New construction at Bradley Hospital appears in the foreground of the architect’s illustration above.

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S/L/A/M Collaborative

EAST PROVIDENCE –– Many more hours than they ever thought possible were spent on the question of toilets.

The hospital president and the medical director, in long committee meetings, puzzled over this question: wall-mounted or floor-mounted? If wall-mounted, the kids might jump on the toilets and break them off. If floor-mounted, it’s hard to clean behind.

One model was quickly rejected: the one with which, at another hospital somewhere, a youngster wedged his head between the toilet and the wall and deliberately broke his own neck.

For Daniel J. Wall, president of Bradley Hospital, and Dr. Henry T. Sachs, medical director, the daunting and thrilling task of designing a new psychiatric hospital for children involved many, many details. But not one of them was trivial.

Yesterday, Wall and Sachs were among the dignitaries at a ceremonial groundbreaking (with construction going on just feet away) for the $31-million building on the hospital’s grounds. They focused on the sunny side of the equation: that mentally ill children can get better, and that the new hospital’s environment –– with a private room for each child, and spacious gathering places –– will be more suited to their needs than what Wall called the “cramped, outdated space” in the 77-year-old structure now in use.

But the months preceding yesterday’s event were consumed, first, with designing the hospital to ensure the safety of children who are very, very sick –– children out of control, suicidal, enraged, depressed, confused, psychotic, traumatized, children often hell-bent on hurting themselves.

So those arched nozzle-free faucets and the recessed sprinkler system were selected because they have “no ligature risk” –– that is, a string or a rope or shoelace tied around it will slip off, and no one can hang himself.

To sort through the myriad choices, the hospital convened a committee from every aspect of care and operations, including physicians, nurses, environmental services people and parents.

The toilets? It was a close call but the group decided on floor-mounted.

The beds –– should they be bolted to the floor? If bolted, a kid could hide underneath, out of reach. If movable, the beds could be used to barricade a door. They settled on beds that were not bolted but too heavy to easily move. And besides, each room has two doors.

How to allow privacy in the bathrooms while preventing kids from locking themselves in? The doors close, but the staff controls the locks.

Should it be possible to open the windows? They decided against it, but not before traveling to Poughkeepsie, N.Y., to check out the special smash-proof windows that a hospital there was using.

“We wanted to maximize safety but not to the point that it looked institutional,” Sachs explains.

In Poughkeepsie, the windows could be opened, but the people working there didn’t like that feature and the locks were reminiscent of a prison. The new Bradley’s windows will be both unbreakable and unopenable, but they look attractive, Sachs says.

And those windows will be plentiful, with natural light pouring in to common areas.

That was hardest part of the design, says Susan Eagleson, chief nursing officer –– “trying to balance the need for security versus the need for a warm and homelike environment.” For example, the interior doors between each unit needed to be locked –– unbreachable, but not a dark steel door. The doors selected are solid, but feature windows and raised wood paneling.

The 44,000-square-foot building will be almost triple the size of the existing one, but with the same number of beds — 60. The children will be divided into “pods” of six to eight patients each, making it easier to monitor and assess them. Each pod has an activity room for organized activities and group therapy, and a great room for informal gatherings.

“We’re hoping when we have good group space, play space, areas for kids to be a little freer it will enhance our relationship with them,” Eagleson says. “We’ll be less focused on security on more on the quality of our relationships with kids.”

The first floor will house the young children, ages 2 to 12, and a group of children with developmental disabilities who also have severe behavioral problems.

The second floor will have 30 beds for adolescents, 10 more than in the current building. Wall said this will almost eliminate the problem of teenagers in crisis being held in emergency rooms at general hospitals for lack of psychiatric beds. With single rooms, the hospital will have more flexibility to fill every bed. (Currently, with two beds per room, sometimes the only bed available is in a girl’s room, and if a boy needs admission, the bed lies empty while the boy waits.)

The extra space brings other advantages. Now there will be separate, quiet areas to prepare and administer medications away from distractions, Eagleson says. Best of all, she says, the new building features more rooms for families, so patients’ parents can more readily come to the unit for family therapy or visits.

The new building encircles a courtyard, closed off from escape but open to the air, where kids can gather for fresh air and unstructured time on their own.

When the new construction is complete –– expected in fall 2009 –– Bradley Hospital will advance from being the nation’s oldest children’s psychiatric hospital to the newest one.

But inpatient care is only part of the picture. The building where inpatients now stay will be renovated to expand outpatient, afterschool and partial-hospitalization programs.

The architect is the S/L/A/M Collaborative of Glastonbury, Conn.; Gilbane Building of Providence is handling the construction. The hospital has raised $3.5 million in charitable donations for the project, nearly half the goal. The hospital plans to borrow to pay for 75 percent of the cost.

ffreyer@projo.com