Demand for inpatient behavioral health facilities has increased significantly, more than any other specialty hospital in recent years, according to the American Society for Health Care Engineering (ASHE) 2020 Hospital Construction Survey. And this trend is expected to continue for the foreseeable future for several reasons.

First, healthcare owners are working to better meet their communities’ needs for services and address a national shortage of behavioral health beds by building new facilities and dedicating more space within existing ones for behavioral patients. Furthermore, spaces designed specifically for behavioral health care are often tied to better patient outcomes such as less likelihood of being boarded in the emergency department (ED) or shorter durations in the ED, including wait times to be seen and time spent as a patient in the ED. Designated facilities also help behavioral health patients avoid setbacks such as increased anxiety, paranoia, or other worsening symptoms by eliminating some of the common challenges in a traditional ED setting, such as longer wait times and a stressful, stimulating environment.

Finally, clinical approaches to treating behavioral health conditions—and the built environments designed to help facilitate healing—have evolved significantly in recent decades. Evidence-based design has led to a new generation of facilities that feel more welcoming and residential with increased focus on exposure to nature and natural light, noise reduction, access to recreation and exercise, and sensory features including beanbag chairs, rocking chairs, sound machines, music, water features, and aromatherapy, that enhance well-being and mood while also maintaining patient safety.

As demand for behavioral facility design and construction continues, it’s important for project teams to understand some of the inherent challenges of these projects, such as increased lead times for specialty products and unique standards and safety requirements for behavioral facilities, as well as potential solutions to address them. Here are some best practices to consider to help ensure successful outcomes:

Overcommunicate. Project teams will likely comprise fewer seasoned experts and more newcomers. This means project leaders should commit to overcommunicating and take an educational and highly collaborative approach to all project relationships, discussions, and decision-making. Involving key stakeholders (design, construction, trade partners, and authorities having jurisdiction) early and making every effort to educate all parties about behavioral health patients and safety strategies will help team members work from the same knowledge base. Because risk tolerances, staffing models, patient demographics, safety standards, and products are ever-changing and can vary greatly from one project to the next, teams should also avoid making assumptions based on previous behavioral health and other hospital projects.

Build in adequate project lead time. Lead times for specialized products can be longer than anticipated and could easily jeopardize project schedules. Furthermore, staff turnover can be high in the behavioral health industry and frequent changes to project team members and end users can also negatively impact the schedule. Behavioral project leaders should build schedules with adequate lead times for everything from communications, education, and decision-making all the way to inspections. This can help prevent delays and rework later in the project and can ultimately save time and ensure schedule certainty.

Intensify the focus on safety. Patient and staff safety are especially critical for behavioral health facilities given the increased potential for patients’ desire to harm themselves or others. To intensify the safety focus throughout each phase of the project, the project team and trade partners should try viewing and experiencing the environment through the eyes of patients through mock security and safety walk-throughs with facility staff and, possibly, even patients. Teams may also benefit from having a third-party ligature consultant to review drawings and walk the job site.

To truly optimize safety, project teams should also coordinate and subcontract the project differently. Selecting the correct specialty items, like the correct screws, which are used for everything from plumbing to furniture, early in the project is important. Making these selections early and educating all stakeholders about these specialized requirements helps trade partners and suppliers procure the correct items from the start and avoid costly mistakes and delays. Additionally, lead times for behavioral products and services are often longer than a typical healthcare project due to their specialized nature and the increased demand relative to supply for behavioral health projects in recent years. So, getting orders correct as soon as possible is especially critical for maintaining project schedules.

Furthermore, the specialized nature of certain safety requirements, the fact that those specialized requirements could vary from one owner or jurisdiction to the next (or even from one year to the next), and because many people aren’t familiar with behavioral health construction can lead to variance, confusion, and therefore, decision-making delays and quality issues. Centralizing accountability to a single trade partner for mission-critical, specialty safety products (such as pick-proof caulk or facility-wide security) reduces the risk of variance across multiple trade partners and increases the likelihood that all partners have the correct products for their portion of the project, ensuring consistency and safety throughout the entire facility.

As demand for behavioral health projects continues to grow and standards evolve, utilizing strategies such as these can help optimize project outcomes, schedule certainty and ultimately, healing and safety for facilities’ staff and the patients they serve.

Josh Meadows is healthcare vice president at JE Dunn Construction (Nashville, Tenn.). He can be reached at