Designing for Diversion

By Zulay Marti and April Vacca

A Case Study for Crisis Stabilization Center Health Facilities

In the Summer of 2023, Frederick County, Md., opened its doors to phase I of its new 24/7 Crisis Stabilization Center, which provides immediate care to individuals experiencing behavioral health emergencies.

This crisis stabilization center plays a crucial role in the county by serving as a vital resource for residents of Frederick County experiencing various crises. Its importance stemmed from providing a safe and supportive environment for residents in distress, offering immediate assistance, and fostering mental health stabilization. With a mission to design architecture that contributes positively to individuals’ lives, Dewberry recognized the profound impact its work could have on the community’s well-being, particularly in the context of crisis care support. The firm designed a space that was functional but empathetic and calming; and highlighted the firm’s dedication to enhancing overall resilience and recovery of those in need within Frederick County.

As Frederick County stated in a press release issued October 20, 2022, “The center will provide immediate care to people experiencing a behavioral health emergency, such as substance use disorder or mental health concerns, and connect patients to ongoing community-based care.” The Mental Health Association (MHA) stated, “The second phase will begin in early 2024 and involves further renovations to the facility, as well as adding additional crisis stabilization services to the center.”

Introduction:
In this case study, we delve into the intricate process of designing a 24/7 crisis stabilization center, where the convergence of architecture and healthcare principles is paramount. The objective was to create a space that fosters healing, prioritizes staff and client’s wellbeing, connects Frederick County residents to ongoing community-based care, and harmonizes form and function.

Privacy and Dignity:
A fundamental concern in behavioral health crisis-care design is preserving privacy and dignity. Strategic layout planning is pivotal. The architectural team emphasized discrete spaces for confidential consultations, men’s, women’s, and family private bedrooms, and showers for overnight visits (which will be completed as part of phase II); a seclusion room that removes external stimuli, providing an opportunity for a child or adult to reset and experience a sense of calm; and private recliner areas for clients needing an immediate place to de-escalate; and private offices configured with the desk closest to the door for immediate exiting, all while utilizing soundproofing materials to create a secure environment.

Safety Measures:
Ensuring the safety of staff and clients, both physically and emotionally, was a primary consideration. Architectural details included rounded corners on millwork to eliminate sharp edges, non-intrusive surveillance to help track client behavior and keep employees safe, and alarms on entry and exit doors. Ligature-resistant door and cabinet hardware, toilet and bathroom accessories, window blinds, and plumbing fixtures are used to reduce self-harm behavior. Safety was top of mind in the furniture selection: no sharp corners, no loose or removable parts, and weighted to minimize misuse, all reducing opportunities to conceal items or cause harm. The design aimed to create an environment that minimizes stressors and promotes safety and security.

Therapeutic Spaces:
The creation of therapeutic spaces played a vital role in the design process. The concept revolves around home-like environments that provide calm surroundings for immediate relief from crisis symptoms. As you enter, the reception counter provides a blank canvas for MHA to add their inspirational signage in three languages: “You are resilient in the face of challenges” and “In this space, you are safe and supported.” A recreational area was added with TVs and games for children and adults to entertain themselves while waiting for a crisis to pass. Natural elements were seamlessly integrated through abundant natural light, biophilic patterns in wall coverings and fabrics, and soothing aesthetics to create a serene atmosphere. The architecture aimed to provide a visually comforting backdrop, supporting the therapeutic process, and contributing to a sense of tranquility.

Ease of Care:
The facility embraced smart and caring solutions for communication. Telehealth spaces were integrated to facilitate remote consultations, a 24-hour call center to support crisis intervention, and a telephone reassurance program for Frederick County senior citizens that provides a regular phone call and a caring listener aimed to provide friendly conversation to those who may live alone or are homebound. The design aimed to balance ease of care and the humancentric approach to crisis care.

Collaboration for Success:
The success of this project hinged on support of the community, a client with a vision for positive change, and the collaborative efforts of architects, interior designers, consultants, and mental health experts. The team had regular meetings with the end users to make sure the architectural vision aligned with the facility’s functional needs. The result is a space that transcends the conventional boundaries of design, embodying a holistic approach to behavioral health crisis care.

Conclusion:
Designing a behavioral health crisis care facility requires a delicate balance between architectural aesthetics and the nuanced needs of mental health care. This case study highlights the successful fusion of privacy, safety, therapeutic elements, and ease of care, demonstrating the collaborative efforts in creating spaces that genuinely prioritize the well-being of Frederick County residents.

Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Guidelines for Behavioral Health Crisis Care quotes the impact of these facilities perfectly “In a recovery-oriented approach to crisis care, the risks of harm to self or others are recognized, but the basic approach is fundamentally different. Crises are viewed as challenges that may present opportunities for growth. When crises are managed in comfortable and familiar settings, people feel less alone and isolated with their feelings of anxiety, panic, depression, and frustration. This creates a sense of empowerment and belief in one’s own recovery and ability to respond effectively to future crises. A recovery-oriented approach to crisis care is integral to transforming a broken system. Not only must we expand crisis care, but we must forge a better approach to crisis care by ensuring implementation of fidelity to these best practice guidelines.”

References: https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf and https://perma.cc/8D8V-DXM4

Zulay Marti, AIA, NCARB is an Associate and Architect for Dewberry, and is based in Orlando, Fla. April Vacca, RID, LEED AP ID+C, WELL AP is an Associate Principal and a Senior Interior Designer for Dewberry, and is based in Fairfax, Va. 

Editor’s Note: This article originally appeared in the March/April 2024 issue of Correctional News.