INTERSECTION OF DESIGN & MEDICINE
also made economic sense. He wanted to cut down on waste, energy
cost and usage, and utilize environmentally friendly products. As
he saw it, economic sense also meant increased productivity for
the occupants. He described a movement in architecture and city
planning that is more deliberate. This movement involves planning
for resilient, thriving living and work spaces where mental health
and well-being are promoted. It is the step beyond “going green”
– it is “going well.” distinct situations. The addition of a door in the psychiatric emer-
gency room decreased the use of restraints, and the expansion of
the inpatient unit with single-patient rooms decreased agitation
that required medication. Our experience suggested that patients
were safer with intelligent architectural planning. Design has been
the orphan child of health care, but perhaps there is room to ex-
pand patient-centered care to include the areas where patients are
In a practical sense, Holland employed certain techniques to
help make The Green Building “green.” He cut down on the use of
volatile organic compounds found in certain commercial paints,
increased natural light within, used solar and geothermal power,
planted native sedums and trees, and paid close attention to pedes-
trian-oriented spaces. The result was the first commercial building
in Louisville to receive a Leadership in Energy and Environmental
Design platinum certification. Additionally, he started noticing a Dr. Farooqui is a resident at the University of Louisville Department of Psychiatry.
trend of decreased employee sick days and increased employee
productivity at green buildings across the country.
The disease burden of mental illness is large (about 14% of the
world population) and disproportionately affects city dwellers.
Citizens in the urban areas are at an increased risk of depression,
anxiety and schizophrenia compared to suburban and country
dwellers. Many theories and hypotheses try to explain why this is,
including pre-existing risk factors, population migration trends,
income disparity and the overwhelming stimuli of city living. The
design-oriented answer to these problems focuses on four main
areas: access to green spaces, integration of people’s daily lives and
activities, creation of pro-pedestrian and social spaces, and safety.
From a design perspective, Holland has opted for green roofs
and has placed an increased emphasis on natural light. He has also
focused on pedestrian spaces with wider sidewalks allowing for foot
traffic and seating. Regarding a feeling of safety, Holland remarks
that he tries to keep buildings under four stories or tapering them if
they need to be taller, allowing sunlight to penetrate onto the street.
These efforts create an atmosphere of walkability and well-being, a
trend that has been transformative in many cities around the world.
After my meeting with Holland, I started to wonder if a “mental
health code” could be introduced in population centers with health
disparities, or if hospitals and physicians’ offices should look a little
more closely on the impact of design on patients. There is no doubt
that the way we structure our cities and neighborhoods affects the
emotional and mental well-being of its occupants. It is therefore
reasonable that design would impact the way our patients feel in
the hospital, which in turn affects their levels of satisfaction and
responses to treatment. Our psychiatry department has noticed
the phenomenon of design-related patient care anecdotally in two
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