As the treatment of mental illness and substance abuse disorders gains parity within the healthcare environment, new approaches are evolving to accommodate the particular needs of these patients. Facility design for these patients must balance the need to provide a healing environment with adequate security for patients, families, visitors, and staff.

While there are new behavioral healthcare facilities being constructed, much of our work at Environments for Health Architecture (E4H) has been in redesigning and upgrading existing psychiatric inpatient facilities to improve safety, code compliance, functionality, and patient comfort. To achieve this, we apply lessons learned from evidence-based design, including new materials, strategies in layout, and lighting and security features. Here are three ideas worth considering:

  1. Enabling better observation

One of the keys to patient wellness and safety in behavioral healthcare facilities is the ability for staff to observe patients throughout the space. This can be especially challenging when patients are in their own rooms. Traditionally, staff members check in with patients at 10-minute intervals by opening their doors and/or entering the rooms to view their patients. While this is effective, it can be labor intensive as well as time-consuming, and it doesn’t allow for much patient autonomy.

One way we’ve addressed this issue is by using polycarbonate electronic glazing on doors that’s controlled with the flick of a switch to be either transparent or translucent. For example, in a project for Weil Cornell Medical Center Psychiatric ED and Comprehensive Psychiatric Emergency Program (CPEP) in New York City, doors to patient rooms are designed with a polycarbonate electronic glazing vision panel. The nursing staff can walk down the corridor, flick a control switch located in the corridor, see the patient in their room, and turn the vision panel back to opaque. This allows the patient to maintain their private space, while the nurse can glance into the room to check on the patient without needing to enter. The technology also improves efficiency by reducing the time it takes nursing staff to make their rounds.

Polycarbonate glazing is also being used in psychiatric facilities to create private work spaces for nurses and clinical staff. If the staff wants to see out they can change the setting on the glazing. We have also used this material in patient group and family meeting rooms.  The walls can be made transparent for optimal patient observation or opaque for group privacy. This technology allows architects to design environments that are both flexible and safe by enabling visibility and supervision as well as privacy.

  1. Enhancing the setting with light

In the past, the only choice that staff had for corridor lighting at night was either to have it completely on or off. Patients in behavioral health facilities often feel safer at nighttime with their doors open because they know somebody’s there to help. But with hallway lights switched on, light streams into patient rooms disrupting their sleep.

We’re now designing facilities with more holistic lighting control systems that are managed from nursing stations to allow for various levels of hallway lighting at different times throughout the day and night. These systems contain a mixture of fixture types on separate controls for sitting areas as well as night lighting along the corridors, so that staff can lower lighting levels at night but still allow patients and staff clear wayfinding. This design creates a more residential-like environment with the ability to adjust lighting levels to correspond with different times of day. LED lighting systems that can be programmed to mimic the circadian cycle are beneficial to patients, whose natural cycles are disrupted by stress and pain, as well as clinicians, whose sleep schedules are disrupted by night shifts.

Advances in lighting controls are also enhancing the patient experience. In the past, many patient rooms had only one general room light and a reading light with only on/off settings. As facilities today seek to give patients more control over their environments, we’re seeing the use of programmable dimmers and multiple types of lighting, such as reading lights, overhead lighting, and desk lighting.

Patients are increasingly being given greater control over the amount of natural light in their rooms, as well. For example, New York-Presbyterian/Westchester Program, part of New York-Presbyterian Psychiatry in White Plains, N.Y., uses blinds between the interior polycarbonate security screen and the historic exterior windows. Patients can control the amount of daylight entering their rooms with a switch or remote control without having to ask staff for assistance with the blinds.

  1. Replacing the panic button

In the past, behavioral health facilities were designed to incorporate panic alarm systems in all rooms where patients might stay. Buttons were located on a wall in case a provider needed to request assistance with a patient. However, the industry has since learned patients can prevent providers from reaching these wall-mounted buttons.

We advise facilities to replace this static system with badges or fobs that the staff wear and can touch to set off an alarm or call for assistance when needed. The systems are linked to a light outside the patient room that’s activated when the badge is touched. This wearable technology allows for a more secure staff-patient interaction and rapid response from other staff members when there is a patient event.

Behavioral healthcare design will always require careful harmonization between addressing safety and creating more comfortable, residential healing environments. By continuing to focus on the patient experience, while being mindful of patient and staff safety, architects can apply the advances in evidence-based design, materials, and technologies to significantly enhance the healing process.

Jaques Black, AIA, is a partner emeritus at E4H Environments for Health Architecture in New York.