In an effort to update mental health facilities state wide, the Commonwealth of Virginia embarked on a project to upgrade or replace all state hospitals to improve efficiency and better address patient care. Western State Hospital (WSH), while in need of a replacement facility for its inpatient and support facilities, required a solution that successfully balanced the often-conflicting needs of behavioral healthcare environments–safety, durability, and normalization.

Serving 246 patients, the new facility houses a variety of inpatient psychiatric functions and includes nine patient care units (PCUs) planned around the active care model concept. Each PCU contains patient rooms, activity zones, a team center, and a staff support zone—all designed to maximize long-term flexibility for patient population changes in the future.

The entire facility is designed around the concept of a “therapeutic platform” for patient care, with every space providing opportunities for patient treatment—supporting stabilization, self-determination, and ultimately, recovery. The active treatment model–introduced from the time a patient arrives at WSH through a dedicated, discrete, and dignified entry—is reinforced not only by the care received throughout their stay, but also by the design of the physical environment. To maximize the amount of treatment patients receive in an active model of care, each PCU provides clear sightlines throughout the unit and maximizes views through the activity zone and outdoor areas—enabling passive supervision of patients by staff, while still prioritizing safety.

A variety of both indoor and outdoor spaces provides patients with appropriate choices dependent on their level of care. From private patient bedrooms with views to the outdoors and secure exterior porches that still enable direct staff supervision, to enclosed “backyards” immediately adjacent to PCUs and a large, secure central courtyard, to surrounding grounds with walkable pathways for the highest functioning patients, WSH functions as a community that patients can experience as their treatment progresses. Upon discharge, patients leave WSH through the main front door—the same door used by visitors and loved ones—a symbolic step as they transition to their next level of care outside of the hospital.