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PsychiatricFacility|WholeBuildingDesignGuide
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Home>DesignGuidance>BuildingTypes>HealthCareFacilities>PsychiatricFacility

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PsychiatricFacility

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byRobertF.Carr
NIKATechnologies,Inc.forVAOfficeofConstruction&FacilityManagement(CFM)
RevisedbytheWBDGHealthCareSubcommittee
Lastupdated:04212011

OVERVIEW

AchievingSustainableSiteDesign
throughLowImpactDevelopment
Practices
AestheticChallenges

Therangeofpsychiatricfacilitiesincludespsychiatrichospitals,
psychiatricandneuropsychiatricnursingunitsofgeneralhospitals,
facilitiesforthepsychiatricmedicallyinfirm,geropsychiatricunits,
alcoholanddrugaddictiontreatmentfacilities(bothinpatientand
outpatient),mentalhealthclinics,dayhospitals,daytreatment
centers,andothers.

WithinThisPage
Overview

AestheticOpportunities

BuildingAttributes
EmergingIssues
RelevantCodesand
Standards
MajorResources

Inadditiontoinpatientnursingunits,psychiatrichospitalsinclude
theirassociateddiagnosticandtreatmentareas,aswellasthenecessarydietetic,supply,
housekeeping,andadministrativespacescommontoallhospitals.Theydonotgenerallyinclude
thecomplexandhightechdiagnosticandtreatmentareasofgeneralhospitals.

AirBarrierSystemsinBuildings
AirDecontamination
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VIEWRESOURCEPAGEINDEX

Psychiatrichospitalsmayincludeoutpatientpsychiatricareas.Theseareasshouldbelocatedona
directpathfromthelobby,andcirculationpathsoftheoutpatientsshouldbeseparatedfromthe
pathsofthemoreacutelyillinpatients.Teachinghospitalswillalsoincludespacesfortrainingand
education,andoftenspacesforresearchstudies.
Thementalhealthclinicisthebasicoutpatientunit,
providinganinterfacebetweeninpatientcareandthe
community.Assuch,itprovidespreventativecare,
primarycare,andaftercare.Theclinicmayalsoserve
asasiteforresearchandfortrainingofmentalhealth
professionalsonallaspectsofoutpatienttreatmentof
mentalhealthproblems.
Asubstanceabuseclinicprovidesoutpatientcareand
treatmentofalcoholand/ordrugdependentpatientsno
longerneedinginpatientcare.Inahospital,itshouldbe
solocatedthatitspatientsdonotneedtotravelthrough
otherpartsofthehospital.

PsychiatricFacility,VAMCAugusta,GA

Thedayhospitalhasnobeds,butistypicallylocated
withinoradjacenttoahospital.Itofferstotalhospitalpsychiatricservicesforacutelyillpatients
withoutremovingthemfromthefamilyandcommunity.
Thedaytreatmentcenterprovidesasupportivelearningenvironmentawayfromahospitalinwhich
patientshavingchronicdifficultieswithcommunityadjustmentandotherpsychosocialproblems
mayreceivehelp.Suchpatientshaveoftenhadlongperiodsofhospitalization,andneed
continuingmonitoringoftheirgeneralhealthandmedicationneeds.
BACKTOTOP

BUILDINGATTRIBUTES
EfficiencyandCostEffectiveness
Thedesignofasuccessfulpsychiatricfacilityshould:
Promotestaffefficiencybyminimizingdistanceofnecessarytravelbetweenfrequentlyused
spaces
Alloweasyvisualsupervisionofpatientsbylimitedstaff.Nursestationsoninpatientunits
shouldbedesignedtoprovidemaximumvisibilityofpatientareas.
Includeallneededspaces,butnoredundantones.Thisrequirescarefulpredesign
programming.
Forinpatientunits,provideacentralmeetingareaorlivingroomforstaffandpatientsand
providesmallerroomswherepatientscanvisitwiththeirfamilies
Makeefficientuseofspacebylocatingsupportspacessothattheymaybesharedbyadjacent
functionalareas,andbymakingprudentuseofmultipurposespaces

TherapeuticEnvironment
Thecharacteroftheimmediatesurroundingscanhaveaprofoundaffectonthepsycheofa
psychiatricpatient.TheNewYorkPsychiatricInstitutereportsadramaticdropinthenumberof
patientswhoneedtoberestrainedsinceoccupyingtheirnewfacilitywithitsbrightopenspaces.
Everyeffortshouldbemadetocreateatherapeuticenvironmentby:
Usingfamiliarandnoninstitutionalmaterialswithcheerfulandvariedcolorsandtextures,
keepinginmindthatsomecolorsandpatternsareinappropriateandcandisorientolder
impairedpatients,oragitatepatientsandstaff.SeealsoVAInteriorDesignManual.
Admittingamplenaturallightwhereverpossible.
Providingawindowforeverypatientbed,andviewsoftheoutdoorsfromotherspaces
whereverpossible.Viewsofnaturecanberestorative.
Providinginpatientswithdirectandeasyaccesstocontrolledoutdoorareas
Providingadequateseparationandsoundinsulationtopreventconfidentialbutloud

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conversationfromtravelingbeyondconsultingofficesandgrouptherapyrooms.
Givingeachpatientasmuchacousticprivacyaspossiblefromnoisesofotherpatients,toilet
noises,mechanicalnoises,etc.
Givingeachpatientasmuchvisualprivacy,andcontroloverit,asisconsistentwiththeneedfor
supervision.
Givingeachinpatienttheabilitytocontrolhisimmediateenvironmentasmuchaspossible,i.e.
lighting,radio,TV,etc.
Providingcomputerstationsforpatientusewhenpatientprofileandtreatmentprogramallow.
Designingfeaturestoassistpatientorientation,suchasdirectandobvioustravelpaths,key
locationsforclocksandcalendars,avoidanceofglare,andavoidanceofunusual
configurationsandexcessivecorridorlengths.
Designinga"wayfinding"processintoeveryproject.Apatient'ssenseofcompetenceis
encouragedbymakingspaceseasytofind,identify,andusewithoutaskingforhelp.Color,
texture,andpattern,aswellasartworkandsignage,canallgivecues.(Foraguidetoclear
signage,seeVASignageDesignGuide).
Providingexerciseequipmentforpatientusewhereappropriatefortheprogramofcare.
Providingaccesstokitchenfacilities,preferablyontheunit,wheresnacksormealscanbe
preparedbypatients,whenpatientprofileallows.

Cleanliness
Psychiatricfacilitiesshouldbeeasytocleanand
maintain.Thisisfacilitatedby:
Appropriate,durablefinishesforeachfunctional
space
Properdetailingofsuchfeaturesasdoorframes,
casework,andfinishtransitionstoavoiddirt
catchingandhardtocleancrevicesandjoints
Adequateandappropriatelylocatedhousekeeping
spaces
IncorporatingO&Mpracticesthatstressindoor
environmentalquality(IEQ)

GeroPsychiatricFacility,VAMCSalem,VA

Aesthetics
Aestheticsiscloselyrelatedtocreatingatherapeuticenvironment.Itisalsoamajorfactorina
facility'spublicimageandisthusanimportantmarketingtoolforpatientsandstaff.Aesthetic
considerationsinclude:
Useofnewlightingsystems,highperformanceglazing,increaseduseofnaturallight,natural
materials,andcolors
Useof(soothing,notexciting)artwork
Attentiontodetails,proportions,color,andscale
Brightandopenpublicandcongregatespaces
Comfortableandintimatelyscalednursingunitsandoffices
Compatibilityofexteriordesignwithsurroundings

SecurityandSafety
Thepotentialsuicideofpatientsisaspecialconcernofpsychiatricfacilities.Thefacilitymustnot
unwittinglycreateopportunitiesforsuicide.Designtoaddressthisandothersafetyandsecurity
issuesincludes:
Plumbing,electrical,andmechanicaldevicesdesignedtobetamperproof
Useofbreakawayshowerrodsandbars,noclotheshooks
Eliminationofalljumpingopportunities
Controlofentrancesandexitsbystaff
Provisionforpatientbedroomdoorstobeopenedbystaffincaseofemergency
Laminatedglassforwindowsininpatientunits
Fiberreinforcedgypsumboardforwalls
Specialfeaturesinseclusionroomstoeliminateallopportunitiesforselfinjury,including
outwardopeningdoorwithnoinsidehardware
Carefulconsiderationofappropriatelocationsforgrabbarsandhandrails.Wheretheymustbe
usedinunsupervisedspaces,andpatientprofilejustifiesextracare,specialdesignsare
availablethatprecludetheiruseforselfinjury.
Eliminatetheuseofdoorknobsandhandles
Solidmaterialspecifiedceilings

Sustainability
Psychiatricfacilitiesarepublicbuildingsthatmayhaveasignificantimpactontheenvironmentand
economyofthesurroundingcommunity.Asfacilitiesbuiltfor"caring",itisappropriatethatthis
caringapproachextendtothelargerworldaswell,andthattheybebuiltandoperated
"sustainably".
Section1.2ofVA'sHVACDesignManualisagoodexampleofhealthcarefacilityenergy
conservationstandardsthatmeetEPAct2005(PDF1.3MB,550pgs)andExecutiveOrder13693
requirements.TheEnergyIndependenceandSecurityActof2007(EISA)(PDF740KB,310pgs)
providesadditionalrequirementsforenergyconservation.AlsoseeLEED's(LeadershipinEnergy
andEnvironmentalDesign)USGBCLEEDforHealthcare.

RelatedIssues
TheHIPAA(HealthInsurancePortabilityandAccessibilityActof1996)regulationsaddresssecurity
andprivacyof"protectedhealthinformation"(PHI).Theseregulationsputemphasisonacousticand
visualprivacy,andmayaffectlocationandlayoutofworkstationsthathandlemedicalrecordsand
otherpatientinformation,paperandelectronic,aswellaspatientaccommodations."
BACKTOTOP

EMERGINGISSUES
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Thereisacontinuingshifttooutpatientpsychiatriccareasnewandmoreeffectivedrugsare
developedfortheclassicpsychiatricconditions.Manyofthehomelessinoururbanareasareex
psychiatricinpatientswhoreceivelittleornofollowupoutpatientcare.Thereisalargeunmetneed
forsupportivehousingand/ortreatmentfacilitiesforthem.
Thereisalsoagreatneedforeffectivetreatmentofdrugaddictionandalcoholism,particularly
amongthepoor.Thisissueisalsorelatedtohomelessness.
BACKTOTOP

RELEVANTCODESANDSTANDARDS
Healthcarefacilitiesareamongthemostregulatedofallbuildingtypes.Likeotherbuildings,they
mustfollowthelocaland/orstategeneralbuildingcodes.However,federalbuildingsonfederal
propertygenerallyneednotcomplywithstateandlocalcodes,butfollowfederalregulations.Tobe
licensedbythestate,designmustcomplywiththeindividualstatelicensingregulations.Many
statesadopttheAIAGuidelinesforDesignandConstructionofHospitalsandHealthCareFacilities,
asaresource,andthusthatvolumeoftenhasregulatorystatus.
StateandlocalbuildingcodesarebasedonthemodelInternationalBuildingCode(IBC).Federal
agenciesareusuallyincompliancewiththeIBCexceptNFPA101(LifeSafetyCode),NFPA70
(NationalElectricCode),andArchitecturalBarriersActAccessibilityGuidelines(ABAAG)orGSA's
ABAAccessibilityStandardstakesprecedence.
FacilitieswhichtreatpatientswhoarereimbursedunderMedicaremustalsomeetfederal
standards,andtobeaccredited,theymustmeetstandardsoftheJointCommissiononthe
AccreditationofHealthcareOrganizations(JCAHO).Generally,thefederalgovernmentandJCAHO
refertotheNationalFireProtectionAssociation(NFPA)modelfirecodes,includingStandardsfor
HealthCareFacilities(NFPA99)andtheLifeSafetyCode(NFPA101).
TheAmericanwithDisabilitiesAct(ADA)appliestoallpublicfacilitiesandgreatlythebuilding
designwithitsgeneralandspecificaccessibilityrequirements.TheArchitecturalBarriersAct
AccessibilityGuidelines(ABAAG)orGSA'sABAAccessibilityStandardsapplytofederaland
federallyfundedfacilities.ThetechnicalrequirementsdonotdiffergreatlyfromtheADA
requirements.SeeWBDGAccessible.
Federalagenciesthatbuildandoperatepsychiatricfacilitieshavedevelopeddetailedstandardsfor
theprogramming,design,andconstructionoftheirfacilities.Manyofthesestandardsareapplicable
tothedesignofnongovernmentalfacilitiesaswell.Amongthemare:
DepartmentofVeteransAffairs(VA),OfficeofConstruction&FacilitiesManagementTechnical
InformationLibrarycontainsmanyguidesandstandards,including:
DesignManualsoftechnicalrequirements,equipmentlists,masterspecifications,room
finishes,spaceplanningcriteria,andstandarddetails.
BACKTOTOP

MAJORRESOURCES
WBDG
FederalMandate
ExecutiveOrder13693,"PlanningforFederalSustainabilityintheNextDecade"
ProductsandSystems
BuildingEnvelopeDesignGuide

Websites
SeeWBDGHealthCareFacilitiesforgenerichealthcarefacilitieswebsites

Publications
DesignConsiderationsforMentalHealthFacilitiesbyAIACommitteeonArchitectureforHealth.
Washington,DC:AIAPress,1993.
DesignDetailsforHealth:MakingtheMostofDesign'sHealingPotential,2ndEdition by
CynthiaA.LeibrockandDebraHarris.NewYork:JohnWiley&Sons,Inc.,2011.Innovative
designsolutionsinkeyareassuchaslighting,acoustics,color,andfinishes
PsychiatricServicesJournaloftheAmericanPsychiatricAssociationprimarilyfocusedon
treatmentofmentalillnesses,butcarryingoccasionalarticlesdealingwithfacilities.
Sound&Vibration:DesignGuidelinesforHealthCareFacilitiesbytheAcousticsResearch
Council.2010.
UFC451001Design:MedicalMilitaryFacilities
SeeWBDGHealthCareFacilitiesforgenerichealthcarefacilitiespublications
BACKTOTOP

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