Building on history at Eastern State Hospital

With its spacious courtyards, sloped roofs, and carefully selected exterior materials, the facility will achieve the residential character desired by the client and follow the style of the surrounding community. Rendering by Peter Girardeau.

Founded in 1773, Eastern State Hospital in Williamsburg, Virginia, was the nation's first public facility for the care and treatment of people with mental illness. Building on this rich history, the new 150-bed Adult Mental Health Treatment Center will be the second phase of a three-phase campus master plan, intended to consolidate the hospital's sprawling 500-acre campus to an efficient use of 100 acres at its “front door.” Currently under construction, the Adult Mental Health Treatment Center is scheduled to be occupied during the summer of 2010.

Designed by Clark Nexsen and developed by Gilbane Development Company for Virginia's Department of Behavioral Health and Developmental Services (formerly the Department of Mental Health, Mental Retardation and Substance Abuse Services), the 188,000-square-foot facility will replace nine separate buildings, with most of the materials from these structures' demolition being salvaged or recycled. The first phase of Eastern State Hospital's campus master plan was the 150-bed Hancock Geriatric Treatment Center (also designed by Clark Nexsen and developed by Gilbane), which was occupied in the spring of 2008. The third phase of Eastern State Hospital's campus master plan will consist of a support services facility for phases 1 and 2.

Housed under one roof, the Adult Mental Health Treatment Center will include seven patient living units along with areas for recovery programs, medical services, and administrative offices. The primary consideration in designing the center was to incorporate risk management solutions that focus on patient and staff safety in parallel with finishes that are low maintenance, address infection control, and provide visual appeal. Because the patient population includes those of a higher acuity, the project team's behavioral healthcare experts helped to select products, finishes, and details in support of Eastern State Hospital's risk management objectives and protocols. For instance, in designated areas the hospital will have tamper/abuse-resistant fixtures, fasteners, and devices; anti-ligature hardware and plumbing fixtures; security windows/glazing; and “hardened” construction details (e.g., wall construction including impact-resistant gypsum wallboard) so the building can be flexible in accommodating the entire patient population, regardless of acuity level.

The design team set out to create a healing, timeless environment for patients, family, and staff. To achieve this, the interior design concept reflects the elements of nature: wood, stone, water, metal, and fire. A select group of interior finish materials will be used in a variety of design applications throughout the facility to provide balance for a relaxing, comfortable, and stimulating residential neighborhood atmosphere-for instance, the use of warm-tone faux wood wall-protection in the patient admissions lobby. The visitor lobby will feature a secure vestibule “softened” through the use of a wood console table for the sign-in area. Also, as a means of “drawing visitors in,” the ceiling height will transition upon entry from two stories to one. Moreover, the use of indirect cove lighting and metal panels will help break up long corridors and provide visual cues for both visitors and patients.

To promote a more residential atmosphere with smaller patient groupings, the living units are modeled on “neighborhood” clusters of five private patient bedrooms surrounding a shared living area and adjoining a central dining area. Six of the patient living units have 20 beds each (4 clusters of 5 beds each), and one has 25 beds (5 clusters of 5 beds each). Adding the 5-bed medical unit brings the facility's total bed count to 150.

Each patient living unit will offer a distinct entry with a sidelight and transom framing a maple wood door. Differing resin panels within the sidelights and transoms will make each entry unique. This concept will be repeated at the dining area, pharmacy, and team work areas. To reinforce an interior design concept that reflects nature, durable, textured, floor-to-ceiling resin panels resembling flowing water will be installed in living areas.

The patient bedrooms will be of a contemporary design, with finishes and furniture selected to achieve clean lines while maintaining durability and patient safety as the main focuses. Sheet vinyl flooring resembling cork and a soothing green painted to 4 feet high on the headboard wall will unite with a matching color bed bolted to the floor. Between-glass blinds in the windows will control natural light and provide privacy, while addressing patient safety and risk management concerns. Patient bathrooms will reflect a residential design, with durability as the main consideration in the selection of materials. For instance, ceramic tile floors will be coupled with biscuit matte subway ceramic tiles in a brickwork pattern on the walls and white glass subway ceramic tiles in a stacked pattern in the shower.


A comforting environment for enjoying meals together is the theme for each living unit's central dining area, with natural light flooding the space from a clerestory light monitor directly above. (A light monitor is akin to a large cupola with windows on all four sides. It projects upward from the main roofline, creating an attractive exterior design element while increasing the interior volume of the space below and introducing plentiful natural light.) This, along with a gypsum board ceiling of varying heights painted a soft blue, will add to the feeling of comfort. Other design features will include round columns that eliminate hard edges and wall protection with the appearance of travertine block. The entry foyers leading from the central dining area to each of the unit's patient room clusters will be uniquely themed to help orient patients toward their bedrooms. Patients will engage in treatment, education, vocational rehabilitation, and social activities in the “Recovery Mall,” a central area directly connected to all living units. The mall integrates a treatment center recovery model that provides patients with a daily sense of leaving “home” (their rooms) to go to specific destinations. They will travel from their living units to the mall through corridors resembling outdoor city sidewalks, an effect achieved with textured vinyl tile resembling slate and installed in a brickwork pattern. To create the feel of classic stucco garden walls, warm-tone wall protection will be installed up to 48 inches from the floor, above which the walls will be painted a sky blue. To reinforce the feeling of being outdoors, this “commute” for patients will include passing beneath one or more 27-foot-high clerestory natural light monitors.

In keeping with sustainable design philosophies, the facility will incorporate highly efficient environmental systems, and more than 90% of the occupied spaces will have access to natural daylight. Additionally, interior finishes will feature low volatile organic compound (VOC) emissions.

The building's exterior will reflect the residential character desired by the client and in keeping with the neighboring community. Brick, cementitious siding and columns, and porches will be combined with attractive windows and sloped roofs to create a “residential village” of patient units, treatment mall areas, and clinical space. Outdoor patient areas will consist of four internal courtyards as well as two external secure areas, all designed to ensure patient safety while providing a relaxing and therapeutic environment. The courtyards, each of a unique design character, will be strategically located to assist in wayfinding throughout the facility.

When opened in 2010, the Adult Mental Health Treatment Center will be a state-of-the-art behavioral healthcare facility representing an exciting evolution in Eastern State Hospital's rich history, one that would amaze the patients and staff of the hospital's founding facility in 1773.

Garry G. Kiskinis, PE, is a Principal of Clark Nexsen Architecture & Engineering based in its corporate headquarters in Norfolk, Virginia. With more than 30 years of professional experience, Kiskinis is an active member in the National Society of Professional Engineers and Virginia Society of Professional Engineers.
John D. Keegan, PE, is Vice-President for Gilbane Development Company. He is based in its Mid-Atlantic regional office in Tysons Corner, Virginia. A 23-year veteran of the Gilbane organization, Keegan is co-chair of the National Council for Public-Private Partnerships' Real Estate Institute.

For more information, write to him at Clark Nexsen, 6160 Kempsville Cir., Suite 200, Norfolk, VA 23509, or visit https://www.clarknexsen.com.

For more information, contact him at Gilbane Development Company, 8245 Boone Blvd., Suite 690, Vienna, VA 22182; (703) 752-8588; or jkeegan@gilbaneco.com. Or visit https://www.gilbaneco.com.

Behavioral Healthcare 2009 July-August;29(7):41-44