The Mental Health Challenge
By James Mueller (07/26/2008)

Mueller

The planning, design and operation of a mental health treatment facility within the correctional environment presents a unique challenge for prison management personnel and design professionals.

If the goal of behavioral healthcare in the correctional setting is at the very least to stabilize the mental health status of the inmate or to improve upon it by optimizing outcomes, then programming should be based on a best-practice approach. Facility planning and construction, in support of the program, should be predicated on evidence-based design practices.

The application of these principles, particularly from the facility planning and design perspective, creates a dilemma that at best can be frustrating and at worst irreconcilable for corrections administrators and the design team.

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Although practiced in the healthcare arena for many years, evidence-based facility design has been only marginally applied in the correctional setting. Empirical evidence suggests that the built environment can have a beneficial effect on patient wellness and recovery, while concurrently improving staff attentiveness, productivity and satisfaction.

Many evidence-based design studies show a direct correlation between effectively implemented programs and positive effects on inmate behavior and recidivism. But few studies address the consequences of building design on inmate conduct and staff operations.

The implementation of evidence-based practices and guidelines can lead to a long-term reduction in the demand for criminal justice services among individuals with mental illnesses. With more individuals suffering from mental health issues and psychological disorders housed in correctional facilities than in state hospitals, the need for functional behavioral health services within correctional facilities is urgent.

An endless cycle of recidivism results when inmates with mental health issues are released with their needs unmet. Studies as far back as 1991 find that 64 percent of offenders with mental illness are rearrested within 18 months of release.

Evidence suggests the recidivism cycle can be broken by ensuring inmates have access to effective mental health treatment, services and support that assist recovery. However, few if any such studies specifically address the effects of facility planning and design on the behavior or social/psychological rehabilitation of inmates.

Most building planning standards applied to correctional facilities, such as those developed by the American Correctional Association, address either matters of control or constitutionally mandated conditions of confinement.

Some professionals argue that the direct supervision management model emulates an evidence-based planning parameter, but direct supervision is more accurately defined as a best-practice operational method that achieves architectural expression in podular housing design. True evidence-based building design embodies the application of specific architectural techniques to enhance rather than merely support a defined programmatic goal.

Healthy Facilities

The many evidence-based studies developed in the healthcare community may have direct applicability to the design of mental health facilities in the corrections setting. Yet, it is in the application of these proven parameters that the almost inevitable quandaries for the correctional practitioner find their origins.

If mental health services should strive to improve the psychiatric conditions of the patient then providers should attempt to employ all available assets, including those design elements that promote positive treatment outcomes. One could argue that this is especially true in correctional environments if, as evidence suggests, improvement in an inmate’s mental health reduces the likelihood of repetitive criminal behavior.

Evidence from the healthcare industry indicates that spatial variety, selective use of color and texture, sound control, clearly articulated wayfinding, and access to daylight and the outdoors improve patient health and recovery. These same attributes improve staff efficiency, productivity, satisfaction and retention, recommending that evidence-based design practices be employed in the development of correctional mental health facilities.

However, if those same concepts were widely applied in the corrections environment a new building type that is quite uncommon, and possibly antithetical, to standard prison environs and practices would emerge. Though designed to be safe and secure for inmate patients and clinical staff, it would be a structure that communicates health and welfare rather than restraint and control.

Finding a Balance

The very evidence-based design parameters that enhance programmatic goals are the same attributes that encourage inmates to feign disability in order to gain entry to agreeable surroundings and avoid general population housing.

Despite the possibility that treatment services provided in such an environment may have positive results in reducing criminal behavior and recidivism, the overall institutional management problems also created could suggest that its operational desirability is in fact contraindicated.

Staff must have the ability to determine who should be committed to the facility, how long they should stay to successfully complete their specific program requirements, and when they should be discharged.

Most correctional administrators are aware that this in itself is problematic. Attracting qualified staff to the socially and geographically remote locations that typify correctional facilities, to the salary limitations of the industry and to the institutional environment itself presents a challenge for facility administrators.

Correctional officers must be trained to use protocols that enable them to identify and appropriately respond to inmates with mental health issues. A clear and consistent compendium of treatment-program standards must be established, including codified screening mechanisms and case planning guidelines, specific criteria for levels and delivery of care, designated uses of medication and an integrated data system.

Taken collectively, these approaches and procedures could create the circumstances necessary to allow corrections and mental health professionals to develop a new facility type within the prison system. Such a facility would represent a productive step toward rehabilitating a substantial portion of the prison population and reducing systemic recidivism.

James Mueller is executive director at KMD Justice, a division of international design firm Kaplan McLaughlin Diaz Architects, where he supervises all phases of development and service. Contact justiceinfo@kmd-arch.com.

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