Exterior courtyard enclosures - how much is enough?

June 14, 2012
Exterior courtyard enclosures - how much is enough? Exterior mural by residents
24 inch diameter PVC Pipe on top of wall makes it difficult to get a grip.

It is a generally accepted principle that patients need access to the outdoors.  In some states, like California, it is a requirement.  Parents often encourage their children to go out and get some “fresh air and exercise”.  Health authorities recommend the same for healthy adults.  The same advice applies to those who find themselves struggling with issues that have resulted in their being patients in behavioral health facilities.

One of my favorite quotes is from Swedish architect Stefan Lundin in his book “Architecture as Medicine”.  This book provides a discussion of the design philosophy behind the new Ostra Hospital in Gotenborg, Sweden.  It includes the following passage: “The patient’s self-esteem can be boosted by offering them dignified premises, premises signaling 'OK, so you’re ill and may not always be on your best behavior, but help and sympathy are forthcoming from those of us who, for the moment at least, are better off.'”  (emphasis added)

If there can be agreement that it is desirable for behavioral healthcare patients to be allowed periods of time in the open air outside the unit, then the issue becomes: How do we define the space to which they are to have access? How do we protect against them leaving the area without authorization?  What is included in these outdoor areas and how they are designed will be addressed in a future discussion.  I will limit this blog to the perimeter enclosure.

If we subscribe to Mr. Lundin’s premise above, (and the general consensus of the clients I have worked with) the courtyard will be more therapeutic if it does not have an enclosure that makes it look like a prison yard.  Therefore, a twelve foot high chain link fences topped with concertina wire is probably not an acceptable choice.  So what is the perfect choice of material for the enclosure?

Like many issues in the design of these facilities, the “correct” answer may vary widely between different facilities. 

Some of the variables are:
• Are the patients voluntary or involuntary admissions?
• What is the facility’s position on elopements?
• Is the courtyard located at ground level or a number of stories above ground level?
• Are views to the distance desirable?
• Is the courtyard intended to be for meditation and introspection?
• Is it intended to be used for physical activity and exercise?

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It should be noted that

It should be noted that facilities are not the only ones who decide acceptable elopement rates or risks. State regulation boards can be a barrier to this type of openness, even when the professionals involved agree to it.

Thank you for the ideas on risk management and reasoning for support of accessible, safe outdoor spaces for patients.


Very important blog, relevant not only for the outside environment, but also how to do the inside most therapeutically. For the outside one, a wall that is paintable will lend itself to some art therapy and buy-in to the wall, which can then turn into a collective work of art instead of a barrier.


we know it can be hard to get used to things being in dfinereft places, which is why we wanted to make it easy for you to switch back and forth for a little while, in order to learn where everything went.

I agree completely

I have a photo that shows a good example of this, but I can't figure out how to get it posted.