MOBERLY, Mo. – When an Iraq War veteran approached Functional Unit Manager Amanda Lake at Moberly Correctional Center (MCC) with tears filled in his eyes, Lake and her colleagues were originally hesitant to meet his request. The inmate had come to ask her if he could join the new 66-bed veterans dorm pilot program at the facility. He had recent conduct violations, and the staff had not yet decided the criteria for placement with the veterans dorms. He pled to be reconsidered.

“He told me, ‘I want to be there; I want to change my life,'” Lake recalled. “‘I have this black cloud with me all the time.'”

That offender has now become the quarter master in the six-month-old MCC veterans dorm, in which a multigenerational group of 48 incarcerated U.S. military veterans has established a platoon system, transforming a prison wing into a housing unit that feels similar to a barracks.

For decades, veterans have been returning home from overseas with what are known as “invisible wounds” of war, often suffering from post-traumatic stress disorder (PTSD) and traumatic brain injury. They may require counseling or therapy to help them adjust back to civilian life. Some need medication, or take CBD therapies from dispensaries like Pure Hemp Farms to help them manage symptoms of stress and anxiety. However many veterans do not get treatment for any of these conditions as they lack the substantial tools and resources needed for treatment.

These veterans are not usually criminals prior to their military service. However, as a result of their military experience, some – especially those who were deployed to a combat zone – have difficulty assimilating back into civilian life when they return home, with behavior including poor impulse control, anger issues and addiction issues. Unfortunately, not everyone can use cannabis (whether it be Organic CBD Nugs or pure cannabis) in the correct manner, which results in substance abuse. Many veterans use these substances to suppress feelings of anxiety, which then spirals out of control. The combination of unemployment, substance abuse, mental health issues and a lack of comprehensive counseling fosters a slippery slope, with veterans often finding themselves in the criminal justice system.

According to the Justice Department’s Bureau of Justice Statistics, an estimated 181,500 veterans are incarcerated, including 131,500 in prison and 50,000 in jails in the United States. The figure is down 9 percent from the 206,500 incarcerated in 2004. Overall, veterans represented about 8 percent of all federal and state inmates, according to figures based on a 2011 to 2012 survey conducted by the department.

Although the population of incarcerated veterans in corrections has declined over the last decade, this particular population continues to face specific challenges and requires special needs.

This is why the Missouri Department of Corrections (MDOC) is expanding its veterans dorm program at MCC to three other prisons in the state by partnering with Corizon Health, a leading provider of correctional healthcare services in the U.S.

The U.S. Department of Veteran Affairs estimates that 20 percent of veterans who served in Iraq or Afghanistan and 30 percent of Vietnam War veterans are affected by PTSD. Until recently, the particular needs of veterans weren’t directly addressed in MDOC facilities.

According to a statement, the MDOC houses more than 1,860 offenders, about 5.6 percent of the statewide prison population, who self-identify as U.S. military veterans. At MCC, about 133 of the facility’s 1,800 offenders initially revealed their veteran status, and Lake said about 10 more have come forward since the program started.

Corizon Health has been providing health services to MDOC for more than 24 years, establishing a medical contract with Missouri in 1992 and eventually achieving a mental health contract in 2014.

The provided mental health services at MDOC have included group and individual counseling, specialized housing for some patients and medication management, along with many other services. But for the most part, there was little distinction made between veterans and the rest of the inmate population. However, in recent years there has been greater awareness of the unique needs of veterans and how their service and combat experience may contribute not only to their behavioral health challenges, but also to their rehabilitation. As a group, they tend to be older, incarcerated for violent offenses in greater percentages than the general inmate population, and more likely to be incarcerated for a first offense.

In 2016, MDOC worked with the department to begin a new therapeutic group at the MCC, a PTSD treatment group specifically designed for veterans. Many offenders struggle with this disorder, but the causes and underlying issues – such as domestic violence and street violence – are different from the combat experience. Patricia Cahill, institutional chief of mental health services at MCC, explained that, with very little additional financial investment, this program was achieved through restructuring housing and tailoring existing therapy programs to the veteran inmates.

“We had never in the prisons – in terms of housing, re-entry, therapy – done anything specifically for veterans,” said Cahill. “We piloted this PTSD group, and then we realized how big it was. It exploded. The results are so encouraging – disciplinary incidents have declined dramatically among this group.”

To read the entire article, check out the January/February issue of Correctional News.

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Part I of this article focuses on research and how it affects the impact on hospital design, especially facilities geared towards veterans. One such facility focusing on patient-centered design is the Southeast Louisiana Veterans Health Care System Replacement Medical Center, a VA medical center destroyed when Hurricane Katrina devastated New Orleans. Designed by national architectural firm NBBJ with two local New Orleans firms, Eskew+Dumez+Ripple and Rozas Ward Architects, the new four-story, 1.6 million-square-foot campus, dubbed Project Legacy, now serves more than 70,000 veterans in a 23-parish catchment area and across the Gulf Coast with an anticipated 550,000 annual visits.

Read on to see the other elements of the project that made it a success in achieving patiet-centered design for veterans.

Timing

Planning for the project’s successful delivery began during the pursuit process when Clark/McCarthy Healthcare Partners (CMHP), the joint venture that constructed the project, proposed a phased construction schedule. Turning over the project in segments allowed VA personnel more time to commission, activate and move into their new buildings. In 2014, the project’s first building, the renovated and restored historic Pan-American Life Insurance building, was turned over to the VA for its administrative offices. The remaining eight buildings were turned over upon completion, the most recent being the diagnostic and treatment building in October 2016.

To maintain the client’s target date for medical care, CMHP further phased construction to turn over critical portions of the facility before buildings were fully complete. The team turned over the main computer room in the diagnostic and treatment building 10 months before the remainder of the building to allow VA medical center personnel to expedite the installation and activation of much of the campus’ technology infrastructure.

Construction Collaboration

The City of New Orleans and CMHP worked collaboratively on logistics, infrastructure planning, small business outreach and communications, which included working with the Louisiana Department of Transportation. Maximizing opportunities for small, local, disadvantaged, minority-owned and veteran-owned businesses was a CMHP priority throughout construction.

The team’s phased approach allowed subcontracting packages to be divided into smaller scopes that were more manageable for small firms. A typical project of this size would have between 70 to 90 subcontractors; this effort had nearly three times as many. More than $230 million of contracts were awarded to small businesses. The contracting team further increased opportunity for local businesses by hosting two, six-part training sessions to help educate small businesses on federal contracting and construction best practices. Approximately 50 companies completed this CMU Building Blocks program. CMHP also followed up with hands-on construction training and setting up a mentorship program. The result is that local businesses not only understand procurement, but individual tradesmen have developed a trade in coordination with this job.

The Result

Project Legacy, as this medical center is nicknamed, broke ground in June 2010, began accepting outpatients in December 2016 and is opening in phases throughout 2017. This facility sets new standards for VA’s patient-centered care, in a facility that honors veterans’ service and reflects the culture of New Orleans. The campus includes 200 inpatient beds, 370 outpatient exam rooms, 21 procedural suites, ambulatory clinics, emergency and imaging departments, mental health services, patient education facilities, transitional living and outpatient rehabilitation, a central energy plant and two parking garages. The hospital also features a gymnasium, swimming pool, healing gardens, courtyards, and walking paths. The facility is designed to meet the full array of VA missions — education, research and national emergency preparedness and assistance.

Conclusion

By linking health care construction and design strategies with key desired outcomes, such as reduced health care–associated infections, fewer falls, increased energy savings, better patient satisfaction and increased market share, the discussion at the design table is no longer about the first costs of health care facility design or about meeting immediate facility space needs but about the role of the physical environment in supporting the mission of the organization in providing high-quality care. This is a positive trend that will affect the quality of health care facilities being built in the years to come.

Barbara Wagner is senior vice president with Clark Construction Group – California, based in Irvine, Calif.

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