Bridging the Gap
By Mike Brenchley and Jeff Getty (12/09/2005)

Mental health issues among prison populations have been a growing concern since the 1960s when, on a national level, state-run mental health facilities began to be phased out.

Industry experts estimate that only about 20 percent of the current prison population deemed mentally ill is housed in facilities specifically designed to deliver appropriate targeted services. Research and statistics from the National Institute of Justice back up these claims, and a number of states are currently addressing the issue with RFPs that better represent mental health populations.

The process of developing a facility that meets those needs involves the integration of custody staff and treatment staff who come to the table with different, though not diametrically opposing, perspectives. While their underlying missions are distinct-that of corrections staff is security, while that of clinicians is the patients' well being-both are equally important. However, the marriage of these ideologies can assist in making the project a success, therefore, it is critical that the facility design supports this spirit of cooperation.

Staff Integration

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Clinical staff and custody staff do not have to be at odds with each other, or even feel forced to tolerate each other's responsibilities. It is possible to overlap their responsibilities so that those on both sides of the house can be of assistance to one another.

Correctional officers and supervisors were concerned that clinician activities would not be secure at the mental health facility for the central prison in Raleigh, N.C. The challenge was to design a space with clear sightlines that allowed security staff to share the space with a suite of clinical offices.

This cooperation does not mean sharing each other's duties or intruding on the other's area of expertise; it simply means being cognizant of their colleague's responsibilities and keeping open lines of communication. Assistance can come from the layout of the floor plan, which may call for moving health care staff offices, perhaps from separate office space on another floor, to an arrangement in which clinicians are based at the housing units. In this type of arrangement, clinicians tend to circulate more among patients, making treatment modalities more effective.

Interaction among all staff and patients helps increase awareness of the overall mood of the facility's population. Mental health workers who are closer to the action can immediately report any security breeches or disturbances to corrections officers on the floor. Corrections staff, likewise, are trained to report any unusual behaviors to clinicians, which could help to intercept or circumvent confrontations. Overlapping duties empower staff to be more efficient. Again, health care personnel and corrections staff do not take on responsibilities beyond their area of expertise, they simply extend their effectiveness.

Four Major Steps

The success of the project often hinges directly on group planning meetings and workshops that provide checks and balances. An integrated team of designers, clinicians, and correctional staff comprise an ideal mix to discuss the treatment modalities and begin the process. Planners conduct four major planning phases to flesh out correctional requirements and identify best-treatment modalities. An integrated clinical and correctional approach is utilized by HDR in the conceptual development of these types of mental health projects.

During the in-depth planning stages, planners encourage corrections officials to analyze and understand their current care delivery methods, identifying optimal treatment modalities, and developing a performance-focused management program.

At the planned mental health facility for the central prison in Raleigh, N.C., corrections officers and supervisors were concerned that clinician activities would not be secure in this setting. Constant interaction of clinical staff with patients increases the chance that staff might get into a dangerous situation.

The campus setting and sprawling grounds at the San Carlos Correctional facility improves both circulation and security. The new building's elevation was designed in a curving form so supervisors in the control station could see the face of each structure, including the entry/exit points.

The solution rested with excellent sightlines. It is a simple matter to design a control station with a 360-degree plane of vision where supervisory staff can view their charges if there is nothing to obstruct the view. However, the ultimate challenge is to design a space with clear lines of sight when security staff shares the space with a suite of clinician support offices.

Because limited real estate was available at this site, the footprint of the building was constrained. Planners compensated by designing a vertical solution, which will contain a two-tier observation-control area. Designing a hardened custody station on a second level will provide a sweeping overview of the area and will alleviate staff concerns. It also raises the level of staff efficiency; for instance, staff on third shift may be able to observe several housing units at once.

The campus setting and sprawling grounds available at the San Carlos Correctional Facility in Pueblo, Colo., permitted designers to spread across one level an addition to the building. Patient circulation on the grounds often was done outdoors, and the original design allowed officers to visually supervise movements outside. Elevation of the new building was designed in a curving form so that supervisors in the control station could see the face of each structure, including the entry/exit points. Moreover, designers planned the expansion as a pair of pods with a clinician support suite in the center that could feed both sides. The result will be sightlines that are completely unobstructed, making it easier for staff to do their jobs.

Adjacency Advantages

Ideally, populations that require the most critical level of care do not move from designated areas. Once the patient is stabilized, however, he or she may participate in any number of rehabilitative activities offered at the facility, such as sheltered workshops, counseling, religious services, or library visits. Designing adjacencies between housing and program spaces minimizes inmate movement, which provides several benefits. Because the quality of these patients' mental health is delicate to begin with, less movement is less disruptive emotionally. Adjacencies, therefore, may keep patients calmer.

Staff efficiency also is a consideration. Any time a patient needs to be moved from a housing unit to another location, he or she must be escorted by staff. Fewer movements mean less time wasted by corrections officers, as well as less opportunity for disturbances. Adjacencies, then, not only save money and time, but also make the house a safer place.

Michael Brenchley, AIA, NCARB, is senior vice president and national director of HDR's Justice Program in Dallas. He can be reached at (972) 960-4000 or e-mailed at mbrenchl@hdrinc.com. Jeff Getty is vice president and director of design for HDR's Alexandria, Va., office. He can be reached at (703) 518-8500 or e-mailed at jgetty@hdrinc.com

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