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Behavioral health design is shifting from isolated, institutional rooms toward connected settings that make care easier to reach, safer to deliver, and more humane to experience. SmithGroup’s September 2024 interview with Cindy Beckham describes a “Whole Health” approach that links behavioral and acute care while extending services into neighborhood clinics, virtual care, residential programs, and dedicated hospital suites. These ideas are design strategies, not proof that a particular floor plan causes better clinical outcomes.
The need is substantial: the National Institute of Mental Health (NIMH) estimates that 59.3 million U.S. adults, or 23.1%, experienced any mental illness in 2022, while 30.0 million (50.6% of adults with any mental illness) received treatment. Owners and design teams can use the trends below to plan a coordinated continuum without sacrificing privacy, dignity, observation, or code-compliant safety.
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Wellness-focused design treats behavioral health as part of ordinary healthcare rather than a separate destination associated only with crisis or institutional care. In SmithGroup’s description, the objective is an integrated continuum in which people can enter care through several doors, move between levels of treatment, and encounter environments that feel understandable and respectful.
That does not mean making every space look residential or removing clinical controls. It means planning access, circulation, visibility, privacy, acoustics, furnishings, and staff operations together. A welcoming lobby is of little value if wayfinding is confusing, a family cannot find a private place to talk, or staff cannot maintain safe observation. Conversely, a secure unit can still provide daylight, choice, comfort, and opportunities for social connection.
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The source for these trends is a September 4, 2024 SmithGroup interview with Cindy Beckham, Senior Principal and Health Studio Leader. It presents the firm’s practice perspective and examples, not a controlled evaluation of outcomes.
Why is behavioral health design an urgent facilities issue?
Demand spans prevention, routine treatment, crisis response, and longer-term recovery. NIMH’s 2022 estimate covers any mental illness among U.S. adults age 18 and older in the civilian, noninstitutionalized population. The 23.1% figure is a past-year estimate, not a lifetime prevalence rate. NIMH also reports that treatment includes inpatient or outpatient care, counseling, or prescription medication for mental health.
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- Any mental illness: 59.3 million adults, or 23.1%, in 2022.
- Receiving treatment: 30.0 million adults, or 50.6% of adults with any mental illness, in 2022.
These numbers indicate a large potential user base for clinics, emergency departments, inpatient units, residential programs, and teletherapy support. They do not, by themselves, prescribe a building type. NIMH notes that 52.0% of selected adults did not complete the 2022 interview and that nonresponse adjustments may not fully capture differences by mental-illness status. Pandemic-era changes in data collection also make direct comparisons with earlier years less straightforward.
How can hospitals and long-term-care facilities incorporate behavioral health?
Behavioral health should be planned in emergency rooms, medical units, and long-term-care settings instead of being treated as a service that begins only after transfer to a specialized building. Beckham argues that crisis and behavioral-health units should be understood as places for care and progress. Her wording is direct: “It is important to think of crisis and behavioral health units not as holding stations but as healing stations where progressive improvement can take place.”
In an emergency department, that philosophy can influence where behavioral-health patients wait, how quickly they can reach a quieter assessment area, and whether staff can maintain observation without making the person feel publicly displayed. In a general hospital, it can mean a dedicated behavioral-health suite with appropriate environmental controls rather than repeatedly adapting a medical room. In long-term care, it can support familiar daily routines, access to outdoor or communal areas where appropriate, and spaces for private conversations with residents and families.
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Each application still requires a clinical risk assessment, infection-control review, accessibility analysis, and compliance with applicable building, fire, ligature-resistance, and behavioral-health requirements. The SmithGroup interview offers planning examples; it does not replace the governing code or the owner’s safety standards.
What is a “Whole Health” campus?
SmithGroup uses “Whole Health” to describe a campus or facility that connects mental and acute care in one coordinated setting. The concept is broader than putting two departments next to each other. It calls for shared planning around how people arrive, find services, move through assessment and treatment, and maintain privacy and dignity.
Core planning questions include:
- Access: Can a person reach the appropriate level of help without navigating an intimidating or confusing entrance?
- Wayfinding: Are routes, destinations, and exits legible to someone who may be distressed, medicated, cognitively impaired, or unfamiliar with the campus?
- Privacy: Where can patients discuss sensitive information away from public circulation and unnecessary observation?
- Dignity: Do arrivals, waiting areas, bathrooms, and transitions avoid making people feel processed or detained?
- Safety: Can staff observe and respond appropriately while preserving a calm, non-punitive atmosphere?
- Healing: Are daylight, views, acoustics, material choices, social spaces, and opportunities for quiet considered as part of the care environment?
The Whole Health idea is a design framework attributed to SmithGroup, not a universally validated model. Owners should define measurable project goals—such as reduced transfer friction, clearer navigation, or improved staff sightlines—without claiming that the concept itself guarantees recovery.
Which settings form a distributed behavioral-health continuum?
The interview describes care distributed across locations rather than concentrated in one large institution. The right mix depends on local demand, staffing, referral relationships, transportation, reimbursement, and clinical scope.
| Setting | Primary role | Design priorities |
|---|---|---|
| Neighborhood walk-in clinic | Accessible entry for assessment, counseling, and referral | Visible but discreet arrival, simple wayfinding, welcoming waiting and consultation rooms |
| At-home virtual teletherapy | Remote contact for people who cannot or prefer not to travel | Reliable connection, privacy at home, clear escalation pathways when in-person care is needed |
| Integrated campus | Coordinated outpatient, inpatient, and residential services | Logical transitions, shared support functions, privacy between populations, efficient staff circulation |
| Behavioral-health suite in an acute hospital | Specialized care close to medical services | Safe observation, comfortable groupings, sensory support, patient and staff control of the environment |
This is a descriptive comparison of models discussed by SmithGroup, not a ranking of clinical effectiveness. A rural system may emphasize teletherapy and a small access clinic, while a regional medical center may need a full range of inpatient and residential capacity.
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What features are emerging in behavioral-health suites?
SmithGroup identifies several approaches for hospital suites. They are examples for briefing and programming, not proven products or guaranteed interventions.
More open, legible layouts
Open planning can make circulation and destinations easier to understand and give staff better awareness of activity. Openness must be calibrated: unrestricted sightlines are not the same as constant exposure. Use zoning, thresholds, glazing, and acoustic treatment to separate public, therapeutic, staff, and private functions.
Comfortable seating groupings
Instead of arranging every seat in rows facing a desk, designers can create smaller groupings for conversation, peer interaction, or family visits. Furniture selection still has to meet cleanability, durability, tamper resistance, mobility, and safety requirements set by the clinical team.
Staff spaces in shared areas
Locating staff work points closer to shared activity can support timely interaction and reduce the sense that clinicians are hidden behind a barrier. The layout must protect confidential information, provide staff retreat and documentation space, and preserve clear emergency response routes.
Sensory rooms and lower-stimulation options
A sensory room or quiet zone gives patients an alternative to busy corridors and common rooms. Programming should define who may use it, how it is supervised, what equipment is permitted, and how the room is cleaned and reset. A sensory space is not automatically therapeutic for every patient.
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Patient control of environmental conditions
The interview mentions controls for lighting, sound, projected entertainment, and voice-activated functions. These controls can offer meaningful choice, but they should include staff override, simple interfaces, infection-control review, and a safety assessment for each patient population. Technology should not become a substitute for responsive staffing or observation.
How should designers balance openness, privacy, and safety?
The central trade-off is not “open versus secure.” It is how to provide appropriate visibility and rapid assistance while allowing people to feel respected and in control. A project team should map different observation needs by room and activity rather than applying one visibility rule everywhere.
- Classify activities. Separate assessment, treatment, sleeping, bathing, medication, family meetings, recreation, and staff work in the space program.
- Set observation levels. Define where direct observation, intermittent checks, or remote monitoring are clinically appropriate, and document who owns each decision.
- Protect confidential conversations. Use acoustic separation, visual screening, and private consultation rooms so that safety does not expose personal information.
- Coordinate hardware and finishes. Review doors, glazing, furniture, fixtures, ceiling elements, and technology for tamper resistance and ligature risk with qualified specialists.
- Design for de-escalation. Provide calm retreat options, uncluttered routes, and staff positions that do not unnecessarily block exits or crowd a patient.
- Validate operations. Walk through admissions, emergencies, family visits, cleaning, deliveries, and staff handoffs before finalizing the plan.
Local authorities, clinical leadership, security professionals, and people with lived experience should review the design. No single feature can resolve every behavioral-health risk.
How do the care models differ in practical terms?
The following comparison uses the axes raised in the SmithGroup material: location, range of care, integration, interaction, patient control, and safety or privacy demands.
| Model | Access and location | Range of care | Distinct planning challenge |
|---|---|---|---|
| Walk-in clinic | Neighborhood-based | Assessment, brief intervention, referral | Welcoming entry without compromising confidentiality or secure operations |
| Virtual teletherapy | At home | Remote counseling and follow-up | Private participation and a reliable route to in-person escalation |
| Whole Health campus | Single coordinated campus | Outpatient through inpatient and residential | Wayfinding and transitions between populations and acuity levels |
| Acute-hospital behavioral suite | Embedded in a medical facility | Specialized short-term or acute care | Balancing medical access, observation, sensory needs, dignity, and safety |
The table helps teams identify where a model fits operationally; it should not be read as evidence that one setting produces better outcomes than another.
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How should an owner plan a wellness-oriented project?
A disciplined process turns broad aspirations into decisions that can be documented and maintained.
- Define the service network. Map existing outpatient, emergency, inpatient, residential, community, and virtual services before drawing a building boundary.
- Describe populations and acuity. Identify age groups, diagnoses, mobility needs, cognitive conditions, substance-use presentations, family needs, and periods of peak demand.
- Build the operational brief. Document staffing models, observation practices, admission and discharge routes, security procedures, cleaning, medication handling, and emergency response.
- Create a privacy and dignity map. Mark where people arrive, wait, change clothes, meet families, receive care, and leave. Eliminate avoidable public exposure.
- Set environmental goals. Decide where daylight, views, quiet rooms, group spaces, outdoor access, patient controls, and staff respite are priorities.
- Test adjacencies and circulation. Separate public, patient, staff, service, and emergency routes while preserving intuitive wayfinding.
- Review safety and codes early. Coordinate building officials, fire protection, accessibility, ligature-risk review, infection prevention, and security before design is locked.
- Plan for adaptation. Select robust finishes, movable or reconfigurable elements where safe, maintainable technology, and clear procedures for repairs and replacement.
- Define post-occupancy measures. Establish how the owner will monitor incidents, wait times, transfers, staff experience, patient feedback, and maintenance. These measures belong to the owner’s evaluation plan, not to assumptions about design efficacy.
What mistakes undermine behavioral-health environments?
- Copying a medical template: A standard exam-room layout may ignore sensory load, de-escalation, family interaction, or behavioral observation.
- Confusing visibility with surveillance: Excessive exposure can damage privacy and trust; insufficient visibility can delay help.
- Adding technology without operations: Voice controls, projection, or lighting systems need ownership, maintenance, downtime procedures, and staff override.
- Leaving wayfinding until the end: Signs cannot fully repair confusing circulation or poorly placed entrances.
- Designing only for the patient: Staff need safe work points, documentation privacy, respite, storage, and efficient routes to sustain care.
- Treating a sensory room as a universal solution: Its value depends on programming, supervision, patient choice, and safe contents.
- Overstating evidence: The SmithGroup interview does not provide comparative outcomes, cost data, or proof that any listed feature improves recovery.
What does the available evidence actually establish?
The evidence in this article supports two bounded conclusions. First, SmithGroup presents an integrated, approachable continuum and specific environmental strategies as a way to organize behavioral-health projects. Second, NIMH documents the scale of mental illness and treatment among U.S. adults using 2022 survey estimates.
The sources do not establish that a Whole Health campus, open layout, sensory room, patient-controlled lighting, or any other feature causes better clinical outcomes. They also do not supply construction costs, staffing ratios, return-on-investment figures, or a universal space standard. Owners should treat those issues as project-specific questions requiring clinical, financial, regulatory, and post-occupancy evaluation.
What should owners take away?
The strongest behavioral-health projects connect levels of care and make every transition—arrival, assessment, treatment, family contact, discharge, and referral—more understandable and humane. They design for safety and privacy at the same time, give patients appropriate choices, and provide staff with the visibility and support needed to respond well. The Whole Health concept is a useful planning lens, but responsible teams must test it against local need, operations, codes, and measurable outcomes rather than presenting it as a proven clinical prescription.
Frequently Asked Questions
Are NIMH’s 23.1% and 50.6% figures lifetime rates?
No. They are 2022, past-year estimates for U.S. adults in the civilian, noninstitutionalized population. The treatment percentage is the share of adults with any mental illness who reported inpatient or outpatient care, counseling, or prescription medication for mental health.
Does the SmithGroup interview prove that these design features improve recovery?
No. It is a design-practice interview that offers concepts, examples, and professional perspectives. It does not report comparative clinical outcomes, cost studies, or causal evidence for a particular layout or feature.
Can teletherapy replace inpatient or residential behavioral-health space?
The described continuum treats virtual care as one access point, not a replacement for higher-acuity services. Facilities still need clear escalation and referral pathways when someone requires in-person assessment, crisis care, inpatient treatment, or residential support.
Who should approve environmental controls such as voice-activated lighting?
The owner’s clinical, facilities, information-technology, infection-prevention, security, and risk teams should review them together. Controls need a simple patient interface, staff override, maintenance and downtime procedures, and a safety assessment for the populations served.
