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Mental and behavioral health settings: Importance & effectiveness of environmental qualities & features as perceived by staff

Originally Published:
Key Point Summary
Key Point Summary Author(s):
Dickey, Andrew
Key Concepts/Context

While many previous studies have examined how facility designs can benefit patients within non-psychiatric acute care settings, there is a lack of research exploring how physical environments can be better suited to promote the health of patients in mental and behavioral health (MBH) facilities. MBH facilities typically differ from non-psychiatric acute care settings in terms of patient length of stay, medications used for treatment, methods for care delivery, overall treatment protocols, and patient-staff interactions. The authors of this study propose that the development of a new tool for designers and healthcare staff to identify and address the spectrum of needs within MBH environments could benefit future MBH facility designs.


To develop and test a novel tool for mental and behavioral health (MBH) facilities, evaluate the effectiveness and importance of certain environmental features, propose design guidelines for MBH facilities, and make recommendations for future studies. 


The authors performed a literature review in order to formulate a survey concerning important topics within MBH facility design. A total of 16 design topics were compiled, with the most important design concepts identified through the literature review being natural lighting, private rooms, outdoor/indoor therapy, and the importance of providing a homelike environment. This review resulted in the creation of the Psychiatric Staff Environmental Design (PSED) survey. The survey features 17 demographic questions, 11 ranking questions, 63 Likert-style questions and two open-ended questions that are intended to allow MBH professionals a way to gauge the presence and importance of different MBH environment designs. This survey was given to four psychiatric nurse organizations for distribution to MBH professionals. The authors used the survey results to assess how the perceptions of MBH professionals differ from the current realities of common MBH facility designs, and to help further develop a set of preliminary MBH facility design guidelines.

Design Implications
MBH facility designers should carefully consider implementing physical features that promote patient and staff safety, facility cleanliness and orderliness, positive distraction, outdoor access, spaces for staff respite, and homelike appearances. Although study participants identified these elements as the most important, designers are encouraged to engage with MBH professionals within their own unique contexts in order to assess relevant design objectives. 

A total of 134 MBH professionals completed the PSED survey. Results showed a statistically significant difference between the perceived importance of desirable MBH facility features (from the point of view of MBH professionals) and the actual presence of these features within MBH facilities. This implies that there is a noticeable gap between what MBH professionals think are important features and which features are actually available within their work environments. In descending order, the design qualities identified as being most important were a well-maintained environment, physical and physical access to nature, aesthetics and overall attractiveness, a homelike environment, and a generally organized environment. The authors conclude that their survey indeed identified areas for improvement within MBH facility designs, and that the survey may be used to give designers better insight into the needs of MBH professionals and patients.


The authors note that this study involved a small sample size of participants relative to the number of MBH professionals that are in the workforce. Participants were limited to professionals from the US, UK, Australia, and Canada. Additionally, patients and families were not included as study participants. 

Outcome Category
Staff satisfaction|Patient / resident health outcomes
Key Point Summary Author(s):
Dickey, Andrew
Primary Author
Shepley, M. M.