Designing behavioral health facilities requires a thoughtful, people-forward approach that centers on the needs and experiences of patients, staff, and visitors. These spaces must balance safety, functionality, accessibility, and empathy to foster dignity and inclusivity while supporting healing and recovery.
By actively engaging stakeholders—patients, families, providers, and advocacy groups—in planning and design discussions, project teams can tailor environments to reflect diverse needs, demographics, and treatment goals.
Designing for diverse patient needs
A wide range of demographics may receive care and treatment in a behavioral health facility, so working with stakeholders to understand not only the demographic but also the treatment needs will influence planning and design.
For example, children and adolescents’ spaces should be engaging, safe, and adaptable to developmental needs, including interactive elements, child-sized furniture with soft, rounded edges, and dedicated spaces for play therapy, creative expression, and sensory regulation (e.g., quiet rooms and sensory walls).
For elderly patients, design strategies may include non-slip flooring and handrails for fall prevention, high-contrast color schemes for wayfinding and cognitive ease, and comfortable seating with proper ergonomic support.
Neurodiverse individuals, including patients with autism, attention-deficit/hyperactivity, and sensory disorders, can be supported through environments that adapt to different sensory needs. These design strategies can include controls for dimmable lighting, sound-absorbing materials to address acoustics, and spaces with different sensory zones, including both quiet areas and interactive spaces.
Understanding care duration is also essential for effective behavioral health facility design. The length of patient stays in behavioral health facilities can vary, with inpatient hospitalization typically lasting 3-12 days, residential care extending to 30-60 days, and partial hospitalization or intensive outpatient care spanning 4-8 weeks. These varying durations underscore the importance of flexible design to accommodate diverse care pathways and treatment goals.
Designing for patient, staff safety
Safety is a cornerstone of behavioral health design, with approaches that focus on minimizing risks of self-harm or injury while maintaining dignity and respect. For example, clear sightlines between staff and patient spaces allow for unobtrusive patient observation.
Controlled access points and strategically placed monitoring stations at public access in combination with smaller physical stations dispersed within units at access points, transitional areas, and/or group activity spaces ensure security without creating an overly restrictive environment. Spaces designed for emergencies, such as de-escalation rooms and crisis intervention areas, enable staff to respond effectively to urgent situations.
The layout of spaces as well as the selection of finishes and materials, such as wall protection or patterned flooring, can also assist patients, staff, and visitors in navigating the facility and feeling more comfortable. For example, zoned areas such as patient rooms, clinical one-on-one rooms, and group activity rooms offer different levels of socialization; clear wayfinding can help reduce patient anxiety by minimizing confusion; and natural light and outdoor access can reduce the feeling of confinement.
Thoughtful layout planning can also minimize congestion and allows seamless transitions between rooms, therapy spaces, and communal areas. For example, wide, unobstructed corridors and strategically placed entry points streamline movement while reducing stress for patients and staff.
The proximity of key treatment spaces enhances accessibility and minimizes unnecessary travel, improving patient experiences. Additionally, staff stations near patient activity spaces, group areas, and patient rooms support efficient monitoring and coordination of care, enabling quick responses to patient needs.
To further promote healing and recovery, multifunctional spaces for patient and staff needs are also necessary. For example, single and double patient rooms provide flexibility, allowing individualized care and the ability to accommodate different treatment needs. Private rooms offer solitude for patients requiring a quieter environment, while shared rooms foster social interaction and peer support.
A variety of therapy spaces can also create a well-rounded therapeutic environment, including dedicated spaces for one-on-one counseling to support personalized therapy and group therapy spaces to encourage communal healing.
Beyond patient rooms and therapy areas, secure access to communal spaces, dining areas, and outdoor environments is essential. Controlled access into a unit, between patient rooms and group spaces, and between staff areas and patient spaces ensures security while allowing supervised movement.
Outdoor spaces such as gardens, courtyards, and walking paths contribute positively to mental health, offering therapeutic activities, exercise, and relaxation. Additionally, dedicated spaces for exercise, socialization, and daily routines such as laundry or haircuts help maintain normalcy and independence.
Interior design ideas for behavioral health
The selection of furniture and fixtures also plays a crucial role in ensuring safety and comfort. Modern, well-designed furniture should be durable, cleanable, and capable of withstanding frequent use while maintaining a warm, welcoming aesthetic.
Wood-like finishes and built-in seating solutions provide a residential feel, reducing the institutional atmosphere. Fixtures should prioritize safety with tamper-resistant hardware and rounded edges to minimize injury risks.
Thoughtful color selection in patient rooms, therapy areas, and communal spaces enhances the therapeutic atmosphere. For example, cool colors such as blues and greens promote calmness, while uplifting hues like soft yellows and earth tones create warmth and optimism.
Color and wayfinding strategies, such as sculptural organic shapes of acoustic material in group areas, outdoor or abstract mural images in wall protection for smaller and quiet spaces, and dimmable can help distinguish between noisy activity spaces and quiet areas, helping to prevent overstimulation and accommodate diverse patient needs.
Shapes also influence perceptions of safety and comfort. Squares and right angles convey stability and structure, while rounded corners and organic forms add visual interest and softness. Staff spaces within behavioral units may be designed using straight lines and rounded corners; for patient rooms, project teams can incorporate softened edges into furniture and design details to help reduce the risk of injury. In group rooms, circular tables or curved modular seating can help create a more relaxed gathering space.
Additionally, organic shapes can be incorporated into murals or wall sculptures in therapy and sensory rooms to provide a calming effect.
Introducing curved patterns on floors softens the long corridors and reduces the sterile, institutional feel. Tactile elements like smooth stones, soft fabrics, or textured wall panels can also add depth and grounding, creating an inviting space that contributes to overall well-being.
Ensuring staff respite in healthcare
Equally important is providing designated spaces for staff to take a break, host a meeting, and decompress. Behavioral health facilities can be high-stress environments, making private recharge areas essential for caretakers and employees.
These spaces should be easily accessible, whether directly adjacent to the unit or elsewhere in the facility, and securely separated from patient and visitor areas to maintain privacy and safety.
To prioritize staff well-being, these recharge areas should be quiet and low in stimulation, with access to natural light and plants to promote relaxation. Facilities can also include amenities—such as a meditation room, fitness area, and nap pods—to improve staff recovery.
Employee areas should be clearly identified and secure, so staff feel safe and able to decompress.
People-forward design creates an atmosphere where individuals feel valued, protected, and empowered on their journey to recovery. By blending compassionate design with practical functionality, behavioral health facilities can achieve meaningful, lasting impacts, ensuring that every space is a catalyst for healing and positive transformation.
The team at Margulies Perruzzi has been compiling information and data from our clients, and we would like to share some metrics that are trending as we consider the workplace in 2025 and beyond.
It is finally here — the 10th edition of the Massachusetts State Building Code (780CMR). The highly anticipated code change has been formally approved and is now in effect as of October 11, 2024.
The 10th edition is based on the 2021 International Building Code (IBC) with state specific amendments. Since the 9th edition was based on the 2018 IBC, this current update will effectively capture two versions of IBC changes. To help with the alignment of current design practices and new codes, there will be a concurrency period allowing either version to be used for a limited time. Projects will be able to use either the 9th or 10th editions of 780CMR until January 1, 2025. After January 1, 2025, all projects will need to submit based on the 10th edition codes only.
Code updates often prompt questions about changes in design approach, testing methodology, and compliance paths, especially if they incur additional costs to a project. While new construction code requirements are straight forward, an existing building requires an understanding of potential challenges to help with evolving market demands and project feasibility aspects.
Existing buildings are often constructed with an initial use group in mind. Since usage may change over time, it is important to understand what a structure was originally designed for as much as it is helpful to know what it is being currently used for. Changes in use often trigger a review of multiple aspects of building infrastructure, ranging from health and safety to energy efficiency.
A use change could therefore impact egress calculations, fire ratings, and plumbing fixture requirements, just to name a few. The latest version of the building code includes expanded guidance, including expanding lists on institutional uses. It should be noted that some of these require additional structural review or upgrades such as addressing seismic reinforcing for compliance.
In some cases, a change in use may require an addition or certain amount of alteration to a facility. It is important to define the percentage of the work area early to confirm the level of building alteration. Depending on project scope, compliance with new construction requirements or testing of existing elements may be necessary. As a continuation of a due-diligence effort, an egress and occupancy load calculation should be reviewed since there were some changes to the 2018 IBC that are now being formally implemented.
Important Change in Occupancy Rules
The 10th edition has a notable change in occupancy area calculations with business use changing from 100 SF to 150 SF per person. This simple change would alter a maximum allowable load in a 10,500 SF space from 105 down to 70. This may still be permissible with other factors and design considerations such as appropriate egress pathway sizing that includes appropriately sized doors and stairs, but it should still be noted.
As sustainable construction grows, the focus on carbon footprint for both existing and new buildings continues to evolve. To help with this, there is a significant expansion of construction type IV, which had historically been thought of as heavy timber construction but has expanded to include definitions and methodologies of Mass Timber construction and includes information for sub-types A, B, and C. This is important since any additions to existing structures may now have additional compliance path options.
Additional elements for consideration are the insulation and vapor barrier aspects of wall and roof assemblies. While some of these have already been captured in the energy stretch codes, the 10th edition base code now raises the minimal amounts required for certain conditions. Accommodating for the additional dimension inboard or outboard should be understood.
All the code changes put Massachusetts in a better place to address the current needs of our built surroundings, balancing the needs of life safety, public health, and sustainability. However, it will still be up to project teams to ensure that the triggers and dimensional changes created by these changes are understood early on in a project as we adapt to the new codes.
Healthcare Studio Leader, Eddie Marcey, sits down with us to discuss how to design behavioral health facilities to benefit the staff, families, and most importantly, the patients.
Director of Science Strategy Kerrie Julian discusses how the new building code impacts landlords and life sciences tenants.
High-hazard areas, often referred to as “H-rooms,” allow scientists to conduct research, and companies to manufacture, process, or store different types of hazardous substances in quantities greater than what is permitted in standard control areas. Control areas have been established in the International Building Code (IBC) and National Fire Protection Association (NFPA) to limit the number of hazardous materials that are used in a space to keep the occupants of the space, and adjacent spaces, safe. As you go vertically up in a building, control areas increasingly restrict the amount of these materials allowed in the space. This is because higher up in a building, it is more difficult for the local emergency teams to control the hazards, such as for a fire department to contain a large fire when their ladders cannot reach the floor where it is located.
There are different types of high-hazard spaces, classified by the IBC as H-1 through H-5. These classifications are based on the types of materials used in them and the hazards that are present. No matter the classification, high-hazard spaces can add substantial cost to a project, so their use is often limited to areas critical to a company’s business operations.
Why Companies Need High-Hazard Space
Different industries and site types utilize high-hazard spaces to perform functions critical to their business operations. For instance, medicinal chemists working in pharmaceutical laboratories often require these spaces to store larger quantities of flammable liquids for their experiments to proceed efficiently. Central chemical storage rooms, classified as high-hazard spaces, may free up more allowance for in-use chemicals across a floor or within a building or suite.
Manufacturing facilities often designate parts of their facility to high hazard working areas to ensure their process is happening safely, minimizing risk to their employees and avoiding disruptions to their production. Raw materials can be stored in high hazard areas as well.
Hazard Categories
The IBC classification of high hazard space is a numerical system H-1 through H-5. This is often considered to be a 5-level ranked numbering system, like the category ratings assigned to hurricanes or tornados, but that is only partially true. The first three levels, H-1, H-2, H-3, do represent similar hazards in decreasing severity, but H-4 and H-5 are for different categories of hazards altogether.
The differences among the levels include:
H-1 spaces contain materials with detonation potential.
H-2 spaces contain materials that promote accelerated burning.
H-3 spaces contain materials that are easily combustible or pose a physical hazard.
H-4 spaces contain materials that pose a health hazard, including toxic and corrosive chemicals.
H-5 spaces are specially classified to contain materials typically used in semiconductor fabrication facilities.
All these hazardous materials can cause significant damage and risk in the event of an incident, so extreme care should be used when designing for any level of high-hazard space.
Determining a Spaces Hazard Level
Before entering lease negotiations, a company should assess whether they require high-hazard space, since not all properties can accommodate such spaces. The company’s Environmental, Health, and Safety (EH&S) department, along with the end users and design team, should work with a code consultant to confirm the types of hazardous materials used in the facility. Sometimes, a hazard analysis is necessary to better understand the materials being stored and used. This analysis can also help identify ways to make the process safer or more efficient.
A local fire department or other city official may need to be involved in the design process to address any safety concerns early and prevent delays during the permitting and construction process. If a space needs to accommodate multiple hazards, the code requirements for the most restrictive level must be followed, and appropriate segregation of hazardous materials must be managed.
Cost and Schedule Implications of High-Hazard Spaces
The construction requirements for maintaining safety in high-hazard spaces are very strict and go beyond those for a typical laboratory, manufacturing, or storage space. Architectural elements such as fire-resistant walls, ceilings, and flooring materials are required to separate hazardous spaces from adjacent areas, and special finishes are required within the space itself.
Shorter egress routes are a requirement for high-hazard spaces, which limits their placement within a building. In some cases, they may even need to be situated on an exterior wall. High-hazard spaces are limited in size, usually to no more than 500 square feet. Both new and existing buildings often require modifications to the construction of the space to comply with the requirements for a high-hazard space.
Mechanical, electrical, plumbing, and fire protection considerations are also more complex than for non-hazard spaces. Higher amounts of ventilation, as well as dedicated exhaust, may be required. Explosion-proof electrical devices are frequently required due to the possibility that chemical vapors could ignite from an electrical arc. There must be adequate containment to capture any potentially contaminated water if the sprinkler system goes off.
When creating high-hazard spaces, having an experienced design and construction team onboard is critical. To successfully design and construct the space, it is important for end users to provide as much information as possible during the programming and design phases. By doing so, any additional costs for special fixtures, finishes, equipment, etc. can be identified early on, and the construction schedule can be streamlined to accommodate long-lead items and special installations.
In this video, Principal Marilyn Shen discusses how to design for inclusivity.
By Milly Baker, AIA, ACHA, LEED AP, Senior Medical Planner at Margulies Perruzzi
Many hospital administrators feel pressure to increase the size of their healthcare spaces despite a shortage of capital available to support facility investment. Even with efforts to tighten up space and increase efficiency to cut costs, hospitals need larger and larger buildings. The outcome is more space per patient and provider and, therefore, increased costs.
Why is everything getting larger? A combination of many program developments has added area to hospitals. These changes include technology, general improvements in diagnostic and treatment methods that require bigger clinical teams and larger equipment sizes, more robust mechanical, electrical, and plumbing (MEP) systems, the introduction of robotics, an increase in team collaboration space, and revised requirements for accessibility. Each of these changing requirements adds increments of additional square footage.
Technology
Technology, the equipment that continues to improve patient care, requires greater infrastructure capacity. Years ago, there were 20 square foot data closets, but now, data rooms as large as 180 square feet are needed to accommodate all the digital equipment racks. Cutting-edge features throughout hospitals drive this growth, including the interconnectedness of different clinical and monitoring systems, intelligent boards in patient rooms, smart boards in conference rooms, digital communication at the patient room entrance, signage and tracking systems, and direct clinical access to patient records. Because of the continued increase in technology use, it is critical to build specific data room requirements into the program from the start.
Robotics
For many institutions, robotics are being introduced to augment surgery, save on staffing costs, and increase safety. While robotics in operating rooms, pharmacies, and labs is nothing new, re-engineering supply management through robotics is becoming more common. Robotic devices provide improved services, but they take up space both when in use and stored. Planners for new buildings should consider adding space to supply rooms and depots with dedicated corridors and elevators for this equipment. Isolating robotics equipment movement from staff and public circulation may also double circulation requirements.
MEP Infrastructure
Particularly since the start of the pandemic, hospitals require better air flow and humidification. While new technology and equipment increase typical floor-to-floor dimensions, the MEP infrastructure should grow to serve the larger space requirements. Concerns for preventing contagions from spreading have also increased the demand for protective isolation wherever patients are treated. These robust systems need flexibility and capacity for future changes as well.
Equipment
Equipment size has increased, challenging staff to accommodate the need for more space within current program standards. An example that requires more space is the reliance on ECMO (Extracorporeal Membrane Oxygenation), a form of life support for patients with life-threatening illnesses, often used to combat COVID. An ECMO setup for an inpatient requires large elevators, wider doors, and greater patient room clearance than current standards. Introducing ECMO into current, smaller patient rooms has proven difficult.
Hospital room size creep is frequent in treatment areas, including Operating Rooms, Nuclear Medicine Rooms, Radiation Treatment Rooms, and MRI Rooms. These spaces are vital to each hospital’s mission but require more space than traditional planning methods. It is now not unusual for surgeons and patient staff to request 800 – 1,000 square feet for specialty and hybrid operating rooms.
Collaboration Space
As recruiting clinical staff has become increasingly challenging in recent years, many organizations have started paying more attention to the functionality of their workspaces. Many hospitals have inadequate meeting areas and workspaces to accommodate all the staff meetings. The historic administrative model, including a nurse station and one physician’s office, is no longer sufficient for an inpatient unit. Staff now include clinical nurses, physicians, residents, case managers, social workers, educators, and nurse management. Workstations are needed for this range of support staff to do their jobs efficiently.
The ability for staff to collaborate in appropriately sized areas supports teamwork and protects patient confidentiality but is missing from minimal space standards in the Facility Guidelines Institute (FGI) guidelines. Both patient-facing workstations and private areas are needed to support team workflow. Many institutions have also started to request rest space for staff, particularly in high-stress areas, such as emergency departments and intensive care units. Breakrooms and other areas should be carefully designed to support staff respite.
Accessibility
As Americans get larger, FGI guidelines are requiring a whole new category of room sizes for “patients of size” and a newly required expansion of the American Disabilities Act (ADA) Standards turning radius. These new requirements to build larger inpatient rooms, exam rooms, and bathrooms, have been put in place to improve patient care and staff safety. However, they come with added space and cost requirements.
Program needs are driving hospitals to increase space. The challenge to planners, architects, and builders is how to manage client expectations, specifically during the programming phase when space requirements are established. The old space requirement formulas for area per bed or area per operating room need to be carefully re-examined and revised. It is critical to take account of these conditions when developing conceptual fit plans and pinpointing scope feasibility to ensure that clients understand this new paradigm. The old rules no longer apply.
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