Tammy Felker, RN, AIA
Let's commit more resources to behavioural heatlht
A Conversation with Dr. Curtis Wittmann, Associate Director, Acute Psychiatry, Massachusetts General Hospital
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. Curtis Wittmann: The biggest issue currently is a lack of resources. This crosses many domains, ranging from a lack of true parity, which makes recruitment of providers more difficult; a lack of places to refer patients; inadequate inpatient and state hospital beds; and a lack of social resources and programs, which impedes our patients’ ability to engage in treatment.
An increased availability of resources, both within the mental health field and as social supports, would allow for meaningful and novel approaches to be implemented. Until then, even in relatively resource rich-environments, we don’t have enough to offer our patient populations.
What is an innovative approach/treatment you — or another institution, city, state, country, etc. — are working on when it comes to behavioral health treatment?
At Massachusetts General Hospital we have been redesigning our dedicated emergency psychiatry space and increasing both our capacity and attention to patient comfort. We are moving to minimize the use of inappropriate clinical space and attempting to allow for a more open design to allow more patient interactions and increased programming while patients are boarding in the emergency department.
Concurrently, we are working to initiate treatment from the point at which patients arrive to the ED and are screened by emergency medicine. Both of these initiatives are designed to decrease the amount of boarding that takes place and the length of stay for patients who are boarding.
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?
There is always a balance between the need for safety on the one hand, and maximizing patient comfort, freedom and environments on the other. Increasing safe open spaces to allow for connection between patients, between patients and staff, and between patients and their families and visitors is critical.
Ideally these settings would make better use of natural light or, if possible, outdoor spaces — though this is very challenging in city environments. It may be possible to create a more natural space indoors through the use of plants and more creative design.
Finally, there is increasing attention to the role of physical activity and exercise in mental well-being, and even suggestions that exercise may be an effective treatment for several mental health conditions — a creative design would work to implement increased walking space and/or a semi-dedicated space for exercise with associated programming to implement positive habits or continue them while patients are hospitalized.
What makes you hopeful when it comes to combating the behavioral health crisis?
I’m made hopeful when I see the response to the opioid use disorder epidemic. Although it was delayed, across the country there has been a dramatic increase in the commitment of resources to treatment and to novel programs within hospitals and communities. These resources have been a blend of government resources along with hospital and private resources.
The mental health epidemic does not have the same dramatic statistics regarding increasing death rates, but arguably it extracts an even larger price from a larger number of people. Should we be able to learn from some of the lessons of the opioid crisis — rapid access to treatment, de-stigmatization, increased recovery supports — we could have a similar impact on improving our country’s approach to behavioral health.