With a continued shift in how behavioral health is perceived and treated, the environments that once served this population are also evolving. “I’ve worked on projects in an array of complex and sensitive settings, but behavioral health presents a very unique set of challenges,” Project Executive Mark Murillo says of the renovation project for CPMC Davies, 2nd and 3rd floor Behavioral Health program. “Our processes had to be meticulously planned to work in an occupied hospital adjacent to a sensitive population. Progress was hampered by deficiencies discovered during demolition that did not match initially reported existing conditions – all, while dealing with the start of the pandemic and its evolving guidelines.”

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The project required building systems to be brought up to code and the existing program to be demolished and rebuilt all within the confines of an operational hospital. Creating open space on the third floor significantly changed the existing structure and required new concrete and steel reinforcement. This updated footprint modernized the space for the intended program and provided important sight lines for enhanced observation of patients by doctors and staff. The Herrero team worked in groups of three to ensure the safety of the work team and account for tools and materials at all times.

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Special attention was paid to all materials and finishes to ensure it was anti-ligature, preventing anyone from attaching anything to it that could inflict harm, tamper-proof and shatter-proof to maintain a safe space for patients and staff.

• Bathroom facilities had to be large enough for access by both a patient and caregiver. They were outfitted with custom made sinks and toilets that were resistant to vandalism and bolted to the floor.
• The existing windows were insufficient for the behavioral health setting. A full replacement of all the windows with 2000lb-impact rated glass required structural steel picture framing for support.  
• The team utilized pick-proof caulk to eliminate the possibility of vandalism and ingestion.
• To meet the requirement for a secure outdoor space, a 625-square-foot open-air gazebo enclosed by metal mesh was constructed.
• Anti-ligature doorknobs were used throughout the space. The flush lever-style handles made it impossible to loop or tie anything to the fixture.
• Tight tolerances for the installation of the specialty materials and fixtures were in place as improper install could pose a risk to patients and staff.

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The onset of the COVID-19 pandemic presented its own complications.

• Social distancing meant the project team had to spread out across the project site. This infringed on the already limited storage space making it necessary to use off-site storage for project materials.
• As the hospital adapted to pandemic requirements, the spaces adjacent to the project changed uses. “A significant amount of scope, like plumbing rework and stainless steel installation, occurred above occupied spaces. The adjacent departments operated 16 to 24 hours and sub-acute patients were relocated to the ward below the project. To minimize disruption to the operations of the hospital, we had to negotiate use of space to one or two rooms at a time,” explains Brian McDevitt, Project Superintendent.
• Procurement and supply-chain took a direct hit due to COVID. To mitigate any further schedule delays specialty items such as the custom-made sink and toilet fixtures were ordered as far in advance as possible.

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Taking on a project that had many challenges coupled with the uncertainty of a global pandemic, Murillo cites, “a resilient, project-first team culture and our application of LEAN principles were integral to the project's success. We educated our client through direct communication to navigate the challenges that came up daily in this project.” CPMC Davies’ new modern behavioral health facility is a welcome upgrade meeting the needs of this vulnerable patient group for now and in the future.