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Lighting for Behavioral Health by Lauren Roberts and Brienne Willcock

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Lighting for Behavioral Health by Lauren Roberts and Brienne Willcock

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Lighting for Behavioral Health by Lauren Roberts and Brienne Willcock

  1. 1. Designers Light Forum Lighting for Behavioral Health Lauren Roberts, LC, EDAC, IES Brienne Willcock, LC, MIES March 28th 2017
  2. 2. Credit(s) earned on completion of this course will be reported to AIA CES for AIA members. Certificates of Completion for both AIA members and non-AIA members are available upon request. This course is registered with AIA CES for continuing professional education. As such, it does not include content that may be deemed or construed to be an approval or endorsement by the AIA of any material of construction or any method or manner of handling, using, distributing, or dealing in any material or product. ___________________________________________ Questions related to specific materials, methods, and services will be addressed at the conclusion of this presentation.
  3. 3. This presentation is protected by US and International Copyright laws. Reproduction, distribution, display and use of the presentation without written permission of the speaker is prohibited. © Visa Lighting 2017 Copyright Materials
  4. 4. 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. Course Description
  5. 5. Learning Objectives 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:
  6. 6. 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”
  7. 7. Behavioral Health Stigma Understanding Self and Public stigma: Inaccurate portrayals of mental illness
  8. 8. • 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
  9. 9. Understanding
  10. 10. Serious Mental Illness (SMI): – Diagnosable mental, behavioral, or emotional disorder that in the past year has resulted in serious functional impairment Understanding
  11. 11. 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
  12. 12. Understanding
  13. 13. 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)
  14. 14. • 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 2017 Hospital Construction Survey http://www.hfmmagazine.com/articles/2750-hospital-construction-survey Understanding
  20. 20. 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”
  21. 21. 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
  22. 22. 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
  23. 23. Resources Culmination of 115 articles: • Relevant to BH facility design • Clear research methodology • Post 1960 data • Published in peer –reviewed journals
  24. 24. 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”
  25. 25. 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
  26. 26. 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)
  27. 27. Design Care zones • Patient Area Priority – Safety – Security – Cleanliness – Perception & Quality (visual comfort) and balance
  28. 28. Design Care zones • Staff Area Priority – Task accuracy – Productivity and alertness – Color quality & consistency – Cleanliness
  29. 29. 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
  30. 30. 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
  31. 31. Case Study Swedish Ballard Behavioral Health Unit, Seattle ZGF Architects Design
  32. 32. • 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 Study Swedish Ballard Behavioral Health Unit, Seattle ZGF Architects Design
  33. 33. 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”
  34. 34. 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
  35. 35. Daylight Trends
  36. 36. 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
  37. 37. 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
  38. 38. Our body clock Trends
  39. 39. 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...” DesignTrends
  40. 40. Dose, Duration, Direction DesignTrends
  41. 41. 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) DesignTrends
  42. 42. 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
  43. 43. Light & Health Studies 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
  44. 44. 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”
  45. 45. Behavioral Health Today Strategies
  46. 46. 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
  47. 47. 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
  48. 48. 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
  49. 49. • 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
  50. 50. This concludes The American Institute of Architects Continuing Education Systems Course
  51. 51. Designers Light Forum Lighting for Behavioral Health Lauren Roberts, LC, EDAC, IES lroberts@visalighting.com Brienne Willcock, LC, MIES bwillcock@illuminart.net March 28th 2017

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