Well-being by design: Design guidelines for behavioral health care in Hawaiʻi

Abstract

High rates of mental illness, substance use disorders, and houselessness in Hawaiʻi highlight the need for inclusive behavioral health care that not only provides essential services but also reflects cultural values. Financial constraints often faced by behavioral health agencies underscores the urgent need for affordable, adaptable reuse strategies to enhance accessibility and long-term viability of the facilities for behavioral health care. Certified Community Behavioral Health Clinics (CCBHCs) are an emerging care model in Hawaiʻi that provide high quality, community-based behavioral health care for all ages through a comprehensive array of services. This dissertation studies how the built environment can support well-being and mental health in behavioral health settings. The findings inform the development of evidence-based design guidelines that foster stabilization, support recovery, and promote well-being for CCBHCs in Hawaiʻi. The guidelines are applied in a design prototype to transition an existing community mental health center in Kāneʻohe, Oʻahu to a CCBHC, serving as a tool to justify, validate, and exemplify the strategies in a practical application. This dissertation is organized in two parts and follows a methodology closely aligned with the established approach in evidence-based design. Part 1 synthesizes the research components of this project; a literature review synthesizing existing findings on how the built environment can impact mental health and well-being; and, an in-depth analysis of case study facilities providing behavioral health services. This research informs the design components in Part 2; design guidelines for CCBHCs in Hawaiʻi, and the proposed application of the guidelines. This body of work—encompassing research, guidelines, and design applications—serves as a foundation for designing behavioral health environments that promote well-being and mental health. By bridging research and practice, it offers a scalable framework for communities to reference and expand upon in shaping CCBHCs that are supportive, inclusive, and adaptable in their neighborhoods.