Therapeutic military and veteran settings

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There is a growing commitment among military and veteran health care organizations to provide services and environments that support both physical and mental health and well-being. 

The design of military and veteran health care facilities is a crucial factor when considering how to best support the therapeutic process. Some elements of the physical environment may even provide a nonpharmacological means to bolster the health and wellness journey. There are several new studies on this topic in the recent additions to The Center for Health Design’s Knowledge Repository. Three are highlighted here. 

In a study by Ameli and colleagues, we find evidence of the benefit of the natural environment for military service members. Twelve service members and veterans participated in this cross-over research design, taking walks at two outdoor military health care sites: a woodland environment (called “the Green Road”) and a campus road (called “the Urban Road”). 

Researchers used interviews as well as quantitative assessments of distress and mindfulness. Participants had significantly more positive experiences on the Green Road than the Urban Road, and reported less distress and greater mindfulness on the Green Road compared to how they felt before the walk. 

Later in life, those with post-traumatic stress disorder (PTSD) have a high likelihood of dementia as well. Multisensory environments (MSEs) are becoming more popular as a nonpharmacological treatment option for both trauma and dementia. MSEs are typically interior spaces that include a variety of sensory stimulation through visual, auditory, olfactory and tactile stimuli. 

Lorusso and colleagues examined the effectiveness of MSEs in supporting the well-being of veterans with dementia. Through interviews with staff at various Veterans Health Administration (VHA) sites, researchers found MSEs to support positive distraction and engagement, with outcomes of reduced agitation and aggression. 

A study by Nuamah and colleagues engaged veterans with PTSD to better understand how different aspects of the interior environment affected them. Results showed how the environment can either trigger anxiety or support veterans by giving them a sense of control. 

Veterans shared their perception of several aspects of the environment, including preferences for wide walkways and hallways, clearly marked exits, open floor plans, access to nature, minimal furnishings and natural lighting. Some findings were mixed. For instance, large windows were seen as a positive in most of the interviews, providing a calming view of nature, but some veterans shared that being able to see out the windows made them feel hypervigilant, having to keep track of what was happening outside. 

The results of these studies are complex and do not offer a clear answer for every circumstance, but they do shed light on how design can minimize and even mitigate anxiety and trauma. When military members or veterans need health care, they need health care environments that can provide a sense of control, restoration and tranquility. 

For more information on therapeutic environments, as well as several other topics related to health care design, visit The Center for Health Design’s Knowledge Repository. 

Research used for this column

The following citations from The Center for Health Design’s Knowledge Repository of health care design resources were used by the author when writing this column:

• R. Ameli et al., “A Nature-Based Health Intervention at a Military Healthcare Center: A Randomized, Controlled, Cross-over Study,” PeerJ 9 (2021): e10519.
• L. Lorusso et al., “Sensory Environments for Behavioral Health in Dementia: Diffusion of an Environmental Innovation at the Veterans Health Administration,” HERD: Health Environments Research & Design Journal 13, no. 4 (2020): 44–56.
• J. Nuamah, C. Rodriguez-Paras, and F. Sasangohar, “Veteran-Centered Investigation of Architectural and Space Design Considerations for Post-Traumatic Stress Disorder (PTSD),” HERD: Health Environments Research & Design Journal, 2020, in press.

About this column

“Design Discoveries” highlights research from The Center for Health Design’s Knowledge Repository, a user-friendly library of health care design resources. This research effort is supported by the American Society for Health Care Engineering, the American Institute of Architects, the Academy of Architecture for Health Foundation and the Facility Guidelines Institute.