Environmental wellness is experiencing daily living in harmony with the environment. This includes living and working in pleasant, safe, and stimulating environments.
People living with serious mental illnesses (SMI) continue to face a disproportionate burden of tobacco-related prevalence, morbidity, and mortality as compared to those without SMI. The risk of mortality related to cigarette smoking among those with SMI is six-times that for persons without SMI.
For this video, I am going to share with you common myths about mental health challenges and facts based on research that addresses these misconceptions.
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13. Klarić M, Lovrić S. Methods to fight mental illness stigma. Psychiatria Danubina. 2017;29(suppl. 5):910-917.
This is Dave. Dave has been smoking for the last 25 years and has also been struggling with depression and anxiety. He wants to improve his health but feels like he is tied down by his addiction to tobacco.
Video created by Michele Gulley.
Read Transcript
For people living with mental health challenges, such as Dave, it can feel like a cloud is looming over their heads. Some days are overcast; some days are full of storms; other days, there just might be a little sun peeking out from behind the clouds. Being tied to the tobacco boulder makes the days feel cloudier and darker.
Dave’s anxiety and depression medications help him cope and clear the clouds, however, his smoking is holding him back. The TOBACCO boulder weighs him down. Having to pull the tobacco boulder makes Dave short of breath and induces coughing fits.
To make matters worse, Dave is having trouble finding somewhere to live because most rental homes and apartments don’t allow TOBACCO boulders in their spaces. His lack of housing increases his stress which means more clouds in the sky! And don’t forget, it takes a lot of money to buy tobacco products to keep the TOBACCO boulder happy, so Dave doesn’t have much money left over for rent. In addition, Dave has addictive behavior which makes him more susceptible to using multiple addictive substances at the same time. Dave becomes further weighed down by tying himself to other boulders, such as alcohol and drugs. They become an added burden.
For people with mental health challenges, such as Dave, the burden of multiple addictions can make it even harder to ‘clear the skies’. But Dave has had enough! He is tired of being weighed down. He wants to be free from the boulders AND he wants clearer skies in his day-to-day life. This is why he seeks out a healthcare provider who can prescribe nicotine replacement therapy and provide substance use treatment to get rid of those pesky boulders weighing him down.
Smoking puts an enormous strain on your body. By stopping smoking, Dave has decreased his risk of cardiovascular disease, stroke, and cancer. Without addictions weighing him down, his heart and body don’t have to work as hard, so he can focus on receiving mental and behavioral support. With that support, the clouds can begin to clear and Dave can focus on taking care of his mental health and living his best life.
Why should you care about the health and well-being of your legislators?
The legislative session is in full swing in Kentucky. The schedules senators and representatives keep during this time are long and the issues discussed may impact you personally. Could your legislator’s occupational balance affect you? Try applying the seven domains of occupational science to legislator as an occupation and see!
Activities of Daily Living and Instrumental Activities of Daily Living
Activities of Daily Living (ADLs) are basic tasks that people do daily such as bathe, manage personal hygiene and eat. Everyone, including legislators, function best when ADLs are met. Beyond these essential and routine ADL tasks, there are Instrumental Activities of Daily Living (IADLs). These tasks include managing finances and clearly communicating ideas. Given that legislators are responsible for making decisions about how our taxes are spent and what bills become laws, a legislator’s level of advanced thinking is essential so they can best serve you and your community.
Health Management
Taking care of one’s health, eating well-balanced meals regularly, and allowing breaks to recharge during stressful days are all necessary to maintain good health. Managing health is one way a legislator can assure they will be present more, absent less, and better able to serve you.
If a legislator has health issues, they may miss work or fall behind in their work priorities. For a legislator, this could mean being absent for a critical vote. If an issue you feel strongly about is up for a vote, but your legislator is home sick, they will not be able to vote on that particular issue even if you have communicated effectively with them.
Rest and Sleep
Several legislators have been “caught” on camera falling asleep during session over the years. If your legislator is tired during session, they may miss important discussions taking place on the floor. These discussions involve potential bills that could become laws on a broad array of issues from education to health to taxes. Decisions made on issues impact everyone. Given that they are in a high-stress environment and career, legislators need adequate rest to process information quickly and effectively. Might there be a day when your legislator needs to rest or nap in their offices between meetings? Yes! Adapting sleep patterns in this way allows them to be alert during the most critical times.
Education and Work
Have you ever thought about how much information your legislator must learn? Legislators must understand how to draft a bill, find co-sponsors, discuss, and promote issues that are of high importance to their communities, and more. There is much to learn so that the work can begin.
Beyond the legislative process, community members expect legislators to be up-to-date on a wide variety of issues. You need your legislators to read, listen and learn about new topics in a critical way that values best practices and evidence-based science.
Work for your legislator does not end when the day’s meetings conclude. Legislators often volunteer alongside those who voted them into office. This gives you opportunities to participate in these local experiences and get to know your legislator. Imagine talking to your legislator about issues that are important to you! You can have those conversations by seeing them in your hometown or by visiting their office.
Leisure
Sometimes you may see your legislator playing golf or going to a sporting event and you may question why they are spending time engaging in leisure activities during a legislative session. Participating in such activities helps your legislator avoid burnout. They can return to their next day’s session refreshed and better ready to serve you.
Social Participation
Most legislators enjoy activities in their own communities. Beyond that, local events allow legislators to discuss issues with you during re-election campaigns. Legislators are there to represent their constituents. Sometimes you and your legislator will see an issue similarly and sometimes you will see it differently. Allowing your legislator the opportunity to know you on a more personal level will help them understand why certain issues are important to you.
As you can see, there are many reasons why it serves you better if your legislator has occupational balance. Through the lens of Occupational Therapy, a legislative career may create barriers to occupational balance, requiring dedication to bring these seven domains back into working order, especially during a legislative session.
I asked a new Kentucky legislator, Amanda Mays-Bledsoe, if she found the balance to be a challenge and, if so, which of the seven domains she has found to be most challenging during this legislative session. Senator Mays-Bledsoe replied, “A mentor told me that, in the beginning, it’s all overwhelmingly new – the people, the physical location, the protocol of session, the legislation, the intense schedule not to mention the fast pace. Only experience will help build muscle memory to allow for more margin. I’m trying to balance learning it all while maintaining the understanding that it’s going to take time. I am fortunate to come home at night to see the kids but session is mentally, physically, and emotionally exhausting leaving little to give them. The phone calls and e-mails come in high volume about bills with little time to respond. Sleep has been challenging as the conversations and material from the day continue to replay in my head. No question, this is one of the harder things I’ve done. Even so, I’m committed to keep learning and trusting that I will be a stronger legislator and person in the end.”
And in finding that balance, occupational science confirms that a legislator will be stronger and make better decisions for you, the ones who voted for them!
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Occupational therapy is a health-based profession that uses physical and social-emotional considerations to provide quality of life, and health and well-being to our clients. Using skills to enhance everyday living makes occupational therapists unique among the healthcare team.
The University of Kentucky Behavioral Health Wellness Environments for Living and Learning (BH WELL) research team works to promote behavioral health and wellness among individuals facing behavioral health challenges. Mental health is health.
Resources
American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001
Battaglini, M., Sciabolazza, V. L., & Patacchini, E. (2018). Effectiveness of connected legislators. American Journal of Political Science, 64(4). https://doi.org/10.3386/w24442
One day, about five years ago, while resting and eating the previous night’s leftovers with my college roommate and lifelong friend Abby, we came across a video on how to take old candle jars and turn them into pots for plants. We boiled the leftover wax, removed it from the old candle jars, and set them aside. Then, we visited a local home improvement store.
Having a limited budget, we both picked two discount cacti on the verge of death, about 50 cents each, shared a bag of potting soil, and went home to continue our repurposing project. After potting the struggling cacti into the old candle jars, they thrived! The cacti grew with us over the years as we moved from house to house and grew into young professionals.
Today, my home has roughly two hundred plants of a wide variety of species, colors, shapes and sizes. My old cacti from the candle jar is affectionately named “Richard”. He has remained in my home for the past five years, living in ten different pots over the years. He never stops growing! Moreover, my tallest indoor plant, a Bird of Paradise (Strelitzia Reginae), is about seven feet tall. My smallest plant, a lithop (part of the Aizoaceae family native to Southern Africa), is the size of a quarter. For me, plants represent responsibility, fragility, dependency and hope. Plants demand their caregivers be responsible for them. Yes, a plant receives some of what it needs organically, like absorbing sunlight; but ultimately, if a plant is going to stay in an unnatural environment, we must adjust the environment to meet its needs. Plants can be fragile and easily harmed. Too much light, not enough humidity, overwatering, or pulling roughly at a stem are all ways plants can be harmed. I may have given you pause in considering gardening and raising indoor plants given the required responsibilities; but, you have yet to hear the best part. The best thing that plants do is to provide undeniable hope.
Do you recall the devastating nuclear disaster in Chernobyl? Against all odds, guess what was recently discovered in the area? Native plants. Martin Hajduch, a plant biologist for the Slovak Academy of Sciences, conducted a study on soybeans growing near Chernobyl. The soybeans were so resilient, they adapted to the soil conditions and grew despite all odds. Isn’t that incredible? Imagine if we had the strength of a tiny, seemingly insignificant, soybean. Plants are hope!
Other studies have shown the mental and physical health benefits of plants. In a review by Hall and Knuth (2019), emotional and mental health benefits of plants included decreased depression, reduced anxiety and stress, enhanced memory, and improved creativity and self-esteem, to name a few. Native American tribes use sweet grass to promote emotional strength and dispel negative energy. Sensory gardens, sometimes known as healing gardens, are beneficial to individuals living with or without special educational needs. These gardens offer a variety of plants which appeal to all of the senses and promote positive reactions to new sights, sounds, smells and touch.
It’s an odd thing to say I have a kinship with plants, but I DO! They are magical. Want some magic in your life? Grab any kind of seed from your local home improvement store and plant it with a little dirt in a tiny paper cup or empty egg carton. Give the seed a little light, a little water and a lot of patience. The day it sprouts, you will experience the magic! As your plant grows, share cuttings with your friends. You will be amazed at the magic plants create in your life.
There is a quote that comes to mind when I catch my priorities shifting and I am no longer caring for myself, my plants and the Earth. It comes from a fellow member of the Kentucky Wild Ones Chapter, a chapter of the national organization that studies and fights to preserve native plants for the health of our state.
“No matter what you encounter in the years to come, do not forget to look above at the sky and marvel at the clouds and the stars… Look about and note the individuality of every tree - the architecture of its branches, texture of its bark, venation of its leaves. All these things may be oblivious of us, but we do not need to be oblivious of them. This is what we belong to, and what grounds our sense of self.”
Anne Lubber
That, I believe, is magic! Plants remind us to pause and appreciate the details around us. So, what are you still doing here? Go plant a seed. Then, go share the magic of plants with the world!
References
Charles Hall, Melinda Knuth; An Update of the Literature Supporting the Well-Being Benefits of Plants: A Review of the Emotional and Mental Health Benefits of Plants. Journal of Environmental Horticulture 1 March 2019; 37 (1): 30–38.
Elsevier. (2012, April 19). The influence of sensory gardens on the behaviour of children with special educational needs. Procedia - Social and Behavioral Sciences. Retrieved January 18, 2023, from https://reader.elsevier.com/reader/sd/pii/S187704281200835X?token=C22C57413BFBC5B6367119D246E1E6740D2E7C055871565963437AC8B4D5D05C68A8864E55807FF12D46E462346C4B9B&originRegion=us-east-1&originCreation=20221201165408
How Plants Survived Chernobyl. Science. (n.d.). Retrieved January 18, 2023, from https://www.science.org/content/article/how-plants-survived-chernobyl
Sweet Grass has a pretty sweet history of health and Wellness. Beekman 1802. (n.d.). Retrieved January 18, 2023, from https://beekman1802.com/blogs/almanac/sweet-grass-has-a-pretty-sweet-history-of-health-and-wellness
Prior to the beginning of the century, very little literature existed that discussed the impact of architecture on mental and behavioral health recovery. As a result of this, a larger emphasis has been placed upon conducting research that reveals the true intersection of architecture with mental health care, and how it contributes to positive mental health outcomes.
An interdisciplinary team of researchers at the University of South Australia found that there had been an increase in academic interest in the relationship between mental health care and architecture at the turn of the century, particularly between 2008 and 2013. Many key themes have been identified across published literature relating architecture to mental health care. The three prominent themes include security, light, and the impact of architecture on health outcomes. This blog provides examples of each of these themes through the use of photos from Eastern State Hospital’s old and new facilities. These photos provide examples of exactly how far architecture has come in playing a key role in behavioral health inpatient care and recovery.
Security
Security is very important to mental healthcare facilities. As reported by a Haller and Deluty study in 1988, psychiatric hospitals and units in the U.S. have a significantly higher average number of assaults per bed yearly than non-psychiatric hospitals or units. As such, it is extremely important for architects to design mental healthcare facilities that allow these issues to be quickly resolved. In a mental healthcare facility, security includes the ability to effectively and swiftly respond to acts of aggression from inpatients and to mitigate the impact of environmental stress on patients and staff alike.
The safety of patients and staff are at the forefront of every design decision. The new facilities at the Eastern State Hospital campus, located in Lexington, Kentucky, are a testament to the careful planning and execution of safety both during the architectural design and construction phases. The architecture was designed to support a secure, safe environment for serving inpatients and conducting daily operations. Emphasis is also placed upon what is referred to by Jayaram and Herzog as “SAFE MD”:
S- Suicide
A- Aggressive behavior and promotion of the safe use of seclusion and restraints
F- Falls
E- Elopement
M- Complications when dealing with medical comorbidities
D- Drug / Medication errors
This is an area where the impact of architecture on mental health is extremely apparent. Here are two examples of how Eastern State Hospital’s new facility better provides safety according to the SAFE MD areas of concern:
S- Suicide
The old hospital had complete doors in patient rooms, regular door handles, and other features that would not give way if a patient were trying to cut off their breathing pathway. The new hospital features doors with triangle cutaways, door cuffs instead of handles, and other features that enhance safety and reduce the likelihood of suicide attempts.
Note how the bed and the windows of the old hospital bedrooms make it more difficult to create an environment free of pathways to suicide such as bars on the beds and open windows.
The new hospital has beds, doors, and windows designed to create a safe environment for those contemplating suicide.
E- Elopement
The old hospital was disjointed and had numerous doors from which entry/exit could occur, increasing the likelihood of elopement. While still meeting or exceeding the fire code, the new hospital has fewer entries for each unit and only three entry/exit points into the hospital.
The original ESH built in 1817
The new facility was built with numerous windows and courtyards.
Light
Light and lighting is the second category that impacts patient recovery. Spaces that have special meaning to patients can be made to stand out and can be defined with emotive lighting and colors. Lack of natural light is linked to many issues in published literature, including eating disorders, depression, circadian rhythm disruptions, and poor sensory stimulation. Since light affects mood and perception, it is important for mental health recovery. Architecture can design spaces with adequate natural and artificial lighting. This can include features such as the placement of rooms in relation to the rotation of the sun, and the inclusion of enough windows to allow adequate natural light into the space.
In the photos above, notice that the windows were smaller in the old hospital. In fact, some rooms that housed several patients only had one small window. In contrast, the new hospital allows every patient to have a room with a view, also shown in the photos above. It also provides a sunroom and even an outdoor courtyard for soaking in the sun. The new hospital is Silver LEED-certified, in part because of how well it incorporates light. Achieving Silver LEED certification requires much hard work and dedication during the planning, design, architectural, and construction phases to assure that a supportive, sustainable environment exists.
A bedroom for multiple patients with little natural light in the old facility.
A day room with large windows allowing increased natural light.
The Impact of Architecture on Health Outcomes
The impact of architecture on health outcomes is primarily focused on aesthetics and sensory stimulation, which is directly related to the spatial design of a mental healthcare facility. Spatial design is when the designer thinks about how the space feels, is organized, and might feel to the person experiencing the environment. Architecture plays an important role in creating an environment that directly impacts stress levels and social interactions. For a behavioral health facility such as Eastern State Hospital, there needs to be a balance between what is best for the patients, how the community perceives the design, and how all health and building regulations are met. Creative conflicts may arise when attempting to meet these environmental requirements, thus creating an issue that may prevent the “perfect” patient facility from existing. For example, the need for patients to have access to health professionals can be in opposition to the need for health professionals to have separate areas for medication preparation, charting, and behavioral health team discussions. The compromise made at Eastern State Hospital shows the huge contrast between the old hospital nurse stations and the new open team stations with private areas incorporated into the design as well as full glass walls in the dayroom allowing for easy patient observation while still allowing the patients a sense of privacy.
The former nursing station.
A nursing station in the new facility.
ESH is a 239-bed inpatient psychiatric hospital located in Lexington, Kentucky. They are the oldest continuously operating psychiatric hospital in Kentucky and the United States, having provided care to individuals requiring mental and behavioral health inpatient services since 1824.
Hunter McKenzie worked as a BH WELL project assistant until he graduated from the University of Kentucky College of Design in 2021 with a Bachelor's degree in Architecture and is now working toward his Masters of Architecture at Columbia University.
Lovoria Williams, Ph.D., FNP-BC, FAANP, is an Associate Professor in the UK College of Nursing. She is also a part of the BH WELL faculty team. In this brief video, she shares her thoughts about dealing with seasonal affective disorder.
Healthcare providers (HCPs) are uniquely vulnerable to occupational trauma exposure due to the responsibility of caring for people in diverse settings.
