Practice Makes Perfect: Unwritten Rules of Behavioral Health Design

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Steven Reutter
Jan 23, 2020 JJCA Lessons Learned

The rules related to behavioral healthcare design are many and oftentimes complex. This is understandable given how much impact the design of the facility has on the health, welfare and safety of its occupants. That's one of the reasons JJCA has a designated behavioral health practice leader. In that role, Steven Reutter is charged with having hands-on involvement in every behavioral health project we do. Over the years, Steven has worked on dozens of these projects and has learned that the unwritten rules related to this complex sector are often as important as the written rules. These unwritten rules crop up when the existing "written" rules are suddenly found not to be sufficient to address some new and/or unanticipated situation. Following are just a few examples from some of our recent behavioral healthcare projects:

Door Hardware: The interpretation of rules regarding anti-ligature door hardware and where it is to be installed is ever-changing. Years ago, anti-ligature hardware was generally specified for areas where patients could be without staff supervision. It quickly extended to any area to which a patient had access, regardless of the level of staff observation (e.g., requiring anti-ligature hardware on corridor doors in direct view of a nurse station). We are now seeing interpretations as broad as providing anti-ligature hardware on a staff toilet that can be accessed only through a locked staff lounge door off of a staff controlled corridor.

Ceiling Types: We are seeing requirements for ceilings lower than 9’-0” AFF that mandate a monolithic, gypsum board ceiling, even in heavily-observed staff areas. For ceilings or bulkheads lower than 7’-6” AFF (usually only occurring in existing conditions), we have seen requirements to install a plywood substrate to the drywall ceiling. While these requirements are necessary and appropriate to protect the patients in behavioral settings we, as designers, need to account for the impact to sound levels, to facility maintenance access above ceiling, and of course, to construction costs.

Ceiling-Mounted Fixtures: Inspectors are becoming more and more critical of the type and mounting of exit signs. This is fairly easy to address when you are specifying these fixtures. But this can be very costly if it is not caught until construction is complete and an inspector won’t let you occupy until all of the exit signs are changed out to a flush-mount wall or ceiling type.

Furniture: Furniture is often procured by the facility’s owner or operator, but sometimes is specified and procured by the Owner’s architect or interior designer. In any case, furniture selections in behavioral settings must take into consideration the potential for a patient to use the furniture as a weapon, a barricade or as a ligature risk.

Behavioral health design is truly a specialty. A facility’s ability to comply with both the written and unwritten operational regulations is critical not only for receiving and maintaining proper accreditation, but ultimately for the health, safety and welfare of patients.

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

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