America’s Shadow Pandemic

Here’s How To Design Now For The Behavioral Health Crisis Ahead

April 12, 2021

Healthcare Partner, NBBJ

This post initially appeared on Forbes. It was co-authored by Ryan Hullinger and Sarah Markovitz.

The past year forced healthcare and design professionals to quickly reimagine hospitals in order to meet the influx of patients with Covid-19. But far less attention has been paid to the shadow behavioral health pandemic. That’s why healthcare systems should start planning now to integrate best practices in design so the physical spaces are well-equipped to provide patients with the support they need.

While the coronavirus pandemic has taken an unprecedented physical toll on millions, the resulting social isolation, economic uncertainty and other context-related stressors have also led to a dramatic increase in behavioral conditions including depression, anxiety, isolation, PTSD, eating disorders and substance abuse, as well as rising levels of self-harm and suicidal ideation. This can be seen across nearly every segment of American society, but it’s especially pronounced among children and young people, BIPOC persons, essential and frontline workers, caregivers, and those with preexisting psychiatric conditions.

Reimagine behavioral health design to plan for patient surges
When providers, architects and builders collaborate to respond to rapidly evolving healthcare needs, a lot can happen. Look no further than the Covid-19 crisis, where we quickly built field hospitals, triage tents, drive-through testing and vaccination facilities. Just as we’ve worked to meet the surge in demand for physical care, we now need to ask ourselves, how will healthcare design teams proactively respond to the pending surge in behavioral healthcare need?

One idea is to adapt the flexible field hospital approach that allowed us to significantly expand care capacity at the height of the pandemic for use in behavioral health care delivery. By leveraging the latest innovations in pre-fabricated and ‘pop up’ architecture, we could deploy community-responsive and integrated behavioral health clinics in and near schools, workplaces, retail spaces and places of worship. This approach is flexible, scalable and transportable, giving us an opportunity to expand behavioral healthcare access in underserved communities – both in low income urban areas and in rural areas that often don’t have access to specialty care.

And there are opportunities to design these surge spaces in a way that addresses the other major behavioral health challenge – a shortage of qualified practitioners and specialists – through design layouts that maximize caregiver sightlines and by integrating advancements in telehealth with in-person, physical support space. This reimagination of behavioral healthcare ‘surge’ spaces gives us an opportunity to redesign the experience – destigmatizing treatment, bringing it closer to where people live and work and removing as many barriers as possible.

Rethink emergency room space
A sobering trend over the course of the pandemic has been an uptick in suicidal ideation, attempted suicide and self-harm requiring emergency mental health treatment.

According to a recent report from the CDC, ”through most of 2020, the proportion of pediatric emergency admissions for mental problems, like panic and anxiety, was up by 24 percent for young children and 31 percent for adolescents compared to the previous year.” Hospitals from Philadelphia to Anchorage are reporting their concerns over the rise in patients of all ages coming to the emergency department for urgent behavioral health support.

But traditional emergency departments were not designed to care for behavioral health patients well. They often lack appropriate dedicated space and because of inefficiencies, can be more expensive as well. This insufficient behavioral health bed capacity can mean that patients can spend days waiting for placement in a proper care environment.

Healthcare organizations like Nationwide Children’s Hospital in Columbus, Ohio, are working to fill the gap. Nationwide Children’s opened a new nine-story pavilion just before the pandemic in 2020 that includes a dedicated psychiatric crisis department. This functions like an emergency room, but it was designed from the ground up for children experiencing a mental or behavioral health crisis. As well as a youth crisis stabilization unit, in which treatment is provided by a multi-disciplinary behavioral health team consisting of a care coordinator, clinicians, psychiatrists, nurses, and specialists in family support and therapeutic recreation – all working together to address the core needs of pediatric patients.

Seeing this amplified need, Massachusetts General Hospital worked with design and construction teams to expedite the completion of a new behavioral health emergency department during the pandemic. Recognizing that behavioral health patients were both a bottleneck in the emergency department and that their experience was sub-optimal, they built a separate section where patients can be cared for appropriately while waiting for bed placement, allowing them to begin treatment with trained staff, rest privately, and if they are able, to leave their private, safe rooms and socialize in a small lounge space overseen by nursing staff.

What is good for patients is good for providers
Beyond serving the industry with better capacity to deal with behavioral health surge events, there is also the issue of longer-term care. Even before the pandemic, designers and behavioral health administrators were working together to guide a sea change in the look, feel and approach of treatment spaces such as residential care programs – one that is a vast departure from the cold and clinical environments we typically associate with mental health institutions. And these shifts have proven even more critical in the pandemic.

Employee burnout within behavioral health fields was alarmingly high before 2020 (at a rate of up to 40%). This past year has magnified the challenges for our frontline workers facing the current mental health epidemic; staff who themselves are dealing with stress, isolation from loved ones, increased patient load, concerns about getting sick, and often having to act as surrogate family members for their patients.

Design strategies responsive to the latest research on the impact of our physical environment on the brain can improve well-being and outcomes for both patients and for the staff guiding their recovery.

  • Designing with nature: Incorporating views or courtyards, walking paths and outdoor gardens — has been shown to reduce stress and improve patient outcomes. Daylight and fresh air also promote recovery from depression and bipolar disorders.
  • Bringing in amenities allowing for active engagement: At both the Big Lots Behavioral Health Pavilion at Nationwide Children’s Hospital and Ohana Montage Health in Monterey, CA, amenities like centralized gyms and sporting facilities and gardens for growing fruit and vegetables help reduce stress and elevate a sense of competency and control.
  • Minimize noise where possible: Care should be taken to minimize ambient noise, as doing so has been shown to decrease stress levels. This can be accomplished through material and layout considerations, such as placing seclusion rooms or other potentially noisy spaces outside the main corridors, dayrooms and therapy areas.
  • Focus on lighting: Poor sleep quality is associated with a slew of behavioral health issues Integrate best practices in lighting healthcare settings for optimal well-being. These strategies include the use of daylighting wherever possible, allowing for high light levels in the early part of the day, and shifting color temperature, table-mounted lighting and dimming lights to low levels in the couple of hours before bedtime.

While the prevalence of mental and behavioral health challenges has existed in society long before the pandemic and will exist well-after, the past year has cast an intense spotlight on our need to create appropriate space for treatment and care. This requires balancing short and long-term thinking and planning – developing immediate design solutions to scale-up care while investing in expanding access and care in communities in a way that normalizes care.

If you or someone you know is thinking about suicide, please call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or text the Crisis Text Line at 741-741.

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There’s a Pandemic-Driven Learning Deficit

How Design Can Support Lifelong Learning at Work

March 31, 2021

Principal, Workplace Strategist, NBBJ

Editor’s Note: This is the fourth article in a six-part series on five different work modes. The first piece outlined a framework for each work mode, while subsequent posts explore a single work mode in greater depth — including focus, collaborate, learn, socialize and rest.

This post was co-authored by Kelly Griffin and Andrea Vanecko.

Learning is essential to the growth of individuals and organizations. As society evolves faster than ever before, the ability for companies to stay relevant rests in part on new attitudes toward learning beyond employees’ formal education. The coronavirus has also created a deficit of learning across companies that work from home. This virtual format lacks the richness of unique in-person learning moments in the workplace — for example, when colleagues work side-by-side or overhear conversations.

At the same time, a generational tsunami is impacting organizations and businesses. Generation Z — those born between 1996 and 2010 — will become a quarter of the workforce in just a few years. For Gen Z, learning opportunities are one of the top two factors important to building trust with employers. Maximizing learning opportunities can help attract this incoming workforce.


To better support learning, the workplace can enhance educational opportunities so when employees return once Covid-19 recedes, work is more effective, empowering and meaningful. Below are three ways organizations can employ design and design thinking to stimulate new learning outcomes.

Acknowledge that vehicles for learning are varied and diverse.
Learning in the workplace can take many forms. But first, understand why learning is needed. Is it to develop a solution, bring new practices and processes to how work gets done or gain a new skill? Then, consider four key learning modes:

  • Mentorships. One of the most valuable forms of hands-on learning is to develop a close working relationship with another individual in the workplace. It can provide a host of benefits for both the mentor and mentee, from building a network to expanding perspectives on an issue.
  • Networks. Another avenue of learning is to stay informed of the latest news, happenings and updates through colleagues. Opportunities to build formal and informal networks are incredible sources of fresh insights, different perspective and new ideas.
  • Partnerships. Learning opportunities can also expand outside an organization’s walls. Developing ties with other organizations, nonprofits or consultants can provide unique ways to close knowledge gaps and even beta test out new initiatives.
  • Whole-life Learning. By providing the space for employees to expand their repertoire of life skills and hobbies — organizations can only strengthen their commitment to and knowledge in the workplace.


Engage in best practices for successful learning.
As learning is unique for everyone, consider what matters most to your employees and organization. What can learning help achieve? How can people grow and better contribute to their organization? Opportunities to personalize the learning experience in the workplace can boost its value for employees, teams and organizations. To help tailor knowledge experiences, it may be helpful to survey employees’ preferred learning styles. But above all, consider the importance of fostering choice and agency, so employees are empowered to learn and have access to the right tools when they come back to the office.


Create spaces that foster an open learning environment.
The pandemic has both escalated and challenged the need for learning. To help employees, teams, and organizations more effectively gain new skills and knowledge, design strategies can help enhance learning opportunities in the office. A range of environments can support the ways people absorb information and also provide a fertile environment for those all-important in-person face-to-face learning moments, from overheard discussions to impromptu hallway conversations. Below are a few ways the office can support knowledge exchange.

  • Consider formal and informal learning opportunities. As learning can happen anywhere, a range of environments for formal and informal learning can help organizations support key knowledge-building moments across teams and departments. For instance, an atrium with large stadium-style steps that double as seating can transform a pass-through space into a dedicated area for lectures, presentations and talks. Meanwhile, a continuous stair, as seen in F5 Networks’ headquarters, which spirals up 28 stories, can provide unique spaces for employees to exchange knowledge as they casually connect in social spaces along the way, overhear conversations and even get some brain-boosting exercise. On the more informal end, office kitchenettes with large islands can create opportunities for impromptu group learning sessions. Booths in window-lined hallways can offer convenient spots for discussions between mentors and mentees, while also providing opportunities for colleagues passing by to join the conversation.
  • Offer spaces for group and individual learning. Some people learn best by listening, while others learn best by observing. In addition, introverts and extroverts learn differently too. Welcoming “learning rooms” with comfortable chairs, movable tables, digital whiteboards and dimmable lighting can support more social learning activities, such as group discussions and debates. Furthermore, dedicated spaces for cohort learning, such as “knowledge huts” can provide areas for teams to regularly learn together over an extended period of time. Ideally, these would be located in a new environment, filled with unique and atypical experiences, to help imprint the learning and knowledge gain. For introverts, library-like reading nooks can provide the perfect place to review the latest research report, work alongside a peer, or meet with a colleague one-on-one. More formal learning centers with multi-purpose rooms, breakout spaces and places to gather around food, can support a range of learners and breakout sessions. No matter the size, these spaces should be free of distractions and interruptions, so employees can effectively absorb new knowledge.
  • Build internal and external learning environments. Organizations can also enhance information exchange — as well as their network and brand — by opening their workplace up to the community. Underutilized ground floor retail space can be repurposed into popup classrooms or “maker spaces” for course partnerships with nearby academic or nonprofit institutions. For example, a culinary school can use an organization’s space to teach a weekly course on how to prepare nutritious meals, while a local “mobile” library can provide literacy resources for children in the neighborhood. In addition, co-working “learning lounges” can offer unique opportunities for employees from different organizations (and freelancers) to learn by working alongside one another.

In Summary
Knowledge can come from anyone and anywhere. The idea that people end their formal years of education knowing everything that is needed for an entire career is no longer valid. Yet harnessing and encouraging learning moments at work, from mentorship to upskilling, can be a challenge, particularly during the pandemic. By opening the workplace up to a diversity of talent, skills and experiences, the office environment can enhance a range of in-person learning activities so organizations can flourish, increase innovation and foster wellbeing in a post-pandemic world. The workplace needs to provide space — literally and figuratively — where people can continue to seek knowledge, pursue their curiosities and apply them to the work they do every day.

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Multiple Minds Are Better Than One

How Density Builds Better Ideas in the Workplace

March 16, 2021

Principal, Workplace Strategist, NBBJ

Editor’s Note: This is the third article in a six-part series on five different work modes. The first piece outlined a framework for each work mode, while subsequent posts explore a single work mode in greater depth — including focuscollaborate, learn, socialize and rest. This post was co-authored by Kelly Griffin and Ryan Mullenix. 


“Problems cannot be solved with more of the same thinking that created them.” ― Albert Einstein 

If innovation is the backbone of the creative economy, ideas are its lifeblood. The ability to productively come together with colleagues — to brainstorm, review and provide feedback on ideas that help solve problems — is essential. However, today’s problems are incredibly complex. They are often broad, imprecise and incomplete. Therefore, finding the right solution requires a process that not only includes different areas of expertise but, just as importantly, individual preferences. As a result, it can be challenging to effectively work together to generate impactful insights — and to build and expand on new thinking.

Bringing people together in the right way can help spur creative growth. Humans are innately social beings. This “herd” mentality carries over from pre-historic times when our social groups allowed us to thrive as a species. In modern times, a plethora of studies show that diversity improves creativity and performance by up to 35%, while density increases innovation, especially in urban populations.

In the post-pandemic world, there isn’t time to wait for corner office ideas. Ideas must be encouraged to come from anyone, anytime. In the workplace, design strategies can help improve these connections both in-person and remotely to build teamwork, trust and emotional intelligence such that organizations and society at large can flourish and be ready for what’s next. Below are three ways to nurture innovative ideas in the workplace.

Recognize that working together can take different forms.
Organizations, teams and individuals require multiple levels of teamwork depending on the industry, role or company culture. To start, it can be helpful to identify why teams come together in the first place. Collaboration is a very loose term. Define the ideal outcomes for these efforts, then review how much time is typically needed, including frequency: Is it for a few hours a day, a couple of times a week, several days a month?

Teamwork typically is structured in three different ways:

  • Long-term team sessions. This entails groups working together over an extended period of time, from initial idea generation and strategy development to production. These teams often know each other well, so consider how a virtual network can enable new voices to offer insights at the appropriate moments.
  • Formal interactions. This type of group work frequently includes activities such as report-outs, information sharing and formal meetings with colleagues or customers. Given the rote aspect of this engagement, sharing information in advance will enable the interaction to be more of a discussion that leads to active problem solving.
  • Quick touch bases. This encompasses a range of informal dialogue, from those serendipitous moments in the hallway that lead to unexpected ideas, to planned coffee breaks to discuss work strategy. Teams working remotely or in hybrid modes will be at risk of losing this critical impromptu dialog. Reflect on how important this mode is to ideation to determine ways to overcome this potential detriment.

Regardless of the cadence and duration, it is important to foster open communication to create a groundwork that enables creative and connective work. Transparency, awareness, and visual expression of processes and outcomes are crucial elements.

Observe where group creativity and empathy flourish best.
As various means of team engagement take shape, reflect on and discuss how in-person and remote employees engage in teamwork. What makes working together more successful in one instance and less so in another?

A tailored environment can allow team members to improve upon ideas, while also giving and receiving constructive feedback. Strategies to enhance teamwork can include reverse mentoring, affect labeling (putting feelings into words) and theory of mind (understanding what others are feeling).

Design spaces and behaviors that enhance and align group work.
While many organizations continue to work remotely during Covid-19, when the pandemic ends, new hybrid in-person and remote teamwork are likely to become the norm. This may mean learning new ways of working and building new habits. Here are a few design frameworks to boost team synergy.

  • Embrace a hybrid work mode. As social creatures, nuanced body language and facial expressions are a key part of communication, which is fundamental to group work. Yet this can be a challenge over Zoom. Humans hear 25% of what is said and retain half of that — the rest is picked up in body language. The office can help “build muscles” for employees to come together. Design strategies that integrate technology in an intuitive way can support hybrid in-person and remote work more effectively so team members are aligned. Digital walls and platforms are quickly being adopted for brainstorming sessions, so consider the visibility and acoustics to such spaces for remote workers. Live-streaming can not only enable an awareness of ideation in the office, but if placed properly, it can also provide a casual yet important glimpse of fellow co-workers — and a reminder to connect with them. In addition, by determining how in-person space will be used, many offices can do away with rigid, formal conference room tables and instead offer comfortable furniture to encourage gathering and build cohesion.
  • Consider interstitial zones. Transition or “in-between” spaces between meeting rooms and individual work areas can help enhance the knowledge and ideas shared before teams come together, as well as in the moments afterward. Warm-up and cool-down areas connected to group spaces can help colleagues prepare and assimilate thinking. These areas are best when adjacent to the “beaten path” but furnished for shorter, stand-up conversations. As important as this informal sharing is, be aware that those who are remote may miss out on these critical divergent and convergent moments. As basic as it may sound, develop protocols for how to communicate these in-between outcomes.
  • Create systems to manage time well. Effective teamwork builds in ample time to develop ideas, process thoughts and solve problems with colleagues. To create a balance between group work and individual tasks, it can be helpful to schedule collaborative bursts in 60- to 75-minute segments, with five- or ten- minute breaks in between. Digital panels outside and inside conference rooms can communicate group schedules, and even include a countdown on how much meeting time has passed, while reminding teams to take breaks. Also, acknowledging that contributions to these sessions will vary based on individual location and preference for engagement ensure multiple modes of sharing are possible, as well as cadences that allow for processing and follow-up.
  • Enhance access and views to nature. Numerous studies show that nature, both real and simulated, improves wellbeing and productivity by lowering blood pressure and heart rate. Outdoor cabanas equipped with digital technology can create new ways for distributed employees to work together. Interior spaces can also benefit from the positive effects of greenery, from team booths with green planting screens that add privacy to digital displays in conference rooms that showcase nature scenes. Furnished with soft seating, these indoor and outdoor spaces can also serve as informal touchpoints that break down barriers, ease the flow of conversations and build trust. The in-person office must offer benefits that employees don’t have in their remote setting. A diverse, welcoming and nature-laden environment that is energized by colleagues is a great start.

In Summary
Working together productively is a critical component of knowledge exchange and idea generation. Knowledge workers require focus to internalize information and transform it into new strategies, and they also need collaboration with a diverse group of colleagues to advance ideas into truly innovative solutions. The physical environment is a key enabler to help encourage these behaviors, supporting a process that helps people openly create, improve, and refine ideas. Design strategies that help people come together — even when apart — can help teams harness these ideas for an even greater purpose.

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