A Conversation with Dr. Susan Swick, Physician in Chief and Medical Director, Ohana Montage Health
Editor’s Note: The number of people reporting behavioral health issues is on the rise, a crisis often compounded by lower-than-average funding, a lack of psychiatric beds and high occupancy rates of behavioral health facilities. This week we are posting interviews with experts in behavioral health, following an NBBJ-hosted panel discussion, to learn how different parts of the country are addressing the crisis.
NBBJ: What is the most impactful change that could be made to how behavioral health is handled in the United States?
Dr. Susan Swick: Psychiatric illnesses are common and treatable, often curable, but access to effective treatment remains maddeningly difficult in the United States. Yet even with effective treatments, being disease-free is not the same as being healthy. Building mental health can protect against disease and contribute to a life of meaning, with happier relationships, satisfying work and better physical health. Helping people to understand that good mental health is something each individual must develop will not only improve public health, but also diminish the stigma that remains around mental illnesses.
Finally, by helping parents to understand that mental health is something we help our children develop, rather than simply protecting them from mental illness, we contribute greater resilience in children and well-being in families. I have seen the power of these ideas at work in my patients and in my own family and am passionate about contributing to a health care system that builds health.
What is an innovative approach/treatment you — or another institution, city, state, country, etc. — are working on when it comes to behavioral health treatment?
The physical environment in which care occurs contributes profoundly to the well-being of patients and caregivers, just as classrooms affect students. Environments create our sense of what is possible, while raising or lowering the volume of what we are hearing in the moment. Environments — including the materials, presence of natural light, fresh air and sounds — have the power to be soothing and quieting or highly stimulating and activating.
In a windowless, crowded psychiatric emergency department in NYC, I experienced the power of music to quiet agitation and comfort the lonely: a cozy office filled with art, books and overstuffed furniture created the personal, warm and reliable setting that allowed effective psychotherapy to take place. In addition, an escalating child was able to go on a walk outside with a trusted adult and was able to naturally re-regulate themselves and not require medications or restraints to do so. The setting never does all the therapeutic work, but the right setting makes it possible for the clinician and patient to do the work together.
Traditional behavioral health facilities are sometimes seen as socially isolating or unpleasant to the senses. How should the design of behavioral health facilities transform to better serve patients (and their families and visitors) and staff?
Behavioral health facilities are still healthcare facilities, and they must ensure safety, including infection control, prevention of suicide and everyone’s safety around agitated or aggressive patients. But they must support quality care, also. I think design for highest-quality behavioral health care should create an environment which is soothing — with, for example, lower noise levels, natural materials, neutral colors, predictability and options for retreat or privacy. At the same time, they should be inspiriting or support a sense of possibility with higher ceilings, dynamic views, fresh air and ample, diffuse, natural light.
It is critical that these spaces include the potential for agency or choice, more so when patients spend more time in them. We hope that the skills which our patients build in these spaces will remain when they return to their homes, offices and schools. Therapeutic spaces should echo the spaces our patients inhabit. But they can still be special — spaces in which to pass storms and glimpse a new horizon.
What makes you hopeful when it comes to combating the behavioral health crisis?
If design can serve both the passing of a storm and the promise of an open horizon, all while promoting agency, it will be an extraordinary space. When we provide care and offer education about mental fitness in spaces that everyone is delighted to be in, it destigmatizes mental illness in ways that words and statistics cannot. When we provide care in humane spaces that promote autonomy and individualism, alongside nurturing connections between patient and clinician, between family members, among colleagues, between friends, and across a community, we support mental fitness in our patients, ourselves, our colleagues and our guests.