Designing a More Equitable Future: Talking with BWBR’s Design Equity Scholarship Winners

Today, we’re so excited to recognize the achievements and talent of the recipients of BWBR’s second annual equity scholarships. Each award is designed to support equity in the built environment by providing a $1,000 prize to a student of architecture, interior design, or graphic design. Applicants submitted both a personal statement and a sample design project, and we were truly blown away by the caliber of submissions we received for year two.

We had the chance to sit down with our recipients for a conversation about their backgrounds, their winning projects, and their vision for the future of architecture and design. It was a fascinating conversation that gives us even more hope for the future of our industry. (Make sure to listen to the episode for the full conversation!)

But first, some context:

The Scholarship for Gender Equity in Design is awarded to a woman, gender nonconforming, or trans applicant, studying architecture, interior design or graphic design. This year’s Scholarship for Gender Equity in Design recipient is Saylee Bhogle, who is pursuing a Master of Science in Architecture at the Illinois Institute of Technology.

The Scholarship for Diversity and Inclusion in Design is offered to a BIPOC student in graphics interior design or architecture. This year’s Scholarship for Diversity and Inclusion in Design winner is Nicole Niava, who is pursuing a Master of Architecture at Yale University.

Now let’s hear Saylee and Nicole share in their own words how they came to develop an interest in design.

Here’s what Saylee had to say:

I have a passion for contributing positively towards the community just as much as I do for buildings. As architects, we create functional buildings for society to use based on varying needs and desires. Understanding our clients and the community is imperative and ultimately fuels my passion for this field. I strongly feel it’s a worthwhile career that can make a significant and visible impact on our surroundings, people, lives, and society as a whole, because the role is constantly evolving and changing. We spend most of our lives in buildings and through architecture you can influence the way people live their lives for the better.

And from Nicole:

I knew pretty early on that I wanted to do architecture. As a kid, I was always fascinated by the aesthetic of houses in my neighborhood. It was a time when the architecture in Abidjan, Cote d’Ivoire, where I’m from, was transitioning from French colonialism to post-modernist, and we started to see more contemporary style, a lot of minimalist design. I was always really attracted to that. So that’s why I started to look into a career in interior design and architecture. Through traveling in China, Europe, and here in the United States, I learned that architecture is so much more than aesthetic, and can really be a tool to shift and shape the trajectory of communities.

Saylee and Nicole have very different projects and approaches, but they share some important commonalities, namely a belief that design can and should be used to serve the community; influence social, environmental, and economic realities; and enhance quality of life.

Saylee says, “I believe that equitable architecture focuses on developing equitable and affordable housing, safe and secure neighborhoods, and hospitable public areas. I think that planning for equity also entails prioritizing people.” Her application centered on the idea of reconditioning Dharavi, an area of Mumbai that is frequently characterized as one of the world’s largest slums. Saylee envisions incremental development of Dharavi, addressing critical needs while acknowledging the humanity, economic potential, and social and cultural vibrancy that exists there today.

Nicole’s winning project takes place 7,800 miles away in Queens, New York and centers on biophilic diversity and the belief that “the built environment can transform one’s life trajectory.” Her project establishes sustainability standards by introducing timber as the primary building material for affordable housing development in Queens, New York.

Nicole believes “in architecture that begins with life: providing accessible housing to nurture families and their culture, creating healthy work environments and recreational spaces to be a magnet for opportunities for all, and shaping public spaces and streets to invite communities to flourish.” She writes that “as a black female designer, my approach goes beyond delivering beautiful and functional spaces and aims to respond to diverse communities and their holistic needs, emphasizing healing, wellness, and empowerment.” Ultimately, both winning projects are about leveraging design to humanize spaces and make them inclusive and supportive of the diverse populations that spend time there.

Our recipients are currently wrapping up their schooling, but as lifelong learners, we know they will not only continue to cultivate their expertise but will ultimately shape the industry — and we can’t wait to see what they achieve! (To hear the full podcast episode, click here.)

Urgent Care: Intentional Design for Mental and Behavioral Health Care

We’re in the middle of a mental health care crisis. Needs are on the rise. At the same time, there’s a severe shortage of mental health professionals. The number of mental health beds are declining. The emergency department (ED) is the de-facto front door for behavior health crises, and yet these departments are understaffed, overwhelmed, and ill-equipped to navigate the layered complexities of highly demanding physical and behavioral health needs.

There are two sides to this problem: providing care, and designing to facilitate that care. That’s why a holistic approach is so important and why we see so much power in a combined perspective — “we” being Melanie Baumhover, AIA, LEED® AP, BWBR principal and behavioral health design specialist, and Melanie Gullixson (yes, two Melanies), an RN, BSN, and patient care manager at Allina Health with 30 years of healthcare experience.

Recently, we were fortunate enough to sit on a panel called Exploring Facility Models for Emergency Mental Health at the 2022 ASHE Annual Conference alongside Scott Holmes, BWBR principal specializing in medical planning, and Devan Swiontkowski, BWBR project planner. Our goal? To address the very real, high-stakes challenges facing the behavioral health industry and how design can help.

Right now, it’s estimated that one in eight patients showing up to the ED is there with a mental health-related need. That number is increasing. In addition, it’s estimated that at least one in four people in the U.S. population face a mental health issue, so that means that at any given time, at least 25% — and likely more — of the people in an ED waiting room are facing complex, layered issues that may include both physical and mental health needs.

An Emergency in the Emergency Department

As Melanie Gullixson knows all too well, mental health-related visits to the ED were already on the rise well before the pandemic, with the Agency for Healthcare Research and Quality reporting a 44% rise between 2006 and 2014. Any ED professional can attest that things have only become worse in the wake of the pandemic. Alarmingly, during those same pre-pandemic years, the number of patients arriving at the ED with suicidal ideation rose an astonishing 415%. Again, imagine what those numbers are like now.

Emergency departments are designed with critical, physically oriented medical care in mind. They’re meant to fit as many people in as efficiently as possible, with as much relevant medical equipment as accessible as possible. The problem: that setup is in direct contrast to the most urgent needs of many people in mental health crisis. EDs are flooded with the exact triggers and risks that should typically be avoided in mental health emergencies, including crowding, overstimulation, and potential access to sharp objects, medications that may be used inappropriately, and ligature risks.

And it’s not only patients who are at risk in this environment. The healthcare sector is one of the most dangerous sectors for employees in the U.S. Healthcare has the most nonfatal occupational injuries, and in the case of mental and behavioral health, there is a significantly increased risk of violent events for psychiatric staff compared to other populations.

Even when a space is designed to care for people in mental health crises, the default approach for generations may in fact make things worse. In light of the safety risks to both patients and staff, healthcare design for people in mental health crisis tends to be cold, punitive, isolating, institutional, fear-based, and oriented toward extreme security (think: nurses’ stations behind walls with plexi-glass blocking all contact).

Mental health crises demand a unique combination of mental, emotional, and physical health support and that demands tremendous resources. But smart, thoughtful, intentional design can provide tremendous return on investment in staff safety, patient outcomes, and patient satisfaction. That’s where our paths collide, and where we think we and our colleagues can make a real difference.

Designing for Healing

As Melanie Baumhover can attest, for spaces designed for mental health care, the default approach is confrontational and cold. Intentional design, on the other hand, is inviting and promotes appropriate choice and control. Yet intentional design in mental health care is not without its challenges. How do you maintain patient privacy and safety without creating an alienating space? How do you mitigate risk to staff while presenting the staff as approachable?

The main lobby of the Regions Inpatient Mental Health Center third floor features a nurse station, game tables, and a large TV
Regions Hospital Inpatient Mental Health Center Third Floor Buildout

Some of the solutions those of us at BWBR have used in our work include incorporating color, texture, artwork, and natural light; providing sensory rooms; utilizing furniture such as bookcases to reduce the perception of crowding; and blending open spaces with a sense of personal space. Research suggests that elements aimed at reducing stress and aggression among patients experiencing a mental health crisis can improve safety for both patients and staff. A cold, institutional space might appear safer, but it can be incredibly triggering.

One promising trend we’re seeing is design that optimizes space and outcomes for people with layered needs. Providing a dedicated mental health patient room might be ligature-resistant and promote a healing environment specifically for those in mental health crisis. A flex room might be suitable for a person facing a physical or mental health crisis and might have locked cabinets or rolling partitions that can be pulled down to mask triggering elements and equipment. A great benefit of the flex rooms is they provide flexibility to staff when they have a census that flexes, or in rural areas where they just can’t have dedicated spaces for one patient type. These flex spaces also make sure that physical needs can be met if the layered issues necessitate it. A co-located space is ideal for someone who might be experiencing a long-term stay. It’s more like a private studio apartment instead of an institutional room, with a window to the outside, a desk, and a dedicated toilet. Because it is not uncommon for mental health patients to end up boarding in the ED for days, weeks, or more, providing compassionate accommodations while staff look for safe discharge to another facility is so important.

Specialized emergency psychiatric assessment, treatment, and healing (or EmPATH) design is arguably the most exciting and impactful trend emerging. With EmPATH models, an individual arriving at the ED with a mental health crisis will be medically cleared in the ED but then promptly taken to an open, specialized area. With this approach, patients can start treatment, therapy, and applicable medication right away. Patients and staff are less likely to be injured when design elements allow care to occur in the safest area in the facility, and patient flow is optimized to promote healing, allowing patients to return home sooner. They’re typically able to stay for up to 24 hours, but with prompt and appropriate treatment, many are discharged earlier, at which point they’re connected with relevant resources for ongoing care. Initial results indicate that the EmPATH model produces much lower rates of hospitalization compared to non-EmPATH models, reduces crowding in the ED, and can improve patient outcomes and satisfaction.

Final Thoughts

While these are complex social problems without easy answers, we are hopeful for the future of mental health care design. By taking fairly simple steps like facilitating daylight for both patients and staff, providing sensory and retreat spaces, and offering a sense of control to patients who feel they can control very little, we can promote care models that treat patients instead of simply holding them. And by incorporating a holistic view that centers this kind of intentional design, we can provide empathetic patient care that makes a real difference.