Designing Spaces for Behavioral and Mental Health Treatment

From the ground up, a balance of care and safety is why the floor matters
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Sponsored by Tarkett
By Sandra Soraci, EDAC, LEED AP, NCIDQ, and Kathy Price-Robinson
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EBD Goal 1: Reduce slips, trips, and falls

  1. Medical spending for fatal falls was estimated to be $754 million annually.19
  • Avoid complex patterns, color stimulation, and reflective surfaces.
  • Ensure transitions between surfaces are seamless and color-matched to mitigate certain patients from becoming fixated on the material and picking at it.

2. EBD Goal 2: Reduce patient and staff injuries associated with falls

  1. The Centers for Medicare and Medicaid Services (CMS) no longer pay for any additional costs associated with “never events.” Falls with injury are a serious reportable “never-event” and are non-reimbursable to the health system.20
  2. Utilize varying light reflectance values (LRV) as a means of identifying differences in height between areas.

3. EBD Goal 3: Reduce noise levels

  1. In healthcare environments, evidence suggests that increased noise levels can have a measurable impact on both the patient and staff experience.21
  2. Material selection that can mitigate in-room impact sound.

4. EBD Goal 4: Reduce staff fatigue

  1. Nurse fatigue can profoundly impact adverse patient outcomes, such as patient mortality and medication errors, as well as individual adverse nurse outcomes, including musculoskeletal injuries, emotional disorders, and job burnout. Finishes can support staff physically and cognitively.22,23
  2. Artwork can reduce environmental stressors and patient aggression.24

5. EBD Goal 5: Reduce surface contamination and potential risk of healthcare-associated Infections (HAI)

  1. Products within the healing environment must support human health. The Advisory Board, a leading healthcare research group, stated, “Suppliers who produce materials that passively fight infection without added antimicrobials have a high value.” In 2003, the CDC noted that no evidence was available to suggest that using products treated with antimicrobial chemicals would make patients healthier or prevent disease.
  2. Flooring materials need to withstand heavy use and abuse and be easily repairable. Consider product composition, construction, and installation details.25
  3. Monolithic sheet vinyl with integral base and heat welded seams.

6. EBD Goal 6: Improve indoor air quality (IAQ)

  1. Every day, patients and healthcare workers are exposed to an array of chemicals. Many of these chemicals have been shown to impact individual health and the environment negatively.26
  2. Flooring materials and maintenance protocols need to foster positive indoor air quality.27
  3. Specify certified asthma and allergy-friendly flooring solutions.

7. EBD Goal 7: Improve patient and family satisfaction

  1. Flooring can substantially contribute to patient experience, safety, and outcomes and is a critical capital investment decision for healthcare facilities.28
  2. Avoid distracting patterns, color combinations, and large chips to mitigate visual misperceptions, particularly among those with schizophrenia and dementia.

8. EBD Goal 8: Represent the best return on investment

  1. When making design decisions, it is crucial to evaluate a flooring material’s long-term cost-effectiveness in relation to its initial costs.29
  2. Durability is key as weighted furniture is dragged, and the floor can scuff, scratch, or gouge.
  3. Monolithic floor installation mitigates pick points that are always a concern. Downtime for replacement flooring in this setting can have financial implications if a unit or space needs to be shut down.30

Photo courtesy of Tarkett

Homogeneous floors benefit patients, staff, caregivers, and visitors.

Safety Factors to Consider when Specifying and Installing Flooring for Behavioral and Mental Healthcare Centers

Consider these factors when specifying flooring for these specialized facilities:

Benefits of Homogeneous Floors in BMH Facilities

  • Homogenous sheet vinyl heat welded to create a virtually seamless, water-tight, monolithic surface, eliminating potential pick and ligature points.
  • No floor finish ever.
  • Durable–can withstand high static and traffic loads.
  • Can be used in hallways, common spaces, patient rooms, labs, back of house.
  • Supports infection control protocol.
  • Holds up to medical staining agents, scratches, and chemicals.
  • Ideal for Level 3 and Level 4 patient care areas: seclusion rooms, admission rooms, and quiet rooms.

Slip-resistant vinyl flooring: A flooring solution for heavy-traffic wet areas where safety is of utmost importance. It provides a confident grip for bare feet and reduces the risk of slipping. Suitable for corridors and back-of-house areas.

Hybrid resilient sheet flooring: A heterogeneous construction of nylon and closed-cell cushion fused through heat and pressure, making the layers integral and inseparable. The innovative closed-cell cushion is the most significant component of performance and design capabilities. Seamless flooring is much harder for patients to pick at and potentially hurt themselves. Suitable for corridors, common spaces, therapy areas, and dining areas.

Installation Detail for Pick Resistance

The product and installation should resist picking, preventing parts of the flooring system from being picked off and becoming a tool for harm. Covings should be tightly adhered to the wall.


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Originally published in November 2023