1. www.healthcareglobal.com August 2013
MOVING TO
THE CLOUD
MOVING TO
THE CLOUD
WORLD CLASS
MEDICAL
SOFTWARE
PROVIDERS
COST
SAVING
SUPPLY
CHAIN
SOFTWARE

2. HOSPITALS | AUGUST
22
SPECIAL REPORT:
An Integrated Approach Provides
Support For Law Enforcement & P
B
ehavioral health, often
misunderstood, is one of
the largest components
of our nation’s spending on
healthcare. In fact, expenditures
on behavioral healthcare exceed
the combined expenditures for
cancer, cardiovascular disease,
and orthopedics. According to the
National Institute of Mental Health,
over a quarter of the general
population will face some form of
mental illness in their lifetime.
Vast changes are under way in
how our society delivers healthcare.
Regardless of the outcome of our
nation’s healthcare debate - whether
“Obamacare” remains in its current
form or is significantly altered -
mental health and its associated
Behavioral health facilities at the University of Arizona
Medical Center support local law enforcement agencies and
importantly provide safe and suitable treatment for its patients
Written by: Carl Hampson >>>

3. | www.healthcareglobal.com
23AUGUST | 2013 |
Mental Health
Patient Care
treatment are undergoing a
transformation. That transformation
will have major impact on the design
of behavioral health facilities.
Normalization refers to the
creation of an environment where
the clinical goals of healing and
rehabilitation are balanced with
safety and security. Past practice
often placed the emphasis on
security and the resultant facilities
functioned more as places of
incarceration. These obsolete
facilities, many of which are still in
use today, simply do not permit
modern approaches to mental
health treatment; and in many
cases, are a hindrance to proper
care.
Solutions At University Of
Arizona
In 2003, a partnership of public and
private organizations in southern
Arizona united to find a solution
for a growing mental healthcare
problem. Tucson’s emergency care
system was being strained to its
limits by the increasing numbers of
behavioral health and substance
abuse patients. What resulted
from this partnership are two new
pioneering behavior health facilities
integrated into the University of
Arizona Medical Center - South
Campus. Working in unison with
the hospital, the new facilities
offer an integrated approach and
a continuum of care for patients
experiencing mental health issues.
Radically changing the practice
of behavioral healthcare, the new
center’s role is to provide psychiatric
support for local law enforcement
agencies and the court system. To
that end, the 96-bed psychiatric
hospital is integrated with county
court facilities as well as a 24-hour
crisis response center.
Nearly every level of care is
provided: acute and sub-acute

4. inpatient and outpatient services;
crisis assessment and stabilization;
specialized facilities for law
enforcement; and first responders.
The courtroom actually serves as a
starting point for patients who are
entering into hospitalization through
the legal system.
The organization of the facility
is based on a shared sally port--
providing a secure circulation zone
for medical staff, law enforcement,
courtroom personnel, and patient
transfers. The solution features a
parti of parallel bands of patient
and support spaces with dedicated
staff, patient, and visitor circulation
systems all oriented along an east/
west axis for optimal sun control.
This clear organizing strategy
provides a framework for the
numerous activities that occur
within each building, mitigating
potential conflicting traffic flows of
patients, staff, and visitors.
The facility’s Crisis Response
Center is the single point for
assessment, stabilization and
treatment of patients that do
not require emergency or acute
psychiatric care. This allows
emergency rooms, inpatient units,
jails and juvenile detention facilities
to no longer be filled beyond
capacity, and not to just become
inadequate holding places that
fail to address individuals’ real
needs. Furthermore, this approach
fills a current gap in coverage by
providing comprehensive care and
social services for patients who
cannot be appropriately treated
within the justice system and who
otherwise might be handled by law
enforcement agencies.
Multiple separate entry points at
the Crisis Center allow for access,
by individuals seeking care, to
first responders, ambulance and
law enforcement officers. First
responders have access to a call
center, which helps determine
which entry point is appropriate
for individuals in crisis. Once
Expenditures on behavioral
healthcare exceed the combined
expenditures for cancer, cardiovascular
disease, and orthopedics
Hospitals
An Integrated Approach Provides
Mental Health Support
24

5. | www.healthcareglobal.com
Each room is set up for security and patient care
Map of the facility
Multiple separate entry points at the Crisis
Center allow for access, by individuals
seeking care, to first responders,
ambulance and law enforcement officers
25AUGUST | 2013 |
an individual arrives, a medical
assessment is made to confirm that
the patient is in the correct location.
By centralizing mental health
agencies and social services, a true
comprehensive assessment can be
made to help the individual in crisis,
and provide an appropriate care
path for both immediate and long
term needs.
Environment As Treatment
Connection to nature is important
in the facility. The two buildings—
the Behavioral Health Pavilion and
the Crisis Response Center—are
organized around accessible
exterior spaces on multiple levels
that connect patients and staff
directly to nature. Sustainable
design strategies have been
utilized in multiple aspects of the

6. facility including landscaping, site
utilization, energy-use reduction,
and daylighting strategies. The
best technology is passive in
nature, and the building features
drought resistant native Sonoran
landscaping, locally produced
materials, cradle-to-cradle
recyclable metal building cladding,
pervious paving and bio-swales
at parking lot, high performance
glazing, reflective roofing, and an
east/west building orientation that
minimizes western exposure and
allows for best control of the sun on
southern and northern facades. The
south-facing perforated sunscreens
actually reduce peak energy
loads by over 30 percent. These
strategies minimize environmental
impacts on the site by reducing the
building footprint, restoring native
plant habitats, and optimizing
building performance.
The facility configuration balances
vertical stacking with organizational
and operational efficiency and
safety while preserving land for
future expansion. Travel distances
are minimized on each floor
while maintaining appropriate
staff distribution. Patient units
feature a standardized design for
quick orientation, an emergency
department shared by the acute
care hospital, outdoor spaces on
each level, two buildings linked with
linear service spine, and a shared
central sally port that accesses both
buildings and courtroom.
As the project proceeded, the
design team met frequently with
hospital administrators, medical
staff, and behavioral health
Hospitals
26
Connection to nature is important in the facility
An Integrated Approach Provides
Mental Health Support

7. specialists to ensure that the
design was always in harmony with
the overall project goals >>>
• Create a comfortable, healing,
safe and non-institutional
environment
• Provide a healthy, safe work
environment promoting
teamwork and communication
• Create a functional, efficient,
flexible, dynamic and multi-
purpose facility
• Design a state-of-the-art
technology
• Create an environment that is
accessible, ecologically sound,
inviting and convenient.
• Provide outcome oriented
care responsive to a diverse
population
• Be fiscally responsible
• Provide an open process
As the project
proceeded, the
design team
met frequently
with hospital
administrators,
medical staff, and
behavioral health
specialists to ensure
that the design was
always in harmony
with the overall
project goals
| www.healthcareglobal.com
27AUGUST | 2013 |
Separate circulation for multiple competing
needs while still addressing patient and staff
safety was the primary design challenge

8. Consistent Community
Involvement
Outside of the hospital, project
architects held numerous meetings
with professionals from the
Community Partnership of Southern
Arizona, the local collective
health organization charged with
providing collaborative care for
patients with multiple behavioral
diagnoses. Beyond this, the
local community was consulted
in a series of town hall meetings
intended to inform and receive
input on the overall design and
strategy. Technical and operational
requirements were ground-tested
by the presiding county judge and
local law enforcement officials; this
was necessary in order to maintain
the intricate and secure circulation
system in the building that blended
patient, staff, and visitor safety
with the effective operation of
courtrooms and hold facilities.
Many challenges face the designer
of behavioral health facilities. But two
were paramount in this project: the
complexity of circulation and care and
the facility cost.
Separate circulation for multiple
competing needs while still
addressing patient and staff safety
was the primary design challenge.
Normalization - the merging of the
clinician’s desire for an environment
of healing and rehabilitation with
the law enforcement requirement
for rigorous safety and security
- was provided by an additional
front door for walk-in patients, a
recognition that not every patient
arrived via police cruiser. The
organization of horizontal movement
in two buildings, involving a rather
complex interdisciplinary program,
required extensive coordination
with stakeholders and user groups.
In addition, a harsh desert climate
demanded a sustainable approach
to the design if energy and
environmental goals were to be met.
The building architecture,
designed to relate to the
Normalization refers to the creation
of an environment where the clinical
goals of healing and rehabilitation are
balanced with safety and security
Hospitals
28
An Integrated Approach Provides
Mental Health Support

9. | www.healthcareglobal.com
29AUGUST | 2013 |
environment and cultural aesthetics
of southern Arizona, includes public
lobbies for welcoming the general
community in an amicable way
and becoming a public amenity.
The main lobby of the Behavioral
Health Pavilion is also used as an
art gallery for the community and
was recently host to an exhibition
commemorating those lost and
injured in the 2011 Tucson mass
shooting. Outdoor spaces on all
levels connect patients and staff
with nature to suggest a more open
environment based on healing
rather than containing patients.
Lean Design & One Stop Shop
Cost was the next obstacle to
be overcome. Utilizing lean
design approaches, effective cost
management, and the creative use
of standard materials and systems,
the project was completed at $38.9
million, which equates to a very
significant $187 per square foot
cost.
A highly organized system of
program and circulation networks
was necessary in order to achieve
the building’s “one stop shop”
approach to treatment. Openness
and connectivity are balanced
with safety and security to express
a normalized, clinically effective
environment. In crafting the
facility, the design team and client
addressed patient dignity, staff
retention, and visitor comfort in new
and compelling ways; the design,
regionally inspired, transforms
an ordinary health facility into a
The building architecture, designed
to relate to the environment and
cultural aesthetics of southern Arizona,
includes public lobbies for welcoming
the general community in an amicable
way and becoming a public amenity
The facility has a state-of-the-art design

10. valuable public amenity.
A state-of-the-art information
management system ties every
component of the facility together;
the synergy created between
two clinical operations, court
functions, and law enforcement are
unparalleled for a facility of this type.
The Crisis Response Center utilizes
high-tech communications that
actually allow law enforcement and
first responders to receive real time
information and decisions regarding
care for patients in crisis situations.
The system then alerts the facility to
the arrival of patients, streamlining
the admission and intake procedure
and maximizing staff efficiency.
The facilities offer an integrated
approach and a continuum of
care for patients experiencing
behavioral health crises involving
mental illness and/or substance
use. The innovative, collaborative
effort brings together the entire
community including behavioral
healthcare, physical healthcare,
law enforcement, families, and
consumers to deliver an integrated
approach to behavioral health
treatment. The new facilities ease
the pressure on Pima County’s
community resources such as
emergency rooms and detention
centers. They also provide a
setting to train new physicians in an
integrated healthcare environment.
The facilities were created
through a unique partnership
between public and private entities.
Participating partners are:
• Pima County
• University Physicians Healthcare
• Community Partnership of
Southern Arizona
• University of Arizona College of
Medicine
Combined office space for the
many social and behavioral health
staff that are involved in treatment,
The facilities offer an integrated
approach and a continuum of care for
patients experiencing behavioral health
crises involving mental illness and/or
substance use
Hospitals
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An Integrated Approach Provides
Mental Health Support

11. | www.healthcareglobal.com
31AUGUST | 2013 |
care and services for these patients,
brings a comprehensive team and
care plan together in one location,
addressing the multifaceted needs
of this patient population. Having
appropriate spaces to support the
many care providers needed to
make an assessment contribute
to a positive healing environment.
These include both small and
large spaces, open spaces, group
rooms, as well as safe exterior
environments.
The innovative, collaborative
project brings together the entire
community including behavioral
healthcare and physical healthcare
provisions, law enforcement,
families and consumers to deliver an
integrated approach to behavioral
health treatment. This pioneering
model of care meets a growing
problem, setting a new standard for
behavioral healthcare in the future.
About The Author
Carl Hampson,AIA,LEED,AP isAssociate
Principal and Design Leader for Cannon
Design.His contact information is:
champson@CANNONDESIGN.COM;
(310) 770-2085
Normalization refers to the creation
of an environment where the clinical
goals of healing and rehabilitation are
balanced with safety and security