Photo: Southwood Psychiatric Inpatient Hospital was designed for safety and includes designing excellent lines of sight, so staff can always be aware of patient whereabouts.
By Rusty Hoffman
The demand for behavioral healthcare services remains high in the United States. According to the 2024 State of Mental Health in America report, 23% of American adults have experienced mental illness in the past year, and 18% of adults report having a substance use disorder. Of those reporting substance use disorders, 77% did not receive any form of treatment.
To ensure more people get the help they need, it’s important for stakeholders such as local communities, legislatures, and insurance companies to support expanding mental health programs and constructing new and renovated facilities. These behavioral healthcare (BH) facilities must provide a safe, therapeutic, and supportive environment designed to meet the unique needs of each patient as well as staff and visitors. This can be challenging, as constructing and upgrading a BH facility is significantly more complex than traditional healthcare or commercial construction.
By understanding the unique challenges and following some best practices, building, design, and construction teams can collaborate effectively to ensure their next BH facility construction projects get completed successfully and benefit the whole community.
Behavioral Health Construction Challenges
Photo Credit: Warfel Construction (all)
Along with the typical challenges of constructing a multi-bed healthcare facility, three unique obstacles need to be fully considered during planning and construction.
- Gaining community support: The introduction of BH facilities can sometimes be met with concern among community members regarding safety and property values. While these concerns can often be resolved through public collaboration and education, they can impact the progress of projects if not addressed appropriately.
- Managing safety risks: BH facility construction requires a different risk-management mindset than conventional healthcare projects. When complete, the facility’s design and construction must foster healing, while simultaneously minimizing risks associated with patient self-harm or aggression. Even elements that appear benign—light fixtures, windowsills, door hinges and furniture—must be scrutinized for potential safety risks.
- Overcoming regulatory complexity: Intricate, overlapping federal, state and local regulatory requirements must be satisfied to complete each project. With BH facilities, these can be significantly more complex—and potentially contradictory. Building, design and construction teams need to be fully conversant with these regulations for each project and be prepared to manage the documentation necessary to satisfy all reviewing parties.
Best practices for BH facility construction
While every project is unique, experienced teams can leverage best practices to address these challenges and meet stakeholder expectations.
Be active in the community
Community engagement is important for alleviating some of the potentially negative connotations associated with BH facilities. The most successful projects are those that involve the community early in the process. Building owners and executives can work with their construction partners to host public forums, participate in community events and offer site tours before the facility opens. This type of proactive and transparent community engagement helps build trust in a project and can turn initial negative perceptions into support for the facility.
Being available and ready to engage with planning commissions and at municipal meetings where projects are reviewed and approved is critical—but so are local community events where public acceptance can be built. Many communities now host seasonal fairs and festivities—like Halloween ‘trunk-or-treat’ events—which offer opportunities for families to socialize with local business owners. This type of interaction allows residents to meet the people behind the BH project and learn how it can be a valuable community asset.
Design for safety at every level
From the layout of patient rooms to the selection of fixtures, an exceptional level of safety must be built into BH construction. For example, protruding objects and areas such as corners that a patient could use to harm themselves must be eliminated from the room. Experienced contractors and design teams incorporate ligature-resistant elements throughout the space. Design features such as tamper-proof outlets, continuous hinges, impact-resistant glass and recessed casework are standard. Furniture is often bolted to the floor and sealed with pick-proof caulking, while air diffusers are designed with serpentine patterns to prevent concealment or access.
Safety also includes designing excellent lines of sight, so staff can always be aware of patient whereabouts. Nurse stations must be central to patient rooms and shared spaces. One critical step is to communicate with the staff who will be using the spaces during constructability reviews and understand how everything needs to work, down to how the doors lock and unlock on interlocking vestibules.
The sequencing of construction activities must also be adjusted accordingly. For example, be aware that access for diffuser installation can be through light fixture openings, which needs to happen prior to light installation. It’s also key to arrange psychiatric window installation in conjunction with the sequence of drywall finishing. These and other conditions require careful coordination among trades and suppliers. Clear communication and documentation during this stage will help avoid any potential complications with subcontractors. This is especially critical with tasks such as electrical work that must happen in a certain sequence to ensure the safety of all the patient rooms and common areas.
Check back next week for Part II of this article, which offers more best practices for successful BH facility construction, including steps to work more effectively with subcontractors.
Rusty Hoffman is a project executive Warfel Construction.
