How to stretch $50 grand

Behavioral Healthcare recently presented top experts with a design challenge, asking for advice on what facility upgrades they might prioritize if they had a budget of only $50,000. While it’s easy to make improvements with $1 million in hand, not all centers have that luxury.

“It’s tough to make much of an impact with $1 to $2 per square foot,” says Kevin Turner, AIA, LEED, principal, Perkins+Will.  

Although that might be the case, low-cost changes can have noticeable impact. In fact, you might be surprised to see what can be done on a tight budget.

Safety upgrades

Every year, new antiligature products are developed and brought to market, says Turner, and each one that you don’t have in your facility can represent a liability. Some examples would be installing safer door handles, swapping out hinges, updating shower curtains, and adding over-the-door alarms.

“If I had a small pot of money and wanted to reduce my liability, I would look for the best bang for my buck in safety improvements as a risk management strategy,” he says.

When minimizing risk, James M. Hunt, AIA, president of Behavioral Health Facility Consulting, LLC, recommends prioritizing spaces where self-harm acts traditionally take place: patient bathrooms and bedrooms. He says those are the locations where patients spend time without supervision.

Aesthetic upgrades

Depending on the space, Turner says $50,000 may not get much more than a coat of paint. Instead, he advises focusing on improving one specific room or area instead of trying to impact the entire facility. Look at the details. Even something as simple as a nicely-designed niche for the television with a ventilated safety-glass cover might be a nice improvement, he says.

Improved quality of interior light is another aesthetic opportunity to consider. For example, Turner says designers can improve the feel of a space by simply changing out ballasts and bulbs in existing fixtures. Designers agree lighting is an aspect that can often be overlooked.

 “If it’s an older behavioral health facility, chances are the lighting isn’t up to current standards or isn’t providing warmth; it’s probably more of the typical florescent lighting,” says Dennis Vonasek, AIA, ACHA, CID, vice president and healthcare principal, HGA Architects and Engineers in Minneapolis. “Lighting is one of the best ways to get a bang for your buck.”

Making a space more aesthetically pleasant with effective use of light will drive in users of that space, whether it’s an art room or a lounge area. Lighting has also been found to benefit treatment.

“There have been multiple studies done that show the benefits of color-corrective lighting in a patient environment as far as lighting speed and the right blend of color temperature,” Vonasek says, explaining that it helps with things like patient skin tone, and promoting a healthy environment.  “Shop your options when it comes to lighting. See what’s out there because there are lots of people providing very similar outcomes at very different price points.”

Article: How to enhance your space for next to nothing

Don Thomas, design principle, BWBR Architects, recommends enhancing the aesthetics of a space by incorporating a collection of graphics and art that could be rotated out and personally selected by the patients. Another option would be setting up an art program that would bring artists in to guide patients through various projects. Artistic expression would not only be therapeutically beneficial for the patients, Thomas says, but displaying the resulting projects would visually enhance the treatment space.

“You don’t want to just buy one piece of art— I think that would be a waste—but art doesn’t have to be expensive,” he says. “Having the patients choose what would be near their room gives them choice and allows them to be more empowered. There are a lot of ways to work with that, and you could stretch $50,000 out pretty far.”

Thomas adds that it’s important to avoid chaotic or relationship-focused pieces when choosing artwork because they could potentially trigger stress, sadness or other negative emotions. For example, a Jackson Pollock might increase anxiety and anything depicting romance might be painful for someone who is away from their loved one. Instead, he says, it’s best to select items that emphasize warmth and communicate healing.

Vonasek says that although custom artwork might not be an option given the budget, poster art could be an economical solution that would be even more beneficial when paired with improved lighting. 

“Providing any sort of positive distraction and throwing the light source on it could be a pretty high impact solution aesthetically with not a lot of money,” he says.

Another aesthetic option would be to establish thresholds, or thick bands of color that can  act as physical barriers, on the floor around clinical stations or door frames throughout a facility. “Those transitions become really important to patients who have been in crisis,” Thomas says. “It gives them a safe space to negotiate coming and going, sort of like a neutral safe zone.” 

Depending on how many thresholds a facility wants to incorporate, Thomas cautions that this type of upgrade could potentially go over the designated price point, but he also says it doesn’t have to be expensive. “It doesn’t take much—paint on the floor, vinyl floor or even a colored door jamb can make a big difference,” Thomas says.  

Functional upgrades

Thomas recommends creating a sensory room that would incorporate hands-on functional elements combined with interaction with staff to enhance treatment for patients experiencing crisis.

“There could be softer, quieter kinds of furniture; a scenario where patients could control the light, touch things and see things,” he says. “Sensory for kids is one thing, but sensory for adults would be kind of a guided meditation and focus area. Those have amazing impact. It calms people down, tends to reduce the amount of meds they might need, and helps them focus on issues so that they become better communicators to their care teams.” 

The biggest cost for a sensory space would be commissioning a room and renovating it, he says. Another important aspect to consider is the placement of the room. Thomas advises positing it away from communal spaces such as the front entrance, dining room or living room areas in order to maintain a quiet environment.

Another option in functional upgrades would be to create an exercise and fitness space, something that tends to be lacking in most behavioral health facilities, according to Tammy Felker, AIA, RN, LEED AP BDC, associate partner, ZGF Architects, LLP.  An effective wellness space, Felker says, would allow patients to self-select their wellness route so they can blow off steam when needed

“Regular exercise helps with symptoms of depression and anxiety, overall mood and the feeling of well-being, and we should really be trying to incorporate that it into every project,” she says. “It’s also an important coping skill to help with illness in recovery, and it can help establish health patterns that patients can take with them and apply at home once they’re discharged.”

Thomas recommends considering interactive gaming consoles that require players to get up and move. However, facilities will want to sound-proof the room or separate the space so stomping or other loud noises don’t disturb patients in the surrounding area.

The biggest challenge with incorporating a wellness space into a treatment facility is finding the square footage, Felker says. The space would need to be large enough to accommodate physical fitness equipment, such as a recumbent bike and a treadmill, and also have adequate space for group wellness activities like meditation and yoga.

However, if an indoor space isn’t available, she says another option would be to utilize outdoor spaces by investing in low-tech, durable exercise equipment like elliptical and stepper machines that are designed to be used outside.  “Getting access to daylight, fresh air, green space and nature with exercise really creates a very healing and therapeutic environment,” she says.   

Lastly, natural elements consistently prove to be beneficial in treatment. Facilities that incorporate biophilic design will not only be aesthetically pleasing but clinically impactful.

“To be able to tend vegetables or plants is very therapeutic,” Felker adds. “If you could do a green wall that has edible plants on it that people can engage with and give them some focus other than their clinical therapeutic activities that would be a great bonus.”

Julia Brown is associate editor of Behavioral Healthcare.