When it first opened in 1851, the Fulton State Hospital became the first public mental institution west of the Mississippi River, and since that time it has experienced numerous upgrades and expansions. Since 1937, the facility’s Biggs Forensic Center has been treating patients with serious mental illness who are committed by Missouri courts for evaluation and treatment related to a crime, or who have seriously assaulted patients or staff in other state psychiatric hospitals.

But more than a century-and-a-half after its arrival, the security and safety needs for Missouri’s only maximum security psychiatric facility could no longer be addressed through repairs to the existing buildings.

After several years of planning and preparation by the Missouri Department of Mental Health, construction of a new hospital began in May 2015. The new $211 million Fulton, Missouri facility has been renamed the Nixon Forensic Center and was introduced to the public during a ribbon-cutting ceremony on Wednesday, May 22.

WSP joined the project team in 2014 as prime consultant for the construction of a 300-bed state psychiatric hospital to design the replacement facility, working on behalf of the Missouri Department of Mental Health and in collaboration with EYP, project designer. WSP also led the consultant team from programming through construction completion.

The new facility was designed with staff and client safety in the forefront, according to Tom Brooks-Pilling, WSP project manager.

“The concept was built upon a design strategy first deployed at St. Elizabeths in Washington D.C., which was very much like the old Fulton State Hospital with many of the same Civil War-era buildings on a campus that was not secure and not safe.”

The living units are designed with a central nurse’s station that has a physical view of every patient room, exam room, toilet room, accessory and living spaces. “The primary job for the person at this nurse station is to watch the other staff members backs,” he said. “This frees up the other staff to interacting and providing treatment with their clients.”

The new hospital features 12 living units, each housing 25 clients and clustered around four community treatment areas that are served by a treatment mall, known as the Hope Center. Each community is designed to be secure and therapeutic, adhering to the most progressive standards of care for the mentally ill.

“The four specialized treatment communities are a noteworthy concept and a unique clinical element for Fulton State Hospital,” Brooks-Pilling said. “The patients are assigned to a treatment community and living unit based upon their illness and treatment program. The Hope Center is a central location where patients gather to socialize, shop, take classes and work. It acts like the community’s ‘downtown,’ if you will.”

The project was implemented in multiple phases to avoid disrupting patient services during construction. Work involved abatement and demolition of 20 buildings and associated utility tunnels; grading, roads, utilities and landscaping.

Collaboration was critical to the success of overcoming the project’s biggest challenges and developing innovations like the community suites design, as well as three levels of patient-accessible courtyards provided for each living unit, medium courtyards for each program community, and a large recreation yard for the entire facility.

“The scale of therapy space, based on Fulton’s specific organization of four unique programs, differs from any other facility to our knowledge,” said Richard Clarke, senior design principal for EYP. “Engagement and sharing in the charrette process produced trust and support for problem-solving, and the overall project benefitted from close collaboration between our offices in New York, Washington, D.C., and WSP in St. Louis—as well as with numerous consultants and with hospital and state officials.”

The 50-acre site for the new hospital has an 80-foot-high fall from the northeast to the southwest corners to secure the perimeter of the facility. The entire site was designed as a single-story structure – a design feature that posed some challenges with the hospital site.

“Fulton State Hospital wanted a single-story building for the patients, as stairs create a safety nightmare,” Brooks-Pilling said. “Our design team was able to solve this problem through a massive regrading program that resulted in a single-story building without any changes in elevation across the length of this quarter-mile-long building.”

Although constructed as a maximum-security complex, it was designed first as a treatment facility. “Our designers worked hand-in-hand with hospital administration, clinical and nursing staff to design a first-class treatment facility that happens to be a maximum-security complex,” he said.

“One of the biggest challenges was integrating critical security features while minimizing visual impact and providing both real and perceived security to staff and patients,” said Eric Kern, project director for EYP. “This was done from the careful design of perimeter security fences ¬– integrated with the building’s massing – down to many intricate details within the interior of many spaces.”

The new building includes a 63,000-square-foot services building with a central utility plant, warehouse, maintenance and dietary buildings; and a 360,000-square-foot secure psychiatric hospital with a central control and command center, and a visitation center.

One major issue with the design of this type of facility is how maintenance can be performed on the building systems without impacting the occupants—or more challenging, without the maintenance staff being impacted by the occupants.

To address these concerns, WSP designed a service “attic” where all mechanical, electrical, plumbing, fire protection, communications and security infrastructure are housed.

“The attic can be access by maintenance staff without penetrating the secure perimeter,” Brooks-Pilling said. “In this way, maintenance is performed without interacting with the building occupants. This limits the potential for tools to be left out where patients can access them; and it keeps the maintenance staff out of harm’s way.”

The new building was designed and constructed with sustainability in mind, according to Gregg Christian, WSP construction administrator.

“While this project was not intended to become a LEED-certified building, that did not stop us from using the best sustainable practices available,” Christian said.

The new facility uses 156 solar thermal arrays connected to a 11,000-gallon solar storage tank for pre-heating all domestic hot water, as well as hot water for the building heating system. The facility also features a robust electrical backup system.

“The entire facility can be run off two 2000kW/2500kVA paralleling generators capable of producing a total of 4000kW,” Christian said. “The facility cannot be offline and these generators ensure that it never will be.”

The building also incorporates more natural light, which reduces the need for lighting and improving visibility within the facility, creating a safer and more inviting interior for patients and staff.

Incorporating sustainability features into the building not only ensures greater efficiency, but also prepares the client for future growth. Through its Future Ready™ program, WSP seeks ways to help clients look beyond the world as it is today to anticipate growth and technology advances so they are prepared to support future implementation.

The ribbon-cutting ceremony included participation from several Missouri lawmakers, including Gov. Michael Parson, former Gov. Jay Nixon, and other local state legislators, as well as Missouri Department of Mental Health employees, who toured the facility following the ceremony. Members of the design and construction team were on-hand, including Brooks-Pilling, Christian and Dan DeArmond, transportation area manager, representing WSP.

It has been a satisfying culmination of work on the project for Brooks-Pilling that began more than two decades ago.

“Having started in 1998 on the consolidation and conversion study and seeing the results of this effort 20 years later is highly rewarding,” he said. “I feel that this project is the greatest achievement of my 40-year career.”

He said that when the state was able to fund the project 16 years later, his background from his work on the original study enabled him to assemble a team that had a proven track record of developing cutting-edge forensic psychiatric facilities.

“The new Fulton State Hospital has client and staff safety built-in to every detail,” Brooks-Pilling said. “Once several years of operation are under their belt, we will begin to determine how effective its design has been to reduce staff and client injuries.”

Christian added that the experiences he gained from this project extend far beyond his construction management work.

“My sense of compassion has completely changed for people with mental health issues hearing how the hospital staff and leadership would deal with the day-to-day challenges of giving a forgotten group of people some stability, hope—and most of all, some dignity,” Christian said. “I’m immensely proud to have worked on this project.”

With the project now complete, patients will begin moving into the new hospital the week of July 8.

“The project provided me with a breakthrough in understanding the enormity of the behavioral health problem in the U.S. and provided great satisfaction to work on a cutting-edge approach to addressing those issues,” Clarke said. “I’m very pleased with the grace and elegance of the planning solution for a very complex problem and the level of innovation in addressing program and budget issues through the power of design.”

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