By Kevin Barbee, Project Manager
Engineering system design and installation for behavior health spaces and buildings require a different approach than traditional spaces or even institutional spaces like hospitals. In today’s world, healthcare spaces are designed to look and feel like home, with much weight being on patient satisfaction.
Behavior health spaces do consider these factors, yet a more important factor is in play: safety of the patient. These patients in many cases are just like you and me, and they are not a risk to themselves or others most of the time. Some patients, on the other hand, can become violent or even suicidal and must be protected for their and others’ safety. Here are some design considerations to help prevent unexpected risks in behavioral health units.
Mechanical systems and components require special consideration in patient and seclusion rooms. Grilles of the security type with security fasteners should be used. Thermostats need protective covers or to be in the adjacent corridor or similar space. Serviceable components should be in the corridor or other space than the patient room to allow maintenance and repair of equipment without disturbing the patient. Grilles in common areas and areas under constant surveillance are more of user preference.
Electrical systems and components require special consideration in patient and seclusion rooms. Lights of the security type with thick, impact-resistant lens and security fasteners should be used. Switching of lights should be outside the room or, if in the room, under a secured protective cover. Exit signs should either be tamper-resistant or have covers to protect them from damage. Receptacles located in patient rooms also should be tamper-proof and include ground fault protection.
Gym areas, if provided, require some form of protection for lights and exit signs. Seclusion rooms should not have receptacles. Nurse call is not normally required and, when required, should have a risk analysis performed to determine what should be allowed in the room and not put the patient at risk. Power circuits for receptacle should be supplied from a disconnecting means outside of the room, allowing power to be turned off without entering the room or affecting others. Switching and power in common and surveillance areas are more user preference.
Plumbing systems and components require special consideration in patient, seclusion, and toilet rooms. Lavatory and sink faucets and exposed shower components should be ligature-resistant and from a manufacturer with a proven design. Piping serving lavatories and sinks must have a cover over all piping with tamper-resistant fasteners to prevent access by the patient. Shower accessories should include an anti-scald device. Ligature-resistant floor and shower drains should be considered. Water closets should be floor-mounted with rear discharge. Working components for flush valves, shower valves, and temperature regulation should be in a chase or small closet, with access outside the room, for maintenance and replacement of components.
Sprinkler systems must use institutional tamper-resistant sprinkler heads in patient and seclusion rooms. Common spaces and areas under constant surveillance is more of a user preference.
Security and access control systems require special consideration. Access control systems have some code relief for locked exits. Code for each specific area must be consulted, with access control designed accordingly. Locking doors should not be taken lightly. The owner should identify camera systems and locations. Protecting cameras is required to prevent damage or tampering.
Owners may also want to consider the following optional functions.
- Domestic water cutoff valves for each room or group of rooms outside of those spaces in the event of a water leak caused by intentional damage.
- Isolation valves including tamper switch in the sprinkler line serving each room or group of rooms to allow quick isolation of a damaged sprinkler head. Location of sprinkler shutoff valves should be in an easily accessible space for water shutoff in the event of an emergency. Shutting any sprinkler valves would require coordination with fire department before an event. Unauthorized personnel should not close sprinkler valves in an alarm condition.
- Nurse call systems are not normally required. If a system is needed, a risk assessment should be conducted with specific attention on length of pull cords and other portions of the call station.
- TVs should only be used in public supervised areas, and they should be in a cabinet with Lexan cover or similar protection. Wall mounting is not recommended due concern of damage.
- Provision for metal detector should be reviewed by owner.
- Water closets of stainless-steel construction should be considered to remove the risk of china being broken and a sharp edge being used for harm.
Behavioral health units present unique challenges for designing and installing engineering systems. Patients in these units have been known to dismantle their rooms either out of boredom or during a violent episode, so keeping them, other patients, and staff safe is paramount. Understanding the risks that engineering systems can pose in this environment will help increase safety.