Prior to the beginning of the century, very little literature existed that discussed the impact of architecture on mental and behavioral health recovery. As a result of this, a larger emphasis has been placed upon conducting research that reveals the true intersection of architecture with mental health care, and how it contributes to positive mental health outcomes.
An interdisciplinary team of researchers at the University of South Australia found that there had been an increase in academic interest in the relationship between mental health care and architecture at the turn of the century, particularly between 2008 and 2013. Many key themes have been identified across published literature relating architecture to mental health care. The three prominent themes include security, light, and the impact of architecture on health outcomes. This blog provides examples of each of these themes through the use of photos from Eastern State Hospital’s old and new facilities. These photos provide examples of exactly how far architecture has come in playing a key role in behavioral health inpatient care and recovery.
Security is very important to mental healthcare facilities. As reported by a Haller and Deluty study in 1988, psychiatric hospitals and units in the U.S. have a significantly higher average number of assaults per bed yearly than non-psychiatric hospitals or units. As such, it is extremely important for architects to design mental healthcare facilities that allow these issues to be quickly resolved. In a mental healthcare facility, security includes the ability to effectively and swiftly respond to acts of aggression from inpatients and to mitigate the impact of environmental stress on patients and staff alike.
The safety of patients and staff are at the forefront of every design decision. The new facilities at the Eastern State Hospital campus, located in Lexington, Kentucky, are a testament to the careful planning and execution of safety both during the architectural design and construction phases. The architecture was designed to support a secure, safe environment for serving inpatients and conducting daily operations. Emphasis is also placed upon what is referred to by Jayaram and Herzog as “SAFE MD”:
This is an area where the impact of architecture on mental health is extremely apparent. Here are two examples of how Eastern State Hospital’s new facility better provides safety according to the SAFE MD areas of concern:
The old hospital had complete doors in patient rooms, regular door handles, and other features that would not give way if a patient were trying to cut off their breathing pathway. The new hospital features doors with triangle cutaways, door cuffs instead of handles, and other features that enhance safety and reduce the likelihood of suicide attempts.
Note how the bed and the windows of the old hospital bedrooms make it more difficult to create an environment free of pathways to suicide such as bars on the beds and open windows.
The new hospital has beds, doors, and windows designed to create a safe environment for those contemplating suicide.
The old hospital was disjointed and had numerous doors from which entry/exit could occur, increasing the likelihood of elopement. While still meeting or exceeding the fire code, the new hospital has fewer entries for each unit and only three entry/exit points into the hospital.
The original ESH built in 1817
The new facility was built with numerous windows and courtyards.
Light and lighting is the second category that impacts patient recovery. Spaces that have special meaning to patients can be made to stand out and can be defined with emotive lighting and colors. Lack of natural light is linked to many issues in published literature, including eating disorders, depression, circadian rhythm disruptions, and poor sensory stimulation. Since light affects mood and perception, it is important for mental health recovery. Architecture can design spaces with adequate natural and artificial lighting. This can include features such as the placement of rooms in relation to the rotation of the sun, and the inclusion of enough windows to allow adequate natural light into the space.
In the photos above, notice that the windows were smaller in the old hospital. In fact, some rooms that housed several patients only had one small window. In contrast, the new hospital allows every patient to have a room with a view, also shown in the photos above. It also provides a sunroom and even an outdoor courtyard for soaking in the sun. The new hospital is Silver LEED-certified, in part because of how well it incorporates light. Achieving Silver LEED certification requires much hard work and dedication during the planning, design, architectural, and construction phases to assure that a supportive, sustainable environment exists.
A bedroom for multiple patients with little natural light in the old facility.
A day room with large windows allowing increased natural light.
The impact of architecture on health outcomes is primarily focused on aesthetics and sensory stimulation, which is directly related to the spatial design of a mental healthcare facility. Spatial design is when the designer thinks about how the space feels, is organized, and might feel to the person experiencing the environment. Architecture plays an important role in creating an environment that directly impacts stress levels and social interactions. For a behavioral health facility such as Eastern State Hospital, there needs to be a balance between what is best for the patients, how the community perceives the design, and how all health and building regulations are met. Creative conflicts may arise when attempting to meet these environmental requirements, thus creating an issue that may prevent the “perfect” patient facility from existing. For example, the need for patients to have access to health professionals can be in opposition to the need for health professionals to have separate areas for medication preparation, charting, and behavioral health team discussions. The compromise made at Eastern State Hospital shows the huge contrast between the old hospital nurse stations and the new open team stations with private areas incorporated into the design as well as full glass walls in the dayroom allowing for easy patient observation while still allowing the patients a sense of privacy.
The former nursing station.
A nursing station in the new facility.
ESH is a 239-bed inpatient psychiatric hospital located in Lexington, Kentucky. They are the oldest continuously operating psychiatric hospital in Kentucky and the United States, having provided care to individuals requiring mental and behavioral health inpatient services since 1824.
Hunter McKenzie worked as a BH WELL project assistant until he graduated from the University of Kentucky College of Design in 2021 with a Bachelor's degree in Architecture and is now working toward his Masters of Architecture at Columbia University.
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