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Environment can help, but it can't cure

January 19, 2014
by James M. Hunt, AIA
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There has been a lot written over the years, mainly by architects and interior designers about how properly designed environments can cure patients with either physical or mental illnesses.  Much of this has been under the banner of “Evidence Based Design”.  If examined carefully, much of what is represented as “evidence” may be questionable.  The facilities studied are not laboratory situations and the ability to control variables and repeat studies for validation are minimal, at best.

Buildings cannot provide treatment.  Only human beings can provide treatment.  Placing a patient with a broken leg in the absolute ideal environment will not set the bone.  Similarly, providing the best possible space for a psychotic or suicidal behavioral healthcare patient will not resolve their issues.

Does the environment make a difference in recovery time for either of these patients?  Definitely.  If a medical patient is calm, comfortable and well rested it is conceivable that their recuperation will proceed well.  The same can probably be said for patients with mental illnesses.

The difference may be that the environment may actually cause a behavioral health patient’s condition to get worse.  If a patient who is suffering from depression and low self-esteem is admitted to a facility that looks and feels like a prison, it is very possible that their condition will become worse and make them more resistant to the treatment that is offered to them.  A patient who is experiencing a manic episode and is brought to a typical hospital emergency department with its bright lights, overhead paging and bustle of activity may find it very difficult to tolerate the environment and their symptoms may escalate.     

Many standard features of general hospitals that almost literally scream “institution” or “hospital” are not necessary in behavioral healthcare facilities and serve to greatly increase the negative character of the environment.  Items as simple as 2’x4’ fluorescent light fixtures, overhead paging, call lights and lay-in ceilings are good examples. 

Paddle style door handles, bedpan washers, wall-hung lavatories, call lights, electrically adjustable medical beds, light fixtures directly over the beds and over-bed tables are just a few examples.  All of these can either be eliminated completely, or replaced with vandal-resistant products that look much more like items you and I have in our homes. 

Colors and finish materials also can contribute significantly to a less-institutional environment.  There are large number of studies regarding which colors are best to use in these environments.  A few years ago, a client asked me to send them some color studies for their review.  I was careful to send them a variety of studies.  For every one that said that blue was the best, I sent them two that said blue should never be used, and so forth for all of the recommended colors.  In my opinion, if we are trying to make these facilities look more “typically residential” we should use the colors that are in vogue now and use them on surfaces that will be renewed periodically such as wall paint, upholstery fabric, etc.



Jim Hunt

Behavioral Healthcare Design Consultant

Jim Hunt


James M. Hunt, AIA, is a practicing architect and facility management professional with over 40...

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