You may have noticed over the past year or so that we’ve been covering the design of behavioral health (BH) facilities with more frequency here at Healthcare Design. It’s not necessarily something we set out to do but instead happened rather organically.

As we hear the industry talk more about the design ramifications for these spaces, it’s given us plenty of paths to follow to explore the challenges of this particular healthcare setting and share some solutions with all of you.

And the buzz surrounding BH facility design is likely to become even more audible, thanks to the expansion of services that’s provided under the Affordable Care Act. As the service line grows across healthcare organizations, design firms’ boards may just be filling up with new construction and renovation projects.

But when teams sit down to tackle these new projects, what research, case studies, proven approaches, etc., are available to base design upon? A new report from The Center for Health Design (CHD) says not much.

Design Research and Behavioral Health Facilities” (available via CHD’s Knowledge Repository) reports that little attention has been given to the role of the physical environment in behavioral health settings in the past 40 years.

And while, as many of you know, the healthcare design research ante has been upped over the last couple of decades and encompasses a variety of facility types from acute care to outpatient, that trend never quite reached behavioral health.

“The amount of research and associated funding on the topic of BH environments is minimal and insufficient to inform the design process or generalized to other BH facilities. Likewise, the institutionalized guidelines for these facilities, with few exceptions, lack research evidence to support their recommendations. The authors strongly suggest that more research and more effective collaboration between researchers and the generators of guidelines be encouraged via both public and private sectors,” the report states.

While the problem has now been identified, the CHD report also recognizes the challenges of correcting it. To start, there are numerous settings where behavioral care is provided, from psychiatric hospitals to specialized nursing units to alcohol and drug treatment facilities to day hospitals.

There’s also the issue of diagnoses—patients largely suffer from a variety of conditions, so it’s tricky to connect the dots from one design solution to each individual patient population. And, finally, the report states, it’s simply difficult to gather data from BH patients and residents.

So as the course is corrected, if it’s able to be corrected, what do we know?

The study authors admit there’s little to go on right now, but that their research did identify some design recommendations that can serve, at least, as preliminary approaches to be studied further as they’re implemented.

Here’s the gist of it:

  • It was largely determined that multiple-patient rooms are unsuccessful, resulting in a higher percentage of isolated passive behaviors. However, while some researchers/practitioners support a single-patient room approach, others are in favor of a two-bed model that promotes patient safety.
  • One post-occupancy evaluation showed that regardless of environmental changes made at a facility, programs are likely to return to previous institutional models of care delivery. With that said, updates such as new furniture and finishes did have a positive effect on patients and staff.
  • While the reduction of items in a space that may support hanging or self-injury is certainly beneficial, the physical environment can play a role in reducing harmful behavior, too, with elements like nature art reducing stress and aggression.
  • For children and adolescents, more success was seen when the physical environment was designed to support small inpatient clusters, leading to an increased feeling of belonging, competence, and staff satisfaction.

For more on BH design, and what some designers are doing to tackle the challenges of this sector, check out recent Healthcare Design articles: