Vermont Psychiatric Care Hospital rebuilds after hurricane

Hurricane Irene slammed into Vermont in 2011 and caused millions of dollars of damage to private and public buildings, including the aging Vermont State Hospital in Waterbury.  In the aftermath, the damage to the hospital made it unusable, and a new facility needed to be opened quickly. Reopening also presented an opportunity, however.

The old hospital had served the state's most acute mentally ill patients, but its 19th century design no longer fit with today’s modern care models. In fact, the Centers for Medicare and Medicaid Services (CMS) decertified the hospital in 2003, and state leaders made plans to close it. It was often described as a prisonlike facility and was overdue for a redesign.

With funds from the Federal Emergency Management Agency (FEMA), state officials were able to finance a long-needed new facility and rethink the way they approached treating its most severely ill patients.

"This was part of an initiative to remake the state's mental health system," says Frank Pitts, founding partner and president of Troy, N.Y.-based architecture+, the company that spearheaded the design of the new Vermont Psychiatric Care Hospital. "This went beyond just getting into the building as soon as possible."

The Department of Mental Health reassigned 50 beds from the original facility and dispersed them to different facility types, targeting the best fit for the patients’ needs. A final 25-bed group reserved for the most refractory patients with the highest security needs would be located at the new hospital building in Berlin.

The state engaged architecture+ and Montpelier-based Black River Design to begin the design of the new hospital building. 

The primary challenge was not the design itself, but completing a building on a fast-track schedule that would meet the needs of a challenging patient population and with input from dozens of stakeholders. Clinicians, consumers, mental health officials and even state senators were involved. To accommodate the schedule, the building footprint was locked-in early on in the process, while allowing for flexibility on some of the internal elements to incorporate stakeholder input.

Another challenge was accommodating the alternative heating technology that was added later in the design stage: a large biomass boiler fueled by locally sourced woodchips.

"That takes up more space than an ordinary system, so we had to accommodate that," Pitts says.

Secure environment

The team drew on European hospital strategies to balance the security needs of the patients and staff with a calming interior design that provides privacy for residents while reducing the potential for aggression. Practical needs were considered throughout.

On the exterior of the hospital, there are two sections: the front is covered in red brick with Vermont slate panels and houses the public and administrative functions. The inpatient wings are housed in the rear of the facility, which includes board and batten siding made from recycled fly ash.

Inside, the inpatient rooms were designed for practical and clinical considerations. The beds are clustered in groups of four to eight.

"That math had to do with the IMD exclusion," Pitts says. "It creates a 16-bed subset to meet those requirements. The staffing space is between those eight-bed clusters. So the staff sees that as a 16-bed unit, but the patients feel they are in a smaller, eight-bed group."

The hospital features private bedrooms and bathrooms for each patient that include built-in beds and desks. Living rooms, quiet rooms, comfort rooms and in-unit dining areas with kitchenettes are located off the bedroom wings. The bedrooms, recovery spaces and offices have working windows with views of the grounds, proving natural light and ventilation. The windows, which came from a U.K. supplier, meet the building's security requirements but can still be opened by the residents.

"The bedrooms are designed on a model I had seen in Scandinavia that positioned the bed where you could sit in an enclosure with a window right next you, and the desk in a nook with its own window," Pitts says. "They are fairly intimate, and there's lots of daylight."

Architecture+ developed the interior surfaces using Vermont bluestone and slate, along with locally harvested white ash. Each of the inpatient units has a seasonal theme with coordinated colors and icons. A mural in the gateway corridor leading to the recovery and learning center is an abstract painting of a forest of birch trees.

The treatment mall of the hospital is in its own zone, just outside of the door to the inpatient unit. This area includes a library, fitness room, greenhouse, art room, a sensory room for individual therapy and visiting rooms.

Unique to the building is a round multi-purpose space that, using screens, can be converted to a chapel, courtroom or a large family visiting room near the main lobby.

"Because this is such a small hospital, it wasn't practical to have a separate courtroom, chapel and central living room," Pitts says. "The round room was designed with alcoves and moving screens so you can change the nature of the room."

Entry and outdoors

The admission suite was also designed for a patient population that generally arrives in the custody of police or other officials.

“We needed to provide an indoor sally port, because the weather conditions are frequently awful," Pitts says. "We also wanted to provide some dignity to the patients."

Vehicles arrive near the center of the facility in a space with an all-polycarbonate door on one side.

"They have privacy on the admission side, but the transit is as short as possible to get from admissions to inpatient," Pitts says.

In the outdoor areas, Pitts and his team wanted to provide the necessary security, but in a way that didn't make the building feel like a prison—which is how the old hospital was often described. Instead of a traditional security fence, the activity yard is enclosed with a 14-foot-high fence that uses wood, polycarbonate, screening and stone to create the impression of a very high garden wall.

Working with management firm Engelberth Construction, the entire project was completed in just over two years. Patients began moving into the facility in July 2014. According to Pitts, the new facility resembles a European hospital in scale, but with a modern North American psychiatric hospital design.

"I'm proud that this one crosses the ocean, so to speak," Pitts says. "It achieves human scale both internally and externally. It is relatively large, but it can be experienced as something that is far more intimate."

Vermont Psychiatric Care Hospital

Cost: $23 million

Architect: architecture+, Black River Design

Interior Design: architecture+

Construction Manager: Engelberth Construction, Inc.

Mechanical, Electrical, Plumbing and Structural Engineer: SMRT Inc.

Civil Engineer: Grenier Engineering, P.C.

Landscape Architect: Wagner-Hodgson

Environmental Consultant: The Johnson Company, Inc.

Food Service Consultant: Colburn & Guyette Consulting Partners, Inc.