When it comes to the safety of patients in a behavioral health facility, there is “no one-size-fits-all solution,” according to James Hunt, AIA, NCARB, an architect and consultant for the building and design of such facilities. Each population comes with its own risks and each organization must decide just how far to go to incorporate safety into design.
The patient bedroom is a particularly high-risk area, since patients are unsupervised for the longest periods of time in this space. When furnishing a patient bedroom, staff should consider each item carefully.
Beds. Hunt identifies “platform beds with no storage drawers or exposed wires, springs, or restraint loops” as the best choice. Facilities can minimize the institutional look and feel of these beds by selecting the bed's finish. Hunt suggests choosing a wood or wood-appearing finish, such as synthetic materials with a surface made to look like wood, as long as it is well-sealed and durable.
Facilities may also choose to select plastic beds, rather than wood, as these can be more durable (figure 1). “These have the advantage in that they … have no joints into which liquids can penetrate,” Hunt says.
Whatever the bed choice, Hunt advises facilities that these beds be anchored firmly to the floor “to reduce the likelihood of patients using them to barricade” bedroom doors leading out into the corridor.
Dressers, armoires, and closets. According to Hunt, “clothes poles and hangers have been a significant issue” for patient safety for many years. Patients have commonly used these features as ligature attachment points from which to hang themselves. To reduce this risk, the Facility Guidelines Institute eliminated space for hanging clothes as a requirement for facilities, effective this year (see FGI Guidelines for the Design and Construction of Health Care Facilities, 2010 edition).
Instead, Hunt recommends a sloped, open-front cabinet with fixed, shallow shelves (figure 2). The selection of this type of product:
Ensures that patients cannot easily sit or climb on the top of the cabinet's sloped surface;
Eliminates cabinet doors, which are “often used as an attachment point,” and reduces the risk of hanging;
Reduces the risk that the secured, shallow shelves can be used for climbing or removed for use as weapons; and
Eliminates drawers, which can also be broken, used as attachment points, or removed and used as weapons.
Hunt insists that, like beds, these cabinets should be securely anchored to walls or floors.
Nightstands, desks, and chairs. Because these furnishings are typically light in weight, Hunt says that facilities may need to eliminate the potential for patients to stack or throw nightstands, desks, and chairs. This can be done by anchoring them to the floor. The presence of drawers should also be eliminated by replacing them with open shelves.
For desk chairs, Hunt suggests choosing products that are lightweight plastic, as they “are not easily broken” and “do not make good weapons.”
Windows and window coverings. Windows are highly susceptible to abuse by patients, according to Hunt. Because of this, adequate selection of durable glass is essential for the patient bedroom. The FGI Guidelines refers facilities to specific American Society for Testing and Materials (ASTM) tests at http://www.astm.org for window glazing impact resistance ratings.
Some facilities choose to use clear polycarbonate (Lexan) for windows in patient areas because it is very difficult to break. However, it is susceptible to being scratched. There are some mar-resistant and abrasion-resistant coatings available that will help reduce this problem. In the event that patients scratch the polycarbonate windows, Hunt suggests keeping replacement panels on hand.
Window coverings pose a potentially high safety risk for patients, as blinds, draperies, curtain rods, and cords or chains for adjustment could be used for hanging. To prevent this, Hunt identifies “mini-blinds sealed between layers of the exterior window glazing” as the best selection for window coverings, provided that “the device used to adjust the position of the blind [does] not provide a ligature attachment point.”
For facilities that cannot afford or use such window coverings, Hunt makes another suggestion: a flush-mounted track with break-away drapes (figures 3 and 4). This track is directly mounted to the ceiling, reducing the risk that patients can hang from it. The fabric selected for the drapes should be “breathable, to reduce the risk that patients use it to suffocate themselves.” Facilities should also be sure to eliminate any and all cords, chains, and wands typically used to adjust drapes.