May 21, 2024

Designing for Behavioral Health: Learning from the past to create the future

New data, better treatments, and a wealth of trial and error are changing behavioral health environments – and the design that supports them. And in the middle of one of the greatest healthcare crises the world has ever seen, advancements can’t come quickly enough. As we continue to think more holistically about the needs of patients and the facilities that support them, understanding both the lessons of the past and how they might influence the opportunities of the future can help us design smarter, healthier, and more efficient spaces that nurture the healing of people that occupy them. We recently discussed designing for behavioral health with Suzanne Phillips Fawley, CHID, IDS, ASH from Stance and together we identified learnings over the past 200 years and imagined what the future holds.

The evolution from harrowing to healthier.

The Eastern Lunatic Asylum, founded in Williamsburg Virginia in 1773 with its 24 cells and hay beds, held patients considered incurable or dangerous. And the treatments offered were about as frightening as the hospital’s name. It wasn’t until the 1800s that doctors like Pinel, Krirkbride, and Dorothea Lynde Dix began a new practice called Moral Treatment. Radical for its time, Moral Treatment replaced centuries-old practices like bloodletting and isolation therapy with human dignity that included, for the first time, therapeutic activities and talk treatments. And it wasn’t until 1841 that Dr. John Galt brought this to the Eastern Lunatic Asylum.

Gradually, design elements we see today began to take shape as behavioral health facilities across the U.S. began to support Moral Treatment. Centralized administration rooms surrounded by wards, an emphasis on natural light, spaciousness and movement, and the introduction of workshops where patients could practice skills like sewing and shoemaking as they prepared to re-enter society, marked significant shifts in care and design philosophy. Patients were finally afforded basic comforts such as beds, and, crucially, humane treatment became the norm.

Kwalu Livorno Behavioral Lounge

However, it wasn’t until the 1960s, with President Kennedy’s signing of the Community Mental Health Act, that behavioral health facilities underwent deinstitutionalization. This pivotal legislation, driven by the president’s personal connection to the issue, aimed to make mental healthcare more accessible by transitioning patients from large, often bleak state hospitals to community health centers.

Subsequent decades presented still more challenges to behavioral health delivery including funding shortages and resource constraints, resulting in issues like homelessness, overcrowding, and compromised quality of care in understaffed facilities. Nevertheless, despite all obstacles, we’re seeing innovative trends and concepts shape the future of behavioral healthcare design in promising ways.

KittenChops Illustration wall mural

Embracing a Diverse Approach to Design
Caregivers continue to place a greater emphasis on humanity, comfort, and a strong emphasis on individualized care tailored to specific demographic groups. Whether designing for adults or children, understanding the unique needs of each cohort is critical. Kevin Turner, Human eXperience Principal Architect underscores the importance of creating dignified, therapeutic environments that resonate with patients, regardless of age or background. A humane therapeutic environment looks different to different groups.

Materials play a crucial role in contemporary design, with a shift towards durable surfaces resistant to damage and ligature points. And the emergence of the Treatment Mall Care Model represents a departure from traditional administrative setups, offering patients greater autonomy and familiarity with post-treatment living conditions such as:

Stance Behavioral Health Flo and Frontier

As designers embrace this multi-dimensional approach, there are new challenges concerning space utilization and furniture selection. Designing spaces to support public supervised areas, treatment zones, and solitude areas enables a spectrum of environments catering to diverse needs. Including specialized behavioral health furniture, such as multi-use pieces, prioritizes user safety and comfort and requires better understanding of options.

Stance Behavioral Health Outdoor

Beyond infrastructure, other emerging trends emphasize shorter stays, enhanced treatment outcomes, and biophilic elements that integrate nature into the built environment. These developments signal a shift towards holistic, patient-centered care that extends beyond the confines of traditional treatment modalities.

Building Better Futures through Informed Design

Collaboration and empathy are indispensable qualities for designers shaping behavioral health environments today. Establishing interdisciplinary teams early in the design process fosters holistic solutions that balance safety, comfort, and functionality. Drawing inspiration from resources like the Behavioral Health Design Guide facilitates informed decision-making, guiding designers towards evidence-based practices.

From humble beginnings marked by hay beds to contemporary innovations like bean bag furniture, the trajectory of behavioral health design embodies a journey of continuous improvement. Yet, within the evolving landscape of design trends and technological advancements, the core lesson remains unchanged: patient humanity must always be prioritized.

As designers, our choices shape the experiences of individuals who are not merely patients but family members and friends. By infusing our designs with empathy and compassion, we create environments that honor the dignity of every individual, fostering healing and hope for generations to come.

For more detailed behavioral health design discussions, connect with our Healthcare Team.