Health Care Architecture

Behavioral Health Care in Greater Minnesota

A new inpatient facility in Bemidji

BY CRAIG CLARK, NCARB

In recent years, Minnesota has witnessed a steady rise in suicide rates. According to the Minnesota Department of Health, the state’s suicide rate increased by 40.6 percent between 1999 and 2016. Rural areas have been disproportionately affected, with the suicide rate in these regions being approximately 50 percent higher than in urban areas. Several factors contribute to this disparity, including limited access to mental health care, economic stressors, social isolation and cultural stigma surrounding mental health.

Substance use is another significant issue in rural regions throughout the country, as it is closely linked to mental health problems and suicide. In 2017, the Minnesota Department of Human Services reported there were 401 opioid-involved overdose deaths in the state, with rural areas being hit particularly hard. A lack of access to comprehensive addiction treatment services and social and economic challenges has made it difficult for residents to find the help they need to overcome substance use disorders.

 Designing behavioral facilities presents unique challenges.

Access Issues

One of the main barriers to accessing behavioral health care outside of urban neighborhoods is the distance to care facilities. According to a 2019 Minnesota Department of Health report, 62 percent of Minnesotans live in mental health professional shortage areas. With limited public transportation options and a scarcity of mental health professionals, residents often travel long distances to access the necessary care. Proximity can be particularly challenging for those with limited resources or mobility issues, leading to delayed or missed treatment and worsening mental health outcomes.

“The new facility represents an important continuum of care for the area. We already have a vast array of community-based mental health services, but because of our local needs assessment, a gap in crisis services was identified,” said Jay Coughenour, regional administrator of Sanford Behavioral Health. “We recognize the needs of our population are vast, and in order to meet people where they are, you need significant bandwidth. So, the more services we have, the better we are at meeting people and their needs.”

Before the Center opened its doors in 2022, patients experiencing a mental health crisis would travel significant distances to receive the care they needed and then wait sometimes for hours. Having this resource close to home allows patients to stay connected to their families and support systems. The decision to build a behavioral health and crisis center in Bemidji, MN, came after a thorough analysis of out-of-state mental health issues, financial factors related to construction, ROI projections and the facility’s value to the community. As a result, Bemidji-based EAPC Architects Engineers (EAPC) and Kraus-Anderson Construction formed a partnership for building the facility, with each party contributing their expertise in treating health care design experience and construction capabilities.

The partnership with Sanford Health and Kraus-Anderson Construction allowed EAPC to leverage experience with past crisis crises, residential treatment and detox facilities in creating the innovative new behavioral health project. After more than a year of staff interviews, research and collaboration with Sanford leadership, the building design evolved significantly, with a strong focus on the groundbreaking EmPATH concept (emergency psychiatric assessment, treatment and healing). The final design, a culmination of extensive planning, boasts the only facility in the state to treat juveniles and adults under the same roof, as well as the first EmPATH facility for minors in Minnesota.

The Center is a dual-purpose facility that offers inpatient and urgent care services catering to patients with behavioral health needs. With eight inpatient hospital beds and the EmPATH unit, which operates like an ED for behavioral issues, the facility provides comprehensive care for patients who require longer-term treatment. Services offered include medical exams, psychological assessments, medication assistance and counseling.

Construction Details

Built to meet hospital standards and building codes, this 12,500-square-foot facility is meticulously designed to provide a secure, healing and welcoming environment for patients coping with mental health issues. The architectural team focused on various design elements to achieve this goal, including calming and soothing color schemes, the use of natural light and aesthetics to foster a connection with nature and carefully planned spaces to maximize privacy while minimizing sensory overload.

Safety is a top priority, so the design incorporates anti-ligature fixtures, tamper-resistant materials and furniture designs that reduce the risk of self-harm or harm to others. The architects also aimed to create spaces that encourage positive social interactions and allow staff to supervise patients effectively, while simultaneously providing patients with a sense of autonomy and control over their surroundings.

Designing behavioral facilities presents unique challenges due to the emotional sensitivity and vulnerability of patients. The construction process  requires meticulous attention to every detail, prioritizing safety and minimizing the potential for self-harm or harm to others. Features such as laminated glass, anti-ligature door hardware, alarm sensors and rounded corners, along with multiple exit routes, are immediately noticeable in these facilities. More subtle elements like soft seating, a residential ambiance, dimmable lighting, views of nature, a spirituality room, carefully selected colors and textures and open spaces for relaxation and de-escalation contribute to the calming atmosphere essential for patient well-being. For those experiencing emotional challenges, low-stimulation rooms offer a serene space for patients to find solace and tranquility.

Cultural sensitivity is essential to the facility’s design, especially considering its proximity to three Native reservations. Traditional Native healing practices can be incorporated into a patient’s treatment plan upon request, and a designated room for ceremonies and smudging accommodates the spiritual exercises of all patients.

Continued investment in and expansion of such programs is crucial.

The facility has emerged as a model health care center in addressing both patient care and staff well-being. Recognizing the impact of staff burnout on the mental health field, the center has implemented measures such as adequate staffing levels, professional development opportunities and open communication. Additionally, the facility’s design prioritizes efficient people flow, streamlined records access and a comfortable environment. The combination of these factors has reduced staff burnout and created a more efficient workplace.

The Center’s focus on staff safety and well-being has also contributed to its success. Comprehensive safety protocols and training in de-escalation techniques have created a safer work environment, reduced job stress, and improved overall job satisfaction. As a result, both patients and staff have praised the facility for its comfortable environment and commitment to shared health promotion.

Incorporating EmPATH

A critical component of the facility is the EmPATH program, which has revolutionized urgent care services for patients with behavioral health needs. The EmPATH unit offers timely, specialized care for patients in crisis, including comprehensive assessments and personalized treatment plans. By providing dedicated space for urgent behavioral health care, the program helps destigmatize mental health issues and ensures patients receive appropriate care while alleviating the burden on traditional emergency departments.

“EmPATH programs are transforming how behavioral health and crisis centers support individuals facing mental health crises nationwide. As the need for mental health services continues to rise, these programs provide essential, compassionate care to people when they need it most,” explained Coughenour.

Between 2006 and 2014, mental health-related ED visits saw a 44 percent increase, as reported by a 2018 study in the “Journal of Emergency Nursing.” With more people seeking help in emergency departments, hospitals have been strained, leading to longer wait times for care. Therefore, a primary goal of EmPATH programs is to reduce the number of mental health-related ED visits.

Another essential benefit to this specialized program is that it helps lower the need for inpatient psychiatric hospitalization. By offering dedicated care in the right environment, these programs make it possible for patients to receive the treatment they need without being hospitalized.

Furthermore, EmPATH programs have proven effective in providing comprehensive care that addresses the root causes of patients’ crises, resulting in fewer return visits to the emergency department. This means better outcomes for patients and more efficient use of health care resources.

A key focus of the program is patient-centered care. By creating a calming and supportive environment for those in crisis, patients report high levels of satisfaction with their experience. In addition, this nurturing atmosphere helps build trust and rapport between patients and health care providers.

A 2021 study in the “Journal of Behavioral Health Services & Research” showed that patients treated in EmPATH units had a 35 percent lower risk of returning to the ED within 30 days compared to those in traditional ED settings. This reduced likelihood of return visits suggests that these specialized programs effectively provide comprehensive care addressing the root causes of patients’ crises.

EmPATH programs have revolutionized how behavioral health and crisis centers care for patients, offering practical and compassionate support when needed most. By reducing ED visits, improving patient outcomes, enhancing patient experiences and combating stigma, these programs make a significant difference in the growing demand for mental health care. Continued investment in and expansion of such programs is crucial for ensuring that individuals in crisis receive the help they need.

The Sanford Behavioral Health facility in Bemidji, MN, is a pioneering mental health and crisis care model focusing on patient experience, staff satisfaction and implementing the EmPATH. This innovative approach has successfully delivered high-quality care to those with behavioral health issues, prompting the company to replicate and adapt the rural Minnesota model for other facilities nationwide.

As part of its long-term vision, the health care behemoth is striving to expand the behavioral health and crisis center model  nationwide. This ambitious initiative aims to enhance access to mental health care services and improve outcomes for individuals across the country. By prioritizing both patient care and staff well-being, this approach is poised to create a lasting positive impact on the communities served by these facilities.

One significant benefit of expanding this model nationwide is the reduction of stigma surrounding mental health care. By providing accessible, high-quality mental health services in a welcoming environment, these centers encourage more individuals to seek help and engage in conversations about mental health. This increased openness contributes to breaking down barriers and fostering a culture of understanding and acceptance.

Improved patient satisfaction is another key outcome of this expansion. As more people gain access to these state-of-the-art facilities, they will experience the benefits of a comfortable environment, efficient care and dedicated staff. This heightened level of satisfaction not only encourages continued engagement in mental health care, but also serves as a testament to the effectiveness of this model.

The nationwide expansion of the behavioral health and crisis center model will contribute to the development of a healthier, more resilient population. By addressing mental health concerns early and comprehensively, these centers can help prevent the escalation of issues and support individuals in overcoming challenges. In turn, this will lead to improved overall health, increased productivity and a stronger sense of community.

Craig Clark, NCARB, is a licensed architect in Minnesota, North Dakota and Nevada for EAPC Architects Engineers. Based in Bemidji, MN, Craig has over 30 years of experience in architectural design, construction projects and management. He has designed for a variety of building types, with a specialty in behavioral health facility design.