Academy of Architecture for Health

The ASHE/ICC Ad-hoc Committee on Hospitals is looking for information regarding the definition of Psychiatric Hospitals that distinguish it from a general hospital.  Part of the direction that this committee is moving is to isolate hospitals from other health care types that are now included under the general category of hospitals and nursing homes (I-2).

Beyond the issues of levels of care provided and licensing, what are the physical characteristics that differentiate Psych Hospitals from General Hospitals?

Dave
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David Collins FAIA
Preview Group, Inc.
Cincinnati OH
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Please allow me to clarify the intention if the ICC's Ad-Hoc Committee for Healthcare, of which I am a member representing ASHE.

Within the I-2 occupancy type, there is a desire to establish two conditions, mainly to differentiate between acute care facilities (ie hospitals) and more residential types (ie nursing homes).  This is a similar approach as the one taken up with the ICC's CTC Committee for other Institutional occupancies.  Nursing homes, detoxification facilities, and foster care facilities would be one condition, with hospitals as another.  The discussion as it relates to psychiatric hospitals is which condition it more relates to within I-2 (NOT to isolate it out), and the current thinking is that it would related more to hospitals due to psychiatric care being delivered.  Licensure is central to this distinction, as most states and CMS use similar rules for regulating both types.

Any other feedback is welcomed as the Ad-Hoc Committee continues to discuss and debate this issue.  Many thanks.

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Jeffrey O'Neill AIA
Senior Project Manager
University of Pennsylvania Health System
Philadelphia PA
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The physical environment needed for a psychiatric hospital is vastly different than a general hospital.  The reason for this is that the two function completly differently.

In general hospitals the patient room is the primarially location of the patient receiving treatment. Medications, most types of treatment and food are brought to the room.  Visitation largely takes place there also.  It is where the inpatient spends the vast majority of his or her time.

In psychiatric hospitals the patient is discouraged form spending time in his or her room.  It is used primarially for sleeping.  Most treatment, dining, visitation and leisure time is spent in other aras of the unit such as group rooms, dining rooms quiet and noisy activity rooms that are not needed or present in general hospitals.  In addition, the risk of patients inflicting physical harm to themselves or others require unique attention to opportunities for hanging, breaking glass and many other hazards.

In my opinion, it belongs in I-2, but as a separate group entirely.
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James Hunt AIA
Behavioral Health Facility Consulting, LLC
Topeka KS
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Jim is absolutely right, but there are other distinctions as well. 

1.  In a psychiatric hospital the patients are mostly ambulatory, so requirements for corridor width and door swings may not be as applicable. 
2.  The biggest issue not addressed in the code currently has to do with special locking arrangements.  Leaving it to local code officials puts pressure on them to  rule on an area that they don't have expertise in.  It can also lead to inconsistent enforcement from one jurisdiction to another.  We have developed language that most code officials are comfortable with and allows the hospitals to function both safely and effectively.
3.  While all hospitals depend on staff to manage patient movement in an emergency, this is especially true in a psychiatric hospital with a high level of security.  Special provisions for exit signs to support code allowed operational procedures would be a welcome change.
4.  Of course it would be great if we could standardize the requirements of the ICC, NFPA and te AIA guidelines to make compliance a whole lot easier!

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Kevin Turner AIA
Architect
The Freelon Group, Inc.
Durham NC
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Original Message:
Sent: 09-30-2011 09:27
From: James Hunt
Subject: Psychiatric Hospitals

The physical environment needed for a psychiatric hospital is vastly different than a general hospital.  The reason for this is that the two function completly differently.

In general hospitals the patient room is the primarially location of the patient receiving treatment. Medications, most types of treatment and food are brought to the room.  Visitation largely takes place there also.  It is where the inpatient spends the vast majority of his or her time.

In psychiatric hospitals the patient is discouraged form spending time in his or her room.  It is used primarially for sleeping.  Most treatment, dining, visitation and leisure time is spent in other aras of the unit such as group rooms, dining rooms quiet and noisy activity rooms that are not needed or present in general hospitals.  In addition, the risk of patients inflicting physical harm to themselves or others require unique attention to opportunities for hanging, breaking glass and many other hazards.

In my opinion, it belongs in I-2, but as a separate group entirely.
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James Hunt AIA
Behavioral Health Facility Consulting, LLC
Topeka KS
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Thomas Fannin AIA
FKP Architects, Inc.
Houston TX
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It goes much further. While we are used to the restrictions on door swing and size needed for medical hospital space, with mental health facilities it becomes a different question because of the potential for patients barracading themselves in rooms with in-swinging doors.

It gets more complicated than simply separating psychiatric hospitals into a new category since much of psychiatric care is given in general hospitals in dedicated units. So we need to apply rules to both free-standing and unit-within-hospital situations. And then, those of us who have been around the bush a few times, can recall all of the psyc units we have had to convert to medical and vice-versa. Rarely is it done gracefully. Finally, there are the units which are for "medically compromised" psyc patients and need both sets of criteria applied. With truly secure units, such as a forensic psyc unit, you must also look at the code categories for correctional facilities.

As for the provision of the socilization and activity space on units, it must be positioned so that it is observable and has a staff presence even on evennings and weekends if it is to be truly usable by the patients. This is an added complication if the staff control station must also have visual control of all patient room doors, seclusion facilities  and control over unit access. CCTV helps, but "presence" is invaluable.





Original Message:
Sent: 10-19-2011 08:51
From: Kevin Turner
Subject: Psychiatric Hospitals

Jim is absolutely right, but there are other distinctions as well. 

1.  In a psychiatric hospital the patients are mostly ambulatory, so requirements for corridor width and door swings may not be as applicable. 
2.  The biggest issue not addressed in the code currently has to do with special locking arrangements.  Leaving it to local code officials puts pressure on them to  rule on an area that they don't have expertise in.  It can also lead to inconsistent enforcement from one jurisdiction to another.  We have developed language that most code officials are comfortable with and allows the hospitals to function both safely and effectively.
3.  While all hospitals depend on staff to manage patient movement in an emergency, this is especially true in a psychiatric hospital with a high level of security.  Special provisions for exit signs to support code allowed operational procedures would be a welcome change.
4.  Of course it would be great if we could standardize the requirements of the ICC, NFPA and te AIA guidelines to make compliance a whole lot easier!

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Kevin Turner AIA
Architect
The Freelon Group, Inc.
Durham NC
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