Newton's Notes

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    Erin Sharp Newton
    Aug 13, '18 6:44 PM EST

    AUTHOR: Wellcome Library, London, Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0

    AUTHOR: Wellcome Library, London, Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0

    As an advocate for the best design possible for Behavioral Health Architecture, and as a designer who is passionate about seeing the built environment of mental health improve and rise to a better level of design,so that the buildings and environments can truly be more healing, efficient, safe and less institutional, I am challenged to forge through the many layers of (perceived) obstacles to good design, while simultaneously required to understand those (again, "perceived") obstacles to come up with solutions that maintain safety and security, and still succeed in gently pushing the envelope for better design outcomes.

    NK Architects Behavioral Healthcare Architecture, SUN Behavioral Health

    NK Architects Behavioral Healthcare Architecture Design, SUN Behavioral Health

    Sometimes in my work, I am asked for references, to help people find their way through the requirements and evidence based “best practices” for mental/ behavioral health projects. This article is meant to provide a quick overview of preliminary required/ suggested resources.  These resources outline basic information, and do not begin to be exhaustive, by any means.

    NK Architects, Mental Health Architecture, Carrier Clinic

    NK Architects Behavioral Healthcare Architecture, Carrier Clinic
    First and foremost, The Facility Guidelines Institute’s book is essential for reading, and though is it considered a “guideline”, many jurisdictions reference it as a requirement. The design industry uses these documents as a reference for the planning and design of health care and residential healthcare, and support facility projects. State departments of health, the Joint Commission, federal agencies and other authorities that regulate facility construction often adopt or refer to the guidelines. When a state adopts them, they shift from being a suggestion, to being a requirement. That said, like the suggestion to pull the cord of a parachute when jumping from a plane, so it is in regards to the FGI. 

    To be most current in 2018, as a result of the industry moving towards more outpatient-based care, the Facility Guidelines Institute released a stand-alone Guidelines for Design and Construction of Outpatient Facilities reference in January 2018.  Relevant changes regarding behavioral health are found regarding outpatient psychiatric facilities:

    Space requirements were added for consultation rooms, group rooms and observation rooms. Requirements for optional exam, seclusion and quiet rooms were also added. In addition, where the need is indicated by the behavioral and mental health risk assessment, “space for a clear path of escape for staff” and a “staff assist device to communicate with [others]” are required, although the “staff assist device” is required for all consultation and group rooms.


    The baseline, or fundamental, requirements for designing behavioral health facilities appear in the FGI Guidelines for Design and Construction documents. In addition to these requirements, one of the major resources that can be found on the FGI website is the Design Guide for the Built Environment of Behavioral Health Facilities.  This year, 2018, a major update was incorporated as a new edition (7.3) in January.  This resource is published by its authors Jim Hunt and Dave Sine.  The current edition of this document can be found at their Behavioral Health Facility Consulting website: The design guide deals with designing for the built environment for general adult inpatient units, and adds to current regulatory requirements what the authors propose as best practices.  In this guide are products, specifically reviewed by the authors. 

    To download a free copy that includes a revised Patient Safety Risk Assessment Tool to align with The Joint Commission’s November 2017 Recommendations through their site go here:

    For the safety risk assessment tool, go here:

    To read the Joint Commission’s Online issue that addresses the surveying, scoring of ligature, suicide, self-harm in inpatient psychiatric setting , as well as other related topics, including a Sentinel Event Alert that focuses on leadership’s role in establishing safety culture, go here: https://www.jointcommission.or...

    These documents are the touchstone for research and should be used as the departure point for understanding guidelines or requirements. 

    For more reading of evidence based research, and works in progress dealing with design for behavioral health the Center for Health Design launched a topic toolbox: Behavioral & Mental Health Toolbox. Each toolbox contains a library of newly-created and Center staff-curated content - research findings, expert insights, strategies, tools, and other useful resources. To connect to these resources go here:

    For resources related to Urban Design, The Centre for Urban Design and Mental Health (UDMH) curates and creates research and dialogue among policymakers and urban practitioners to inspire, motivate and empower the integration of mental health into projects for a healthier, happier urban future. The website can be reached here:

    National Alliance on Mental Illness (NAMI), Mental Health By the Numbers

    National Alliance on Mental Illness (NAMI), Mental Health By the Numbers Factsheet
    There is no lack of need for attention in this area on many levels. A basic understanding of the actual numbers and facts regarding the need for intervention on every level, from the built environment, to awareness and understanding from individuals and communities, can be found through the National Alliance on Mental Health (NAMI), in their Mental Health Facts in America:

    National Alliance on Mental Illness (NAMI), Mental Health By the Numbers Fact Sheet

    National Alliance on Mental Illness (NAMI), Mental Health By the Numbers Fact Sheet

    Approximately 1 in 5 adults in the U.S.—43.8 million, or 18.5%experiences mental illness in a given year. (Any Mental Illness (AMI) Among Adults. (n.d.). Retrieved October 23, 2015, from

    Approximately 9.8 million adults experience a serious mental illness in a given year that substantially interferes with or limits one or more major life activities. (Serious Mental Illness (SMI) Among Adults. (n.d.). Retrieved October 23, 2015, from

    Among the 20.2 million adults in the U.S. who experienced a substance use disorder, 50.5%—10.2 million adults—had a co-occurring mental illness. (Substance Abuse and Mental Health Services Administration, Results from the 2014 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-50, HHS Publication No. (SMA) 15-4927. Rockville, MD: Substance Abuse and Mental Health Services Administration. (2015). Retrieved October 27, 2015 from

    For more NAMI facts, go here:


    The National Alliance on Mental Illness (NAMI):

    The National Institute of Mental Health (NIMH):

    The Federal Guidelines Institute (FGI):


    • i'm curious, have you ever come across a building that is 'architecturally' stellar or interesting that also addresses these concerns? seems like most of the architecture that is formally interesting is rather 'harsh' and the building which answer health concerns are rather bland...

      Sep 6, 18 6:51 pm  · 

      That is the mission & the challenge. See more about the challenges here:

      Healthcare Design Magazine has examples of nice interiors:https://www.healthcaredesignma...

      Nov 29, 18 11:34 pm  · 

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