+ Mental Health This project should be designed to combine research and healthcare in order to better the lives of students and people of the surrounding community regarding overall wellness. Wellness is more than an absence of disease. It involves complete general, mental and social well-being. And mental health is an essential component of overall health and well-being. The fact is our overall well-being is tied to the balance that exists between our emotional, physical, spiritual and mental health People of all ages are at risk of stress given the demands of daily life and the challenges it brings-at home, at work and in life. Steps that build and maintain well- being and help us all achieve wellness involve a balanced diet, regular exercise, enough sleep, a sense of self-worth, development of coping skills that promote resiliency, emotional awareness, and connections to family, friends and community. This project entails creating a comfortable and private environment for students and community residents to visit a counselor, in order to overcome the issues listed above.
+ Vision, Mission, & Values CAPS Counseling & Psychological Services is the model for this project, since it is the institution already in tact on FIUs campus. Offered by licensed psychologists, licensed clinical social workers, and trainees with expertise in dealing with student concerns and development, their goal is to provide professional care to each student in a culturally sensitive environment. CAPS is funded by the FIU student health fee.
+ Project Description Services & Programs Mental health clinics should provide but are not limited to the following services & programs: Individual, Couples & Group Counseling Short term psychotherapy that addresses concerns such as: Self-Esteem issues, Anxiety, Depression, Grief & Bereavement, Stress Management, Relationship issues, Lifestyle choices… etc. Consultation, Evaluation & Referrals To appropriate community agencies for eating disorders, substance abuse/dependence, & family therapy Balanced Minds A computerized programming service for students to help them increase their relaxation skills Testing Neuropsychological, educational, ADHD, personality Victim Empowerment Program Confidential assistance to FIU students who have been victimized through threatened or actual violence. This service identifies needs and options, accompanies students who need medical services, helps during the healing process, and helps with safety planning… etc.
+ Statistics 75% of lifetime cases of mental health conditions begin by age 24. 1 One in four young adults between the ages of 18 and 24 have a diagnosable mental illness. 2 More than 25% of college students have been diagnosed or treated by a professional for a mental health condition within the past year. 3 Suicide is the 3rd leading cause of death on college campuses. 20 64% of young adults who are no longer in college are not attending college because of a mental health related reason. 11 Depression, bipolar disorder and posttraumatic stress disorder are the primary diagnoses of these young adults. 12 31% of college students have felt so depressed in the past year that it was difficult to function and more than 50% have felt overwhelming anxiety, making it hard to succeed academically. 13 1,400+ undergrad and grad students visited CAPS in the past year. …which is why its important to implement this facility to be readily available on all college campuses.
+ Project Client FIU Health FIU Students & Faculty Sweetwater/Doral, FL residents
+ Client Profiles Bad relationships Fraternity hazing First time living on campus Sexual, verbal, emotional abuse Stress from academics FIU Students FIU Staff Stress from office work Stress from dealing with students Deadlines Personal issues
+ Client Profiles FIU Student Health Services is the umbrella in which CAPS specifically falls under. FIU Student Health Services offer a safe, private and welcoming setting to address students needs and concerns. FIU Health Community The community surrounding FIU including Sweetwater and Doral would be potential clients of this facility. Issues that affect everyone: Sexual Health, Nutrition, Relationships, Fitness, Career, Lifestyle
+ Site FIU – PG5 Floor 1 Floor 2 885 SW 109th Avenue, Suite #131, Miami, FL 33199
+ For the therapy rooms (group or individual) for the materials and objects is recommended not to use anything that the patients can harm themselves with or harm the counselor. Acoustics walls should be provided to avoid noise in the clinic, and to keep the privacy of each patient. Overhead lighting should be the main source of light. If possible, provide natural light to some of the offices but also provide shading systems to maintain the privacy of the patient. Typically the users tend to personalize and buy their own lamps (table lamp, floor lamp, etc.) These settings don't require too much furniture mainly of chairs and a small table. The exam room is used to perform all kind of test, using computer for assessments, cards, written exams, etc. Computers should be provided for the offices since all the records are shredded and kept in the system.
+ BUILDING ATTRIBUTES GUIDELINES AS PER Psychiatric Facility WBDG Health Care Subcommittee facility standards Minimizing distance of necessary travel between frequently used spaces Easy visual supervision of patients by limited staff. Situate support spaces so that they may be shared by adjacent functional areas, and by making prudent use of multi-purpose spaces
+ Codes THERAPUTIC ENVIROMENTS GUIDELINES AS PER Psychiatric Facility WBDG Health Care Subcommittee facility standards Using familiar and non-institutional materials with cheerful and varied colors and textures, keeping in mind that some colors and patterns are inappropriate. Admitting ample natural light wherever possible. Provide views of the outdoors from other spaces wherever possible. Views of nature can be restorative. Providing adequate separation and sound insulation to prevent confidential but loud conversation from traveling beyond consulting offices and group therapy rooms. Provide as much acoustic privacy as possiblefrom noises of other patients, toilet noises, mechanical noises, etc. Provide visual privacy, and control over it, as is consistent with the need for supervision.
+ Codes Cont. THERAPUTIC ENVIROMENTS GUIDELINES AS PER Psychiatric Facility WBDG Health Care Subcommittee facility standards Giving each inpatient the ability to control his immediate environment as much as possible, i.e. lighting, radio, TV, etc. Providing computer stations for patient use when patient profile and treatment program allow. Designing features to assist patient orientation, such as direct and obvious travel paths, key locations for clocks and calendars, avoidance of glare, and avoidance of unusual configurations and excessive corridor lengths. Designing a "way-finding" process into every project. A patient's sense of competence is encouraged by making spaces easy to find, identify, and use without asking for help. Color, texture, and pattern, as well as artwork and signage, can all give cues. Providing access to kitchen facilities, preferably on the unit, where snacks or meals can be prepared.
+ Codes CLEANINGNES GUIDELINES AS PER Psychiatric Facility WBDG Health Care Subcommittee facility standards Appropriate, durable finishes for each functional space Proper detailing of such features as doorframes, casework, and finish transitions to avoid dirt-catching and hard-to-clean crevices and joints Adequate and appropriately located housekeeping spaces Incorporating O&M practices that stress indoor environmental quality (IEQ)
+ Codes AESTETICS GUIDELINES AS PER Psychiatric Facility WBDG Health Care Subcommittee facility standards Use of new lighting systems, high performance glazing, increased use of natural light, natural materials, and colors Use of (soothing, not exciting) artwork Attention to details, proportions, color, and scale Bright and open public and congregate spaces Comfortable and intimately scaled nursing units and offices Compatibility of exterior design with surroundings
+ FGI Guidelines General GUIDELINES AS PER Specific Requirements for Psychiatric Outpatients Centers | Section 3.11 FUNTIONAL PROGRAM 3.11 – 1.2 Number and type of diagnostic, clinical, and administrative areas shall be sufficient to support the service and estimated patient load describe in the functional program. PARKING 3.11 – 1.3.1 Parking spaces for patients and family shall be provided to meet the function of program. DIAGNOSTIC & TREATMENTS AREAS 3.11 – 3 Facility Shall Provide for only those services specified in the program. AREAS FOR PATIENT SERVICES 3.11 - 3.2 Consultation Rooms Group Rooms Small Group Room Large Group Room Observation Room
+ FGI Guidelines Cont. General GUIDELINES AS PER Specific Requirements for Psychiatric Outpatients Centers | Section 3.11 SUPORT AREAS FOR PSYCHIATRIC OUTPATIENT CENTER Nurse Station Multi Purpose Room Medication Room Nourishment Area Storage PUBLIC AREAS AND ADMINISTRATIVE AREAS 3.11 – 6 Entrances shall be marked at grade level and secured at least at the psychiatric unit Entrances Shall Be convenient to parking and public transportation area Reception and information counter shall provide visual control of entrance Waiting area: seating shall contain no fewer that two spaces for each consultation room and no fewer than 1.5 spaces for the combined projected capacity. Waiting areas shall accommodate for wheelchairs. Water provisions shall be provided for waiting patients. Toiles for public use shall be immediate access to waiting area
+ FGI Guidelines Cont. General GUIDELINES AS PER Specific Requirements for Psychiatric Outpatients Centers | Section 3.11 PUBLIC AREAS AND ADMINISTRATIVE AREAS 3.11 – 6 Cont. Spaces for private interview related to social services, credit and other shall be provided Clerical spaces or rooms for typing shall be provided and separate to public areas to ensure confidentiality Record rooms shall be provided for filing and storage. DESIGN AND CONSTRUCTION REUQIERMENTS 3.11 -7 Observation of all public areas including corridors shall be possible and can be accomplish by electronic surveillance Niches and hidden areas in corridors shall be prohibited. ARCHITECTURAL DETAIL 3.11 -7.2 Tamper Resistance Suicide prevention, ceilings, wall, floors, windows etc. shall be tamper resistant. Cubicle curtain and draperies shall not be used where a risk assessment in the functional program clearly identifies their potential risk.
+ NAPHS GUIDELINES GENERAL COMMENTS Space Planning Considerations: All electrical circuits having receptacles near sources of water (such as sinks, lavatories, and toilets) must be protected by (GFCI) breakers. When possible, locate water shut-off valves in corridor walls where they are accessible from the corridor by opening a locked access door. This has been successfully accomplished during remodeling projects of existing units. Housekeeping rooms should be large enough to lock away the carts when not in use. All cleaning materials must be locked inside at all times when the carts are in patient areas or corridors and not attended by staff. When possible, locate serviceable parts of patient-room HVAC systems where they can be serviced without entering the patient rooms. In new construction, consideration should be given to radiant heating and cooling systems that greatly reduce the need for mechanical devices in the patient rooms.
+ National Institute of Building Sciences Private Counseling Room Standard
+ Issues/problems Stigmas and Discrimination : the stigmatization of people with mental disorders varies across population. Stigma discourage people from seeking and wanting to pay for care. Stigma also reduces patients access to resources and opportunities such as housing and jobs, and leads to low self-esteem, isolation, and hopelessness. (Russell, 2010) Many people with mental health problems are afraid to seek treatment because of discrimination and stigma. There are problems with discrimination in the community. A mentally ill person will struggle to obtain and keep employment and housing. (Russell, 2010) Overall approaches to stigma reduction involve advocacy and public education programs, and contact with persons with mental illness through schools and other societal institutions. (Russell, 2010)
+ Issues/problems Mental health remains a hidden health issue: An additional factor that influences the willingness to access treatment is a lack of mental health literacy on the part of the public, specifically a lack of knowledge of how to recognize mental disorders and beliefs about treatment that are at variance with those of health professionals. Many people who live with a mental health problem or are developing one try to keep their feelings hidden because they are afraid of other peoples reactions.
+ Issues/problems Not enough mental health care facilities are available, and treatments are expensive. In the past three years, $4.35 billion for services has been cut from state budgets across the country, according to a report by the National Association of State Mental Health Program Directors Research Institute. While states are slashing funding for treatment, private care is getting harder to obtain. Mental health advocates say that the number of providers nationwide has decreased in recent years. The ones that do practice often dont take insurance or are all booked up. (Horowitz, 2012)
+ Specific requirements Privacy and safety Privacy has the ability to provide refugee which at the same time will promote healing by providing rest and recovery. Patient safety remains a top priority, and elements such as high ceilings to eliminate contraband and vandalism, consideration of door swings to eliminate potential barricades, and non-breakable glass partitions are key elements in solutions. However, these can be addressed in a fashion that makes the space feel comfortable and personable
+ Specific requirements Sense of control and Access to social support from family and friends. (Group therapy - Family therapy) Lack of sense of control is related to negative consequences such as depression, high blood pressure, and malfunctions in the immune system. (Marberry, 1995) Freedom is an important feeling when trying to achieve a sense of control. Stress often appears when the user feels the lost in control over the physical environment. Privacy, places for refugee, and design coherence are some factors that can affect the sense of control on patients. (Gifford, 2004) Choice and control are important elements to reduce the chaos and stress of the health environment. (Stewart -Pollack & Menconi, 2005) Problems such as depression and anxiety have been linked to the lack of social support. (Gifford, 2004) Social support is usually recalled as the actual assistance, help or any action that will show somehow support for the patients. Some studies point to family and friends visits as well as friendly and supportive hospitals staff to have a beneficial response in the recovering process. (Ulrich, 1992)
+ Specific requirements Stress: A Major Obstacle for Psychological Wellness Psychological stress gives you a sense of helplessness and can induce to depression and anxiety. (Ulrich, 1992) Keep et al (1980) and Parker and Hodge, (1976) connected the use of rooms without windows with the increases of anxiety and higher chances to develop depression and delirium. The lack of windows will increase the negative effects of sensory deprivation and will reduce the positive outcomes. (as cited in Ulrich, 1992) Behavioral stress refers to a stress caused by sleeplessness, alcohol abuse, and social withdrawal. This instance of stress can appear not only in patients but in family members, friends, and healthcare staff as well. (Ulrich, 1992) When a health environment, clinical or mental, evokes stress for a patient, it has adverse outcomes. As Ulrich said, when an environment minimizes stressors and offers restorative features, outcomes can be positively affected. Environmental factors includes: positive distractions, view of nature, and appropriate lighting and acoustic levels.
+ Possible care theories Attention Restoration and Evoking positive emotion The Kaplan's formulated four properties for a restorative space. These properties are being away, extent, fascination, and compatibility. Being Away: sense of being removed from the source of the mental fatigue ; Extent: the new setting offers an experience of sufficient scope to sustain interaction for a period of time without boredom; Fascination: an effortless way of attending with involuntary attention ; Compatibility: fit with a persons inclinations and purposes. If the experience is compatible to the person then it will require less mental effort to engage with it. Positive emotions help to distract the user, even for just a moment, about his or her situation, illness, etc…, giving a positive emotional response. Research has found that positive distractions have a positive effect in reducing stress levels in patients. Positive distractions are any element that would produce a positive feeling and will help to reduce unpleasant thoughts. (Ulrich 1992) This approach implies that the benefits of nature come from the positive emotions it produces in us, and that any setting or space resembling calm and peacefulness will have the same results. (Gifford, 2004)
+ Possible care theories Color Color when applied in the interior environment can have a significant impact on the occupants within that space. Color mixed with light will alter a persons perception of visual contrast. Visual contrast greatly influences peoples perceptions of interior environments. It can positively influence mood and behavior. A full range of psychological and emotional effects can be achieved through the use of color (Hegde & Woodson, 1999).
+ The functional Area of Primary Care The primary objective of the interior design of the Mental Health units and facilities is to provide: A residential, therapeutic environment. Finishes, fixtures and furnishings that maintain the safety and security of the facility need to be integrated into the interior design without detracting from this primary objective. A warm, welcoming, and familiar environment can help calm patients and promote their participation in treatment and their rehabilitation and recovery.
+ Planning 1. Patient spaces should have an attractive, therapeutic environment without compromising patient and staff safety. Incorporate wall color, trim, accent colors, and securely-anchored artwork in common areas and patient therapy rooms to enhance the environment. 2. The clinic planning and design should maintain patient privacy. 3. The circulation (corridors) in this clinic should be open, easily observed from reception and nursing stations, and should be free of blind corners. 4. Provide outdoor space to allow patients to sit or talk with others outside, when possible. 5. There should be ample signage that is clear and has large letters that can be read from a distance by patients, some of whom have imperfect vision. 6. Therapy room areas should have appropriate acoustic control. 7. Include an identifiable reception area, for greeting patients, family members, and other visitors that is adjacent to a comfortable waiting area. The waiting area should provide some privacy from common traffic.
+ Planning 8. The overall reception/waiting area should be subdivided into smaller waiting areas easily observed from a central reception point. 9. All areas must be wheelchair-accessible. Corridors should be a minimum of 6 [1.83 m] clear to allow passage of two wheelchairs. 10.Ample light should be provided in common hallways. 11.Areas where patients are minimally supervised such as patient toilet rooms should be outfitted to minimize the potential for fixtures, and accessories within the room to be used as a weapon or anchor point for hanging. Grab bars should have a solid plate behind the bar. All plumbing fixture piping should be concealed and motion sensors should be used for toilet and lavatory operation. 12.Exposed devices should be fastened with tamper resistant fasteners in any area where a patient is left unattended. Laminated glass should be used in areas readily accessed
+ Lighting Natural & Artificial Lighting Natural light : Design to provide daylight in all feasible areas in appropriate quantities. Artificial Lighting: Artificial lighting will be required to supplement day-lit areas at night and light areas without access to daylight. General Illumination: 2x2 [.6 m x.6 m], 2x4 [.6 m x 1.21 m] recessed fluorescent fixtures (Figure 220.127.116.11) or 9 diameter [228.6 mm] (Figure 18.104.22.168) vandal/wet-lensed down-lights may be used with a high strength acrylic lens andflush trim anchored with tamper resistant screws.
+ Acoustics A Sound Absorbing Material & Acoustical Tile At least one wall in the room should be covered with a sound absorbing material to minimize reverberation and acoustical tile ceilings may also be used. The room itself should be acoustically isolated from external noise sources such as mechanical noise, street noise or corridor noise. Sound absorption is the next most common acoustic need, especially in areas where patients gather. Interior wall and ceiling finishes can help reduce excessive noise.
+ Interior Finishes Flooring, Wall & Ceiling Flooring/Base: Sheet vinyl flooring now comes in a range of colors and textures. The wood grain patterns in particular create a more residential feel and are strongly recommended. Use of wood toned vinyl flooring can significantly brighten up the area and enhance the aesthetic environment. Similarly, rubber base manufactures now produce a base that simulates wood base profiles which creates a residential image without sacrificing safety. Wall Finishes: Wood paneling and trim create a warmer, more residential environment, but should be limited to areas such as reception and waiting areas where this material can not be easily scratched or damaged. Ceiling Finishes: Painted Gypsum Board: All gypsum board ceilings shall be painted with an off-white color, eggshell finish.
+ Wayfinding & Signage Readable Numbers & Letters Wayfinding and signage that allows patients and visitors to navigate to and throughout any mental health unit, clinic or facility with minimal or no assistance is essential. Safety/security considerations: Artwork should be installed in a manner that mitigates potential use as a weapon.
+ Corridor Area Protect the wall Handrails/Wall Protection: Corridors in patient areas should have handrails for patient use as required and to protect the wall. Additionally, corner guards and exterior wall corners help protect the wall but also soften a hard edge that a patient could harm themselves on.
+ Furnishings Heavy & Rounded Areas should be furnished with comfortable chairs and tables that cannot be easily thrown or taken apart and used as a weapon. Lamps, coffee tables and other loose accessories should not be used. Furniture edges should be rounded and not easily damaged.
+ Bathroom Toilets & Labatory Toilets: Toilets should not have any exposed piping. As defined in the plumbing section, controls should be utilized to prevent excessive flushing and flooding. Lavatory: Lavatories should be solid surface material with an integral sink. All piping below the sink should be concealed behind a panel
+ Bathroom Mirror: Mirrors in patient bathrooms should be reflective polycarbonate with a stainless steel frame firmly anchored to the wall. No shelf should be part of this frame assembly Toilet Paper Dispenser: A safety toilet paper dispenser consisting of a soft spindle should be used in all patient bathrooms. Grab Bars: Grab bars, as required for accessible rooms, should be fixed to the wall with a welded horizontal plate on the bottom of the bar to prevent using these bars as anchor points. Clothing Hooks: Clothing or towel hooks should be designed to collapse when any weight above 4 lbs [1.81 kg] is applied Shower/Floor Drains: Drains should be attached with security screws to prevent removal by patients Paper Towel Dispenser: Paper towel dispensers in patient bathrooms shall be Recessed Soap Dispensers: Soap dispensers shall be wall-mounted with sloped tops to prevent this fixture from being used as an anchor point.
+ Group Therapy Rooms Lighting: Auxiliary lighting should be provided to allow soft, diffuse front lighting so a patients face can be clearly seen on the remote conference screen. In rooms with natural light, window shades with full black out capability should be provided to control glare and shadow in the room during a video-conference. Acoustics: At least one wall in the room should be covered with a sound absorbing material to minimize reverberation and acoustical tile ceilings may also be used. The room itself should be acoustically isolated from external noise sources such as mechanical noise, street noise or corridor noise. Interior Finishes: the room should use solid colors preferably in a medium tone color to allow for the best backdrop during video conferences.