Internship Program

May 2018

Space Planning Observations on Specialized Mental Health

Observation and experience are great teachers. Debbie McDonald and Pat Cawley recently toured several recently developed/expanded specialized mental health facilities in Ontario (including ones that other firms programmed) to observe and learn from users what’s working well and what they would change. Key findings from these tours include

  • Bed styles that work with the CSA/GOS bedroom sizes:Mental health rooms are typically planned at 140 NSF plus an entry vestibule (about 30 NSF) and washroom. While larger than in the past, this room size does not effectively accommodate large acute care beds leaving little circulation space. We recommend that programs think carefully about their patient populations. Most patients will be able-bodied and will not require specialized beds. For the smaller percentage that do, we recommend a mock-up of the proposed room to ensure functionality when selecting beds.
  • One-bed rooms are highly valued by patients and staff:We consistently heard that patients really appreciate the privacy of a one-bed room and no staff concerns were identified.
  • Seclusion rooms – location and configuration are key:The highest functionality and flexibility we observed was achieved by locating the two seclusion rooms together in a quiet sub-corridor between the two pods of beds; doors from each pod provided convenient access while preserving privacy. We also heard that seclusion rooms are being used much less frequently for a variety of reasons including increased attention on coaching clients, through positive reinforcement, to manage their behaviours. Over time, there may be a need to convert seclusion rooms into other room types which should also be a consideration in determining room location.
  • Day areas – avoid large open spaces: While large open spaces make it easier for staff to supervise patients, they’re contra-indicated for mental health units. Many patients are unable to tolerate extensive social interaction; others have high control needs. We consistently heard – and observed – the need to provide choice and flexibility. We suggest planning patient social spaces with sliding doors that can be opened or closed depending on patient needs. We observed a number of creative strategies. One facility with very limited space has created “destim” rooms offering a choice of music and calming visuals. Another has “listening centres” at the ends of corridors.
  • Quiet spaces with views to the exterior: One facility we toured has quiet sitting niches (2 seats) with views to the grounds at the end of each corridor; these spaces were visible from the team centre though some distance away. All were occupied when we toured. Staff confirmed the popularity of these quiet spaces and didn’t identify any safety issues with use.
  • Fitness space is important and should be on the unit:When fitness space is located off the unit where patients must be escorted or have special privileges to access, patient use is much reduced. Given the prevalence of metabolic syndrome and obesity among mental health patients, fitness space should be considered a “core space”.
  • Room dimensions are as important as room sizes: For group rooms and meeting rooms, square (or close to square) rooms provide the greatest functionality and flexibility. While the total space may be the same, narrow rooms and “L-shaped” rooms won’t accommodate as many people and don’t support effective group dynamics.
  • Light, light, light: The positive effects of generous and effectively placed windows were evident in several facilities and should be a priority in design.