A place people would want to be

On Exempla Saint Joseph Hospital's sprawling Denver, Colo., campus, between the hustle and bustle of sick children and busy doctors, is a one-floor, 25,000-square-foot psychiatric hospital dedicated to the treatment and recovery of clients with eating disorders. But unlike the rest of Saint Joseph's buzzing campus, the Eating Recovery Center maintains a quiet, serene environment.

The Eating Recovery Center, founded in October 2008, provides inpatient, residential, partial hospitalization, and outpatient services to men and women 17 years of age and older. The center has a capacity of 24 inpatient and residential clients and 50 partial hospitalization and outpatient clients. Through these programs, clients participate in one-on-one, group, or family therapy sessions. Regardless of which program a client participates in, treatment is tailored to each of his or her individual differences and needs. However, all patients must be medically stable before they can participate in the center's various programs.

“It was very clear that was there a need nationally for a center that could treat the people with the most serious, life-threatening eating disorders, as well as a facility that had a medical orientation associated with it and could put in all the different levels of care,” says medical director and co-founder Kenneth L. Weiner, MD, CEDS. The presence of the hospital community enhanced the level of care that the center would be able to provide, but it also presented a certain challenge, as the facility would have to be built within a pre-existing space.

To meet this challenge head on, Weiner and co-founder Susan Coppage Evans, DMin, MA, brought in the architectural firm Boulder Associates Architects to plan the space and create something very new and different. Evans identifies two design goals that the founding members established with their architects going into the project: to create a presence of health and healing and to produce a space that would encourage staff support.

“We chose colors that were along the theme of natural growth, with a lot of greens and tans and things related to the earth and growing,” Evans says of their efforts to bring health and healing into the physical design of the facility.

To meet their second goal, two nurses' stations were planned into the layout of the space. “The center is a butterfly shape, so we have two wings-each with six rooms and 12 beds-that flow off of the central nurses' station,” Weiner says. “We just expanded, so we put the second nurses' station in the new wing.” He explains that the establishment of two nurses' stations allows staff to more closely monitor patients and provide more immediate assistance.

The nurses' station (figure 1)-which, Weiner notes, is most likely the only nurses' station in the country with a view of the mountains-also has a clear line of sight into the spa-like bathroom (figure 2). This is typically a difficult space for clients to be in and requires a great deal of monitoring by staff. To address this, Weiner formulated an idea: a shared bathroom that would de-stigmatize the space for clients. “Rather than putting bathrooms in the patients' rooms, we created the spa, which makes it much less secretive for people with eating disorders,” Weiner says. “It also allows us to monitor and support people effectively.”

Nurses' station

Spa bathroom

Weiner was met with mixed feedback from other professionals in the field when he first shared his idea, as many felt that patients would react negatively to the lack of privacy. “In hindsight, it's turned out to be pretty special,” he says. “We don't have to worry about locking doors, turning off the water, monitoring the toilets, which are all things that you might have to do otherwise in an eating disorder center.”

According to Evans, the spa bathroom is more of a community area, with two sitting areas (figure 3), a massage room, a fireplace, and flat-screen TVs. “Most people are really impressed with the spa bathroom and assume the main reason for its design is to be beautiful. But we tried to transform the place where secretive symptoms are expressed into a community space to allow for positive peer pressure, community support, and clinical supervision,” she adds.

Sitting area in spa bathroom

The Eating Recovery Center's population is 99 percent female, but for the small population of males that it serves, there is a single inpatient room with its own private bathroom.

Another complex area for clients is the dining room (figure 4), which Weiner says is “almost the trenches” for the center's population. The founders relied again on beauty to help relieve their clients of the stress of their environment. “There are lots of windows because it's a difficult place for these patients,” Weiner says. To complement the wealth of natural light, lighting in the dining room is subdued, while the walls are painted in deep purple, green, and orange.

Dining room

Meals are served both individually and buffet-style, giving clients more freedom in choosing their food, and they are prepared by the center's own chef. “We really make an effort to be sure that the quality of food as well as presentation is first rate,” Weiner says. “We spend a lot more per meal than any hospital that I know of.”

This effort to provide patients with a first-rate environment carries over into the patient rooms (figure 5). “The patient rooms are more like an upscale Marriott than they are a hospital,” Weiner says. “You can look at downtown Denver and see the mountains from the patient rooms. We're up on the top floor of the building, so it has that sort of urban feel to it.” Furnishings were selected from Workplace Elements, a furniture dealer, and each room contains a bed, dresser, and armoire. A metallic blue pattern was chosen for the patients' bedding, reinforcing the youthful, urban feel of the décor.

Patient room

The diverse environment of Colorado is the inspiration behind several other spaces throughout the Eating Recovery Center as well. The residential welcome room (figure 6) reflects the design of a ski lodge that you might find among Colorado's mountains, providing clients with cozy chairs, loveseats, a library, and a stone fireplace for relaxation. “We tried to create the ambiance of a place where people would want to be, not a place where people have to be,” Weiner says. “The fireplace is the favorite perch for our patients because a lot of them are cold all the time. It really provides a space for people to get away from treatment and retreat and be comfortable.”

Residential welcome room

Meanwhile, the center's individual and group therapy rooms are modeled after the diversity of Coloradan nature. “Each of the group rooms and lounge areas has its own name and its own motif,” Weiner says. “We have a prairie room, a mountain room, a blue sky room, a Mesa room, and a river room. The décor is really reflective of that motif in terms of the artwork, colors, and fabrics that were chosen for those rooms.” For instance, the woodlands room (figure 7) utilizes flower-patterned chairs in earth-tone shades to reflect the environment of Colorado's greener spaces, while also tying the room back into the center's overall theme of growth and healing.

The woodlands therapy room

“Of course, we wanted the beauty of the Eating Recovery Center to create an environment for transformation,” Evans says. “But additionally, there is a lot of function in our beauty.” By achieving their design goals of creating a serene space that promotes client-empowered recovery as well as staff support, Weiner, Evans, and their team have established a forward-thinking and unique facility for eating disorder recovery.

Furnishings for the Eating Recovery Center were supplied by Workplace Elements and help to reinforce the individual design themes selected for each room. Manufacturers of the items shown here are:

• Art and Soul Gallery (Boulder, CO): Artwork

• Carolina: Patient room case goods

• Knoll: Patient room side chairs, workstations

• Leland: Dining chairs

• Room and Board: Patient room bed frames

• SitOnIt: Task chairs, executive chairs, conference chairs

• Studio Q: Group therapy room seating, occasional tables

• Versteel: Dining tables

Behavioral Healthcare 2010 March;30(3):23-27