Design standards for mental health care units

Both NZ and Australian mental health services advocate patient-centered models of care and a focus on recovery on the person's own terms. However, the current design requirements generated by health boards, nurses and other therapists are sometimes at odds with this,with the main drivers being efficiency of staff routines (therefore, staff-centered). For example, the nurses stations still largely follow the old paradigm of security and surveillance - the nurses are behind closed doors and windows, with views down all corridors and patient areas (radial lines of sight). The wards are focused around these nurses stations rather than around patient spaces.

The current standards for nonacute inpatient mental healthcare design (Australasian Health Facilities Guidelines) updated in November 2013 do, however, support most if not all the design features previously discussed eg.

• considerations for diverse needs from special groups of patients (eg. culturally and linguistically diverse backgrounds), Maori & Pacific Islanders, those from rural/remote areas, age-related differences etc
• privacy & dignity, with appropriate control over their environment (eg. single bedrooms with ensuites, the ability to lock bedroom doors, to access quiet spaces)
• the reduction and eventual elimination of the use of seclusion is a goal both nationally and internationally, by providing adequate 'de-escalation' strategies:
• private bedrooms
• lounges furnished with heavy furniture
• rooms where patients can engage in activities that relax them (eg. music, aromatherapy etc)
• a generous number of quiet lounges and private courtyards
• each kitchen to have its own dining area for no more than 10 people to 'contribute to a more domestic atmosphere' - however, 10 is a large family group for most people!
• cluster beds for the separation in to groups of patients based on behaviours/risk/gender/age/diagnosis as appropriate
• unobtrusive observation, however, 'good sight lines from staff areas such as staff stations, to consumer areas is an important design criterion' still.
• views into surrounding gardens
• the main lounges should open out onto an outdoor area
• outdoor areas to include private courtyards, seating in landscaped gardens, active areas such as basketball courts and walking paths, fixed BBQ
• the landscaping should allow people to participate in gardening if they want to
• provide acoustic privacy, and reduction of noise in general 
• provide as much natural light as possible, ' higher levels of natural light may help people better orient themselves in the building and thus enhance wayfinding.'
• the quality of darkness should be maximised at night to enhance sleep quality
• avoid extremes of colour and pattern such as geometric designs which could disturb perception
• colour should be used to highlight doors/paths commonly walked along
• soft furnishings, artwork and plants should be used to create a homelike and calming environment
• 'it is important to allow patients to have some control of their surroundings eg. access to light switches and television remotes'.
• CCTV must not be used as an alternative to direct clinical patient observation by staff - the use of CCTV for security must be 'balanced between consumer rights for privacy and the need for observation for safety and security reasons'