Growing awareness of the importance of behavioral healthcare is renewing focus on the design of inpatient psychiatric facilities, with the goal to provide welcoming, relaxing, safe environments that put patients at ease and help them be receptive to their treatment. However, according to leading researchers in the field of health environment design, evidence on the subject isn’t sufficient to influence the design of such spaces.

The Institute for Patient-Centered Design (IPCD), a nonprofit organization dedicated to improving the built environment to better meet the needs of patients and their families, has been working to fill this void over the past several years. In 2015, IPCD held a design competition focusing on the behavioral healthcare inpatient bedroom and bathroom, for which three finalists presented their ideas using virtual reality during an educational session at the Healthcare Design Expo & Conference. Conference attendees then voted on the top design, selecting HDR’s “One Haven” project as the winner.

HDR’s restorative environment was designed to empower patients to take active ownership of their behavioral health wellness journey while maintaining a safe and secure environment for all. The team used an evidence-based design process and consulted peer-reviewed journals, case studies of existing behavioral health facilities, experts, patients, and families to gain important perspectives. Strategies to promote safety for all parties in every aspect were incorporated, from the fixtures and furniture to the flooring and doors.

Providing patients an appropriate level of choice and control of their environment was also important in the design, to empower patients in their recovery and to convey a sense of respect from caregivers. For example, a patient-controlled digital artwork display on the footwall allows patients to choose the natural landscape they wish to view.

Mock-up development
But the work didn’t stop with the conceptual design. HDR spent the next three years working closely with the IPCD’s team of advisers, including lead juror Jim Hunt, founder and senior consultant at Behavioral Health Facility Consulting (Topeka, Kan.), and juror Mardelle McCuskey Shepley, professor at Cornell University (Ithaca, N.Y.). The group developed a mock-up of the design, including a low-fidelity version, during a design charrette held in 2017 at Savannah College of Art & Design.

IPCD also teamed with the U.S. Department of Veterans Affairs New Jersey Health Care System (VANJHCS) to build a high-fidelity mock-up on its campus in Lyons, N.J. Eighteen manufacturers and vendors donated specialty products and materials, and VANJHCS provided the space and the labor to build the unit, which was completed in early 2018.

The goal of the mock-up was to apply an evidence-based design approach to gain feedback from veterans, staff, and outside groups regarding preferred design features, such as furniture, lighting, door hardware, toilet accessories, and plumbing fixtures. In support of the VA’s guiding principles for its behavioral health service delivery system to deliver hope, self-direction, empowerment, respect, and peer support to patients, the design also incorporated elements that give patients choice in basic life activities, such as controlling temperature and flow of water in the shower.

Gathering feedback
After construction was completed, IPCD held an open house event for groups to tour the space and provide feedback on the design features and products incorporated in its construction. Shepley, along with Naomi Sachs, founding director of Therapeutic Landscapes Network and a postdoctoral associate at Cornell University, and staff from Cornell University, collaborated with the project team on performance improvement activities. Those included two evaluation methods of the mock-up room used by the VA, listening sessions and written feedback. In gathering feedback, participants were asked to agree or disagree with statements about the design of the room, including aspects of patient and staff safety, communication of respect, patient privacy, patient empowerment, patient and family participation in treatment process, connection to nature and daylight, comfortable accommodations, and acoustical control. Three listening sessions, two with staff and one with patients, were held in a group setting and intended as a qualitative follow-up of the written feedback form.

Informal results indicate that the mock-up’s design and product choices were generally positively received and considered to be “peaceful.” For example, the viewers found the furnishings comfortable and less institutional than traditional behavioral health furniture. The light fixtures near the bed were noted for minimizing glare and allowing control of brightness. One element that received mixed reviews was the open shower, which has no walls or curtains separating it from the other bathroom fixtures. Viewers suggested that patients may not be comfortable with the lack of privacy, while staff members may prefer the added visibility of patients.

Moving forward
Shepley is wrapping up the project with a thorough evidence-based design study of the high-fidelity mock-up, which will contribute evidence-based design data to help fill the shortage of research regarding inpatient behavioral and mental health facilities. The Veterans Administration Office of Construction and Facilities Management is also currently undertaking a comprehensive revision to the VA’s Behavioral Health Design Guidelines and will use these findings to help inform its process. Additionally, IPCD presented the project in detail, as well as lessons learned, at the 2018 HCD Expo in Phoenix. This collaborative work will continue to inspire innovation and provide resources that enable designers to improve behavioral health environments. More information on the project may be found at

Brian Giebink, AIA, LEED AP BC+C, EDAC, is project architect at HDR. He can be reached at Mary Therese Hankinson, MBA, MS, RD, EDAC, is chief of patient-centered care and veteran experience at VANJHCS. She can be reached at Kimberly McMurray, AIA, EDAC, is principal at Behavioral Health Facility Consulting LLC and vice president of design for the Institute for Patient-Centered Design. She can be reached at