Practice Makes Perfect: Written Rules of Behavioral Health Design

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Steven Reutter
Jan 20, 2020 JJCA Lessons Learned

Regardless of the type of architecture, numerous building codes must be followed to ensure the health, safety and welfare of a building's occupants. But there is, perhaps, no sector where knowledge of and adherence to the rules is more critical in design than behavioral healthcare. Architects are responsible for complying with many codes that define the minimum standards of care including building codes, life safety codes, accessibility codes, energy codes, and healthcare codes, among others. Here are just a few examples of the written rules that guide the design of behavioral health facilities:

Locking in Path of Egress: The ability to control access and egress in a behavioral health facility is obviously critical. Building code dictates certain requirements that allow for locking occupants in the building “where the clinical needs of persons receiving care require their containment.”

Corridor Widths: This is an example of a nuance that doesn't necessarily impact safety but certainly impacts design options. While building and life safety codes require 8' corridor widths in medical hospitals, they only need to be 6' wide in psychiatric hospitals where there will not be stretcher or bed movement. While there still may be compelling reasons to stick with 8’ corridor widths in psychiatric settings, this is one of many examples of how behavioral healthcare design has its own set of rules.

Minimum Space Requirements: Most health regulations define minimum square-foot requirements for specific rooms, such as patient, day and seclusion rooms, and often dictate the minimum size of windows for specific rooms.

In most if not all cases, the buildings we design for our behavioral health clients go through a rigorous accreditation process with an entity such as CARF (Commission on Accreditation of Rehabilitation Facilities), CMS (Centers for Medicare & Medicaid) and/or TJC (The Joint Commission) to obtain reimbursement funding for the care they are providing adding to the list of rules that healthcare architects must follow.

Design of behavioral health facilities is truly a specialty. As JJCA's behavioral health practice leader, Steven Reutter has learned that, in addition to the numerous written rules, there are a number of unwritten ones as well. A facility’s ability to comply with both the written and unwritten operational regulations can sometimes determine whether or not they can continue to serve their communities without risk of losing reimbursement funding.

Check out a few of the "unwritten rules" of behavioral healthcare design in this companion post.

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