June 18, 2024

Elements of Effective Lighting Design in the Behavioral Health Facilities

By: Ellie Motevalian- Lighting Designer, LC, LEED GA and Toranj Noroozi, Lighting Designer, LC, P2S, a Legence company

 

Lighting design plays a crucial role in creating supportive environments in behavioral health facilities, promoting well-being, and facilitating healing journeys.

Beyond its technical aspects like anti-ligature and vandalism, lighting serves as a companion, subtly influencing wellness. Join us as we explore how this understated element, with its artful touch, profoundly shapes the healing experience in behavioral health facilities.

Biophilic Design:

Biophilic design is an architectural and interior design approach that seeks to reconnect people with nature within the built environment to encourage them to co-exist with it. Rooted in the idea that humans have an innate connection to the natural world, biophilic design incorporates elements and features inspired by nature to enhance the well-being and productivity of occupants.

There is much research supporting the hypothesis that biophilic design will enhance physical, mental, and cognitive health and has positive impacts on stress relief, cognitive skills, and sensitivity both in children and adults.

There are various ways lighting can be incorporated into the biophilic design:

• Light Therapy
• Natural Daylight
• Circadian Rhythm through Artificial Lighting
• Shapes, Finish and Pattern

Light therapy, also known as phototherapy, has emerged as a crucial tool in addressing Seasonal Affective Disorder (SAD), which is characterized by symptoms such as low energy, mood fluctuations, and a general sense of lethargy. Light therapy involves exposure to a bright light that mimics natural sunlight, stimulating the production of serotonin and regulating melatonin levels to alleviate symptoms of depression. Beyond SAD, the importance of light in treating mental health issues extends to various conditions, as exposure to natural or artificial light influences circadian rhythms and affects neurotransmitter levels. Light therapy has shown promise in treating other forms of depression, bipolar disorder, and sleep disorders. The role of light in regulating mood and overall mental well-being underscores the significance of incorporating light therapy into comprehensive mental health treatment strategies.

Exposure to natural light has been consistently linked to improved mood, enhanced cognitive function, and regulation of circadian rhythms. Integrating daylight into these spaces creates a more pleasant and uplifting environment, reducing feelings of confinement and fostering a sense of connection to the external world.

By introducing daylight, as much as possible into the architecture through windows, light wells, skylights, and clerestories, the therapeutic impacts of natural light can be harnessed to create a supportive atmosphere for individuals seeking behavioral health services.

Given the constraints within architecture and construction, coupled with varying durations of time users spend within interior spaces, the thoughtful integration of architectural lighting becomes pivotal for the enhancement of circadian rhythms. Not all architectural designs allow for abundant natural light to penetrate indoor environments, and users may find themselves exposed to artificial lighting for extended periods. In such cases, leveraging architectural lighting becomes a strategic tool to simulate the effects of natural light on the circadian system. The usage of a diffused indirect lighting approach as an expansion and continuation of daylight perception into the interior space provides an opportunity to integrate biophilic design with architectural lighting.

In applications where the users are deprived of receiving enough natural light throughout the day incorporating human-centric lighting within the architectural lighting to provide the blue wavelength (490nm) for maximum daytime circadian impact is essential. The sky-blue wavelength which mainly lies within the invisible spectrum can be provided for several hours depending on the technology used to balance the circadian rhythm through Melanopic and skin pathways.

Quality sleep plays a crucial role in maintaining good mental and behavioral health. As the sun sets, much of the blue light is scattered, signaling to our bodies that it’s time to wind down and prepare for sleep. In residential and relaxation spaces, lighting can be strategically utilized to promote healthy sleep patterns, particularly through the use of “zero-blue” light fixtures. These fixtures eliminate the blue spectrum of light to mimic the natural pattern of sunlight. Additionally, during nighttime hours, it’s recommended to use amber night lights to illuminate pathways for safety while still supporting the body’s natural sleep-wake cycle.

Another way the lighting can be part of the biophilic design is through effects and forms. One example is in interior nature spaces, by creating lights and shadows, lighting will enhance the vibrant nature-like environment.

In addition to the quality of light and its impact on the space, the shape, form, and finish of the light fixtures are influential design factors in the mental and overall emotional state of the occupants. One of the main driving factors is to implement lighting to create a calm, inviting atmosphere that provides a sense of safety and tranquility. This can be achieved by the implementation of light fixtures that offer soft edges and earthy color tones, with more of a hospitality aesthetic. By opting for fixtures with gentle curves and natural finishes, the overall design can further enhance the soothing ambiance of the space. These fixtures not only provide functional illumination but also contribute to the overall design cohesion, promoting a harmonious environment.

Figure 1 Example of lighting in common spaces, using indirect sources of light to reduce glare, providing multiple layers of light including vertical illumination, in addition to using nature-inspired finishes and shapes.

Shaping serenity: optimal visual comfort and glare management

In the behavioral health facility setting, where individuals may already have higher sensitivity and emotional challenges, the importance of creating a visually soothing environment should not be ignored. Effective lighting design is characterized by glare reduction, flicker-free illumination, and appropriate color temperature selection. The overall lighting effect should be continuous, soft, and even to minimize any discomfort or agitation. Harsh patterns and shadows created by light should be avoided, as they can exacerbate feelings of anxiety and disorientation. It’s also important to eliminate dark corners and avoid extreme contrasts between light and dark spaces, which can induce feelings of unease. To create a more dynamic and therapeutic environment, it’s recommended to incorporate various layers of light, including vertical illumination and accentuating features and materials.

Indirect lighting, edge-lit light fixtures, and fixtures with louver and diffuser can minimize the harsh glare. One of the metrics to evaluate the light fixture glare is UGR. Many lighting manufacturers provide fixture UGR information on their cut sheets or IES files. Based on some of the standards like LEED Well, UGR below 16 is considered a low-glare fixture and can help with visual comfort in behavioral health facilities. Choosing the appropriate lighting color temperature (in most cases warmer CCT in the patient area) contributes to creating a calming atmosphere that facilitates relaxation and promotes a sense of security for the user.

Some conditions such as autism spectrum disorder are more sensitive to lighting fixtures flicker. Providing flicker-free lighting solutions minimizes visual disturbances that could decrease anxiety and stress levels among the patients. Several key aspects warrant consideration to minimize light fixture flicker, including High-quality drivers with higher frequency, compatibility of the driver and light control, and light fixtures with certifications like Energy Star.

Figure 2 Example of corridor lighting, using an indirect source of light as a continuation of natural lights, to minimize glare and enhance visual comfort, providing even illumination on horizontal and vertical surfaces.

Balancing safety with patient autonomy (independence)

Effective lighting design should consider the specific needs of patients, ensuring adequate visibility for staff while minimizing potential hazards like sharp objects or ligature risks. At the same time, providing patients with control over their environment can significantly reduce their stress and anxiety levels, increase their self-esteem, and improve the patient’s mental well-being.  By collaborating with healthcare professionals this delicate balance can be achieved in the design, and it will enhance the overall quality of care and patient experience.

In high-risk areas of the facility like patient rooms, anti-ligature light fixtures can be considered. Using this type of fixture can reduce the risk of self-harm and ensure the patient’s safety. Design strategies such as using tamper-resistant fixtures, avoiding protruding elements, and selecting durable materials are critical to mitigate the risk of ligature-related incidents.

There are no specific codes or regulations governing anti-ligature fixtures. While various organizations offer guidelines and recommendations, there is no mandated standard applicable across all jurisdictions. One commonly referenced source is the New York State Office of Mental Health recommendation that many lighting manufacturers rely on to design anti-ligature fixtures. Designers can use this reference when selecting fixtures for high-risk areas.

While utilizing anti-ligature fixtures in high-risk areas is critical for patient safety, the design should still provide patients with a degree of control over their environment.  Examples of these controls can be:

• Adjustable lighting settings to allow individuals to customize the light fixture brightness based on patient preference.
• Personalized bedside reading light fixture with dimmer switch.
• Natural light control options like adjustable blinds or curtains.

Figure 3  Typical lighting design for patient room.. Access to daylight, dimmable anti-ligature reading light, and low glare recessed downlight. Tamper-proof dimming switch for controlling the lights.

 

In conclusion, the careful orchestration of lighting design elements explored in this paper underscores the pivotal role played by environmental factors in shaping the healing process within behavioral health facilities. By embracing the principles discussed above, the designers can craft spaces that enhance the well-being of the users and empower individuals in their recovery journey. As we advance in our understanding and implementation of lighting design strategies, designers must remain vigilant in implementing evidence-based practices to foster environments that nurture both physical and psychological healing.

 

References:

• S. Department of Veterans Affairs (2021), Design Guide for Inpatient Mental Health And Residential Rehabilitation Treatment Program Facilities.
• New York State Office of Mental Health, 30^th edition (2023), Patient Safety Standards, Material and Systems Guidelines.
• Perkins , Deborah (2024), How Designers can Use Flicker Safe Dimming.
• Amber Roguski, Philipp Ritter, Daniel J. Smith – Sensitivity to light in bipolar disorder: implications for research and clinical practice (2024. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists)
• Bios Lighting. (2024). Technology – Bios Lighting. Retrieved from https://bioslighting.com/architectural-lighting/technology-2/