Across many U.S. regions, the demand for space in mental health treatment facilities far outpaces availability. In fact, in Massachusetts, according to a February 2022 report titled “Estimating Psychiatric Bed Shortages in the U.S.” in JAMA Psychiatry, “hundreds of patients have been wait-listed for acute inpatient psychiatric beds.”
Former Massachusetts Gov. Charlie Baker put out an urgent call for more inpatient mental health treatment for all ages in 2022. In response, Cambridge Health Alliance (CHA) embarked on an ambitious plan for a series of renovations. The plan started with consolidating and expanding its children and adolescent programs as well as adding much needed adult beds at its Somerville, Mass., campus.
The effort included relocating one of its children’s programs from a floor of its Cambridge campus, opening up opportunities for a new 7,800-square-foot adult inpatient mental health program.
The healthcare organization contracted with Lavallee Brensinger Architects (LBA; Boston) to design the Somerville facility. As that larger space was conceived and constructed, the team at LBA met regularly with CHA leadership and the clinical team to discuss options for the soon-to-be-vacated treatment unit in Cambridge.
The existing unit had not been renovated in many years and would need to incorporate the newest codes and best practices for an adult inpatient behavioral health program. In order to meet the growing demand for these services, each phase of the project was given a tight time frame tied to the anticipated needs of the communities and the availability of funding.
The demand required that the design and construction team have dedicated staff that would focus specifically on this series of projects. Typically for an adult inpatient program of this scale and complexity, roughly eight months would be planned for design and documentation followed by another six to nine months of construction.
This project, from start to finish, allowed just over nine months to opening day. There was no time to waste.
Planning for a hospital renovation
This one-floor renovation project required gutting 50 percent of the top floor of a fully operational hospital. Bathrooms were fully gutted, as well, to incorporate ligature-resistant fixtures, new flooring, plumbing, lighting, accessories, and updated finishes.
Leadership at CHA along with the LBA design team immediately set to work identifying a construction partner that could accomplish the specialized project in the short timeline. Columbia (North Reading, Mass.) had deep experience in mental health treatment centers and also knew how to put together a comprehensive construction plan on short notice.
To accomplish this specific schedule, Columbia’s standard preconstruction process—when materials and products are typically identified and ordered and plans are reviewed and revised—had to be compressed dramatically.
With no time for long-range planning, the Columbia and LBA teams brought together the client and all design/build MEP subcontractors for an abbreviated but informed exploration of opportunities and possible issues. This exercise included the use of 3-D modeling and virtual walk-throughs to help anticipate and prepare for concerns before work began.
It also allowed the team to review design solutions and product opportunities, including the sourcing of long-lead items, quickly and efficiently.
One example is working together to determine the light fixtures that needed to be replaced. The team knew that older units would require new ligature-resistant fixtures. Picking the right model that would limit the amount of work needed to install it was a team effort.
For instance, installing certain fixtures in areas with gypsum ceilings would mean that the ceiling would have to be entirely rebuilt; in these cases, alternative solutions were sought.
Product and material procurement for behavioral health
Because the new facility would serve individuals facing behavioral health challenges, many of the necessary products and materials required safety-related design elements. For instance, the original nurses’ station in the space had been hidden a bit from patients. And its placement and design also created blind spots where staff couldn’t see patients.
The team knew a new nurses’ station was needed that was centrally located within the unit but not obtrusive within the overall space. Clinical staff members also wanted an open nurses’ station that promoted engagement and eliminated blind spots where patients might hide.
The team contracted a craftsperson to custom build a durable unit made with a shapeable material that’s a blend of acrylic resin and natural minerals. The desk was estimated to take four to six months to build. This is related to its construction, which uses a thermoforming process that requires several rounds of shaping, heating, and cooling before it can be finished and installed.
The team determined that the desk, with its specialized shape and design, was essential to the project and coordinated the project schedule around its eventual installation.
LBA had already been working on the new, larger children/teen space for CHA. Thanks to theirs and Columbia’s existing experience in the behavioral health sector, procurement of other items was more manageable.
Establishing hospital project standards
From the start, the team established hospital standards for doors, hardware, plumbing fixtures, paint colors, flooring products, and accessories.
Without these standard options in place, the overall process could have taken months to review and approve each option. The team already had established contacts with manufacturers and vendors, allowing them to quickly assess which options were available and which were not.
One site-specific product need was cabinetry that would be exceptionally durable. The team selected a high-density polyethylene marine-grade product used on ships. This material can stand up to the impact of occasionally rough seas and is about three times the weight of standard millwork construction.
When faced with the report back from the normal bidders that the product wouldn’t be available, the team did a sweeping search and identified a marine supplier that normally didn’t bid on projects of this kind but happened to have the product in stock. In addition to the extra effort needed to procure cabinetry, its manufacturing and installation also took significantly more time than expected, due to its weight and density.
Later, as the project was nearing completion, the team faced another purchasing dilemma: the need for 6,000 anti-ligature, tamper-resistant screws, a high quantity of a specialized item. Utilizing tamperproof screws was understood to be a necessity from day one; procuring them in coordination with the delivery of the millwork and doors was the challenge.
To keep production moving forward, the team used standard screws with the intent to replace them as the tamperproof screws arrived. When a final batch of 1,400 screws arrived close to the project’s deadline, team members spent several long days and nights doing little but removing the original screws and inserting the new ones into millwork that lined the corridors and cabinetry used to hold patient belongings and activity supplies.
Designing the behavioral health inpatient unit
The interior design theme for the new space was created by working with clinical staff at CHA, who felt that a beach and water theme should be used throughout the unit to establish a warm and calming aesthetic.
Subtle ocean-themed colors like blues and tans were chosen, which helped guide the purchase of deep blue seating; the blues, tans, and yellows of the wallcovering and paint; and the light-colored flooring.
The team also decided to include three large murals at the entry point of the unit and across from a large, open activity and dining room. Murals were sized from floor to ceiling, with two of them measuring 12 feet and 16 feet long apiece. The manufacturer allowed for either stock or custom photos on its wall protection units. To accommodate more rapid delivery, stock images were used.
With the renovations came an opportunity for CHA to convert the floor, which had been a combination of private and semiprivate rooms, to all private rooms as well as update all patient bathrooms. The rooms, many of which had previously featured two beds, were redesigned as eight single-occupancy rooms.
CHA’s clinical staff had previously faced issues with the storage of necessary items such as patients’ personal belongings that need to be secured but accessible, art supplies, games, and other group activity materials.
In the existing unit, there were bench seats throughout the main passageway that were not needed in this program; those spaces were repurposed to include full-height, lockable storage cabinets that slid into the corridor walls.
The previously hidden nurses’ station was shifted out into the open corridor to help centralize the staff between the waiting room where visitors are welcomed and the open activity area, and to increase staff visibility and engagement.
Also, a new gathering area is located at the core of the unit across from the nurses’ station. To allow for an expansive and light-filled patient experience, all staff workspaces were relocated to a back-of-the-house area.
This section was designed to include a separate staff entrance, break room filled with natural light, reorganized team room with integrated conferencing tools, and a documentation area for focused work.
Crossing the project finish line
Ultimately, the project was completed within one week of the required nine-month timeframe. Only the molded nurses’ station was delivered late due to a stringent production schedule and several design changes.
However, the station’s installation had minimal impact on the project and quickly became a dynamic and well-loved feature of the space.
Although a project with daunting timelines and pressing needs, the teamwide commitment to planning, communication, and working collaboratively were the foundation for its success.
With combined knowledge and expertise, team members were able to anticipate and stay ahead of potential “show stoppers,” while expedited decision-making helped combat a tight schedule even in an era of potential supply chain and inflation-related roadblocks.
Dan Drover is a project executive at Columbia (North Reading, Mass.). He can be reached at firstname.lastname@example.org. Joan Eagleson is a principal and studio leader at Lavallee Brensinger Architects (Boston). She can be reached at email@example.com.