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Several young men stroll down a corridor, greeting each other with a firm hello and making eye contact. Floors glow with fresh wax, and walls gleam with clean, white paint. One man steps into the library to work on a newspaper article, while another enters the gym to prepare for his workout. Through large windows, the men can glimpse grass and trees, and the view, combined with the high ceiling and skylights, creates the feeling of being outdoors.
The people appear to be students at a local college, but actually they are patients in Clifton T. Perkins Hospital, a state institution for the criminally insane in Jessup, Md.
Perkins has been almost entirely rebuilt in recent years. The transformation has taken it from a dark and drab institution that once had bars on the windows to a bright, open, building with a virtually invisible security system and access to outside courtyards from each ward. Staff, architects, and even residents involved in the redesign of the hospital wanted to create a "normalizing" environment that was pleasant to be in as well as a layout that allowed staff to do their work efficiently and residents to obtain services conveniently.
Placing skylights in rooms, creating space for art and music therapy and for learning daily living skills, and putting therapist offices on wards made the environment less institutional. Placing nursing stations at the entrances of wards in view of corridors, seclusion rooms, activity rooms, and other corridors made the nurses' jobs easier. Putting conference and activity rooms and offices for nurses, psychiatrists, psychologists, and social workers on wards made them more convenient for patients and staff.
"We feel this current design has had a positive influence in normalizing patient experience within a facility where the average stay is three years long," said Superintendent Richard Fragala, M.D. He noted that residents take pride in the appearance of the hospital and tend to keep it cleaner than they had before the remodeling.
From the mall described above, staff and residents can access libraries, a medical clinic (providing general medical, dental, vision, radiologic, and podiatric services), and a visitors center with collapsible walls that can be used to create large rooms for grand rounds and clinical conferences. In addition, there are rooms for legal hearings. Also off the mall are a gymnasium, game room, dining room, and a rehab building where art and music therapy activities take place, a kitchen for residents, a greenhouse, and a multipurpose room for religious services, Narcotics and Alcoholics Anonymous meetings, and so on.
Perkins's architectural evolution was gradual, beginning in the late 1970s when superintendent Jay LeBow, M.D., and clinical director Stuart Silver, M.D., decided to build a medium-security facility. Lebow and Silver applied for funding to add 80 beds in a new wing while eliminating 16 beds from overcrowded areas. Silver became superintendent, and he created a comprehensive plan for the hospital incorporating ideas for design and a new office infrastructure. He had the architect create three different designs and hung drawings of them in patient areas to elicit ideas and responses from patients and staff. The feedback was helpful, said Silver, and he decided to go with an open-ward design with a lot of glass and programmable security. In 1984 the wing opened.
Later, Silver, who became director of Health and Mental Hygiene for Maryland in 1988, used what he learned in building the first wing in planning new wards that featured nursing units at the ends and views of the woods from patient bedrooms. Under his direction Perkins used $23 million to add a maximum-security wing with 170 beds, a training kitchen, central dining room, health suite housing offices for medical personnel, maintenance and receiving areas, and a greenhouse. Builders renovated the gym, tore down walls, and erected fences without barbed wire.
"It was a good process," said Silver. "The staff worked together, and the patients looked at the blueprints. I'm pleased that we accomplished a lot. The old building was a rathole, but the new building is one patients can take pride in."
While creating a new physical environment, said Silver, he and the rest of the staff worked to improve treatment. Administrators and staff developed a "normalizing" treatment approach.
"One area we felt deficient in was helping people learn the skills of daily living," said Silver. The hospital now shows patients how to do laundry, cook, clean, and make transactions at the small hospital store. Patients can use the computers in the library as well.
Fragala said that the motto of the hospital is "Perkins Works." From the moment patients arrive, he said, treatment is aimed at helping them learn to be self-sufficient and preparing them for eventual release. While undergoing treatment, many patients are able to gain more freedom and privileges at the hospital.
These changes in architecture and programming are not unique to Perkins, however. In preparing plans for Perkins, Silver visited a number of maximum-security hospitals in the United States. He said Taylor-Hardin Severe Medical Facility in Tuscaloosa, Ala., and the maximum-security building of St. Peter Regional Treatment Center in Mankato, Minn., also have created open, normalizing environments.
To date, officials from eight states and 11 foreign countries have visited Perkins. Some have been interested in the design of the hospital, others in its programming. Sooner or later, he observed, each state will have to face updating its psychiatric hospitals. As one of the most recently remodeled, Perkins may become the model for many.