When repurposing medical/surgical units as behavioral health units, there are a significant number of elements within the physical environment that must be modified to support the specialized needs of the patients and reduce the risk of self-harm and harm to others. While intention for self-harm cannot be reliably assessed, suicide is a major concern on psychiatric units, and therefore there is a need to design the unit as if all patients may be at risk for self-harm. When designing the unit, considerations cover practically every facet of the space, including unit layout; doors, knobs, and hinges; access to cords, bedding, and curtains; access to glass; operable windows; unanchored furniture; exposed plumbing; nonrecessed fire sprinklers; and a variety of other details in patient rooms and toilet rooms. All of these variables must be considered to increase safety and reduce risk of injury or death.
The goal of this paper is to alert readers to the numerous modifications that must be considered when converting medical/surgical units to behavioral health units, in order to ensure the safety of patients and staff.
The authors recommend that renovated units be regularly assessed to verify how well the design and environmental features are supporting the particular needs of the current occupants. The main design considerations for behavioral health units include a meticulous list of features that may increase risks specifically relating to attempted hangings or using sharp objects as weapons within patient rooms, toilet rooms, dayrooms, and other areas with limited staff supervision. Units must be designed to minimize access to any possible room feature that might either be used as a weapon/tool (e.g., mirrors, loose furniture, utensils, cords) or as an attachment point to tie something to for a hanging or strangulation (e.g., doors, knobs, hinges, exposed plumbing, nonrecessed fire sprinklers).