Insights

The landscape of behavioral healthcare is evolving rapidly in exciting and revolutionary ways. New modes of patient care in both rehabilitation and prevention are being offered, and engineering teams are tasked with understanding the details of the care provided in each facility. The cookie-cutter days of behavioral healthcare design are in the rearview mirror. So, what does it mean to design in today’s behavioral health environment?

It is well known that in behavioral health facilities, healthcare providers often care for patients who may be at risk for self-harm — up to and including suicidal tendencies. That reality is a significant influence on the design of behavioral health facilities. By default, behavioral health design starts with a broad goal of reducing risk to patients and staff while providing a functional and comforting environment. It is practical to start with the most conservative approach – favoring safety and anti-ligature elements above all else- but in certain behavioral health applications, the risk to patients is considerably lower than in others, and other factors may become the priority.

Developing an Aligned Approach

Early in design, the FGI Guidelines require the completion of a Safety Risk Assessment (SRA) for the facility’s function. Whether a given project is subject to the criteria of FGI or not, this step is critical to project success and should never be glossed over. A Safety Risk Assessment is ultimately the responsibility of the healthcare institution, its governing body, and caregivers. Caregivers bring priceless insight into day-to-day operations, patient tendencies, and - perhaps as important as anything else - the expected worst case. An effective SRA for behavioral health will include topics of interest to the design team not limited to the potential for self-harm but also identifying concerns for aggression, vandalism, contraband, staff safety, and much more.

An experienced design team with extensive behavioral health expertise can and should expand the scope of the SRA beyond the healthcare organization’s basic obligations, ensuring a deep understanding of the space’s boundaries and priorities. The design team should never compromise the level of protection required for the expected worst-case scenario. However, recognizing when traditional behavioral health approaches exceed the actual needs of a specific function can spark a dialogue that leads to cost savings, easier maintenance, and a more familiar, comforting environment for those receiving care.

Behavioral healthcare design is fundamentally about durability, safety, and resilience. However, it’s important to recognize the diverse range of behavioral health facilities. Some, like certain intervention and rehabilitation centers, have minimal concerns about self-harm and instead prioritize comfort and familiarity—resulting in spaces that feel more like a home than an institution. To achieve a successful design, the entire project team must have a shared understanding of these needs. A well-informed architect who carefully responds to caregivers’ requirements, but is paired with an engineer who defaults to “common practice,” can lead to a mismatched design and a missed opportunity to create the best possible environment for those in need of care.

Scaled Design

So, what does it look like for an engineering team to respond to the specific needs of each function? The answer is complex, and the range of potentially-applicable products and configurations for behavioral health is broader than in standard spaces, considering that sometimes “standard” products might be the best answer for your specific behavioral health scenario.

Plumbing design is a prime example. Among all engineered elements, plumbing fixtures are often the most tactile - patients interact with them directly, unlike electrical, HVAC, or fire protection systems, which are more passive. A wide range of anti-ligature products is available, each addressing different safety needs. As with many patient safety solutions, valuable resources such as the New York State Office of Mental Health Guidelines and the BHFC Behavioral Health Design Guide provide essential guidance on safety considerations and product applicability.

The questions to consider are nearly endless. What is the risk of self-harm? Does it vary by space, or are specific areas designated for the highest-risk patients? Are patients constantly supervised, or do they have privacy? Are we concerned with both self-harm and vandalism? If vandalism is a concern, what type—flushing foreign objects, attempting to destroy fixtures, or both?

A higher-flow showerhead may provide greater comfort but can also flood a room more quickly if the drain is obstructed. Would a lower flow rate be preferable? Should we account for the possibility of contraband being hidden in the shower drain? How will maintenance access the fixtures? Which plumbing fixtures have caused issues in past facilities?

Beyond plumbing, similar considerations apply to fire protection. Sprinkler heads in private areas or rooms with low, easily reachable ceilings may require specialty anti-ligature models. However, in supervised areas with 11-foot ceilings that are inaccessible to patients, more traditional sprinkler heads may be appropriate.

This is not an exhaustive list, and the answers have real consequences. They may lead to specifying a welded stainless steel, institutional-grade, anti-ligature toilet with a concealed flush valve—an expensive but sometimes necessary solution. But sometimes isn’t every time, and it won’t always be the right answer. In some cases, the best choice might be the same toilet used in a standard office building.

HVAC grilles and diffusers fall along a similar spectrum of considerations. In the same high-risk areas where specialty sprinkler heads are required, heavy-duty, anti-ligature grilles may also be necessary. However, in supervised spaces where ligature risks are minimal, a different approach may be appropriate. In such cases, the primary concern might be ensuring a flat, perforated face to prevent agitated patients from jumping up, grabbing an edge, and pulling the grille down.

It’s also important to consider how grilles and diffusers interact with the ceiling assembly. For example, heavy-duty anti-ligature grilles are often incompatible with lay-in ceilings. If the drawings show a misalignment, it should prompt discussion among the design team to clarify the requirements. Catching these issues early ensures a well-coordinated design—overlooking them until after construction results in a poor outcome for the healthcare facility.

Behavioral health design is not one-size-fits-all—it is diverse, nuanced, and deeply complex. Success lies in understanding the specific needs of each function and accurately assessing the true worst-case risks. Without this clarity, a project team risks delivering a space that falls short of expectations. The key? Keep asking questions.