Understanding the Influence of Environmental Design on Physical and Psychological Safety of Psychiatric Patients

Presented by: Sara Bayramzadeh 

Arguably, patients with mental disorders are some of the most vulnerable patients in the healthcare system (Borckardt, 2007). As psychiatric patients admitted to the psychiatric units with a risk of hurting themselves or others (NAPHS, 2013), implementing measures to improve the patient safety becomes essential. There is evidence that healthcare facilities can incorporate design strategies to promote safety attributes (Hunt, 2011). Such design strategies include but are not limited to eliminating hazardous components, increasing visual access, and appropriate furniture (Huffcut, 2010). Moreover, some studies emphasize on the significance of the psychological safety, which is defined as how safe the patients feel (Delaney & Johnson, 2008). Despite the emphasis of existing literature on psychiatric units design, there is little research on the evaluation of design strategies. Therefore, the current study aims to explore the environmental design implications that influence safety of psychiatric patients from both physical and psychological standpoints.

This mixed method study is based on qualitative interviews and a quantitative web-based survey. First, 20 staff members in a psychiatric unit of a Southeastern hospital were interviewed about patient safety and the built environment. The results of the interviews used in developing a 41-question Likert scale questionnaire, which contains close-ended and open-ended questions. Later, more than 75 participants completed the web-based survey. The open-ended questions allowed for further exploration of the role of environmental design in patient safety. To eliminate bias in research the participants of the interviews and the web-based survey were recruited from 2 different facilities.

The results revealed a consensus of perception among staff regarding the influence of the design strategies on physical and psychological safety. For example, on a scale of 1 to 5, with 5 as the highest level of agreement, a mean of 4.18 indicted that inpatients feel vulnerable because they don’t know other patients and their conditions. This result can inform designers on the importance of considering appropriate personal space among patients to maximize their psychological safety. Another example, which relates to the physical safety, is a mean of 4.01 agreement that providing visual access from the nursing station to the dayroom (activity room) will reduce violent incidents. The results of several t-tests and ANOVA test showed no statistically significant difference between the responses from different age groups, positions, or years of experience; however, some factors were found to be statistically different between male and female respondents. Finally, several design recommendations, such as wall color consideration, were collected through open-ended questions.

The results merged with the existing literature, support the influence of the environmental design on physical and psychological safety of patients. In addition, they specify the effectiveness level of the environmental factors. The findings underscore a holistic design approach to the psychiatric safety issues, which encompasses physical and psychological considerations. This research will help to inform safe healthcare design practices in psychiatric units, in addition to serving as a base for further research in identifying the influential environmental elements in design of the safer psychiatric units.


  • Borckardt, J. J., Grubaugh, A. L., Pelic, C. G., Danielson, C. K., Hardesty, S. J., & Frueh, B. C. (2007). Enhancing patient safety in psychiatric settings. Journal of Psychiatric Practice®, 13(6), 355-361.
  • Delaney, K. R., & Johnson, M. E. (2008). Inpatient psychiatric nursing: why safety must be the key deliverable. Archives of psychiatric nursing, 22(6), 386-388.
  • Huffcut, J. C. (2010). Can design promote healing?. Behavioral Healthcare, 30(9), 33-35.
  • Hunt, J. M. (2011-11-01). A therapeutic approach to preventing self-harm. Behavioral healthcare, 31(8), 30-3.
  • NAPHS updates design guide for behavioral facilities. (2013). Mental Health Weekly. Retrieved from https://www.naphs.org/quality/design-guide-for-the-built-environment.
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