In the interest of determining the state of knowledge on the relationship between behavioral health and the physical environment, the authors explored the literature on research, guidelines, and funding related to this topic. Approximately 300 articles were reviewed for possible incorporation in the literature review, of which 115 were deemed sufficiently appropriate. The criteria for inclusion included (a) relevance to the topic of behavioral health facilities, (b) a demonstration of clear research methodology or practice/research supported guidelines, (c) post-1960 publication, and (d) publication in peer-reviewed journals. This resulted in the development of a literature analysis at three levels: emerging evidence, studies requiring additional corroboration, and design considerations.
The research team also evaluated existing guidelines and summarized the contents by: intended audience, clinical areas addressed, intent, process, environmental aspect addressed, source of information, peer-reviewed references, and strengths and weaknesses. Additionally, sources of potential research funding were explored and summarized. The review addresses a variety of behavioral health environments, some of which have particularly salient needs in terms of safety and suicide-resistance. The research team concluded that the amount of research on the topic of behavioral health environments is minimal and insufficient to inform the design process. Likewise, the institutionalized guidelines for these facilities, with few exceptions, lack research evidence to support their recommendations. The authors recommend that more research and effective collaboration between researchers and the generators of guidelines be encouraged via both public and private sectors.