By Rusty Hoffman
The National Institutes of Health estimates that more than 1 in 5 Americans live with a mental illness, amounting to 59.3 million adults in the United States — roughly half of whom can go untreated. Further, Mental Health America’s 2024 State of Mental Health in America report shows that 77% of those reporting substance abuse did not receive any form of treatment. These statistics highlight the urgent need to improve access to behavioral healthcare across the country.
To close the treatment gap and provide more people with the help they need, many communities are expanding mental health services by building new behavioral healthcare facilities or renovating existing ones. However, designing and constructing these facilities is more complex than traditional healthcare or commercial construction. It requires special considerations to meet the unique needs of behavioral health patients, staff and visitors.
In addition to standard healthcare construction challenges, behavioral health projects must address unique risk management requirements to minimize safety risks associated with patient self-harm or aggression, ensure inspection readiness amid regulatory complexity and foster community support for projects that can sometimes spark local concerns.
While every behavioral health project is unique, experienced teams can apply four best practices to overcome these challenges and deliver successful projects that benefit the whole community.
Rethink risk management mindsets
Behavioral healthcare facility construction requires a different approach to risk management than conventional healthcare projects. From the layout of patient rooms to the selection of fixtures, an exceptional level of safety must be built into the facility at every level, even in design elements that seem benign. For example, protruding objects and areas like corners that a patient could use to harm themselves must be eliminated from the room. Ligature-resistant design features like tamper-proof outlets, continuous hinges, impact-resistant glass and recessed casework are standard. Furniture is often bolted to the floor and sealed with pick-proof caulking, while air diffusers are designed with serpentine patterns to prevent concealment or access.
Managing safety risks also includes designing for excellent line of sight throughout the building, so staff can be aware of patient whereabouts at all times. Nurse stations must be central to patient rooms and shared spaces. Construction and design teams need to communicate with the staff who will be using the spaces to understand how everything needs to work, down to how the doors lock and unlock on interlocking vestibules.
The sequencing of construction activities must also be adjusted accordingly. For example, be aware that access for diffuser installation can be through light fixture openings, which needs to happen prior to light installation. It’s also key to arrange psychiatric window installation in conjunction with the sequence of drywall finishing. These activities require careful coordination among trades and suppliers. Clear communication and documentation during this stage will help avoid any potential complications with subcontractors. This is especially critical with tasks like electrical work that must happen in a certain sequence to ensure the safety of all the patient rooms and common areas.
Collaborate closely with trade partners and vendors
With this added complexity, some subcontractors may require extra guidance on behavioral healthcare projects. An experienced contractor will take the time to engage trade partners and vendors thoroughly to ensure behavioral health facility construction is carefully sequenced to avoid introducing elements that put patients, staff or visitors at risk. For instance, light fixtures need to be secured with four all-thread rods from the structure above. But if there are floor-to-ceiling constraints in a particular area, it can complicate installing other systems like plumbing, electrical or ductwork if not planned properly. Ideally, contractors will work with facility teams and trade partners to prepare them for the complexities of the project early in the process with in-depth interviews and detailed prequalification checklists.
Vendor relationships can also have a significant impact on the quality and success of a project. Many key products — such as ligature-resistant hardware or psychiatric-grade windows — are produced by only a few manufacturers with potentially long lead times. It can be helpful to work with a construction management partner that has well-established relationships with key vendors and understands the procurement timelines. This allows teams to identify opportunities for early release products, get what they need on time and keep projects running smoothly.
Understand the regulations to be inspection-ready
Overlapping federal, state and local regulatory requirements for behavioral health facilities can be significantly more complex than typical projects. To avoid inspection delays — which can push critical services out for weeks or months — building, design and construction teams need to be fully conversant with regulations for each project and be prepared to manage all the documentation necessary to satisfy all reviewing parties.
Behavioral health construction contractors need to be prepared for multiple rigorous inspections, which include separate inspections for local building codes, state Department of Health regulations and highly detailed multi-day inspections from The Joint Commission. To prepare, teams need to prioritize documentation from day one — maintaining comprehensive submittal records, flame-spread certificates, UL labeling for fire and smoke barriers and life safety punch lists. A construction partner should schedule interim walkthroughs with inspectors at 75% project completion to identify and resolve issues before final inspections.
Proactively informing officials about the unique aspects of a project before inspections is also important. Some officials may not be closely familiar with building code exceptions related to the facility, such as the use of fail-safe versus fail-secure emergency exits, which can be a key factor in emergency response times. Sharing these details ahead of time reduces confusion and ensures a smoother inspection process.
Engage the community
The introduction of behavioral health facilities can sometimes get pushback from community members concerned about safety or property values. While these concerns can often be resolved through public collaboration and education, they can impact the progress of projects if not addressed appropriately.
Community engagement early in the process is critical. Project stakeholders can host public forums, participate in community events and offer site tours before the facility opens. This type of proactive and transparent engagement helps build trust in a project among local residents and can turn initial negative perceptions into support for the facility.
Being available and ready to engage and answer questions at planning commissions and municipal meetings is important, but so are local community events where project leaders can talk directly with the public to build acceptance. Attending seasonal fairs and other events give residents the chance to meet project stakeholders on a more personal level and learn about the value of behavioral health projects in their community.
Collaboration is essential for any team undertaking a behavioral health project. Success depends on the combined efforts of owners, designers, contractors, inspectors and community members to create a facility that is safe, effective and meets the needs of both patients and staff. By adopting these best practices and ensuring all stakeholders understand their importance, projects are more likely to stay on track, resulting in a facility that fosters healing and improves access to behavioral healthcare in the community.
Rusty Hoffman is project executive at Warfel Construction.
