ARCHITECTURE

Designing Behavioral Health Care Spaces

An evolving element of architecture

BY Dan Abeln

Design Aesthetic

As awareness grows about the impact of sights, sounds and textures within a space, it’s widely recognized that certain colors have a more “soothing” effect, and this knowledge often guides our initial design choices. Details such as wallpaper patterns, however, can unexpectedly act as trauma triggers for specific groups, including veterans, police officers or victims of violence. Similarly, the temperature and intensity of lighting can elicit strong reactions but can also be tailored to accommodate patient preferences in many instances.

In a recent initiative for a private-sector behavioral-health crisis center, the design incorporated adjustable lighting and climate controls. These features give caregivers the flexibility to modify the environment to either calm or stimulate the senses, tailored to the needs of each patient. As renovations and expansions are undertaken to better serve these vital patients, the design process must consider how individuals are influenced by and react to external stimuli. This understanding enables the development of strategies to effectively contribute to improved outcomes.

The physical spaces where mental health care is provided can have a positive impact on outcomes.

Sensory Spaces

The design of sensory spaces has seen significant advancements over the past few years, evolving more rapidly than many other areas. These spaces, featuring specific considerations for texture, light and sound, have become increasingly common in various clinical settings, including those dedicated to behavioral health.

In a recent project, one of our clients undertook a major renovation at its behavioral health clinic in the Twin Cities. This renovation was not only about updating the space but also about adapting it to the unique needs of those with sensory-processing challenges. A key feature of this redesign was the introduction of custom wall protection that allowed for the assembly of multiple images to create an expansive “vista” style view along the corridor walls, replacing traditional, smaller “vignette” style artwork. This approach not only crafted a space with a clear and cohesive visual narrative but also incorporated more organic and curvilinear forms, minimizing environmental overstimulation. Moreover, the innovation in materials used in this project ensured that the flexibility in design did not compromise the durability or aesthetic appeal of the space.

Other design renovations included sensory rooms outfitted with tunable LED lighting systems capable of adjusting both color and lumens to suit individual needs, along with multi-texture wall surfaces. This combination enhances the ability to create a controlled, adaptable environment that can significantly mitigate sensory overload for patients. This continued innovation in the design and material selection offers greater flexibility and effectiveness in catering to the specific needs of those utilizing these spaces.

Thoughtful Layouts

Building on the innovative designs in sensory spaces, the importance of thoughtful layouts extends into other areas of health care facilities as well. Discussions with outpatient providers have shed light on the needs within public areas of their clinics. Patients, particularly those newly diagnosed or those with specific conditions, often seek more privacy in these settings. This has led to the creation of “huddle areas,” small, private spaces where patients can wait comfortably with their companions.

Sensory Spaces

The design of sensory spaces has seen significant advancements over the past few years, evolving more rapidly than many other areas. These spaces, featuring specific considerations for texture, light and sound, have become increasingly common in various clinical settings, including those dedicated to behavioral health.



In a recent project, one of our clients undertook a major renovation at its behavioral health clinic in the Twin Cities. This renovation was not only about updating the space but also about adapting it to the unique needs of those with sensory-processing challenges. A key feature of this redesign was the introduction of custom wall protection that allowed for the assembly of multiple images to create an expansive “vista” style view along the corridor walls, replacing traditional, smaller “vignette” style artwork. This approach not only crafted a space with a clear and cohesive visual narrative but also incorporated more organic and curvilinear forms, minimizing environmental overstimulation. Moreover, the innovation in materials used in this project ensured that the flexibility in design did not compromise the durability or aesthetic appeal of the space.

Other design renovations included sensory rooms outfitted with tunable LED lighting systems capable of adjusting both color and lumens to suit individual needs, along with multi-texture wall surfaces. This combination enhances the ability to create a controlled, adaptable environment that can significantly mitigate sensory overload for patients. This continued innovation in the design and material selection offers greater flexibility and effectiveness in catering to the specific needs of those utilizing these spaces.

Thoughtful Layouts

Building on the innovative designs in sensory spaces, the importance of thoughtful layouts extends into other areas of health care facilities as well. Discussions with outpatient providers have shed light on the needs within public areas of their clinics. Patients, particularly those newly diagnosed or those with specific conditions, often seek more privacy in these settings. This has led to the creation of “huddle areas,” small, private spaces where patients can wait comfortably with their companions.

Moreover, the introduction of self-check-in kiosks has proven beneficial, helping to make patients feel more at ease by providing an option to avoid the public reception areas, reducing the feeling of being on display. Effective design can also include strategic furniture arrangements, such as pods of seating, or the installation of part-height privacy walls. These elements work together to further reduce stress for patients, ensuring that the environment is supportive and accommodating to their needs. This attention to detail in the design of public and waiting areas is just as crucial as the careful planning of treatment spaces, as it contributes significantly to the overall comfort and well-being of patients.

Cultural Implications

In a recent design charrette with one of our Native American clients, we engaged in thorough discussions focused on planning a crisis center located on their reservation. As with any health care space designed for tribal communities, it is essential to invest significant time and effort into understanding how these spaces will be utilized to ensure they meet the community’s needs effectively.

The concept of healing, particularly in mental health, within this tribe incorporates traditional medicinal practices such as sweat lodges, talking circles, healing hands, prayer spaces and rituals like smudging, purification and cleansing. These practices require specific architectural considerations to facilitate the integration of such spiritual accommodations within the facility. It is of utmost importance that the design of these spaces does not hinder the inclusion of these vital cultural and spiritual practices. Instead, the design should support and promote an environment conducive to spiritual-driven healing, ensuring that these traditional practices are seamlessly incorporated and respected within the health care setting.

Operational Considerations

As the demand for behavioral-focused spaces continues to surge, it is imperative that both the physical design and operational procedures of these spaces offer flexibility and are capable of serving multiple purposes. The trend toward developing alternative units like EmPATH, designed to alleviate pressure on emergency departments by diverting certain patient populations, highlights the importance of adaptable spaces. However, not all sites can accommodate the construction of these specialized units. Therefore, it remains crucial to incorporate flexible room designs within the emergency departments themselves. Adaptable spaces are essential for accommodating and safeguarding a diverse range of patients who might find themselves in emergency situations.

In line with this approach, a recent campus-wide masterplan for a large catchment hospital incorporated a strategic decision to establish medically capable rooms. These rooms are designed to provide a basic level of medical/surgical care directly to behavioral health patients, thereby avoiding the need to transfer them to the main medical-surgical units. This strategy significantly reduces the exposure risk for both staff and patients during the transport process.

Common crimes in health care facilities include sexual assault, physical assault and homicide.

Additionally, there is a shifting focus toward creating behavioral health spaces that prioritize patient interaction over isolation. Considerable thought is being invested in how to effectively utilize one-on-one time among peers within these settings. While caregivers and trained therapy professionals play a crucial role, the interaction between patients themselves is also seen as vitally important. The therapeutic benefits of such interactions can be substantial, with the right mix of patients. The design principles for these spaces take into account various factors, including the population served and the levels of risk and tolerance acceptable within the community. In the masterplan of the mentioned hospital, there was a specific goal to achieve a balance of 40/60 between private and semi-private rooms, reflecting a thoughtful approach to patient care in the behavioral health environment. This careful planning and design aim to support enhanced therapeutic interactions while accommodating diverse patient needs and preferences.

Safety and Security

Building on the strategic design and operational adaptability discussed, it’s crucial to consider how these elements contribute to the overall safety and security within these environments. Effective de-escalation strategies are a key component of this safety framework. Environmental factors, such as those mentioned in the design of flexible and interactive spaces, play a significant role in calming patients and reducing the potential for crisis situations.

It is essential that staff, including security teams, are well-trained in de-escalation procedures. This training enables them to manage challenging situations without resorting to physical intervention, which protects not only the patients but also the health care providers. By maintaining a calm atmosphere and preventing escalation of tensions, the physical security measures in place can serve as a secondary line of defense. This approach reinforces the holistic design strategy, ensuring a safer and more secure environment for both staff and patients. This comprehensive view of safety and security highlights the importance of integrating thoughtful design with effective operational practices to create a cohesive and protective setting for all involved.

Even with robust operational policies and well-designed spaces that minimize risks, conflicts may still arise. Hence, operational procedures should also include emergency protocols like run, hide, fight, tailored specifically for the unique needs of behavioral health settings.

The primary strategy should always focus on evacuation — getting staff and patients safely out of the area or building in the event of a threat. If evacuation is not possible, the next best option is to hide. The principle of “out of sight, out of mind” plays a crucial role here; historical data show that individuals are less likely to attack what they cannot see. Therefore, creating spaces where staff and patients can quickly and safely conceal themselves is imperative. Such areas, often multipurpose in their design, should offer robust locking mechanisms and limited visibility to outside threats.

Further enhancing security, these spaces should be incorporated into a tiered access system. This system involves a gradation from areas that are publicly accessible to more secure zones, controlled by access doors that manage entry based on established security protocols. Implementing such a tiered access approach is fundamental in behavioral health facilities, ensuring that every zone is adequately secured and capable of protecting all occupants in varying scenarios of risk. This layered approach to physical security not only safeguards those within the facility but also complements the holistic safety strategies previously discussed.

Crime Prevention Through Environmental Design in Health Care

Recognizing the integration of security measures in health care settings, while perhaps not as formally structured as in other sectors, is crucial. Valuable lessons can be learned from established security disciplines such as Crime Prevention Through Environmental Design (CPTED). Common crimes in health care facilities include sexual assault, physical assault and homicide. These crimes can be committed by patients against other patients, staff against patients and patients against staff. The International CPTED Association provides a framework particularly relevant to behavioral health architecture, offering guidelines that enhance safety through thoughtful environmental design.

This approach includes a range of strategies such as specific lighting specifications, the strategic use of biophilia to create a calming and secure environment, and the careful fortification of physical boundaries. While many of these strategies align with best practices found across various architectural disciplines, behavioral health settings require additional, unique considerations to address the specific needs of this patient population. By adopting and adapting these CPTED principles, we can further refine the design and operational policies of behavioral health facilities to ensure they provide both safety and healing.

One application of CPTED principles in health care design that stands out is “Positive Activity Generators” for public spaces. These are elements within the environment — be it a specific room, space, view or even a piece of furniture — that create positive distractions for patients. Such features are designed to evoke a sense of safety and calm, providing an atmosphere that is markedly different from typical health care settings. They can also facilitate alternative forms of patient interaction that are less clinical and more comforting.

Furthermore, these spaces are intentionally laid out to encourage natural interactions between patients and staff within designated areas. This setup not only fosters engagement but also allows for a degree of natural surveillance, enabling staff to monitor and interact as needed without encroaching on the patient’s space. The design of these areas is carefully executed to maintain a balance between privacy and accessibility, ensuring that patients can feel secluded when needed while still being within a safe, observable distance from caregivers. This approach to designing flexibility in care spaces, while considering various viewpoints and the need for both privacy and connectivity, is necessary in creating a therapeutic environment that supports both patient and staff needs effectively.

In conclusion, the design of behavioral health care settings transcends traditional safety features, embracing a holistic approach that integrates aesthetic, sensory, cultural and operational considerations. These elements collectively enhance the therapeutic environment, catering to the diverse needs of patients through thoughtful layouts and culturally sensitive designs. The incorporation of safety protocols and CPTED principles further ensures that these spaces are not only secure but also conducive to recovery. By prioritizing flexibility and patient-centered design, these environments adapt to the evolving landscape of mental health care, promoting healing while safeguarding both patients and staff. This comprehensive approach underlines the importance of multi-faceted considerations in creating effective and compassionate behavioral health facilities

Dan Abeln, is an architect dedicated to health care design and leads the health care sector at EAPC.