The construction project on the southwest corner of Miller and Earll Roads in Scottsdale looks like a stylish hotel. Gray masonry walls, layered like an Arizona canyon, are intersected by vertical windows stretching two stories high. Perforated steel “fins” shade smaller windows; trees peek above courtyard walls; and desert shrubs add color to the exterior.
However, the building is actually an expansion of the existing Banner Behavioral Health Hospital, and the team behind it hopes the building will also expand treatment options for Arizonans who need psychiatric help.
The completed facility, which will open in four stages beginning in August, will have room for 156 patients by early 2018 — an increase of 60 beds over the 96 the hospital had before construction began last year.
That increase marks an important step forward, said Brian Beutin, CEO of Banner Behavioral Health, and supplements Banner’s other behavioral-health sites in Phoenix, Glendale and Sun City.
It also bucks a trend, because inpatient psychiatric treatment options have been shrinking for years — and not just in Arizona. State-run psychiatric hospitals, which reached a nationwide total of 558,922 beds in 1955, were down to 37,679 in 2016, according to the non-profit Treatment Advocacy Center, which tracks access to mental-health care. Although private hospitals have tried to fill the need, the problem has gotten even worse in recent years due to a surge of people seeking help for opiate addictions.
And the shortage is particularly severe in Arizona. A 2017 report by the Arizona Health Care Cost Containment System found only 1,503 inpatient psychiatric beds available to serve the state’s population of 6.6 million residents, and Treatment Advocacy Center ranks the state next to last for availability of care.
Waiting for a spot
Although the National Institute of Mental Health estimates that one in five Americans will need behavioral-health treatment in any given year, not all will require inpatient care. But those who do can spend days trying to find a facility with space to accept them.
The dearth of beds has also lengthened wait times at hospital emergency departments, which have seen a dramatic increase in the number of people seeking help for addiction, depression and other mental illnesses. A 2016 survey by the American College of Emergency Physicians found that three-quarters of emergency room doctors saw psychiatric patients at least once during each shift, and half said they had such patients “boarding” in the emergency department every day while waiting for space in a psychiatric facility.
And that wait isn’t short. Psychiatric patients are twice as likely as other patients to be in an emergency room for more than six hours, with an average of between 12 and 24 hours — which not only delays care for them, but drives up wait times for everybody else, too.
More and better space
But in expanding the Scottsdale campus, Beutin said Banner didn’t just want to add beds, it also wanted to create better treatment for patients.
To do that, the hospital hired local architectural firm Orcutt Winslow, which specializes in medical design; consulted with leading experts on mental health and building design; and toured other facilities for inspiration — and tips on what to avoid.
The result is a pair of X-shaped wings tucked next to the existing inpatient and outpatient facilities — which are also being updated and expanded. The two-story wings add a total of four 24-bed patient units, arranged so one leg of each X holds administrative offices, while the other three provide private bedrooms for patients. A nurses station in the center of each unit will give staff a view of the hallways and common rooms, so they can keep an eye on patients without being obtrusive.
Project architect Suzanne Snow Severino, of Orcutt Winslow, said her goal was to balance security with serenity: “It’s important that the staff can watch everybody, but we also wanted to make sure the space doesn’t feel institutional.”
The finished building, with a window in every bedroom and seven new courtyards, cost $36.5 million, which included site upgrades designed to benefit the surrounding neighborhood, like burying power lines, rerouting sidewalks and adding landscaping.
Beutin acknowledged that the price tag was higher than it would have been for a traditional floor plan, but he said amenities like increased daylight and access to nature would pay off for patients.
Access to nature
The overall design was based on biophilic principles, explained Snow Severino, “which is this idea that we all have an inherent affinity for nature, so there’s a view to nature from nearly every room, and also different outdoor spaces to invite people outside.”
The courtyards include a variety of seating arrangements — one even has a potting bench — and large windows brighten the interior, which Beutin said was intended to provide a healing environment.
“We wanted it bright and airy, because that’s often the opposite of where they’ve been emotionally.”
An emphasis on light and nature “is the key to all of this,” agreed Dr. Gagan Singh, the hospital’s chief medical officer.
“Everything was about what is going to provide the best experience and the best results for the patients — what is the most healing for them,” he explained. “This is like our surgical suite; this is where we do all the magic.”
Designed for healing
In addition to nature, Singh noted that the space offered patients a variety of spaces — from private to public — and a range of activities to choose from in addition to therapy sessions and medical care. Most patients stay for about a week, during which time they try to “jump-start” their recovery and re-establish healthy behavior.
“When people are coming here, it’s because their life isn’t working for them,” he said, “so a large part of helping them is answering: ‘What are you going to do with yourself moving forward? What are you going to do when you’re alone? What are you going to do in groups?'”
For that reason, each of the four new units is organized into a small “neighborhood,” with a living room, kitchenette, laundry room, meeting rooms and multipurpose rooms, which can be used for everything from family visits to art therapy to yoga.
The new facility also includes a central cafeteria, where patients can serve themselves healthy foods, as well as an indoor gym and outdoor sport court, which Beutin hopes will provide another type of therapy.
“Physical activity is definitely part of healing,” he explained. “It’s very important for serotonin levels and endorphins. You can only get so well even on medication if you’re sitting in your room in the dark.”
Also important, he said, is the large art collection that Banner will be installing throughout the new spaces, including many pieces from Arizona artists.
“Imagine you’re here for a week,” Buetin said. “You can go outside in the courtyard, but you can’t leave. Art is really important for visual stimulation. And we’ve got different art everywhere, including wood and metal pieces, which you can touch.”
The benefit of other design elements is less obvious, but just as carefully considered — like the length of the hallways, which are 90 feet long, said Snow Severino, “because that’s the maximum distance at which you can recognize a human face, which is important for staff.”
Similarly subtle safety features are integrated throughout the patient spaces, from the recessed handrail in the stairwells that has no gap where anything could be attached, to the flush-mounted door handles that offer the same precaution. Door frames can be released so staff can open doors outward if they’re ever blocked from the inside. Lighting fixtures are all recessed and secured with torque-set screws. And the windows are all made of impact-resistant glass.
Although the ultimate goal is effective treatment, Beutin said, safety is always paramount, “because the primary reason why someone seeks treatment here is they’re a danger to themselves or someone else.”
Who needs help
As for who those people are, Singh said: “It could be anyone. The people coming here are all family and friends of all of us.”
“This isn’t a ‘they’ group. It’s ‘us.’ “
He estimated that half of the patients who come to the Scottsdale facility live in the East Valley and are seeking treatment either on their own or at the recommendation of a psychiatrist. The other half come from Banner’s 19 emergency departments — including the Phoenix area and beyond, from Casa Grande to Payson.
They’re dealing, Beutin said, with “all kinds of things:” depression, anxiety, substance abuse, bipolar disorder, mania, psychosis. All need help as urgently as possible, he said.
Although the new space will be complete by early August, only one unit will open at a time, allowing Beutin time to hire and train the 120 additional staff and psychiatric providers who will be needed.
Although the new wings will house only adult patients, the facility also treats adolescents and — because the demand for adolescent psychiatric services also surpasses the available beds — Beutin plans to shift them from the current 16-bed unit to one of the larger units formerly used only for adults. It will add up to only another eight beds, but it will still help, he said.
“You have people showing up around the clock,” he explained, “and you have people being discharged, too. But there’s such a backlog that the number of people sitting in emergency rooms waiting for a room is growing.”
But soon, Beutin said Banner Behavioral Health hopes to make “a significant change” in that backlog.
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