With the tragedy at Parkland High School, mental health is making headlines once again; however for our healthcare clients the topic is one of constant concern. According to the National Institute of Mental Health, one in six American adults lives with mental illness, a figure that demonstrates the wide reach of the issue. As builders, it is our responsibility to consider the impact of behavioral health factors on construction—ensuring the facilities we deliver meet our clients’ and end-users needs for durability and flexibility through best practices and lessons learned.
The Joint Commission, an independent, not-for-profit entity, publishes accreditation standards for healthcare facility operations and measures adherence by conducting on-site inspections known as surveys. In 2017, Joint Commission surveyors sharply increased their focus on psychiatric considerations in the physical environment of care as related to patient and general safety standards.
As a result, healthcare providers must now modify existing medical facilities and design new facilities to support the needs of those in mental health crisis. This applies not only to emergency rooms, a common intake point for mental health crisis, but also in areas of hospitals and ambulatory care not specifically designated for behavioral health treatment.
The challenge is that there isn’t a simple, one-size-fits-all solution to upgrading and updating facilities. Every healthcare facility has its own design considerations tailored to the services provided and the patients served. For example, the environment of care is very different for child, adolescent, and adult patient sets, and is further dependent upon factors such as geography and socioeconomic demographics. These considerations, among others, affect the safety requirements for healthcare spaces.
While understanding the uniqueness of healthcare facilities, one of the most prevalent adjustments we’ve observed recently is the use of equipment and materials that are anti-ligature, tamperproof, and shatterproof. Preventing patients from harming themselves or others is often facilitated by some of the following design features and construction materials:
- Drywall ceilings, instead of acoustical tile ceilings, at an increased height
- Anti-ligature doorknobs, shower knobs, cabinet pulls, louvers, vents, and other hardware
- Door sensors or wall recesses to detect excess weight applied vertically to doors
- Shatterproof light fixtures
- Lexan windows and/or specialty windows designed for psychiatric use instead of traditional glass windows
- Cement board or high-impact resistant drywall with plywood backing or wire mesh and/or full-height interior wall protection
- Pick-proof caulk
- Tamperproof outlets and devices
- Modified sight lines for enhanced observation of patients by staff
- Cameras, panic alarms, RFID tracking devices, and other specialty security systems
- Tighter tolerances in specifications for fit and finish of materials
The trend towards these features is a direct response to increased awareness of psychiatric health factors. They were not typically used outside of behavioral health-specific construction until recently, but are now specified for many areas within healthcare facilities. This shift is adding pressure to health systems’ capital budgets and is coupled with a compressed timeline to complete such work in front of Joint Commission surveys.
As healthcare builders, we must remain hyperaware of the changing trends and standards in our industry. Tomorrow will bring new concerns and along with them new products, design approaches, and yet new systems for us to learn. By learning from our design partners and sharpening our expertise in trends and innovations in healthcare construction, we can effectively contribute to our clients’ efforts to preserve patient safety and meet regulatory compliance.