on 24-7. They’re overnight, right? (Janet: yeah).

And so having a space where there’s kind of that circadian lighting, the color therapy that, you know, say they’ve worked a night shift and they’ve got to go home and go to sleep. (Janet: yeah). Can they go into a space, turn on that amber light, start to bring their levels down and then get prepared to be able to go home and go to sleep, right?

And vice versa, (Janet: right). If they’re starting a night shift and they’re getting tired, can they go in there, you know, get that dose of the blue light (Janet: right), to kind of, you know, increase that cortisol. So it’s small spaces, but they’re so important and so key and something that we really need to be considering and part of the projects.

Janet: Yeah, absolutely. I’m such a believer of that. And we did an episode of Inclusive Designers with Alex Tan from Philips. And Philips had created these— I think it was for a pilot, but it was for adolescents in crisis. And what they had done was, is that they were really giving the autonomy back to the patient, resident, what have you.

And they were able to pick like the noise level, what their images were supposed to be. And all this, I mean, again, it goes back to the trauma-informed design principles where it was about choice and agency, you know, and giving them that option, but it really helped to bring down, I mean, sure there was loud music probably at points, but it helps to bring down your levels.

Stephen: Absolutely. We find that integrating these sensory enabled architectural elements, so they’re not just isolated to one sensory room. For some sensory enabled spaces we did for Cooper Health, is it in the pre-op area. Is it in the post-op areas, the subway. Is it where the siblings are waiting, who might be having anxiety of waiting for a loved one coming out of the crisis unit?

As well as the staff to Robin’s point of, it can be anything from, you know, in the mother room. (laughs), you have a bottle washing feature, because it’s not just simply the time it takes staff to do something if you’re a nursing mother, but also like, you can kind of give them a little bit extra functionality and flexibility in a space’ and then that pain point is kind of taken care of if you just think a little bit more thoughtfully, a little more deeply, and ask a few more questions.

So whether that’s a piece of functionality, if that’s kind of a sensory element, that’s great. It can be very, very, very simple tactile strips to, I can create a wind generator and a setting in the room to make it feel like an autumn breeze and everything in the room to transform through a haptic projector.

And it makes me feel as if you are in kind of New England right there in fall, or you’re on the spring and the coast. So you can really transport somebody and aid in their self-regulation through the built environment, which is one of those key coping skills they kind of teach you in these environments.

Janet: Yeah, I, you know, we could all use that in our homes. But I love the fact that, you know, things are changing so much and we’re also recognizing the built environment is such an important piece of this.

And I want to tell you another little story. So we just finished up our trauma-informed design class that was at the Boston Architectural College. And one of the students was redoing and rethinking ER and the ER process. And her first instinct is, as all of ours would be, was that, you know, you’re just trying to lower people’s stress level. So like yoga, Zen type of, it’s just everything that you would kind of think about. Like I see a lot of bamboo and I see a lot of waterfalls, that type of deal.

And she said, ‘you know, you’re in such a state of stress, it felt incongruent to have that type of like complete utter change, right? You’re coming from this heightened state and then you’ve got all the, like again, the bamboo and the wind chimes and all that stuff. And I would think to myself, if I’m in that heightened state, I might want to take the wind chimes and knock them off there, you know what I mean?

Is there like a reality to like trying to bring that stress level down within the built environment, but that it’s in stages. Because that question kind of came up and I thought it was interesting to have that gradient as opposed to going from 100 to down to 0 Zen and have a Kumbaya moment. I don’t think it’s really realistic, right? Am I missing something here?

Robyn: No, I 100-percent agree with you. And I’ll give you an example of this was actually in an inpatient facility, but you know, it’s about, again, I think it’s that flexibility, right? (Janet: right). So if you’ve got someone in an inpatient unit, they’ve got a room. They’re kind of isolated in that room. Often therapy wants to bring them out, wants to bring them into group settings. Well, somebody might not really be at that place in their journey to be able to be in a room with a whole bunch of people interacting, you know what I mean?

So it’s about creating spaces. It’s that sort of step down, as you said, right? (Janet: yeah). So we started to create little niches in the corridors that people could go and still be individual, but outside of their rooms. So starting to interact more with people, but not yet quite ready to be in that group setting. (Janet: yeah). So it’s about, it’s exactly what you said. How do we, as that built environment, support all those different levels to meet people where they’re at? (Janet: yeah).

Stephen: Yeah, absolutely. They talk about it fairly often with autism because the transition between spaces and activities, and a lot of, you know, if you look at evidence-based design studies, usually they go back to attention restoration theory. (Janet: um- hmm). And so how do you get that time to kind of refocus from one element, or focus, or space, or task, to the next? And how do you recharge from it?

So you obviously see that in autism where, ‘what is the transition from one activity or one space to the next?’ So that way you’re transiting an individual, they aren’t sort of drawing them through, but you’re decanting them and their stress levels to have them acclimate and give them a greater choice and empowerment as they choose to go through a space.

So a sense of procession, I think is really important. (Janet: yeah). I would orient your focus around a couple of interesting in developments. The state of South Carolina is currently funding a 3-year grant through Clemson University for pediatric behavioral health needs in the emergency department. (Janet: hmm).

And we’re, you know, supporting that research through our professional practice use of our case studies and things of that nature. They’re going to have some really interesting findings to address those specific needs that you just mentioned that your student was going through. (Janet: yeah).

We recently funded a small grant through the UNC Greensboro for a sensory room for college students. And so we’ll be publishing the findings from a sensory room or a built environment intervention for, you know, stressed out college students and sort of what they gravitated towards in the built environment to help them through those critical times which is really exciting to see the investment in practices like ours, but across the industry at states, you know, organizations that are coming together, like the intentional spaces summit that was hosted by John Hopkins this past year. (Janet: right).

They’re coming out with an intentional network, and great findings that are bridging, you know, neuro architecture for the greater understanding and knowledge of all practitioners to view in their projects.

Janet: That’s amazing. I appreciate all that. And again, for the listeners, we’ll have all of that on our website on InclusiveDesigners.com. I’m getting a little bit aware of the time, and so, this has just been fascinating to me. I feel like this was a master class, quite frankly, in this particular world of design for crisis. and I can’t thank the two of you enough for coming on this journey today.

Is there anything that I’m missing? Anything that designers want to know? Was there something when you walked into this conversation, you thought to yourself, I hope Janet really asked me this. I want to make sure that I’m hitting on the notes because you guys have so much knowledge in this area. I want to make sure that, you know, we help to send that out to other designers.

Robyn: Sure. You want me to go first, Steven? (chuckles)

Stephen: Yeah, yeah.

Robyn: Yeah, I mean, I think we’ve touched on a whole lot of stuff today. Kind of a lot of the key design pieces of these types of facilities. I mean, I think for me, the biggest thing is just, I want to help kind of reduce that stigma. (Janet: yeah). Right?  I want to be part of that solution that we could all find ourselves in a situation of needing help at any time, right? (Janet: right).

And my biggest hope working on these types of facilities is to make this a conversation, you know, that it’s not something to be scared of talking about. And that it’s okay. We could all need a place like this, and let’s design places and have places that are healing and kind of support people.

Janet: And support people. How great is that, right? And Stephen, what about you? (Stephen: hmmmm). You can totally say no. And I am A-okay with that. (laughs).

Stephen: No, no. I would say that we strive really hard to design for dignity. And, you know, we balance and harmonize the evidentiary with the empathetic. (Janet: yeah). Right? So, I think we often rely on as designers, this kind of experience we have in the past. But, you know, really championing that lived experience, talking to those individuals in crisis, the family members that have endured it with them, and not make assumptions. And not, to Robyn’s point, let stigma really drive your design decisions. Because every design decision will help or hinder an individual in crisis. And we have a responsibility as designers to do better.

Janet: Yeah. I completely agree with you.

Robyn: This was really nice to be able to hear all of the things that you’re doing that I don’t understand as a person who’s not a design person, and how you’re bridging those gaps in peer support and all of the different things that we’ve been working on as advocacy on this end is making it into the design world. And it has been, but we weren’t aware of it.

So it’s really cool to be able to hear it from the other side, and being able to sort of, see the gaps being bridged. Like that’s exactly what we’ve been trying to do for a long, long time. So it’s really cool to be able to hear it. And there’s a lot of stuff I have to learn yet as well. I was thinking about the blue light thing, because we have in our bedroom, we have lights. I try to make my house into like a sensory house, I don’t know what I’m doing. And then I was like, wait, blue light raises cortisol, and I’m looking at it before I go to sleep. Uh oh!

So like, I find blue light calming, so I thought it would be cool. So like, now I’m like, googling it while you guys are talking.  (Janet: laughs). Well, I’m in, I love learning. (Stephen: um-hmm). So, (Janet: yeah). Well, it’s, it’s fascinating to how something like that can have such a huge impact. You don’t even know it. Right. You know, cause it’s just part of our, it’s just sort of the cycle of life, right? You don’t even realize it, but once you start looking at the science of it, it’s pretty amazing.

Stephen: And that’s just one sense. I mean, we’ve had other like aromatherapy be considered and trying to like get people into a specific mind space, right? Or that trigger of a nostalgia to kind of help them with fixation. we’re doing a neurological institute for Cleveland Clinic and, you know, they’re exploring research around psychedelics. So there’s all kinds of, of, of fun, interesting things going on in the world. (Janet: yeah, wow).

Yeah, I mean, I think there’s, I was doing a behavioral health clinic in Lake Tahoe area. And so we have all these beautiful, like local photography that we commissioned. And so we’re doing renderings of it and it’s a group room and then some break rooms for staff and that kind of thing.

And it’s these majestic mountain ranges. It was snow caps. And they’re like, ‘It feels very cold, and it’s a cold part of the world. You made an assumption about kind of our landscape geography, but it doesn’t kind of fit our culture as a provider organization.’ But you know, that’s part of the conversation, not to make those presumptions and kind of listen.

Janet: Right. It’s funny you should say that. So we, the Trauma- informed Design class that we had, in the front we had all this stuff about you know, if this is too hard for you, please stop. Well, you can come back, you know, like it’s recorded. It’s not like a one-time thing, or, you know, if there’s real issues, contact us or the suicide hotline.

And then at the end we would have this, let’s bring down the stress levels, let’s do a little Zen kind of thinking. And we would have an image and it turns out like Christine and I both were like, well, we should get the one with the mountains with the snow on it. We’re both skiers. So for us, that was sort of in our mindset, right. And then I’m like, we probably should put a beach in there. I think some people might want the beach. They seem to like that. So it was a very humorous comment. (Robyn: laughs). (Stephen: um-hmm).

Robyn: Yeah. I, you know, I did a facility, it was children’s hospital. It was MRI. We use the ambient experience, right? And you know, research shows, you know, oftentimes children will need sedation in order to get into the, do the MRI (Janet: right). And that it actually reduces it.

And it’s like they have this selection of, they can create this whole world, right? You know, they can create a jungle or an underwater, whatever. I mean, it’s pretty amazing. (Janet: right).

Stephen: Oh yeah! There’s a new product that basically lets you preset so you can change the lighting, you can change the wind, the temperature system. (Robyn: yup). A couple other settings of like the features in the room so you can kind of make it… this is a rainbow; this is a spring day; this is a fall; this is, you know, pick something. And then I think that goes, you know, back to like, ‘Hey, we can dial this in a lot better nowadays, if the product is well supported and, and kind of thought through’ and presumably we’ve got, we’ve got the budget as always.

Robyn: Well, there’s that, that’s the key, yes. (laughs).

Janet: There’s that, (chuckles), I know. It’s nice, but you know, it’s a little expensive. but yeah. (Stephen: chuckles).

All right, so I do have one last question. But you know, I can’t go into my doctor’s offices, wherever it is, and I sit there, and I look around, and I’m like thinking to myself, ‘are you kidding me? Come on, like you can do a lot better.’

And it’s interesting to me that at the moment, it’s not all, I’m not talking about like the, the newer high-end hospitals, right? I’m talking about just going to like you know, the local dentist, the local eye doctor and stuff like that. And I just, I can’t understand it. Like the gynecologist. And I would, I’ll tell him things like, you know, listen, you can just put something up on the ceiling, you know what I mean? To distract what’s going on. (Robyn: yup), you know, some pictures of biophilia, something, anything.

And, actually with my gynecologist, there’s a, it’s a frosted window and it’s a frosted window and you can’t see in, but it’s a window to one of the exam rooms that’s behind the table. (Robyn: not what you want. laughs). They now don’t put me in there because I’m just, I am, I’m like triggered by the fact that they thought this was reasonable.

And I said to them, a couple of times now, I’m like, listen, I’m more than happy to like, I’ll go to Walmart. I’ll get our little spring rod, like put some curtains there. You know, it’s a simple solution to fix it. But I was just, I don’t understand, you know, like there should be more stuff like in medical journals. You know?

Stephen: As a member of the American Association for Emergency Psychiatry, I will say that there is very little thought given to the education of clinicians that I’ve seen, to like, these kind of spatial environmental factors. (Janet: yeah). They will definitely point it out if it’s like, yeah, it’s lead based poisoning; or it’s nutritional factor; ‘Oh, wait a minute, you have a vitamin D deficiency. You should probably get out and get some sun’.

And so it’s, it’s fascinating. I’m usually the only architect at these things. And they’re just like, why are you here? I’m like, well, I’m learning from you and hopefully you’ll learn from me, because I want to know how I can better design the spaces for your patients, and for your acute needs. And hopefully you’ll see an example of how for your next project to do something a little differently, a little better. You see in dentist’s office all the time is like the goldfish tank, right? People can just look at that thing all day.

Janet: Right, well, it’s true. I mean, yeah, and it, it always drives me nuts though, that, you know, I come back like the next year or dentist maybe every 6-months or so, they’re not sitting there and like, ‘Oh, we, we took you up on your offer. You know, I’m like more than happy to help let’s just go do this, you know.

Robyn: Yeah. I think it’s just a lack of understanding of how impactful that stuff really is, right? (Janet: bingo). You know, I mean, I think clinical doctors are so focused on their specialty and what they’re really good at, which we need them to be, right? (Janet: right).

But we also have to look at the holistic approach that I think just often gets missed, you know, like that, that emotional reaction to an environment is part of whatever’s happening to your health. You know, it’s so intertwined. And I think we just don’t give that enough credit, honestly. (Stephen: yeah). It’s like, I fixed your leg or I’ve whatever, (Stephen: um-hmm). So everything’s good. But that whole experience of getting my leg fixed is part of that journey for me, you know, and it just gets missed, unfortunately. (Janet: Yeah).

Stephen: You know, they say break a leg, so… (all laugh).

Janet: Oh my goodness. You guys, I have taken up way too much of your time. This has just been quite amazing. I just got chills. Like you guys have been just so wonderful and thank you for your time today. And we just could not be more thrilled that you came today and shared your knowledge and, you know, please come back. We’ll talk about this again, whatever you would like. (Stephen: laughs). I mean it was really, really, you guys know your stuff. Like, there is no ifs, ands, or buts. (Robyn: laughs). So, I really appreciate it. Thank you so much.

Robyn: Absolutely. It’s been a pleasure talking with you. Appreciate it as well. (Janet: great, thanks).

Stephen: Yeah. Thank you again for the opportunity to share.

Janet: Yeah. Thank you. Have a great day. Bye-bye.

(Music / Outro)

Janet:  As a designer, I find this information really exciting to talk about. Good design really can make a difference in mental health treatment centers.

Carolyn: As Robyn said, “the built environment needs to support healing, and typically, it has not.”

Janet: And it’s also about creating trust and showing that we are trying to treat them with dignity. And to be sure that nothing in the environment will re-traumatize them.

Carolyn: seems like that in itself can really make a difference.

Janet: Yes, you’re right. Creating a welcoming environment that gives clients or residents autonomy over their space, and surroundings, is key.

Carolyn: And as Stephen mentioned, it’s important to remember to keep the mental health of the staff in mind too, with spaces for them to decompress. Be sure to let the stakeholders know that this will help with staff recruitment, retention and to mitigate burn-out.

Janet: You are so right Carolyn. This is such an important piece of information for all you designers out there. If the stakeholders do not address the staff’s mental health within the built environment, you can have the most beautiful design in all the world, but it ultimately won’t be as effective to those in crisis.

And I was very happy to hear that a lot of what Stephen and Robyn are doing follows the Trauma-informed Design and SAMSHA principles.

Carolyn: And of course, if you need more information on these, you can find it on our website.

Janet: Absolutely! And we will also let you know how to contact Robyn and Stephen, and provide links to the projects they mentioned, as well as many of the other things touched on during this discussion… all on our website at: Inclusive-Designers-dot-com.

Carolyn: That’s: Inclusive-Designers-dot-com…

Janet: A big thank you to Robyn and Stephen! And, again, to all of you for listening.

Carolyn: Along with all the regular places you get your podcasts— such as Apple, Google, Spotify, and Pandora— you can also find us on YouTube as, you guessed it again, Inclusive Designers Podcast. And of course, if you like what you hear, feel free to go to our website and hit that Patreon button, or the link to our GoFundMe Page.

Janet: Yes, please do. And let us know if you have any questions or suggestions for topics we should be covering in upcoming shows!

And as our motto says: ’Stay Well…and Stay Well Informed’!

As always, thank you for stopping by. We’ll see you next time.

Carolyn: Yes, thanks again!