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.
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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.
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.
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"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).
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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.
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).
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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. …