Beginning in my final year of college, I worked at an inpatient behavioral health clinic where kids who were diagnosed with mental illness, ranging from schizophrenia to bipolar disorder, lived. My job was to hang out with the kids, serve them meals, and keep them safe. Most days passed somewhat uneventfully. However, I noticed one thing that did seem to affect the mood of everyone there: the environment.

The rooms were barren and beige. Common spaces were stained and clogged with bulky, heavy furniture. Windows were located 15 feet up the wall so you couldn’t see outside, and the doors were always locked. The environment looked like it was created as an afterthought—just a space to hold some kids who were going through a difficult time. The space provided no distraction or happiness for them.

After working there for a few years during and after college, I wondered, “Could the environment better support their needs?”

At the time, it was rare to hear about any positive changes for behavioral health settings. Now, these facilities are finally starting to get the attention they deserve. Healthcare designers and researchers are starting to ask what they can do to better support patients, staff, and families in these settings.

Mardelle McCuskey Shepley, a professor at Cornell University, recently presented the results of research she and a team of researchers completed in 2013 about mental and behavioral health facilities (MBH). When she began this work, there were many MBH facility projects underway, but there weren’t (and still aren’t) many design guidelines to help shape those facilities. Shepley and her team conducted a literature review to understand if any evidence existed that could be used to support specific design guidelines. After finding more than 400 articles, the team interviewed multiple experts, including staff at MBH facilities, to determine the design features that they consider to be most important for patients and staff. Among the topics the experts identified were:

  • Creating a deinstitutionalized environment by creating a sense of welcome and security.
  • Ensuring the environment is well maintained to convey a sense of respect for the patients, as well as support the belief in the organization’s mission.
  • Specifying damage-resistant and attractive furnishings, with a focus on using durable furniture that doesn’t look institutional.
  • Providing access to nature.
  • Ensuring that maximum daylight can enter different areas of the facility. (Electrical lighting is not a good substitute for the real thing.)
  • Allocating respite spaces for staff so that they can take breaks.
  • Designing for patient and staff interactions by including rooms and spaces that help everyone feel connected to one another, including multipurpose rooms and gardens.
  • Requiring a mix of flexible seating arrangements to provide patients with choices and control over their environment.
  • Providing spaces and items that promote autonomy and spontaneity, such as computers, video games, and kitchens.
  • Creating indoor and outdoor therapy spaces to promote movement, such as stationary bicycles and ping-pong tables.

Shepley noted two additional topics that generated differing opinions from the experts. First, there was no clear consensus on whether private or shared rooms are better for MBH patients. In general, the interviews conducted with experts suggest patients may be better served by units with mostly private rooms; however, harmful behavior does often occur in private rooms and bathrooms, so some semi-private rooms should be included. Second, the experts didn’t come to a consensus on the layout of nurses’ stations and whether they should be open or closed. They did share, though, that open stations seem to provide better working relationships between nurses and patients, while closed stations seemed to create barriers between caregivers and patients. For now, Shepley recommends providing semi-open nurses’ stations that have the flexibility to be completely open in the future.

There are children and adults living in behavioral health facilities who are already benefitting from some of these design considerations. My hope is that we all become advocates for them and work to ensure more facilities will provide environments that are designed to support the healing process.

Carolyn Glaser, MA, EDAC, is vice president for strategy and operation at The Center for Health Design. She can be reached at