Across the healthcare spectrum, hospitals and other facilities are working to break down their institutional settings, asking designers to instead pursue more homelike and hospitality-inspired models. But deinstitutionalizing behavioral health facilities can come with plenty of obstacles regarding the treatment and care of criminal (forensic) populations.

IKM Inc. faced these challenges while providing architectural services for a 50-bed addition to the state of West Virginia’s behavioral health facility, the William R. Sharpe Jr. Hospital in Weston, W.V. The 33,000-square-foot addition, slated for completion in April 2014, will serve as the primary forensic wing for the facility, where the admission and care of the majority of the hospital’s criminal population will be handled.

The existing building’s layout encourages interaction between patients and caregivers, which has made it difficult to manage a recent spike in forensic patients. Meetings with the staff and administration revealed concerns related to safety (for both staff and patients) and visual control of all patient-access areas. Staff recruitment and retention was also identified as a key area of improvement for the hospital. 

To combat these issues, two approaches were established early in design, with the first focusing on the attending staff. As forensic patients can be prone to violence and suicide, and also be elopement risks, most of the patients are required to spend the majority of their time in the unit. With this in mind, a diagram was created that eliminates blind areas of the common spaces (corridors, gathering spaces, etc).

The nurses’ station becomes the focal point of the unit, with all other spaces able to be viewed from this location. A secure area for staff was noted as a critical area for staff to feel safe and reduce anxiety, so a space was also designed to serve as an off-limits-to-patients area that supports and provides backup to the nurses’ station.

The second design approach introduces an exterior “room” into the units. Enclosed courtyards, which allow patients to move freely from the interior to the exterior, can become part of the therapeutic process for individuals. The design team chose an approach that would allow this freedom while maintaining visual control from the nurses’ station. This integration also allows natural light to enter the core of the nursing unit, helping to promote more vital connections to the outdoors.

A layout was created that positions programming functions around these two overarching design concepts, with the nurses’ station at the hub of the circulation spaces. Taking a typical double-loaded corridor scheme and splaying the corridor into two single-loaded corridors allows for the insertion of social program space and the exterior courtyard. This position promotes the visual control of all the common spaces within the unit. A shared dining room is also located to allow for a large glazed area that overlooks wilderness beyond the site.

Overall, the challenges the project presented also created opportunities for design that incorporate safety and enhance the delivery of behavioral care.  

Jonathan M. Lusin, AIA, LEED AP, is a project manager/architect for IKM Inc. (Pittsburgh). He can be reached at