America’s approach to behavioral health has undergone dramatic transformation within the career span of many of us who’ve been involved in the design of environments that support that care.

Merely a generation ago, it was considered highly innovative to reduce inpatient beds from thousands to hundreds and to reduce length of stay from years to weeks. Today, we’re seeing similar transformations—from hundreds of beds to dozens of beds and from weeks of stay to mere days.

This change has taken place, in part, due to intensive inpatient programs designed to remove the stigma of mental healthcare and to transition patients back into their homes and communities as rapidly as possible, while equally intensive outpatient programs are designed to maintain and improve proper behavioral health.

This period in residential inpatient care has also witnessed multiple innovative concepts for “responsibility testing,” which helps patients better adjust to home and community, including the village system, treatment malls, and other architectural recreations of home environments within a safe, structured setting.

Not only are wards a thing from the distant past but patient bedrooms are more likely to be semiprivate (two beds per room) or, in the newest facilities, private (one bed per room). Patient room furniture is fixed to walls and floors, and doors optimally swing outward—all in an effort to promote the utmost in patient and staff safety. 

Key design features of these new environments strike a balance between individual patient privacy and dignity while assuring that those in the treatment setting can’t harm themselves or others. Design imperatives, therefore, focus on unobstructed lines of sight for staff, accompanied by details that include anti-ligature hardware and plumbing accessories to prevent suicide and suicide attempts.

And among the fastest-growing areas for behavioral healthcare are discrete (and discreet) components that support behavioral health patients within emergency departments. In recognizing the unique needs of growing behavioral health arrivals by private vehicle and by law enforcement, EDs now feature spaces specifically designed with dignity and safety in mind for those individuals, their families, and those who care for them. 

And notably, for those facilities following the current Facility Guidelines Institute’s Guidelines for Design and Construction of Hospitals and Outpatient Facilities, treatment rooms for mental health are possibly the only spaces that feature a maximum room size, in order to limit the movement of those who are excessively agitated by substance abuse or other behavioral issues.

Importantly, for provider organizations and for those in need of care, the provision of environments designed for the specific needs of behavioral health will continue to grow dramatically in the coming years, and design professionals will be challenged to address those needs.


Peter L. Bardwell, FAIA, FACHA, is director of operations for the AIA Academy of Architecture for Health. He can be reached at