April 17, 2024

By: Stephen Parker & Robyn Linstrom

Often the stress experienced by mental health and addiction patients can be mitigated with access to outdoor spaces. Outdoor spaces should be designed to create a safe, therapeutic environment with a close connection to nature.
Elopement prevention should be discreet and effectively detailed, with limited hand and foot holds on vertical surfaces, especially with relation to building devices and systems in need of coordination by the architect.

Natural elements should be safe in case of accidental ingestion while providing a variety of sensory opportunities in terms of color, tactility and olfactory stimulation to mimic biophilia. Trees should be limited in height without easily accessible branches for climbing and prevent elopement while enhancing the feeling of a calming, natural environment. Plants should be selected that prevent their use as weapons or for self-harm while being native species and limit the need for excessive maintenance or irrigation, such as drought tolerance. Materials for walking paths should be selected to avoid loose materials such as small gravel and stones that could be thrown or ingested.

Natural elements, especially those as part of gardening therapy, have a proven stress-reducing effect per evidence-based design strategies. These concepts can aid in staff respite as well. Green micro breaks facilitate stress reduction for overburdened staff, aiding in staff retention in the process. The use of green houses for these adjunctive therapies should be considered as a balance between therapeutic value and patient safety.

If these outdoor environments create views of nature for patient bedrooms or social spaces, then patient privacy should be addressed. Translucent film on windows or vegetative screening are possible solutions to consider.
Landscaping rocks and features should not be able to be moved, thrown or otherwise used for damage to property, others or self-harm. Ample lighting that is exterior-rated and tamper-resistant should be provided for after-hours monitoring. At the Nanaimo Psychiatric Emergency Department on Vancouver Island, British Columbia, this is pushed further with inclusion of a water feature, raised beds and culturally relevant vegetation.

Furniture is often fixed and immovable, so the design of seating arrangements to facilitate patient choice is paramount. These more substantive seating arrangements limit damage while providing comfortable seating for individual self-reflection, one on one conversations or various social gatherings as chosen by patients in a safe manner. Furniture should be sited to mitigate elopement in coordination with other site features. The building could serve as an implicit barrier, defining the space while not aiding in the institutional feel of the mental health hospital. Such outdoor furniture selections should limit contraband opportunities as well as mitigate barricading. All of these considerations should strive to maintain a clear line of sight from staff observation areas to ensure patient safety. Ample camera coverage should be provided in outdoor spaces with clear coverage of exits and entrances, and blind spots should be eliminated. Cameras should be impact-rated for exterior use and coordinated with other outdoor devices and features, such as exit signs, lighting and scuppers to avoid creating a climbing opportunity.

Use of outdoor environments should be considered based on client population, but should include a variety of opportunities. Labyrinths and walking paths allow clients to pace to self soothe and self-regulate helping with de-escalation. Basketball courts and other sports focused areas allow for release of energy or anger. Alternate seating types and areas for reflection all contribute to a healing outdoor environment.