Designers Light Forum

Lighting for Behavioral HealthLauren Roberts, LC, EDAC, IESBrienne Willcock, LC, MIES

March 28th 2017

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In the next 3 years 14% of construction will be placed into specialty hospitals. At the top of the list is Behavioral Health among other project types, which will account for 46% of the total construction. The Affordable Care Act is also driving the trend toward outpatient construction as patient experience becomes more closely tied to reimbursement in a hospital than ever before. This presentation will help you understand about the types of patients, staff and family in these areas, their special needs and how to appropriately light for them. We need to change the institutional public perception of mental health illnesses and creating beautiful deserving spaces is one step in the right direction.

CourseDescription

LearningObjectives

1. Understand the behavioral health population and construction needs.

2. Review codes, guidelines and relevant resources one should use when designing behavioral health

spaces.

3. Show examples of successful designs and review case studies.

4. Critically review lighting trends such as circadian lighting and possible risks and benefits in behavioral

health spaces.

5. Develop strategies for the implementation of lighting quality factors to promote emotional well-being.

At the end of the this course, participants will be able to:

Understanding

• The people• History• Construction

needs

Resources

• Codes• Guidelines• Where to

look & who to lean on

Design

• Case Studies

• Examples of what works

Trends

• Risks and Benefits lighting

• Circadian thinking

Strategies

• Implement• Advocacy

of the “right light”

Behavioral Health Stigma

Understanding

Self and Public stigma: Inaccurate portrayals of mental illness

• She has spent over 365 days in her lifetime, cumulatively, in inpatient behavioral health care in 5 different hospitals.

• When asked about light:– I wish I had more control.– It feels punishing. – I wish my food looked better. – The lighting affects my mood, I think, I’m not very

optimistic when it’s too dark.

Understanding

Understanding

Serious Mental Illness (SMI):– Diagnosable mental, behavioral, or emotional disorder

that in the past year has resulted in serious functional impairment

Understanding

Diagnosis and variations:

• anxiety disorders• attention deficit hyperactivity disorder• autism spectrum disorders• bipolar disorder• borderline personality disorder• depression• eating disorders• prevention• Schizophrenia• Substance abuse• suicide prevention

Understanding

Understanding

Inpatient vs. Outpatient treatment:

SMI divided by Global Assessment of Functioning (GAF)

Understanding

(2009 National Survey on Drug Use and Health 2009, Substance Abuse and Mental Health Services Administration)

• ACA was the largest expansion in behavioral health coverage in a generation.

• Every year, about 1 in 5 American adults suffers from some mental illness, enduring conditions such as depression, bipolar disorder or schizophrenia.

Understanding

Behavioral Health Building Types• Psychiatric Hospitals• Psychiatric Units in a General Hospital• Alcohol and Addiction Treatment Facilities• Behavioral Health Clinics and ED’s with psychiatric specialties

Understanding

Construction Shortages• Lack of inpatient beds in all psychiatric hospital settings• Patients have no where to go but the ED

– Where would YOU go??• As a result psychiatric bed shortages and • Increased use of EDs for acute episodes

Understanding

Construction Outcomes• Outpatient facilities provide a lower cost and community integration

– Helps to change the stigma!• Tele psychiatry is filling gaps • Less patients have to go to the ED• 23 Hour observation units in psychiatric EDs are becoming more common

– This allows clinicians to determine if the patient should be admitted for care• Crisis stabilization units are emerging as a solution to acute psychiatric needs

– Diverting psychiatric or crisis cases away from EDs. – Keeping adults from jail and juveniles from detention centers.

Understanding

2017 Hospital Construction Survey• The survey comprised more than 240 hospitals nationwide, about evenly split

among rural, urban and suburban facilities.• Nearly one-third of the survey’s respondents are undertaking specialty hospital

construction projects• 50 % of those say they are building or are planning to build behavioral health

centers/psychiatric hospitals in the next 3 years

Understanding

2017 Hospital Construction Survey

http://www.hfmmagazine.com/articles/2750-hospital-construction-survey

Understanding

Understanding

• The people• History• Construction

needs

Resources

• Codes• Guidelines• Where to

look & who to lean on

Design

• Case Studies

• Examples of what works

Trends

• Risks and Benefits lighting

• Circadian thinking

Strategies

• Implement• Advocacy

of the “right light”

Existing Guidelines– Patient Safety standards, material and systems guidelines

• Recommended by the New York State Office of Mental Health – Design Guide for the Build Environment of Behavioral Health Facilities

• Distributed by the National Association of Psychiatric Health Systems– Mental Health Facilities

• VA Design Guide– FGI Guidelines– IES Handbook

Resources

Codes Needed

• Impact resistance standards– For walls we have ASTM standards but what about for lighting fixtures and

polycarbonate?– Is ¼” really necessary if stronger 1/8” thick polycarbonate exists?– How about if we bend the poly and make it more rigid, then what?– How tough is tough enough and how is that measured?

• Should fixtures fall under certain safety standards?

Resources

Resources

Culmination of 115 articles: • Relevant to BH facility design • Clear research methodology• Post 1960 data• Published in peer –reviewed journals

Understanding

• The people• History• Construction

needs

Resources

• Codes• Guidelines• Where to

look & who to lean on

Design

• Case Studies

• Examples of what works

Trends

• Risks and Benefits lighting

• Circadian thinking

Strategies

• Implement• Advocacy

of the “right light”

Design

Patient Participation: Critical to treatment success: “ …environmental psychologists agree that the physical

environment can reinforce and encourage appropriate behavior.”

In 2012 a study showed these design attributes can decrease patient aggression: • Availability of private rooms• Better acoustics • Window views & nature art• Higher daylight exposure• “Home-like design”• Visibility of staff from common areas

Design

Luminaire Design Priorities – Narrow selections• Anti ligature – fixed, and load release• Tamper resistant • IP65 common (not required) • Color clarity – CRI, TM30• Color consistency – Luminaire to Luminaire

– Homogenous feel between the color of patient rooms and color of patient gathering areas

• Static color (more later)

Design

Care zones• Patient Area Priority

– Safety– Security– Cleanliness– Perception & Quality (visual comfort) and balance

Design

Care zones• Staff Area Priority

– Task accuracy– Productivity and alertness– Color quality & consistency– Cleanliness

Designing Forward• Creating “normalized” environments • Flexibility and multipurpose treatment spaces • Community spaces to be flexible, open and social• Design to promote patients participation in therapeutic activities and reduce the amount of time

spent alone in their rooms• Access to outdoor spaces, view to outdoors and access to natural light• Patients to have control of the environment including furniture and lighting as much as possible.

Design

Suggested Light Levels• Bedroom

– General – 5FC– Desk – 40FC– Bathrooms – 30FC Grooming– Bed Headboard Reading – 20FC

• Seclusion Rooms– Cleaning 30FC– Observation 10FC

• Group Therapy/Education– General - 20FC– Table Lighting - 50FC

• Hallway – 5FC

Design

Case StudySwedish Ballard Behavioral Health Unit, SeattleZGF Architects

Design

• Patients do not have access to the outdoors

• Communal space was a the focus for this lighting concept and to help bring people together

• Circadian lighting that mimics the sky that allude to relationships of nature

• Finishes and lighting that grounds patients with a familiar sense of orientation

• Lighting with intent to improve sleep, mood and increase pharmaceutical efficacy

• Positive nurse feedback has been received since opening

Case StudySwedish Ballard Behavioral Health Unit, SeattleZGF Architects

Design

Understanding

• The people• History• Construction

needs

Resources

• Codes• Guidelines• Where to

look & who to lean on

Design

• Case Studies

• Examples of what works

Trends

• Risks and Benefits lighting

• Circadian thinking

Strategies

• Implement• Advocacy

of the “right light”

Light & Color• Color Temperature – The color of light at a certain temperature• Black body locus – A physical body (like iron) that absorbs all incident electromagnetic radiation or light. It emits

a spectrum that is determined by the temperature.

Trends

Daylight

Trends

Blue Light– From 380nm to 500nm– Boosts alertness– Heightens reaction times– Helps memory and cognitive function– Elevates mood– Increases feeling of well being– Suppresses melatonin

– Short, High energy wavelength – can cause glare

– Sources include the sun, digital screens, electronic devices, FLR and LED Lighting

– Can cause eyestrain, headaches and mental fatigue if over exposed

– Can cause retinal damage

Trends

Red/Amber Light

• Does not disrupt sleep cycle• Increases alertness without suppressing

melatonin• Which means red/amber lighting will not

disrupt shiftwork or their work

Trends

Our body clock

Trends

Circadian Lighting: Lighting for Behavioral Health is different.

• “How circadian lighting can improve health, sleep and mood”– “Thanks to advancements in color tuning and lighting control technology, it is now

possible to imitate the complex nature of daylight indoors.”

• “The Health Benefits of Human-Centric Lighting Using LEDs”– “At a more sophisticated level, HCL-focused custom LED systems have been installed in

hospitals and assisted-living facilities to help maintain patients’ natural sleep cycles, reduce anxiety during examinations, and aid recovery by providing warmer or cooler white light as appropriate.”

• “How Lighting Affects Mood”– “Research reveals that even light color can affect our emotions and circadian

rhythms...”

Design Trends

Dose, Duration, Direction

Design Trends

Circadian Stimulus • What can you do?

– Request the SPD of the light sources under consideration (rely on more than CCT)• Higher CCTs (5000-6500K) may generally provide greater CS – but there’s exceptions. • Two light sources rated for the same CCT might provide very different CS values depending

on their SPDs. • Design for vertical illuminance at the eye, not just horizontal illuminance on the work plane. • Choose luminaires that provide the best vertical to horizontal balance • Research & Collaborate.

(reference: http://www.lrc.rpi.edu/resources/newsroom/LD+A_CircadianStimulus_Oct2016.pdf)

Design Trends

Light & Health

What we know:– Light impacts performance by enabling performance of visual tasks– Can assist with circadian stimulus – but we need more research on the impact in Behavioral

Health Units – Affects mood and perception – Impacts critical chemical reactions in the body

Free Download - https://www.healthdesign.org/sites/default/files/CHD_Issue_Paper2.pdf

Trends

Light & HealthStudies show:

– Higher light levels link to better performance of visual tasks • Light requirements increase with age• Reduced medication dispensing errors in pharmacies

– Controlling the circadian system in hospitals (general)• Reduces depression• Decreases length of stay• Improves sleep• Less agitation among dementia patients• Eases pain• Improves nigh-shift work among staff

Trends

Understanding

• The people• History• Construction

needs

Resources

• Codes• Guidelines• Where to

look & who to lean on

Design

• Case Studies

• Examples of what works

Trends

• Risks and Benefits lighting

• Circadian thinking

Strategies

• Implement• Advocacy

of the “right light”

Behavioral Health Today

Strategies

Strategies

Lighting for Behavioral Health is different: Overview

• Tunable White isn’t prescriptive: Dynamic white not synonymous with “health” or “well-being” in all environments

• Lighting beyond aesthetics: Consider the population, the outcome, and the potential risks

• Consider nuances of sleep patterns, length of stay, purpose of stay and other key design elements:– Food, Socialization, Visualization of Self Image, Autonomy,

Medication Side Effects• Utilize research-based design techniques and talk with

practitioners

Consider Sleep: First do no harm?

Consider the role of sleep independently from circadian or tunable lighting systems and design to impact: • Sleep problems are more likely to affect patients with psychiatric disorders than people in the

general population.• Sleep problems may increase risk for developing particular mental illnesses, as well as result from

such disorders.• Treating the sleep disorder may help alleviate symptoms of the mental health problem.

(reference: http://www.health.harvard.edu/newsletter_article/Sleep-and-mental-health)

Strategies

Strategies

Lighting for Behavioral Health is different: Specification• Select luminaires based on safety, security & guidelines• Consider the emotional and aesthetic impact of lighting as it relates to other design

features

• Population statistics: http://www.newsweek.com/nearly-1-5-americans-suffer-mental-illness-each-year-230608• ACA & Mental Health Coverage: https://www.mentalhealth.gov/get-help/health-insurance/• Sleep and Light: http://healthysleep.med.harvard.edu/healthy/science/how/external-factors• Decision Making: http://www.medicalnewstoday.com/articles/273064.php• IES Guidelines:• Design Guide for the Build Environment of Behavioral Health Facilities: Distributed by the National Association of Psychiatric Health Systems• Mental Health Facilities - VA Design Guide• Mental Health in America Report - http://www.mentalhealthamerica.net/issues/mental-health-america-printed-reports?sid=160893• National Alliance on Mental Illness https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers• Guidelines for Psychiatric Hospitals http://array-architects.com/revisions-to-the-2014-guidelines-for-psychiatric-hospitals/• Design Guide for Behavioral Health https://www.fgiguidelines.org/wp-content/uploads/2016/04/DesignGuideBH_7.1_1604.pdf• Research: Behavioral Health https://www.healthdesign.org/system/files/chd428_researchreport_behavioralhealth_1013-_final_0.pdf• Design for Behavioral Health Facilities https://www.healthdesign.org/chd/knowledge-

repository/design_research_and_behavioral_health_facilities• Healthcare Magazine: http://www.hfmmagazine.com/articles/1449-behavioral-health-design-regulations• Healthcare Magazine: http://www.healthcaredesignmagazine.com/projects/natural-remedy-biophilic-design-supports-behavioral-health/#slide-

5

References

This concludes The American Institute of Architects Continuing Education Systems Course

Designers Light Forum

Lighting for Behavioral HealthLauren Roberts, LC, EDAC, IESlroberts@visalighting.com

Brienne Willcock, LC, MIESbwillcock@illuminart.net

March 28th 2017