Architect uses science to improve mental health care

Architect Kevin Turner hopes that a recently opened Charlotte mental health care facility will shed light on the impact of well-designed surroundings on patient outcome.

The design of the 12-acre HopeWay residential facility in south Charlotte focuses not only on light, but on textures, color, patterns, materials, layout and landscaping.

Turner, who is based in Charlotte, is the behavioral health care practice leader for Perkins+Will, a global firm with 23 offices and 2,000 employees throughout the U.S.

He was tapped by HopeWay, a nonprofit treatment center devoted to mental health care and education, to renovate an old building at 1717 Sharon Road West in south Charlotte. About 400 people attended the center’s grand opening Sept. 21, and patients will likely begin arriving in November.

“They had this amazing vision,” said Turner. “But it was an old building that was a little depressing. The big question was, ‘What can we do with it?’”

Hope springs

HopeWay was the vision of Bill and Betsy Blue, who faced the challenges of finding appropriate care for someone close to them.

“We saw that we had no residential treatment in this region,” said Bill Blue, who co-founded HopeWay with his wife and serves as chairman of the board. “And we had seen where it had been beneficial elsewhere.”

The center, which will offer residential and day treatment, will provide services that can prevent a person from reaching the point of needing acute care as well as a step down from acute care to help ease the transition.

The Blues began researching the idea in summer 2013, and by March 2015 had raised enough money to purchase the property.

“At the heart of that is a real recognition of the need in our community by those who have been touched by mental illness, so we were successful in raising money for the property and in raising tax-free bond money,” Bill Blue said.

“We visited several facilities in New England and Atlanta and saw where a therapeutic environment really contributed to better outcomes and people getting better and staying better longer,” he said. “We wanted a very warm, nurturing environment as opposed to an institutional hospital setting.”

After receiving proposals from half a dozen companies, HopeWay chose Perkins+Will for the design work.

“Perkins and Will stood out for two reasons,” he said. “They really understood … how this type of care needs to be distinguished from institutional, block facilities. And not only did Perkins and Will have an expertise in health care, they had a real expertise in behavioral health care, and the lead partner was moving to Charlotte, so that was very serendipitous for us.

“We did not even move an exterior wall, but it was a major renovation of the interior. It’s just wonderfully designed for our use. So we are excited to start operations in November.”

The contractor for the project was Shelco.

Said Turner, “They really got what we were trying to do and were ‘all in’ on the process.”

On a mission

Turner’s first foray into integrating design elements into mental health care began in 2003, when he and his wife moved to Durham when she was pursuing a master’s degree in divinity at Duke University.

He went to work for The Freelon Group, which later became part of Perkins+Will, and was part of a team designing the North Carolina Central Regional Hospital in Butner for the state.

“The more I worked with the users and the clients and got to understand what problems we were trying to solve and what we were trying to do… it really captured me,” he said. Now, with his wife, Kathy, working as an advocate for those navigating mental health challenges, “It’s really become a kind of personal mission for both of us.”

One thing he learned was, “You don’t need to resort to a prison-like design to keep people safe.”

The design of HopeWay focuses on connecting clients to nature.

Raised garden beds and a greenhouse were designed and built by Bloc Design on the premise that “horticulture therapy stimulates thought, exercises the body and encourages awareness of the external environment,” according to the presentation Turner made at the center’s grand opening.

Colors, textures, patterns and materials were chosen to represent nature and healing, including woods and soft earth tones.

“I’ve been very interested in the way environment affects human beings,” he said.

Seeing the light

That led to his forming a research lab with a collaborator and friend, Eve Edelstein, a San Francisco-based architect with a Ph.D. in neuroscience. The virtual Human Experience Lab is one of 10 Perkins+Will labs that focus on turning science into beneficial design.

The purpose is two-fold, said Turner: “Use projects and design opportunities that we have to learn more and test new ideas … and taking that technology and implementing it.”

One of the results of the collaboration is a new focus on lighting.

“The basic theory is that different wavelengths of light correspond to different times of the day, and our bodies respond,” he said.

The concept of enhancing circadian rhythms with lighting is being used elsewhere as well, such as in the Charlotte Marriott Center City hotel, which recently renovated rooms so that guests may adjust lights that signal the body to produce light-inducing melatonin or to create alertness. In addition, the rooms offer “dawn simulators” that slowly increase levels of light and sound to gently wake sleeping guests.

“It’s really applicable to any place that people are going to spend a lot of time,” said Turner, including office buildings and educational and health care facilities. “It definitely can make a big difference.”

With incandescent and fluorescent lights, “Lights just came in the wavelength they did,” Turner said. “You could adjust the lights’ intensity, but not the frequency.”

Recent advancements in the technology of light-emitting diodes (LEDs) now permit their use in broader applications than in the past.

“You can have any wavelength of light that you want,” said Turner. “Now you have to choose, there is no default. As designers, we’re obligated to understand the choices that we make. And they can last for 20 years, so you need to make the right ones.”

At HopeWay, the designers used a variety of wavelengths in different spaces, depending on the purpose.

In the bedrooms, for example, the desk lamps have whiter bulbs for tasks, while the night stand lamp holds a softer yellow-toned bulb. The overhead lights are dimmable. Instead of shining down, some fixtures shine up to create more of a natural lighting effect.

“What we believe is going to happen is that the resident will intuitively select the lighting they are most comfortable with. We tried to carefully plan it out.”

In other rooms, which are used for both intimate group therapy sessions as well as art and education purposes, the designers chose a combination of lights that could be turned on separately or in a balance to duplicate the wavelengths that are most soothing or more energizing.

Turner said his firm will be holding a training seminar for the staff so they understand the lighting choices, then check back to see how the lighting is used and whether it worked for its designed purpose.

One of the greatest challenges faced by designers in care facilities, he said, is how to adjust the lighting so that the needs of sleeping patients and night-shift employees are equally considered.

“It’s a complicated decision,” he said. “I’m a big believer that if the staff is not happy and comfortable, nobody is.”

Science vs. perception

Turner’s also a big believer in making science-based decisions.

“In health care in general, evidence-based design is a powerful force,” he said. “In behavioral health care, it’s less so. One clinic will say this way works best, another will say, ‘This is how I think it works.’ There’s still a lot of people trying to figure out what the best practices are in the treatment of mental health care.”

For example, he said, a commonly held belief is that the color red causes aggression.

“But no one has ever done a study,” he said. “What they’ve done has put in an FMRI (functional magnetic resonance imaging) machine and seen what part of brain is activated. There’s no real evidence that that extrapolates.”

Design decisions based on research, he said, include patterns on flooring. Dots and lines in nonlinear patterns, for example, can cause anxiety. Simpler patterns are more calming.

Coatings on windows to reduce heat can create dot patterns that may cause reactions in people on the autism spectrum, he said.

That’s where the lab and the firm’s collaboration with Edelstein come in.

The company is embarking on a “fairly ambitious research project,” in which they will evaluate design decisions made at the state’s three regional psychiatric hospitals and try to determine the effect of those decisions on patient behavior and outcomes. The hospitals are Central Regional, Broughton in Morganton, and Cherry in Goldsboro.

“At Cherry, they wanted a warmer space than we designed at Central, and used a lot of wood laminate. The staff believed it would improve overall outcome.

“We’ll measure things like outbursts and violent acts and where they happened and see if there’s a correlation,” he said, as well as conducting patient surveys.

“We’ll measure whether the impact of a warm, wood-like finish was worthy of the investment. I’m excited to compare the outcomes.”