There’s been a great deal of discussion recently about integrated care and issues related to providing treatment for both medical and psychiatric illnesses in one location, by one team.

Some patients experience both types of illnesses at the same time, and the potential benefits of a single treatment process are tremendous. Yes, integrated care is vitally important as a treatment model, but I haven’t seen any discussion about the physical environment in which it should take place or how spaces must respond to the unique challenges that are presented when designing for psychiatric patients.

For example, some psychiatric patients may try to harm themselves or others while in a treatment facility. One of the most frequent methods of self-harm by patients is to tie something around their necks, so care should be taken to limit opportunities for ligature attachment. Cutting is another activity that should be guarded against and requires avoiding objects that may be broken to create sharp edges.

Patient rooms must include all the typical medical items—medical gasses, IV poles, exam lights, adjustable beds, nurse call systems, and TVs, to name just a few—while bathrooms need to provide the usual level of safety and functionality. However, all of this needs to be delivered in a way that creates the least possible number hazards for psychiatric patients.

Many of the elements that are typically designed into general hospitals that create hazards for psychiatric patients are artifacts of earlier times and may have little or no reason to be used today, if they ever did. Patient rooms and bathrooms being designed in psychiatric facilities now are not only safe for mentally ill patients, but look and function much better than typical general hospital patient bathrooms.

The principles used in these designs may be the basis for better medical facilities that will be safe for psychiatric patient—with modifications, of course.

Here are a few examples:​

1.   Lighting in patient bedrooms is typically provided by 2-foot-by-4-foot fluorescent fixtures, which have a strong institutional and commercial aesthetic. Well-designed psychiatric facilities are now using vandal-resistant fixtures that are round or oval in shape, and some have LED light sources that allow many options of intensity and colors for patients to choose from. If used in a general hospital, these can contribute to creating a more restful and healing environment.

2.   Wall-hung sinks are typically used in acute care patient bathrooms but provide very little space for patients to store their personal items. Psychiatric hospitals, on the other hand, are now providing solid-surface countertops with integral sinks that have a much more residential appearance and provide space for belongings.

3.   The exposed pipes below typical general hospital sinks are both unsightly and present potential ligature attachment hazards. At psychiatric facilities, cabinets are now being provided below countertop-mounted sinks that safely enclose the pipes and provide a more homelike appearance. These can be the shape required for wheelchair clearance and still retain much of the aesthetic and all of the safety benefit.

4.   Toilet fixtures that are wall-mounted and equipped with exposed flush valves are common in institutional facilities. Toilet fixtures that are floor mounted, fit tightly to the wall behind them, and have recessed flush valves are alternatives used in psychiatric facilities. The floor-mounted fixtures present cleaning issues not associated with wall-mounted fixtures, but providing units that fit tightly to the wall can eliminate the problem of cleaning behind these fixtures.

5.   Showerheads and valves typically used in hospitals provide ligature attachment points that are potentially hazardous for psychiatric patients. There are ligature-resistant heads and valves (some of which appear to satisfy ADA requirements) that are successfully used in psychiatric facilities and would function well in general acute care, too.

It will not be possible, at least initially, to eliminate potential hazards to psychiatric patients in integrated care environments, such as tubing, IV poles, and the ever-present electrically adjustable beds. Several companies are working on solutions right now to reduce such risk and may be available in the not-so-distant future (especially if the need and potential market for them is clearly identified).

This will require a major paradigm shift—so let’s get started!