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The second best place to be: the long-awaited Saint Elizabeths Hospital is a comforting environment for consumers second only to home.

It was more than a decade in the making, but in April 2010 Saint Elizabeths Hospital in Washington, D.C. opened to consumers, filling its 292 inpatient beds (figure 1). As the public psychiatric facility for the District, Saint Elizabeths serves both civil and forensic consumers, who are integrated among the facility's two intensive (for severe consumers) and transitional (for less severe consumers) wings.


Operating on the trauma-informed model of care, Saint Elizabeths acknowledges the vulnerabilities and triggers of the individuals it serves. By implementing evidence-based design strategies that balance security and comfort, the hospital not only ensures the safety of its consumers and staff, but reduces their stress levels.

Consumer privacy

According to Marc Shaw, ALA, LEED AP, principal at Einhorn Yaffee Prescott, Architecture & Engineering, P.C., Saint Elizabeths was designed to have the "ability for consumers to live the way they ought to." In order to recreate a homelike setting, most are given private bedrooms, furnished with dorm-style beds, wardrobes, desks, and chairs (figure 2). All furniture is abuse-resistant with anti-ligature fixtures, and though it is moveable, staff is able to secure it if needed.


"We have higher-security furnishings if they are appropriate for a population or individual, but the idea was not to pick the worst condition and design the whole thing around that," Shaw says. "That didn't seem to be consistent with the goals of the project."

Instead, consumers are given their own space to come home to, a place to reflect privately after a day of treatment in the therapeutic learning center (TLC). "By virtue of having the private rooms, we've really de-stressed the environment," says Patrick Canavan, PsyD, CEO of Saint Elizabeths. "People can go and get to a quiet comfortable place on their own for a time-out, and then come back out into the larger group spaces once they're feeling better."

Because the hospital wants "interaction between people to be the first level of security," according to Shaw, staff conducts checks at 30-minute intervals in the evening and night in lieu of surveillance technology. To manage this, consumers are divided among seven clusters with 27 beds. Each cluster is then divided into three units of nine beds (figure 3).


Each nine-bed unit is equipped with a single-use bathroom, providing added privacy and comfort to consumers. Bathrooms are also furnished with anti-ligature fixtures and a privacy curtain, to be used if a consumer requires staff presence during use. "But that would not be a routine thing," Canavan notes.

Social spaces

Because social interaction reduces stress levels, Saint Elizabeths offers many planned spaces for consumers to socialize with peers, staff, and visitors.

Whether consumers prefer to gather for a quiet game of checkers or cheer for their favorite sports team on TV, a space is available to accommodate their needs. Each nine-bed unit has its own den, while the larger 27-bed cluster provides a larger living room, both equipped with TVs (figure 4).


Each cluster also has a multi-purpose room where consumers eat breakfast and dinner together, or attend other programs throughout the day. "When you have a group of 10 to 15 people playing poker or having an AA meeting, it's held in the multipurpose space," Canavan says.

The units also provide a visiting space for family or friends, which allows them "to be on the unit without fully coming on," says Shaw. This visiting space is located off the main corridor directly before the unit entrance.

"We're trying to have this nice balance between having families feel like a part of what's going on in treatment and maintaining privacy for everyone else," Canavan adds.

For consumers with privileges, there is also public seating in the main lobby and outdoor picnic areas where they may meet with family and friends for a meal or visit.

Positive distractions

Saint Elizabeths offers consumers a variety of areas where they can step back from the daily stressors of treatment. "We devise a safety plan [with each consumer] ahead of time so that when something is stressful or anxiety provoking, they have alternative areas they can use to regain a sense of safety," Canavan says.

Some of the best places to activate these safety plans are "comfort rooms," which are located in each 27-bed cluster. Comfort rooms are equipped with stress-reducing devices, such as massage tools, weighted blankets, and perforated walls for playing music.

These spaces are glass-fronted and located off the same corridor as the clinicians' offices, so that staff may casually monitor them without interrupting. "Sometimes you want to chill out, and that's a necessary skill," Shaw says. "The comfort rooms are places where you can step out of the bustle."

Other spaces in the facility encourage bustle in order to recreate what Canavan calls "the tempo of life that gets lost when you're in a hospital." A library and an auditorium are open to the public, and Saint Elizabeths hosts several programs that bring the community onto the campus. Among these programs are political forums and debates, monthly movie nights, and a summer concert series--all open to consumers.

"If you're from D.C., it's the most normal thing to go to an outdoor concert in the summer and eat ice cream and listen to jazz," Canavan says. "I want there to be normal experiences here."

The use of art throughout the facility also offers consumers an opportunity to interact with the community. Through the D.C. Commission on Arts and Humanities, Saint Elizabeths received a grant to secure six pieces of aft, which are displayed in prominent areas throughout the facility (figure 5).


"The rules said that the artist would include individuals in our care either in the theme of the art, the development of that theme, or in the actual production of that art," Canavan says. "Many of the artists ended up doing classes on art and the creation of art."

Consumer art created during those classes will be on display in the public auditorium's corridor.

Access to nature

Natural light is available in almost every area of the facility, giving patients continuous access to the healing benefits of nature during their recovery. "We tried to integrate natural light everywhere," Shaw says.

Every cluster opens to a courtyard that is used by consumers (figure 6). These garden spaces can be monitored by staff through line of sight as well as supplemental security cameras. Intensive resident courtyards are enclosed by multiple fences, including a six-foot nuisance fence, a pressure-sensitive, taut-wire fence, and a curved-top fence with climb-proof mesh. A single mesh fence surrounds the transitional resident courtyards and allows views through the lower portion, but is lined with climb-proof mesh at the top.


Two commercial-size greenhouses, located outside of each wing, are available for resident use. The greenhouses allow consumers to connect with nature, as well as learn skills that they may put to use after treatment. "Eventually, I'd love to offer a certificate program where folks could learn about lawn care or landscaping," Canavan says. "So not only are we helping people get back to nature, but also training them for a job skill when they leave the hospital."

Canavan adds that providing consumers with access to nature has made "a huge difference for folks," as the former Saint Elizabeths facility was not equipped to host outdoor activities.

With privacy, social supports, positive activities, and nature readily available, consumers are able to experience comfort that can often only be found at home. "One of the judges at the opening said, "This is the second best place for them to be, and the first is their home,'" Shaw says. "The second best place to be is an achievement."


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Title Annotation:DESIGN FOCUS
Author:Barba, Lindsay
Publication:Behavioral Healthcare
Geographic Code:1USA
Date:Sep 1, 2010
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