It all started on the car ride from the airport.
Behavioral Health partner Marty Martin-Forman and EYP Medical Planner Jacqueline Guerra Armenta were the only two team members who flew in—Marty from Missouri and Jackie from Texas—and they used their time carpooling from the Richmond International Airport to the project site in Petersburg, Virginia, to compare notes and get to know each other.
Soon, those car rides turned into something they both looked forward to, a space where they could ask questions and tap into each other’s expertise. Here are Jackie and Marty, on how those 30-minute conversations became a form of mutual mentorship:
Marty: I spent my career in the field of behavioral health. I am a licensed clinical social worker from Missouri, and I’ve worked primarily in inpatient, high-security settings. Most recently, I worked for the Missouri Department of Mental Health as chief operating officer of a 500-bed, high-security hospital. During that period, the state legislature allocated money for a new 300-bed section at Fulton State Hospital, and that’s where I met the folks at EYP.
Jackie: You were the customer.
Marty: Yes, I was part of the Fulton team that worked with EYP to design the hospital’s Nixon Forensic Center. When EYP discovered I was going to fully retire at the end of construction, they asked if I’d like to work as a partner on other behavioral health projects with them. I said sure, and wow, it’s been an incredible journey. Not to mention all those car rides with Jackie, back and forth, back and forth.
Jackie: And that was the start of 30 Minutes with Marty! Marty, you taught me a lot. During our rides, our conversations were pretty much all over the place. We sang, shared stories, learned about each other, and debriefed after the meetings. Initially, I came into behavioral health knowing only what I had researched; I hadn’t seen the research in practice. I had a lot of questions—it was like trying to learn a new language. I found the differences between a behavioral health facility and a medical hospital intriguing. For instance, what was being called a nurse station wasn’t truly a medical nurse station. It was a station for therapeutic staff to observe the unit. Their main task was to keep an eye on safety and patient well-being, including who comes in, who goes out, who’s in the courtyard, etc. Those staff were there for safety and the staff on the unit floor were who assisted the clients.
Marty: I’m learning to call them staff stations now, in the settings that still want them.
Jackie: It’s a good example of how the name changes the meaning behind the object, as well as the understanding of the term by the architect and the owner. If you say nurse station, I, as a medical planner, am thinking nurses. But staff stations, who are the staff? What does the staff need at the station? These were the questions I was asking Marty that would really help me before we got to the meetings—and after.
Marty: I learned a lot from Jackie, too. Central State was my first project, not being on the owner's side but actually part of the design team. Architect-speak is not the same as behavioral health language, either. I was able to ask Jackie in the privacy of the car, oh my goodness, what did that mean? I got a chance in a very safe place to say, well, where was that going and why? Terms like CMU (concrete masonry unit) or impact-resistant gyp (gypsum panels)—we don’t use those in my world. So, it was really a nice give and take. While I had some experience in the physical health world, Jackie had more in terms of design. We were able to talk a lot about the differences between the design for behavioral health spaces vs. physical health spaces. While safety is important in both, it takes on a new level in behavioral health. The same basics apply, but you have to add a layer due to considerations like self-harm.
Jackie: I loved your stories and scenarios; that’s what made it real to me. Through them, I was able to picture the clients, and myself, in those situations. And being able to hear the background behind their experiences helped me to connect. I was able to imagine different points of view, from the clients to the staff. When you told me about attending an individual’s graduation from the program or hearing a client share stories about their time in the facility, it made everything about the project personal.
Marty: Real-life examples and experiences form the basis for good design ideas. Take the research about calming colors and trying to avoid high-contrast, black and white, dark gray, since contrast can be bothersome. You need to make every decision about interior design mindfully. Some 90- 95% of people in behavioral health facilities have been severely traumatized in their life, physically or emotionally, and are very vulnerable. Many have mental health or substance abuse issues. During design, especially early on, I learned that giving the team of architects real-life examples about why things were important, from sightlines to rounded corners, made a difference.
Jackie: We really do care about the clients and making the facilities places of healing and comfort for them.
Marty: Yes, you do, which is why I work with you. I wouldn’t do this if there wasn’t a sense that the ultimate customer, the client, would continue to benefit from what I do. Fulton State was a very old facility, and when we started to give clients visits into the new center, one of them stepped into the living area and, with this look of awe, said, “I think I can get better here.” It still gives me goosebumps. Now that people have moved into these new facilities, they’re able to give feedback to us: “I like this, not so much this.” We are constantly learning simple things. For example, anti-ligature hooks in the bathrooms will hold a robe but not a towel. Where do they hang their towels? Where do they put their dry clothes? From one project to the next, EYP uses this feedback to make their design better. Now, we have a built-in bench toward the back of the shower, and clients can put their things there.
Jackie: Yes, and you also taught me to call the users of behavioral health facilities clients, not patients. You have to look at everything differently in a behavioral health setting vs. a medical setting. Take the bedrooms. From the medical side, a patient room is a treatment space. But in behavioral health, the “patient rooms” are places for clients to rest and be safe and to have their own space while being secure and observed.
Marty: Absolutely. The rooms in a behavioral health facility are their safe-havens. I think someday I am going to work myself out of a job, and I’m good with that because the architects are constantly learning. I can create a bridge and translate behavioral health speak. But the teams I’m working with now, they already know the questions to ask. That’s the magic.
Jackie: I remember one of my questions when I first started: What is a treatment mall? What is it for? I feel like that is one of the spaces that differentiate medical health care from behavioral health. The treatment mall is the main treatment space.
Marty: Well, don’t forget about program communities, which are the new “middle step” of treatment space we developed collaboratively. Clients can leave “home” (their living unit) and go to smaller areas to receive treatments that are not so large and overwhelming. The third space is the treatment mall, which has more of a recreational feel and has services such as a hairdresser, gym, music room, games. There might be a clothing exchange, where you take old clothes and get new clothes. The treatment mall gives clients a greater sense of freedom and begins to simulate real life as the client moves from “home” to “neighborhood” to “downtown.” It’s all very safe, but it gives a client the sense that, “I can organize this. I can make choices.” We are preparing them to leave the hospital, which is the purpose of all this. When I was at Fulton State, EYP helped us realize our dream of a program community because of the distinct populations we were treating. Now we are seeing more facilities wanting that middle step.
Jackie: This was my first Behavioral Health project, so to me, that was just the way it’s done.
Marty: Well, that is what happens with collaboration and visioning and goal setting, all of which take place early on. And that’s another reason why it’s very cool to work with this team.
Jackie: Yes, you made me understand the importance of seeing everything from the client’s perspective and how difficult that is in behavioral health because you have to keep in mind such a diverse group of people.
Marty: Remember your question about schizophrenia—when it comes to design, what does that mean? I talked about how, with schizophrenia, there’s confusion, and the person may not see the world as we see it while they are ill. They can interpret the expression on someone’s face as very different from what it actually is. And they can believe that very lifelike pictures are real. If you use watercolors or oversized pictures, they’re able to interpret, oh yeah, that’s a picture. Once in a geriatric setting, we had a realistic drawing on the wall of an apple tree with apples on it, and the clients tried to pick the apples. How frustrating would that be?
Jackie: Yes, we talked a lot about different diagnoses and what they might mean for design. Also, we talked a lot about the admissions process, and the state of mind clients are in at that moment. That is the first impression they get of the building.
Marty: That’s the stage for hospitalization, and EYP is trying to change the stage: it’s not, “What have I done wrong?” but “What has happened to me?” It’s not, “We’re afraid of you, and we’re going to put you over there in the corner,” but “Welcome, we are glad you are here.” Even after 40 years in behavioral health, I’m still learning, which is very important to me. I don’t think I’d do it if there wasn’t that element as well.