- The 2026 FGI Code for Planning and Design of Hospitals is the first edition to include minimum requirements for medical/psychiatry units.
- The new guidelines integrate safety elements from both medical/surgical and behavioral health settings.
- Therapeutic features, including group therapy rooms, calming rooms, outdoor access, and natural light, are now codified as part of MPU design, not optional additions.
Virginia Pankey (Image Credit: Courtesy of HOK)
The regulatory and physical boundaries separating general medicine and psychiatric care are inconsistent.
Choosing the primary reason for hospital admission—medical or psychological—does not consider the whole person. For patients dealing with medical and psychiatric comorbidities, the effects of such separations can be devastating.
All patients and staff in a medical/surgical inpatient unit are impacted when a patient needs treatment for simultaneous conditions but is only being treated for one. For example, for a patient with schizophrenia who also has poorly controlled diabetes, delaying diabetic treatment is not an option, so they are admitted to a traditional inpatient medical unit in the hospital.
Why traditional inpatient units fall short
Due to the patient’s psychiatric condition, they require one-on-one supervision, which is highly resource-intensive and expensive. General medical staff might not have sufficient training, experience, or time to care for patients with a serious mental illness (SMI). As a result, the patient’s symptoms might be misattributed, and staff might miss opportunities for intervention, as reported by the University of Iowa.
This creates a challenging dynamic in which the hospital staff might feel unsafe, patients perceive that their needs are being dismissed, and the healing environment for everyone in the unit becomes disrupted.
Additionally, people with an SMI have a higher prevalence of several chronic physical health conditions. A 2022 report from the World Health Organization states that an individual with an SMI will die 10 to 20 years earlier, on average, than the general population, mostly due to preventable diseases. Often, chronic diseases add another layer of complication on top of already difficult medication management common to mental health issues.
Medical/psychiatry units (MPUs) present a solution. These units are designed to deliver acute hospital care to patients with concomitant medical and psychiatric needs and help them access services, according to the Association of Medicine and Psychiatry’s Medical Psychiatry Unit Consortium.
The approach allows caregivers to give equal attention to psychiatric and medical care rather than treating one diagnosis as an obstacle to addressing the other.
Rise of medical/psychiatry units in healthcare design
MPUs first emerged in the U.S. in the 1980s, but their adoption has been slow.
According to a 2023 article published by Psychiatric Services, less than 3 percent of hospitals have one. The primary barrier is reimbursement: Physicians are required to select a primary diagnosis, and medical diagnoses have historically been reimbursed at a higher level than behavioral health diagnoses. This has led health systems to treat patients’ medical and behavioral diagnoses sequentially rather than simultaneously.
Because too few units have been built, only a limited amount of data has been gathered for health systems to justify the investment. MPUs have developed inconsistently across the country with no standardized model, leaving hospitals that might consider adopting one without a clear blueprint to follow.
The Facility Guidelines Institute’s (FGI) 2026 FGI Code for Planning and Design of Hospitals, which will be published in fall 2026, will be the first edition to include minimum requirements for MPUs. The code offers specific guidance for planning, designing, and constructing these much-needed units and helps address the unique needs of the individuals that use them.
Explaining MPU guidelines in the 2026 FGI edition
Space and privacy needs vary between medical and psychiatric diagnoses, so no one size or layout fits all. The 2026 code builds on existing requirements for behavioral and mental health risk assessment and patient spaces, applying them to the MPU context in two main ways.
First, a behavioral and mental health risk assessment informs the physical safety features of the unit. That assessment drives decisions such as:
- Whether a sally port, which provides a secure, double-door entry that prevents patients from accessing unsecured areas, is needed
- Where handwashing sinks should be located relative to patient areas
- What kind of staff communication systems the unit requires
Secondly, the facility’s functional program determines the therapeutic and social spaces needed on the unit. The code includes provisions for areas including consultation rooms, group therapy rooms, calming rooms, and visitor rooms. It also outlines group dining areas, social gathering spaces, and access to outdoor space, which are standard in behavioral health settings but often absent from traditional medical/surgical units.
Creating space for safe movement with appropriate supervision gives patients the mobility they need to self-regulate and maintain a sense of normalcy. Rather than restricting patients’ movement, like many behavioral health facilities, MPU code manages safety through the inclusion of ligature-resistant products and encourages mobility by giving patients destinations, such as artwork, windows with views to natural scenery, an outdoor courtyard, or other common spaces, to which they can walk.
Balancing safety and comfort in MPU design
MPUs exist at the intersection of two healthcare domains with different, sometimes conflicting, safety standards and requirements. As a result, designers must seek special approval for regulatory variances and custom product solutions.
New MPU code combines elements from both medical/surgical inpatient units and behavioral/mental health inpatient units to offer clear standards, marrying the functions of both unit types to allow for treatment of the whole person.
Designers should build MPUs to create comfort and a sense of normalcy while adhering to safety standards. The appearance of safety elements, such as visible restraints and barriers, can implicitly identify patients as “other” or “dangerous” and discourage hope for healing.
Incorporating safety features discreetly can help make the space feel normal and therapeutic. This might mean seeking custom solutions, such as television enclosures and ligature-resistant handwashing sinks, which offer a safe version of the amenities that are common in medical/surgical units but often absent from MPUs. Fortunately, more products are being developed and coming to market with these considerations in mind.
The most successful MPU designs incorporate natural light, noise-reducing materials, and clear sight lines for staff supervision without creating an institutional feel. A milieu where patients can move and a group therapy room for safe social interactions can help with the healing process.
Color psychology is another important tool for setting the tone. Design teams should choose palettes that promote calm, such as those incorporating natural greens and blues, while avoiding institutional grays that can feel depressing or clinical. Artwork that is reality-based rather than abstract is more soothing to many.
Framework for building better healthcare environments
The new MPU code gives design teams a concrete framework to build from while leaving room to develop spaces that reflect specific patient populations and care models. Healthcare systems and project teams can work together to meet the operational needs of a specific unit being developed and the patients it will serve.
As a result, the addition of MPUs to the 2026 FGI code represents a step toward building more environments that heal—not just for medical/psychiatric patients but for all people receiving care.
Virginia Pankey, AIA, LEED AP, EDAC, is a behavioral health practice leader at HOK (St. Louis) and co-chair of FGI’s Health Guidelines Revision Committee’s (HGRC) Behavioral and Mental Health topic group. She can be reached at [email protected].
FGI offers resources and webinars on MPUs and other topics here.
