Planning and Design of Behavioral Healthcare Facilities

Behavioral Healthcare Facilities: The Current State of Design

In keeping with most districts of healthcare, the marketplace has seen a boom in the construction of Behavioral Healthcare facilities. Contributing to this increase is the paradigm shift in the way society views mental illness. Society is placing a heavier value on the need to treat people with serious addictions such as alcohol, prescription and elicit drugs. A large percentage of people suffering from behavioral disorders are afflicted with both mental and addictive behaviors, and most will re-enter communities and either become contributors or violators.

These very specialized facilities do not typically yield the attention from today’s top healthcare designers and their quantity accounts for a small fraction of healthcare construction. However, Behavioral Healthcare projects are increasing in number and are being designed by some very prominent architectural firms such as Cannon Design and Architecture Plus. Many are creating state-of-the-art, award-winning contemporary facilities that defy what most of us believe Behavioral Healthcare design to be.

Changing the Way We Design Behavioral Healthcare Facilities

As with all good planners and designers, A+D (along with facility experts) are reviewing the direct needs of patient and staff while reflecting on how new medicine and modern design can foster patient healing rates, reduce environmental stress, and increase safety. This is changing the face of treatment and outcome by giving the practitioner more time to treat because they require less time and resources to “manage” disruptive patient populations.

The face of Behavioral Healthcare is quickly changing. No longer are these facilities designed to warehouse patients indefinitely. And society’s expectations have changed. Patients are often treated with the belief that they can return to their community and be a contributor to society. According to the National Association of Psychiatric Health Systems (NAPHS), depending on the severity of illness, the average length of stay in a Behavioral Healthcare facility is only 9.6 days.

What has changed?

Jaques Laurence Black, AIA, president and principal of New York City-based daSILVA Architects, states that there are two primary reasons for the shortened admission period:

1. Introduction of modern psychotropic drugs that greatly speed recovery

2. Pressures from insurance companies to get patients out of expensive modes of care

To meet these challenges, healthcare professionals are finding it very difficult to effectively treat patients within the walls of antiquated, rapidly deteriorating mental facilities. A great percentage of these facilities were built between 1908 and 1928 and were designed for psychiatric needs that were principled in the belief to “store” not to “rehabilitate.”

Also impacting the need for Behavioral Healthcare construction is the reluctance of acute-care facilities to provide mental health level services for psychiatric or addiction patients. They recognize that patient groups suffering from behavioral disorders have unique health needs, all of which need to be handled and treated only by very experienced healthcare professionals. This patient population also requires a heightened level of security. Self-harm and injuring staff and other patients are major concerns.

The Report of the Surgeon General: “Epidemiology of Mental Illness” also reports that within a given year about 20% of Americans suffer from a diagnosable mental disorder and 5.4% suffer from a serious mental illness (SMI ) – defined as bipolar, panic, obsessive-compulsive, personality, and depression disorders and schizophrenia. It is also believed 6% of Americans suffer from addiction disorders, a statistic that is separate from individuals who suffer from both mental and addiction disorders. Within a given year it is believed that over one-quarter of America’s population warrants levels of mental clinical care. Even if these statistics were cut in half, it cannot be denied as a serious societal issue.

With a growing population, effectively designing in accordance with such measures is at the heart of public health.

Understanding the Complexity of Behavioral Healthcare Design

Therefore, like Corrections, leading planners and designers specializing in Behavioral Healthcare are delving deeper to better understand the complexity of issues and to be the activist to design facilities that promote treatment and healing – and a safer community.

The following is a list of key design variables that are being studied and implemented:

1. Right Sizing

2. Humanizing Materials and Color

3. Staff-Focused Amneties and Happiness

4. Security and Safety

5. Therapeutic Design Tenants

Right-sizing

Today’s Behavioral Healthcare facilities are often one-story single buildings within a campus size. Often debated by Clients due to costs, this design preference is driven by the demand for Uncategorized light, window views to nature for all patient areas, and outdoor open-air gardens “wrapped” within. All of this provides soothing qualities to the patient, reduces their anxieties, counteracts disruptive conduct and helps to reduce staff stress.

“When you look at the program mix in these buildings, there’s a high demand for perimeter because there are a lot of rooms that need Uncategorized light. Offices, classrooms, dining areas, community rooms, and patient rooms all demand Uncategorized light, so you end up with a tremendous amount of exterior wall, and it forces the building to have a very large footprint.” – James Kent Muirhead, AIA, associate principal at Cannon Design in Baltimore

These design principles are also believed to improve staff work conditions. Unlike a multi-story complex, at any moment staff can walk outdoors and access nature, free from visual barriers, and within a building that more accurately reflects building types that both patients and staff would encounter in their communities.

In addition to right-sizing for the overall building footprint, is right-sizing for internal patient and staff support area. Similar to the move we have seen in Corrections to de-centralize support spaces, Behavioral Healthcare is moving to decentralized nursing/patient units called “neighborhoods.” With mental health facilities there is a large concern with distances and space adjacencies in relation to the patient room and patient support areas such as treatment and social spaces. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, Troy, NY, advocates neighborhoods that average 24-30 beds arranged in sub-clusters, called “houses”, of 8-10 beds. Thus, each neighborhood consists of three houses. Often these layouts will include a common area where patients congregate and socialize, with a separate quiet room so patients can elect to avoid active, crowded areas. In addition Pitts states, “There’s a move away from central dining facilities. So, while facilities will still have a central kitchen, it’s a whole lot easier moving food than it is patients.” However, it is important for the facility to mimic normal outside daily life routines, so patients are encouraged to frequently leave their neighborhoods to attend treatment sessions, and outdoor courtyards.

Humanizing Materials & Color

In all facilities that play a role in rehabilitation, design strives to create spaces that humanize, calm, and relax. Behavioral Healthcare patients need to feel that they are in familiar surroundings; therefore, the architectural vocabulary should feel comfortable and normal. Since these facilities are about rehabilitation (when possible) and encouraging patients to merge back into society, the facility should feel like an extension of the community. Their spaces should reflect the nature and architecture of the surrounding region and thus so, no two facilities should look too much alike.

“Our a
pproach to designing these facilities is to view the facility as an extension of the community where patients will end up when they’re released. Interior finishes also depend on geography because you want to replicate the environment patients are used to. You want to de-stigmatize the facility as much as possible.” – Tim Rommel, AIA, ACHA, OAA, principal with Cannon Design in Buffalo, NY.

Therefore, materials and colors within these spaces want to feel familiar to one’s region and everyday life. To soothe the psyche and rehabilitate, they want to feel soft and comfortable, yet visually stimulating. An interior that is overly neutral or hard in appearance is not appropriate. Materials should reduce noise, and colors should lift the spirit. This can help to create an environment in which the patient can learn, socialize, and be productive while easing anxieties, delivering dignity, and modifying behavior. As stated previously, behavioral studies advise the use of softer interior materials-like carpeting, wood doors and tile. Doing so translates directly to both patient and staff well-being, particularly staff safety, and makes for a nicer place to work. In addition, staff have more resources to “treat” instead of manage heated situations. When staff experiences are eased and satisfied, morale is boosted and life-saving rules and policies are more likely to be enforced.

Staff-Focused Amenities & Happiness

While reducing staff stress and fatigue through a healing supportive environment seems like an obvious goal, there are relatively few studies that have dealt with this issue in any detail. More attention has been given to patient outcomes. However, many leading hospitals that have adopted therapeutic tenants into their newly built environments have seen vast improvement through their “business matrixes” and financial reporting.

In one example, the Mayo Clinic, a national leader in implementing healing design in its facilities, has reported a reduction of nursing turnover from a national annual average of 20% to an annual 3%-4%. In another example, when Bronson Methodist Hospital incorporated evidence-based design into its new 343-bed hospital, they cited their 19%-20% nurse turnover rate dramatically dropped to 5%.

Now, both the Mayo Clinic and Bronson Methodist Hospital have had to initiate a waiting list for nursing staff seeking positions. This converts to better-trained and qualified staff, and a reduced error rate. Therefore, more health facilities are investing in staff support areas such as lounges, changing rooms, and temporary sleep rooms. Within these staff spaces and in the hospital throughout, facilities are also recognizing the need for upgrade materials, better day lighting, and an interesting use of color: One soon realizes that the need of patients and staff are interwoven, each impacting positively or negatively the other.

Security & Safety

Without debate, self harm and harm to staff is one of the biggest concerns mental health facilities manage. Often the biggest safety and security concern is the damage patients can do to themselves. “There are three rules I had drummed in me,” says Mark Hanchar; Director of Preconstruction Services for Gilbane Building Company, Providence, R.I. “First, there can’t be any way for people to hang themselves. Second, there can be no way for them to create weapons. Third, you must eliminate things that can be thrown.” Hanchar says that the typical facility is, “a hospital with medium-security prison construction.” This means shatter proof glass, solid surface countertops (laminate can be peeled apart), stainless steel toilets and sinks (porcelain can shatter), push pull door latches and furniture that cannot be pulled apart and used as a weapon. These are just to name a few.

Additionally, removing barriers between patients and nursing staff is a safety consideration. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, says what may be counter-intuitive for safety precautions, “Glass walls around nursing stations just aggravate the patients.” Removing glass or lowering it at nursing stations so patients can feel a more human connection to nurses often calms patients. There is also discussion of removing nursing stations altogether; decentralizing and placing these care needs directly into the clinical neighborhoods and community spaces. Pitt says, “The view is that [nursing staff] need to be out there treating their patients.”

Therapeutic Design Tenants

As medicine is increasingly moving towards “evidence-based” medicine, where clinical choices are informed by research, healthcare design is increasingly guided by research linking the physical environment directly to patient and staff outcomes. Research teams from Texas A&M and Georgia Tech sifted through thousands of scientific articles and identified more than 600 – most from top peer-reviewed journals – to quantify how hospital design can play a direct role in clinical outcomes.

The research teams uncovered a large body of evidence that demonstrates design features such as increased day-lighting, access to nature, reduced noise and increased patient control helped reduce stress, improve sleep, and increase staff effectiveness – all of which promote healing rates and save facilities cost. Therefore, improving physical settings can be a critical tool in making hospitals more safe, more healing, and better places to work.

Today’s therapeutic spaces have been defined to excel in 3 categories:

1. Provide clinical excellence in the treatment of the body

2. Meet the psycho-social needs of patients, families, and staff

3. Produce measurable positive patient outcomes and staff effectiveness

Considering the cost of treating mental illness, which is exceedingly high, and wanting facilities to have effective outcomes, a further practice of incorporating therapeutic design is increasing. The National Institute of Mental Health (NIM H) approximated in 2008 that serious mental illnesses (SMI ), costs the nation $193 billion annually in lost wages. The indirect costs are impossible to estimate.

The estimated direct cost to clinically treat is approximately $70 billion annually and another $12 billion spent towards substance abuse disorders. In addition to the increased need of care and the boom in Behavioral Healthcare construction, it becomes an obligation to make certain that we as facility managers, architects, designers and manufacturers therapeutically plan and design these facilities.

Notably, in 2004, “The Role of the Physical Environment in the Hospital for the 21st Century: A Once-in-a-Lifetime Opportunity,” published by Roger Ulrich P.H.D., of Texas A&M University, was released. In a culmination of evidence-based research, research teams found five design principles that contributed significantly to achieving therapeutic design goals.

The report indicates five key factors that are essential for the psychological well-being of patients, families and staff, including:

1. Access to Nature

2. Provide Positive Distractions

3. Provide Social Support Spaces

4. Give a Sense of Control

5. Reduce or eliminate environmental stress

Access to Nature

Studies indicate that nature might have the most powerful impact to help patient outcomes and staff effectiveness. Nature can be literal or figurative – Uncategorized light, water walls, views to nature, large prints of botanicals and geography, materials that indicate nature and most importantly, stimulating color that evokes nature. Several studies strongly support that access to nature such as day-lighting and appropriate colorations can improve health outcomes such as depression, agitation, sleep, circadian rest-activity rhythms, as well as length of stay in demented patients and persons with seasonal affective disorders (SAD).

These and related studies continue to affirm the powerful impact of Uncategorized elements on patient recovery and stress reduction. Thus, it is clea
r that interior designs which integrate Uncategorized elements can create a more relaxing, therapeutic environment that benefits both patients and staff.

Positive Distractions

These are a small set of environmental features that provide the patient and family a positive diversion from “the difficult” and, in doing so, also negate an institutional feel. These can be views to nature, water walls, artwork, super imposed graphics, sculpture, music – and ideally all of these want to be focused on nature and, when applicable, an interesting use of color. Therapeutic environments that provide such patient-centered features can empower patients and families, but also increase their confidence in the facility and staff. This helps with open lines of communication between patient and caregiver.

Social Support Spaces

These are spaces designed partially for the patient but mainly for the comfort and socialization of family members and friends of the patient; therefore, family lounges, resource libraries, chapels, sleep rooms and consult rooms all play a role. When family and friends play a key role in a patient’s healing, these spaces encourage families to play an active role in the rehabilitation process.

Sense of Control

In times when patients and family feel out of control, it is very healing for the facility design and staff to provide it back when appropriate. Although, this cannot always be done suitably in mental healthcare facilities. However, when applicable, these design features include optional lighting choices, architectural way-finding, resource libraries, enhanced food menus, private patient rooms and

optional areas to reside in. A few well-appointed studies in psychiatric wards and nursing homes have found that optional choices of moveable seating in dining areas enhanced social interaction and improved eating disorders. When patients feel partially in control of their healing program and that the building features are focused to them, an increased confidence of the quality of care enters and tensions lower.

As with all therapeutic design, this allows the caregiver to use their resources healing in lieu of “managing” patient populations.

Reduce or Eliminate Environmental Stress

Noise level measurements show that hospital wards can be excessively noisy places resulting in negative effects on patient outcomes. The continuous background noise produced by medical equipment and staff voices often exceeds the level of a busy restaurant. Peak noise periods (shift changes, equipment alarms, paging systems, telephones, bedrails, trolleys, and certain medical equipment like portable xray machines are comparable to walking next to a busy highway when a motorcycle or large truck passes.

Several studies have focused on infants in NIC Us, finding that higher noise levels, for example, decrease oxygen saturation (increasing need for oxygen support therapy), elevate blood pressure, increase heart and respiration rate, and worsen sleep. Research on adults and children show that noise is a major cause of awakening and sleep loss.

In addition to worsening sleep, there is strong evidence that noise increases stress in adult patients, for example, heightening blood pressure and heart rate. Environmental surfaces in hospitals are usually hard and sound-reflecting, not sound-absorbing causing noise to travel down corridors and into patient rooms. Sounds tend to echo, overlap and linger longer.

Interventions that reduce noise have been found to improve sleep and reduce patient stress. Of these, the environmental or design interventions such as changing to sound-absorbing ceiling tiles, are more successful than organizational interventions like establishing “quiet hours.”

Conclusion and Additional Information

The information contained in this excerpted report is intended as a guide for architects, specifiers, designers, facility planners, medical directors, procurers, psychologists and social workers which have a stake in providing improved facilities for behavioral healthcare patients. It is a portion of a report entitled “The Contributions of Color” authored by Tara Hill, of Little Fish Think Tank. Ms. Hill was commissioned by Norix Group Inc., in 2010 to research the role color plays in the safe operation of correctional facilities and behavioral health centers. More in-depth information specifically about the psychological influence of color and behavioral healthcare facility design can be found by reading the full report.

Life After Death

Following my accident when I was severely burnt, my last memory was being injected morphine at Staincliffe Hospital, Dewsbury, the place I was born and nearly died; following this I was rushed to Pinderfields Hospital at Wakefield where I was to spend the most painful 13 weeks of my life.

My next memory was awakening and finding me stood in a darkened room and in the far corner was a bed, to which all sorts of electronic equipment were attached beeping away and in the bed seemed to be a person but I just wanted to get away from the place.

Strangely all the pain I had previously suffered was gone like one big nightmare, I remember in my disorientated state somehow leaving the room, into a long deserted corridor, illuminated sparsely with a few night lights.

As I approached the end of the corridor a nurse came out of a nearby staff room, laughing merrily at some joke her and the rest of the staff must have been sharing, as she turned and walked towards me I just froze, however, her eyes showed no acknowledgement of my physical presence as she passed by me.

I called out to her when she was about 15 feet past me but she showed no signs of either seeing me or hearing me, I thought this was a little weird by now, but my instincts told me to find an outside door and get away from this strange place.

After a while travelling through the maze of corridors I found a locked exit, upon trying the door to my amazement I found my hand just passed right through it and to my utter bewilderment I found I could walk right through it, I could feel no warmth or cold, I seemed to myself what I can only describe as a physical point in space that could see and hear but could not interact.

With further astonishment I now found myself perhaps 150 foot up in the air and heading through the night, below I could see the tops of the street lamps and a few cars wondering around, I distinctly remember flying over a railway viaduct and towards the city of Wakefield.

The neon sign over the nightclub called Rooftop Gardens drew me like a magnet being familiar with the place during my many nights out with my friends The Gangster and The Savage One, I must of thought in retrospect that a familiar place would relieve me of all this craziness but I was flying for Gods sake.

I came down to land near the entrance to the club in front of two of the bouncers I remembered from yesteryear I had on many occasions in the past greeted these two individuals however on this occasion they just continued their small talk oblivious to my sudden appearance from the night sky.

I paused to think and reached out with my hand to touch a nearby wall that was adjacent to the clubs entrance but my hand appeared to have no physical substance and just passed into the fabric of the wall.

It was now that the awful truth finally dawned on me… The people unable to see or hear me, The wall, The doors to the hospital, just suppose they were perfectly normal? Just suppose that it was me who had changed? What if for example I had somehow lost my ‘hardness’, my ability to grasp things, even, to make contact with the world – even to be seen?

I mean what is the point in going anywhere if as the final shreds of my rational mind pointed out if you cannot be seen, and what was that mound in that bed in the little hospital room I had left could that have been my physical body?

I didn’t like this line of thought a human being is not separated from his body unless he is dead, then what state was I in now.

It can go through doors without opening them, it can fly like a bird, it does not feel cold or warmth and remarkable these qualities are, they are no good if one cannot be seen. I decided at this point to go back to Pinderfields and see if I could reacquaint myself with my body, surely pain is better than this.

No sooner had this thought occurred to me I found myself moving at incredible speed through the night back to the doors of Pinderfields, it seems in this strange state you travel by thought alone, handy this may be but the novelty soon wears off rapidly.

Now Pinderfields is a big hospital and in my rush to get out of there I had forgotten just where I had left my body (or indeed what was left of it by now)

I just didn’t have a clue which room it was in. I rationalised that it must be somewhere in the burns unit but it was no use asking the doctors or nurses because they couldn’t see me or hear me.

After an extensive search I managed to find the burns unit and by wondering from room to room I finally found the room I had left earlier and there I was lying unconscious, wired up to an whole variety of strange gadgets.

At this point out of pure desperation for something to do, I decided to recite the lord’s prayer something I had learnt many years ago at school.

The very next moment the absolute impossible happened; a tiny pinprick of light at the side of the bed began to grow brighter and brighter, at first not noticing the pin prick of light I thought it was a tiny night light that was the rooms only illumination that was getting brighter.

But then I saw it was coming from beside the white bedside table at the head of the bed, it continued to brighten as I watched, it brightened to such an extent that had it been any ordinary light I would most certainly of been blinded.

The next moment there flooded directly into my mind the words “Stand Up… you are now in the presence of the Son of God”, whereupon out of the light stepped what I could only describe as the most magnificent being I have ever known.

Thankful at last for a little company in this strange situation I joked “That’s it! Just like that… I am with the Son of God… Isn’t there a reception area or something before we meet?”

I felt a presence of Power and pure love that was older than time but yet more modern than anyone I have ever met.

In the first stage of my experience, what I can only refer to as the earthbound state I had lost three of my senses; smell, taste and touch, however in this further stage in the light, time disappeared completely, a bit like in a dream and I was aware of all my thoughts and actions in my life up to the present day as on big whole.

Every moment in my life was recurring before me at one and the same instant as part of some enormous four dimensional sight and sound mural.

I guessed this was my life review.

But emanating from the being projected pure love, up to that point in my life I had come across much laid back always blaming anyone and everyone for the results of my actions

I also saw from a further dimension an observation of my interactions with others from the other persons point.. I also saw parts of the future which was hazy however I distinctly remember being told that a girl I had met but would never marry had an important role in the creation of my son who was very special. I saw all of my educational achievements so far were purely superfluous but it was the way I treated others that was important and I could see the consequence of my lack of interactions with my fellow students at York University (which I had luckily just graduated a month before).

I could see how the other students saw me as weird and very anti social and they tried to avoid me where possible so that they could avoid the negative effect I had on them hence leading to a deeper feeling of depression thus increasing my isolation.

An endless viscous circle that had dominated my life.

I even could see the hurt on my best friend – The Gangsters emotions when he pulled a bird called Cherelle at Rooftop Gardens, but, I had done my best to split them up by pouring a pint of lager on her head and being very rude.

The tapestry of life was in front of me and I could see how my decisions now would effect the future all of my ambitions of being wealthy and having many material possessions was regarded by the being of light with has much distaste as was my lack of enthusiasm for interacting with
my fellow men.

I could see how my life would change and where I had once sought money and possessions I now treasured simply making other peoples lives more pleasurable at the expense of my own wellbeing.

The being of light then turned to me and said via thought dynamics “Michael, What have you done with your life so far?” I replied using my mind “Why didn’t someone tell me this was what life is about?” the being replied “Somebody did nearly 2000 years ago in your linear time – me!”

I suddenly found myself on the move again, this time we didn’t bother about doors it was straight up through the hospital roof, then we flew at incredible speeds across the surface of the earth however there was no wind to slow us and just a few moments later I found myself approaching a city beside a huge expanse of water.

In the city all the streets and offices were unbelievably crowded, and I could see people passing through other people like they wasn’t there.

We walked into a factory and I saw assembly line workers who were putting together lawnmowers enjoying a coffee break while behind them a woman was pleading for a drag of their cigarette as through she wanted it more than anything in the world.

When one of the workers clearly blind and deaf to the women behind him actually took a cigarette out of his packet and began to smoke it, the woman repeatedly snatched at it but, it was as if she was clawing at thin air.

I came to the conclusion that those people must be ghosts, even though they were dead, they remained chained to the material world by the very things they had deemed most important during their lifetimes their jobs, their cigarette smoking their material possessions.

Myself and the being of light moved from city to city visiting endless places he had to show to me, in one house I remember a younger man followed an older man from room to room “I am sorry dad!” he kept saying repeatedly “I did not know it would do this to my mum – I just didn’t understand!”

The older man was carrying a tray filled with tea and toast into a room where a clearly unwell elderly lady was sat up in bed “I AM SORRY” the younger man cried in frustration over and over again but, clearly his agony fell on deaf ears.

“Why is he so sorry?” I enquired to the being of light, referring to the younger mans pleas “He committed the ultimate selfish act” said the being touching his long beard “suicide” he continued with tears welling in the corner of his eyes “and chained to every consequence of their act of cowardice they are well and truly earthbound” he finished but I knew the answer before I asked.

My next visit was back to the night club in Wakefield called Rooftop Gardens where I had visited earlier in my disorientated state, but, without the concept of time earlier and later were meaningless it is a bit like telling someone bind from birth what is like to see.

Inside the nightclub was an impossibly crowded place where I watched ghost alcoholics mingling with living drunks and whenever a drunk lapsed into a drunken stupor a desperately thirsty ghost sprang inside his body so that the two became one.

The living could be distinguished from the ghosts by a faint cocoon of light around him, however when any living being became inebriated their light cocoon faded, enabling one of the many hovering ghosts to take over their body and literally possess the person.

S horrific was the scene that the only words in my mind that could describe this was “hell”

The mingling ghosts with their eyes so set on alcohol desperately clutching at real life beer glasses had blinded themselves to the magnificent being that accompanied me – Indeed the being told me to keep my eyes firmly on him – probably he was aware of my past record.

In this world of thought far beyond space and time (Thought is a more fundamental principle than the illusion of space or time which pale into mere shadows) it can seemingly be either heaven or hell of your own making.

Earthbound ghosts destroyed by hatred, lust and destructive thought patterns find that whatever they think however fleetingly or unwittingly became instantly apparent to all those who was around him and more completely than words could of expressed it and much faster than sound waves could of carried it.

The thought most commonly communicated amongst earthbound spirits was usually selfish thoughts and this by its very act kept the being earthbound, the being it seemed felt only compassion for these unfortunate souls but he knew it was their will not his that kept them there.

I felt like scrooge in The Christmas Carol having this wise being accompany me back to the hospital for the final time, I wanted to start my life again a fresh when I would care far more about other people and not myself.

No longer would money and possessions be my supreme objective but I would live my life with a desire to make other people happy – the old Mad Mick was truly dead and the new one ready for a reincarnation.

We entered the hospital room for the final time and the image of the being and the bed before me faded – the walls that surrounded my little room at Pinderfields became solid again it was early morning and I was informed by a nurse who had come into open the curtains that it was two days since my accident.

The pain was still there but somewhat dulled by the drugs I had been given, It was to be another thirteen weeks before I was released and I had many more strange experiences in there but nothing that could be compared to the one I have shared with you all.

After subsequent research into my favourite subject Physics I have found that with the merging of two theories of the universe Quantum Mechanics and General Relativity it appears that the 3 dimensions of space and one dimension of time is in fact an illusion created by the world of thought.

Spirits who remain earthbound do eventually find that the hatred and envy are the very emotions that keep them there but wouldn’t it be easier to help our fellow human beings while we are alive.

“Lay not up for yourselves treasures on earth” Jesus…

Immediate Cash Loans – Ravel the Abstruse Fiscal Problems

Immediate cash loans are another name for unsecured and short term loans that are endowed to those people, who are in urgent need of money to ravel the abstruse fiscal problems. These financial helps are immediately approved and some of them are even managed for the financial victim individuals within a very short span of time. Hence, people can take care of their adverse standings without any hindrance. Lenders always come up with these loans to help the needy people in dire straits. They do not check past and current credit history of the borrower because they work on focus of dealing out the best financial helps to the borrowers to meet various fiscal requirements.

Lenders have arranged immediate cash loans for both good creditors and bad creditors because there is no credit check procedure. In actual fact, these loans are available in unsecured forms that enable people to acquire immediate money without pledging any collateral as security against the loan. Thus, people are scared to avail the standard loans because of losing their collateral; they can consider cash loans the best to carry out their financial needs.

With the succor of these loans, the applicants can derive a loan amount up to £1,500 that is sufficient to unsnarl all complicated fiscal problems. These finances are quite popular throughout UK because immediate cash loans not only help you in your pressing needs but also assist you ameliorate your poor credit records so that you might fetch instant money hereafter based on your improved credit records.

Even if you want to acquire these loans without any trouble, the best way is to apply via online mode. There are so many online lenders who deal out loans at quite comparatively low interest rate together with delightful reimbursement terms and conditions. Just make a systematic analysis so as to get your hands on an amazing and delightful loan deal. As a matter of fact, you must vigilantly exam the loan terms and conditions so that you might keep yourself sage and sound from any hurdle hereafter.

What New Drivers Need to Know About Car Insurance

If you are a new driver, there are several things that you will need to know about car insurance. The most basic rule though, is that if you are going to drive a car, you must carry some form of coverage. This is just one fact you need to know pertaining to auto insurance. Listed below are several more things you will need to know as well.

Locating a Provider

First of all, in the past, you would have to sort through page upon page of ads in your local yellow pages to locate insurance providers in your area. Then, you had to phone them one by one to get quotes. However, this is no longer the case. The Internet has made locating insurance companies extremely easy.

You simply need to choose one of the many car insurance comparison websites available and type in some basic information pertaining to you and your car. The site will then match you with several providers in your area. At this point, you can choose to have these companies phone you, email you or both.

Comparing Coverage and Rates

The next thing you must know about auto insurance is how important it is to compare the coverage and rates of several providers before you choose one. Different companies offer varying rates, coverage and even discounts. With that said, you should always contact the providers in your area and find out more about them before you choose to purchase a policy.

When it comes to discounts, if you search long enough, you are sure to find some valuable ones that will help reduce your insurance premiums. Many insurance providers offer attractive discounts in an effort to gain clients. Some of the discounts that are commonly offered include new drivers, senior citizens, excellent students, safe-driving courses, air bags, safety equipment and good driving histories.

Raising Your Deductible

In addition to discounts, there are many other ways you can reduce your insurance premiums. One way is to opt for a higher deductible. This is a matter of choice, and you should think this through carefully before making a decision. While a high deductible will lower your monthly premiums, you may have to pay more should you become involved in an accident.

Liability or Full Coverage?

Another thing you need to know about car insurance is the difference between liability and full coverage. Liability is the minimum coverage that you can purchase, and it will provide compensation to other drivers in the case of accidents if you are at fault. However, it will not pay for any damage to your car or injuries to you or your passengers.

Full coverage is much more expensive than liability but there are many benefits to this type of coverage. The best thing about full coverage though, is that it not only will pay for the other driver’s damages and injuries, but it will pay for yours as well. In many cases, it will also cover such things as theft and damage to your car due to weather conditions or falling objects.

These are just a few things that new drivers need to know about car insurance. If you are a new driver, the above information can help steer you in the right direction when choosing a policy to suit your needs. However, always remember that you should compare the rates and coverage of several providers before choosing one.

What Is Involved When You Have Laser Therapy For Mole Removal?

If you have been undesirably blessed with a mole on an embarrassing part of your body or have developed moles during your formative years then you might want to get rid of them in a safe manner. If you have unsuccessfully tried various home remedies, Uncategorized treatments, and over-the-counter products, and are apprehensive about traditional surgery to remove your mole or moles then you should definitely explore the laser therapy mole removal option.

You could be afflicted with moles that might belong to different categories such as sebaceous moles, junctional moles, decimal moles, compound moles, or blue moles, that each has different characteristics and sizes. Unlike traditional surgery that might uproot the mole in one single sitting, laser therapy requires several sessions that slowly destroy each layer of the mole with a precisely guided CO2 or Erbiumyag laser beam.

You might require local anesthesia over the mole and its surrounding area during treatment to eliminate any pain, which anyway is minimal. The laser beam basically cauterizes each layer and this ensures hardly any bleeding at all. This ensures that no stitches are required after laser therapy mole removal. However, laser therapy has proved to be more successful on flat or raised moles that do not have very deep roots since moles tend to bounce back with added aggression and size if they are not eliminated completely from the roots.

You should make it a point to visit a trusted dermatologist that can examine your moles and suggest appropriate treatment. Laser therapy requires a few sessions based on the size and depth of your moles. This form of treatment is also quite costly as compared to creams or traditional surgery, but if successful hardly leaves behind any scars. Once the treatment is completed then you will observe the formation of scabs over your moles that will usually fall off within a week. There is also a risk that another mole might replace the existing one if the roots of that mole have not been completely destroyed by the laser.

If you do opt for laser therapy mole removal treatment then you might also need to pay the bills from your own pocket since most insurance companies do not pay for such cosmetic treatments. You will also need to undertake regular checkups once your treatment is complete so as to observe if any new mole is trying to emerge in place of the old one. In case you have a history of skin pigmentation or vitilago then you might need to undergo skin tests before starting the treatment. Laser treatments involve the use of low and high intensity laser beams to slowly destroy the mole while ensuring minimal damage to surrounding tissues. You might require up to 3 sessions before a mole is fully destroyed by the laser.

If you have tried all types of mole removal treatments including using homemade concoctions, products made from Uncategorized ingredients or over-the-counter creams that usually involve acidic chemicals, and are also afraid to go under the knife then you still have one option left. You could opt for laser therapy mole removal treatment that is painless and usually leaves behind no scars. Although this form of treatment is quite costly, it will usually reward you with freedom from moles and a clear skin that bears no scars.

Cookie Decorating and Cocktails: Themed Parties For the Holiday Season

The holidays are upon us, and one of the most timeless, beloved traditions is cookie decorating before Christmas time. Instead of setting aside an afternoon to bake batch after batch of Christmas cookies, why not plan a full-blown cookie decorating party to include friends and family?

How a Cookie Decorating Party Works

A cookie decorating party can work in one of two ways. You can ask all guests to bring their own favorite cookies, undecorated, to the party for a group decorating project. Or, you can ask guests to pitch in and make batches of cookies in your kitchen that you can all decorate together once they cool, fresh out of the oven.

For a smaller gathering with a few friends, baking cookies and decorating together will work well. For a larger party of five or more, it’s a better idea to ask guests to bring their own undecorated cookies so you don’t have to worry about squeezing a large group into a crowded, hot kitchen to bake cookies together.

To plan ahead, make sure that you have all of the necessary decorating supplies set up in advance in different stations throughout the room, including:

• Aprons or smocks
• Paper towels
• Tubes of icing in different colors
• Sprinkles and other assorted decorations
• Food coloring
• Small paintbrushes

From there, it’s time to get cracking! Guests can decorate plain cookies of their choice with different icings and assorted decorations, like sprinkles, chocolate chips, M&Ms, crushed peppermint, and more. You may also choose to splurge on fancy holiday cookie decorations like colored sugar, silver ball candies, and cinnamon hearts.

All of the decorations can be set up in individual bowls for use at each decorating station. Guests can also create their own colored icing with food coloring to paint different designs on each cookie using a small paintbrush.

Adult Beverages for Cookie Decorating

If this is an adults-only party, you have the perfect opportunity to pair holiday cookies with delicious seasonal cocktails to enjoy throughout the decorating process. Depending upon the type of cookies that you decorate, whether they’re plain sugar cookies, snickerdoodles, or even peanut butter cookies, you can pair your holiday drinks accordingly.

Decorated holiday sugar cookies will go well with a warm beverage like Irish Coffee or spiked cider. You can also make a large batch of alcoholic holiday punch with flavors of cinnamon, cloves, and nutmeg, served chilled and topped with a splash of cranberry juice and sparkling wine.

For more flavorful cookies, like peanut butter or snickerdoodle, serve a refreshing holiday favorite like mulled wine, peppermint martinis, or rich yet satisfying alcoholic eggnog.

For an adult-themed cookie decorating holiday bash, make sure to provide guests with the convenience of arranging transportation to and from the venue with a limo rental or luxury town car. This will allow guests to ride safely to and from the party destination so that they can enjoy a few holiday cocktails without having to worry about driving home at the end of the evening. ‘Tis the season!

Heavy Equipment Operator Jobs For the Future

Back in the days before the industrial revolution, everything was done by hand. Although the invention of machines dated all the way back to the wheel, it was only during the industrial revolution that machines became automated. Today, our world revolves around machines and nowhere is our mechanical advances seen more clearly than with heavy equipment. Whether its in mining or construction, it seems like we can move the world with our modern machines.

Operating these machines has become a very specialized skill and something that evolved from flipping a few leavers to becoming a full operator. Modern machines like cranes, bulldozers and dumb trucks are sophisticated pieces of equipment that requires skilled people to operate them.

Heavy equipment operator jobs are currently in high demand and in short supply. With billions of dollars of construction work on the horizon in the USA, we are set for some major shortages of operators.

The fact that there are more and more machines required to speed up building work and improve productivity, now is the time to get into this occupation.

Becoming an operator can not just give you a stable job, but it can potentially be a very lucrative career. With the demand being so high, salaries are set to rise and if you advance yourself and become more skilled in operating different heavy machines you can secure yourself a bright future – and always be certain of a job.

What is particularly good about being qualified as a heavy equipment operator is the fact that you can work across several different industries. Although the majority of job opportunities is in the construction industry, there is a lot of work in mining, shipyards and disaster relief.

Regardless of your preference and your skill level, you can find a job in this exciting industry.

Getting qualified usually involves a full year of training. Many trade schools and technical colleges offer 1 year programs and upon completion you will receive a certificate as well as a heavy vehicle drivers license. Not all qualifications are equal though and its important that you look into the school or college very closely. Prospective employers value certain qualifications more than others.

Its always a good idea to find someone who is already in the profession and ask around. Some construction companies eve have training programs where they will train you while you are in employment with them. This will allow you to earn while you learn and graduate with experience.

Visit my blogto read more on finding heavy equipment operator jobs.

Women's Boots – All Time Favourite Ultra-Chic Footwear

One of the most popular footwear among women is boots. Boots are usually worn in cold winter months, but now the concept has changed and it is being worn throughout the year. Women’s Boots are usually easily available at all online stores. Shopping for boots at an affordable price is very easy. There are online stores where you would find boots, of your style and size. Sometimes it can be difficult to choose a pair from the wide variety that is available at these online stores.

There are variety of styles and designs available in boots for women. Whether it is a wedge heeled boots or ankle length or knee-high ones each type of boots evoke a different type of fashion statement. Wide calf boots are more popular in middle-aged woman. Leather buckled boots are ideal for the younger generation. You can team up your boots with any kind of outfit. From short skirts to hot pants to denim trousers and leather jackets and short dresses, women’s boots goes well with almost anything. Narrow fit jeans can also be teamed up with your boots if you are going for a party.

Women’s Boots are available in a variety of colours. Colours like black, brown, blue, red, and many more. The heels can vary from the clogged ones to flat and stilettos. Hiking boots and military boots are also very popular among young women. More and more brands are coming up these days with more options and variety from which you can select when you are shopping for your dream pair of stylish and trendy boots. Boots are available in wool, plastic as well as leather.

There is boots of various styles and heels, which you can choose. From -inch heel to 6 inches, you can choose your heel type according to your needs and requirements. The heel improves the posture however; continuous use affects the general health too. According to the present fashion trend, the fur and suede style is simply wonderful. Another very popular style that has caught on is the thigh high boots. Of course, this is not ideal for the working people. However, if you want to make an impression with your gorgeous outfit and boots then it is the perfect choice.

The classy colours and chic styles make women’s boots one of the most popular footwear. If you are choosing these boots then you should go for the ones with a rounded toe. With these kinds of boots it is better that, you opt for leggings since they are so sleek and fitted. Therefore, if you want to stand out in the crowd then you should go for these ultra chic boots.

If you are planning to purchase from online counters then you can choose to go for ones, which has a free shipping policy and the returns policy, which is easy and hassle free. There are many stores where you would find a suitable designer or brand offering your size. Whatever is your need or desires, choose the shoes, which best suits, your budget and style. You are sure to look stunning and very attractive when you are wearing trendy and fashionable boots for women.

How To Properly Remove A Bumper Sticker and Blend the Paint to Match

No matter what your reasons may be you’ve decided its’ time to remove that old faded bumper sticker from your vehicle. Lucky for you in just a few minutes and with a small amount of effort your car can be bumper sticker free. This process can be repeated for just about any type of adhesive stuck to your vehicle. It can be used to remove inspection stickers from windows, or vinyl lettering/vinyl graphics from the vehicle as well. The most important part is to be very patient and not try to rush through any steps. All of the steps below should be completed in a garage, under a carport or during dawn/dusk to provide as much time as possible before the adhesive remover dries on the car.

What You Will Need:

Razor Blade (Single Sided Square Blade Recommended)

Citrus Based Adhesive Solvent (Goo Gone Automotive Cleaner Recommended)

Automotive Paint Safe Bug Brush (Can be purchased at Walmart, or any auto parts store)

Microfiber Towels

Wax

Compound

Applicators

STEP #1: Take your razor blade and carefully slide the edge of the blade under a corner of the sticker. With the edge of the razor blade under the sticker gently tease up the corner of the sticker.

STEP #2: Grab the freed corner of the sticker and slowly pull the sticker in the direction of the remaining sticker. NOTE: If the sticker becomes too difficult to pull without tearing, apply your citrus based adhesive solvent to the adhesive sticker backing during this step. The solvent will loosen the adhesive, making it easier to remove the sticker. It is recommended to wait at least one minute to allow the solvent to penetrate and break down the adhesive.

STEP #3: Once you have removed the entire sticker, there will still be bumper sticker adhesive left behind. Now apply the citrus based adhesive remover to your automotive paint safe bug brush. Using the bug brush, apply some citrus based adhesive remover to the remaining adhesive on the vehicle in a circular motion. NOTE: This step may will most likely have to be repeated in order to remove all the adhesive from the vehicle. To ensure everything is removed, run your hand across the area once dried. Any remaining sticker glue will create a rough/sticky feeling. If there is still some leftover then repeat step #3. If there is no residue or leftover you may proceed to step #4.

STEP #4: Remove the excess adhesive remover with your microfiber towel.

Note: There will be some slight scuff/mar marks as well as a discoloration of the paint depending on how long the bumper sticker was on the car. This will need to be removed by compounding and polishing the area to smooth out any blemishes and blend the clear coat to match the rest of the bumper.

STEP #5: Now that the bumper sticker has been removed and all adhesive cleaned up it is time to make it look like the rest of the bumper. Follow the steps on how to properly compound and polish a car to remove light swirls and scratches.

STEP#6: Inspect the area where the sticker was to ensure it is satisfactory. Remember to apply a couple coats of wax, since it has been a long time since this portion of the bumper saw any.

Removing a bumper sticker can seem like an insurmountable task, and often people will give up because of the difficulty. With a little patience, the right tools and know how anyone can learn how to properly remove a bumper sticker without any blemishes to the paint.

The Easiest Way to Write, Publish And Be Selling Your First Kindle eBook in 30 Days or Less

Who else would love to write their first eBook this month? Are you a coach, consultant, teacher or trainer who would love to see your first book published, downloaded and discussed around the globe?

The truth is, most online entrepreneurs crave the attention, the affection and the publicity that publishing a book will bring, but don’t have the stamina and persistence to get to the finish line.

After all… writers block is probably the biggest enemy for “REAL” writers who want to self publish, how much harder is it for online entrepreneurs and marketers who want to publish purely for publicity purposes, right?

I’m going to give you a really simple “secret” strategy that will help you overcome this obstacle, and if you follow my directions, you’ll have your first book ready to be uploaded within 30 days. (works in just about any niche you have PASSION or genuine authority or expertise)

The secret is simple.

Codify and collate questions from your community, into content.

For example, the Tumblr platform has baked this into their platform incredibly well, and as a result, some of the most popular Tumblr’s are now very books to boot.

How so?

The “Ask Me Anything” and “Submit” feature allows other readers from around the web to submit questions, thoughts, opinions or stories… and due to the viral nature of social media, and built in beauty of blogging around a topic that people share passion and a sense of purpose… you can get an AVALANCHE of submissions in YOUR niche, very quickly.

Next –

You simply take the best questions, content and submissions, and codify it into a structure that works as a book. It really IS that easy, and if you have a popular blog or Tumblr now with lots of existing readers, you can literally do this in a weekend. (especially if you are in an emotive niche where people like to share)

A great example of this?

There are a bunch, but one of my favorites is the “Clients from Hell” blog. Not only have they created a world famous blog around a pretty common shared experience by service professionals (difficult clients) they’ve turned the blog into a brand, a business and a blooming bank account to boot! (with a whole store set up around T-shirts, Mugs, and other branded goods that creative professionals buy by the busload)

Their book… and blog is ALL user generated content. Anonymous people submitting their horror stories working with clients, or short blurbs about difficult customers. It’s very entertaining, a lot of fun, and one of the most popular books (and brands) in the industry.

I’ve seen this done by psychics, mediums, personal development coaches, online entrepreneurs, designers, credit repair counselors, spiritual teachers and just about every other type of “publisher” you can imagine.

The good news? you can do the very same thing with WordPress, or any other blog platform that accepts submissions, and the truth is… you can do the same thing with Twitter, Facebook, and social media that allows you to accept content from your community.

It’s creative – and cool, and pretty darn easy to establish yourself as a bonafide writer, publisher, expert and authority site in just about any niche you choose… including the one that MAY make you rich!