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Fallacies in the thought process of designing psychiatric hospitals

March 6, 2012
by James M. Hunt, AIA
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I very much appreciate being invited to be a regular contributing blogger on this website. I am a recovering architect with 34 years of experience in psychiatric hospital design and operation. In 1978, I was a member of the design team for a major psychiatric hospital relocation project. At the end of that project I was asked to become the Director of Facilities Management for that facility.

All architects should try living with the buildings they design for a few years to learn what things they should be doing differently. I held that position for 20 years and gained a great deal of insight into the day to day functioning of these buildings and organizations.

I now consult with psychiatric hospitals and their designers on patient and staff safety issues. I am a co-author of the “Design Guide for the Built Environment of Behavioral Health Facilities” that is published by the National Association of Psychiatric Health Systems (NAPHS) and is available free of charge on both their website and mine. This was first published in 2003 and has been updated 12 times, most recently in February 2012. I write and speak frequently on designing for patient and staff safety in psychiatric facilities as well as ways to humanize them and make the environment more therapeutically welcoming and comforting.

While thinking about what types of issues I would discuss here, it seems appropriate to start out by debunking some of the platitudes that I hear over and over again. These come from hospital staff members and designers and are given as statements of fact that are irrefutable and, therefore, close the discussion on a given topic.

A few examples of these fallacies are:

  • We use 15 minute checks for suicidal patients so we don’t need to build in other provisions for suicide prevention.
  • Securing only a few rooms near the nurse stations for suicidal patients is all that is necessary.
  • There is no way to keep patients from using the top of corridor doors as hanging attachment points.
  • High staff to patient ratios in outdoor courtyards will prevent elopements.
  • We have had that item (lavatory faucet, air grille, door handle, etc.) in our facility for years and it has not been a problem, so let’s use it in the new project.
  • We haven’t had an inpatient suicide in many years. Our staff is so good that we don’t need to spend money on patient safety features.
  • Our staffing levels, use of overtime and one-to-ones is so high that our building can contain a lot of potential hazards.

Some readers may not agree that these statements are fallacies. I welcome the opportunity to discuss these issues and many more through lively and thought-provoking conversations.


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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